MMR Vaccine

Baroness Brinton Excerpts

Thursday 20th July 2023 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, the NHS says that susceptibility is not just among the under-twos; it is particularly high among 19 to 25 year-olds whose parents were affected by the unfounded Wakefield stories two decades ago, and many may still not be vaccinated. What is the NHS doing to reach this cohort, including at further education colleges and universities, to ensure that they are fully vaccinated before they start their own families? Catching measles when pregnant can cause miscarriage, stillbirth, premature birth and low birth weight.

[Lord Markham (Con)]

The noble Baroness is correct. The unfortunate Wakefield effect had quite an impact on that cohort of people, so the campaigns have been targeted particularly at specific communities in particular areas. Outreach campaigns are being done as part of that, looking at every area where it can be done. Sometimes that involves looking at colleges and sometimes it involves going specifically to community centres themselves.

NHS Long-term Workforce Plan

Baroness Brinton Excerpts

Tuesday 4th July 2023 Lords Chamber

[The Deputy Speaker (Baroness McIntosh of Hudnall) (Lab)]

My Lords, the noble Baroness, Lady Brinton, is contributing remotely.

[Baroness Brinton (LD) [V]]

My Lords, while this NHS plan is welcome, can the Minister say whether this Government will undertake to commit to the plan and, crucially, to its funding and not change the number of education and training places, as happened last year and in too many previous years, causing chaos in planning for doctors, nurses and allied healthcare professionals? On hospital training places for junior doctors after they have finished their medical school courses, last year 790 medical graduates could not begin their junior doctor in-hospital training because the NHS did not have enough placements. Given that university medical school places are already capped and highly competitive, this is a complete waste of newly qualified medical graduates.

[Lord Markham (Con)]

It is absolutely a pipeline; some people might say, “Why are you not doing more earlier in this plan?”, but, as the noble Baroness says, there is no point training a lot of people at the university end if you do not have junior doctor places later in the system. That is why we are trying to get a sensible ramp-up so that we can build capacity into those places, recognising the point that the noble Baroness makes. On the numbers in the plan, we have set down £2.4 billion for the first five years of training and development, but the point about it being a live plan is that we will update it every two years. Given the data—this is an NHS document, not a Department of Health one—I would expect those numbers to change, as I would be amazed if we got it spot on first time. The whole point about making this an NHS living document that we can use and which updates is that we can all stick to the plan.

NHS Procurement: Palantir Contract

Baroness Brinton Excerpts

Thursday 22nd June 2023 Lords Chamber

Asked by

[Baroness Brinton]

To ask His Majesty’s Government, in light of the contract awarded to Palantir, what plans it has to ensure that NHS contracts are procured through a public and transparent tender system as outlined in the Procurement Bill.

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

All NHS contracts are procured using correct procedures. This is a new transition contract with Palantir, with new and improved contract terms, including robust exit and transition schedules to support transition from Palantir to the new federated data platform supplier. This contract includes additional terms, such as termination for convenience and a six-month break clause. The contract was procured by a compliant and transparent direct award tender process, using a Crown Commercial Service framework agreement.

[Baroness Brinton (LD)]

My Lords, it is not the first closed contract used that way, particularly for Palantir, since 2020. Ministers deliberately excluded the NHS from the new rules in the Procurement Bill, giving the Secretary of State for Health the powers to create regulations, resulting in untransparent closed contracts such as the £24 million Palantir contract just granted. Unlike every other public body and government department, senior NHS leaders are excluded from any restrictions when they move to providers, as happened last year when two senior staff moved to Palantir. These NHS practices are the exact opposite of what the Government hope to achieve in the Procurement Bill. Will Ministers please reconsider bringing the NHS under the Procurement Bill?

[Lord Markham (Con)]

This was a very sensible move to ensure that the tender process we are going through at the moment allows us to transition to whoever wins the federated data platform. That is a sensible way to do it. It was done according to the Crown Office pre-tendering framework agreement, which is very transparent and well set out. It is normal in these situations that, when you need transition arrangements, you do not want hospitals left in the lurch. You need a transition so that, whoever wins the new bid, hospitals are safe in the meantime.

Sodium Valproate

Baroness Brinton Excerpts

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is correct. First, the MHRA is working on guidelines which say that you must always dispense in the original packaging, come what may. In the meantime, secondly, all pharmacists should absolutely be putting leaflets in, whatever the packaging. Thirdly, everyone should have to sign an acceptance form so that they are going into this with their eyes open and understand the risks. Every year they are supposed to renew that acceptance form to make sure that, while it may be necessary in some cases, everyone goes into it with their eyes open to the risks.

[Baroness Brinton (LD)]

My Lords, in 2020 after the publication of the report by the noble Baroness, Lady Cumberlege, we had many debates in your Lordships’ House about the role of and the support for the Patient Safety Commissioner. She had not heard what her budget for the current financial year was at the beginning of May and said that, even leaving that aside, she would not be able to do her job properly. To follow the course of how patients with sodium valproate are supported and treated, she will need that resource. Will the Government review the resource needed for her to do this and many other tasks in her important role?

[Lord Markham (Con)]

My understanding from speaking to Minister Caulfield on exactly this subject this morning is that she has recently spoken to the Patient Safety Commissioner, who is happy that she has the resource that she now requires to do this part of the study.

Long Covid

Baroness Brinton Excerpts

Tuesday 25th April 2023 Lords Chamber

[The Senior Deputy Speaker (Lord Gardiner of Kimble)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely.

[Baroness Brinton (LD) [V]]

My Lords, 2 million people currently reporting symptoms of long Covid is a shocking 3.1% of the population, with over a million people having had it for at least one year. There are some very successful models for assessment and treatment, but some clinics still assume that long Covid is like ME/chronic fatigue and do not investigate for microclots and heart and lung problems. Why is there not a gold standard for assessments and treatment of long Covid in England as there is in a number of other countries, including Scotland?

[Lord Markham (Con)]

I thank the noble Baroness. My understanding is that the 90 specialist adult centres and 14 specialist children’s centres have care pathways which they are supposed to adhere to. Therefore, I hope that the instances which the noble Baroness brings up are the exception, but I am happy to investigate because I think we all agree that a consistent care pathway is vital in this space.

Gender Identity Services: Children and Young People

Baroness Brinton Excerpts

Wednesday 19th April 2023 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we have a virtual contribution from the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, in reply to the question from the noble Baroness, Lady Hunt, the Minister referred to the new GID services at the Evelina and GOSH. But the original proposals were for regional clinics in Manchester and London—so when will the Manchester clinic open? Since March of this year, the waiting list and all new referrals are being held by the Arden and Greater East Midlands commissioning support unit. There is real confusion about how this list will be integrated with the existing case load as the new services open. Can the Minister explain what will happen? If he does not have the answer to hand, please will he write to me?

[Lord Markham (Con)]

As ever, I am very happy to write. In terms of the northern hub, I mentioned GOSH and Evelina just as examples. The Royal Manchester and Alder Hey are the northern sites that will be used to provide these services. The idea is that we will have eight regional centres—but I would be happy to provide the detail on both cases and follow up in writing.

Diphtheria

Baroness Brinton Excerpts

Tuesday 18th April 2023 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we have a virtual contribution from the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, to follow on from the question by the noble Baroness, Lady Blackwood, last week the European Congress of Clinical Microbiology and Infectious Diseases published a report on the rise of diphtheria cases, noting that:

“Linked to an increase in migrant arrivals via small boat in … 2022, the UK experienced a sharp increase in diphtheria cases”.


Its report recommends that border officials and doctors should all have training on screening and identification of symptoms of infectious diseases, such as diphtheria and others outlined by other speakers. Will the Government implement this specific recommendation? Can the Minister say whether, on arrival, all asylum seekers are now offered a full health check and vaccination with doctors?

[Lord Markham (Con)]

As I mentioned, we are doing the screening. We lead Europe on this; my understanding is that no other European country is taking the extensive measures that we are. I can also reassure the House—I was speaking to Susan Hopkins on this just yesterday—that UKHSA has deemed that there is a very low risk to the general population. The uptick in cases that we are talking about is in the migrant population, and the fact that we are vaccinating 88% of them against diphtheria shows that we are on top of the problem.

Covid Pandemic: Testing of Care Home Residents

Baroness Brinton Excerpts

Monday 6th March 2023 Lords Chamber

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

My Lords, for the record, noble Lords are aware of the Covid testing business that I set up at the beginning of the pandemic. We offered testing to the Department of Health and Social Care on a not-for-profit basis. That offer was not taken up and the business never had any government contracts. I wanted to make that clear at the beginning of my answer.

To answer the noble Baroness’s question on the Covid inquiry, the team is staffed to make sure that all the information that is needed is provided. Everyone agrees that we need to learn any lessons from what happened and that all the information that is available is brought to bear.

[Baroness Brinton (LD)]

Mr Hancock denies that he rejected Chris Whitty’s advice in April 2020 that everybody going into a care home should be tested. On 19 May, I said to the then Minister in the Lords:

“The Secretary of State has repeated his claim that he has prioritised testing in care homes, yet he still repeats that testing for everyone in care homes … will be only ‘offered’ by 6 June.”


My noble friend Lord Rennard asked whether the Minister had heard the programme “More or Less” and the

“total demolition of the claim that 100,000 tests were being conducted each day”.—[Official Report, 19/5/20; cols. 1086-94.]

The following day, I said that

“Dame Angela McLean said testing had been prioritised in the NHS over care homes. Today, Justice Secretary Robert Buckland said the Government had prioritised the NHS over care homes as well.”

The Minister said that

“we rolled out outbreak testing for all symptomatic care home staff and residents.”—[Official Report, 20/5/20; col. 1177.]

Two weeks later, I said that

“a number of CCGs are still pushing care homes to take block-bookings of patients coming out of hospital without having had Covid tests.”—[Official Report, 3/6/20; col. 1417.]

We all knew what was going on at the time because we were being told by care homes and by the families of residents. Will the Government now apologise to the many families who lost loved ones as a result of the delay in getting full testing into care homes?

[Lord Markham (Con)]

It is to the regret of everyone that so many deaths were caused in care homes. That is something that I know everyone feels very deeply about. At the same time, the testing capacity was expanded very rapidly. As we know, at the beginning of the pandemic in mid-March, there was capacity for only 3,000 tests a day. At that point, the decision was made that they should go to NHS front-line staff. However, it was then rapidly expanded: on 15 April there were 39,000 tests, and by May there were about 100,000 tests a day. Obviously, at that point, the Government were able to expand the tests more fully to care homes.

Was that prioritisation right? That was the subject of the Gardner review but, clearly, the body that can decide best on whether the right decisions were made at the right time is the inquiry, with which everyone will co-operate fully.

Health and Social Care Information Centre (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023

Baroness Brinton Excerpts

Wednesday 25th January 2023 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, let me say at once that I support the digital transformation of the NHS and the use of information to enhance patient outcomes. I want to see the NHS move faster in a digital world, but it is essential that there are safeguards in place to protect the integrity and confidentiality of patient data. I say that as I look back into the history of NHS data, where we confronted a number of occasions when this did not happen. That is why this is such an important debate. I am grateful to the Minister for the assurances he has already given in his opening speech, and through him I thank his officials for the way in which they have been prepared to engage with us over the past few months, which has been very helpful.

I remain of the view that it was a mistake to bring NHS Digital, or the Health and Social Care Information Centre as it was formerly known, into NHS England, and feel that there are some inevitable tensions and conflicts in so doing. I think the review that led to this overlooked the issue of the integrity of patient information and public confidence when it suggested that the two functions should be brought together. That was legislated for; here we are now, examining some of the details.

The noble Lord has already referred to the Select Committee’s disappointment about the way in which it considered this had been done in a rushed and piecemeal manner. I have no doubt the House will want to take account of the Minister’s response. It is a pity that the full statutory guidance is not available as we debate these regulations. I think, as a matter of principle, it would have been much more sensible if that had occurred.

The core issue is that in the passage of the Bill, and a number of noble Lords who are here took part in that debate, the Government gave assurances that governance arrangements would protect NHS England from marking its own homework, with independent oversight of governance decisions under the new arrangements. The noble Lord, Lord Kamall, the then Minister, said that

“I can assure your Lordships that the proposed transfer of functions from NHS Digital to NHS England would not in any way weaken the safeguards. Indeed, when I spoke to the person responsible in the department, who the noble Lords met, he was very clear that in fact we want to strengthen the safeguards and take them further.”—[Official Report, 5/4/22; cols. 2005-06.]

Having said that, when one comes to look at the arrangements, there are still some questions and doubts that we would like to put forward tonight. I pay tribute to medConfidential, which has raised questions on how some types of data will be handled under the new regime and whether, in pursuit of efficiencies, NHS England’s handling of the data will be less transparent and subject to fewer checks and balances. I think that expresses the issue and the potential tension in a nutshell.

This was reinforced by the comments of the National Data Guardian, to whom I pay tribute for her strong involvement in these matters. In December, Dr Nicola Byrne expressed concern that, in the statutory instrument before us, there is no recognition of the need to have independent oversight. She noted that provisions to obtain independent advice from specialists and experts to advise on and scrutinise NHS England’s exercise of its data functions, which were originally included in a previous draft of the SI, had been removed. She reminded the Government that the commitments to putting the current, non-statutory provisions safeguards regarding oversight into regulations had been made by officials to the House of Commons Science and Technology Committee. I understand from the briefing we received last night that the advice received by the Minister’s officials was that it is not possible, due to the nature of the statutory instrument and the original primary legislation. It is, though, a pity.

In relation to the membership of the Data Advisory Group, the National Data Guardian referred to the arguments put forward by the department for having NHS England representatives on the group present in their capacity as senior individuals with responsibility for data access. I think they are not full members, but they will be present. The department’s argument is that that will support more efficient discussions regarding applications for data access. I can see that, clearly, officials may need to make presentations. I think it is a bit of grey area when they are members, albeit not full members, of the actual group. The National Data Guardian reiterated that moving from a completely independent group to a hybrid model could affect public trust, particularly when advice is given and decisions are made on the internal uses of data.

We need to be clear why NHS Digital had an entirely independent oversight group. It was for very good reasons; it was put in place following the 2014 Partridge review which was conducted due to concerns about the way that patient data had been shared with insurance companies. There was a huge furore at the time. It was interesting that one of the resulting proposals after Partridge was the disbanding of an oversight group which involved staff members for a new independent oversight group. A public consultation in 2015 found support for this change. This is now being reversed. My fear is that something may go wrong with patient data and the department will come back and say, “Actually, we should make this an independent function”.

We have dealt with the issue of timing, and tonight the Minister has given an assurance that the outcome of the internal review into how well the transfer has gone will be made public—that will be very welcome. I will go just one step further and say that I hope the Minister may be prepared to brief parliamentarians on this at the same time.

The noble Lord also answered a question about social care that was asked in our briefing. I think he said there would be a person from a social care field on the group, which is definitely welcome. I suggest that discussions take place with the Local Government Association and the Association of Directors of Adult Social Services to make sure that they are fully involved and supportive of this happening.

So I remain of the view, as I have made clear, that it has been a mistake to bring NHS Digital into the NHS executive. Whatever the structure, one has to build in rigorous safeguards. The key here is the integrity and confidentiality of patient data. It is pretty clear that if the NHS is to be at all sustainable, it has to embrace the digital revolution and it has a long way to go. So I am right behind the Minister in what I know he is personally seeking to do. It is just that if anything that goes wrong with patient confidentiality, the whole thing can fall down. That is why this is so important. I very much look to the noble Lord and NHS England officials to ensure that we recognise that the integrity of personal patient information is important. I beg to move.

[Baroness Brinton (LD)]

My Lords, I echo the thanks of the noble Lord, Lord Hunt of Kings Heath, for the helpful and detailed discussions that the Minister, his predecessors and officials have had with the small group of us who have been worried about this issue, even before the Health and Care Bill started its passage through your Lordships’ House. Although some of us were more expert than others, and I was definitely not one of the expert members of the group, I care greatly about the digital revolution and ensuring that patient data is kept confidential.

The noble Lord, Lord Hunt, said that he supports improving and transforming data in the NHS. That cannot come soon enough. I have said before in this House, and it is still true probably a decade on from when I first said it here, that for my monthly blood tests I have to print out, photocopy and send copies to my hospital consultant because the hospital that I go to and the hospital that processes my blood tests do not use the same data system. That is ridiculous. It needs to change.

It is a real problem, as the noble Lord, Lord Hunt, set out, that the consultation and draft statutory guidance have been rushed through. I want to set that in the same context as that to which he referred, about perhaps going at a slightly slower pace while wanting the revolution to start. That might have been helpful. Omitting organisations such as the BMA from seeing the original statutory guidance raises the question: who else has not seen it? The question is almost impossible to answer. However, the detail of how this is going to work in practice inside the NHS will be the business of all clinical and administrative staff at all levels. It is vital that it works.

The Minister will know that I have repeatedly raised concerns about patient data and how people were not consulted in the two previous patient data and care.data communications. Both had to be held back because there has been outrage from the public that they were not given the chance to understand how their data would be used. Earlier this week, the Mirror reported that Matt Hancock had talked about handing over private patient medical records and the Covid test results of millions of UK residents to US data company Palantir fairly early on in the pandemic. It had offered to hold its data in its Foundry system, clean it and send it back to the NHS. I spoke about this in the Procurement Bill because I am concerned about how data can be kept truly confidential. Regarding the GP data for planning and research, the NHS has already published its federated data platform details, which is called by the Mirror the Palantir procurement prospectus. Perhaps I may ask the Minister, as an example of transparency for the new NHS England digital processes set out, whether organisations such as Palantir that are handling data records will absolutely not be permitted to use that data—even anonymised or deidentified—outside the purposes of the NHS, other than for agreed research being used in what my noble friend Lord Clement-Jones would say, if he were able to be in his place today, was a safe haven, thereby ensuring that that patient data remains completely confidential. The Minister knows, because I have said it before, that the problem is that in the past it has been possible to identify patient data when it was pseudonymised. I want confirmation that deidentifying really means that individuals cannot be tracked down and, most importantly, that the data will not be used elsewhere or sold on.

United Kingdom: Future Pandemics

Baroness Brinton Excerpts

Monday 16th January 2023 Lords Chamber

[Lord Markham (Con)]

I agree with my noble friend that some of the lessons learned from all this are around consequences of lockdown that we had not quite imagined. Clearly, the impacts on mental health are impacting us to this day. We need to make sure that we are learning all those lessons, so that we do not walk into situations in the future where we put in lockdowns without fully considering the impact on the whole of society, including the mental health consequences. That is what the inquiry is about.

[Baroness Brinton (LD)]

My Lords, the Minister said in his earlier response that the Government were flexible and well tested, had learned the lessons of the pandemic and were using the experience of response to emergencies. Can he explain why there are over 9,000 patients currently in hospital with Covid, over half of whom have acquired it in hospital? Could he ask the Secretary of State to reinstate the mask mandate in hospital for these very vulnerable patients?

[Lord Markham (Con)]

I know that the use of masks in hospital is being debated as we speak, to make sure that we are prepared for any new eventuality. As we are aware, 9,000 beds being taken up by Covid is a response to our seeing more waves: this is something that we see each time. Thankfully, due to the vaccines and our treatments, the death rate from those waves is very much reduced, but there is still a big impact. The House is aware of the impact that it is having on us all right now: 9,000 is a big number.