Covid-19 Update

Baroness Brinton Excerpts

Thursday 8th July 2021 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for the Statement today, which takes us further into the discussion that we were having on Tuesday and allows him to address some of the questions that perhaps he was not able to on Tuesday.

We all want our economy to open and get back to normal. The question is whether we do it in a controlled way or a chaotic way. The Health Secretary told the Commons on Tuesday that, under the Government’s plan, infections could go to as high as 100,000 a day. There are some huge issues that the Minister and the Government have failed to address with information and clarity about the massive change in policy contained in the announcements on Monday and Tuesday. The first of these is surely the potential 100,000 infections a day in a few weeks’ time. When I asked on Tuesday about the scientific advice, the Minister gave me what can be described only as a pick-and-mix answer, one in which he said SAGE’s advice was “interesting”. I am sure that SAGE’s advice is always interesting, but is it being taken into account in decision-making as it used to be? I specifically refer him to the most recent SAGE papers, which made it clear that with high infection rates there would be a greater chance of new variants emerging and greater pressure on the NHS. More people will get long Covid and test and trace will be less effective. As NHS Providers said today,

“current pressures on the NHS mean that the predicted rising infection rates for COVID-19 will inevitably affect the speed at which trusts can recover care backlogs.”

I quote Chris Hopson:

“Trust leaders can see the strong logic of ‘if not now, when?’ and they recognise that, as a nation, we must learn to live with COVID-19. But they want the Government to be clear about the risks of relaxing restrictions. This includes the inevitability of higher hospitalisations and mortality, albeit at lower levels than previous waves and the risk of new and more dangerous variants emerging. They are also worried about the impact of long COVID. It’s important these trade offs are clearly set out, including the impact on the NHS’s ability to bear down on the backlog.”


Indeed, a letter from 100 experts in the BMJ today raises the same issues. That is why the impact assessment is so crucial. The Prime Minister seemed to find this impossible to address yesterday, so I would like to see if the Minister with his much greater and closer knowledge of these issues could be more enlightening to the House today. Have the Government undertaken an impact assessment of the projected rate of infection? Yes or no would probably suffice. If it is yes, when will it be shared with Parliament and the public? If it is no, the Minister must explain why this has not happened and tell the House when it might. We need to know what is the number of hospitalisations and deaths; what is the number of people with long Covid, which will be the outcome of 100,000 infections a day; and what is the impact on the NHS, will it slow down the catch-up for diagnostics and treatment and by how much? I am very happy if the Minister wants to email the details of the answers to me, if he does not have them to hand–although he ought and they need to be in the public domain.

We know that the link between infection rates and deaths has been weakened, but it has not been broken. All the experts seem to agree on that. Let us be clear why infection rates are so high: it is because the Prime Minister let in the delta variant. I agree with my right honourable friend Keir Starmer that we might now change its name to the “Johnson variant”. Let us be clear why the number of cases will surge so quickly: it is because the Government are taking all protections off in one go. As my right honourable friends Sir Keir Starmer and Jonathan Ashworth have said, this is reckless.

The next obvious question is the one about the dreaded ping and the huge number of people who will be asked to isolate. If there are 100,000 infections a day, that means hundreds of thousands—perhaps millions —of people are going to be pinged to isolate. The Financial Times estimates that it could be 2 million people and the Daily Mail says it could be 3.5 million people. Either way, it is a massive number. How many people do the Government expect will be asked to isolate if infection rates continue to rise at this rate? Again, this question was asked of the Prime Minister yesterday and he clearly did not know the answer or refused to say, so I will repeat it again: how many people are going to be asked to self-isolate if there are 100,000 or more infections a day?

Does the Minister appreciate that those who are immunocompromised or for whom the vaccine is less effective will have their freedoms curtailed by ditching masks on public transport? Blood Cancer UK warned yesterday that people with blood cancer will feel that their freedoms have been taken away from them. It is quite possible that the 19th will not be freedom day. It might be the day when a record number of people will switch off their NHS app, because they will see coming down the track isolating and cancelling holidays. It is already beginning to happen. Has the Minister seen those stories? We on these Benches do not support that course of action, but does he realise that this could seriously undermine the expensive track and trace system, on which so much depends?

I have to repeat again that the biggest barrier to an effective isolation policy has been not the inconvenience but the lack of financial incentive to stay at home. If we are to live with this virus, the days of people soldiering on when unwell are over. Sick pay is vital to infection control. Will the Government please now fix it?

Business leaders are expressing very serious concerns about the loss of staff and customers. There are now 700,000 children off school per week. At my grand- daughter’s school this morning, two classes were sent home due to two teachers being pinged. After-school sports were cancelled and she is very disappointed. It is happening everywhere, as our amazing head teachers and school staff limp towards the end of term doing everything they can to deliver teaching, joy and normality to our children under the most difficult and often underappreciated circumstances.

The question I want to ask for clarity from the Minister is about the ubiquitous ping. Is the ping advisory for self-isolation or mandatory? If you get an email or phone call, does that trigger mandatory self-isolation? Finally, I ask about data in the last 24 hours or so from Israel’s Ministry of Health, which points to the Pfizer vaccine being just 64% effective at stopping symptomatic and asymptomatic transmission of the delta variant. Can the Minister tell the House about this?

[Baroness Brinton (LD) [V]]

My Lords, one year ago when lockdown was lifted, we had around 1,000 new cases a day. Yesterday it was 32,000 new cases. Equally concerning, cases are doubling every nine days; hospitalisations are going up; ventilation bed occupation is going up; NHS Providers, as the noble Baroness, Lady Thornton, has said, is talking about hospitals moving back into created-Covid wards and managing safe areas. GPs and hospitals are all reporting a worrying large increase in young people with long Covid, putting further pressure on their services, let alone the worries of an epidemic of long-term illness in the working population. Anecdotal evidence suggests that some hospitals are now considering cancelling some staff summer leave. Wonderful as yesterday’s England victory was, the sight of 60,000 fans walking down Wembley Way in very close proximity with hardly a mask in sight was concerning. As with the England-Scotland match, we must expect a surge in cases. Yesterday, the BBC asked Dr Mike Ryan of the World Health Organization about the UK proposals to lift all restrictions on 19 July. He replied:

“The logic of more people being infected is better is, I think, logic that has proven its moral emptiness and epidemiological stupidity”.


The letter in today’s Lancet from 100 senior medics and scientists echoes the WHO view. What are the Government doing to explain to the experts why their strategy is safe?

I will return to the substance of the Statement later, but I start by thanking the Minister for the meeting yesterday with other Peers, Blood Cancer UK and the Anthony Nolan trust to discuss the immunocompromised and the clinically extremely vulnerable. There are over 2 million CEV who had to shield—that is 3% of the population. So, arising from questions I have asked the Minister many times before in your Lordships’ House, I will ask the following. The CEV, of whom I am one, are worried at the total silence to them over recent weeks since shielding ended formally but, with stay-at-home advice still in place, with cases rocketing daily and all restrictions easing, can the Minister explain how advice to them is being co-ordinated publicly by government? One blood cancer patient said today to an APPG of parliamentarians that the dissonance of their safety versus everyone else’s freedom was hard to bear, especially with no advice. In particular, who has clinical responsibility for drawing together the different issues of therapies, responses to vaccines and continuing care for underlying diseases, and which Minister has overall responsibility?

Overnight, there have been some suggestions from journalists that shielding might even return. If so, that needs to be communicated very urgently to those at high risk, who have not been told about their low vaccine antibody rate. They may be planning to mix with people, or perhaps even go on holiday. Will benefit support for the CEV who have to stay at home but cannot work from home be reintroduced? If the Government are serious about the irreversibility of the lifting of all restrictions, some of the CEV will not be able to return to work for weeks, or even months.

I turn to testing. There are reports today that the Government plan to charge for the lateral flow tests from the end of this month. As LFTs are supposed to be the great self-regulators that the Government are relying on, how much are people going to be charged? You do not pay the Government for a blood test to see whether you have picked up any other infection. The level of charging for PCR tests for people returning from abroad also remains a big issue. Last week in your Lordships’ House the noble Baroness, Lady Vere, told my noble friend Lady Ludford that PCR tests could be obtained at a price of £85 for two. My noble friend’s local pharmacy is charging £398 for a test on the same day, or £240 for the next day for two tests. I know other members of the public have reported similar problems. Can the Minister say how the pricing of PCR tests is being managed and, perhaps more importantly, where one can find the “£85 for two” tests?

On Tuesday, I set out what we from these Benches seek in a return to normal life. We want people to return to work as soon as possible, to be able to mix with family and friends and for our children to be able to have consistent access to education without interruption. We also agree that now is the time to start to do some of that but—and it is a big “but”—we cannot get rid of all the safeguards that protect people mixing together while the virus is still live. An effective test, trace and isolate system is essential. This Statement makes it clear that that is being dismantled. Can the Minister explain why that makes any sense?

Last night, Sebastian Payne of the Financial Times reported the re-election of Sir Graham Brady MP as chairman of the 1922 committee, and tweeted:

“Brady’s re-election is … a reminder of why Johnson is dropping masks and nearly all other … restrictions on July 19: ministers privately say the government no longer had the … votes to keep the measures in place. Relying on Labour would have been … difficult for the PM.”


Are the Prime Minister and the so-called Covid Recovery Group now putting health and lives at risk for their own principles?

Finally, with the threat of 100,000 cases by the end of the month, with hospitals saying they are already worried about the increase in patients and with the threat of the new lambda variant and new north-east variant under investigation, please will the Minister confirm that these changes are not irreversible and that the protection of the NHS, and the safety of all the people in this country, remain the Government’s priority?

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

My Lords, I am enormously thankful to the noble Baronesses, Lady Thornton and Lady Brinton, for such thoughtful questions. I will certainly try to address as many of them as I can.

In reply to the noble Baroness, Lady Thornton, on the advice we get, I am afraid, as I said last time, that we of course draw on lots of advice from lots of people. I completely acknowledge, as she rightly pointed out, that no decision in this pandemic is risk-free. She set out the list of possible risks very well. There is always the possibility that there will be new variants. We are extremely concerned about the existing 1 million people who have self-diagnosed with long-Covid symptoms; the possibility that that number may rise is very much on our minds, and we are putting in place NHS provision to assist in diagnosis and treatment of that.

We are extremely concerned that test and trace resources will be stretched. We are therefore looking extremely closely at the policy around testing and isolation, while providing test and trace with the resources it needs to get through any increase in the infection rate. I also completely acknowledge the concerns of the NHS Confederation on hospital beds and hospitalisations —although the statistics on those today are extremely encouraging.

Those are all acknowledged concerns that we keep close track of, while putting in place measures to mitigate and minimise their impact. However, the noble Baroness, Lady Thornton, half-answered her own question, because she is entirely right: we need to focus on getting the NHS back to speed in order to address the very long waiting lists and to get elective surgery back on track. It is very difficult to find an answer to the question, “If not now, when?” That has been tackled by the CMO and a great number of people. It must surely be right that we take the inevitable risks of restarting the economy and getting people back to their normal lives at the moment of minimum risk from the virus, which has to be in the middle of summer. Assessing those risks precisely is incredibly complex. Impact assessments of the kind that we would normally associate with legislation are the product of months of analysis. They often identify one relatively straightforward and simple policy measure. We are talking here about a machine of a great many moving parts.

I cannot guarantee that any model anywhere could give us accurate projections of the exact impact of what is going to happen this summer. We are, to a certain extent, walking into the unknown: the Prime Minister made that extremely clear in his Statement. As such, we are ready to change and tweak our policy wherever necessary in reaction to events. However, what we know very well now on the basis of our assessment of the data, and because of the pause we put in place to give ourselves breathing time to assess and additional time to roll out the vaccinations, is that that direct correlation between the infection rate and severe disease, hospitalisation and death has massively diminished. There is a relationship, but it is a fraction of what it used to be.

We can therefore look at a period where those who are at extremely low risk of any severe disease may see an increase in the infection rate, because we know that those in the highest-risk groups have been protected by two doses of the vaccine, and two weeks, and because we are working incredibly hard to get as many in the high-risk groups vaccinated as possible—half a million a day—and to roll out the vaccine to younger cohorts. That is the balance. I cannot deal in certainty here, because certainty does not exist. Balance is key, and I believe the balance we have here is the right one.

The noble Baroness asked specifically about the NHS Covid app. It is in some ways emblematic of the kind of decisions we are making at the moment. She is entirely right: the anecdotes are loud and clear. The app is pinging loudly around the country as the infection rate moves up. To clarify the legal point, as noble Lords probably know, the app protects privacy. We do not know the identity of the person who has the app. In fact, we have no information about people who have the app at all because it has such rigorous privacy protection. As such, the ping from the app is advisory but a telephone call from test and trace is mandatory. That has a legal status and a breach of that advice could lead to an FPN or a knock on the door. It has a different status in that respect.

Given the large number of infections and the large number of pings, we clearly need to review the way in which the app works. The Prime Minister talked about this earlier today. He talked about moving from a quarantine-and-isolation approach to more of a test-and-release approach. We are not quite there yet but we are clearly well on the way. Therefore, I would be glad to clarify how we have made those decisions once they have been announced.

The noble Baroness, Lady Brinton, talked about the plight of the immunosuppressed. I am grateful to her and to Anthony Nolan, Cancer UK and others who were on the call yesterday. I express complete sympathy with the point made by the noble Baroness. If you are at home and your immune system does not work as well as other people’s, and you see the rest of the country opening up, you will feel extremely uncomfortable, as though the world has moved on and that you have perhaps been left behind. Those were the feelings described to me by the experts I met yesterday. On an emotional level, I completely sympathise with that. There are some people in this country whose immune systems do not protect them from flu and contagious diseases that would have no impact on those with a fully functioning immune system. We have complete sympathy for those people.

I acknowledge the noble Baroness’s point that there is a need for clear advice because the immunosuppressed are a highly diverse group. There may be people recovering in hospital with a completely flatlined antibody system, compared to someone who has rheumatoid arthritis but is otherwise living at home and is mobile. It must be right that that communication is done on a tailored basis through the healthcare system. We will look at ways in which we can ensure that GPs are informed and have the right information in order to give that bespoke advice.

The dissonance is hard to bear. I recognise the noble Baroness’s point but I do not necessarily have a suite of answers for absolutely everyone in this condition. We have large investments in antivirals and in therapeutic drugs, including some of the monoclonal antibodies that may offer some protection to some people in this situation, but it is not going to be a blanket measure. As a result, we are putting a huge amount of investment in the OCTAVE study, which looks specifically at ways in which vaccines, boosters or therapeutics can be used to protect those whose immune systems are not right. Ultimately, it is going to be down to the vaccine. The vaccination of a large proportion of the population, including the carers who look after the immunosuppressed, is how we will offer protection to these people.

On the noble Baroness’ question about the LFT system being dismantled, I do not recognise those press reports. On the provision of PCRs by the private sector, she asked how prices are determined. The answer to that is through the market. The marketplace introduces competition and innovation. I am pleased to say that the price for tests is coming down and will come down further. The one provided by Chronomics for TUI is now £30; that is a very encouraging sign that there is more to go.

Covid-19 Update

Baroness Brinton Excerpts

Tuesday 6th July 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, on the 73rd birthday of the NHS yesterday we supported and echoed the thanks to everyone in the NHS and the care sector for their extraordinary and humbling response to the pandemic, which continues to this day. We are far from being an NHS back to normal, whether through increased Covid cases, the backlog of hospital appointments and life-threatening delayed diagnosis, all the way through to the more routine but also vital services. So, our best present to the NHS will be to lift restrictions and return to normal in the safest way possible for them, for patients and the wider health of our country.

For months, the Prime Minister has talked of “data, not dates”. The data shows cases running at over 25,000 per day and predicted to rise to 50,000 per day by the end of the month. Hospitalisations are up and even ventilator bed use is up, which, while not as bad as in the previous two waves, is putting pressure on the hospitals dealing with them.

There is a large surge of cases in the north-east, and there are concerns that a new variant may exist there. Cases in the UK of the lambda variant from Peru are now being investigated as it appears more transmissible and possibly more resistant to vaccines. If the UK is following the route out of the pandemic used by Israel and the USA, we should note that both those countries are now finding that that system is not working for them: Israel’s proportions are picking up again and Florida is struggling to cope with a very large surge in cases.

Yesterday’s Statement was a case of ideology over science. It says that the vaccine is a “wall of defence”, but it is a wall with holes in it. First, one-third of adults have not yet had their second jab; nor have any children. That is a reservoir of millions—not just thousands, as the noble Baroness, Lady Thornton said—who are at risk of catching Covid, whether seriously or not, and passing it on to others. Secondly, double-jabbers are not conferred with magical total immunity and protection, and we know that they can transmit it too.

We on these Benches want to start with a return to normal and to lift restrictions. We desperately need to kick-start the economy, to start to socialise again and, as my noble friend Lord Scriven said last month, to live with Covid as it is now endemic and will be with us for some years to come. However, that means providing the safety net needed to ensure that people are as safe as possible. Asian countries that managed their pandemic well learned from SARS. The use of face masks became routine and a matter of personal and wider social responsibility, allowing life to continue in the flu season and in the pandemic. They also maintain strong and effective test, trace and isolate systems all the time. We will be discussing test, trace and isolate in detail following the Statement that is due to come to your Lordships’ House on Thursday, but the proposed reductions in test, trace and isolate will remove the UK’s ability to manage outbreaks swiftly, during which time others will catch and pass on Covid.

When we drive into our towns and cities, we rely on local authorities to set up traffic systems, including traffic lights, to help to guide us on safe journeys, regulate movement and reduce harm and damage. But it is as if “freedom day” is getting rid of all our traffic lights.

Proportionate responses are needed, and these include face masks. Early last year, even the WHO was equivocal on the use of face masks but, as the world became aware that this is a respiratory disease passed on through droplets, most countries moved to face mask mandates. On 19 July we switch to rules that make it only the responsibility of individuals. Thankfully, most people have taken that responsibility seriously, but not everyone has. That is important because, despite what the Minister said in response to my question yesterday about the clinically extremely vulnerable, there is no direct reference to the CEV in this Statement—unless he meant the passing reference to them being part of the priority group that will get the third jab. They need to know where they stand. There is no new advice, just the burning of the remaining rules that keep them safe.

Last night the Government published the Health Protection (Coronavirus, International Travel and Operator Liability) (England) (Amendment) (No. 5) Regulations 2021 and brought them into force at 6 am this morning. This amendment allows supporters of foreign teams with tickets for the final stages of the Euros to travel. Tens of thousands of foreign fans will be waved in, despite the high number of daily cases and despite 1,300 cases among Scottish fans after they travelled to Wembley to play England last month. I am not surprised: it is a crowd-pleaser. But as a legislator I find it extraordinary and unacceptable that the Explanatory Memorandum states this amendment is needed “to protect public health”. Frankly, that is in complete contradiction to the regulations themselves. Such inconsistent behaviour from the Government typifies a desire to please people, rather than think ahead and manage scenarios.

What we need is careful planning when lifting restrictions that keeps people safe by having effective measures in place: face masks in risky environments; test, track, trace and self-isolate rules that protect people; and funding for those who have to self-isolate. That is the way we can move to a new normal, to an economy that can work again, with health traffic lights around us to manage and minimise Covid.

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

My Lords, I am enormously grateful for the thoughtful questions from the noble Baronesses, Lady Thornton and Lady Brinton. I will address the first question from the noble Baroness, Lady Thornton, on where we get our advice from and will try to explain a little bit about how these decisions are made.

We get advice from a wide variety of inputs. They include the NHS, and we look very carefully at NHS capacity and projections for trying to catch up with the very large waiting lists that we have for electives. We get advice from schools about the prevalence of infection and attendance at schools. We look to Parliament for guidance, scrutiny and challenge. We have talked to GPs about the front-line picture that they see. We look to the JVCI for epidemiological advice. SAGE provides an important challenge and interesting support, particularly in terms of modelling, but it is not the sole repository of all the evidence for our decision-making. We are extremely grateful for its input but we have to take on board a very large set of perspectives when we make these decisions. We cannot rely on just one data set from one group. It is a holistic situation, and we have to balance a lot of different and competing needs at the same time.

That is why the decisions made in the Statement yesterday and in the Statement made by the Secretary of State an hour ago are proportionate and have, I hope, the caution, care and clarity that the noble Baroness quite rightly referred to. She is right that some infections will, very sadly, lead to severe disease, hospitalisation and, in some cases, death. But the proportion of those infections is much smaller than it was before the vaccine arrived. We have successfully vaccinated a huge proportion of those who are the most vulnerable to this disease. As a result, although infections are rising, the impact on hospitalisation and death is a very small fraction of what it once was.

We need to proceed with caution, keeping a very close eye on those relative relationships, but the picture that we see at the moment is relatively straightforward: the vaccine works. The statistics for both the BioNTech and the AstraZeneca vaccines are incredibly impressive in terms of both hospitalisation and transmission.

The noble Baroness challenged me to explain what I thought might be an acceptable level of deaths. I do not wish to split words with her, but the honest truth is that I do not accept any deaths as acceptable. I am not just trying to be smart with the language. It is our mission, particularly in the Department of Health but in the Government as a whole, to try to tackle all deaths as well as we possibly can.

All health decisions are always based on a balance of risk, whether it is a GP taking your blood pressure in his or her surgery or whether it is for big demographic interventions of the kind that we are debating today. Balance is the essence of public health decisions, and we are trying to make the best possible decisions around this. They have to take into account the huge challenge that the NHS faces in tackling business-as-usual disease. Millions of people have not turned up for the diagnostics that they should have taken or to have examinations of the lumps and bumps that they are worried about. There is a huge catch-up in terms of the waiting lists, and those have an impact on illness, long life and death. We have to balance the priorities of the pandemic and those of our existing healthcare system, and also the usual life of our communities. That is why we are taking the route that we are.

The noble Baroness, Lady Thornton, raised public transport. That is not only a practical and very important context for this discussion; it is iconic of the decision to move from mandation to a voluntary principle on behalf of a large amount of the public for a large number of the measures that we did, at one point, put into law. We are trying to seek a new covenant with the country based on consideration for each other. The noble Baroness put it extremely well, and I entirely share her scruples. I have four children—who are vectors of infection, to put it politely—and I attend a large number of business meetings, including here in the House, and I regard myself as a high-risk candidate for carrying the disease. I have never caught it myself and I have been vaccinated but when I sit on a Tube train I wear my mask, not to protect myself but to protect the person next to me. That is my personal assessment and my personal decision. That is the spirit in which we are inviting people to step forward and make their own decisions and to be considerate to each other.

We cannot have laws on all these matters for the rest of time. At some point we have to ask the country to step up and take responsibility and to have personal agency in these decisions. If we do not put that challenge to the country in the summer months, when our hospitals are relatively safe and the virus has the right conditions, when will we be able to make those decisions?

I agree with the noble Baroness about the position that many workers find themselves in. She is right that PHE data is very daunting when you look at the low-paid, front-line workers who drive taxis and buses or are in all sorts of other front-line positions. They have been hard hit by the pandemic, partly because of their living conditions, partly because of their environment and partly because of the prevalence of comorbidities, but also because of the risk that they personally put themselves at. I call on everyone to be considerate on that point. We need to think about the kind of risk that people are putting themselves at when they go about their normal day-to-day work. I ask people to be thoughtful about infectious respiratory diseases and, in fact, all diseases. That is why the Prime Minister has talked in the terms that he has.

In the meantime, we are making changes to the way we are doing things. The noble Baroness, Lady Thornton, asked me about children. To be clear: the Secretary of State said in his Statement that anyone under 18 who is a close contact of a positive case will no longer need to self-isolate after 16 August. Instead, children will be given advice about whether they should get tested, dependent on their age, and will need to self-isolate if they test positive. These measures will come into force on 16 August, ahead of the autumn school term. That is a proportionate response to the changed situation we find ourselves in, with the massive rollout of the vaccine and the evidence that we can see in front of our eyes of the impact of the disease on those who are under 18.

In reply to the noble Baroness, Lady Brinton, I spoke about the Secretary of State’s speech yesterday, in which he said very clearly, on the clinically extremely vulnerable, that guidelines will be published, and that remains the case. We are extremely sympathetic to those whose immune system does not allow the vaccine to have an impact. What use is a vaccine that supports your immune system if your immune system does not work very well? That is a challenge that more than a million people in the country face, and we are working extremely hard to address that issue. That work includes a huge amount of research through the OCTAVE study and a massive investment in the antivirals task force and the therapeutics task force. Those who are clinically extremely vulnerable, particularly those who are immunosuppressed, have not been forgotten and are very much the focus of our efforts, but it is an extremely difficult challenge to meet.

Coronavirus Act 2020 (Early Expiry) Regulations 2021

Baroness Brinton Excerpts

Monday 5th July 2021 Grand Committee

[Baroness Brinton (LD) [V]]

My Lords, at the one-year review of the Act, we pushed for it not to be reviewed. It would have been really useful to understand why there has been such a delay. I remind the Minister that we were concerned over some of the civil liberties issues in the Act, such as on policing, protests and fines—we know the fines did not hold up when applied in practice—and over transparencies. We have raised repeated concerns about the transparency on the dashboard. We were also concerned about people not understanding the rules. Famously, where guidance versus the law happened, it was interesting to watch the Government having to retreat very fast when they realised that they were telling people in Greater Manchester that something was covered by the law, yet the people in Greater Manchester were clearly able to show that it was guidance.

There are also concerns about the enormous blank-cheque powers that this legislation has provided. I am grateful to the noble Lord, Lord Bethell, for saying earlier that the expiry of these provisions was announced on 25 March. His exact words then were:

“We made a promise to Parliament that we would not keep any provision in place for longer than was necessary, and we have made good on that promise.”—[Official Report, 25/3/21; col. 985.]


It has been 14 weeks since the Government decided that they did not need the provisions, and they have not yet removed them. They are still in place until this SI comes into force.

We also had particular concerns about the provision of social care. Part 1 of Schedule 12 and Section 15 enabled local authorities to divert resources to care and support from other duties. This was used eight times and not since 29 June 2020. We were really concerned about this provision because those who needed support for care suddenly found it was removed. The parents of disabled children who needed 24-hour care had found that their entire support mechanisms were removed from them. On the Disabled Children’s Partnership website today, one mother has been saying that the lack of that support has meant that she and her husband have had no more than two hours of consecutive sleep in over a year, because they have had to try to manage it. They are both utterly exhausted and extremely concerned that they might be making mistakes. That is because of the loss of this diversion support. What is particularly worrying is that most local authorities have not yet reinstated it.

Because we still do not know when this SI will come in, it is a little difficult to approve it until we also know the exact details about the level of Covid in our communities and its effect on the NHS. The Prime Minister famously talked about “data, not dates”, but the dialogue in recent weeks has become entirely the other way around, with cheery communications about the mask mandate being about to go. It is very noticeable that people have taken that as a signal that they can stop wearing masks already. Yet just over a year ago in June, when we lifted that first lockdown, cases were down to around 1,000 a day. This last week, it was around 25,000 new cases per day with hospitalizations increasing, even if at a lower rate, and certainly—thank goodness—ICU occupancy at a lower rate. However, GPs, doctors and nurses in hospitals all report that the NHS is nowhere near going back to being normal.

Today on LBC, a member of ICU staff at a hospital called in to say: “They can keep the medal and just get everyone to keep wearing masks, if they truly care about NHS staff”. I am with her on that one. Also today Chloe Smith, the Constitution Minister, said that some people more susceptible to infection than others may wish to carry on using a face mask. She cited her recent cancer, saying that she sympathises with those who want to carry on taking precautions.

As the Minister knows from my repeated raising of this issue, for some people this is not a matter of choice. That is so for at least 1 million people in the country: the clinically extremely vulnerable. Current government guidance to the CEV, which came out on 21 June, says:

“We are also advising clinically extremely vulnerable people to … follow the practical steps described below to minimise your risk of exposure … close contact with friends and family will be a personal choice, but you are encouraged to exercise caution”.


They were advised to work from home but, if they could not, to get their employer to make their workspace Covid-safe—I am paraphrasing because the guidance goes on at some length—and otherwise to get advice from professionals. It also says that the furlough scheme will end in September.

In addition, from 1 April there was no longer any SSP for clinically extremely vulnerable people who could not work from home. It is really important that provision is made to avoid clinically extremely vulnerable people having to go to work. Will the Government now take this up? Losing the mask mandate and lifting regulations mean that this group in our society and their immediate carers are put at risk.

I also note that the clinically extremely vulnerable advice says that pupils should be back in schools but the Department for Education lifted the mask mandate for schools some time ago. These children are still at high risk of Covid, which could indeed—

[Baroness Penn (Con)]

I remind the noble Baroness that the speaking limit for Back-Benchers is five minutes.

[Baroness Brinton (LD) [V]]

Thank you. I have finished.

Health Security (EU Exit) Regulations 2021

Baroness Brinton Excerpts

Monday 5th July 2021 Grand Committee

[Baroness Brinton (LD) [V]]

My Lords, I declare my interest as a vice-president of the Local Government Association. It is essential that, when dealing with future health risks, the UK is equipped to effectively share knowledge, data and skills within our borders and internationally. I support the calls from the noble Lord, Lord Lansley, for clarity over the role of the WHO’s regions—in our case, Europe. I also support his calls for WHO reform, but hope that we and the other member nations will remember that it is the members of the WHO, not the WHO itself, who maintain its power and direction. Too often, the WHO has been the whipping boy, as though the members have no role at all.

The past 18 months have shown how global health threats can shut down the entire world. By leaving the EU, the UK has lost unconditional access to the EU’s Early Warning and Response System. The trade and co-operation agreement states that the UK may be granted access to EWRS on an ad hoc basis via written request. Can the Minister clarify how these requests will be overseen and managed? Are there any plans to negotiate a more consistent and collaborative relationship? It is important that Parliament and public health professionals more widely can see the detail of how this will work before it comes into force.

This SI creates a new body within the health protection committee. How have these plans and new structures been influenced by the learning process of the past 18 months, during which we have been exposed to be woefully unprepared for the health threat that the pandemic has given us? We have had huge issues with data sharing. How will this new framework and committee help us not to repeat those same mistakes?

The Minister said it is vital that the UK has excellent surveillance provisions, and we on these Benches agree, so it is good news that the four nations that make up the United Kingdom are working together on this. It is self-evident that this co-operation is vital to make it work. As we know from Covid, viruses do not recognise boundaries, whether those of devolved states or European countries. I echo the questions raised by the noble Lord, Lord Hunt, about Northern Ireland, given the sensitivities of the Northern Ireland protocol. There seems to be something of a war of words on other matters; it would be awful if there was a war of words on these important health issues.

Our directors of public health are the unsung heroes of the pandemic, yet there has been confusion regarding the structural change of the UK Health Security Agency. It is not clear how much influence directors of public health will have. What they need now is clarity of communication and leadership around the new roles and responsibilities. That is vital as we shift into the endemic phase of Covid-19 management, when we are likely to be very reliant on these directors of public health and their small teams in local authority areas. Alongside this legislation, we need long-term funding boosts for health protection capacity in local councils and our public health budgets, so that our directors of public health are supported in the wonderful but often invisible work they do.

It certainly felt as though their work was invisible to Ministers and Public Health England during the first half of the pandemic—and this is not just about the pandemic. I am reminded of the Salisbury poisonings and how the exceptional director of public health in that area worked locally and nationally to try to resolve a really difficult and unpleasant situation; the BBC’s drama was able to show people on the ground exactly the work that public health colleagues do. Can the Minister confirm that we will be seeing a proper increase in their budgets in this year’s spending review? Otherwise, we will once again have to say that this Government’s words and figures do not agree. It would be awful if large numbers of expensive consultants again had to be contracted at the centre to manage a crisis when we have teams of experts on the ground in our local communities. They cannot magic essential resources to be available 365 days of the year out of thin air.

Finally, contact tracing will continue to be a vital part of public health work in the future. Can the Minister confirm that the Government are still committed to ensuring that we have an effective test and trace system to manage outbreaks of this disease as well as other incidents to do with environmental health locally and to prepare for the possibility of malign forces at work, as with the Salisbury poisonings? Given reports last week that care providers are still failing to get the data that they need, what action are the Government taking to improve this? How will the UK Health Security Agency provide the overarching leadership that is so desperately needed to strengthen partnership at a local, regional, and national level?

Health: Dementia

Baroness Brinton Excerpts

Monday 5th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, guidance to help enhance best practice in dementia assessment and diagnosis was recently updated and published to support a personalised approach and choice in the delivery of remote consultation or face-to-face diagnosis. The guidance was developed in collaboration with stakeholders, including those with lived experience, and through the Dementia Change Action Network. I completely acknowledge the point that the noble Baroness makes. We are working as hard as we can to get the kind of face-to-face assessments she describes. They play an essential role in what we do.

[Baroness Brinton (LD) [V]]

My Lords, the 2019 national memory service audit carried out by NHS London reported that a quarter of English dementia services were unable to provide or refer on for carer psychoeducation. Knowing the struggles that my stepmother had over a decade ago getting recognition, let alone support, as my father’s dementia worsened, these figures remained stubbornly low. Can the Minister say when early support will automatically be available for all carers of those diagnosed with dementia?

[Lord Bethell (Con)]

My Lords, I pay tribute to the role of carers in the kinds of situations the noble Baroness describes. We are doing an enormous amount to supply training for carers in all facets of their delivery, including support in caring for those with dementia. I am not sure that I can make the guarantee that she seeks right now, but I reassure her that this is one area of our investment in carers that we take extremely seriously.

Covid-19 Update

Baroness Brinton Excerpts

Tuesday 29th June 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I start by saying how much these Benches identify with the words the Government have issued about the horrifying treatment of Chris Whitty, our Chief Medical Officer. It was completely shocking and disgraceful. For a truly amazing public servant to be treated like this is unacceptable at any level.

I thank the Minister for presenting the Statement and echo the words of my right honourable friend John Ashworth yesterday in welcoming the new Secretary of State to his position. It was pleasing to see the new Secretary of State at St Thomas’ Hospital yesterday; I hope it is the first of many visits to our inspirational and dedicated NHS and social care staff. I hope the Minister’s new boss will be more receptive than the previous one and make arrangements for them to receive a fair pay rise, and not the real-terms pay cut that is currently pencilled in.

Yesterday the Secretary of State let it be known that the 19 July reopening will, in effect, go ahead. He told the news that there is “no going back” and that lifting the restrictions will be “irreversible”. It is probably not an exaggeration to say that many across your Lordships’ House will give a collective and noble eye- roll at these words. Like many here—and unlike the Secretary of State—we have responded to a lot of these Statements in the last 15 months. We heard that there was “nothing in the data” to suggest that 21 June could not go ahead. Noble Lords will remember that children returned to school for one day before the January lockdown and the words “It will all be over by Christmas.” Some time last spring, I think the words “We will send it packing in 12 weeks” were used.

The context this time is that there has been a rise of 84,000 cases in the past week—an increase of 61%. Yesterday saw the highest case rate since January. If these trends continue, we could hit 35,000 to 45,000 cases a day by 19 July. We know that this variant means fewer hospitalisations and fatalities, but it also means that young people will become ill and some will have long Covid. It will again mean disruption to our schools and our youngsters’ learning and socialisation. When will we see a review of the arrangements in schools?

We also all know that this is a race between the vaccine and the infection, but I fear it will not be won by the vaccine in the next three weeks, so if we are looking at possibly 200,000 people infected with Covid on 19 July, the Minister needs to tell us what impact that will have on the road map out of restrictions. Can he confirm whether “irreversible” means the Government are now ruling out restrictions this winter? Have they abandoned the plan that the previous Secretary of State and officials were drawing up for that?

The Secretary of State has promised to give the NHS everything it needs to get through the backlog, so will the hospital discharge and support funding be extended beyond this September, or will trusts have to make cuts instead? We have already had some discussion about the backlog today; for example, when will the NHS again guarantee that 95% of patients will start treatment within 18 weeks of referral? How long is it likely to be until we can reach those sorts of targets again? When will the Government give primary care the resources to meet the challenge of the hidden waiting list of over 7 million patient referrals that we would have expected since March 2020?

Given the pressures on primary care, is it still the Secretary of State’s plan to press ahead with the GP data transfer? Frankly, if this department cannot keep its own CCTV footage secure, how does the Minister expect it to keep our personal data secure? I think that is a legitimate question.

Given the pressures across the whole healthcare system, will the Government now abandon the ill-thought-out top-down reorganisation of the NHS that the previous Secretary of State was about to embark on?

Finally, I have raised with the Minister the importance of the Nolan principles which must guide the ethics and behaviour of us all, particularly those in government. The Good Law Project today published emails which used the noble Lord’s private address. Transparency is the word I am looking for here. The spotlight has been turned on the Minister in recent days, including a formal complaint to the Lords commissioners about the issuing of passes.

The Minister might do well to consider a couple of things: actually referring himself to the commissioners about that matter, if there is a chance he may have acted outside the rules, and—he has had to deal with this question several times and is very robust about it—making his emails and communications transparent and explaining them. He is sure that he has done nothing outside those rules; he would therefore be wise to be transparent about that. It is not the original scandal that gets people in the most trouble—it is the attempted cover-up, or the chance that there might be one. Transparency is the best advice I can give the Minister today.

[Baroness Brinton (LD) [V]]

My Lords, I echo on behalf of these Benches the concerns about the treatment of Professor Chris Whitty. It is totally unacceptable, and it is good news that the police are now investigating this.

Just now, in reply to my question on the Urgent Question, the Minister said that the health and social care Bill has been published. Over the last few minutes I have been searching the web, but I cannot find it— can he help me any further?

Yesterday’s Statement from the new Secretary of State struck an interesting new note. The department is clearly no longer going to be led by data but by dates. Yesterday, 22,868 new cases of Covid were reported. This time last year, when lockdown was finally lifted, daily cases were under 1,000. Even with the high level of vaccinations, this is causing illness and pressures on the NHS—even if it is a different kind of pressure to that of a year ago. On Sunday, Andrew Marr reported on his programme that his own experience of catching Covid had been difficult. He said that, while he had not needed to go to hospital, he was more ill than he had ever imagined possible, and it was not an asymptomatic experience. In the light of this and the reports of growing numbers of people living with long Covid, can the Minister say why data will now clearly not factor into the decisions about 19 July?

On these Benches, we believe that we need to learn to live with this disease, but unlike the Statement from the new Secretary of State, we do not believe that this is just about vaccination, important though that is. This week, Israel has found that, despite early and comprehensive levels of vaccination, the delta variant is ripping through its communities. We have argued since February 2020 that controlling outbreaks is vital. Can I ask the Minister about the provision of test, trace and isolate arrangements moving forward? Specifically, have local directors of public health been given access to emergency funding for the provision of surge testing and tracing and vaccination in their communities? When will the pilots for increased support for those needing to self-isolate be published? We still believe that people should be paid their wages if asked to self-isolate. As that number is considerably fewer than six months ago, it would be not only cheaper for the Treasury but a much more effective way of ensuring that the spread of the virus is reduced.

Usually the Minister agrees with me on the importance of test, trace and isolate, even if we perhaps disagree on how that should be funded and supported. Can he respond to the concerns of the doctors and scientists who are appalled with today’s proposals that company directors will be able to temporarily leave quarantine for business meetings? People are still furious that the Prime Minister delayed adding India to the red list, with the resultant rapid spread of the more transmissible and more serious delta variant. As Professor Christina Pagel says:

“luckily elites don’t get or transmit covid.”


Stephen Reicher, the eminent behavioural scientist, said he was horrified by the

“scandalous misuse of science as a cover for political decisions … which is putting us all at risk.”

When commenting on the DCMS report published on Friday, he said:

“The headlines and the political response isn’t just an exaggeration, they directly contradict what the report says. It warns that the research wasn’t designed to draw any conclusions about the effects of events on transmission and mustn’t be used to do so”.


Yet Ministers and the press are all reporting that these events in the trial had no effect on infections and were safe to reopen.

Yesterday, a No. 10 spokesperson explicitly denied that government Ministers have used private email addresses. They said:

“Both the former health secretary and Lord Bethell understand the rules around personal email usage and only ever conducted government business through their departmental email addresses”.


This is directly contradicted by the Second Permanent Secretary in meeting minutes published by the Sunday Times. Those minutes clearly state that former Health Secretary Matt Hancock

“corresponds only with private office via a gmail account”.

As the Good Law Project has reported, on 19 April 2020, the noble Lord, Lord Feldman, emailed the noble Lord, Lord Bethell, at his private address, about the availability of Covid-19 test kits via a Canadian company, saying:

“Certainly worth contacting … to see if they can help … and the pricing seems competitive.”


Self-evidently, this is government business, and specifically within the portfolio of the noble Lord, Lord Bethell. The noble Lord, Lord Feldman, once co-chair of the Conservative Party, was writing to the Minister at his private email address on government business. In addition, I note that the Minister’s meeting with Abingdon Health on 1 April 2020 was not disclosed on the ministerial meeting schedule.

We note that, unlike the response from the noble Lord, Lord True, on the earlier UQ, it is not possible for the public to access private emails; the Freedom of Information Act specifically excludes it. Not going through the formal government-approved routes, whether for emails or declarations of meetings, gives the impression that perhaps the Minister has something to hide from his dealings with a former chairman of the Conservative Party and the company he was acting for. I note that the company was awarded an £85 million contract after the meeting and the emails.

There has been considerable speculation about the role of Ms Gina Coladangelo as a lobbyist, unpaid adviser to Matt Hancock and then a non-executive director for the Department of Health and Social Care. The press and media have also reported that the Minister gave Ms Coladangelo a parliamentary pass last year. Can he tell the House what personal parliamentary service she provided for him during that period? Does the Minister feel that his position is tenable, given this evidence?

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

My Lords, I am enormously grateful for those extremely thoughtful questions. As ever, I welcome the challenge and scrutiny that the House of Lords always provides on these matters.

I completely endorse what the noble Baronesses, Lady Brinton and Lady Thornton, very thoughtfully said about Chris Whitty. Chris Whitty and JVT are both complete legends, and both have been accosted in public. This is completely unacceptable. We must look at the security of those who serve us so well, and we must somehow address the disrespect that often happens when public figures walk in public. It is a great regret that this has happened.

The noble Baroness, Lady Thornton, asked about nurses’ pay. I repeat to her what my right honourable friend the Secretary of State for Health said yesterday: this absolutely remains a priority. We must have a fair pay settlement. That pay settlement is going through the pay review process at the moment, and we look forward to receiving the output on that.

Both the noble Baronesses, Lady Brinton and Lady Thornton, asked about the basis for the optimism that we have at the moment. I have stood at this Dispatch Box for 18 months as the purveyor of difficult news to the House, and have lived through some very difficult moments in that time. I am acutely aware of the concerns that noble Lords have. I think the questions put were very reasonable and deserve a clear answer, so let me explain why we are a bit more optimistic than I think we ever could have been in the recent past. The case rates are slowing down, for both over and under-60s. Hospital admissions among the over-60s have started to fall, and while there are signs in both measures that the rate of growth is slowing, there is just not enough to fundamentally change our assessment of the risk of delta. In the last two weeks, we have seen case rates fall in both Bolton and Blackburn. That is an incredibly important observation, and one that bears testimony to the effectiveness of the local authorities, test and trace, and all of those who have contributed. It is mainly driven by the under-60 group, but not wholly. Rates among older people are plateauing right across the country at a lower level, and hospitalisations and severe illness are being prevented by people being doubled vaccinated against Covid-19. There are very clear signs that the vaccine is working in lots of ways.

By 19 July, two significant things will have changed that may give us stronger confidence. First, we will have offered a first dose to all adults in the United Kingdom. The NHS states that it can do this by 19 July. We will have also given a second dose to a higher proportion of over-40s, giving them more protection against hospitalisation. Secondly, we will be very close to the school holidays, which start on 26 July, and school-aged children being out of school. This will significantly reduce transmission among the population which is unvaccinated and has driven case growth. Universities should also be out.

We are monitoring the data every day. So far, we have not seen indicators that substantially change our assessment of the four tests. I hear loud and clear what the noble Baroness, Lady Brinton, says about Andrew Marr and his experience. Vaccination is not a panacea. It does not save everyone from any illness at all, but it has a significantly strong effect for us to move on to the next stage.

In terms of the backlog, I assure the noble Baroness, Lady Thornton, that we are putting funds in place to do whatever it takes to get us back to where we began. I cannot give the specific reassurances she asked for on whether specific funds will be extended, but it is our aspiration to work as hard as we can. On GP data, I assure her that the clinical trial progress that we have made on things such as Regeneron in the last few days gives us such a clear inspiration and motivation for ensuring that we get this project right. On trusted research environments, we have demonstrated that we listen and that we will change how we implement the GP data transfer, but our objective remains resolute. We are committed to continuing with this programme of work.

I will give a very clear response to the very important question regarding emails, asked by the noble Baronesses, Lady Brinton and Lady Thornton. I am absolutely rigorous in ensuring that government business is conducted through the correct formal channels. Contracts are negotiated by officials, not by Ministers. Submissions from officials are handled through departmental digital boxes, and that is right. Official decisions are communicated through secure governmental infrastructure.

I have read the Ministerial Code; I have signed it and I will seek to uphold it in everything that I do. The guidelines are clear that it is not wrong for Ministers to have personal email addresses. I have corresponded with a very large number of noble Lords in this Chamber from both my parliamentary address and my personal address. That is right and I will continue to do so. In their enthusiasm, third parties often seek to engage Ministers through whatever means that they can find, including their personal email. That is not the same as using a personal email for formal departmental decision-making. Those who have seen material on the internet should judge it extremely sceptically, because distorted fragments of evidence do not provide sufficient grounds to rush to judgment on how Ministers do their business.

I do not recognise the substance of the comments of the Second Permanent Secretary, as referred to by the noble Baroness, Lady Brinton, and he has indicated to me that he does not recognise the substance of those comments. I completely recognise the comments that were made regarding the meetings with Abingdon Health. The meetings schedule from that week was overlooked because of an administrative oversight. It has now been uploaded to the internet. I will be glad to share a link to that register. On the complaint made by Anneliese Dodds, I have written to the Parliamentary Commissioner for Standards and would be very glad to share that letter with the noble Baronesses, Lady Thornton and Lady Brinton.

I take this post extremely seriously. During the work of the pandemic, many people—officials, Ministers and those in industry—worked extremely hard to address the severe epidemic that we face, and I am extremely proud of how that business was conducted.

Social Care Reform

Baroness Brinton Excerpts

Tuesday 29th June 2021 Lords Chamber

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

My Lords, the commitment to publishing a review of social care is absolutely heartfelt. We have delivered on Brexit and the vaccines, and we will deliver on social care. The Prime Minister has made it crystal clear that that will be done by the end of the year; that commitment remains in place. It will require enormous financial commitment by the whole nation at a time when our finances as a nation are extremely stretched. Therefore, it is entirely right that very careful consideration is given to it. It will also involve a very large amount of engagement with other parties and the relevant stakeholders. Again, this is not something that has been rushed. We have just been through the most awful pandemic; it is not possible to do a review of this generational nature at the same time as fighting this awful disease, but we will be true to our commitments and deliver the plan as promised.

[Baroness Brinton (LD) [V]]

My Lords, in last Thursday’s debate on social care and carers, the Minister said

“a plan for reform absolutely is under way. We have before us the building of foundations, which will be laid in the social care measures in the health and care Bill, which will support us in working together”.—[Official Report, 24/6/2021; col. 447.]

Arising from that, is it planned to publish a White Paper or any other consultation document or, as the Minister’s speech implied, will the reforms be published as part of the health and social care Bill without any wider consultation? Given his answer just now to the noble Baroness, Lady Wheeler, will parliamentarians be ask to make decisions on the health and social care Bill without seeing the details of the future social care reforms?

[Lord Bethell (Con)]

My Lords, new legislation will increase integration between health and social care by removing barriers to data-sharing, enabling joint decision-making and putting more power and autonomy into local systems. The noble Baroness is entirely right on that. The Bill has been published and the noble Baroness is very welcome to engage in some of the engagement sessions that I have had on it already. I should be glad to run more, if that would be helpful to her. A White Paper and a public consultation are not planned.

Hospital Waiting Lists

Baroness Brinton Excerpts

Tuesday 29th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, there has been an enormous pandemic, which has, of course, had a huge impact on the healthcare system. During the pandemic, the financial support for the NHS—as well as the system support—has been huge and had a huge impact. We are looking at a backlog and working hard to get through it, but noble Lords should be in no doubt that we are thoroughly committed to getting back to full operational capacity.

[Baroness Brinton (LD) [V]]

My Lords, around 10 million people across the UK are affected by arthritis, and the widespread impact of rheumatology conditions costs the NHS over £10 billion a year. The recent British Society of Rheumatology report, Rheumatology Workforce: A Crisis in Numbers, lays bare the shortage of all multidisciplinary staff, including the consultants, nurse specialists and physiotherapists who are needed to deliver the NICE treatment guidelines. This shortage of staff and funding is already impacting severely on rheumatology waiting lists. Can the Minister say how this funding and workforce gap can be addressed with immediate effect? If he does not have the figures and answer to hand, please can he write to me?

[Lord Bethell (Con)]

The noble Baroness points very well to exactly the kind of challenge that we face at the moment. She is entirely right that conditions such as arthritis and rheumatology require complex combinations and collaboration between many different staff, as well as the application of new and effective treatments and therapies. That is exactly where we are working hard to catch up. I will go back to the apartment, dig out any statistics I can and write to her accordingly.

Social Care and the Role of Carers

Baroness Brinton Excerpts

Thursday 24th June 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I declare an interest as a vice-president of the Local Government Association. I thank my noble friend Lady Jolly for instigating this debate and for her wonderful service to the Liberal Democrats’ health team, and to your Lordships’ House, in speaking calmly and authoritatively on health issues for over a decade.

The right reverend Prelate the Bishop of Carlisle was so right to start with the suggestion that we need to go back to the absolute fundamentals of social care, because the current system is plainly not working. Over the last two hours we have heard many stories alongside examples and statistics of how the system is failing. As my noble friend Lady Walmsley said, this needs to extend to housing too. Habinteg has produced homes for life standards that cost only a fraction more when a place is built new but can mean people then stay in one place for their entire life, with very minor and cheap adaptations.

The noble Baroness, Lady Cavendish, is right that we need to think in completely different ways. I, too, want to mention an exemplar from the Netherlands, where students are now living alongside residents in care homes. In return for accommodation, they are also providing some support. Not only has it proved career-changing for the students but the record of dementia has reduced because of regular contact with younger people. That is the sort of radical idea we need to think about.

From these Benches, we are calling on the Government not to delay any longer but to engage urgently in cross-party talks on the future of social care. Our Prime Minister, Boris Johnson, pledged during the 2019 election and then from the steps of No. 10 to

“fix the crisis in social care once and for all”.

With social care services in such crisis, it is time that he and the Chancellor acted. People are selling their homes to pay for care and more than 1.5 million people are missing out on the care they need. Others are stranded in hospital, unable to leave because the follow-up care just does not exist. This is putting an increasing strain on the NHS, which also does not have the cash to cope.

The Dilnot review has been repeatedly referenced, including by my noble friends Lady Jolly and Lady Tyler, and by the noble Viscount, Lord Chandos, who is right that Dilnot’s proposals demonstrated that this is not difficult. I also agree with the noble Lord, Lord Rooker. In 2010, all three major parties agreed on proceeding with Dilnot and then the Conservatives pulled out. A decade further on, nothing has happened.

The noble Lord, Lord Forsyth, might feel that his committee is long in the tooth now but its report was exemplary and will last the test of time. He is right that this is all about money. As many other speakers have said, people’s lives are being damaged because the system has fallen apart. If the Treasury is the block, we must now commit to extra funds to make this work. We cannot continue with this broken system.

In England, publicly funded but means-tested adult social care is primarily funded through local government. It constitutes the biggest area of discretionary spend for local authorities, which are already cash-strapped due to repeated cuts and extra responsibilities. If the adult social care workforce grows at the same rate as the projected number of people aged 65 and over, the number of jobs in that sector will increase by one-third to around 2.17 million by 2035. We are not even thinking about the growth in our demographics and its consequences. Everyone is thinking about mending the short-term problem.

As the noble Baroness, Lady Donaghy, pointed out, new analysis for the Care & Support Alliance found that since the Prime Minister stood in Downing Street and promised to fix social care once and for all, 2 million requests for formal care and support from adults aged over 18 have been turned down by their local councils. This is equivalent to about 3,000 requests being turned down every day, putting immense pressure on unpaid carers as well as the NHS. These numbers show the human cost of the Government’s dither and delay. Will Ministers please stop their internal spats and off-the-record briefings, and start the urgently needed cross-party talks, involving the sector, so that we can look at fixing this urgently?

The cost of inaction is also far higher, as 11.5 million unpaid carers are bearing the brunt of the Government’s failure to reform social care. The pandemic has exacerbated the immense pressures they were already under; many have not had a single break since the crisis began. It is clear that any reform of social care must consider the impact on unpaid carers and include ways to alleviate the pressures that they face. Will the Government commit today to the emergency funding that would give unpaid carers across the country at least a weekly break? Will the Minister also commit to involving unpaid carers and carer organisations in talks on reforming social care services?

Last week, 50 organisations wrote to the Prime Minister, calling on him to fix social care. They wrote in the letter:

“During the pandemic tens of thousands died before their time in care homes from COVID-19. The best possible legacy we can give all those who have lost loved ones would be to ensure that we fix the care system so that a similar tragedy cannot happen again.”


The Local Government Association tells us that the ongoing recruitment and retention problems show that a high vacancy and turnover rate is really affecting service quality. As others have outlined, many staff have uncertain incomes because of the prevalence of zero-hours contracts. Temporary shifts in these patterns due to Covid-19 have highlighted the need to deal with these issues permanently. A recent Skills for Care report on the state of the social care market found that pay in adult social care is on average 25% lower than in the NHS, that the adult social care sector in England still needs to fill more than 100,000 job vacancies on any given day, and that the staff turnover rate of directly employed staff in that sector was 30% in 2019-20.

The ability to attract and retain staff with the highest skillset is hampered by poor pay, poor reward and a lack of coherent career structures that allow people to think beyond temporary work in social care. We need better pay and rewards to form part of a package of reforms and to transform the sector. All this means that we should have a 10-year workforce plan. It is vital that this is part of any proposals made by the Government. Professionalism is key but so is the registration of healthcare professionals in the social care sector, along with proper pay scales and funding for the sector, so that local government is not put in impossible positions. The pressure should certainly not end up with care providers.

My noble friend Lady Thomas of Winchester is right: being a carer is not a low-skilled job. The skill must be recognised. I noted she said that carers are often from overseas and face racial abuse, especially from clients as they slip into dementia. That is another reason why carers need to be trained properly: to help and understand their clients in what is and is not appropriate.

Thanks so much to my noble friend Lady Scott for talking about the role of volunteers in our communities; her speech was very powerful. The noble Baroness, Lady Uddin, referred to disabled children. I repeat her question about proper funding for respite care for the families trying to manage the most vulnerable children in our society.

Unpaid carers can also be children. Our own experience as foster parents to two children who lost their mother through a long terminal illness demonstrates that in addition to missing school, which was already reported on, there are other long-term psychological issues in having to face the death of a parent when they are your sole parent. I give particular thanks here to CAMHS, which provides a service but, as my noble friend Lady Barker said, mental health support is woefully limited at the moment and needs to be tackled.

The cost of inaction and delay is also falling on the shoulders of the 11 million unpaid adult carers in the UK, whose contribution to the current social care system is almost completely ignored by government. The cost of reform may seem great, but without these carers—particularly if they themselves break down—the burden will fall further on government itself.

The Lib Dems are also calling on government to immediately raise the carer’s allowance by £1,000 a year to support unpaid carers and to recognise the huge financial pressure that many of them are facing during this pandemic.

The noble Baroness, Lady Browning, noted that half the social care budget is going on working-age disabled people. That is also important, because there are not often houses to sell afterwards. That is why we have to review everything and completely rethink the way our social care system works. I will end on another point on which I agree with the noble Baroness, Lady Browning. Everybody today has said that we have waited far too long for these reforms. The only block to progress is the Government, specifically the Treasury. Act now. Bring it on.

Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) (No. 2) Regulations 2021

Baroness Brinton Excerpts

Wednesday 16th June 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I declare my interest as a vice-president of the Local Government Association. I join in the thanks for the Minister’s briefings to Peers, which are helpful in the ever-changing landscape of the Covid pandemic. These Benches are pleased that we are debating these two SIs prior to them being enacted. We warned weeks ago that renewal was almost inevitable given the way that the delta variant had seeded so quickly and case numbers were increasing steeply, as they still are.

It is obvious that the delta variant is much more transmissible than the previous dominant variants. PHE has said today that the variant may have an R number as high as seven without measures. It is clear that we are at the start of a further major surge in infection and to do anything other than renew these regulations now would be a major mistake. This time last year, when the first lockdown restrictions were lifted, the daily case rate was below 1,000. Two weeks ago, it had crept up to more than 3,000. Today’s rate is a shocking 9,000. The delta variant is spreading fast, hospital admissions are increasing and in the north-west ITU beds have also increased, so my first question to the Minister is: if in two to three weeks’ time the data shows that restrictions need to continue, will he guarantee that further renewal of these SIs will be before they are brought into effect and before we go into recess?

This afternoon, it has been announced that business evictions will now be stayed until March next year. That is something, but on its own it is not enough. Why are residential evictions proceeding? For those struggling to find alternative housing, this is a real crisis. I am afraid it also sums up this Government’s attitude. They will help business tenants, but not individuals who are likely to end up homeless. Can the Minister explain why other government support for people and businesses is not being extended? The furlough scheme rates are about to reduce on 1 July and it will be abolished in September, despite hospitality not being able to open up fully, the creative sector still not being able to work and all workers still being advised to work from home if at all possible. Other support for businesses also remains firmly locked on the “freedom day” of 21 June, which is now clearly anything but.

I echo the points made by my noble friend Lord Scriven on the Government’s delay in putting India on the red list. There is only one reason why we are having to extend these regulations: the Prime Minister’s trip to India.

The Speaker of the House of Commons made it plain on Monday that the Prime Minister and his Government should not make announcements to the press first, yet today our papers are full of news that Ministers plan legislation to force social care home staff to have vaccinations. When will this be announced in Parliament? Given that the leaks seem to cover a lot that was not part of the original consultation, will the Minister answer the following questions? Will the scheme cover just care home staff? There are mutters about the wider social sector, so will it include supported living staff, staff in sheltered accommodation and staff at residential boarding schools for pupils with medical or learning disabilities? If not, what are the differences?

What will the Government do to assist the sector? Many small care providers took legal advice about whether, if they could not redeploy unvaccinated staff elsewhere, they would be liable to be sued by any staff who are sacked on Government orders. Only the Government can help to answer that. What will be the effect of this proposal on the social care workforce? Care providers are currently reporting that staff are leaving to go to work in the hospitality sector, where substantial pay increases are being offered as restrictions are lifted. Agriculture is also short of workers and is reported to be offering £20 an hour, which social care just cannot match. Will all agency staff have to be vaccinated too? What is the timescale to introduce this?

I support the call of my noble friend Lady Walmsley for proper funding for those who have to self-isolate. From these Benches, we continue to ask repeatedly for wages to be paid and, as a last resort, sick pay to be increased to a sensible level. That will increase the numbers of people self-isolating.

Overall, the proposed measures are sensible and continue part of the process of enabling local, rapid response on the ground, run by directors of public health, local authorities and local resilience forums, without the need to constantly return to central government. This process needs to include more powers over protective measures to be taken in schools, so that locally they do not need to ask the DfE for permission. With the delta variant growing in schools, rapid action needs to be taken.

To the noble Lord, Lord Robathan, I say that the tripling of cases in a fortnight, and hospitals in surge areas seeing an increase in patients—even if not as severe—are preventing our NHS from being able to tackle the backlog of urgent cases, including cancer and other serious and life-changing illnesses. I have known three people who have died of Covid—but, much more worryingly, a young family friend in her 30s has been diagnosed with terminal cancer, which was missed because of a missed smear test last year. We have to have an NHS that can operate and look after the whole population and is not just trying to catch up with Covid.

One thing is evident: with the delta variant, we are going to have to learn to live with Covid and its restrictions, whether on mask wearing or ventilation inside. At times like this, we must continue the current arrangements in some form while the variant can be seen to be working its way round to those who are still vulnerable. If we do not manage these restrictions well, we will find ourselves back in a much more stringent lockdown, which not one of us wants. We must continue to take these precautions to keep ourselves safe. We must continue to test, trace and isolate to keep everyone safe. That is why, from these Benches, we cannot support the fatal Motion of the noble Lord, Lord Robathan.