Covid-19

Baroness Brinton Excerpts

Thursday 11th February 2021 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, a hotel quarantine policy has been debated for months and was finally announced two weeks ago, yet the legislation underpinning the scheme has not been laid. That means that, yet again, Parliament cannot scrutinise and vote on the regulations until after they have been brought into force. Can the Minister advise the House when they will be published and when we will get the opportunity to debate them? I hope that he will be able to assure me that they will not be laid at the 11th hour, as so many other coronavirus regulations have been, which would mean that people who are impacted by this policy and need to implement it will have to get up to speed very fast indeed to make the necessary arrangements.

The UK’s quarantine policy is due to come into effect on Monday. It is exactly a year to the day since I raised this exact issue in your Lordships’ House in response to a Statement repeated by the Minister’s predecessor, the noble Baroness, Lady Blackwood. Her answer was basically that the Government would be putting the resource into dealing with quarantine immediately. A year later, “immediately” has not really happened, which is a shame. We have possibly borne the burden of deaths as a result of that, too.

It is also clear to see that there are gaping holes in the Government’s new hotel quarantine system. Figures suggest that thousands of people travelling from higher-risk countries will be missed by the scheme every day. Analysis of passenger data suggests that 10,000 passengers will arrive in the UK on Monday from countries where the South African or Brazilian variants of Covid-19 are circulating but which are not yet on the Government’s “red list”. These people—roughly 19 out of 20 passengers —will avoid hotels and ask to quarantine at home. Yet just three in every 100 people are being checked to ensure that they comply with home quarantine. Does the Minister think that that is good enough? Given that we know that the South African and Brazilian variants of the virus involve a key mutation, E484K, which may help the virus evade antibodies and render the Pfizer and Oxford/AstraZeneca vaccines less effective, the Government’s failure to secure our borders risks jeopardising the fight against Covid-19 just at the moment when it looks like we are making significant progress. So I hope that the Government will urgently review the policy and extend quarantine to all travellers arriving in the UK.

I turn to the implementation of the policy. Will the Minister update the House on the number of beds in hotel rooms that have been secured for travel quarantine measures? Can he confirm whether they are seeking to expand capacity in anticipation of extending the policy to further countries? What steps are being taken to ensure that staff in quarantine facilities are given adequate PPE? I would also be grateful if the Minister could outline what support and financial assistance will be in place to help people seeking to return to the UK from “red-listed” countries who cannot afford the up-front £1,750 quarantine cost. This is very important, given that, among the numerous categories of travellers, there are likely to be people who had to go abroad at short notice for family emergencies.

Finally, it has been announced that people found to have omitted to reveal that they have travelled from a “red list” country could possibly face up to 10 years in prison under the Forgery and Counterfeiting Act 1981. While the penalties for non-compliance are a core part of any regime, does the Minister accept that a 10-year prison sentence is really disproportionate? It is more severe even than sentences given out for some violent and sexual offences. Sir Keir Starmer has, quite rightly, pointed out that pretending judges would sentence anyone to that long in prison, in court cases that—given the current backlog—will not be heard for several years, is not going help anyone and probably will not deter anyone.

[Baroness Brinton (LD) [V]]

My Lords, the Minister is right to say that it looks as if the corner has been turned on cases, and even on hospitalisations, in this most recent surge. I too, like the noble Baroness, Lady Thornton, look forward to actually seeing the quarantine regulations being laid in Parliament. We keep asking for sight of them as early as possible. We have known that this quarantine arrangement was coming in—leaks started in December.

The BMA and other medical groups are concerned that those without GPs must have access to the vaccine. Last week, the Government announced that undocumented migrants can register with GPs for a Covid vaccine without fear of being prosecuted by the Home Office. This is good news, as we need everyone possible in the country to be vaccinated, to keep us all safe. However, the law currently requires the NHS to report those without a defined migration status. This amnesty announcement, based on the suspension of so-called immigration data sharing between the health service and the Government, is temporary, only during the pandemic. What safeguards are there that this data will not be shared after the pandemic is over? A temporary amnesty will not encourage people to come forward if their data can later be shared.

According to Ministry of Justice data, 2,400 Covid-positive cases were recorded in prisons in December—a rise of 70% in a single month. Given that the Government have a legal duty to provide equivalent healthcare to those in prison, can the Minister explain why prisoners in priority groups 1 to 4 started to be vaccinated only from 29 January?

Will the Minister answer a question I asked earlier this week without a response? There have been number of reports of Sitel and other call centre contractors having their contracts reduced by government and immediately sacking track and trace staff because, as a Sitel manager said,

“At this point in time as a business we need to reduce the number of agents because we have done our jobs.”


Can the Minister please confirm or deny that the Government have asked for track and trace staff numbers to be reduced? Do the Government still believe that test, trace and isolate remains a vital part of coming out of this pandemic, or are they totally relying on the vaccine? Everything that the scientists and doctors are telling us is that we will have to continue to take all precautions, such as “hands, face, space”, and will also need all the protection tools, such as test, trace and isolate, for some time to come, otherwise we will be hurtling towards yet more cases, hospitalisations and deaths.

That brings me to borders. On 22 January last year, alongside the noble Baroness, Lady Thornton, I asked the Minister’s predecessor what steps were being taken to monitor flights from places where Covid-19 had been confirmed or was suspected. I have repeatedly raised worries that the UK was not following either the World Health Organization advice or the actions of the CDC in America, which has resulted in many cases coming into the UK from China and the Far East and, during February, through those returning from skiing holidays in Italy, France and Austria. Every step of the way, the Government have been too slow in making arrangements to monitor passengers, whether placing them in quarantine at home or, as is now proposed, in quarantine hotels.

Some countries have learned through experience that early action at borders is vital. South Korea, Australia and New Zealand are notable examples. Taiwan should be a role model for us all. It began monitoring passengers arriving as early as 31 December 2019, and shortly afterwards created formal quarantining, both at home and in hotels, with electronic monitoring by health teams. Its Government’s clear communication with its people, providing the carrot of a support package for anyone quarantining, as well as the stick of substantial fines, has meant that a country of 23 million people had, in 2020, fewer than 800 cases, with only seven deaths. One city alone has 3,000 hotel rooms reserved for quarantining; the Government here are proposing 4,000 for the whole of the UK. And the fines in Taiwan are not small, at up to 300,000 New Taiwanese dollars—about £7,500—with one businessman who breached quarantine seven times in three days fined more than £26,000.

Taiwan’s approach is as much about self-isolation as it is about quarantine for those coming from abroad, and the view of the Taiwanese public is that everyone should do their civic duty, helped by the clarity of messaging from the Government and their medical experts. So it is a shame that our Government’s key message is all about the maximum prison sentence. We need as much of the carrot in our approach, rewarding people for self-isolation, preferably by paying their wages and by supporting them with care calls and delivering shopping and medicines, most of which has been notable by its absence to date.

Two things are clear from the worries over the new variants. The UK public want to do their duty. The vast majority of people are complying with lockdown. They also understand that the nature of Covid-19 is changing, and that new variants mean we must change the way we live too. So will the Government please make the changes that we on these Benches have asked for, for over a year, regarding borders? Otherwise, we risk losing all the progress made with vaccinations, we risk children not returning to school, and we risk further and substantial damage to our economy.

[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 the two noble Baronesses. By way of introduction, both the noble Baronesses are entirely right that the variants of concern have been a massive game-changer and the reason for this profound inflection point in our approach to border control. Having invested so much in vaccine deployment, having got it right so emphatically, having been ahead of the world in the identification, development, purchase and now deployment of vaccines, and having got so many people who were at threat of sickness and death into a position of safety, it seems entirely right that we now protect the country from mutations that might escape the vaccine by taking tough measures on the border.

That is different from the situation of a year ago: we had comparable infection rates and were all facing the same virus, which did not seem to mutate for months on end. At that point, the priority was to keep our borders open in order to keep the flow of goods, medicines and essential supplies in the planes, trains and boats that are necessary to support Great Britain. But the variants of concern have completely changed that view. That is why we brought in this new, robust and emphatic regime. It depends, in very large part, on existing legislation, but I reassure noble Lords that our plans are to bring in new regulations, where necessary, at the earliest moment. I hope that that will be very soon.

The noble Baroness, Lady Thornton, asked about international surveillance. That is an important part of our overall plan. In Britain, as noble Lords know, we have the most advanced investment in genomic sequencing anywhere in the world, by far. We are hugely investing in a great dash on capacity, turnaround times, accuracy and the geographic distribution of that surveillance in the UK. But we are also investing in international systems. We have made an open-hearted, big and generous offer to the countries of the world to do genomic sequencing for them, wherever necessary. If anyone wants to send their specimens to the UK, to the Sanger at Cambridge, we will do that for them. We are sending machines, often from Oxford Nanopore, the British diagnostic company, to diagnostic centres in countries that have some genomic capability, to enhance their testing and speed up their turnaround times.

The noble Baroness, Lady Thornton, asked about the enhanced measures we are putting in place to check when people arrive in the UK. I can reassure her massively, because the system for the passenger landing form has been digitised and hugely enhanced. We have dramatically increased the amount of validation of the data put into the PLF. The pretesting certificates are linked directly to the PLF, and we are working on linking it to the hotel booking and testing forms. We are also putting in enhanced surveillance of those isolating at home, which includes phone calls, SMSs and an increased investment in police time to follow up where there may be suspicion of a breach. We are also making a crystal-clear communication to those who have access to private jet travel that we will not tolerate those who have the resources to pay the fines but feel that they can, or want to, get around these measures.

The application of the hotel quarantine measures to all countries—both red list and amber—is something that we keep under review. There is a rolling review of the red list, and we are putting in place the necessary infrastructure, should it be required, for a blanket hotel quarantine protocol on all travellers to the UK.

The noble Baroness, Lady Brinton, kind of answered the question on the number of hotels, for which I am enormously grateful. We have currently booked 16 hotels with 4,600 rooms. However, I reassure her that this is an on-call framework, and we will have access to a massively increased number of hotel rooms if that should prove necessary.

But I have to be clear: the signal from the British Government and the instruction from the Home Office and the Department of Health and Social Care is that there should be no need to travel other than under the most exceptional circumstances. We are not trying to encourage anyone to travel, and we expect the number of people travelling to and from the UK to remain at a low level for the foreseeable future. For those who are currently overseas and seek to return but are experiencing some hardship because they were not expecting, did not plan for and cannot afford the considerable cost of the hotel quarantine, we will publish schemes to spread the payment of that to help people out.

Regarding the legislation, the noble Baroness, Lady Thornton, made a big point of saying that a sentence of 10 years was too long for a breach of contract. I remind her that Section 1 of the Fraud Act 2006 creates a general offence of fraud and introduces a number of ways of committing it, including fraud by false representation and fraud by failure to disclose information. Committing fraud is a very serious offence. Not everyone who commits their first fraud will get a custodial sentence, but if people repeatedly breach these restrictions or put the lives of others at risk, it will be up to either the magistrates’ court or, ultimately, the Crown Court to decide on the sentence. The maximum sentence is 10 years and it is quite right that it should be. The noble Baroness, Lady Brinton, made a very good point when she referred to Taiwan, which I shall mention in a moment.

The noble Baroness, Lady Brinton, asked about the data flows on undocumented migrants and the temporary amnesty. I reassure her that it is absolutely our intention to get everyone in the UK vaccinated, whatever their status. We are completely status blind when it comes to distribution of the vaccine, but we need to know who you are before we inject you with drugs—that is a basic clinical need and one that we cannot avoid.

She asked specific questions about the flow of data and whether this would be a temporary amnesty or would last longer. I do not have access to the precise answer to that question but am happy to commit to write to her on that important point.

The noble Baroness asked about prisons. She is entirely right to be concerned. We have had a terrific track record on protecting prisoners from this disease over the year, but she is right that in recent weeks epidemics have emerged in prisons. We are working incredibly hard to deploy a very large amount of testing and, where necessary, implementing isolation, and the vaccine has been rolled out to those who are qualified.

Turning to Sitel managers, I assure the noble Baroness, Lady Brinton, that we are enormously thankful to all those who have contributed to the tracing operation. We balance the workload between a variety of providers, and Sitel is just one of several that we have. There is no question of our backing off from our tracing operations—quite the opposite. Test, trace and isolate remains an important part of our armoury and it only increases. In recent times, we have doubled up on our commitment to the Lighthouse labs, which have proved cost-effective, accurate and fast. The genomics turnaround in tracking variants of concern has been remarkably efficient. On tracing and VOCs, Project Eagle is working extremely well and I saw incredibly impressive numbers on that this morning. Pharmacovigilance around the vaccine is being supported by test and trace, and the creation of the NIHP is apace.

Finally, the noble Baroness, Lady Brinton, mentioned Taiwan. Given that I am married to a Taiwanese wife, I can absolutely bear testimony to the remarkable achievement of that island nation. Taiwan was hard hit in 2003 by SARS, a time I remember well, since my Christmas was cancelled. It learned the lesson and applied important measures. The island has the advantage of social cohesion, but both the stick and the carrot were thoughtfully used, as the noble Baroness rightly pointed out. It created a green list country with a remarkably low level of infection and death, and that is a lesson we can all learn from.

The public are doing their duty and absolutely understand the threat of variants of concern. It is incredibly impressive and I am optimistic for the future.

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) Regulations 2021

Baroness Brinton Excerpts

Monday 8th February 2021 Grand Committee

[Baroness Brinton (LD) [V]]

My Lords, these regulations once again are being hurried because of their expiry date, before the Prime Minister addresses Parliament and the country on 22 February with his route map out of lockdown. I ask the Minister: what evaluation have the Government done of the tiered system and the total lockdown? Do they think that the slow decline to around 15,000 cases per day and just under 9,000 deaths per week means that it is safe to consider easing lockdown next month?

We note that the regulations make minor changes to the tiers legislation, including on elite sports competitions, the exemption to leave home to collect goods ordered via click and collect and from libraries, cafes and canteens in post-16 education centres being open, and marriages and conversions under marriage being permitted. I do not believe that these are contentious. But, as my noble friend Lord Scriven said, it is the bigger, more strategic approach to what needs to happen to unlock the “stay at home” orders that must be considered.

As my noble friend Lady Walmsley outlined, too many people still think that vaccines alone are the answer, but in the light of the spread and strength of the new variants, can the Minister say how the surge testing in the postcodes announced last week is proceeding? Are there effective results in further isolating both the South African and UK variants? Are there any indications yet about the spread of these variants that might affect the easing of lockdown?

For 11 months, we from these Benches have urged the Government to run an effective test, trace and isolate system. The need for that will be even more important as part of the route map out of lockdown, so I echo my noble friend Lady Barker’s concerns that the Secretary of State is reducing or curtailing some contracts with tracing firms, which have summarily sacked their staff. On Friday, Sitel—one of the contractors—said:

“At this point in time as a business we need to reduce the number of agents because we have done our jobs.”


But while there is some reduction in case numbers, the daily level, at around 15,000, is substantially higher than the 1,000 a day when the first lockdown was lifted last year. As the Minister said, the numbers in hospital and number of deaths remain too high.

Does this mean that the Minister no longer believes that test and trace is an essential tool? Perhaps it means that, at long last, local test and trace teams, which have always had a much better success rate at contacting people and persuading them to isolate, will be increased. Can the Minister please explain what is going on?

Last week, in a reply to my noble friend Lord Scriven, the Minister said that 86% of contacts were now being traced, appearing to show a substantial improvement. However, “More or Less”, the Radio 4 programme, reported last week that if a tracer tells one person in a house of five that they must all isolate, that apparently now counts as five separate successes. Is this correct, and does it explain the rapid increase in tracing rates for call-centre companies such as Sitel? What arrangements are in place to give confidence that everyone in any household is self-isolating after they have been asked? Can the Minister say whether this higher level of success is connected to the new way that tracing data is assembled?

From these Benches, we have repeatedly listed the key steps needed for successful test, trace and isolation, especially the latter. Those self-isolating need to be paid their proper wages, as they are performing a civic duty. The Government’s sick pay levels are pathetic, with a theoretical, one-off £500 grant that hardly anyone can access because, local government tells us, the rules are too hard and complicated. Those with dependants, such as unpaid carers looking after disabled or elderly family members who are not allowed to be in the same room for their self-isolation as those they care for, may also need particular support.

As my noble friend Lady Tyler commented, there should be state-funded places in pandemic hotels for those who cannot effectively self-isolate at home, especially when there are many other family members living in a confined space. There should also be a proper care package of support for those isolating, as in Germany and Taiwan, with regular calls to check on mental health, and to ensure that food and pharmacy supplies are getting through. Most importantly, there should be consistent, strong, clear messaging to the public every day. That would provide confidence for those who currently have to choose between feeding their families or self-isolating.

Finally, as we approach 31 March, when the emergency pandemic legislation expires, I echo the comments of my colleagues on the broader issues relating to these almost daily Covid SIs. The Government took to themselves extraordinary Henry VIII powers on the understanding that SIs were to be brought to Parliament in a timely fashion for debate. They are not. Far too often they are enacted weeks ahead of when the Commons debates them, and we have to wait a number of days before they then come to the Lords. The Government must start consultation on the renewal of these powers with both Parliament and the wider public as soon as possible. When will this happen?

Covid-19 Update

Baroness Brinton Excerpts

Thursday 4th February 2021 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for this debate on the Statement made in the Commons on Tuesday. I start by joining the Minister and everyone across Parliament and government in sadness at the death and in celebration of the life of Captain Sir Tom Moore. I also join everyone in celebrating the fact that 10 million people, 15% of the population, have now been vaccinated with a first dose. That is a fantastic achievement and I am so grateful to the NHS and all those who have contributed to this amazing national effort. Another Statement about vaccines is being taken in the Commons today, so I think we can see that this is a fast-moving world that requires Parliament to be quick on its feet to make an input and provide both scrutiny and support.

However, we are all aware of some people who are refusing the vaccine, including care workers. Can the Minister advise the House how many people in the priority vaccine groups have refused the vaccine? If he does not yet have these figures to hand, can he say when the figures, broken down by area, age, gender and ethnicity, will be available? This data seems to be crucial to understanding and tackling vaccine hesitancy moving forward. I am sure that the Minister will be aware of the research carried out by Professor Tim Spector and his team at King’s College London into why people are refusing or doubtful about the vaccine. Only yesterday there was a webinar about this. What was quite clear from that is that communication and example setting are important, and I hope that the Minister can share some of the thinking that may be going on about how to tackle this.

I turn now to the vaccination of the most vulnerable. I thank the Minister for his letter today in response to my question last week about how the bedridden and the homebound, and their carers, are being vaccinated. I would appreciate it if we could have some numbers showing how many people are in this vulnerable cohort. Only yesterday on the news we saw the example of an elderly man living alone who is recovering from cancer. He is isolated and his family are very anxious indeed that he has not yet been vaccinated.

According to recently released figures, Covid-19 deaths in care homes in the week ending 22 January represented 46% of all deaths in homes. That was the highest proportion of deaths since the beginning of the pandemic, surpassing even the previous high of 39.2% set last May. During that week, 1,817 care home deaths involved Covid-19, taking the total to more than 25,000. Gavin Terry, head of policy at the Alzheimer’s Society, said that, given the worsening figures

“staff vaccinations must be urgently prioritised along with rapid rollout of second jabs.”

The Government are being optimistic in saying that vaccines have been offered in care homes—but that is not the same as them having been taken up. Time is rolling on for older people who have not been able to see and touch their loved ones for almost a year. We all admit that this is cruel. In many ways, it underlines the dreadful inequalities that Covid has revealed in our society and its care of the most vulnerable.

If the current rate continues, the UK will be on track to have offered a dose to everyone in the top four priority groups by mid-February and to complete the remaining five priority groups in early April, when the need for the second dose begins.

The Minister will be aware of concerns as to whether medical and administrative staff can continue at the current pace for many months at a time, when many are already working seven days a week. What steps are the Government taking to relieve the pressure on staff and ensure that the pace of vaccination remains sustainable in the weeks and months ahead?

The new research from Oxford shows that the AstraZeneca vaccine is 76% effective after one dose and can reduce transmission by 67% over 12 weeks. This is fantastic news. Will the JCVI review this evidence and consider using the AZ vaccine to help prevent spread of the disease—not just serious illness and death—once everyone in the priority groups has received two doses? This would allow public health directors to speed up the vaccine rollout in more deprived communities, including among black and ethnic minority groups, and in hotspots where the disease is threatening to run out of control.

We all agree that children’s health must always be a priority. On current plans, how many teachers will be vaccinated as part of bands 5-9? How many teachers and support staff will have to wait until the period between Easter and summer to be vaccinated? Last September, it was reported that 25,000 teachers had been off sick with Covid-related illness, further disrupting children’s learning. How can the Government ensure that we do not see the same disruption again from March, when it is hoped that the schools will return? I hope that the JCVI will prioritise this as part of its review because, once schools have reopened, we need them to remain that way.

Finally, high infection rates, death rates and the identification of the South African variant in the community and the E484K mutation in the infectious Kent variant are deeply worrying. Although the noble Baroness, Lady Harding, claims that this was

“something that none of us were able to predict”,

the Minister must know that scientists have long warned of new variants as the pandemic unfolds and that the likelihood of mutations increases when there are high rates of transmission. It is more urgent than ever that this hole in our defences is fixed.

Increased testing is always welcome but will ultimately be insufficient unless test and trace is made to work for everyone. This week, the noble Baroness, Lady Harding, advised that at least 20% of people—she reckons approximately 20,000 a day—who should be self-isolating are not abiding by the rules. These figures demonstrate the need for both decent sick pay to break the chain of transmission and for test and trace to work properly.

[Baroness Brinton (LD) [V]]

My Lords, we also express our condolences to the family of Captain Sir Tom Moore. He was an inspiration and an example to so many.

The health Statement reminds us that this is HIV testing week. HIV Prevention England rightly says that the message about early HIV testing must be well publicised. I pay tribute to our Lord Speaker for his key role as Health Secretary in the 1980s in managing urgent and uncompromising messages to the public about HIV and AIDS. This Government could learn much from those campaigns about communicating clear messages.

From these Benches, we also echo the excellent news that 10 million people in the first four priority groups have been vaccinated so far. Last week, I asked the Minister whether the vaccine dashboard could break down vaccine take-up below national level. I note that this Statement says that this is happening at local health and local authority level. However, there is still no breakdown between health and social care staff. On Tuesday, the United Kingdom Homecare Association reported that only 32% of its staff had been vaccinated so far. It said that invitation to vaccinate care staff was a local lottery, with some areas having excellent arrangements, but others not. Live-in carers face even harder access to vaccines, as they are often completely left off local vaccination lists.

Further, we know that some care staff have concerns about taking the vaccine, so dialogue is vital. Recently, there was an excellent radio interview with a GP from the north-east who explained how they had talked to staff who were worried about vaccinations at the care home where they worked. Those staff were reassured and were vaccinated. Too many social care staff are just referred to large vaccination hubs with no opportunity to discuss it with a known and trusted GP. Will the Minister ensure that GP surgeries can still have vaccine doses for everyone in groups 1-4, including social care staff, so that the barriers to vaccination are tackled and removed? Please can we see the NHS and care staff separated out on the vaccine dashboard?

This Statement also raises the emerging problems with the South African variant, with further restrictions in some postcodes. These, as well as the new changes to the UK variant discovered in Bristol and Liverpool, remind us that Covid-19 is still challenging us at every turn. I say well done to the local directors of public health and leaders of councils, working with their local NHS, on their excellent speed of response and the clarity of their local messages to people in the relevant postcodes.

I have a couple of questions for the Minister. First, Ministers have said that the new South African variant problems were discussed and planned for last Thursday. So why was there not an announcement before the weekend, ensuring that affected residents could protect themselves and their neighbours as soon as the risk was apparent? Secondly, the Statement says that everyone in these areas must have a PCR test—good. However, a letter sent from the NHS to hospital staff said that no staff were to go to work until they had had the results of a PCR test. Given that hospitals already have a large number of staff off sick or self-isolating, what help are they getting to deal with further staff absences?

The Minister will remember that I have urged the Government to include unpaid carers in the priority list in order to protect those they care for. The announcement of their inclusion in priority group 6 is welcome. However, they are not in the summary lists in the vaccines delivery plan. Will the Minister commit to clear up any confusion by explicitly including unpaid carers in government communications and by publishing specific guidance on making sure that they are vaccinated as part of group 6?

Finally, we look forward to hearing the Prime Minister speak on 22 February about the route map out of this third lockdown. Progress on vaccination is vital, but test, trace and isolate is also essential if we are to avoid a fourth national lockdown. We on these Benches believe that people who are self-isolating should be paid their wages and have access to a proper care package, as in Germany and Taiwan. We have been asking for this for 11 months. The failure of people to comply with self-isolation rules demonstrates that the current system is not working. Will the Government urgently review the arrangements for isolation and encouragement to comply?

Yesterday, Chris Whitty and the Prime Minister were clear that this third lockdown cannot be lifted until it is safe to do so. Yet already MPs and some Peers are pressuring the PM to open schools immediately. Strong, clear messaging is needed every day—as strong as on the AIDS campaign by the noble Lord, Lord Fowler, 30 years ago. We know from polling data that the vast majority of people want to do the right thing. The Government’s role is to tell us what and why and to provide support for those who need help to do it.

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

My Lords, I am enormously grateful to both the noble Baronesses for their thoughtful and provocative questions. I join the noble Baroness, Lady Thornton, in paying tribute to Captain Sir Tom Moore. His story touched on something we have talked about in this Chamber this year: the way in which someone, in their 99th year, can make a tremendous impact on the whole country, bringing us together and raising money for NHS staff. It was an amazing achievement so late in life. It demonstrates that every year of every life, however late in that life it is, is valuable. That is why this Government are extremely proud of the measures that we have put in place to protect the lives of, and avoid severe harm to, the elderly and infirm.

I also share in the noble Baroness’s tribute to NHS staff and the vaccination rollout. She is entirely right; there is huge mental and social attrition across the NHS at the moment. The hard work that goes on, particularly in intensive care, is having a tough impact on those who work there. We hear of the need for some form of respite for NHS staff, loud and clear, but I have to be candid: when we are done dealing with the hospitalisations for Covid, there will be a massive wall of work to manage the huge backlog and restart business as usual. We are looking at the human investment needed. I pay tribute to my colleague Helen Whately, the Minister who covers the NHS workforce. She speaks to the NHS and social care workforce daily. We are looking extremely carefully at the investment that will be needed to support healthcare staff in the difficult year ahead.

The noble Baroness, Lady Thornton, asked about those who refuse the vaccine. I am afraid that those statistics do not exist, because people do not identify themselves as vaccine refusers. However, the overall picture is extremely positive at the moment. Those in categories 1 to 4 are stepping forward for the vaccine in tremendous numbers, and we are extremely encouraged by that. I take on board the insight of Tim Spector and others who have spoken thoughtfully about the barriers. I pay tribute to civic and particularly religious groups, which have often put vaccination sites in their temples, synagogues, churches and other religious settings. That is exactly the kind of trusted civic engagement that has led to vaccine deployment reaching deeply into communities that might otherwise have been worried or suspicious.

The challenge that we will face will be when we turn our attention to the younger. To answer the other question from the noble Baroness, Lady Thornton, we will be rolling out the vaccine to all age groups. The very good news from AstraZeneca about the vaccine being an extremely effective agent against transmissibility is exactly what we need to know, because it gives a green light to using the vaccine to avoid not just severe illness, hospitalisation and death, but transmissibility. We have to get the message across to those whose lives are not necessarily saved by the vaccine—it saves someone else’s life—that taking it is important and something they should feel trusting about and obligated to do. That will be the second phase of the vaccine rollout, and we are thinking carefully about how to do it as effectively as possible.

The noble Baroness, Lady Thornton, alluded to staff vaccination. She is entirely right about the very high number of Covid deaths in homes at the moment, and I reassure her that vaccines have been offered to every person in every home. There is an email address, which I would be happy to share with all noble Lords, for anyone who thinks that they have not been offered the vaccine. There is an absolute backstop for anyone who thinks that they have been overlooked or have missed out. We are doing our level best with an effective deployment and rollout programme to ensure that all social care homes, whatever their status, and all staff in them are protected by the vaccine.

I will say a word about schools and teachers. I completely support the views of the noble Baroness, Lady Thornton, and many other Peers who have spoken thoughtfully and emotionally about the importance of getting schools back. The Government and I agree that this is our priority. I spoke to the Schools Minister, Nick Gibb, about this yesterday. I pay tribute to the work of the Department for Education in rolling out testing in schools. Either today or very soon, we will have had the millionth test in schools, which is a great tribute to the work that schools, teachers and the DfE have done on asymptomatic testing in schools. It is an important way to cut the chain of transmission and to protect all those in schools, from both the disease and being agents of transmission to those who are more vulnerable. I support all the measures on social distancing, PPE and testing that we can put in place to keep schools open.

When it comes to vaccinating teachers, I emphasise that saving lives and avoiding severe harm is the priority for the vaccination programme. While we are sympathetic to teachers and will definitely have them on the prioritisation list, the protection from harm and death is our current priority.

We take the news on mutations from South Africa, Brazil, California, Kent and Bristol, and all the other manifestations of mutations, extremely seriously. The noble Baroness, Lady Harding, spoke about not expecting a mutation, but of course it was not the virus mutating that was not expected—that is commonplace. The CMO spoke about that impactfully and early, in February and March; he utterly predicted that mutations would lead to a second wave. But the virus had not mutated much last year. In fact, it was a phenomenally rigid and consistent virus for a long time. What was not easy to predict was that a highly transmissible disease would emerge that completely outperforms its previous classic manifestation. We saw that only when the infection rates started to climb extremely quickly. We changed our tack accordingly, and we continue to change our tack.

As I have said from the Dispatch Box previously, we are in a different game now. Previously, the focus was on keeping a lid on infection rates and getting the prevalence levels low. That remains an important feature of our battle against Covid. On the other hand, we have to protect the vaccine. We are aware of the potential for a mutation to emerge that escapes the vaccine. That has been seen in other diseases and could be seen in this disease. That is why we have mobilised Operation Eagle to track down the South African variants that have landed in the UK, where we do not have a clear chain of transmission. That is why we are going door to door, offering PCR testing to all those—around 10,000 people—in each of the relevant postcodes, to put a lid on any community transmission. That is why we have deployed a special team, tracing variants of concern, which is tracking down the origins of each infection to stamp out and suppress variants of concern, where they emerge.

This is exactly the kind of capability that we need to put in place should a highly transmissible vaccine-escaping variant manifest itself. I pay tribute to those in test and trace who have put together this capability extremely quickly and are implementing it so thoroughly.

Both the noble Baronesses, Lady Thornton and Lady Brinton, alluded to the important issue of isolating. I hear those points loud and clear. We support those who are isolating, and make a £500 payment to those on benefits, who need it. Charities and local authorities support those who isolate. But I hear the point made about additional measures, and we are looking at further ways to support those who are required to isolate, either because they are infected themselves or because they are the contact of someone who is infected.

The noble Baroness, Lady Brinton, spoke thoughtfully and movingly about the role of the Lord Speaker in fighting HIV and AIDS, and I join her in paying tribute to the Lord Speaker, whose 83rd birthday was earlier this week. The messaging in that campaign was poignant, it cut through and we all remember it very well.

I also pay tribute to those in the communications team who have, during the last year, put through some incredibly impactful campaigning around the Covid messages. There has been massive societal behavioural change because of the clarity and the impact of the campaigns that we have done. Those campaigns have got better and better, and the most recent “look into my eyes” campaign, as it is now called, is one of the most impactful. When we look back on this campaign, we will think very highly of the marketing and communication skills of those in the Department of Health, the Cabinet Office and other departments, who have worked so hard in this area.

The noble Baroness, Lady Brinton, alluded to the vaccination of social care staff. She is absolutely right to allude to lists. One of the current difficulties is that we do not have proper lists of all those who work in various roles in social care, either as domiciliary staff or in unpaid roles. My colleagues are looking at this, and we are moving quickly to address it. I know that the noble Baroness feels very strongly about the vaccine dashboard; I have taken it back to the department and spoken to the vaccine team about it and I will raise the matter with them again. Regarding the unpaid carers and the delivery plan, I will take that to the department again. I will be happy to write to the noble Baroness.

International Year of Health and Care Workers

Baroness Brinton Excerpts

Monday 1st February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Baroness makes a completely fair point. Her observation is entirely right and her recommendation is one that the Prime Minister has made clear is part of his thinking. Social care workers have done a phenomenal job during this pandemic. Their role in supporting the elderly and infirm is extremely valuable to the whole country. It is only right that they should be treated fairly; a review of their pay and circumstances will be part of the social care package when that is announced.

[Baroness Brinton (LD) [V]]

My Lords, the WHO notes with concern the increase in international health worker migration; there are also concerns about their workplace treatment in their host countries. The 14% of brilliant non-British NHS staff are essential in holding up our healthcare systems, as has been especially evident during this pandemic. Last week, there were worrying press reports that hospital trusts were telling non-UK NHS staff without NHS numbers that they were not eligible for the Covid vaccine. Please, can the Minister say whether all NHS staff are eligible for the vaccine—and if he cannot, will he explain why not?

[Lord Bethell (Con)]

I take this opportunity to confirm to the noble Baroness that all NHS staff qualify for the vaccine. I would be very grateful if she could communicate to me any incidents where an NHS trust has said otherwise. We are enormously grateful in this country to all those who migrate to support our social care services. We are profoundly grateful for those efforts, and I want to ensure that everyone is treated well in their workplace. Generally, those in the social care workplace are treated well; there are exceptions, and we crack down on those exceptions extremely hard.

Social Care Funding (EAC Report)

Baroness Brinton Excerpts

Thursday 28th January 2021 Grand Committee

[Baroness Brinton (LD) [V]]

My Lords, I declare an interest as a vice-chair of the Adult Social Care APPG. This has been an excellent debate on an excellent report, and almost without exception everyone has said that they support virtually all its recommendations. Those who have had issues have had one or two specific points only. But here we are—again—in another year with yet another debate where we discuss the scandal that is the funding of social care in this country.

In fact, this problem is more than just four or five years old. Twenty-five years ago, when I was a member of Cambridgeshire County Council, there was cross-party agreement that the social care funding system was in deep trouble and needed urgent reforms. Sometimes it really does feel like Groundhog Day. However, this report provides a megaphone to government by expertly identifying the urgent issues facing our social care system. It has made a series of excellent recommendations that have received broad consensus across the parties, and even across the sector.

This debate has also demonstrated that the problems are well known and, in policy terms, much has been done to start to address them. Along with other parties, so ably listed by a number of Peers including my noble friends Lord Razzall and Lord Campbell, and the noble Lord, Lord Young of Cookham, we note that the Conservatives had reforms to social care as key manifesto promises in 2017 and 2019, yet here we are still waiting for even the first and most basic of initial announcements. Why are the repeated calls of this House, the Commons, the sector, residents and their families still falling on deaf ears? I urge the Minister and this Government not to start from scratch again with further prolonged consultation or a Green Paper. What we need now, as my noble friend Lady Tyler said, is action and a White Paper which truly addresses the unfair way in which social care is funded and provided.

The comparison has already been made this afternoon between dementia care and cancer care; it is always worth repeating to demonstrate the total unfairness. Worse than that, the noble Baroness, Lady Browning, just mentioned the case conferences where the NHS and social services are at loggerheads about deciding whether something is personal care. I have witnessed this myself when sitting in on a meeting where a discussion about incontinence was whether it was actually due to the dementia, in which case it would be personal care, or due to osteoporosis and a crushed vertebra, in which case it would be nursing care. This is ridiculous. One of the problems with the current system is that it pits one part of it against the other, and that should end.

The founding principle of our much loved NHS is to provide care that is free at the point of use and ensure that no one is bankrupted or pays catastrophic costs for their care. This principle must also apply to long-term care. We need to revisit and update the Dilnot commission to make sure that the amount people are expected to pay out of pocket is capped with, as the report says, the cost shared between the public purse and the social care user.

The pandemic has rightly drawn attention to the plight faced by our social care workers, and I very much agree with Sir Andrew Dilnot’s evidence to the committee. He said:

“It is easy to neglect how wonderful the people providing this care are and, by and large, they are fabulous people working in circumstances that many people would not find desirable.”


During the first lockdown, we saw evidence of care workers leaving their families and going to stay in care homes for its duration to look after and protect their residents. That is the sort of commitment we see from the workers, so it is wrong that social care staff are not regarded in the same light as NHS healthcare staff. There needs to be a complete attitude change, in government and more widely, about the workforce: their supply issues, their pay levels and parity of investment, treatment and esteem between the sector and the NHS. I believe there should also be a royal college for social care to confirm their status and develop best practice, and to raise the esteem of social care workers.

As the noble Baroness, Lady Pitkeathley, outlined, unpaid carers face a really difficult task and this past year, particularly, has been a major problem with the pandemic. These carers have to navigate ever-changing, complicated government guidance to care for those they love, while facing increased anxiety as there is no one to take over if they fall ill or have to self-isolate. Unpaid carers must be part of the conversation on social care reform. Currently, there are just under 1 million full-time carers, relying on the carer’s allowance of just £67.25 a week. It is the lowest benefit of its kind. What does that say about how we value this sacrifice and commitment as a community? Raising the carer’s allowance would certainly be a start. However, it is not sustainable for mostly female, unpaid carers to continue to hold up the care sector with their free labour. We need to take the report’s recommendation and restore access to local authority funding to ease the pressure on friends and family carers.

I add here a brief word about young and child carers. Their education often suffers and although there are things in legislation about it, they are not universally applied. These young people need that support because they face a real difficulty in trying to manage caring for their relative as well as their education. I applaud local government, where some councils have extremely good young carers’ groups, whose work should be spread across the country as good practice.

As well as funding and support, we need to start being innovative in our approach to social care. This means thinking about how we could enrich lives and our communities and not regard those who need care as perhaps a burden. Schemes such as the Humanitas home in Holland, where university students are offered free accommodation in exchange for volunteering with residents, demonstrate how we can look across sectors to find inventive solutions to societal issues. Good adult social care can transform lives and, in turn, prevent mental and physical ill health, providing savings for the National Health Service in the long term and, most importantly, improving the quality of life for all the residents, whatever their age. Those Dutch university students said that it transformed their views about what they wanted to do in their future lives.

Working-age adult social care patients were mentioned by my noble friends Lady Jolly and Lady Tyler, and the noble Lord, Lord Forsyth. They all made the vital point on adult social care being about so much more than the elderly. That those with long-term disabilities and learning disabilities are treated as if they are in the same category as those who have perhaps led a full life must be remedied sooner rather than later. A fair system would recognise that they are different to those who have had the advantage of 40 years’ working.

Finally, many noble Lords have demonstrated that the impact of the pandemic has laid bare the perilous financial position of our care sector. Let me be clear: I am not referring just to the emergency short-term funding via local authorities, which has been vital. The pandemic has exposed the imbalanced relationship between the NHS and the care sector, demonstrating the need for the long-term financial commitment required to fulfil the recommendations of this report. I am referring to the paucity of local authority funding—not the fault of local authorities, because their own funds have been cut so badly, as so well outlined by my noble friend Lord Shipley—for those who cannot fund their own care. This results in even higher barriers to access local funding, as the boundary below which you cannot get funding is raised higher and higher.

As for the care providers, they have faced extraordinary increases in rising insurance premiums and exclusions, and insufficient clinical indemnity. I note that the Government have come in to help on indemnity, but only until the end of March. Please will the Minister look at this and address it? Care homes are already overwhelmed and it is not as if they are going to solve this in the next six to eight weeks. Although the Government have introduced that cover, it does not provide the broader indemnity required after the pandemic to put homes on a parity with the NHS in future. Worse, the future viability of some care homes is at risk, with staff shortages causing reductions to capacity, not least as a result of workers leaving the country following our Brexit. Beds are not being filled because people are reluctant to go into homes after the high death rate in the first lockdown. The big warning, though, is that any future pandemic preparedness must take into account the impact on the social care sector, with clear guidance on how to protect residents and those requiring care.

What do we think has been the impact of the two years of inaction since the committee’s report was published? How many individuals have not had access to the care they need, or been bankrupted to pay for care? How many individuals have reached a crisis point and put pressure on our NHS in its time of crisis, as they have not had access to appropriate community care? This excellent report makes it clear that the time for action is now. Will the Minister please make sure that happens?

Covid-19: Vaccinations

Baroness Brinton Excerpts

Wednesday 13th January 2021 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, I thank the Minister for allowing this Statement to be taken. This is a challenging moment in the handling of the pandemic. We have growing infection rates; we are in lockdown; businesses are shut; schools are closed. Tragically, more than 80,000 people have already lost their lives to this awful virus. However, the vaccine provides us with a light. It is a glimmer of hope; a way to beat the virus, save lives and get us back to normal. I congratulate the Government on investing in multiple vaccine candidates —that has definitely paid off. But a vaccine alone does not make a vaccination programme. Given the Government’s record with test and trace, and the procurement of PPE, it is right that the Minister will face many questions about the delivery and implementation of the vaccine programme.

The plan that has been launched is quite conventional. Aside from big vaccination centres, it uses traditional delivery mechanisms, operating within traditional opening and access times. If the Secretary of State’s target for the number to be vaccinated is to be reached, exceptional circumstances call for an exceptional response. Why did the Government believe that 24/7 access is something that people would not be interested in? What is that view based on? However, I see that, in a characteristic U-turn, Prime Minister Boris Johnson has said today that the coronavirus vaccine programme will operate 24 hours a day, seven days a week, “as soon as we can”. What does this actually mean? When will the details of the plan to provide this service be published? The Secretary of State has said that the only limiting factor on the immunisation programme will be the speed of supply. Can the Minister confirm that this plan will receive the supply which is needed?

I think we can all see that the logistics of vaccinating a nation are huge, and we now hear many anecdotal stories about the reliability of supply, the organisation of vaccination, cancelled appointments and uncertainty of supply. On 17 December, I asked about the inoculation of our NHS staff, as it seemed obvious to me that, if we did not give vaccines to those dealing with the most sick Covid patients, and given the spike we are now experiencing, we would find many of our precious NHS staff becoming ill—as indeed we have. We are now experiencing the consequences. We are currently missing around 46,000 NHS staff for Covid reasons. When will all our NHS staff have been vaccinated?

What consideration has been given to vaccinating patients who are going to be in hospital? I am thinking, for example, about maternity services. Has it been considered that expectant mothers, and those who have just given birth, should also be vaccinated?

London currently has by far the highest rates of Covid in the UK, yet it is receiving fewer doses of the Pfizer and Oxford vaccines per head of population. Will the Minister commit to providing those desperately needed additional supplies urgently?

We are all reassured to see pharmacies included in the plan. They are at the heart of the communities of our country. They are trusted and are all ready to deliver mass vaccination. It is slightly odd that the number being trailed publicly is of 200 participating pharmacies, given that there are in fact 11,500 community pharmacies in England. Can the Minister clarify whether that is right? Why are not more involved, or is that number wrong? Can the Minister share with us what the number is?

On social care, it seems that about 23% of elderly care home residents have been vaccinated compared with 40%—which is brilliant—of the over-80s. Given their top prioritisation, can the Minister tell us when all care home residents will have been vaccinated? Will it be the end of the month, as has been promised?

When is it likely that our school and nursery staff will be vaccinated? I can see that the prioritisation lists are difficult and demanding—there is huge demand on this vaccine—but if we are to return to any semblance of normality, we need to get our children back to school.

[Baroness Brinton (LD) [V]]

My Lords, I welcome this Statement on the on the vaccine strategy and rollout, which we have been asking for from these Benches, in both Houses, since before the first lockdown. The Government have rightly set themselves stretching targets and we agree with them, especially in the light of the new variant’s high levels of transmission. The news this week of the severe problems that our NHS is facing across the country shows how out of control the virus is at the moment. Individuals must comply with the spirit and the rules of lockdown to help to reduce cases as soon as possible.

The Prime Minister has talked repeatedly about a vaccine signalling the end of the pandemic. I fear that lax messaging about the hope that vaccines bring is hampering the message about lockdown. It is a relief to hear in this Statement a more measured tone about this being a staging post in a long journey. Please can somebody tell the Prime Minister? The Minister will know that epidemiologists repeatedly make the point that we are a long way from life returning to normal. I note, for example, that in the debate about the vaccination priority list, the advice to clinically vulnerable people from government is that, even after their vaccine, they must remain shielding until told that it is safe for them not to shield.

On supply, we remain concerned that the Government will struggle to reach 2 million a week by next week—mid-January—given the numbers of vaccines being delivered this week. We are also receiving reports from GP surgeries of fewer doses arriving than ordered or, worse, short-notice cancellation of orders causing administrative chaos for already hard-pressed administrative surgery staff. While the opening of super vaccine hubs is welcome, can the Minister say why the hubs are vaccinating only during the day? If it is truly a priority to vaccinate as many people as possible, arrangements should be made for close to 24/7 delivery. I hear that, in the last hour, the Prime Minister has announced that the Government will try to start a pilot of some 24/7 hubs as soon as supplies permit—but how soon is soon? What are the vaccine supply pinch points? It is clear that targets are already slipping. This week, the target of 2 million a week has moved from mid-January to the end of January, and it is now the end of March instead of the end of February for the top five priority groups. Is this for the supply of all three approved vaccines, or just the AZ vaccine, where there is a much larger order to be rolled out with more substantial delays if there are supply pinch points? Also, it is because of a shortage of glass vials, or vaccine manufacture and regulation checks?

What are the Government doing to ensure that vaccine hubs are not superspreader locations? There have been worrying reports about people being asked to change masks and sit and wait less than two metres away from other people in the vaccine hubs. Given that the first five priority groups are all high-risk people, the last thing the NHS should be doing is encouraging them to go to areas that do not follow the government guidance on “hands, face, space”. Inevitably, there are glitches with any new process. We are still hearing of problems with the Pinnacle IT system that is being used for vaccinations. Some hubs were resorting to pen and paper in despair, and there are further problems reported with patients being asked to give the same detailed answers to a group of questions about Covid symptoms and allergies as they arrived, as they were registered and then as they were being given their jab. Any effective IT system should enter that information once. IT delays are reported as causing major delays, queues outside centres and daily targets missed at hubs. Can the Minister say what is being done to remedy these problems?

Can the Minister also say whether the vaccine dashboard will separate out the number of care home residents vaccinated? I see that care home cases are increasing again, which we deplore. As earlier this year, we strongly object to Covid patients being sent from hospitals into care homes, unless they are specialist Covid-designated units separated from other non-Covid residents. Even better would be to follow the example of Southampton hospital, which is using local hotels as step-down facilities. Will the Government endorse this and ensure that care home patients are kept safe through this surge until they are vaccinated?

The Government have announced that fewer than 1,300 surgeries and pharmacies are approved to deliver vaccines. The large hubs are all in urban areas. What will the Government do in rural areas, where elderly people do not have access to transport and may have to travel considerably further than the 90-minute journey for vaccinations announced this week? Are there plans as yet unannounced to increase substantially truly local-level provision, at a high-street level, in every rural village and small town—whether at a local surgery, pharmacy or visiting mobile vaccination unit—to ensure that vulnerable people who cannot travel or take the risk of infection will get access to the vaccine? It is not good enough for the Government to say that vaccines have been offered if the patients concerned cannot get to the vaccination delivery point.

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

My Lords, I am enormously grateful for the detailed questions from the noble Baronesses. In particular, I endorse the words of the noble Baroness, Lady Thornton: it is indeed a remarkable achievement to have invested in such a broad array of candidates and to have purchased such an enormous quantity of doses—367 million. This is indeed a profoundly important step by the Government and one that we should celebrate and take pride in.

However, I acknowledge the searching questions from the noble Baronesses, so let me try to cover as much ground as I possibly can. The noble Baroness, Lady Thornton, asked about the digital backbone. This is absolutely critical to vaccine delivery. In many ways, injecting it into arms is the simple bit. Capturing the records, getting the invitations out right and the process of establishing identity are absolutely critical; in any project of this scale and complexity, that is where the problems are most likely to happen. That is why I pay tribute to colleagues at NHSX, NHS D, Test and Trace, PHE and elsewhere in the NHS who have done an amazing job of bringing together patient records around the nation to ensure that the invitations are sent out promptly and accurately and that the records are captured correctly. That information will be absolutely essential to both pharmacovigilance and the policy assessment of key issues such as transmissibility and efficacy. It employs the yellow card system to spot adverse incidents, and all data will go straight into the GP record, which is profoundly important when it comes to the research and analysis of the rollout of the vaccine. These may seem like prosaic details, but it is the most enormous digital achievement and one that will have an amazing impact on the health of the nation. I enormously encourage everyone in the country to ensure that they know their GP number, that they are properly registered with their GP and that they respond to any correspondence about the vaccine.

The noble Baroness, Lady Thornton, characterised the vaccine rollout as “traditional”. Can I just push back gently on that suggestion? There is nothing traditional about the sheer scale of this rollout, or about its speed and complexity. Our approach has been to work through the NHS, and from that point of view it might seem traditional, but I reassure noble Lords that not only is the latest technology being used but there is also the complexity of the collaboration between all the different parts of government—the Army, the NHS and PHE. Every single relevant part of government is being employed in this huge task, and it is something we should be enormously proud of.

The noble Baroness, Lady Thornton, asked about the supply figures. I am pleased to tell her that AstraZeneca has confirmed that it will be supplying 2 million vaccines a week. That is an enormous sum and it will mean that we can hit some really ambitious targets. Some 14.5 million people will be vaccinated by mid-February. Those are in categories 1 to 4, which includes care home residents and residential care workers, and they represent 88% of the mortalities in hospital. That will be transformational to the resilience of our healthcare system and to our approach to the pandemic. Some 17 million further people from categories 5 to 9 will be vaccinated by the end of spring, and all adults over 18—52 million of them—will be offered the vaccine by the autumn. That is a massive achievement.

The noble Baroness, Lady Brinton, quite rightly emphasised that this does not change absolutely everything overnight. She asked, quite reasonably, about schools and workplaces. I can confirm that there is still a huge amount to do by the entire nation to ensure that we do not have high infection rates, that we still deploy testing in order to break the chains of transmission and that we understand how to keep infection down—because the tragic thing about this awful virus is that it hits the old and infirm, who can be protected by the vaccine, but it also hits the young. It has become very clear from recent hospital admissions and from our growing understanding of long Covid that this disease hits all parts of society, and although we will have the most afflicted vaccinated by the spring, this is still going to be a societal challenge for months to come.

The noble Baroness, Lady Brinton, mentioned the letters to those shielding, which suggest that people should still remain shielded. That is a really important point and one we have to resolve, because those who are shielded who may go out into the community can themselves still be vectors of transmission. Those very people who we have done so much to protect may themselves be transmissible. Therefore, people are going from being protected to being potentially dangerous to others, and this is going to be a mind shift that we will all have to go through.

The noble Baroness, Lady Brinton, asked about GP surgeries. I acknowledge her point. There have undoubtedly been stories of GP surgeries which have set up queues of people to be vaccinated and then there has not been a delivery of the vaccine. However, I reassure the Chamber that it has been a very small minority. More than 95% of vaccination deliveries have happened on time, and in the grand scheme of things I take the view that if some GP surgeries have stood people up and asked them to come back another time, that is a small price to pay to ensure that the greatest number of people can be vaccinated as fast as possible.

The noble Baroness, Lady Thornton, asked about London. It is true that if we look at the infection rate, London has a relatively small distribution of the vaccine, but we are a young city here in London, so it makes sense that we have a lower proportion of vaccination. There are 2.8 million people who are more than 80 years old in the country. Not many of them are found in London, which is why the London figures look as they do.

On pharmacies, I reassure all noble Lords who have asked me about this that my colleague in the other place, Nadhim Zahawi, is incredibly energetic in engaging pharmacy chains and community pharmacies. It is true that we have a pilot with hundreds of pharmacies already running in it, but it is very much our intention to work closely with pharmacies to deploy the vaccine. As noble Lords know, vaccines come in plates of 1,000. It is much easier to deploy those plates in large centres than in small ones. We are working extremely hard to break those packages down into smaller groups and to get those groups into smaller locations but, quite reasonably, in order to get the vaccine into the most arms possible, we are starting with the big centres.

The noble Baroness, Lady Brinton, asked me about hygiene management in the distribution of the vaccine. She is entirely right: if you have a small room, such as a GP surgery, and you have a large queue of people, it is going to be extremely difficult to keep them all separated. That is why the development of these seven massive distribution centres in such places as the ExCel and Millennium Point in Birmingham is such an important development, because there is the space to be able to move very large numbers of people safely through the process. They will have a huge impact when they are opened next week.

On 24/7 vaccination, I am pleased to say that the Prime Minister has made an announcement on that. I must share with noble Lords that there has not been an overwhelming consumer demand for vaccinations at 4 am, but we are going to try this out as a process, and if there is indeed a big demand for late-night vaccination, then we will step up to the opportunity.

I was asked about rural distribution. Yes, it is incredibly important to get through to rural communities, particularly as many of the elderly and infirm can be found outside the city centres. I reassure noble Lords that, before very long, we will have vaccination centres within 10 miles of all communities. The noble Baroness, Lady Brinton, is entirely right to say that there will be some people for whom we have to take the vaccination to them; we cannot expect them all to drive to a vaccine centre. Provisions are being made through local health authorities in order to ensure that that is delivered.

Covid-19: Vaccine

Baroness Brinton Excerpts

Tuesday 12th January 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Lord is entirely right: the second dose is important. However, it is important not for efficacy but for durability. We have put in substantial data provisions to record every single dose into every single arm, and to put a follow-up dose into exactly those arms. We are using the NIMS system and every single vaccination is put into the GP record. They will be tracked down extremely diligently for exactly the reasons that the noble Lord describes.

[Baroness Brinton (LD) [V]]

My Lords, a number of scientists have expressed concerns about delaying the second dose of the Pfizer/BioNTech Covid vaccine. On the excellent Radio 4 programme “How to Vaccinate the World”, Professor Sir David Spiegelhalter said that, as the RNA technology used is new, there is less data to give confidence on spacing. But he suggested that, given a number of people have received their first dose, now is the perfect time to do a small randomised research trial on comparing those receiving their second dose at 21 days and others receiving it at 12 weeks, which would then perhaps give more confidence. Is that happening?

[Lord Bethell (Con)]

Who can hold a torch to Professor Spiegelhalter and his analysis of the data? Although I did not hear him, I completely welcome his comments. I reassure the noble Baroness that enormous efforts are being put into the pharmacovigilance around this vaccine. Some of this is of a clinical and scientific nature, and it takes a while to read out. We have therefore put in parallel systems to get an early read-out on exactly the kinds of questions that she has asked.

Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020

Baroness Brinton Excerpts

Thursday 7th January 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, the Minister has outlined the severity of this third wave of coronavirus and, with over 1,000 deaths yesterday, it is now all too evident in large parts of the United Kingdom. But I disagree with him, along with my noble friend Lord Greaves, about whether this is less serious than in March. The signs were all there well before Christmas and once again SAGE, with other medical and scientific experts, as well as politicians of all parties, said “Please lock down” before Christmas. Regretfully, once again, our Prime Minister delayed and, despite our wonderful clinicians and support staff, we now see the overwhelming of our NHS in London and the south of the country, with other regions following a few short weeks behind. Today, the Health Service Journal reports that hospitals in the Midlands are likely to be overwhelmed within two weeks. We can see the numbers going up in hospitals all over the country.

All eyes are now on the Government, as vaccines begin to be rolled out. With a more transmissible variant spreading across the country, the infection rate spiralling and hospitals under severe pressure, the Government must use this new lockdown to provide time to roll out vaccine support for those who need it, and to build trust with the public to control the virus, so that we can have a realistic route map back to safety and certainty for the future.

As a nation, we have never sought to vaccinate so many people in such a short time. To ask hospitals, GPs and other health trusts to manage this while they simultaneously try to prevent the NHS being overwhelmed is, frankly, extraordinary and worrying in equal measure, especially in light of the difficulties with barriers to using people such as retired doctors and nurses as vaccinators. Can the Minister say how other volunteers and the military will be used to get to every small town and village in the country to deliver the vaccine 24/7—and I do mean 24/7? If we need to get to 2 million a week before the end of January, and to 30 million to 40 million by Easter, it has to be at that level. It must be available at the most local level and preferably on every high street, whether in a surgery, pharmacy, village or town hall or sports stadium.

So far, all the evidence points to an urban and suburban process, managed by the NHS for the territory it knows, that assumes people have access to private transport. There are reports of people in Cornwall being asked to travel to Bristol for a vaccine, of hundreds of over-80s queueing for hours in the wet and cold to get into surgeries that are too small, and of short-notice delivery cancellations creating chaos and work for hard-pressed NHS staff.

I heard today of a vaccine hub where cars filled with over-80s queued for about 40 minutes beyond the appointment time because there was no space in the car park. Many of the elderly were too frail to even walk from the car park into the centre. Lots of elderly people who seemed cold were shuffling across the car park and then across a road to get into the hub. The wi-fi was down, so registration had to be done on paper, and it was very difficult to socially distance. That all-important 15-minute period of recovery time to check for adverse reaction was in a marquee where the heaters had broken down. The NHS workers and volunteers were all extremely helpful in doing all they could to improve the situation, but the issue was the logistics, including not understanding that elderly people need extra support before and after—as well as when—they receive their injection.

Why is the logistical expertise of the military not being used to its full extent? They demonstrated with the building of the Nightingale hospitals, and then with mass testing in Liverpool, that their expertise is second to none. We need this organisational burden removed from the NHS. Why has Public Health England announced that there will be no deliveries of vaccines on a Sunday? That immediately reduces the capability, when we have plenty of volunteers available to deliver the vaccine into arms. Why are only large pharmacies being used, rather than providing volunteer support to enable them to manage vaccination in small rural areas and villages?

The Minister rightly welcomes the approval of the Oxford/AstraZeneca vaccine as a game-changer but, as my noble friend Lord Scriven has pointed out, the virus will be with us for a long time. Even yesterday, the Prime Minister was still talking about being out of this by the spring. The Government’s communications with the public have been woeful—always trying to give us a bit of good news, which people inevitably cling to when they are worried. Alternatively, the Government have made decisions too late, making people cross and confused, as with the announcement of this lockdown, which once again meant frustration and further exposure to the new variant virus for children, school staff and their families.

We know from epidemiologists that it is likely that we will have future variants and outbreaks, whether small or large, whether here or abroad, for a long time. We must continue to have a full test, trace and isolate system available to respond to this—preferably locally based, as we know that local trace experts and isolation support are much more effective than call centres. Our own data over the last nine months has shown that.

Countries that have implemented successful test, trace and isolate systems have seen fewer cases and far fewer deaths, and built the trust needed to encourage a culture of voluntary compliance with the rules. An isolation policy will work only with effective long-term local test and trace systems, which have to continue to be in place. Yet the Government are silent on how they are to be used, not just during lockdown but after it. Even after many millions of people have received their vaccine, it will still be necessary to keep infection numbers low if we are to lift restrictions successfully and return to normal life. Can the Minister confirm what plans there are to maintain test, trace and isolate for the longer term, so that we do not repeat the problems of the last 10 months? Will the Government look at paying full wages to those on lower incomes who are self-isolating, to help them manage and not leave home?

This morning, I asked the Lord Privy Seal if she could help with the problems faced by care homes, now that insurance for designated Covid settings is almost impossible to get. Without indemnity cover, they cannot take Covid patients; she referred me back to the noble Lord the Minister. NHS Providers is begging the Treasury to help, as hospital beds need to be freed up, but the Treasury is refusing. Please can the Minister take this up with the Chancellor as a matter of extreme urgency to help with this problem, which is not of the care homes’ own making, and which is now blocking beds in hospitals at exactly the time when they need them released at a time of national crisis? Please will he keep me up to date with progress?

On these Benches, we believe that people want to do all they can to bring Covid-19 under control to keep those who they know and love and our communities safe. I ask the Minister: will decisions, messaging and communicating with the public be more honest, timely and realistic? The vast majority of people want to do the right thing. We all need to work together in this national crisis, and together come out of this third national lockdown back into a safe and secure future, where the safety net is in place in case there are future outbreaks.

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 2) Regulations 2020

Baroness Brinton Excerpts

Wednesday 30th December 2020 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I would like to start from these Benches by thanking all those working in health and social care over the last few weeks, and especially those who have had no break over the Christmas holiday. Everyone has talked about Christmas being different this year, but for those staff on Covid wards, those on equally pressurised non-Covid wards, staff in primary care, in laboratories processing tests, those tracing contacts of patients, those working on 111 or running our paramedic services, this has been a really tough end to an already tough year. In tier 4 areas, where cases continue to rise alarmingly, everyone in the extended health system has risen again to do everything they can to keep people safe despite being exhausted. We salute you and we thank you.

These three statutory instruments are, as has become common, already out of date before Parliament has a chance to debate them. Some of that is understandable: this pandemic continues do its best to battle us at every turn and, make no bones about it, we are at war with Covid-19. The role of the scientists and medics is to warn us of the next skirmishes and battles, and the role of government is to provide the resources to defeat the next attempted incursions. Over the last few weeks members of SAGE, Independent SAGE and many front-line doctors and nurses have told us repeatedly that we must act now to prevent further surges.

From these Benches we have been critical of the patchy nature of the tier system, and specifically of the fact that this Government have repeatedly introduced new arrangements, whether local or national, much later than scientists and medical experts have recommended. Over the last three weeks they have said that the Government should take strong action now across England.

However, on Radio 4 this morning the Secretary of State for Health and Social Care once again said that he will go against this, refusing to take that strong action to get on top of the virus, despite many reports across the country that health services are already under extreme pressure, with patients being treated in ambulances and corridors, and some hospitals again facing low oxygen pressure, others with high levels of staff sickness or staff in isolation, and others converting more and more wards for Covid patients. This all seems horribly familiar.

To those who have been saying either that we should not have restrictions or that they are not convinced by them, and that the needs of the economy should take precedence, just before Christmas Dr Tedros Ghebreyesus from the World Health Organization reminded nation states that

“there is no excuse for inaction. My message is very clear; act fast, act now, act decisively. A laissez-faire attitude to the virus, not using the full range of tools available, leads to death, suffering and hurts livelihoods and economies. It’s not a choice between lives or livelihoods. The quickest way to open up economies is to defeat the virus.”

Worrying news was reported overnight in the Health Service Journal that patients with the new high-transmission Covid variant from London and Kent are likely to be moved into hospitals in regions with much lower levels of the Covid variant. What happens when the receiving hospitals in Devon, Newcastle, Sheffield and elsewhere are filling up with patients from the greater south-east, but their own local cases increase and there are no beds for them? Is there enough PPE available for hospitals for a winter wave larger than the spring wave we have already seen?

Before Christmas it was reported that NHS England had not yet signed any new deals with private hospitals because of arguments over costs. Now that some non- Covid services—including elective and cancer services —are beginning to be paused in these overburdened hospitals, are we using private hospitals to full capacity to ensure that those patients are not left behind?

We are hearing that pressure is now being put on care homes in tier 4 areas to take both Covid and non-Covid patients from hospitals. Can the Minister assure those who live or work in care homes that there will not be a repeat of untested patients being moved into care homes, and that care homes will have access to full testing, early vaccines and appropriate levels of PPE?

I would like to build on the question asked by my noble friend Lord Scriven. In the spring Ministers said that the Nightingale hospitals were the NHS safety net. The military delivered them in record time ready for use—for which both it and Ministers deserve credit. Yet, with the exception of the Exeter Nightingale, they lie unused. Can the Minister say when and how will they operate? We keep being told that staffing is the problem, but surely when they were planned there was also an emergency plan to staff them? If there was not, what have Ministers been doing over the last nine months since they were built? As Andy Cowper of the Health Service Journal has asked, were they just theatre?

Finally, the Minister began with news about the MHRA approval of the Oxford University/AstraZeneca vaccine—which is indeed great news, and they are to be congratulated on their joint work which started in January. The logistics for delivering 2 million doses a week if 50 million people are to be vaccinated by the summer are extraordinary. I hope that this House will have a chance to debate the detail of that, with a repeat of the Statement Matt Hancock is making this afternoon in the Commons. Can we debate it preferably next Tuesday?

Covid-19: Vaccinations

Baroness Brinton Excerpts

Thursday 17th December 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness makes the case extremely well; I pay tribute to her personal testimony. I looked into this matter after giving my answer to the question last week. I assure the noble Baroness that those who are terminally ill are, of course, clinically vulnerable by nature. We will ensure that those who are clinically vulnerable will get the vaccine when it is clinically appropriate to do so, which I hope brings her some reassurance.

[Baroness Brinton (LD) [V]]

What provisions and logistics are in place for those not registered with GPs to receive the vaccine?

[Lord Bethell (Con)]

Those who are not registered with GPs and would like to take the vaccine need to register with GPs. We have put in place provisions to allow easier registration processes, we have updated our data arrangements and we are expecting a large number of people to seek out registration. That will be one of the benefits of the vaccination programme: clearer, better records of those in this country who are part of the NHS family.