NHS Update

Baroness Brinton Excerpts

Thursday 22nd July 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I first record from these Benches our thanks for the hard work of the noble Baroness, Lady Penn, who has gone on maternity leave. We wish her and her baby all the very best for the future. Also, adding to the words of the Government Chief Whip, I thank the clerks, the virtual technicians, the managers and all our staff, for keeping the show on the road and for keeping us safe throughout this year. I particularly echo his words about their patience with us. We have continued to do our job and could only have done so with the support of these dedicated teams. I also thank the Lord Speaker, his predecessor, and Members of all those Committees that have been in almost permanent session this year, for guiding us through.

This is the last repeat Statement before the summer—I think this may be number 50; the Minister will know. We have three matters to deal with today: the somewhat puzzling Statement made in the Commons yesterday afternoon, the Written Statement from the Secretary of State which announced the results of the NHS pay review and—I have given the Minister notice—I will also address some of the issues raised in the Covid update given in the Commons this morning.

The Statement made by Helen Whately yesterday was an odd moment. We of course join her and the Minister in thanking Sir Simon Stevens for all his work in the NHS—he has also taken up his place in your Lordships’ House. We also join others in welcoming progress on the autism strategy, which the honourable lady talked about in her speech; although, in due course I will seek the views of the organisations who are experts in this area. However, the honourable lady gave what can only be described as a parliamentary doorstep clap for the NHS and its staff. Welcome though that might be, it does not pay the bills or provide the respect that this Government owe to our NHS staff.

The Statement was followed within hours by a Written Ministerial Statement outlining the NHS pay award. This is not a respectful way to treat Parliament or our NHS staff. As my honourable friend Dr Rosena Allin-Khan said yesterday, once again the Government have had to roll back on a shoddy, ill-thought-through position, with their 1% pay rise—a real-terms pay cut —rejected by the independent pay body. Less than an hour before, there were competing briefings on what the deal was to be and, at that moment, it turned out to be nothing. Our NHS staff deserve better than this. My honourable friend invited the Minister in the other place to shadow her in the A&E department where she has worked shifts throughout the pandemic. I suggest that she takes her up on that offer, and that the Minister here might do the same.

My right honourable friend John Ashworth has said:

“Ministers were dragged kicking & screaming to 3% for NHS staff. But after years of cuts & rising pressures, NHS staff will feel let down & disappointed especially after today’s chaos. And where is the pay rise for junior docs? Where is a fair pay rise for care workers?”


It really was not worthy of a Government. We had chaos and confusion, with the Government once again rowing back on their position. Does the Minister agree that the pay review body has done what Ministers could not and would not do in recognising that our NHS staff absolutely could not be given a pay cut? Does he accept that, after last year, this is not enough?

Does he accept that this is not an NHS-wide pay settlement? It does not cover all the health and care workforce, who do not fall under this pay review body, and it does not cover junior doctors—I declare an interest, as two are nephews of mine, both of whom were redeployed during the pandemic. We know that our junior doctors have been put on the front line, caring for sick patients, and redeployed across an understaffed, pressured NHS, and that their training has been disrupted. Will the junior doctors get a pay rise? Will all health staff employed in public health receive the settlement? Again, when we know absolutely the value of care workers, why do the Government not guarantee a real living wage for those working in social care?

How will this pay settlement be funded? NHS trusts do not even know what their budget is beyond September, and NHS employers pointed out that this settlement will cost the best part of £2 billion, so where is that coming from? Is the Minister expecting trusts to find it from their existing budgets? These Benches keep repeating this question: the Government seem not to appreciate how central this is to stopping the spread of the virus, so when will they address support for low-paid workers who have to self-isolate?

I posed many of the immediate questions yesterday to the Minister. Sometimes I felt enlightened by his answers and sometimes I did not, but the one I wish to go back to concerns the Government’s plans for September. Are they ready to reimpose safeguards? Will our schools get filtration units over the summer so that we can feel that our children will be safer? Will our teenagers be vaccinated so that, next year, this cohort can do a full year of learning without being sent home in their millions?

[Baroness Brinton (LD) [V]]

My Lords, I echo the thanks to all the staff who have made a hybrid Parliament work over the last year especially, from these Benches, to the health team, because of the high workload of health and Covid business. I also repeat the good wishes to the noble Baroness, Lady Penn, as she starts her maternity leave.

Along with colleagues in the Commons, I am unconvinced that the first half of this Statement was planned to be delivered by the Minister yesterday. In the bizarre events of this week, of Covid restrictions being lifted, a rush of announcements—Monday’s, and today’s on vaccine passports—U-turns, and No. 10 contradicting Ministers, this Statement is definitely filed under “Y” for “You couldn’t make it up”.

Yesterday morning, the press were briefed and opposition politicians heard on the parliamentary grapevine that the NHS staff pay rise would be announced in the Statement. Even Sky News and the BBC news channel were saying that there would be an announcement on NHS pay in the Commons yesterday afternoon. Yet, when the Minister stood up, there was not one word about the pay award, just an end-of-term report and a much-deserved paeon of praise about how wonderful our NHS staff are—they are, and they deserve that praise. However, an extraordinary line in the Statement says:

“But I can assure those hardworking nurses: you should feel it soon”.


Well, they did. Four hours after that Statement, a Written Ministerial Statement and a press release were slipped out, bypassing parliamentary scrutiny, presumably in the hope that it would not be spotted. NHS staff, especially junior doctors and nurses, are appalled. I am not sure this is what the Minister meant by

“you should feel it soon”.

However, it gets worse. This morning’s Times says that the 3% NHS staff pay rise will be funded by robbing the expected increase in national insurance contributions reserved for the social care proposals leaked earlier this week by the Government. That is an absolute disgrace, especially given the appalling way that No. 10 has handled the social care reform proposals. After the Queen’s Speech, Ministers told us that it would be this autumn. Last week, they suddenly said that there would be an announcement this week but, this week, they have thrown the proposals back into the long grass, with a promise—again—of later this autumn, two years after the PM promised us, on the steps on No. 10, that this was his absolute priority. His actions are showing otherwise.

I know that the Minister understands that social care needs urgent reform and that it has borne the brunt of the first year of the pandemic. Can he confirm the Times story about the funding of the NHS pay rise and whether this decision was made by the Secretary of State for Health and Social Care or by the Chancellor of the Exchequer? Can he also say when the full proposals for social care will now be published, including the funding arrangements?

Moving to the only substance of this Statement, the autism strategy, we on these Benches also pay our respects to the late Dame Cheryl Gillan MP, who was such an advocate for those with autism. Peter Wharmby, the autistic writer, speaker and tutor, says that the autism strategy sets its targets very low in saying:

“Moreover, we have been able to transform society’s awareness of autism, as … 99.5% of the public have heard of autism … which is so important in autistic people being able to feel included as part of their community.”


Peter Wharmby is right. Much of the strategy talks about continuing as usual, but if you talk to autistic people or parents of autistic children, they all say that much needs to be done in supporting those with autism, especially in education and at work. Knowing that autism exists is not the same as providing the best environment for those with autism to overcome the barriers they face in society and giving them the support that they need to succeed. The Disabled Children’s Partnership points out that the pandemic has exacerbated existing problems around support for those with autism, creating further social isolation and poor health outcomes. It is depressing that the autism strategy is so unambitious.

One particular problem that parents face when trying to get support for their autistic children is an automatic assumption that parent carers are treated as a resource—worse, their parenting capacity is often questioned. There is no mention here of support for their needs. As John Bangs, a special needs expert, points out, this deliberately ignores carers’ legal rights. It is noticeable that this autism strategy makes no real reference to ensuring that parental and familial carers are supported. When will these wider issues relating to positive support for those with autism and their familial carers be addressed?

Finally, briefly on the Covid Statement in the Commons today, page 4 says that

“two doses of a covid vaccine offers protection of around 96% against hospitalisation.”

But the key bit of information we need in the “pingdemic” at the moment is the rate of double-jabbers getting Covid. I understand that it is part of the same study that is quoted, but what is the answer and where can we find it? If the pingdemic is due to the virus spreading —we hear of police and control rooms unable to operate and empty shelves at supermarkets—perhaps it is time we actually understood how many double-jabbers are getting Covid and having to go into self-isolation, and thereby creating a problem. The Minister needs to consider whether lifting all restrictions on Monday was the right thing to do.

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

My Lords, I join the noble Baronesses, Lady Thornton and Lady Brinton, in thanking my noble friend Lady Penn for her hard work over the last 18 months and wishing her well in her pregnancy. She looked absolutely fantastic as she left, and our hopes and good wishes are with her.

I also thank the usual channels, the House of Lords staff and the Speaker’s office for all their contributions to the virtual House and for keeping the business of the House going during this awful pandemic. There has been an enormous amount of traffic from the Department of Health—more than 50 Statements, 2 Acts and hundreds of regulations. I thank all noble Lords for their challenge, their scrutiny and their patience during this difficult time.

The pay review body has given us its recommendations, and we have accepted them. I thank it for its work and insight. I reassure the noble Baroness, Lady Thornton, that the Office of Manpower Economics will publish its analysis online shortly. We are extremely pleased that we can follow the guidance of the pay review body. Junior doctors have their own separate framework, worth 8.2% over four years. They are working from that framework today.

On the funding of the pay review, as noble Lords know, we gave the NHS a historic £33.9 billion settlement in 2018 and have provided £92 billion to support front-line health services throughout the pandemic. The pay uplift will be funded from within that budget, but we are very clear that this will not impact funding already earmarked for the NHS front line. We will continue to make sure that the NHS has everything it needs to continue to support its staff and provide excellent care, throughout the pandemic and beyond. That is why we accepted the PRB’s recommendations in full and provided NHS workers in scope with the pay rise.

On the question from the noble Baroness, Lady Brinton, on safeguards in September, I cannot make any guarantees but I definitely hope not. We very much hope that we are in the final stages of this pandemic, as the impact of the vaccine is being felt, bringing down the R number and saving those who are infected from hospitalisation, severe disease and worse.

The noble Baroness, Lady Thornton, talked about filtration for schools, and I noted her question on this yesterday. I said that we had been looking at it. I am not aware that the results of that analysis have come through yet. To be honest, I am wary of investing too much in unproven technologies. The two things that have been proven to work are isolation and vaccination; we are backing those two measures most of all. However, I accept her point about the importance of ventilation and will continue to look at it.

Likewise, the JCVI is looking very carefully at vaccination for children. We are working with international partners to get to the bottom of it. At the moment, we have a clear read-out—we will move—but our priority is providing either third shots or variant booster shots in the autumn to the most vulnerable. That is where our priorities are at the moment.

The noble Baroness, Lady Brinton, asked about social care. I note the Government’s statement on that; we will bring reform recommendations in the autumn. On her point about the autism strategy, I also pay tribute to the contribution of Cheryl Gillan, who worked so hard in this area and whose impact is still being felt.

I think the noble Baroness, Lady Brinton, overlooks some of the really good work in this strategy. There is £74 million of funding for a number of high-priority projects, which have been designed in collaboration with stakeholders from the community. I guide her to the implementation plan that accompanies the strategy, which has detailed recommendations on a six-point implementation matrix that has grit and traction. I would be very grateful for her feedback on that.

I pay tribute to parent supporters; the noble Baroness, Lady Brinton, is entirely right that they often bear the brunt of care and are often best placed to care for and support those with autism. I remind her that we have provided £31 million through the mental health and well-being recovery action plan specifically for the parents of those with autism, recognising how the pandemic was hitting that group in particular.

Calorie Labelling (Out of Home Sector) (England) Regulations 2021

Baroness Brinton Excerpts

Thursday 22nd July 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, today’s debate on calorie labelling regulations has demonstrated how complex and sensitive this subject is. At face value, the idea of labelling calories on the menus of large chains of food outlets may appear sensible and easy. On behalf of these Benches, I thank all those organisations that have sent us briefings, including Diabetes UK and Beat Diabetes, which have helped our thinking on what is not at all an easy subject. This is a complex issue with competing demands from vulnerable people on both sides who need help and support. Helping one group may cause serious problems for another.

We know that there are many people who have or who are at risk of developing type 2 diabetes and obesity. As a number of noble Lords have mentioned, more than a quarter of adults are obese and 66% are overweight. These two conditions provide the basis for a high risk of developing other serious disease, requiring much treatment and possibly leading to early death. This is a serious crisis for our country. The noble Lord, Lord Brooke of Alverthorpe, and the noble Baroness, Lady Jenkin, set that out well in their contributions.

Obese people need support and information to change their lives. Calorie labelling could be a tool in that. Can the Minister answer the noble Lord, Lord Brooke, and the noble Baroness, Lady Finlay, as to why the Government have decided not to put calorie labelling on alcohol? These are rightly described as empty, hidden calories. Is the noble Lord, Lord Brooke, correct that this is because of the alcohol lobby? Doing this would seem more obvious than putting calories on menus.

The amendment in the name of the noble Baroness, Lady Bull, sets out the equally serious problems that well over 1 million, mainly young, patients with eating disorders face and how calorie labelling could exacerbate their illness, whether in withholding food or binge-eating. Even though eating disorders are primarily classified as a mental illness, the reality is that a patient’s reaction to controlling their food intake is at the heart of it. Some will always choose the least calorific option; for others, it is the opposite. Labelling for this group acts as a signpost, supporting their control of their intake. As my noble friend Lady Parminter said, calories on menus could bring young people with eating disorders to a “place of fear”. She spoke movingly and eloquently from family experience, a reality that most of us just cannot understand. But we need to listen, as we also need to hear the testimony from the daughter of the noble Baroness, Lady Wheatcroft.

My noble friend Lady Walmsley made a thoughtful contribution highlighting the need for an integrated public health approach to food that takes account of these wider issues relating to diet and well-being, rather than just focusing on calorie labelling. We believe that public policy should always be evidence-based and we are struggling with the Government’s lack of any compelling evidence on or an impact assessment of mandatory calorie labelling on menus at some restaurants and take-aways. As worryingly, there is little evidence of serious effort to consult experts and stakeholders on all sides of this debate. There has been no formal review of similar initiatives and no attempt by Ministers to trial a pilot scheme or to draw from the evidence from those restaurants that choose already to list calories on their menus, which would have been a useful resource.

As outlined by others, there is limited evidence to suggest that this legislation would even have its intended outcome. A Cochrane review found that there is only a small body of low-quality evidence supporting the idea that calorie counts on menus lead to a reduction in calories purchased. A more recent study found that calorie labelling in American fast-food restaurants was associated with a 4% reduction in calories per order but that this reduction diminished after a year, suggesting that any small differences that may occur are not maintained.

The Minister mentioned reformulation of supermarket products. The 2020 sugar reduction report said that supermarkets had indeed started reformulation and that there were some reductions but that there was still a long way to go before the food industry meets the targets in 2024. That means that evidence is being assembled, but it is not there yet.

Both eating disorders and obesity are extremely important illnesses, which are severely damaging the health and well-being of millions in the UK. On these Benches, we remain committed to tackling both issues. We have long argued, also, that mental health should be considered in every government policy and that it should be treated with the same urgency as physical health.

I agree with the noble Baroness, Lady Bull, and my noble friends Lady Walmsley and Lady Parminter: given the concerns expressed from a large number of speakers during the debate, please will the Government commit to reviewing the regulations’ impact, both beneficial and adverse in 12 months’ time to ensure that they are fit for purpose and not wait the proposed three years?

Animal Diseases: Future Pandemics

Baroness Brinton Excerpts

Wednesday 21st July 2021 Lords Chamber

[Lord Bethell (Con) [V]]

My Lords, the noble Baroness is right that we need to massively increase international capacity for vaccine production. The Government are working on a vaccine strategy that will include ideas for doing that. A TRIPS waiver is something we have looked carefully at. It is our strong view that this Government support intellectual property, because it is only through our commitment to intellectual property that we can encourage the kind of massive investment by the private sector necessary to develop vaccines in the first place. For that reason, we remain hesitant about supporting a TRIPS waiver policy.

[Baroness Brinton (LD) [V]]

My Lords, Professor Sir Jeremy Farrar says in his new book that viruses do not change how they transmit between humans and animals, but humanity has become much more mobile. He deplores the pandemic nationalism evident over the last year, saying:

“Only the virus benefits from a pivot towards myopic nationalism because that will keep it circulating for longer. A divided world is a diseased world.”


I thank the Minister for saying what the Government plan to do through their chairmanship of the G7, but can he please confirm the timetable for the delivery of the “one health” approach, including its funding?

[Lord Bethell (Con) [V]]

My Lords, the “one health” approach is moving through the G7 process at the moment. I am not sure whether a precise timetable exists. I am happy to check to see whether dates are available, and I will write to the noble Baroness accordingly.

Covid-19

Baroness Brinton Excerpts

Wednesday 21st July 2021 Lords Chamber

[Baroness Thornton (Lab) [V]]

I thank the Minister for this discussion on the Statement made on Monday in the Commons. In fact, even since Monday the world has moved on. The infection rate continues to rise. There are mixed messages from government Ministers about responses to the ping. For example, does the Minister share my concern that the Investment Minister, the noble Lord, Lord Grimstone, wrote to the car manufacturer Nissan, pointing out that isolating after being pinged by the app was only “advisory” and that there was no “legal duty” to isolate? I recall the noble Lord explaining this to the House some weeks ago at my prompting. Indeed, many noble Lords came to me afterwards and said that they had not realised that there was no legal obligation to isolate after the ping. There is huge confusion now about vaccine passports, and 1 million children are out of school as their term ends. Here in London, we still have some challenges about getting people vaccinated.

So let us start with the issue of the vaccination of teenagers. The MHRA has approved the Pfizer jab for all 12 to 18 year-olds. Indeed, such countries as the United States, Canada, Israel, France, Austria, Spain, Hong Kong and others have started or soon will be vaccinating their 12 to 18 year-olds. Can the Minister tell us when we might start doing the same?

The Prime Minister obviously took fright on Monday, because on Tuesday he made the announcements about vaccine passports in September. I think that even he could see that nightclubs were offering superspreader events, with music and strobe lights attached to them—talk about closing the door after the horse has bolted.

The risk of death to children from Covid is mercifully very low, but they can become very sick and develop long-term conditions and long Covid. Indeed, according to the Office for National Statistics, 14.5% of children aged 12 to 16 have symptoms lasting longer than five weeks. Will the Minister spell out in detail the clinical basis for why the JCVI has made its decision? Will he publish all the analysis and documents in the same way that SAGE has published its analysis, not just its advice? Will he guarantee that this decision was made on medical grounds, not on the grounds of vaccine supply?

The Statement talks about infection among children being disruptive. We know that infection among children is highly disruptive for learning. We have seen hundreds of thousands of children out of school. We are not vaccinating all adolescents. Can the Minister tell the House what the Government’s plan for September is, when children return to school? For example, are the Government considering using this summer to install air filtration units in every classroom in every school?

Testing is already stretched, with turnaround times lengthening, so can the Minister guarantee that through the summer, especially once contacts can be released from isolation on the back of a negative PCR test in August, and into September when schools return, there will be sufficient PCR testing capacity to meet demand? As we move into autumn and winter, we can anticipate more flu and respiratory viruses, so do we need multi-pathogen testing going forward? Is this being developed?

It has been announced that critical workers such as food, health, utility and border staff with two Covid jabs will be able to avoid self-isolation. Many ambulance and acute hospital trusts have found themselves under extreme pressure because of the combination of very high demand and very high levels of staff absence due to self-isolation.

Three weeks ago, the Health Secretary told us that unlocking would make us “healthier” and promised us it would be “irreversible”, but today we have some of the highest infection rates in the world. Can the Minister tell us what the experts say about the risk of reimposing new restrictions in future? Our already exhausted NHS staff face a summer crisis. Covid admissions are already running at about 550 a day, and hospitals are now all cancelling cancer surgery. For example, liver transplant operations were cancelled in Birmingham last week.

It is clear that more infections mean more isolation. The NHS staff released from isolation if double-jabbed will still want to protect themselves and their patients, so will the Minister ensure that the standard of masks worn in NHS settings is upgraded to the FFP3 requirement that NHS staff have called for? What is his plan for keeping the economy and public services functioning through the summer, as more and more people are asked to isolate? Can the Minister confirm reports that SAGE scientists have advised that some measures, such as mandatory masks and working from home, should be reinstated at the beginning of August?

Recent days have seen some of the lowest numbers getting first-time jabs on record, with the daily average now lower than at any point since the start of the programme—although I suspect the Prime Minister is hoping that his threat that you will need a vaccine passport to get into a nightclub might help in that direction. Unused vaccine doses are being sent back by GPs as demand for jabs slows to a fraction of recent levels, yet we still have millions of unvaccinated adults. Does the Minister share my concern that falling demand, combined with emerging evidence of the effectiveness of vaccines beginning to wane over time, may mean that we in this country will be less protected in September?

Finally, I understand that the “hands, face, space” slogan is about to be dropped in favour of a plea to “Keep life moving”, despite the fact that hundreds of thousands of people are still isolating. Can the Minister explain what this actually means?

[Baroness Brinton (LD) [V]]

I thank the noble Lord, Lord Bethell, and the noble Baroness, Lady Penn, their officials and all staff in the Lords, the Whips’ Office and the health team, as well as Members, for their extraordinary work this year on Covid-related business—mostly emergency Statements and statutory instruments. From these Benches, we particularly wish the noble Baroness, Lady Penn, a safe delivery and a happy maternity leave.

The Statement talks about enjoying “new experiences” following the lifting of lockdown and safely slowing the spread of this deadly virus, but 48 hours is a long time in politics, as evidenced by the difficulties of taking this Statement two days after it was delivered. So much has happened, much of it demonstrating that this Government are still struggling to get a grip on keeping people safe from this deadly virus.

The phrase in the Statement:

“We are cautiously easing restrictions”


is the most extraordinary thing to say, given all the rhetoric about freedom day—and it is wrong. All restrictions have been lifted—no mandatory face masks—and young people have understandably taken their lead from Ministers. There are videos of young people deservedly enjoying themselves in nightclubs in the knowledge that the Prime Minister has declared it safe to do so, yet hidden in this Statement is the bizarre announcement that in two months’ time only those who are double-jabbed will be able to go to such crowded venues, thus delivering Covid ID cards by the back door. Once again our young people, who have had to bear much of the brunt of lockdown life, are the ones targeted by this Government.

That little phrase caused chaos on Tuesday morning. Paul Scully was not clear about which other large venues might be included—for example, pubs with performance dance venues, large or small. He thought so. Two hours later, No. 10 contradicted that: no pubs. Can the Minister tell me what is the difference between a pub with a large dance venue of, say, 500, and a nightclub that can have up to 400 people and why one will require everyone to be double-jabbed but the other will not? I am really struggling to understand the difference. Perhaps the Minister can point your Lordships’ House at a safety document that sets out what the risks are for these different venues and why it is appropriate to ignore lateral flow tests and only go on double vaccination when we know that people can still get Covid after they have been double-jabbed.

The Statement is right to praise the progress of the vaccination scheme, although there is some considerable way to go, including awaiting the data on whether the booster jab can be given at the same time as the flu jab in the autumn. What plans are in place to provide support for GPs if the jabs cannot be given at the same time? We all know that the annual flu vaccine date requires a very large amount of administration by medical and admin staff alike.

The Statement says that JCVI has decided not to vaccinate all 12 to 17 year-olds yet but is keeping it under review. I too refer to today’s ONS data that was referred to by the noble Baroness, Lady Thornton, demonstrating underlying illnesses and a greater prevalence of long Covid among the young than among older people. I thank the Minister for the helpful briefing on Monday, but I remain concerned that with up to 1 million children out of school now it has been clear that the alternative to vaccinating secondary-age pupils appears to be allowing Covid to rip through our schools. We all want our children back in school in the autumn, so what are the Government going to do about that? It is good that the Government are finally allowing the children most vulnerable to Covid to receive the vaccine because they deserve protection and that those children with an immunocompromised or immunosuppressed adult in their home will also finally be able to be vaccinated. That is good.

This Statement also refers to the regulations debated in your Lordships’ House last night, and I hope the Minister has taken away the many concerns expressed by all sides of the House. The Statement refers to tradespeople, such as plumbers and hairdressers, who will also have to be doubled-jabbed to gain entry into a care home. I have two questions about these non-staff members. I am happy to receive a reply by correspondence if the Minister does not have immediate answers. First, if the registered person is not on the premises when an outside worker comes in, can another member of staff admit them and make the decision about their vaccination status? What does that do to the registered person’s responsibilities? If a plumber comes out of office hours to, say, mend a burst pipe and the registered person is not there, must they be turned away? Secondly, care homes are already reporting that some contractors are heavily ramping up the rates for care homes for their staff who have been double-jabbed. Did the hurried and inadequate impact statement published on Monday include the cost to homes of this outrageous practice, and will the Government issue guidance that it should be stopped immediately? Can the Minister say when the detail of how this is all going to work in practice will be published?

The Statement refers to the fact that we must be pragmatic about how we manage the risks we face, yet the past two days have been full of contradictions from the Prime Minister and other Ministers about the need to self-isolate when people are pinged. It has taken journalists to reveal that the only legal responsibility to self-isolate is when called by track and trace, but after the embarrassing U-turns on Sunday morning of the Prime Minister and the Chancellor about not self-isolating, the PM is confidently saying “You must self-isolate once pinged”. Apart from the irony of that statement, given his behaviour, once again we have Ministers not seeming to understand the difference between advice to people—moral guidance, perhaps— versus the reality of a chaotic series of SIs that confuse not just the police, the public and Parliament but the very Ministers responsible for them.

With a further 44,000 new cases today, making us world-beating in one league table no one wants to head, a further 73 deaths and millions of people being pinged and everything in chaos, I fear we are in for a long and difficult summer.

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

My Lords, I am enormously grateful for the thoughtful and challenging questions from the noble Baronesses, Lady Thornton and Lady Brinton. I will start by using a couple of their specific questions to illustrate, as clearly as I can, the strategy behind our approach and the challenges and limitations in what government can and cannot do.

When it comes to the app, this situation illustrates the difficulties of leaving an epidemic. I remember well the CMO talking about what happens to a country when it enters an epidemic; at the beginning of last year, he gave us an introduction and said how difficult it was when you are trying to make that transition. The challenge is of having a partially vaccinated population that has huge pressures to get on with life, while at the same this infection leaves many largely untouched by the virus—in fact, the largest proportion of people. That is exactly the kind of dilemma we are wrestling with.

With the app and the Government’s position on whether you have to isolate when you get pinged, isolation remains the most important action that people can take to stop the spread of the virus. It breaks the chain of transmission. There is no single better measure for breaking the spread of the virus than isolation, so it is argued that it is crucial for people to isolate when told to do so, either by test and trace or by the app. I can confirm that the Government’s advice is to isolate if you are pinged by the app although, as I have said previously, this is not captured in law.

Both noble Baronesses asked about policy on schools and why we emphasise Covid vaccination over LFDs for entry into venues. Those questions give me an opportunity, I hope, to be really clear about the strategy. It is to vaccinate a sufficient proportion of the country that the virus cannot spread so easily, and that R is brought below 1. When we have that moment, we can be more confident that the impact of the virus on hospitalisations, severe illness and worse will be brought under control. At the rates at which we are vaccinating, we are hopeful that we can reach that stage relatively soon.

There is no other plan; there is no way of beating the virus other than ensuring that the vaccination deployment is as effective as possible. That is why we are looking at ways to bring young people and those who are reluctant onside, by engaging them in dialogue, answering their questions and emphasising through our measures the critical importance of vaccination, particularly when sharing space with others in your community.

On vaccinating children, healthy children are at a very low risk from Covid-19, with their risk of death being around one in 2.5 million. No previously healthy child in the UK under the age of 15 has died from the pandemic in the UK, and admissions to hospitals or intensive care are very rare. That is why we are taking a cautious approach in this area. The JCVI will keep this advice under review as more safety and effectiveness information becomes available on the use of vaccines in children; for example, regarding reports of myocarditis as an adverse event following vaccination with Pfizer. However, we will be extremely energetic in looking at all avenues in this area.

We are also looking at booster shots. Following the publication of interim advice by the JCVI, the Government are preparing for a potential booster vaccination programme from September. The noble Baroness, Lady Brinton, asked what the state of the country will be in the autumn. That will in large part depend on the flu vaccine and on the Covid vaccine, which can be taken at the same time. We are working closely with GPs to ensure that that rollout is as effective as possible, because the resilience of the NHS depends enormously on the success of our dual vaccine rollout.

Lastly, the noble Baroness, Lady Thornton, spoke about the importance of keeping life moving. I do not know that phrase but I know that there is a huge backlog in the NHS. There are other profound impacts of our social restrictions and our lockdown measures on the health of the nation, the economy and our society. We cannot continue in this way for ever. There is value in trying to open up our economy and giving individuals the information to be able to make decisions for themselves. That is the inflection point we are at now. I have enormous sympathy for those looking for information on the best approach but I hope the direction of travel is crystal clear.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021

Baroness Brinton Excerpts

Tuesday 20th July 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I declare my interests as a vice-chair of the All-Party Group on Adult Social Care. Many have spoken from the heart, including my noble friend Lady Tyler, about the principles of ensuring that those who need to be cared for by the care sector are kept safe. From these Benches we unequivocally support that principle but we argue that this SI itself is flawed, as demonstrated by the eighth and 10th reports of the Secondary Legislation Scrutiny Committee. These echo the concerns of cross-party MPs in their debate on this SI last week.

First, it is important to say that a year ago the shockingly high death toll in care homes was because neither residents nor staff were protected by our Government. In the early days, patients with Covid were discharged from hospital into homes. Worse, staff could not get access to proper PPE. I do not take the view of our Prime Minister—as reported by Dominic Cummings—that anyone over 80 is going to die soon anyway. For too many, Covid is a very nasty disease, as he well knows. Shame on him for dismissing the lives of anyone over 80.

I turn to the regulation itself. There is still no impact assessment. The statement of impact, hurriedly published yesterday, does not answer the questions raised in the Commons debate last week and does not provide the evidence for its assertions. Further, it is not clear exactly where the boundaries of the Minister’s powers lie in the regulation and what ability there is, therefore, for mission creep and Henry VIII powers.

One example is the nature of the evidence required for vaccination status. It might be an app. It might be an NHS letter. There is no evidence yet for your Lordships’ House to understand how secure this process would be. Nor are the duties under law of the registered person in a care home or a care company stated. The Secondary Legislation Scrutiny Committee pointed out that it was not certain

“whether that would provide a sufficient defence to a registered person if they needed to contest a sanction for non-compliance.”

The real concern from the evidence given by Ministers and their officials is the actual size of the problem they are trying to solve. SAGE has said that the target for staff vaccinations should be around 80% and, in his opening speech, the Minister said that we are so nearly there with the vaccinations and then quoted the data to confirm that, despite localised variations. The 10th secondary legislation report says:

“It became evident that the DHSC are trying to target this legislation on particular groups of people”.


It is not explained in the Explanatory Memorandum, perhaps because it is those people in deprived areas, younger staff and ethnic minorities.

I reassure the noble Lord, Lord Wei, the noble Baroness, Lady Fox, and others that, for months, the care sector and unions have been working with vaccine-hesitant staff. Back in January, a GP in Newcastle was reported as saying that the single most effective tool to overcome vaccine hesitancy was getting local doctors who staff know to listen to their concerns and answer them. Care providers confirm that this technique is highly effective and, frankly, it is probably why the SAGE targets and more are achievable. Why are the Government not backing this route, which would appear to overturn staff hesitancy more than any other technique, and certainly more than coercion?

There is a long litany on the lack of legislative compliance, commented on by many noble Lords, in addition to the lack of the vital impact assessment. The sector has faced a perfect workforce storm in the last 18 months. Brexit has resulted in large numbers of EU staff leaving the UK. Now, as restrictions are lifted, staff are being wooed by those able to pay premium salaries in hospitality and, in rural areas, agriculture. Social care providers say that there are already over 120,000 vacancies. They know that they will have to sack those who refuse vaccinations and will find it even harder to recruit from an ever decreasing pool. All the Government say is that it will cost the sector £100 million—much better to work with the sector to do this voluntarily.

To workforce issues, we must add the lack of detail in the Explanatory Memorandum about how this proposed system would work. Nor do the SI or the EM have key definitions, again leaving your Lordships’ House in the dark. I add to the comments of others about the inconsistencies of targeting just this sector and not others in the NHS. So, care assistants, plumbers and hairdressers must be vaccinated if they are going into care homes, but not GPs and other doctors—that is extraordinary.

I end by returning to the fundamental issue of whether there is a need for this SI. One of the largest care organisations, Four Seasons Health Care, challenges the Minister’s assertions that care homes are not safe at the moment. In its evidence, it said:

“Since March 5th 2021 we have had 2 covid deaths, during which time 955 residents have passed away. Covid therefore accounts for 0.2% of all our deaths in the past 18 weeks.”


Can the Minister provide the nationwide data on deaths in care homes over the last four months? I believe it matches these figures, so is this SI necessary? The Government admit that SAGE’s target was met, but have said there should be even more vaccinations. Other than the Minister, every speaker tonight has raised problems with these regulations, from all sides of the House. From these Benches, we say that the litany of minor and major issues means that the instrument should not be brought into effect, so we will support the amendment of the noble Baroness, Lady Wheeler.

Elderly Social Care (Insurance) Bill [HL]

Baroness Brinton Excerpts

2nd reading
Friday 16th July 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I declare my interest as a vice-president of the Local Government Association and a vice-chair of the All-Party Parliamentary Group on Adult Social Care.

I thank the noble Lord, Lord Lilley, for securing this early slot to present his Bill, although these Benches have serious issues about the principles and details of his proposals for creating an insurance scheme for elder social care. In March, I read the noble Lord’s paper on his scheme, which was published by Civitas. It is right that policymakers on all sides of the political spectrum think through the series of complex problems our social care sector currently faces. I thank him for continuing that debate in your Lordships’ House through the Bill, even if we do not believe that it is the solution.

The noble Lord referred to a live rail running alongside the funding reforms for elder social care. As many other noble Lords have said, these proposals miss the point. We need to devise a comprehensive elder social care system for everyone, whether home owners or not, and regardless of the value of their property if they are. We agree with many speakers today who have talked about having that universal social care system for everyone regardless of assets or income. I also echo the comments made by other noble Lords about the excellent report on this issue by the committee chaired by the noble Lord, Lord Forsyth, and the noble Lord, Lord Cormack, is right to say that this House needs to debate that report as soon as possible. It is a disgrace that we have not had the chance to do so. It is very overdue.

In 2011, Andrew Dilnot’s report on the funding of elder social care was published and, for a while, all three major parties worked together to make it happen. Dilnot proposed a neat solution, using facts about average stay in a care home, percentage of people needing it and average costs. All three parties were on the point of agreeing it, when, I am sorry to say, the Conservatives walked away. Ten years on from the publication of the Dilnot report, it looks, if the leaks to the Times and the Telegraph are right, as if it is back on the agenda. I hope that is correct. It was a fair and equitable proposal that merited serious consideration.

We await the Government’s long-overdue proposals. It is two years since the Prime Minister announced it as an absolute priority and well over 18 months since he stood at the door of No. 10. However, the devil will be in the detail. The current funding system for elder social care is a disgrace, and we must remove the fault line, as the noble Baroness, Lady Chakrabarti, called it, between health and social care at the source. The problem with this Bill is that it tries to create an insurance system which the insurance sector does not want to provide for, so the noble Lord proposes that the Government go into the insurance industry themselves, an industry where they have no experience or track record of success. That way disaster lies.

What we need is a system that sets a cap on costs that individuals have to pay, in the style of Dilnot, but underlying that there must be a mechanism for funding social care properly, on a par with health and, as we said in our manifesto in 2019, to be funded beyond that Dilnot cap through taxation. That means that those who do not own their own homes or have homes of low value will have access to the same social care as those who have houses of high value. It would also stop the current inevitable but wrong practice of private social care patients funding the publicly funded ones because local authorities are not given enough funding by central government to cover that public funding duty.

Our social care sector needs a much more fundamental review, and I hope that the Government will provide that root-and-branch review beyond funding. The noble Baroness, Lady Verma, is right: until there is parity of esteem with the health sector, it will always be treated like the Cinderella service it feels it is. This Government’s callous discharging of patients with Covid into care homes last year in order to protect the NHS epitomises that, and I am glad they stopped that practice. Pay structures, career pathways and the treatment of staff are always compromised by the amount of funding coming into the social care system, which is why we are in this mess.

We also need to fund care support that is not based around care homes, which gives older adults the protection and support they need to keep them independent to avoid the need to go into care homes, which is vital with a rapidly ageing population. This Bill would not cover that critical part of the multidisciplinary services, including, for example, encouraging post-retirement, part-time working, whether paid or in the voluntary sector, to keep minds active, or including a healthcare system that considers prevention as a priority—for example, of fractures, rather than always just having to repair them, which often leaves people much less independent than they were before. It should also include investment in social activities in communities, which many local councils can no longer afford to do with their squeezed funding following government cuts.

We on these Benches do not support the Bill. I hope that proposals from the Government, whenever they finally appear, will present a root-and-branch reform of social care and not just the funding mechanism for home owners. Can the Minister say when they will be published and whether they will be the comprehensive reforms that all Members have highlighted in today’s debate?

Organ Tourism and Cadavers on Display Bill [HL]

Baroness Brinton Excerpts

2nd reading
Friday 16th July 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I join in congratulating the noble Lord, Lord Hunt of Kings Heath, on presenting this excellent Bill, which will give the United Kingdom confidence that no one having a transplant with an organ from abroad will have received an organ donated without consent, and which will prevent the display of cadavers where that consent has also not been obtained. The noble Lord’s role in taking the opt-out organ donation Bill through Parliament was much welcomed at the time, and the change in legislation has worked, with public opinion very much supporting opt-out. Transplants are a wonderful medical advance, when the organs have been donated with the consent of the individual. They are a real gift of life to those who knew that they had run out of treatments.

This Bill tackles a very specific problem that has emerged in recent years and is a very helpful clarification of the law in two areas. First, I suspect that members of the public who visited the Imagine Exhibitions tour would have been horrified to discover that the plastinated cadavers on display came from China and were the bodies of those executed by Chinese authorities—and, possibly worse, that some of their organs had been harvested. The noble Lord, Lord Hunt, along with other noble Lords, is right to say that the treatment of the Uighur Muslims by the Chinese authorities, as reported to the United Nations by the expert China Tribunal, chaired by Sir Geoffrey Nice, is extremely worrying.

The Chinese may, as with their treatment of the Falun Gong, deny their involvement in the use of people’s organs or bodies without their explicit consent. They say that forced organ transplanting stopped in 2015. We may choose, as we do, to listen to the evidence to the contrary presented to the United Nations. The noble Baroness, Lady Northover, made an important point about the lack of Chinese explanation about evidence presented to the United Nations; their silence on this does not confirm their innocence.

We on these Benches note that the NHS Blood and Transplant organisation has reported that between 2010 and July 2020

“there are 29 cases on the UK Transplant Registry of patients being followed up in the UK after receiving a transplant in the People’s Republic of China”.

We know that UK citizens are going to China to receive transplants. I wonder how many of them know exactly where those organs came from.

It is vital that the UK, whether its citizens or its NHS in treating people after transplants, is protected from the possible lack of consent from individuals into the use of their bodies for organ transplant or bodies on display. We are now behind the curve compared to many other countries that have legislated already against these practices, and that needs to be remedied as a matter of urgency. The noble Lord, Lord Ribeiro, with his expertise through his role in the Royal College of Surgeons, and the chairing role of the noble Baroness, Lady Finlay, on ethics, both spoke with authority on the medical practice of transplants and true consent. The experience of the noble Lord, Lord McColl, as a kidney transplant surgeon, of various nefarious practices in gaining consents for transplant, was very helpful. His last comments at the end about the development of plastic lenses for cataracts just shows how slowly and carefully this country has taken the progression of transplantation.

Along with the noble Baroness, Lady Finlay, my thoughts turn to Burke and Hare, and their appalling supply of bodies for profit. Our own shameful history in this area means that we must ensure that standards of consent are of the highest calibre, which is why we need absolute clarity on consent for any practice involving organ transplants and cadaver display. The noble Baroness is right to say that this Bill prevents double standards. The right reverend Prelate the Bishop of St Albans confirms the view of all speakers in this debate so far that we in the UK must be robust in ensuring that we have those right standards in our country and that we continue to push for an examination of the treatment of persecuted minorities in China. I hope that the Government, who are now taking very seriously the issue of China’s treatment of Uighur Muslims, will smooth the rapid progress of this small but vital Bill through Parliament and into legislation as soon as possible.

Covid-19

Baroness Brinton Excerpts

Thursday 15th July 2021 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for taking this Statement, although I have to say—and I know this is not in his gift—that Monday to Thursday is probably too long a gap, but taking the Statement today might in this case prove useful because we have seen the reaction to the nearing of so-called freedom day, nationally and internationally. We have also seen the Government becoming progressively more cautious. That is not surprising because in England 42,000 Covid infections and 49 more deaths were recorded yesterday, hospital admissions have increased to more than 500 a day, up 50% on last week, and we now see routine operations being postponed and cancelled.

The NHS is rightly focused on waiting lists, which are at their highest level over the past decade at 5.3 million, and 336,733 people have been waiting more than a year, more than 76,000 have waited for at least 18 months and more than 7,000 have been waiting for two years. Emergency care is grappling with some of the highest summer demand ever, and this is in the context of NHS staff being exhausted and facing burnout. The NHS is also losing a significant number of staff to self-isolation, which has led to much reduced capacity due to infection control. As infection rates get worse and increase, what is the Government’s plan to deal with this situation?

Since Monday we have seen an increasing number of announcements and questions about how to safeguard against further increases in infection and the impact it is having on our NHS, schools, businesses and communities. Indeed, our own Lord Speaker wrote:

“Members are still expected to wear a face covering both in the Chamber, in indoor crowded spaces and when moving around the Estate, in line with general advice from Public Health England and the Chief Medical Officer. Members are strongly encouraged to use the testing facilities provided.”


On these Benches we intend to follow that advice, and I regret that some Members have already abandoned their masks when moving around the building and in the Chamber. We have staff to look after us who may not yet be fully vaccinated and, anyway, have no choice but to be here and who will continue to wear their masks to protect us. We should afford them the same consideration. Does the Minister agree?

On the “Today” programme a few days ago Professor Graham Medley, the chief modeller for the SAGE committee said: “Wearing face masks is worth it but only if everyone does it, not just 70%. I understand the Government’s reluctance to actually mandate it. On the other hand, if it is not mandated, it probably won’t do any good.” In other words, my understanding is that unless more than 70% wear masks, the protection for those who are still vulnerable will not work.

I fear we have been here before, with the Government back-pedalling and, in doing so, creating confusion and ambiguity—exactly the circumstances for the virus to thrive and mutate. The guidance issued by Ministers yesterday was stronger than businesses expected, many of which feel that they have been led astray, given the Government’s repeated characterisation of 19 July as “freedom day” and the end of most restrictions. The truth is that the guidance is hardly different from the current rules, except that businesses are now “encouraged” to keep many of their Covid adaptations rather than required to do so. Businesses now have just five days to decide how to implement the rules and how to communicate that to their customers. Does the Minister accept that the Government’s mixed messages have left many in legal limbo?

The new guidance gives little clarity to the 3.8 million extremely vulnerable people who are being told to avoid all unvaccinated people. How are they supposed to know whether or not someone is vaccinated? Does the Minister share the concerns raised by charities and patient groups that guidance has effectively told the extremely vulnerable to shield, without backing that up with any formal support from the Government for working or food shopping? Government advice to the clinically extremely vulnerable is to go to the shops at quieter times of the day after 19 July. I am not sure if that can be dignified as “support” for those most at risk of serious illness from Covid-19.

Is it true that the Government have not had anyone in post to deal with the clinically extremely vulnerable for three months, since Dr Jenny Harries was appointed chief executive of the UK Health Security Agency? If that is true, it is deeply concerning and it may explain why the Government have failed to prioritise support for these 3.8 million people.

What are the contingency plans for surging hospital admissions, which may remain high until the end of August, as called for by members of SAGE? The new guidance also says that businesses should encourage customers to check-in using the NHS app or otherwise leave their contact details. Can the Minister confirm reports that plans to reduce the sensitivity of NHS contact tracing have been reduced because of the surge in cases? What assessment have the Government made of the effectiveness of the app as an infection control tool, given reports that more than 20% of adults and a significantly greater proportion of young people have actually now deleted the app and many more are ignoring the advice to self-isolate?

I turn to those working from home. Despite the lifting of guidance to work from home, the Government say they expect and recommend a gradual return to offices. This is very confusing. What protection is proposed for those who are vulnerable, and for whom “freedom day” is not freedom day but a further lockdown day? If their employers demand that they return to work, even if they are immunosuppressed, for example, travel and enclosed places pose a threat to them. Under these circumstances, we need to be grateful for the good sense of the Mayor of London in following the science. Sadiq Khan has said that Transport for London will continue to enforce the wearing of face masks on services in the capital beyond 19 July.

While industry bodies said on Tuesday that no domestic train operators or major bus and coach firms will require customers to wear masks, the city mayors and others are calling for mask wearing on all public transport. Does the Minister agree with them? If Tracy Brabin, Andy Burnham and the other mayors had the power to enforce mask wearing to protect drivers and passengers, they would do so. They are doing the Government’s job for them.

What support are the Government going to give those areas with the lowest vaccination rates? Local authorities in London have, variously, 35%, 36% and 42% of their populations vaccinated. Does the Minister support the leaders of those authorities who say that they wish mask wearing to continue until they have got their populations caught up with vaccination?

[Baroness Brinton (LD) [V]]

My Lords, the Prime Minister told us 10 days ago that we were heading for “freedom day” and that all the data was going in the right direction; all restrictions would be lifted, and now was the time to take personal responsibility for our behaviour and for the Government essentially to step back. The Secretary of State’s Statement on Monday confirmed that, although with a marginally more cautious note about taking care. I echo particularly the comments made just now by the noble Baroness, Lady Thornton, about the mixed messaging in the new guidance for business and on returning to work, which conflicts with what was said both in the Statement and by the Prime Minister.

However, since the Prime Minister’s and Mr Javid’s confident assertions on Monday, there has been an outpouring of disbelief from senior scientists and doctors. Cases are currently doubling every nine days, and yesterday there were 42,000 new daily cases—a level last seen at the beginning of the January total lockdown. If there is no slowing of that doubling rate, we will have hit 100,000 new daily cases by the beginning of August. And that is before the Government’s expected extra cases as a result of “freedom day” on Monday.

Ministers constantly say that there are fewer people in hospital, that fewer people need ventilation and there are fewer deaths, but what they do not mention is that those numbers are a matter of ratios, and that with the current level of cases our hospitals are already reporting A&Es with the equivalent of a winter surge and more wards being turned into Covid wards for patients. A letter published a few days ago in the BMJ, initially signed by 1,000 doctors, is at over 7,000 signatures and still rising. The data is already clear that the surge in new cases from three weeks ago is increasing hospital admissions right now. So what are the Government doing to support and protect our NHS from this sharp increase and pressure on doctors, nurses and hospitals right now?

While many people are being responsible, still following the guidance and using their face masks, sadly there are many who are not. I was talking to a young security guard who told me that, this week, she is finding it impossible to persuade people to put masks on in their local shopping mall, despite the fact that the rules are still in place. Yesterday, my local community pharmacist told me in despair that two people arrived separately asking him for PCR tests as they each had Covid symptoms and thought all the previous rules had just finished. Not for the first time, much of this is about the Prime Minister’s muddled communication style. In the light of the fact that Scotland, Wales and Northern Ireland are going to retain the face mask mandate, and that the metro mayors, including Sadiq Khan and Andy Street, would like to do so, will the Government please reverse the lifting of the face mask mandate immediately, so that it remains in place, especially on public transport?

I turn to the new guidance for the clinically extremely vulnerable. I have to say that I have never read such an inconsistent and contradictory formal guidance note from the Government—and I have read a few. You should stay at home to be safe but if you cannot work from home, go in; you must remain socially distanced from everyone outside your bubble, even if they do not have to; you must not mix with unvaccinated people, outside or inside. I ask the Minister to tell me how on earth you know who is unvaccinated. As one of the CEV, do I stand in the doorway at opening time at my local greengrocer’s—a quiet time—and shout out to any customers and staff, “Anyone not vaccinated in here”? Of course not. The inevitable logic of this is the restart of shielding but without any of the previous support.

Worst of all, on Friday evening Public Health England put out a press release in which it mixed up advice to the clinically vulnerable and the clinically extremely vulnerable by citing vaccine efficiency research relating to the former in advice to the latter. That paragraph has been repeated in the formal guidance published on Monday. It is plain wrong. In a total administrative muddle, no one has gone through the nine pages of this guidance and updated it, so it is littered with references to the need to follow other rules and guidance for the general public in place at 17 May and 21 June, all of which goes next Monday. Please will the Minister ensure that the guidance is reviewed immediately to remove these anomalies?

All this, and the lack of answers to my questions last week about who the clinical lead is on the clinically extremely vulnerable, tells us 3.8 million former shielders that we have been not just forgotten but thrown to the wolves. Please will the Government actually review the guidance to keep the CEV group safe and provide the support that they need?

I also gave the Minister notice of the following two questions, as they both concern urgent and slightly unusual elements of lifting restrictions. First, for a couple of weeks now, Malta has said that it will not accept UK citizens who have received particular batches of the AZ vaccine manufactured in India, about 5 million doses of which have been given in the UK. Earlier this month, the Prime Minister reassured the press, saying:

“I am very confident that it will not prove to be a problem.”


However, holidaymakers are being turned away from Malta right now. When will the Government resolve this problem?

Secondly, those thousands of wonderful people who came forward to take part in the AstraZeneca clinical trials have been told that their vaccine status cannot be put on the NHS app, which means that they cannot go abroad, either to work or on holiday, or do certain jobs in the NHS that require this evidence. In early June, there was a blog on the BMJ website that set out these problems, but three months on from this issue being initially raised, there is still no resolution. It is utterly wrong that these publicly-minded people have now been left in limbo. Can the Minister say when this problem will be resolved and their vaccine details uploaded?

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, I am enormously grateful to the noble Baronesses, Lady Thornton and Lady Brinton, for their thoughtful questions. The noble Baroness, Lady Thornton, put it extremely well: we are at a delicate inflection point. It is a moment when the whole country needs to be cautious about rushing into change, but it is also a moment when the vaccine is having an enormous impact and change is therefore appropriate.

Infection rates are rising dramatically, but we cannot avoid the fact that hospitalisations and deaths are holding relatively steady. Today, there are 2,970 Covid patients in beds and 470 on ventilators. This is a massively smaller proportion than in the pre-vaccination spikes, when the connection between infection, hospitalisation and death was much firmer and more profound. At the same time, as the noble Baroness, Lady Thornton, rightly pointed out, waiting lists are huge and the gap for diagnostics for severe diseases, such as cancer, is extremely concerning. It is our responsibility to step up to that deficit and not be wholly distracted by Covid. This is therefore a moment when we have to balance competing demands on our healthcare; we are trying to hit the right balance.

On masks, I pay tribute to the Lord Speaker for his leadership in this area and on asymptomatic testing. I saw his Twitter post where he was being swabbed for his LFD test—a commendable sign of leadership. He and the noble Baroness, Lady Brinton, are entirely right: we should wear masks out of consideration for others, including others who may not have had the vaccine or may not be able to have the vaccine. However, it is also entirely right that central government cannot mandate every aspect of human behaviour for months and years to come. I take great pleasure in the sight of local leaders using their influence to inspire the public in this matter. I remind the noble Baroness, Lady Brinton, that DPHs are able to bring in mandatory measures where there are areas of outbreak. People need to know that the wearing of masks has an impact, and we are hopeful that they will go along with that. Although legal restrictions are being removed, the guidance will recommend that masks continue to be worn in certain situations, and businesses will be encouraged to support staff and customers who continue to wear masks.

In line with businesses, public services have always been free to set their own entry policies as long as they meet their existing obligations, including under the Equality Act. Public services must continue to protect workers and others from risks to their health and safety, including from Covid. That is only right and fair.

On the very important question of the immuno- suppressed and the immunocompromised, both noble Baronesses made extremely powerful points. I want to express in very clear terms my personal sympathy for all those who have concerns about the impact of the vaccine and for whom the rise in infections presents a very real threat to their health. However, I flag the Public Health England report on the clinically extremely vulnerable group as a whole. It makes it clear that there is little reduction in vaccine effectiveness for them compared to those who are not in high-risk groups, with between 76% and 93% effectiveness after a second dose. The PHE data also suggests reduced effectiveness for the immunocompromised and the immunosuppressed, particularly after one dose, but effectiveness after two doses is much higher. These general figures mask substantial variations, which we have discussed before—we would expect this between one set of compromised systems and another—but future studies will provide much more granularity on that. It is not right, however, to suggest that all those with compromised immunities are left unprotected by the vaccine.

The guidance for those who are clinically extremely vulnerable was updated and published on 12 July, as the noble Baroness, Lady Brinton, pointed out. This confirms that changes to social distancing rules in step 4 will also apply to the CEV, who are advised to continue considering additional precautions that they may wish to take on board. I hear very clearly the noble Baroness’s points about anomalies in the guidance; I will take those back to the department and try to tidy up the documentation as she advises.

I can inform the House that we are writing to NHS clinicians to update them on them on the latest position regarding vaccine effectiveness for these groups and provide information on potential treatment options currently under development, such as monoclonal antibody therapies and novel antivirals, as well as access to antibody testing. This guidance will support clinicians in their conversations with patients. This is such a variegated group that that kind of personalised advice is critical.

The interim JCVI advice is that all clinically extremely vulnerable people, including immunosuppressed individuals and their household contacts, should be prioritised for a booster vaccine in the autumn. We are continuing to invest in the OCTAVE study, which will provide further data on patients with suppressed immune response. Interim results for the immediate response to the vaccine will be available from the middle of July.

We are absolutely focused on ensuring that the population is given clear guidance. The NHS app is undoubtedly an area that needs to evolve. Its effectiveness as a technological tool in giving people counsel and advice when they have been in close proximity to someone with the infection is extremely valuable. We are looking at ways in which that value can be enhanced.

On the specific question of the noble Baroness, Lady Brinton, about Malta, it is for member states to determine what they accept at their borders regarding vaccines. Foreign travel advice recently published for Malta misleadingly reported that it would not accept the specific batches received from the Serum Institute of India in the UK. This has now been resolved with agreement from the Maltese Government, and Malta is now accepting proof of vaccination from any Covid vaccine administered in the UK.

Turning to those who, as the noble Baroness, Lady Brinton, rightly pointed out, stepped forward for the critical AstraZeneca vaccine clinical trials, being on a vaccine trial absolutely should not disadvantage them. The Government intend to take any action available to ensure that that is the case. We are working with clinical research sites to add participant information of vaccine clinical trials to the national immunisation management service—NIMS—to allow participants to access their NHS Covid pass for both domestic and international travel purposes.

Medical Devices (Northern Ireland Protocol) Regulations 2021

Baroness Brinton Excerpts

Monday 12th July 2021 Grand Committee

[Baroness Brinton (LD) [V]]

My Lords, I thank the Minister for a non-urgent statutory instrument that was tabled on 16 June and is being debated at an appropriate time, after MPs and Peers have had the opportunity to look at it in detail. I am sure I am not alone in looking forward to more of these in future. I also thank him for his helpful explanation at the start of this debate.

These regulations set out the mechanism to adjust legislation to ensure that the use of medical devices complies with both the EU’s and Great Britain’s regulations. As the noble Lord, Lord McColl, said, most people in Northern Ireland are likely to need to use one of these devices during their lives, so it is important that we get it right. He also referred to the problems with certain devices covered in the Cumberlege review. Can I further refine his question to the Minister? Which Minister will be responsible for the delivery of the Cumberlege review in Northern Ireland? Will it be the Minister in Stormont or the Minister in Westminster?

Even though it has been made necessary by the Northern Ireland protocol, this SI appears to have been come to sensibly, solving the problem without the noble Lord, Lord Frost, or the Prime Minister immediately blaming the EU. That has to be encouraging because an enormous amount of detail has to be sorted out. The noble Lords, Lord Empey and Lord Dodds, and the noble Baronesses, Lady Hoey and Lady Ritchie, set out their frustrations with these regulations as an inevitable necessity resulting from the Northern Ireland protocol. From these Benches—over the past three years, at least—we have warned about the problems of what became the Northern Ireland protocol and the position that it would leave Northern Ireland in, which we deplore. However, given that this Government pushed through the Northern Ireland protocol with the withdrawal Act, we believe that the issues with the implementation of the protocol will be solved only by the EU and the UK working together to find a solution.

It appears that this SI might be one of the first to take that route. This is at least better than the noble Lord, Lord Frost, and the Secretary of State for Northern Ireland, Brandon Lewis, going to the Irish press just after 21 June to accuse the EU of adopting a theological approach to the protocol that is frozen in time, only a few days after the European Commission had announced its proposals for, among other things, medicines entering NI to be exceptionally regulated by the UK. That is a step forward, despite the concerns raised by the Northern Ireland Peers.

This SI lays the pathway for current legislation to be amended, including the creation of a criminal offence. Can the Minister say what scrutiny there will be by Parliament of this specific offence nearer the time? The Explanatory Memorandum makes it plain that this is not

“to address a deficiency in retained EU law”

but because of the withdrawal Act, as has been mentioned. It is good to have that confirmed, although some detail is about the UK elements of its parallel regulation. We are just going to have to become used to this, but I have some questions about the fees for applications and inspections.

Paragraph 12.4 of the Explanatory Memorandum says that “fees for services” will be

“kept on par with those charged in Great Britain, despite there being additional resource requirements to carry out the work under the EU MDR. The fees … will therefore be below the cost recovery level.”

Which Government will bear the cost of that extra work if it cannot be recovered from the manufacturers? Will it be the UK Government or the Northern Ireland Assembly? I hope the answer is the UK Government because the Northern Ireland Assembly should not have its budget penalised because of the Prime Minister’s decision to support the Northern Ireland protocol. In Regulation 12(1)(a) of the SI, in relation to “Prior authorisation of clinical investigations by the Secretary of State”, will the Secretary of State have these powers elsewhere in the UK or does this relate only to Northern Ireland?

Women’s Health Outcomes

Baroness Brinton Excerpts

Thursday 8th July 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I echo the thanks of the Chamber to the noble Baroness, Lady Jenkin, for securing this important debate. Along with the noble Baronesses, Lady Jenkin, Lady Massey of Darwen and Lady Walmsley, I was trustee of UNICEF. Its work to help educate and protect girls and young women in dangerous countries across the world—of which the noble Baroness, Lady Nicholson, spoke so movingly, when talking of the horror of rape for girls and women in war-torn communities—demonstrates that we absolutely need to support United Nations projects to protect girls and women throughout the world. The noble Baroness, Lady Nicholson, is right: we need worldwide action to eliminate this scourge.

The noble Baroness, Lady Jenkin, was so right to set this debate in the lifecycle of a woman. She gave us a female equivalent of Shakespeare’s seven ages of man and, while it may not have been in iambic pentameters, it was striking in its arguments.

The noble Baroness, Lady Penn, faces the glorious arrival of a baby. I want to offer, as other noble Lords have done, best wishes for a safe arrival and a hope that, if the baby is a girl, her daughter’s experience of health will be very different from her mother’s and her grandmother’s. Predominantly male medics told us what they thought we had and wanted but, too often, I am afraid, had not listened to us before they spoke. Much has improved over the years, but there is still room for improvement, as this debate has shown.

The noble Baroness, Lady Bull, talked about the incidence of eating disorders, and how important it is that young women are listened to and supported—and, of equal importance, have access to specialist medical help early on.

The noble Baroness, Lady Massey of Darwen, focused on the problems that many women face with mental health today. The Royal College of Psychologists is right to set out the need for an extra £500 million of funding to ensure that they get the tailored support they need, when they need it. There are too many long delays in CAMHS.

My noble friend Lady Walmsley and the noble Baronesses, Lady Bottomley and Lady Bennett, were spot on to remember the failures that fell to the women with valproate and vaginal mesh problems, investigated by the noble Baroness, Lady Cumberlege, in her excellent report. When will the Government implement the key recommendations from that report, particularly the patient safety commissioner?

My noble friend Lady Walmsley also referred to domestic violence. There is no doubt that the healthcare providers can help to spot signs of concern early on. But the BMA has reminded us that healthcare professionals need training early on and support from other agencies to make that happen. That most women wait until in excess of 30 incidents before they go to the police is shocking, but GPs, nurses and midwives are often able to assist women in recognising that they are facing problems early on, and help them to deal with that.

It is extraordinary that women have a much higher level of autoimmune diseases than men. With some diseases, it is 80% higher. Researchers are still trying to understand why, but serious autoimmune diseases can still significantly reduce lifespan, or the patient has to face many years on immune suppressants to prevent the disease progressing. In this year of Covid, that has of course given them further problems. Endometriosis, which happens to be my second autoimmune disease, introduced me as a young woman to the indignity of the mostly male doctors managing my condition and its consequences for fertility, high miscarriage risk and a life of severe pain, which hardly any medics understand. That GPs think it is just like a bad period pain completely misses the point.

The noble Baroness, Lady Greengross, referred to contraceptive services and their supply during the pandemic. She was right to say that women need to be able to access those services all year round, and throughout the United Kingdom, because failures can have serious consequences for young women.

The noble Lord, Lord McColl, ably set out a range of women’s services where other countries are setting us good examples of how we can improve the lives of women, including respite care for the many unpaid carers, mainly women. His point was echoed by the noble Baronesses, Lady Eaton, Lady Fraser and Lady Ritchie. The noble Baroness, Lady Fraser, also gave us an excellent example of combining data to cross-reference women with epilepsy and their medicines. She said, “If you’re not counted, you don’t count”. I am reminded here that the suffragists scrawled “Votes for women” across the 1911 census and are visible to history, whereas the suffragettes chose just to boycott the census, so their contribution is invisible to history.

The noble Baroness, Lady Bennett, and the noble Lord, Lord Hunt, talked about women’s cancer diagnoses coming significantly later than men’s. I know that other Members of your Lordships’ House have faced this, but we have a close family member whose 34 year- old daughter missed her cervical smear test last year because of the pandemic and now is facing terminal cancer. That is really shocking. The noble Lord, Lord Hunt, rightly reminded us of shocking failures at some maternity hospitals. While it is good that reports are now highlighting these failures, is there also a systematic review of the funding and staffing of maternity services across the country, as most of the reports refer to staff shortages as well as problems with the culture?

The noble Lord, Lord Rooker, vitally reminded us of the Marmot report and how it set out the problems that women face in society today, especially in Northern Ireland. One of the topics in the Government’s consultation paper was on using data to improve women’s experiences. How is this sort of data shared and used to understand the disparity between the four nations?

The noble Lord, Lord Brooke, and the noble Baroness, Lady Bryan, talked about the male-female inequality league and how the UK should do better. How do the Government plan to address some of the clear health disparities?

The noble Baroness, Lady Greengross, also talked about continence services. Twenty years ago, discussion of periods in public was pretty taboo. Endometriosis and the menopause have recently become more acceptable issues to discuss but, frankly, continence services remain taboo for many. Women who often face long-term problems after difficult childbirth are unable to seek the help they need when their bladders start to fail in the later years. I hope that this debate will help to start that discussion and encourage women to seek help from their GPs at an early stage.

Recently, I had some discussion with young doctors working with the elderly—mainly women—who fell and broke limbs, imperilling their independence and ability to stay at home. These doctors are looking at best practice on early intervention with these patients, after minor falls, that supports and trains the patient. This has already significantly reduced the serious falls that too many women have later on. It is also saving the NHS a vast amount of money and keeping these women independent for much longer.

The noble Baroness, Lady Uddin, and the noble Lord, Lord Boateng, raised the problems of unconscious bias and the stereotyping of black and Asian women. I am sorry to say that this is also true of LGBT women. My noble friend Lady Barker has often spoken of the need for specialist geriatric services for them. Those who claim to object to the woke agenda need to understand that these biases—conscious or not—are the root of women’s health inequality. The contribution of the noble Lord, Lord Sikka, pointed at how the voices of, and services for, women were invisible in the Budget. Today’s debate has shown that this House is keen to see the eradication of all health inequalities affecting women, and I look forward to hearing the Minister’s response.