Covid-19: Government’s Publication of Contracts

Baroness Brinton Excerpts

Thursday 11th March 2021 Lords Chamber

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

My Lords, with regard to the publication of contracts, the number of contract award notices that have been published is 609 out of 609. For contract finder notices, it is 892 out of 913—97.7%—and of the redacted contracts to which the noble Baroness refers, it is 792 out of 913, which is 86.7%. That is an enormous proportion of the contracts that exist that have already been published. The redaction is utterly according to Cabinet Office guidelines. I encourage the noble Baroness to have a look at them; it is remarkable how much detail there is in those contracts as they are published.

[Baroness Brinton (LD) [V]]

My Lords, the inevitable public inquiry will eventually set out the truth of what has happened with contracts during the Covid pandemic. In the meantime, given that the Urgent Question Statement says that the Government

“have always been clear that transparency is vital”,

can the Minister say how many of the private meetings that the noble Baroness, Lady Harding, held on test and trace matters were with companies or their directors or staff who won contracts subsequently?

[Lord Bethell (Con)]

I do not know about a public inquiry; that will be for others to decide. I absolutely re-emphasise the Government’s commitment to transparency. As for my noble friend Lady Harding’s meetings, I do not have a full account of them in front of me, but I remind the noble Baroness that of course she met suppliers of test and trace. That is part of her role and that has been an important part of the engagement necessary to put together a very large organisation from scratch, and she has done a terrific job in the way that she has done it.

World Health Organization: Pandemics

Baroness Brinton Excerpts

Tuesday 9th March 2021 Lords Chamber

[Lord Bethell (Con)]

I completely agree with the noble Lord. A multilateral approach is at the heart of our response to the pandemic, and I agree that we are not safe here in the UK until the whole world has addressed the question of the pandemic.

[Baroness Brinton (LD) [V]]

My Lords, the World Health Organization recommends regular handwashing as a critical preventive measure against Covid-19, but 3 billion people worldwide lack access to soap and water at home. The UK’s Hygiene and Behaviour Change Coalition responded to the onset of the pandemic with a £100 million commitment to reach a billion people, but this project is now ending. It is wonderful to have the Government’s support for this project, but will they put their money where their mouth is and continue to fund this vital project?

[Lord Bethell (Con)]

My Lords, I am grateful to the noble Baroness for her tribute to the Hygiene and Behaviour Change Coalition. I cannot offer guarantees from the Dispatch Box on its future funding, but I will inquire about the matter. As the noble Baroness suggests, it sounds like a fascinating and important project.

NHS: Pay

Baroness Brinton Excerpts

Tuesday 9th March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I start by saying how much nursing staff and all healthcare staff are appreciated, not only by the Government but by the entire public. Of course we stand by that appreciation, and there is no way that the Government have anything less than the most enormous amount of appreciation for all those who have committed so much during Covid. On test and trace, I remind the noble Lord that that is an essential service which delivers value for money and, of course, pay increases are recurring and last for a long time. However, the evidence to the pay review body is clear: affordability is a key challenge for the whole country and we wait for the pay body to review that evidence.

[Baroness Brinton (LD) [V]]

My Lords, last year, at the height of the first lockdown, we on these Benches argued that all NHS and social care staff should receive a one-off payment from the Government as thanks from a grateful nation for their tireless dedication and sacrifice. Not only have they not received this but the Government are now reneging on this year’s pay rise as set out in the NHS 10-year plan. What on earth do the Government plan to do to retain and recruit staff after letting them down so badly?

[Lord Bethell (Con)]

My Lords, I am not sure that retention is necessarily the challenge that the noble Baroness suggests. There has in fact been a 26% increase in acceptances to nursing and midwifery courses when compared to last year, and 1,290 more applications were made in 2020 compared to 2019. The truth is that nursing is a challenging job but one that many people want to take up. There is a long queue of people who want these positions because they are rewarding in many different ways. We appreciate the contribution made by nurses and the whole healthcare sector, but there is no disguising the fact that these are attractive jobs, which many people wish to take up.

Women’s Health Strategy

Baroness Brinton Excerpts

Tuesday 9th March 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, we welcome this Statement, made yesterday on International Women’s Day. We believe that the six pillars it outlines are important signals of the need to take women’s health very seriously. It is welcome that the Government want to understand the plight of women throughout the country. However, although the Statement says that this strategy is the first of its kind, that is not the case. For example, when the Government launched the women’s mental health task force in 2017, the Minister responsible for mental health at the time, the honourable Member for Thurrock, Jackie Doyle-Price, said:

“This report is a call to action for all providers, commissioners and practitioners across the health care system to drive forward the ethos of trauma- and gender-informed mental health care.”


That is absolutely right, but we have to ask: why are the Government asking exactly the same questions four years later? The three matters that I want to raise with the Minister are: the questions that arise out of the effect of Covid on women’s health and well-being; the troubling matter of breast cancer and sexual health; and the implementation of the recommendations of the Cumberlege report.

Analysis of Covid-19 data from around the world suggests that men make up a higher share than women of reported hospitalisations, intensive care admissions and deaths, but the impacts of the pandemic extend far beyond health outcomes for people who have been infected with the Covid virus. There have also been significant economic impacts from measures adopted to control the spread of the virus, and those have affected women in specific ways. For example, what support can be offered to a woman who experiences baby loss without her partner by her side?

The Statement is right to highlight the fact that black women are four times more likely to die in pregnancy or childbirth. I welcome the launch of the forum but the Government have known about these inequalities for many years. Now we need to see some actual investment and action.

Covid-19 has worsened the mental health crisis among young women in the UK. Before the pandemic, young women aged 16 to 30 had the worst mental health of any age and gender group in the population. In the last 12 months those in this same group have experienced a bigger fall in their mental health than any other. The mental health of teenage girls and young women is now a very serious health issue. This will need some investment and attention in the call for evidence launched yesterday.

I turn to the issue of working mothers and the increase in the burden of care. The Government were quite rightly criticised for their sexist “Stay at home” advert depicting women doing schooling and housework. I am very glad it was withdrawn at short order. But this is the reality of the lockdown in many households with young children. The pandemic has revealed stubbornly persistent gender stereotyping in the division of domestic labour. It has shown that men and women are not equal when it comes to unpaid childcare and housework.

Before the pandemic, women did more than 60% of home childcare. When schools and childcare closed during the first lockdown, they took on roughly the same share of the massively increased burden of additional care. Evidence from the ONS indicates that women have taken on even more of the burden of home-schooling during the 2021 lockdown. Two-thirds of mothers, compared with half of fathers, report that they have personally home-schooled their children. Half of those who have done home-schooling report that this has negatively affected their mental health and well-being.

Looking at older women, before the pandemic, those aged 70 and above enjoyed a relatively high level of mental health compared to the population as a whole. But they have experienced one of the biggest falls, far greater than that of older men. An important factor is of course that older women are likely to experience a higher level of bereavement, since older men have a higher risk of death from Covid-19. We have seen a higher level of grief following deaths, with the inability to say goodbye to loved ones. The cost of grief has received relatively little attention from economists, with some notable exceptions, but it is a very important factor in the mental health of older women in our society. The cost of grief needs to be factored into this inquiry.

Women are still being misdiagnosed in 2021, with male bodies being seen as the default body. There is a huge historical data gap in understanding women’s health needs. It is shocking that women are 50% more likely to be misdiagnosed following a heart attack, simply because their symptoms differ from those of men. The research of the government commission needs to bridge that divide.

I turn to breast cancer specifically. Almost 11,000 women in the UK could be living with undiagnosed breast cancer because of the Covid-19 pandemic, according to new analysis by Breast Cancer Now. It says that 10,700 fewer people were diagnosed with breast cancer between March and December than one would have expected. That data has to be factored into this commission of inquiry.

I turn now to women’s sexual health. Jo’s Cervical Cancer Trust said that

“600,000 tests failed to go ahead in the UK last April and May … in addition to a backlog of 1.5 million appointments missed annually.”

Thousands of IVF cycles were cancelled or postponed in the early stages of the pandemic, with many clinics then facing a backlog of patients. Again, this needs to be factored into this research.

One of the most potent symbols of how the health service fails women is that identified in the report of the noble Baroness, Lady Cumberlege, First Do No Harm. It shows decades of women being ignored and dismissed by the medical profession and all of those in it. The report talked of the

“disjointed, siloed, unresponsive and defensive”

health service not adequately recognising the needs of women over decades. Surely the best way to mark International Women’s Day would be to commit to implementing all the recommendations in that report, would it not?

[Baroness Brinton (LD) [V]]

My Lords, the warm words in this Statement regarding women’s health inequalities are certainly a start, but there is so much to do. Many of us in your Lordships’ House have been working on the Domestic Abuse Bill, where looking at access to health and mental health support for victims—the vast majority of whom are women—has exposed that there is a major problem.

Mental health has been brought into sharp relief, as the noble Baroness, Lady Thornton, has already said. But we know that it has been underfunded, and services pre- pandemic were already at breaking point. The pandemic has really exposed these shortcomings. What are the Government going to do to provide that parity of mental health services they committed to in 2015, which women in particular are finding difficult to access?

The Statement talks about women’s experiences of specific services. For pregnancy and maternity support, the pandemic exposed that, for far too long, pregnant women have been isolated and their partners not permitted to be with them. My own niece had a baby during lockdown and was not particularly well. When she went in for her weekly tests, not knowing whether she would have to stay in until the birth, her husband was not allowed into the hospital with her until she was actually in the delivery suite. That caused tension for far too long.

We have also seen that the vital role of health visitors and community nurses, which has been curtailed somewhat, is absolutely evident when they are not there. Community services for young mothers are really important, and I hope the Government will look at that.

The Statement talks a lot about endometriosis. I was diagnosed with endometriosis well over 40 years ago. I am pleased to say that treatment in hospitals has advanced considerably since those days. But what seems not to have changed is diagnosis and referral. I ask the Minister this: what support is there to train all GPs, primary care nurses and employers to recognise when women have these problems? They should not be dismissed as “a bit of a bother” because all women have a problem at that time of the month. It is not just an information issue for women themselves to recognise it. We need the professionals and the business community to understand that endometriosis is a very serious illness.

The Statement notes that

“77% of the NHS workforce and 82% of the social care workforce are women”.

They are absolutely on the front line but too often have been let down. Despite that enormous ratio of women in the workforce, there are still pay gaps—certainly at a higher level. It would be interesting to see the publication of the percentage of male and female staff at each level and for all trusts and CCGs to publish their pay gaps on an annual basis, as we ask large companies to.

We also know that a higher percentage of BAME women were at risk of serious Covid and death. This was particularly amplified for our front-line NHS and social care staff.

I echo the points raised by the noble Baroness, Lady Thornton, about caring responsibilities. It is not just about care for children who are home from school. The pandemic has brought into sharp relief the unpaid carers of adult family members. I would like to make a call out, and I hope the Minister will support me: when it is time for every one of us to fill in our census form in 10 days’ time, please will unpaid carers tick the box saying that they are carers? We need to know how many people out there are doing this. We know that the majority of them are women.

The Statement talks about issues facing women with disabilities. Yesterday, it was wonderful to see a series of tweets from disabled women about their lived experiences in our society. Some of it, especially on access to health services, was pretty depressing too.

Women with learning difficulties are also often at the end of the queue for health treatments. Ciara Lawrence, who is a Mencap ambassador, is an absolute shining example of how women with learning difficulties can get access to those services. She went for her cervical smear test a year ago. Since then, she has not only been promoting it among other young women with learning difficulties but is teaching the NHS how to work with women with learning difficulties to encourage and support them to have their tests. Women with learning difficulties also say that access to family planning services can often be harder too. Will the Government make sure that these issues for this group of disabled women are addressed?

The paper refers briefly to LBGT women, who also face particular difficulties in accessing services throughout their adult lives. What will the Government do to reach both these groups? I note that, towards its end, the Statement talks formally about working with women’s organisations, but so much will be missed if women who also have other protected characteristics—and their organisations—are not specifically asked.

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

My Lords, the noble Baronesses, Lady Thornton and Lady Brinton, have both made their points incredibly well, and I will not argue the toss about any of them. I completely acknowledge that Covid has hit women harder than men, for all the reasons that the noble Baronesses have given—I could have listed even more. Women who have worked from home have undoubtedly shouldered more of the burden and done more of the teaching, and that has led to adverse mental health outcomes. Those outcomes are a real struggle for a health system to cope with when it is trying to deal with social distancing. We have done our best, using telemedicine to try to bridge the gap, but there is a shortfall and we will have to work extremely hard to catch up. I know from my own experience the challenge that young girls in particular have felt during Covid, and the statistics confirm that.

I agree with the observation made by the noble Baroness, Lady Thornton, about IVF—it has been extremely tough. It has been hard for the HFEA to restart clinics, and there are women for whom the clock is ticking who have no other options. We have worked really hard to try to meet the practicalities of that service but there has been bad news for some people. That is felt very hard indeed.

The noble Baroness, Lady Brinton, spoke very movingly about pregnant women whose partners had not been able to be there for the scan. There are sometimes good reasons for that because the scanning equipment may be in the basement of airless diagnostics rooms where social distancing is not possible and the risk assessment is very tough. That does not detract from the fact that that has massive and distressing mental health consequences.

The noble Baroness, Lady Thornton, mentioned baby loss. There are many aspects to this. Bluntly, deaths during Covid hit all of us hard but women in particular. The noble Baroness spoke movingly of making grief an aspect of health planning; that is a good point, well made.

I completely accept the point made by both noble Baronesses that this plays into a long-term problem—it is not isolated or new. The review by my noble friend Lady Cumberlege paints a very clear picture of a defensive and siloed system that does not always do well for women; the culture is not always right and the practicalities do not always suit women’s lives and women’s bodies. The clinical trials regime has too often suited men. I will not defend every point that the noble Baronesses have made but I pay tribute to those who ran the clinical trials for the vaccines and did an enormously good job of recruiting women and getting a gender balance in those very important trials.

The noble Baroness, Lady Brinton, is, however, also right about data: too often it is skewed towards men. She mentioned in particular data about LGBT and disabled people and the importance of the census, which I completely endorse. But I know from my own work in the data area that too often our data is skewed away from those who belong to gender, disability or ethnicity minorities. The critical example—the one that is quite rightly often cited—is heart attacks, where the male symptoms are cited and the female symptoms are not. That is such a graphic and good example.

The noble Baroness, Lady Brinton, is right to raise pay gaps and representation, as is the noble Baroness, Lady Thornton, to cite the treatments for breast and cervical cancers, which have not always met the need.

I will not defend each and every one of these points. I would like to convey, however, the strong sense that we are trying to get one thing right in particular: listening. Anyone who reads the Cumberlege report, or speaks to my noble friend, will be struck by the really powerful testimony of patient groups who said that what agitated them most—more than almost anything else—was the feeling that they were not listened to. That has many effects, but two in particular. One is that we do not hear the symptoms and diagnostics: we get the health recommendations wrong because we were not listening. The emotional consequences of illness are, therefore, amplified. People feel frustrated and agitated because they can tell that they are not being listened to. We are absolutely determined to get that right.

This is a big exercise—bigger than the mental health exercise, because we have opened it up to the general public. We have had a phenomenal response, even in the day that it has been open, with more than 2,000 responses from the general public—a figure that I expect to grow dramatically.

We want to ensure that this exercise rights the wrongs because we really listen to women: we give them a platform and an opportunity to be heard and our response will be judged by whether we have truly listened to what we have been told.

I urge all noble Peers to put their evidence before the commission. We want a really good response that is truly diverse. There is always an anxiety in these situations that the groups with the loudest voice will predominate, but we are determined to make this evidence-gathering as diverse as possible. So I call on all in the Chamber to submit their evidence and encourage and enable those who have something to say to use this opportunity with vigour.

Covid-19 Update

Baroness Brinton Excerpts

Thursday 4th March 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for this Statement. I agree with the Statement in congratulating the NHS on its rollout of the vaccine, which continues to be a huge cause for optimism and hope, as does the science and research, in which the UK has played a leading role. However, we are still the country that has the third highest number of deaths in the world, at 124,000. Given the success of the vaccine and the strength of our science base, that is dismal. It must at least in part be attributed to decisions that the Government have taken or not taken, the failure of test and trace to do the job that we need it to do and the porous nature of our borders, on which we have again seen decisions taken too little, too late.

The concern about new variants means that, if the UK does not get on top of them, the valiant efforts of our NHS, our scientists and the vaccine could be terribly undermined. In January and February, cases here were running at tens of thousands a day and we were in lockdown, as we still are, because of our home- grown, new infectious variant. Nevertheless, people were allowed to fly in from abroad, bringing the P1 Brazilian mutation with them. Throughout history, epidemic after epidemic has exploited international travel. Surely it is obvious that tougher border controls should have been in place sooner.

The Brazilian variant cases arrived a month ago. They showed the problems of delays as well as the limitations of the pre-travel tests that did not catch those cases. Even now, 99% of the 15,000 daily arrivals are not covered by hotel quarantine. Most people can still travel home from the airport by Tube, train or even plane, mixing with others, as some of these travellers did, without being tested on arrival in the UK. Why are the Government still refusing to introduce additional tests on arrival and still allowing international passengers to travel onward on UK public transport? Does the Minister recognise that those gaps in the system will let more new variant cases spread? Is it also the case that there is a risk of cross-infection at airports where congestion is occurring? I understand that yesterday there were queues that lasted for several hours at Heathrow. What are the Government going to do about this? It is shocking that people are mixing, having arrived from a list of countries at risk, instead of going straight into hotels for isolation.

Of course, I welcome the progress that the Government have made in identifying the batch of tests from which that of the missing infected person came, but how on earth can a test be processed that does not collect contact details? What mechanisms have been put in place to fix that for the future? Some £22 billion have been allocated to this system, but it feels as though someone has vanished into thin air. How is the hunt for this person proceeding? Can the Minister assure us that this will not happen again?

Is there any information suggesting why this variant is spreading? The Minister might recall that John Edmunds from SAGE told the Home Affairs Select Committee in January that for every identified South African variant case, there were probably another 30 that had not been identified. Can the Minister tell the House, therefore, whether he has received any estimates of the number of unidentified cases in the wider community?

We are in a race against the evolution of this virus, so we have a long way to go. To be frank, nowhere is Covid-safe until everywhere is Covid-safe. None of us wants to yo-yo in and out of lockdown, so will the Minister guarantee that the lockdown easing will, as promised, be absolutely based on data, not dates, and that the assessment time between each step will not be compromised?

I welcome the extra surge in testing, but what is the current timeframe for genetic sequencing? How can it be speeded up? What steps will be taken to ensure that areas such as Ashfield, Leicester, Watford, Worthing and Hyndburn are not left behind when the national lockdown restrictions begin to lift, or will those places be put in localised lockdowns? Will the local authorities there be given extra resources to do more door-to-door testing and retrospective tracing? Will workplaces in those areas be inspected by the Health and Safety Executive to ensure that they are Covid-secure? Will people finally be given decent sick pay and isolation support?

On the Budget, it beggars belief that it did not include any detailed plans for the NHS. Indeed, the OBR highlights this, saying:

“The Government’s spending plans make no explicit provision for virus-related costs beyond 2021-22, despite its Roadmap recognising that annual vaccination programmes and continued testing and tracing are likely to be required.”


We know that the last reorganisation of the NHS cost £3 billion and that does not seem to have been put into the Budget either. Can the Minister explain how the NHS will catch up with the enormous backlog that has been created, as well as the ongoing pandemic-related costs? This is an urgent question.

It has also emerged that the Government appear to have delayed social care reforms until 2022, with the Chief Secretary to the Treasury, Stephen Barclay, telling campaigners that plans for sustainable improvement will only come next year. In January, the Prime Minister told Parliament that the Government would bring forward plans later this year, so will the Minister confirm whether it is this year or next year or when they actually intend to launch reforms on social care?

[Baroness Brinton (LD) [V]]

My Lords, from these Benches we, too, congratulate everyone involved in the vaccination process, including our brilliant teams of scientists, both in this country and abroad, who have been working—and continue to work—tirelessly on safe and effective vaccines for the world. We also congratulate the teams who are organising and managing the supply chains and all of those on the front line delivering jabs in arms, or supporting them to make it possible to reach the target of 20 million doses achieved this week. We will also not forget everyone working on Covid at the moment, whether front-line staff in health and social care or back-office staff who may not be visible to us but who are making sure that all these processes are working. We thank them all.

It is reassuring to hear that the second jab supply chain has been factored in, but can the Minister please tell the House if the supply chain and vaccination dose capacity is also protected for the next priority groups due to receive their first dose? This is critical to lifting lockdown.

It is good news that the clinical trials under way since before Christmas are demonstrating that the over-80s are developing good antibodies to resist the coronavirus and that this is now evident in the data. It is fascinating to see the vaccine gap in graphs, showing that there is a much steeper decline in cases in the over- 75s than there is in the under-60s. It is also encouraging to see reports that there have been very few side effects to both the AZ and the Pfizer vaccines. Can the Minister say if this information will be used to encourage those who have so far refused their first dose?

The Octave trial, funded by the Medical Research Council, is now under way, assessing whether those people with compromised immune systems are able to make antibodies. It was reassuring to read the details of this trial from some participating universities and university hospitals and I am grateful that Professor Chris Whitty was able to outline this project in a briefing to parliamentarians recently. I had understood it to be well under way already, although the press release makes it sound as if it is much more recent and still recruiting. Can the Minister say when the Octave trials are likely to publish their results, given that many people currently shielding are anxiously waiting for them?

The Statement refers to the Brazilian P1 variant and to the case of the individual who had not completed their form correctly. There has been silence over the last couple of days, and I wondered whether the Minister could update the House on the search for this individual. As I raised earlier this week, can the Minister help the House to understand why such an issue was able to happen at all? Is it correct that there are no processes in place to ensure that, as people come into the UK, border agency staff check their passports against the online forms completed in advance, so that personal details, such as addresses, are visible? The noble Lord, Lord Balfe, made it plain—as have many others travelling into the UK—that these checks are rarely made, if at all.

Is it correct that local health and resilience forums are not given any details of people quarantining in their areas? This is important to ensure that care support teams would be able to check and provide help for those quarantining if they have any concerns. That might have helped with this particular case: a traveller from Brazil feeling unwell would have had a local contact to talk to about what to do.

Finally, as we wait to see if cases, hospitalisations and deaths have reduced enough to start lifting lockdown carefully in April, can the Minister respond to the report published today showing that test and trace has barely used the check-in app data from visitors to pubs, restaurants and hairdressers, resulting in thousands of people who have been checked in not being warned that they might be at risk of infection? The report states that the Department of Health and Social Care has noted that more than 100 million people have checked into venues since it went live in the autumn, but only 284 alerts have been sent to 274 venues—not 274,000 venues, just 274. Worse, the report says that the lack of guidance for local resilience forum trace teams on how to use the data has left businesses being asked to, or volunteering to, contact customers and visitors, which is technically a breach of GDPR and leaves those businesses and venues open to potential legal challenge.

After spending £40 million on the contact tracing app, encouraging the public to act responsibly, and the department saying today:

“The NHS COVID-19 App is an important tool in our pandemic response”,


can the Minister tell us which of these statements are true? Can he confirm that the guidance given to local authority health departments on how to use the data to notify people from the app is in full compliance with GDPR legislation? Is the figure of only 274 venues receiving alerts correct—yes or no? What steps are the Government taking to remedy this before pubs, restaurants, hairdressers and non-essential retail begin to open again?

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

My Lords, I am enormously grateful for the questions from both the noble Baronesses, Lady Thornton and Lady Brinton. I start by echoing both their tributes to those involved in the rollout of the vaccine. It is a remarkable national achievement and we should all be enormously proud. My own wife was vaccinated last week, and she told me that she cried as she left the GP’s surgery—so moved was she by the experience. That is something I have heard many times before.

The noble Baroness, Lady Thornton, paid tribute to all those involved in science and research, and I absolutely agree. This has been a remarkable moment for British science. We will start celebrating British Science Week tomorrow, and I cannot think of a more apt moment to do that.

The noble Baroness, Lady Thornton, asked about the highest number of deaths. There are a number of reasons. Before I move on, I mention that today is World Obesity Day, and one of the most telling pieces of research that has come out in recent weeks is the work of PHE. We must all reflect on the nation’s health and whether obesity has played a role in Britain’s higher incidence of mortality. I look forward to reflecting on this issue more in the future.

The noble Baroness, Lady Thornton, asked directly about the decisions that the Government have made, test and trace, and the borders. Let me tackle those head on. On the decisions that the Government have made, I share with the Chamber that the road map announced by the Prime Minister has landed extremely well. It is extremely conservative. It puts school openings first, which is undoubtedly the feedback we have had from both parents and the country at large. The easing of measures for the rest of the economy and civic activity is based entirely on the data that emerges from the infection rates and will be done in a way that contains the spread of the virus.

I reassure the noble Baroness that the test and trace operation has developed remarkable capacity, and both the turnaround times for the testing and the effectiveness of the tracing have now emerged as being fantastic. The tracing of the Brazilian variant pays tribute to the effectiveness of the test and trace operation, as does Project Eagle, which has been mainly focused on the South African variant. We believe that the spread of the South African variant has been largely contained by the tracing of the Project Eagle team working closely with local authorities and infection control teams around the world. It shows what we can do with this remarkable resource.

With regard to borders, the “red list” and managed quarantine system has been stood up in an extremely effective way. The families in south Gloucestershire and Aberdeen isolated themselves, as they should have done, and the handling of their variant of concern has been professional. I am led to believe that progress is being made on tracking down our Brazilian friend, the one stray person with the disease.

In answer to the question of how someone could have a test without filling in the form, we believe that there are two ways in which that could happen. Someone could walk up to a testing site, have their test but not fill in the form properly, or they could have had the test sent to them in the post and returned it without filling in the correct form. There are lessons to be learned from both potential models, and we are communicating with those who provide tests to ensure that barcodes are put on all tests.

We have to run a risk-based analysis on cross-infection at airports and infection control within airports. We could close all airports—that could be one way of doing it—but, under the circumstances, I applaud both the airlines and the airports for putting in mitigation and hygiene measures which the CMO’s office believes will be effective.

The noble Baroness, Lady Thornton, asked about sequencing. We have stood up an enormous amount of new sequencing—30,000 samples a week is our current capacity—and we have dramatically reduced the time it takes to do sequencing. The biggest problem with that is transporting the samples around the country, and therefore we are looking at distributing sequencing capacity to the Lighthouse laboratories so that once a sample tests positive, it can be automatically taken to a plate to be sequenced at the same location. We believe that that could make a big impact.

One lesson from Project Eagle I share with the House is that door-to-door tracing is quite effective, but by far the most effective means of tracing has been intelligence-led tracing. The noble Baroness, Lady Brinton, asked about the check-in data, and this has been its power: it has allowed us to trace those who may have bumped into others in, for instance, areas of hospitality. It is not the objective of that check-in data to send out alerts to large numbers of people who may have been present in a location; it is more about empowering the forensic contact tracing necessary to track down potential connections.

The noble Baroness, Lady Thornton, asked about NHS plans. I will focus on one particular area and one of the lessons we have had from recent weeks. We have done an enormous amount to contain the spread of disease and we have seen—partly because of the lockdown, partly because of the wearing of masks, partly because of hygiene—a dramatic reduction in the amount of flu and gastroenteritis across the country. It is not an unrealistic ambition to hope that NHS resources could and should be focused on reducing contagious diseases across the piece and use the lessons from testing, hygiene and diagnostics generally to massively reduce the impact of contagious diseases. That will have huge benefits to the capacity of the NHS to combat sickness and ill health generally.

I thank the noble Baroness, Lady Brinton, for her kind remarks on the contribution of those in the back office of the NHS. I am sometimes admonished by those who say that there is simply too much white-collar, managerial wastage in the NHS. I do not accept that criticism, and the rollout of the vaccine shows the immense management muscularity at the NHS which is able to organise such a huge national programme with such efficiency and courtesy.

The noble Baroness asked about clinical trials. I celebrate the fact that the large amount of really encouraging evidence that we have had has vindicated the decision by the JCVI, the MHRA and the CMO to prioritise the first dose over the distribution of second doses and to bring in the 12-week gap. That was a wise, pragmatic and impactful decision and we thank those involved.

The noble Baroness is entirely right that the large take-up among older people will have a big impact on younger people. The most influential people in anyone’s life are the people whom they love and live with. I cannot think of a better way of marketing it to younger people than the older people whom they love and live with taking the vaccine.

I also pay tribute to Professor Paul Moss and the team at Octave who are working extremely hard on the impact of the vaccine on those with immune deficiency. As the noble Baroness alluded to, the work at the University of Birmingham is at pace. It has been going on for some months, and its impact is already being shared among professionals. I am not sure whether there is an official report planned, but I reassure her that the insight and intelligence from their work is being shared across the system.

Finally, I give enormous praise to all those currently working on our borders. The situation in other countries remains extremely concerning. Variants of concern are rising in many countries, and in Europe infection rates remain extremely high. We have put in place measures on our borders that have the capacity to protect us from these variants of concern and I am enormously grateful to all those concerned who have strengthened those positions.

NHS: Staff Numbers after Covid-19

Baroness Brinton Excerpts

Thursday 4th March 2021 Grand Committee

[Baroness Brinton (LD) [V]]

My Lords, the Government must tackle the long-term underlying problems of training clinical and associated healthcare staff in a sustained and future-proofed way. We had serious gaps in capacity long before the Covid pandemic.

During Covid, exhausted and stretched staff have doubled, or even tripled, ward capacity in a makeshift manner to save lives over the past year. We must be better prepared for the future. Will the Minister commit to increase funding for the workforce development budget and internal education? We need a flexible, nurtured, resilient workforce to face the health challenges of tomorrow and incentives to retain our excellent NHS heroes.

These issues were urgent prior to the pandemic, and this has been a contributing factor to the appalling death toll in this country. The Government must make fully funded workforce planning a central aspect of any upcoming reforms.

Covid Contracts: Judicial Review

Baroness Brinton Excerpts

Monday 1st March 2021 Lords Chamber

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

My Lords, I am grateful for the question from the noble Baroness, Lady Thornton. During those hectic days, more than 15,000 suppliers approached us. Many of them were credible, but many sadly were not. It was entirely right and the best practice to have a high-priority lane to triage and prioritise those who were the most credible. A sample of 232 suppliers in that lane reveals that 144 came from Ministers, 21 from officials, 33 from MPs and 31 Members of the House of Lords not in the Government—including many who chose to write to me personally with the names of recommendations. I am enormously grateful to those who got in touch.

[Baroness Brinton (LD) [V]]

My Lords, the Prime Minister said last Monday in the House of Commons that

“the contracts are there on the record for everybody to see.”—[Official Report, Commons, 22/2/21; col 638.]

However, the evidence questions that statement. Can the Minister say how many PPE contracts entered into in the first wave of the pandemic, up to the end of June, remain unpublished? If the number is not to hand, please will he undertake to write to me with it?

[Lord Bethell (Con)]

From memory, it is my understanding that 99% of the contracts are published and 1% are outstanding. I am happy to check that and confirm it to the noble Baroness.

Health Protection (Coronavirus, Restrictions) (All Tiers and Self-Isolation) (England) (Amendment) Regulations 2021

Baroness Brinton Excerpts

Monday 1st March 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, here we are again, discussing legislation that was presented to Parliament on 28 January and came into force the following day. Only a month later are we now debating it.

Given that the Government’s intention is to deter people from breaching self-isolation and increase compliance at a time when adherence to self-isolation is crucial, ensuring that infected individuals and their close contacts self-isolate has to be one of the most powerful tools for controlling transmission of Covid-19. If that is the case, can the Minister explain why the new £800 fines that were brought in a month ago are still not published on the Government’s guidance page under the section “if you break the rules”? How on earth can they be a good deterrent if people do not know about them? In short, these regulations are about compliance, enforcement and data sharing but frankly, it is all stick and no carrot.

The Liberal Democrats have been extremely concerned about the half-hearted nature of the approach the Government have taken to self-isolation and quarantine. As others have said, and we agree, we know that in general most people do comply and only very few deliberately choose not to. That is not the issue, as my noble friends Lord Scriven and Lady Tyler have said.

The role of the state is to encourage as well as to force compliance in public health emergencies such as this pandemic. We have repeatedly asked for these carrots to be created and made visible to the public. We know from those nations that run successful self-isolation and quarantine systems that telephone support, food and medicine deliveries and, most important, payment of the equivalent of a minimum wage are what makes them work—not, noble Lords should note, a one-off grant that is almost impossible to get, and sick pay at a level that is a joke and requires the poorest families to decide between isolation and putting food on their table. It is time the Chancellor responded to our calls, because the best way to support people and to help them follow the guidance is also the best way to keep everyone safe.

We note that the regulations increase data sharing for police, including contact details, how the individual was notified to self-isolate and the test result. Has the Department of Health and Social Care monitored whether data sharing has had an impact on people’s willingness to seek help and share their data? Can the Minister say how the data will be kept safe and secure?

May I repeat a question that I asked him 12 months ago, when we discussed the early regulations: what assurances can the Minister give your Lordships’ House that the data will only be used for the purposes of Covid regulations and that the police and any other authority will delete it as soon as it is no longer needed for Covid matters?

All of this is brought into sharp relief with the news headlines today about the travellers who arrived from Brazil last month, and the one whose test result form did not have contact details on it. Without knowing much more about that case, I ask the Minister some questions of first principle. Can a traveller evade registration or notice as they come into the country? Given the remarks of the noble Lord, Lord Balfe, that his forms on coming in were not checked, what guidance is given to border staff to check? Are any links made between the data collected from travellers quarantining at home and NHS Test and Trace, their GPs or local council via the director of public health, or are the two systems completely separate? If so, why are they not joined up? At what point do local councils and tracers become aware of someone coming in from a red country, whether directly or indirectly? Having that local contact could be vital, if a traveller were subsequently to alert key officials if they feel unwell and need a test. It makes the whole issue of support and further testing of contacts so much easier.

If the test form is not completed fully, as in today’s case, can it be checked back to the QR code for the test kit issued, either in a centre or by post, and then reverse-engineered back to small numbers of people and, hopefully, to the individual? Or is it true that it is possible to send it back without contact details and that the laboratory never checks back and queries it? If so, why is that the case? What lessons are being learned from this, very quickly, given that, once again, one of the key elements to managing this virus is putting the lifting of lockdown at risk?

The noble Lord, Lord Blencathra, suggested that the social care sector had decided to introduce a “no jab, no job” policy, and he wondered whether the NHS might follow. I thought that it was the other way around: that the NHS has vaccine rules in its employment contracts with clinicians, but the care sector has not, in the past. The care sector is now applying them to new staff, but is unable to back-date this because of employment law. More importantly, can he say what plans there are to support and encourage social care staff to have their vaccinations, as the low numbers are very worrying? Is the refusal because staff are low-paid shift workers, often without the means to get to vaccine centres, or is it disinformation about the vaccine?

Finally, like the noble Lord, Lord McCrea, I hope that this is the last lockdown, but the end to lockdown is a partnership between the people and government. Compliance is part of it, but people want and need the tools to make it happen. Can the Minister tell us if government will now do that?

Future of Health and Care

Baroness Brinton Excerpts

Tuesday 23rd February 2021 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, I thank the Minister and declare my interests as a former member of a CCG and a non-executive director of a foundation trust.

The Lords Labour health team—myself and my noble friends Lady Wheeler and Lord Hunt—are veterans of the infamous Lansley Bill, which became the Health and Social Care Act 2012. Many noble Lords will take part in the new legislation—including, of course, those on the Lib Dem Benches, who supported the Lansley Bill. I hope that they have come to their senses since then.

We cannot sweep under the carpet, as the Secretary of State and the Minister would have us do, the fact that many of us warned that the huge bureaucracies and implementation costs of something like £3 billion would be a terrible waste of public money and time. They resulted in a loss of initiatives and innovations that lies at the Minister’s door. Some indication of lessons learned would be welcome.

We are in the middle of the biggest public health crisis our NHS has ever faced. Staff on the front line are exhausted and underpaid. The Royal College of Nursing says that the NHS is on its knees. Primary care and CCG staff are vaccinating and will be doing so for months ahead. Today, we learn that 224,000 people have been waiting more than 12 months for treatment. The Secretary of State and the Government think that now is the right moment for a structural reorganisation of the NHS. It might be significant that, in the Statement, I cannot find a single explanation of how patients will benefit from this reorganisation. It is all about systems.

Apart from the timing, some very serious matters need to be addressed. This is a Conservative NHS plan, and it shows. Without the money, none of this is worth discussing seriously. Without a workforce plan funded by that money, it will not work. This Bill should not go ahead in its current breadth until the solutions for social care and public health are also set out. Although reform of the Mental Health Act is welcome, it also needs to fit into the wider solution that is missing around social care.

Why does the White Paper not include an option simply to delete Part 3 of the existing Act, thus abolishing the market and competition regimes that created the burdensome bureaucracies and which, it must be said, many CCGs and ICSs have worked hard to get round in recent times? Let us take some time to work out the rest, bring forward the promised social care reforms, let our exhausted NHS recover and have a system co-created with local government.

I suspect that the need to move powers to the centre is a poisoned chalice. Is the Minister proposing simply to dump the Lansley structures and bring back the situation where the Secretary of State has the power of direction over all and any parts of the system? Although I welcome the place-based commitment, it is woefully undefined. This plan ought to be co-owned and co-developed with local government nationally as well as locally, with real parity of esteem. Far more is needed to remove barriers, but the biggest local barrier now is the absence of any solution for social care and public health.

Looking at the NHS’s history, we should be sceptical of structural reform necessarily leading to changes in care delivery that make services more integrated and benefit patients. We know from Wales, Scotland and Northern Ireland that integrated care systems have not brought about integrated care. It is necessary to remove system barriers but not sufficient. The bigger challenges lie around culture and vested interests, which are not even mentioned in this White Paper. It is all far too complicated, with health and well-being boards and HealthWatch still in place as well as the proposed new structures. It needs a clear explanation of who controls the money. Can you have two boards at the same time and call it integrated, and be sure where the accountability sits and whether good governance can be assured?

There is little about how decisions are made on who sits on these boards. Is it proposed to bring back independent appointments commissions to guarantee the diversity required? Will staff representatives and patients have a seat where it matters? Surely there can be only one body with the power to set the local strategy and sign off the plans that bring the money. This proposal seems to have many bodies, meaning that governance and accountability are at risk. Having providers, and even independent providers, with a place in the decision-making about resource allocation is clearly unacceptable. If there are to be some contracts awarded by competition, there must be clear rules about who is entitled to compete. These organisations and companies must pay their taxes, for instance, and must offer fair and comparable terms and conditions to their workforce. For example, we know that social enterprises totally fulfil those conditions, but one must ask why we need competitive tendering when you can hand out contracts to chums from the stables, the golf course, and the pub, as we have seen in the last year.

The White Paper is silent on the future of foundation trusts, silent on the role of governors, silent on a whole range of potentially competing governance issues which will have to be resolved. How much acute and tertiary care can be brought into locality-based structures? Integration of primary, community and social care is clear, but, as everyone knows, the acute side is far more complex and a single solution, as proposed in this White Paper, almost certainly will not work. The big players such as teaching hospitals do not fit into any single locality, or even single ICS, but are vital players. Will there be extra layers of governance above the ICS, which is not defined at all?

We will of course study the legislation carefully when it is published, but the test of reorganisation is whether it benefits patients and communities, brings down waiting lists and times, widens access, especially for mental health care, drives up cancer survival rates and improves the population’s health.

[Baroness Brinton (LD) [V]]

I am grateful to the Minister for the short-notice briefing just as we were rising for recess.

If you had said to most people in the health and social care sector three weeks ago that the Secretary of State for Health and Social Care was announcing a new White Paper, virtually everyone would have assumed that it was the extremely long overdue White Paper on social care, promised by the Prime Minister in his party’s manifesto in the 2019 general election and repeatedly further promised at the Dispatch Box over the last 14 months. This Statement refers to it appearing at some point later in the year.

Instead, we have a comprehensive White Paper that focuses, despite the references to care, on the NHS and health systems, undoing some but not all of the 2012 Lansley reforms. This White Paper talks grandly of integrated systems, but you cannot integrate systems if one of the key parties is on its knees as a result of appalling neglect for many years. We agree that our clinicians, managers and associated health and social care staff have great ambitions for moving our health and care structures into the 21st century, and we compliment them, and Ministers, on their ambition, but we have been here before. A decade ago, the Government announced and legislated for a Dilnot-style cost model for social care, which, unfortunately, was later scrapped. We went from a point where all three main political parties were in agreement, but, sadly, the Conservatives withdraw from that agreement. As with manifesto promises on the care sector over the last three general elections, when will the Government start the long-promised cross-party talks to find a solution for the care sector? We remain ready and waiting.

The Statement makes the point that the pandemic has brought the structural difficulties in the care sector into sharp relief. That much is true. With more than 25,000 care home deaths, 10,000 of which have occurred since the lockdown started in January, what will it take for the Prime Minister to make good on his promise to fix social care? Why did it take weeks longer to arrange for residents and staff in care homes to get testing, whereas the NHS had reliable access as soon as it was available? Worse, the care sector’s experience of the Department of Health and Social Care taking its orders of PPE out of lorries and diverting them to protect the NHS first—which happened—and the NHS discharging Covid patients into care homes, while reassuring care staff that it was not doing that, has undoubtedly damaged trust. I do not deny that there has been a really strong attempt to get people to work cross-department, but this sort of behaviour has really not helped.

The Statement talks about making Ministers accountable again. A good step would be for the Secretary of State to come to Parliament and explain why he did not publish PPE and other contracts within the appropriate timeframe. There are concerns, too, about cronyism and possibly even corruption. So I say to Ministers: beware of what you wish for.

A further problem of the White Paper in front of us is the need to undo some of the perverse bureaucracies and expenses created by the 2012 reforms. The “internal market” was one such. I cannot see the logic of having a CCG of GPs overriding NICE and a hospital team on a medication pathway because it wants to spend the money elsewhere. The Minister told me that there will be changes and that there will be some representation from trusts, but, from what I hear, it is not enough to leave the clinicians who are expert in charge able to follow the advice of NICE.

The Statement also talks about the portrait of Sir Henry Willink, who published the 1944 White Paper from the Dispatch Box. But Sir William Beveridge’s report that led to that White Paper, and then to the post-war Labour Government’s creation of the NHS, had a clear structure. The five great evils that Beveridge, as a Liberal, set out could be tackled only by a cross- departmental approach, of which health was a vital component but not the sole driver.

When my grandfather was dean of St Mary’s Hospital Medical School, he always used to say that it took only 20 years for the NHS to move to a “national illness service”, as demand and costs in hospitals increased exponentially and any budget that was not for hospitals was squeezed. That is why, in the 2012 reforms, we in coalition wanted at least elements of public health moved to local government, where it could more effectively work with the other parts of the system fighting Beveridge’s five great evils and, through the health and well-being boards, be accountable at a local level. The examples of the excellent directors of public health during this pandemic have shown that it can and does work, despite the NHS finding it difficult to delegate to them. It is no surprise that inequality is one of the greatest predictors of serious Covid illness or death. Can the Minister reassure us that, whatever happens to public health, it will have its funding ring- fenced to tackle these inequalities?

Next week, we have the Budget, in which the Chancellor will have to face the highest levels of national debt since the Second World War. After the publication of his report, Beveridge expressed concern, saying that the Government should be bold:

“Now, when the war is abolishing landmarks of every kind, is the opportunity for using experience in a clear field. A revolutionary moment in the world’s history is a time for revolutions, not for patching.”


Now, too, is the time for such revolutions. This pandemic has left us with a health and social care system that needs not just reform but proper funding. Without it, integration and effective joint working will fail. Can the Minister assure us that there will be bold actions to ensure that any changes are fully funded? Without it, Atlee, Beveridge and Willink will be turning in their graves. Worse, these proposed reforms will fail the UK people, whether patients or just those living in their communities—the very people who need it most.

Covid-19 Vaccines Deployment

Baroness Brinton Excerpts

Thursday 11th February 2021 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, it is clear that we will live with Covid-19 and its mutations for a long time, so a full vaccination programme seems the best way to get out in front of it. Obviously, everyone was very pleased to hear the study results regarding the Oxford/AstraZeneca vaccine reducing transmission and maintaining protection for over 12 weeks. While the daily cases begin to fall, it is vital that the Government do not repeat previous mistakes and take their foot off the gas just as things look like getting better. Could the Minister update us on whether he expects similar trial data to be published for the Pfizer vaccine?

Would the Minister care to comment on the—how can I put this?—forceful comments of his honourable friend Sir Charles Walker MP on “Channel 4 News” when he accused the Government of robbing people of hope and said:

“We cannot cancel life to preserve every life”—


whatever that means? Apart from the fact that, in my own view, that sounds like a petulant child, it is concerning that these are the pressures being brought to bear on the Government, and it is to be hoped that they will bear up and previous mistakes will not be repeated.

It seems that the Government are on track towards their promise of vaccinating the top four Joint Committee on Vaccination and Immunisation priority groups by the middle of this month. That is to be applauded. Regarding data, though, I think everyone is concerned about the reports of lagging take-up among black, Asian and minority ethnic communities as well as among poorer communities. We know that these groups have been the worst affected by the pandemic and we need to get them to take up the vaccine, but I am conscious that much of what we hear is based on anecdotal stories rather than hard data at community level split by ethnicity. What data does the Minister have on that? When can colleagues get council ward level data so that they can be part of the effort to drive uptake?

As the first phase is coming to an end, can the Minister update us on the number of care home staff who have received their first dose, and perhaps what the plan is to encourage those who have not done so to take up the vaccination?

It appears that one in five over-80s in London has yet to be vaccinated; that is what the latest figures suggest. Some 78% of over-80s in the capital have had a first dose, lower than for other groups, while the figures are 83% for the 75-to-79 age group and 79% for the 70-to-74 group, so we still have some way to go in London.

When we get to the beginning of April, those who have had their first dose will be expecting and needing their second one. Can the Minister give an assurance that there will be enough supply to ensure that everyone who is due their second dose will get it?

Also, we do not want the vaccine rollout across Britain to be undermined by a vaccine-resistant strain entering the country, which the Government’s failure to secure our borders risks jeopardising—but we will be coming on to that in the next Statement.

Will the Minister say what conversations are now taking place with the JCVI and what changes might be made to the priorities of the people who will be due the vaccination? For example, will the JCVI be reviewing key workers? Data has shown that those who work closely with others and are regularly exposed to Covid-19 have higher death rates than the rest of the population. By prioritising those workers alongside the over-50s and over-60s and people with underlying health conditions, surely we can reduce transmission further, protect more people and keep the vital services that they provide running smoothly—which, of course, includes reopening schools.

[Baroness Brinton (LD) [V]]

My Lords, I start by congratulating everyone working in the vaccine sector: the scientists, still working behind the scenes to ensure that there are vaccines that will be effective against the South African and Manaus variants; those involved in the manufacture and supply chain; and all those on the front line, making sure that the vaccines are delivered into arms safely and swiftly by clinicians, with administrators, staff, the military and volunteers helping. A notable reason why the UK has been able to manage this so well has been the expertise of Professor Chris Whitty and our vaccine research community, which has so many years’ experience in epidemics, including the Ebola outbreak in west Africa.

The Joint Committee on Vaccination and Immunisation has also kept our focus on who should be protected first, and the government delivery group, led by Kate Bingham, has also done well. The numbers vaccinated in the top four priority group continues to grow and I, for one, hope that the target for next week will be achieved.

The Statement says:

“We … visited every eligible care home possible with older residents in England and offered vaccinations to all their residents and staff. That means we are currently on track to meet our target of offering a vaccine to the four most vulnerable groups by mid-February.”


However, I still cannot find the actual number and percentage of social care staff vaccinated, whether those working in care homes or domiciliary care staff providing essential support to keep people living in their own homes, so please can the Minister provide the number and percentage of social care staff who have now had their first dose of vaccine? Once again I ask: why are care staff not disaggregated from NHS staff in the published data?

The target of “offering” a vaccine to those in or working in homes is, frankly, no target at all. We know that, after Christmas, an alarming number of cases were diagnosed in care homes, which has resulted in residents and staff being refused vaccine until all cases are over in those homes. With very limited visits by families, the only way that Covid could have come in is, unfortunately, via staff, who probably picked it up from others over the Christmas break. Today, the ONS has said that one-third of all Covid cases in hospital during this pandemic have been over the past month. That is truly shocking.

Was the Prime Minister’s bold statement last year that Christmas should not be cancelled and his encouragement to allow people to mix, against all the expert advice from SAGE and alternative SAGE, worth it? How many deaths will have resulted from those cases, which could have been avoided if that expert advice had been followed earlier?

There are reports of some surgery teams arriving at care homes with enough vaccine only for residents and staff being redirected to large hubs, many miles away. This is unhelpful when staff work shifts and are on low wages, with no access to the transport needed to get to a hub. What is planned to ensure that all care home staff can be vaccinated at their place of work by their local vaccination teams?

Another bit of ONS data this week has shown that there were more than 30,000 Covid-related deaths of disabled people between mid-January and mid-November last year, representing 60% of all Covid-related deaths in that period. I remain concerned that many of those under 70 who are disabled or learning disabled and live in homes are still not on a priority list. We know that those requiring close personal care are at very high risk. The ONS data proves that. When will the Government add them to the top four priority lists?

The opening of large hubs is welcome, but they must not replace very local access to vaccines, whether through GP surgeries or local pharmacies. Worrying reports are emerging of GPs running out of supplies and being told that the large vaccine hubs are being prioritised over them. I thank the Minister for the excellent briefing that MPs and Peers had earlier this week on vaccines and possible treatments for Covid-19. The Statement says:

“This trial will look at whether different vaccines can be safely used for a two-dose regime in the future to support a more flexible programme of immunisation.”


It goes on:

“I want to reinforce that this is a year-long study, and there are no current plans to change our existing vaccination programme, which will continue to use the same doses.”


However, the green book on the vaccination programmes states:

“For individuals who started the schedule and who attend for a vaccination at a site where the same vaccine is not available … it is reasonable … to offer a single dose of the locally available product”


to complete the schedule. If safety has not yet been established, why does the green book say that potentially unsafe dosing regimes can go ahead?

The Minister is correct to say that no one is safe until the whole world is safe, and it is good that the UK has made a commitment of £548 million to COVAX with match funding to provide 1 billion doses of vaccine this year to developing countries. I hope that the Prime Minister will use his chairing of the G7 to encourage other countries to donate their share to make this happen. The examples of the South African and Manaus variants are a wake-up call to all of us that we must work as a global community to protect all people and the world’s economies from Covid-19.

[Lord Bethell (Con)]

My Lords, I am enormously grateful for the thoughtful questions from the noble Baronesses. They are entirely right to applaud the progress of the vaccine. I start by sharing some pretty formidable statistics on that. An absolutely remarkable 95.6% of those aged 75 to 79 have received their first dose. I have never seen a government statistic quite like that. It is an astonishing figure. Such a very large proportion of a target population have come forward, have been efficiently vaccinated and are now protected from the worse effects of this awful disease. It is an enormous success story. Of those over 80 years old, 91.3% have received their first dose and 74% of 70 to 74 year-olds have received their first dose. Up to 9 February, an astonishing 13,580,298 people received their vaccine. These are extraordinary figures. It will have a huge impact not just on the personal lives of those who have been vaccinated and their families but on the workings of the entire NHS. It is a massive game-changer and will dramatically reduce the amount of hospitalisation for and deaths from Covid. We are determined to take full advantage as a country of this enormous success story.

We are enormously pleased with the WHO readout on the AstraZeneca vaccine. It is exactly what we hoped for and what we understood from the clinical trials of the vaccine, and it is pleasing to see worldwide recognition that a 12-week gap between the two doses is the right approach and that the AstraZeneca vaccine is good for over 65 year-olds. I greatly thank those at the WHO who have done that. We are completely committed to the vaccine rollout and we will not take our foot off the pedal in any way.

I completely understand the point of those who are concerned about the impact of the lockdown. The noble Baroness alluded to the words of Charles Walker, who is entirely right that the lockdown has a huge impact on the economy, the public mood and particularly on those who cannot make it to school. However, the approach we are taking—a slow and steady approach of not rushing into anything—is exactly the one that will pay the greatest dividends for the economy. It is hugely supported by the general public and it will mean that, when we release the lockdown and return children to school, we can do it with the confidence that we will not have to go back again.

We are concerned about the lag in take up, particularly in black African communities. There are clearly, among the really good stories of take up, one or two areas where we are concerned. The work of the communications team on anti-vaxxers’ stories and the support we have got from social media firms has been really good across the board, but this is one area where we are enormously focused. The data is not always crystal clear, and we have not published it all yet, but this is one area where the noble Baroness is entirely right and we are very concerned.

The noble Baroness asked for reassurance on the second dose: will everyone get a second dose, and are there enough supplies in the warehouses for everyone? I reassure her and all noble Lords who may be concerned on that point that we are absolutely committed to the second dose. Everyone will get it, and they will get it on time. The supplies are in place.

The noble Baroness, Lady Brinton, asked about whether it was our policy to give a difference second dose to the first. I will be crystal clear: this is not our policy. If you are given a dose of “A” then your first dose will be “A” and your second dose will be “A” as well, and not “B.” We are looking into clinical trials that seek to understand whether an “AB” combination might be safe and may even be better. There are examples in other spheres where mixing two different vaccines can have a benign effect on the body and can stimulate a greater antibody response. We are looking at this very carefully. The COM COV clinical trial has been given £7 million to look into this. It is a long-term clinical trial and we are not expecting a readout any time soon but, if there are benefits, we will chase those down.

I completely agree with the noble Baronesses, Lady Thornton and Lady Brinton, on variants of concern. We have all been alerted to the grave danger that a mutation might have enhanced transmissibility, increased severity and escapology. Should such a variant emerge that could somehow jeopardise the Ming vase of our massive vaccination success story, we would be extremely concerned to address it. We are shortly having a debate on borders, and I shall save my comments for that debate, but I completely endorse the concerns of both noble Baronesses.

The noble Baroness, Lady Brinton, mentioned Professor Chris Whitty. To all those who missed it, I mention the presentation he gave yesterday on the investment in therapeutic drugs and antivirals, which was unbelievably impressive. We are enormously lucky to have someone like Chris as our Chief Medical Officer. Indeed, the Deputy Chief Medical Officers, Jonathan Van-Tam and the others, have all served us extremely well. I also praise others who have stepped up to public life in our time of need, including Kate Bingham and the noble Baroness, Lady Harding. They have both done an enormous public service and deserve enormous praise.

The noble Baroness, Lady Brinton, asked about disabled people. She is entirely right: there are those who are disabled or who have learning difficulties, and we are concerned about the impact of Covid on them. Many who are clinically extremely vulnerable are already in the priority level 4 and will already be in the prioritisation list. Others will be in prioritisation level 6. We are looking at whether we should change the prioritisation system in any way, and the JCVI keeps a running watch on this. I reassure the noble Baroness that all those in a high-risk group will be prioritised in a reasonable fashion. We will be reaching prioritisation level 6 very soon indeed.

The noble Baroness, Lady Brinton, talked about the importance of sharing vaccine with other countries. Tedros is absolutely right: we are not safe until everyone is safe. Britain has taken leadership role in CEPI, Gavi and ACT; we continue to support the global distribution of vaccines through our contribution of IP, our massive financial contribution and our diplomatic leadership. We remain committed to that, and we will continue to use our chairmanship of the G7 to influence other nations to step up to their responsibilities.