Covid-19: Government Handling and Preparedness
Baroness Brinton Excerpts(4 years, 1 month ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I absolutely join the noble Baroness in paying tribute to all carers, particularly unpaid carers, who have shouldered a huge burden in the past 18 months. The role that they have played has been a real example of the sense of service and commitment that characterises the social care community in this country. We have put in place a large amount of resources through local authorities and payments to local authorities to support carers. That has helped in infection control and to reduce the itinerant nature of some social care in order to prevent the spread of the disease. But it is undoubtedly true that the burden on unpaid carers remains immense, and we continue to support, both through local authorities and through charities, the work that they do.
Baroness Brinton (LD) [V]
My Lords, in the national Carers Week, it is worth remembering that the 2017 report on Exercise Cygnus said:
“Local responders also realised concerns about the expectation that the social care system would be able to provide the level of support needed if the NHS implemented its proposed reverse triage plans.”
It also recommended that local support should be developed and planned for social care and health. Was that recommendation put into practice? Were the concerns expressed by local responders borne out last year? Will the Government now publish their internal review of pandemic preparedness to ensure that the lessons have been truly learned?
Covid-19 Update
Baroness Brinton Excerpts(4 years, 1 month ago)
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Baroness Thornton (Lab)
My Lords, first, I thank the Minister for this update today and congratulate him on yet another long stint at the Dispatch Box.
We face some uncertainty, as we often have throughout the past 15 months, but we know the delta variant is now the dominant variant in the UK; we know that 73% of delta cases are in unvaccinated people; we know that one dose offers less protection against this variant; and we know that, although hospitalisations are low, an increase in hospitalisations will put significant pressures on the NHS as it tries to deal with the care backlog. We also know, of course, that long Covid is significant and debilitating for so many people. As the Statement makes clear, this is a race between the vaccine and the new variant. I therefore invite the Minister to narrow the timeframe between the first and second dose, given that we know that one dose is not as protective as we would like. We have seen that Wales will be vaccinating everyone who is over 18 from next week. Could the Minister tell us when England will follow?
We all know about the outbreaks among schoolchildren and young people. We know that children can transmit the virus and that children can be at risk of long Covid. In that context, why is mask wearing no longer mandatory in secondary schools? It is good that the JCVI will be looking at vaccination for children. Could we please know the timeframe for when the JCVI will report?
I turn to Nepal. UK Ministers justified the decision to move Portugal from green to amber in the travel list owing to the threat of the new Nepal Covid variant—a mutation of the delta variant—which experts believe may have the potential to make vaccines less effective. Some 23 cases of the Nepal variant have been detected in the UK, up to 3 June. Can the Minister confirm whether these cases are all associated with travel, particularly from Portugal?
In this, Carers Week, from these Benches we join the Minister in paying tribute and are grateful to the 6.5 million people who are carers. Making caring visible and valued is the aim, and this year of all years we need to support them in doing so. Our carers across the country have faced huge challenges during the pandemic; three-quarters of them confess to being exhausted, and a third confess to feeling unable to manage their caring responsibilities.
I am sure the Minister has already read the report produced by the Commons Health and Social Care Committee which addresses the issue of NHS and care staff in England being so burned out that it has become an emergency that risks the future of the health service. This is a highly critical report which said that workers are exhausted and overstretched because of staff shortages. It said that the problems existed before the pandemic, although coronavirus has made the pressures worse. It reports that one of the main problems is that there was no accurate forecast of how many staff the NHS needed for the next five to 10 years—something that we know as “workforce planning.” NHS workers, traumatised and exhausted, need to know there is a solution on its way to fix staff shortages. When will there be an NHS and social care workforce plan? How will the Government respond to the urgent situation that this report reveals? How will the NHS stop the haemorrhaging of its staff, which is already happening?
Combined with all this is the fact that we know that the NHS estate is in urgent need of attention and investment, and so Labour is today calling for a new rescue plan. Data also reveals the scale of the pressure on hospitals before the pandemic and how much worse it is now. Freedom of information requests show that the pressure on A&E was already very serious, with waits in ambulances jumping by 44% in the year preceding the pandemic. We know that the underfunding of the NHS, and the unpreparedness of the UK for a pandemic, has been paid for by people’s lives and by the exhaustion of our NHS. Surely these things call for a long-term NHS rescue plan, with the staff, equipment and modern hospital facilities that we deserve.
I turn briefly to the issue of data again. I record that I welcome the delay in proceeding with this proposal from the Government, but I think the Minister and the Government need to address the transparency that is vital around two things. The first is that somebody should be able to retrieve their data if they want to and pull it back; and the second is that, if their data is being used by a third party, they need to know who that party is, what the data might be used for and who benefits from that. My contention has been, for many years from this side of the House, that NHS data is a gigantic asset that we have that can be used to benefit the world, but we need to make sure that it is the NHS that benefits from the sale of our data—not private sector companies or individuals but our NHS.
Finally, I recently visited the Covid memorial wall myself. I would like to ask the Minister whether he has visited the wall of red hearts that we have opposite Parliament. The Covid memorial wall is immensely moving and a poignant reminder of the scale of loss that we as a country have experienced. Does the Minister believe that the wall should become a permanent memorial? If not, what should be a permanent memorial of the loss that we have sustained?
Baroness Brinton (LD) [V]
My Lords, I declare my interest as a vice-president of the Local Government Association. I also want to thank the Minister for his long stint at the Dispatch Box, yet again.
I want to start with the issue about consultation on NHS Digital patient data, which the noble Baroness, Lady Thornton, just alluded to. In 2013, the Government wrote to every household to explain the care.data project. This new scheme has had no such communication with the public. As people hear about it, they are increasingly concerned about the breadth of data that will be captured. Will the Minister agree to use the delay to ensure that every adult in England is written to as a matter of urgency, including an opt-out form they can use if they so choose?
I also want to pay tribute to our health workers and carers—paid carers and especially the unpaid carers—who have gone not just the extra mile over the last 14 months but a whole marathon. Can the Minister say what steps the Government are taking to help the exhausted staff and carers who know that there are many miles still to go before we are through this? Help is needed right now for them in an emergency plan that does not just focus on getting back to work as normal.
The Minister is right to say in the Statement that there is no room yet for complacency. The delta variant will not be the last variant trying to wriggle between those who are protected and those who are not. We are concerned that there is not a focus on communicating to the public about how we need to find a way to live with Covid circulating, as my noble friend Lord Scriven said yesterday. We have moved into Covid being endemic, and the public will want and need to know what they should do over the next few months.
Communication about the vaccine figures is cheering to hear, but still too many Ministers talk about the one-dose level, not the two. The Minister in the Lords, to his credit, usually make that point, but the Prime Minister and many other Cabinet Ministers do not make it clear that we need 90%-plus of adults to have had two doses before we are anywhere near safe, and that social distancing, mask wearing and hand washing will still need to happen.
I thank the Minister for giving more information yesterday on the isolation support pilots. He said:
“In Blackburn and Bolton, this will include trialling broadening eligibility during surge testing, so that all those who are required to self-isolate, who cannot work from home and earn under £26,000, receive a £500 payment.”—[Official Report, 7/6/21; col. GC 202.]
That is still only £50 a day if you are expected to self-isolate. If you are told to isolate on a Monday, and usually work nine to five, this works out at £7.81 per working hour—less than the minimum wage. If the minimum wage is the very minimum that the Government believe an individual can live on, why are they paying less than this to people for doing the great public good of self-isolating? What about people who work in risky occupations and have been told to isolate multiple times over the last year? For them, it is not just one period of 10 days.
From these Benches, we believe that the Government need to pay people’s wages. Now that fewer people should be required to self-isolate, as community cases are lower, we should be diverting resources to really get right what the Government have been getting wrong all along. We must stop Covid in its tracks. Examples from other countries show that paying wages has a strong and demonstrable effect.
On international travel, the red terminal at Heathrow is an improvement, but there are still issues with those arriving from amber countries, who are asked to jump on public transport to get home and need to travel in various ways before they are tested, once in this country.
Given the increase in cases of the delta variant among primary-age pupils, would the Minister outline what measures are being taken to prevent transmission in schools? When will the JCVI report on vaccines for 12 to 17 year-olds? Are any plans beginning to consider whether vaccination should happen for the under 12s? We strongly echo the comments of the noble Baroness, Lady Thornton, about mask wearing in schools. Is this really the right time to stop that happening?
Finally, I note that the consultation on vaccine and testing certificates has closed. Will the Minister say when the Government will publish their plans following that consultation? What type of legislation will be brought in on this, and will Parliament be able to see and comment on any regulation prior to it being enacted?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I am thankful, as ever, to both noble Baronesses, Lady Thornton and Lady Brinton, for thoughtful and challenging questions. I will try to deal with as many as I can.
The noble Baroness, Lady Thornton, asked about the narrowing of doses. May I remind her that for those classed as vulnerable and those aged over 50, the dose period has been narrowed from 12 weeks to eight weeks. We are giving some latitude in the areas of special enforcement for the narrowing of the doses. I completely endorse her points on that and reassure her that plans are afoot. As for moving the age group to those aged over 18, our instincts are that the JCVI prioritisation process has worked extremely well. It is clear, it is fair and it has been effective. In conversation with those at the G7, I received a huge amount of admiration from other countries for how well that prioritisation process has gone. Therefore, we are reluctant, at this very late stage, to jump the gun on that, but I take her point that particularly those in areas where the infection rate is ticking up may benefit from early vaccination. Therefore, we constantly look at and review that point.
As for vaccination of children in schools, raised by the noble Baronesses, Lady Brinton and Lady Thornton, as they know, the MHRA has given its approval. The ball is now in the JCVI court. We are going to wait for it to pronounce. The state of our vaccine supplies means that we do not have a supply for children at hand right now, so there is scope for a really thoughtful conversation on that. When the JCVI has pronounced, the Government will engage on its recommendations, but I do hear, loud and clear, the obvious support that it has in this House.
As for the Nepal variant, I cannot say exactly how much of it came from Portugal, but it is true that it was present in the UK before Portugal was green-listed, so I think it is fair to say that not all of it came from there.
Moving on to NHS staff, I completely pay tribute to the contribution of NHS staff and those who work to support the NHS, social care and public health. I recognise completely the picture painted by the noble Baroness: many feel exhausted and burned out. Our focus is therefore on recruitment and the recruitment of more GPs and nurses is going extremely well. I would be happy to share updated statistics on that if it would be helpful. The work plan—the NHS People Plan—has within it a clear outline of the kind of workforce planning that we have in place. That is something that the recruitment programme has fully embraced.
I agree that the pressures on A&E, and on acute late-stage interventions from the NHS, have been rising for years—for decades. This is an unsustainable model in the long run, which is why this Government are fully committed to the prevention agenda. We have put in place plans for the Office for Health Promotion. That will be the device for using data to support our prevention agenda, and we will be working particularly with local authorities, and increasingly through the NHS, to ensure that we are putting in place measures that improve the nation’s health and that we do not just focus on those who are already extremely ill.
Moving on to data, I thank the noble Baroness for her kind comments. I completely agree that transparency is absolutely right. We want to be as transparent as possible, with both the professions and the public. These are complex issues. I accept that we could do better to improve our communications. We will be using this two-month hiatus as energetically as we can to engage the public and the professions in the changes that we are bringing about. They are changes that are absolutely essential for any modern use of data to promote resource allocation—when it comes to the workforce, as the noble Baroness rightly pointed out—and for research. I really would encourage all noble Lords who are interested in this to look at the minutes of IGARD. Noble Lords will see exactly which data uses are being sanctioned, and will be amazed by the extremely high-level, science-led research programmes that the GP data is contributing to. It will reassure noble Lords that this is an extremely well guarded and thoughtful process, and a massive asset to the nation. I agree with the noble Baroness that our data is a huge national asset; it is there to benefit patients and is mainly used for clinical trials and for planning within the NHS. That is right and I can reassure her that that is the way we intend to continue.
The noble Baroness, Lady Brinton, asked about mental health support for care workers and NHS staff. I reassure her that we have put in a huge amount of support for NHS staff: 10,300 calls have been made to the helpline, there have been 4,600 conversations on the national line and 200,000 downloads of the app, and 500,000 have engaged through the web page. The provision of mental health support for NHS staff has been extremely helpful for those stressed by the last few months, but we continue to invest in that area.
I remind the noble Baroness, Lady Brinton, that those receiving isolation payments are still eligible for their benefits. They will get support from housing benefit and other benefits if they qualify.
The noble Baroness asked about schools. The use of testing to protect schools has been one of the phenomenal success stories of this pandemic. There have been 65 million tests deployed since January, and a million tests were deployed on Sunday alone. That is both to break any chains of transmission within schools and to protect the opening of schools, which every parent in the country knows is an essential objective of our pandemic response.
On certification, we are making an enormous amount of progress. That is a Cabinet Office lead. When the plans have been crystallised, they will be published, and I am extremely hopeful that we will be able to make progress.
Lastly, the noble Baroness, Lady Thornton, mentioned the memorial wall. I am aware of it and have seen very moving pictures. I have not yet visited the wall, but I will take this prompt to go. While I am not across the future plans for the wall, I am grateful for the suggestion and will take it up.
Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) Regulations 2021
Baroness Brinton Excerpts(4 years, 1 month ago)
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Baroness Brinton (LD) [V]
My Lords, I declare my interest as a vice-president of the Local Government Association. As my noble friends Lord Scriven and Lady Tyler have said, once again we are reviewing and considering these regulations weeks after they have been implemented and published, in that order. It appears that even the routine renewal of SIs is a total surprise to the Government—or they may be treating our democracy with contempt.
The Secondary Legislation Scrutiny Committee noted:
“These national provisions came into effect on 17 May. However the Government published guidance on 21 May which said that to combat ‘the Indian variant’ people … should meet outside wherever possible and travel in and out of those areas should be avoided. This change was not publicised by the Government and caused considerable confusion … It appears that this situation was in part caused by continuing confusion over the status of government guidance and in part by failures in how the advice was communicated.”
The committee says:
“Recent events have illustrated why this is a significant problem: Guidance associated with both the travel regulations and the changes to restrictions in certain areas … have this week caused confusion for the public and have given rise to questions about enforcement, both of which undermine the effectiveness of the advice given.”
The blurring of lines between guidance and regulation, combined with poor communications, is a serious error that made the regulations unworkable, as the Government discovered to their cost.
These SIs will expire on 20 June, as other noble Lords have said—when Ministers, members of SAGE and scientists are all saying to us on a daily basis that the complete ending of restrictions is now very finely in the balance because of the steady increase in Covid delta variant cases over the last month, with cases back up to over 5,000 a day. Is this the right time to lift the ban on pupils wearing masks, when we are now seeing evidence of high spread in schools, including in Cherry Tree Primary School in my home town of Watford?
We agree with the Government that data, not dates, must rule the next set of decisions. What additional resources are being given to local authorities and local resilience forums to help them handle surges in variants of concern? Our local directors of public health are doing an excellent job but, in the areas of high surge, there are requirements for substantial intervention, which costs money. Can the Minister say whether those areas of high surge are receiving extra resources over and above the planned allocation for this year?
The Minister knows that on these Benches we believe in the importance of test, trace and isolate to keep people safe. I was slightly surprised this morning to hear the noble Baroness, Lady Harding, say on “Woman’s Hour” that she was dismissive of its key importance. We believe that it is clearly a vital tool to manage new variants and outbreaks.
The noble Baroness, Lady Harding, like Matt Hancock, talked a great deal about the progress of vaccination, and we applaud that progress. However, over the weekend the Secretary of State said that vaccination had “severed” the Covid link but “not broken” it. Pardon? The dictionary definition of “sever” is “break off”. Can the Minister explain what “severed but not broken” means?
The regulations are silent on advice for those people who, despite shielding being formally ended by the Government, are still under strict advice in letters from the Secretary of State to stay at home wherever possible, to get others to shop for them and not to go into any environment where social distancing is likely to be breached. The Government have been totally silent, but the charities Blood Cancer UK and Anthony Nolan have repeatedly asked for clear guidance for those who are immunocompromised and who have been told that, despite having two jabs, they are unlikely to have the antibodies for long. Will the Minister agree to meet me, them and other noble Lords interested in this issue? What provision is being made for this group of people, their families and friends to guide them through the next stage of learning to live with Covid? Total silence from the Government puts them in an impossible position, and possibly in unsafe surroundings.
We note that the regulations bring back international travel for leisure. We have repeatedly asked for clearer, broader rules, but today all we see is chaos at airports in Portugal as people rush back to avoid having to quarantine. Is this really the best way to do things? Can the Minister say whether the previously ineffective border measures—leading to queues at airports, people jumping on public transport to get home and people having to leave quarantine to get their tests done—have all now been resolved? In particular, are there improved checking arrangements to find forged test results?
The Minister has mentioned the pilots on isolation. Can he give us more details on those? What are “considerable payments”, and who is eligible? On the problem of people coming forward to self-isolate, the noble Baroness, Lady Harding, said this morning that the problem was getting them to come forward to say that they had had a lateral flow test in order to be able to go on working because they needed to earn money. Surely now is the time to reassure people by paying them their wages for self-isolation rather than asking them to go through a ridiculously complex means-tested application procedure.
If the Minister cannot answer all my questions now, please will he write to me with details?
Covid-19: Variant B.1.617.2
Baroness Brinton Excerpts(4 years, 1 month ago)
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Lord Bethell (Con)
I share the noble Baroness’s concern, but I can reassure her on a couple of things. It is, I think, a real tribute to the hard work of parents, teachers and the pupils themselves that the infection rates in schools have been relatively contained, and certainly have not shown the same kinds of behaviours that they did in September of last year. But we remain extremely vigilant, for exactly the reasons the noble Baroness explained. On the question of face coverings, it is a very difficult balance to strike—they are intrusive and disruptive but, on the other hand, they are an effective way of minimising infection. It is an area that we keep a very close watch on.
Baroness Brinton (LD) [V]
My Lords, the delayed publication of official Public Health England Covid variant data, which was slipped out during the Eurovision Song Contest results, is bad enough, but can the Minister say whether the Secretary of State for Education has the power to remove official PHE data on cases in schools? If so, what were his grounds for that removal?
Lord Bethell (Con)
I really bridle at the suggestion that we run our data publication programme on the basis of the Eurovision Song Contest schedule. That really is not a credible suggestion. There is an issue with positivity rates for some of this data because not every test is registered, and, as a result, it is difficult to draw conclusions about exactly what proportion of tests have become positive. It is for that reason that we are careful about how we present some of the data, and that is behind some of the decisions that have been made about which tables to publish.
COVID-19 Variant: Travel Guidance for Local Authorities
Baroness Brinton Excerpts(4 years, 1 month ago)
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Lord Bethell (Con)
My Lords, the characterisation presented by the noble Baroness is unfair. We are trusting people to be responsible and to act with caution and common sense, as they have done throughout this pandemic, and to make decisions on how best to protect themselves and their loved ones. We are seeking to avoid bringing these measures into law and instead are using guidance. The communication of that guidance could have been done better but we are working extremely hard with regional partnership teams, Public Health England, local authorities, JBC colleagues and the incident management teams to ensure that these communications are done in the most effective way possible.
Baroness Brinton (LD) [V]
I declare my interest as a vice-president of the Local Government Association. Earlier, on the “Today” programme, Grant Shapps said that it was down to local authorities to disseminate the new travel guidance to their citizens, but local authorities reported that they had not been told about it. Do the Government expect them to develop telepathic skills? What does that say for the way government truly operates as a partner with our councils, directors of public health and local resilience forums, which are dealing brilliantly with this new, rapidly transmissible Covid variant? Are they getting extra resources to cope with the extra burdens on them?
Lord Bethell (Con)
No, the noble Baroness will be relieved to know that we are not relying on telepathy. Instead we have regional partnership teams, which include Public Health England regional directors, and Contain and JBC colleagues, working together with local authorities, and these meet on a three-times-a-week basis at the regional team updates. Attendees can include government departments, including the MHCLG, the DfE, particularly REACT, and the No. 10 Cabinet Office task force. It is through this kind of extremely regular and intense collaboration between all the different parties working on this extremely complex pandemic response that we share data, provide guidance and ensure that the communications are done to the best of our ability.
Covid-19
Baroness Brinton Excerpts(4 years, 1 month ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, the noble Baroness asks two very pertinent questions which slightly answer themselves, in a way—but let me try to update the House on our plans in that area. She is right that we have powers on local lockdowns, but that is not the focus of our thinking at the moment. Local lockdowns are an important tool, but not one that we think is a priority right at this moment. We are focused on the vaccines. It is beyond doubt that this Indian 2 variant particularly hits those who are not properly vaccinated—and by “properly” I mean “have had two doses and two weeks”. Those who have forgone either their first or second dose are particularly vulnerable, and you have only to look at the infection data and, particularly, the hospitalisation data to understand that.
That is why we have rolled out surge vaccination in those areas. What that means is a huge amount of communication, a huge amount of engagement with the communities and the presence of various mobile vaccination units sent directly into the heart of the communities to provide different channels and mediums by which people can step up for their vaccine. The response has been extremely strong and I am touched, as I have said, by the videos of people in some of those communities, particularly in Bolton, where people have queued up for their vaccines. I pay tribute to the DPHs and local authorities that have facilitated that programme.
Baroness Brinton (LD) [V]
I echo the gratitude of the noble Baroness, Lady Thornton, to the Minister for his stamina this morning. Can he say whether each of the 121 local authority areas reporting cases of Covid variant B16172 are being given specific extra resources for mass surge test, trace and isolate and arrangements for surge vaccination on top of their planned allocation for this financial year? Can he say when the pilots for extra help with self-isolation will conclude? When would any likely rollout of a proper approach to supporting those who have to self-isolate, including paying their wages, start?
Lord Bethell (Con)
My Lords, the noble Baroness alludes to a dilemma that we face. It is not possible to organise surge testing and have pinpoint outbreak management in 120 different areas. That is just too many and our resources do not stretch to that. Many of the outbreaks are substantial clusters. Sorry—let me phrase that better. There is a small number of very substantial clusters in the towns and cities of which noble Lords will be aware. That is where we are focusing the surge testing and surge vaccination. In the other areas, we are working with DPHs to ensure that they know the best way to target the particular behaviours of the India 2. That means that it has very high transmissibility, which requires an extremely quick reaction to school and workplace outbreaks, and within specific communities. That kind of briefing and guidance has been channelled through the Chief Medical Officer’s department and the kinds of infrastructure that I described in my answers to previous questions. The response has been extremely strong and I hope we are making some impact on the spread of the India virus, but we remain extremely vigilant.
Heathrow Airport: Border Control Passenger Safety
Baroness Brinton Excerpts(4 years, 1 month ago)
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Baroness Brinton (LD) [V]
My Lords, how many of the passengers who flew in from India between 2 April and 23 April have now tested positive for Covid? If the Minister does not have the data to hand, please could he write to me with it? Given the guidance—slipped out by Ministers last week—for Hounslow residents to stay at home because of the Indian variant, what advice are the Government giving to all workers at Heathrow, whether they are from Hounslow or not, to keep them safe from Covid?
Lord Bethell (Con)
I do not have the statistic that the noble Baroness asked for, but I would be glad to write to her with it. The surge testing and vaccination in areas of VOC outbreak are now in many communities up and down the country that are not correlated with the presence of airports. They are distinct and specific to each of those communities: we work with the local DPH to ensure that the local outbreak plan is tailored to the needs of that community.
Health Protection (Coronavirus, Restrictions) (Steps and Local Authority Enforcement Powers) (England) (Amendment) Regulations 2021
Baroness Brinton Excerpts(4 years, 1 month ago)
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Baroness Brinton (LD) [V]
My Lords, once again we meet to approve a statutory instrument that has already come into effect. As others have said, it relates to the easing of lockdown by moving from step 1 to step 2 on 12 April, but is being discussed in your Lordships’ House on the day England moves to step 3. Irony is not dead.
Can the Minister explain why the travel regulations, a 92-page document, were replaced and published last Friday evening to come into force today? We also had the amendment to shift us into step 3 published only on Saturday morning. Why was this done so last minute? The Prime Minister confirmed the move days before, and the amendment could have been ready to go. We say again: this is not a way to make the law or for Parliament to scrutinise it. On these Benches we have been asking for more than a year why there is not more planning about the publication and presentation to Parliament of these SIs.
I also note that the steps legislation is due to expire on 30 June. I ask the Minister now: what arrangements will be put in place in the event that the Government have to extend these regulations in light of the Indian variant beyond the end of June? With all the Minister’s rightful warnings about having to take action if needed, surely this is a clear case of being able to plan, publish and debate it earlier. I also ask the Minister about the following comments from the JSCI:
“The preamble to these Regulations contains a statutory proportionality statement in respect of the Steps Regulations but not in respect of the Enforcement Regulations.”
The department responded
“that no statement is required for the amendment of the Enforcement Regulations made by regulation 3, because it does not impose a restriction or requirement under section 45C(3)(c). The Committee believes there are arguments either way … the Committee notes the Department’s approach and accordingly reports regulation 3 for requiring elucidation, provided in the Department’s memorandum.”
Can the Minister comment and tell us when that elucidation will be available?
My noble friends Lady Tyler of Enfield, Lady Walmsley and Lord Scriven all asked why the Government have been so slow to add India to the red list. On these Benches we have raised the importance of controlling our borders effectively, first in January and February 2020, in relation to why the UK did not follow World Health Organization advice and enforce quarantine from countries with Covid. We saw the consequences of that with Covid coming in and spreading fast in our communities, causing the first lockdown. So, with a year’s experience, why did the Government not add India to the red list on 2 April when Pakistan and Bangladesh were added? Was it anything to do with the Prime Minister hoping to go to India and then having to cancel his trip at the very last minute? And why do we hear today on Radio 4’s “The World at One” that there is still no guidance for airports on passenger separation once landed and while queuing to go through the checks?
Tim Hawkins from the Manchester Airports Group said that it was still awaiting government guidance. He said that it would expect to put red-list countries into a separate process but there is an element of mixing at certain points at the moment. Last week we heard that Border Force was instructing people to get used to long queues as there would not be extra staff at the passport and Covid check desks. This is intolerable; because of government inertia, there is no guidance, no extra border staff, and people arriving from red list countries are still mixing with those from amber and green countries. That includes up to four flights a day from India into the UK. If the Indian variant is 50% more transmissible than the Kent variant, we risk rapid spread beyond those coming in from those red-list countries. Quarantining and self-isolation are vital to effective management of transmission and what the Prime Minister has called whack-a-mole.
Directors of public health and scientists from SAGE and alternative SAGE continue to ask for better support for people having to self-isolate. In particular, we on these Benches ask the Government to pay the earnings of those self-isolating, as happens in a number of other countries that achieve a much higher success rate of self-isolation. Local authorities report that the administration of the £500 grant has been so rule-bound it is almost impossible for people to claim it. That is not good enough, especially when the vast majority of people who really need it—who need to pay the rent and put food on the table—cannot manage 10 days without their regular pay cheque.
Finally, while it is encouraging to hear that tracing is now primarily in the hands of the experts in local resilience forums, can the Minister assure the Committee that they are being given explicit extra funding to be able to carry this out? Their roles are vital in controlling Covid because without effective test and trace, isolation and quarantining, this Government’s actions will not keep people safe.
Northern Ireland: Flight Passengers and Covid-19
Baroness Brinton Excerpts(4 years, 2 months ago)
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Lord Bethell (Con)
My Lords, I am enormously grateful to the Irish Government for the very large amount of informal clinical data-sharing that goes on. CMOs of both countries exchange data on such matters as VOCs the whole time, and that kind of day-to-day clinical exchange of on-the-ground information works extremely well. The specific question of travel information is a lacuna that needs to be closed, I recognise that it needs to be shut, a lot of work is going on to shut it and I am grateful to those involved.
Baroness Brinton (LD) [V]
My Lords, I think noble Lords understand that there have to be special arrangements, and the common travel area seems to work well for most things. The Minister knows that I have asked him repeatedly about the joining up of data of international travellers between whichever border they arrive at, the NHS and the testing system, especially the private testing system, otherwise any self-isolation system will fail. Can the Minister say whether this gap that there was before has now been remedied, so that every part of the NHS can pick up data information from borders, and how it works across all four UK countries? Will he explain a bit more about the CTA arrangements between Westminster, Stormont and the Republic?
Lord Bethell (Con)
I reassure the noble Baroness that the data flows between borders, Test and Trace, NHS and JBC work extremely well. I was in the Covid Gold meeting earlier today and we had presentations that captured all the data flows from all those places, and we have extremely good see-through on VOCs, infection rates and bed occupancy. The progress we have made on that area is astounding. Where we have a lacuna is on the transfer of data from Irish travellers to Northern Ireland, and that is something we are working to close.
National Health Service (Charges and Pharmaceutical and Local Pharmaceutical Services) (Coronavirus) (Amendment) Regulations 2021
Baroness Brinton Excerpts(4 years, 2 months ago)
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Baroness Brinton (LD) [V]
My Lords, I thank the noble Lord, Lord Hunt, for tabling this regret Motion. I echo his opening remarks about supporting the principles set out in the regulations, but proper resources are needed.
We on these Benches thank the All-Party Pharmacy Group, the Company Chemists’ Association, the Pharmaceutical Services Negotiating Committee and the Library for their excellent briefings. I personally want to thank my local community pharmacy for the wise advice that it provides for my community and its ability to provide excellent services over the last 14 months, since the start of the pandemic.
A bit of housekeeping first: I note with regret that this instrument breaches the 21-day rule and its provisions came into force on 1 March 2021. The noble Baroness, Lady Thornton, and I often say to the Minister: when will this urgency rule change? I understand that there are some issues about really urgent statutory instruments coming in on time, but this one should have been advertised in advance and ready for us to debate before it came into effect. Is it so inconceivable to think that, a year into the pandemic, we might have wanted to plan for a place to redistribute new medicines urgently? The Government are far too reactive, and they really need to plan. So how have the Government been working with pharmacies throughout the last year on this issue?
It is interesting to note that the Explanatory Memorandum says that the 2021 regulations also make changes to existing legislation on the obligations of different types of pharmacy. As a result, certain types of providers of community pharmacy services will be required to provide a home delivery option for patients with specific prescription items in a pandemic situation free of charge. We have heard from a lot of community pharmacies that are struggling financially, and they may not have the ability or finances to set up a delivery system of that kind. So how are the Government working with pharmacies to ensure that they have the proper resources to deliver medicines to vulnerable patients?
I believe we all recognise that community pharmacies play a vital role in their local areas—often extremely local—which gives them the ability to reach right into the communities, something that is much harder for many other healthcare providers to do. Whether they are in a town centre, a member of a large pharmacy chain or a family-owned pharmacy at the heart of their village or ward community, our pharmacies are an essential tool in reaching everyone. However, we need to note that since 2016 we have lost 400 pharmacies —perhaps not surprisingly, disproportionately from the poorest communities with the largest health inequalities, as my noble friend Lady Barker so movingly described. Thinking about the Government’s focus on health inequalities, community pharmacies in those areas absolutely need the right resources.
The All-Party Pharmacy Group ran an inquiry last November that included a survey of just over 1,600 pharmacy professionals in England and called for written and oral evidence. It found that the cost of staying open throughout the pandemic and offering services when other NHS services were reduced or halted resulted in staff burnout and rising debts. We hear a lot about nurses, doctors and front-line hospital staff but we need to recognise that other healthcare professionals have faced that same burnout.
Nearly half of pharmacy contractors think that their pharmacy is at risk of closing within the year. More than nine out of 10 feel that their place of work is under financial pressure, and over nine out of 10 feel that the Government do not appreciate the role of pharmacies in front-line healthcare. Pharmacies dispense 1 billion prescriptions a year and gave more than 2 million flu vaccinations last winter. Pharmacists are highly trained healthcare professionals, and their pharmacies are the front door of the NHS for many people who may be too scared or just do not know where to take their health issue.
Pharmacists deliver advice via 48 million consultations a year, taking vital pressure off our GP surgeries, urgent care centres and accident and emergency services, as outlined by the noble Baroness, Lady Wheatcroft. They have also moved with the digital times with a confidence and ease that some other parts of the NHS might perhaps envy—for example, with electronic prescriptions sent from surgery to pharmacy and digital notifications letting the patient know when they can collect their prescriptions. During lockdown, they have worked with volunteers to deliver prescriptions to people who cannot leave home, whether they are shielding, self-isolating or quarantining. More importantly, their Pinnacle database was used by the NHS to record Covid vaccines delivered, and then linked back to NHS records. It is very welcome that our pharmacists had an effective system, and that the Government, for once, recognised that it would be faster and more effective to use an existing system. I hope that joint working is symbolic of the esteem in which the Government and the NHS hold our pharmacies.
They have done all this without complaining, repeatedly finding ways to make things happen, especially in the last year, and we know that they are trusted by their customers. However, overwhelming financial pressures are causing them serious concern. As we have heard, many pharmacies are being pushed to the brink of closure. An EY report published last September made it absolutely plain that the community pharmacy network is unsustainable under the current financial framework, predicting that, without any change, 72% of pharmacies will be in deficit by 2024, with a network-wide deficit of just under £500 million.
These financial projections were based on figures that predated the pandemic, which has undoubtedly put further pressure on pharmacies. This extra pressure means that nearly half our community pharmacists believe that their pharmacy is at risk of closing within the year. The problem is that the regulations take no account of these circumstances. Can the Minister tell us when the Government and the NHS will consult with pharmacists so that they have a clear picture of what is happening? When will the Government and the NHS turn that into urgent recommendations for structural financial change? Enhanced resources would make sure that pharmacies are able to be at the heart of any health reforms that the Government wish to announce following their White Paper. Will the Government look specifically at providing resources for training pharmacists to deliver the new community health services that Ministers refer to so frequently?
At this difficult time, pharmacies are also being asked to pay back the advanced funding provided by the Government to help deal with the extra demands relating to Covid-19, but we know that much of this funding did not even cover the extra costs that pharmacies have had to bear. With their other financial problems, as already outlined, plus extra costs not supported by government, many pharmacists will not even be able to make these repayments. If the Government do not relax the repayment timing—or, better still, turn these loans into grants—forcing repayments now may force pharmacies into closure. That would be catastrophic, and a heavy burden for any Government to bear, especially one that has dished out billions of non-repayable grants to many other small businesses, which is what most of our community pharmacies are.
The pharmacy sector is willing and able to step up and help transform health services. The Company Chemists’ Association said on publication today of the Government’s White Paper:
“We hope the proposed changes in this White Paper will create an environment that allows the community pharmacy sector to do more to help relieve pressure within the rest of the NHS. With waiting times for hospital treatment at their highest for ten years, community pharmacies are needed now more than ever to provide patients with clinical care, close to home.”
It went on:
“However, to deliver on this, pharmacies need fair funding for both the services they currently provide and for any additional workload they are ready and willing to deliver.”
Along with the noble Lord, Lord Hunt, I welcome the principles behind these regulations but, without appropriate support and resources, the Government are setting our pharmacies up to fail—something no one in Parliament or government wants to happen. I look forward to the Minister’s response.