Health and Care Bill

Baroness Brinton Excerpts

Lords Hansard - Part 3 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[The Deputy Chairman of Committees (Baroness Henig) (Lab)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness to speak.

[Baroness Brinton (LD) [V]]

My Lords, the amendments in this group, so ably introduced by the noble Lord, Lord Crisp, aim to restrict the powers of the Secretary of State to limit the capital spending of NHS foundation trusts and to ask for the reinstatement of the 2019 agreement. It is important to note that these amendments do not remove the powers as a whole but tighten them to avoid changes by the Secretary of State to funding that would delay capital works which are needed and urgent on health and safety grounds.

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[The Deputy Chairman of Committees (Lord McNicol of West Kilbride) (Lab)]

I now call the noble Baroness, Lady Brinton, to speak remotely.

[Baroness Brinton (LD) [V]]

My Lords, there are two amendments in this group, both dealing with end-of-life arrangements, and I support both of them. Amendment 203 in the name of the noble Baroness, Lady Meacher, would put on the face of the Bill an extremely important provision—that of giving anyone with an end-of-life diagnosis the right to a conversation about their needs, how and where they want to die, and how they can be given the support they need to achieve that. This is long overdue. Our excellent palliative care and end-of-life healthcare clinicians and professionals carry out an invisible yet vital service to people. But unfortunately, it is not universal.

Why, oh why, as a nation, do we hate to talk about dying? I have seen both the best and worst in practice. Indeed, very recently, a friend in hospital who was told that he had a few weeks left wanted to go home to die. No one at the hospital used the phrases “end-of-life care” or “palliative care” or even talked about hospices. They thought he was not close enough to death to get to that stage. Instead, there were discussions about setting up the right domiciliary care, or possibly a care home through the council. This amendment would ensure that when the diagnosis of end of life is made, that conversation will happen for all patients. That is very welcome. It is too late for my friend, who died while he was still in hospital.

Amendment 297 in the name of the noble Lord, Lord Forsyth, sets out the requirement for the Secretary of State to lay a Bill before Parliament to permit terminally ill and mentally competent patients to end their own lives with medical assistance. I offer my deepest sympathies to the noble Lord, Lord Forsyth, on the death of his father. I look forward to hearing his speech on this amendment, and I apologise that, due to the remote contribution rules, I have to comment on it before he speaks.

Both the Private Member’s Bill brought by the noble Baroness, Lady Meacher, and before it the Private Member’s Bill brought by the noble and learned Lord, Lord Falconer of Thoroton, had exceptionally sensitive and thoughtful debates in your Lordships’ House, but neither has progressed any further. We know that public views have changed—like those of the noble Lord, Lord Forsyth—in light of sad family experiences of death where pain and trauma were not controlled and where, for too many people, access to palliative care and end-of-life care was just a lottery.

I have spoken in the debates on both those Private Members’ Bills in favour of assisted dying and remain firmly committed to campaigning for it, but that is not what tonight’s debate is about. If accepted, Amendment 297 would not immediately change the law on assisted dying. It would merely require Ministers to bring forward draft legislation, not even to campaign in its favour.

Government is well placed to draft the legislation, encourage a wider public debate through consultation and bring together voices and views from right across our society in a way that perhaps the polarised debate between individual MPs and Peers on such a complex issue always makes difficult. Government can and should maintain their neutrality on assisted dying, but they can guarantee sufficient time for the consideration of the legislation.

It is worth noting that in those jurisdictions where assisted dying has been made legal, there have not been the disastrous consequences predicted by opponents. Instead, those laws continue to receive huge popular support many years after legalisation. In no jurisdiction has any law been passed on assisted dying and subsequently repealed, demonstrating perhaps that the fears of opponents to assisted dying have not come to pass.

The Crown Prosecution Service has recently opened a consultation on the introduction of a prosecution policy for homicides that can be categorised as mercy killings or suicide pacts. The prosecution guidelines, if approved, would add clarity to the law in the same way as the prosecution policy on assisted suicide adopted over a decade ago. While this is helpful, it does not change the law, and it cannot protect dying people with a legal choice of how to end their life, nor can it protect their families, as decisions would be made by the CPS only after the death of the person. I have seen a family friend have to go through the trauma of a police investigation after her husband took his own life. He deliberately chose a day when she was 100 miles away to protect her. It still took months for the police to make their decision and, frankly, it was cruel.

What we need above all is a commitment to a public consultation and parliamentary time for a wider debate on assisted dying. Amendment 297 provides that. It does not change the law on assisted dying. Tonight is not the right time for that, but I think the country is ready for that debate. Both these amendments are vital in their own way, and I hope that the Minister will be able to respond favourably.

[The Deputy Chairman of Committees (Lord McNicol of West Kilbride) (Lab)]

My Lords, the noble Baroness, Lady Campbell of Surbiton, is also taking part remotely. I invite her to speak.

Health and Care Bill

Baroness Brinton Excerpts

Lords Hansard - Part 1 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, we have just heard a very powerful contribution from my noble friend Lord Sharkey, reminding Ministers and your Lordships’ House of the importance of the problem of Ministers taking delegated powers, stopping Parliament doing its job properly. I support his amendments.

Amendments 133, 139 and 161 in this group, from the noble Baroness, Lady Greengross, are on continuing healthcare and I can think of no better person in your Lordships’ House to speak about the importance of that. I look forward to her speech. I am pleased to support her amendments and will speak to them now. The NHS definition says:

“Some people with long-term complex health needs qualify for free social care arranged and funded solely by the NHS. This is known as NHS continuing healthcare.”


The full continuing healthcare assessment and the toolkit for updating assessments are absolutely vital for any multidisciplinary team and, at least in theory, these amendments put them on a formal footing as part of the smooth package of care that individuals need. The amendments establish a duty to fund and assess continuing healthcare, which needs to be visible, not least because of the abuses in the current system.

The principles of continuing healthcare in current legislation are fine, but unfortunately, as money has got tighter, there are problems with how they work in practice. There are many reports of CCG assessors and social workers having disruptive and degrading discussions, sometimes with family members present, about whether a particular issue is a continuing healthcare or a personal care need, which would be funded by the patient or their local authority, or the NHS. I personally witnessed a debate about the percentage split of continuing care versus personal care concerning the incontinence of a family member. It was not about the patient; it was solely about money and who would pay.

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[The Deputy Chairman of Committees (Lord Lexden) (Con)]

My Lords, I have failed in my duty, and not for the first time. I should have stated before calling Amendment 145 that the noble Baronesses, Lady Brinton and Lady Harris of Richmond, will be taking part remotely. May I apologise, and invite the noble Baroness, Lady Brinton, to speak?

[Baroness Brinton (LD) [V]]

My Lords, this probing amendment from the noble Lord, Lord Hunt, is essential, because it protects confidential patient data from being given out by an ICB in contravention of the ethics rules of the General Medical Council and other regulatory bodies.

When the Police, Crime, Sentencing and Courts Bill arrived in your Lordships’ House in the autumn, it had clauses in it that gave the police, probation and prison services access to a patient’s confidential medical data as part of their role to reduce and prevent serious violence. As originally drafted, that Bill would have required GPs, CCGs and their staff to hand over that data. This was not just about those under suspicion; it could have been anybody involved in serious violence.

I had extreme concerns about this, and I tabled an amendment not dissimilar to Amendment 145. I was grateful for the support of the noble Lords, Lord Patel and Lord Ribeiro, the General Medical Council, the BMA and others in Committee on that Bill. We had meetings between Committee and Report with officials from the Department of Health and the Home Office, meaning that by the time we got to Report the Government had laid amendments to ensure that a patient’s personal data could not be demanded by the police, probation and prison services. It is now recognised that the medical regulators—the GMC, the Nursing and Midwifery Council and other bodies—actually have the responsibility and the excellent ethical standards by which their members are expected to judge what they should do if they are asked for personal data.

The amendment from the noble Lord, Lord Hunt, would address what data an ICB may disclose by adding a subsection to protect the Government in the same way as happened in the police Bill, so that the personal data of patients should not be disclosed. This is a vital amendment. The Government have already accepted in this Parliament that a patient’s personal data must not be accessible by those other than clinical and clerical staff dealing with it, who must abide by the confidentiality rules of their regulatory body or by their employment contract.

This is even more necessary, because the Bill says in new Section 14Z61(1)(g), on permitted disclosures of information, that

“the disclosure is made in connection with the investigation of a criminal offence”.

That is even broader than in the original police Bill. Patient confidentiality is a fundamental ethical duty. It is crucial to upholding the trust that lies at the heart of the doctor-patient relationship. The new section will give the ICB the right to override that.

New paragraph (e) is also more far-reaching than the investigation of any crime. It says that

“the disclosure is made to any person in circumstances where it is necessary or expedient for the person to have the information for the purpose of exercising functions of that person under any enactment”.

So it is not the doctor or the ICB that has the choice about disclosing that information; they must take the word of the person making that request. That is total free access for anyone who says that it is necessary or expedient for them to have that information. Where is the protection of a patient’s individual and confidential data?

It also removes the decision from GPs, despite GPs having very clear and effective guidance from the GMC on when, in exceptional circumstances, they can give out data. I will not quote the whole of the guidance, because we do not have time, but there are two vital points that a GP must consider: the patient must consent, whether implicitly or explicitly; and disclosure must be permitted or must have been approved under a statutory process that sets aside the common-law duty of confidentiality. The doctor also has a duty, even when they have made their decision, to use anonymised information if practicable, and they must be satisfied that the patient has ready access to information explaining how their personal information will be used. It goes on, but I will not quote the rest.

One might hope that Ministers assumed when drafting the clause that confidential patient data would never be included, other than for the treatment of the patient. However, paragraphs (e), (g), (h) and (f), as the noble Lord, Lord Hunt, outlined, put paid to that. If the argument is that the clause is needed because the ICB might have to share data with, for example, care providers or social workers carrying out assessments, that needs to be made clear, and it would be permissible. But, as drawn, it is far too brief.

The amendment from the noble Lord, Lord Hunt, at least protects the personal data of patients. It is very straightforward and provides the protection that every doctor, nurse and patient would expect. So I hope the Minister will say today that he is happy to accept the amendment. If he is not, please will he agree to a meeting with those who have spoken in this debate, and invite the GMC and the BMA? If progress is not made on this, I will lay an amendment on Report and am likely to press it to a Division.

[The Deputy Chairman of Committees (Lord Lexden) (Con)]

My Lords, the noble Baroness, Lady Harris of Richmond, is also taking part remotely and I invite her to speak.

Health and Care Bill

Baroness Brinton Excerpts

Lords Hansard - Part 1 & Committee stage
Monday 24th January 2022 Lords Chamber

[The Deputy Chairman of Committees (Lord McNicol of West Kilbride) (Lab)]

My Lords, we have two noble Baronesses taking part remotely. I first call the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, the present Health Minister and his predecessors for a number of years—far too many years, frankly—should not be surprised by these amendments, all of which cover the issue of workforce planning. Often, Ministers’ words and aspirations have been supportive but the reality is that, without proper long-term workforce planning, the NHS and our social care sectors will struggle to be able to plan for the medium term, let alone the short term.

My noble friend Lady Walmsley introduced this group by saying what is needed in workforce planning and why, and I support her brief but critical amendment to ensure patient safety. The other amendments in this group set out the how: whether the workforce planning reports or clinical and healthcare training needs in Amendment 171, the duty on the Secretary of State in Amendment 173, the report on parity of pay in Amendment 174 or the important Amendment 214 from the noble Baroness, Lady Finlay, on workforce boards. I am looking forward to hearing the expert contributions to follow on them from the noble Lord, Lord Stevens, and many other noble Lords, and I hope that the Minister will take note of how the lack of effective workforce planning is hobbling the provision of health and care services in England.

Health and Care Bill

Baroness Brinton Excerpts

Committee stage
Thursday 20th January 2022 Lords Chamber

[The Deputy Chairman of Committees (Lord Russell of Liverpool) (CB)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite her to speak now.

[Baroness Brinton (LD) [V]]

My Lords, I wish to speak in support of Amendments 54, 74 and 97, tabled by the noble Baroness, Lady McIntosh, and Amendment 163, tabled by the noble Baroness, Lady Finlay. I too pay tribute to the historic work of the noble Lord, Lord Patel, prior to the setting up of NICE.

While it is not an interest in the formal sense, I declare that I have autoimmune disease and have experience of being on the NICE rheumatoid arthritis care and treatment pathway for 19 years, which has been regularly updated by NICE over that time. Where it has been applied in full and from diagnosis, patients have found it very beneficial and, with new and more effective drugs being approved every few years, many are now in remission. I pay tribute to the consultants trying to do their best for their patients and the National Rheumatoid Arthritis Society and Versus Arthritis helplines which support RA patients in navigating their way through access to their NICE treatments when these have been blocked.

I thank the noble Baroness, Lady McIntosh, for her introduction to this group and for explaining the problem with the formulary list. She is right that this should be addressed formally. However, I want to focus on some of the commissioning practices on NICE-recommended treatments, including those on the formulary, in the current CCGs, because I believe these explain the need for the amendments in this group.

In May 2014, the High Court ruled that Thanet CCG could not disagree with NICE guidance merely because it disagreed with it, even when there is no statutory duty to provide that treatment. This specific case was about access to fertility treatments for a woman who was about to undergo bone marrow transplantation to put her severe form of Crohn’s disease into remission. NICE’s 2013 clinical guidance recommended that

“oocyte or embryo cryopreservation as appropriate”

should be offered

“to women of reproductive age … who are preparing for medical treatment for cancer that is likely to make them infertile”.

This was not cancer, and the CCG’s own policy was to not grant funding unless there were exceptional circumstances.

Health and Care Bill

Baroness Brinton Excerpts

Lords Hansard - Part 3 & Committee stage
Tuesday 18th January 2022 Lords Chamber

[The Deputy Chairman of Committees (Lord Lexden) (Con)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite her to speak.

[Baroness Brinton (LD) [V]]

My Lords, I thank the noble Baroness, Lady Finlay, for laying these amendments and pay tribute to her for her tireless work in the palliative care sector and in your Lordships’ House. I also thank Marie Curie, Hospice UK, Sue Ryder, Alzheimer’s Society and Together for Short Lives for their very helpful briefing.

Clause 16 provides integrated care boards with duties to commission hospital and other health services for those for whom they are responsible. While specific services are highlighted in the clause, there is still nothing for specialist palliative care as currently drafted. There should absolutely be a fundamental right to access palliative and end-of-life care and support services for everyone who needs them. It is vital to restate that palliative care and end-of-life care are not always the same thing.

Hospices, homes and special services at home help children and adults for more than just those last few days. However, far too many people already miss out on palliative care, as the noble Baroness, Lady Finlay, set out; estimates suggest that while as many as 90% of people who die may have hospice and palliative care needs, only around 50% will actually receive it. Like many others, I am afraid I know family and friends who were desperate to move to a hospice in their last few days but ended up dying in hospital. In my stepfather’s case it was because of the bureaucracy of the hospital—at the point at which they said it was possible to move him, they said it was too late.

If we can reduce unplanned and potentially avoidable hospital admissions, it would be considerably less distressing for the patient and their families and would also reduce pressure on our hospitals.

With people in the last year of their life in England accounting for some 5.5 million bed days, it is estimated that the total cost of these admissions is over £1 billion for our already pressed acute hospital trusts. I have a friend currently receiving end-of-life care who is also stuck in a hospital. The real problem is the lack of understanding of where and how the specialist services can be provided. That is vital, because otherwise people end up in hospital and cannot get out again.

During debate on a similar amendment in Committee in the Commons, the Minister of State for Health, Edward Argar, indicated that the Government’s view is that everything is covered by aftercare. As the noble Baroness, Lady Finlay, said, this is not aftercare. If you have ever seen the brilliant work of palliative care specialists, you will understand that it is real care at a vital time in people’s lives.

I mentioned Together for Short Lives in opening. I have a particular interest in children’s palliative and end-of-life care. One of the things that worries me most at the moment is that people often do not understand that respite care for families looking after young children with very serious illnesses and disabilities has been a vital way of ensuring that they can have some sort of break. They often work 18, 19, 20 hours a day, sometimes with help at home but often, during the two years of the pandemic, with no help at all.

Take the example of my local children’s respite centre, Nascot Lawn. The parents took the CCG to the High Court twice and won, but it closed down. It was not the first. Part of the problem we have with our hospices and other forms of provision is that they rely utterly on public fundraising. The last two years have been a particular problem. For children’s respite and palliative care, it is an absolute tragedy—far too many units are closing down around the country.

In addition, despite a version of the language used in Clause 16, on aftercare, having been in place since the 2012 Act, many CCGs do not currently commission sufficient specialist palliative care. Worse, in the case of Nascot Lawn, the entire onus was put on the local authority because, it was said, it was about personal care. One of my concerns is a muddle between personal care and aftercare, when all these children required specialist nursing.

It is vital that the funding element is looked at. The noble Baroness, Lady Finlay, is right that the NHS always proudly boasted that it was there for people from the cradle to the grave. Sadly, at the moment this is not true. It is the hidden gem of our public health system and we must find a mechanism to make it not hidden but apparent and something that everyone who wants and needs it can rely on in the future.

Covid-19: Vaccinations for School Pupils

Baroness Brinton Excerpts

Monday 17th January 2022 Lords Chamber

[Earl Howe (Con)]

My Lords, the noble Baroness, Lady Brinton, has indicated her wish to speak virtually, and I think this is a convenient point for me to call her.

[Baroness Brinton (LD) [V]]

My Lords, many parents are still saying that they have not heard when their clinically extremely vulnerable five to 11 year-olds will get their vaccinations, despite the JCVI saying that they should. Last week’s update to the GP green book now includes severely CEV children as eligible for the third primary dose, which is progress. However, there is no news for CEV young children not classed as severe, so can the Minister please say what he will do to ensure that GPs will call all these children for their vaccinations as soon as possible?

[Lord Kamall (Con)]

As the noble Baroness says, the JCVI advised on 22 December that children aged five to 11 in a clinical risk group, or who are a household contact of someone who is immunosuppressed, should be vaccinated. GPs and hospital consultants are now urgently identifying the children eligible, and we expect rollout to have started by the end of this month, with children and parents starting to be called up for appointments by the NHS locally. The message here is that there is no need for parents to contact the NHS; the NHS will make contact with the parents or carers of those eligible. Just to further reassure parents, we will be using a paediatric Pfizer vaccine authorised by the MHRA for use in this age group.

Vaccination Strategy

Baroness Brinton Excerpts

Thursday 13th January 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

The noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness to speak.

[Baroness Brinton (LD) [V]]

My Lords, I too echo the gratitude that this House and this country shows to Jonathan Van-Tam. Four months on, there are still severely clinically extremely vulnerable people eligible for a third primary dose and then a booster who cannot book their booster because the data system still cannot record this. Many CEV young children with underlying conditions are still waiting for their vaccines, as well as for guidance on how they, their families and their schools can keep them safe from Covid. This is important because there are now more children in hospital with Covid in the last three weeks than in the nine months of the first wave. Please can the Minister say how these people, who the Government say need the vaccines right now to keep them safe, can get them?

[Lord Kamall (Con)]

I thank the noble Baroness for making me aware of the issues. She will recall that we had a meeting on how we can address the concerns of the clinically extremely vulnerable, and I had hoped that a number of action points had flowed from that. If those have not been acted upon, I hope she will write to me and I can chase up the department and the NHS. I had assumed that that meeting, where we gave them some action points, was effective. I am sure she remembers that we requested a letter with action points, but if those have not been followed up, I will endeavour to chase that up.

Ambulance Queues: Health Outcomes

Baroness Brinton Excerpts

Thursday 13th January 2022 Lords Chamber

[The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)]

My Lords, the noble Baroness, Lady Brinton, wishes to speak virtually. I think this is a convenient point for me to call her.

[Baroness Brinton (LD) [V]]

My Lords, yesterday NHS England data showed that trolley waits of more than 12 hours in A&E rose in December to just under 11,000, which is three times higher than in December 2020. One hospital reported that it had a dozen patients waiting on a trolley for a bed for over 24 hours. The Minister has talked about extra money, but without staff and bed capacity in both hospitals and care homes, the crisis remains. Can he say what the Government are doing right now to help alleviate the current crisis?

[Lord Kamall (Con)]

I thank the noble Baroness for giving me the opportunity to say what the Government are doing right now. We are working closely with ambulance services, NHS England and the Association of Ambulance Chief Executives to reduce the handover delays. The 10-point plan I referred to earlier goes into detail about how we handle this, both in handling calls at call centres—some calls are not emergencies, for example, and patients are directed elsewhere—and in making sure that the wider system is available to make sure that patients are unloaded within the 15-minute target and that ambulances are turned around as quickly as possible. Where we have spotted disproportionate pressures in the system, as in the 29 hospital trusts across 35 sites, we have focused more resources there.

Respiratory Viruses

Baroness Brinton Excerpts

Tuesday 11th January 2022 Lords Chamber

[The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)]

My Lords, the noble Baroness, Lady Brinton, wishes to speak virtually. We have her on screen. This is a convenient point to call her.

[Baroness Brinton (LD) [V]]

My Lords, government data show that more children have been admitted to hospital with Covid in the last three weeks than in the whole of the nine months of the first wave. Many clinically extremely vulnerable children are still expected to go to school, even though they still await their vaccines and guidance on how to manage the risks they face, including RSV and influenza. Can the Minister say when these children and their families will get the vaccines and guidance they need? If he cannot, will he please write to me with the answer?

[Lord Kamall (Con)]

The Government have put in place a range of measures to protect children from RSV this winter, including expanding the passive immunisation programme for all at-risk infants, ensuring that the NHS has surge plans in place to respond to any increasing cases, raising awareness among parents and at schools of the symptoms of RSV and when to seek medical help, and increasing our out-of-season surveillance capacity.

Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 6) Regulations 2021

Baroness Brinton Excerpts

Wednesday 15th December 2021 Lords Chamber

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, I am getting indications from the Chief Whip that we should move to the winding Front-Benchers. The noble Baroness, Lady Brinton, will be speaking remotely. I invite her to speak for the Liberal Democrats.

[Baroness Brinton (LD) [V]]

My Lords, I declare my interest as a chair of the All-Party Group on Coronavirus. I thank the Minister for his speech on the three SIs before your Lordships’ House today.

Plan B was published four months ago. It was absolutely evident, first from the Secretary of State for Health’s announcement on Friday and then from the Prime Minister’s speech on Sunday, that no real planning has been going on behind the scenes in the department. Before we get into the practical consequences of these regulations, from these Benches we want once again to join in the strongest objection to the slack way in which the regulations and the Explanatory Memoranda are written.

The right reverend Prelate was right to say that we accept that late legislation may need to be written at pace, but this is communication at its worst and, of course, it cannot go through the usual scrutiny from the Secondary Legislation Scrutiny Committee and others. This goes hand in hand with Ministers’ messaging to the wider public, from the Prime Minister down. All because he is worried about certain parts of his party, he has once again announced mitigations too late, which inevitably result in further restrictions and in omicron being allowed to move really fast through our society.

The noble Lord, Lord Hannan, said that he worries this will be the case with every new variant we go through. That has not been the reality so far. What is different about omicron is how quickly transmission has doubled, which, by the way, without mitigations, will have an effect on the economy, because businesses are already seeing staff go off sick. If we have 2 million people with omicron by the end of the year, and that continues to increase at the same doubling rate every two days, we will find that the economy, schools, societies, our GP surgeries, ambulances and hospitals struggle even more than they are now. On Tuesday, at the All-Party Group on Coronavirus, one GP said to us that, on the previous day, every single doctor in her practice had tested positive. That meant that there were no doctors available to work, other than by Zoom.

We are learning about omicron because it is very new to us. The evidence of its exponential growth so far is concerning. The noble Baroness, Lady Foster, said that not one patient in South Africa has had oxygen. This is not true. It is true that there are fewer people in hospital, but some have severe disease. The number of omicron critical care beds is going up. At the end of November, 291 people in hospital were on oxygen. Two weeks later, it is nearly 900. The numbers in ICU have also doubled. These figures are from the Covid dashboard on the Spectator website.

From all Benches, we have heard agreement with the Prime Minister’s confused lines in the sand—for example, face masks must be worn in shops, but not in pubs and restaurants. Even if omicron is less dangerous—by which I think the noble Lord, Lord Robathan, means that there are fewer people with severe disease—its key elements are higher transmission and the doubling of cases. If there are fewer hospital admissions per 100,000, the already beleaguered NHS will have to find many more hospital beds than were needed in January 2021. This is what the doctors are advising us.

The noble Lord, Lord Robathan, constantly repeats his mantra that the only deaths from Covid are in the over-80s or among those with underlying conditions. In a recent debate, he asked if anyone knew anyone under the age of 80 who had died. Last week, a dear friend died of Covid after just four days in hospital. She was much younger than I am. Another friend in his 40s, who had a lung transplant earlier this year, is back in ICU with Covid. He does not know where he caught it because he has been very careful. Is the noble Lord really saying that there should be no mitigations to keep the vulnerable safe? This is the consequence of removing all these mitigations.

My noble friend Lord Thomas of Gresford spoke movingly about his compromised immune system. I too am in this position, though for a different reason. My medical advice is not to come out at the moment.

The 800,000 clinically extremely vulnerable have not had one word of guidance in the last week. It is not good enough to say that shielding ended in July. This group is at high risk and needs advice. When will this be evidenced? I think that even the noble Lord, Lord Robathan, would recognise that some people are at high risk. Shame on the Government for not getting in touch with them at all.

Other noble Lords have spoken about those with long Covid, including children. On schools, we have been asking since last year for air filtration units in classrooms. This has only just happened in the last week. Until now, the Government have been talking about CO₂ monitors, but the public health need in our schools is for air filtration units.

The first regulation is about self-isolation and moving to a daily lateral flow test. If it is negative, you can leave your isolation. We say that test and trace must remain the key defence in fighting Covid—particularly omicron—not least because of the somewhat reduced vaccine efficacy with this variant. The level of transmission of omicron is so high that this is a public health precaution. We disagree, therefore, with the fatal amendment laid by the noble Lord, Lord Robathan, which would remove this vital, basic, public health rule of self-isolation and testing.

The second SI on entry to venues and events creates a broader Covid pass, vaccine or test result, than the previously proposed vaccine pass. We have consistently opposed vaccine passports—first, for public health reasons. Importantly, vaccine passes give people a false sense of security, especially as it is possible to catch Covid and pass it on, even if you are double-jabbed. People cannot tell if their vaccine immunity is waning. We just do not like the reliance on that. We also do not want vaccine passports creeping in by the back door, as the noble Baroness, Lady Bennett, outlined. Our principal concern with this SI is about public health. This hotch-potch Covid pass is a muddle.

We agree with the use of lateral flow tests. They are highly accurate. Researchers from University College London found that they are more than 80% effective at detecting any level of Covid-19 infection. They are likely to be more than 90% effective at detecting who is most infectious when they use the test. None of us wants lockdown, particularly the noble Lord, Lord Robathan, and his colleagues, but I struggle to understand why those who do not want lockdown will not accept lateral flow tests as a mechanism to help reduce transmission.

We cannot support the noble Lord’s fatal amendment on the issue of flow tests, but we are deeply unhappy that the Government are relying on the vaccine element of the Covid pass at a time when we need to reduce transmission by the tried and tested test, trace and isolate system. So, if a vote is called, we will not support the Government’s proposals for Covid passes—although for very different reasons from those of the noble Lord, Lord Robathan.