(4 years ago)
Lords ChamberI remind the noble Lord that the criteria sent out by the JCVI is extremely simple and mainly driven by age, so the selection procedure is very straightforward. He is right that the distribution of the vaccine is limited by both the size of the vials and the need for cold storage. That is why there will be an emphasis on hospitals over GP surgeries. That represents a challenge in places such as rural areas that may be distant from hospitals, but I reassure him that the deployment team is doing all that it can to ensure that no one is left behind.
Does the Minister agree with the JCVI’s decision not to prioritise unpaid carers—most of whom are caring for clinically, or extremely clinically, vulnerable people—when unpaid carers are not just prioritised but encouraged and chased by the NHS to have the flu vaccine in order to help protect the person they are caring for?
My Lords, difficult decisions have to be made by everyone in this. The JCVI has looked very carefully indeed at the challenge of how to prioritise this vaccine, taking representations from a large number of groups. Ultimately, its priority is to protect life and the NHS, and its clear decision has been to have a prioritisation based on age because this is the greatest driver of mortality.
(4 years ago)
Lords ChamberMy Lords, we are debating more than 70 pages of changes to the Covid regulations with only 24 hours’ notice of the detailed impact statement that many sought and with which, as we have already heard from both sides of your Lordships’ Chamber, people are not happy; we heard from the noble Lord, Lord Robathan, that he is particularly unhappy.
From these Benches, we have some differing concerns. Ever since the pandemic made its presence known, we have pushed to follow the best scientific advice. We have pushed Ministers to lock down earlier and have not been heard. We have pushed Ministers to set up an effective test, trace and isolate system locally and fund it right from the start, following the excellent examples set in South Korea, Taiwan and Germany, all of which had a steadier path with Covid-19. Test, trace and isolate, to be kind to the Minster, is still a work in progress. Above all, we have asked for clarity and consistency of message to the public so that each and every one of us can play our part as citizens in the fight against the pandemic.
Despite the apparent reduction in cases because of the lockdown finishing tomorrow, we now face these tougher tiering arrangements. We agree that we have not yet got control of Covid. Perhaps these new arrangements would not have been necessary if the Prime Minister had approved a lockdown three weeks earlier when it was obvious to most of us that we were entering a second wave. People are confused about what they should be doing. A poll a couple of days ago showed that two-thirds of people are worried about how safe they feel under these arrangements.
Although we remain concerned that the Government still have not got a grip on the pandemic, we firmly reject the proposals from others who say that there should be no lockdown arrangements at all. Data yesterday showed a worrying rise in excess deaths. Those with disabilities and learning disabilities still face a particularly tough journey in the pandemic. Can the Minister confirm that those with learning disabilities, many of whom are clinically or extremely clinically vulnerable and appear to fall through the testing net, can now access regular testing?
More worryingly, we are picking up reports that young people with learning disabilities at school and college are being charged by their GPs for a letter to set out their specific category to their education institution. The Down’s Syndrome Association told me today that this is not about one or two cases; it is getting reports from all over the country. Shockingly, one young man was charged £38 for a letter to his college. This is disgraceful. Can the Minister take this up urgently and immediately instruct CCGs and GPs not to charge vulnerable young people?
I am afraid that the same is happening to adults with disabilities, who have been asked by their employers to produce evidence that they should work at home. Can the Minister ensure that there is no charge for letters relating to the pandemic for anyone in the clinically vulnerable group?
Finally, I return to one of my regular topics. The Minister knows that I am on the shielding list—now known as the extremely clinically vulnerable list—along with a million other people. Last Thursday, I looked up the new guidance mentioned in passing by the Prime Minister in his announcement a couple of days before about the new tiers. I wanted specifically to look at the advice about Christmas. I have said in your Lordships’ Chamber before that the previous iterations of advice to shielders were verbose—two-page letters with four pages of detailed explanations as an appendix—but they were short memos compared to the new guidance. It is 16 pages long and full of complex advice about tier 1, tier 2, tier 3 and Christmas. Even my eyes, used to reading formal guidance, glazed over. Therefore, I focused on the Christmas advice. As with previous advice, the message was “Please do not mix with people” and the greater risks were repeatedly evident.
Here I have sympathy with the scientists and civil servants writing this document. The Prime Minster wants families to get together. However, the advice is much more cautious. It says:
“If you do decide to form a Christmas bubble it is advised that you maintain social distance from those you don’t normally live with at all times, avoiding physical contact. Everyone should wash their hands regularly and it is important to keep the space where you spend time with those you don’t normally live with well ventilated and to clean touch points regularly, such as door handles and surfaces. You may want to think about who you sit next to, including during meals, and also consider wearing a face covering indoors where social distancing may be difficult as well as encouraging others to do the same.”
Grandma is going to be really popular, going around the house opening windows, wiping doors, wearing her mask and asking to be moved at the table because she is not convinced that Uncle John understands, or cares about, social distancing.
Will any letter to those shielding be made easier to understand and considerably briefer? Will it be available in all accessible forms, including an easy-to-read version for those with learning difficulties, so that everyone shielding can make informed decisions? If the real advice is not to visit family, please can it say so? Just do not show it to the Prime Minister.
(4 years ago)
Lords ChamberI hear loud and clear the conundrum expressed by the noble Lord. These prioritisation questions are very difficult. I hear his plea loud and clear and I undertake that these kinds of considerations will be considered in the prioritisation process.
What provision is being made for another group who feel totally forgotten by this Government—namely, extremely vulnerable children, whether they have medical conditions or physical or learning disabilities, many of whom have been unable to access carers or schools since March? When is the review that the Minister just spoke about likely to publish its results?
It will not be possible to publish any results until we have the clear data on the vaccines. Individual vaccines may behave quite differently with different groups of people. There may be some vaccines that work well with the elderly, some that work well with those with clinical conditions and some that work well with children. It is only when we know that data that the final prioritisation can be published.
(4 years, 4 months ago)
Lords ChamberMy Lords, as my noble friends Lord Scriven and Lady Jolly and other noble Lords have commented, these regulations came into force on 4 July, well over three weeks ago, and indeed other towns and areas have had partial lockdowns since. However, there is a real problem with the constant delaying of presenting these regulations to Parliament, which shows that the Government are really not taking seriously the job that we have to do, which is to scrutinise legislation. Can the Minister therefore assure us that when we return in September and virtual Grand Committee comes into operation, we will return to the pre-pandemic timetable of notification and presentation of SIs to your Lordships’ House?
A number of noble Lords who have local knowledge of Leicester and the surrounding areas, including my noble friend Lord Rennard, have explained well the problems with the speed—or lack of it—of the Government’s response to the Leicester lockdown, and I agree. Local lockdowns will work only when Ministers and the NHS silo work at speed and openly with affected local authorities. On Friday, I asked the Minister why the leader of Oadby and Wigston Council had not been involved in the decision about his borough remaining in lockdown, despite much better figures than Leicester City Council. I am sorry to say that Councillor John Boyce, the leader of Oadby and Wigston, has still not heard from Matt Hancock, despite the latter saying publicly that he had spoken to him. However, it is not just the leader of the council. Many local residents are extremely concerned, as are senior councillors and officials, about the possibility of unrest if they continue to be treated unfairly compared to their neighbouring councils.
More generally, directors of public health report that communications are improved, and I thank the Minister and his team for that. However, the data still does not always arrive consistently or when it is requested, which effectively ties the hands of the local directors of public health behind their back. They say that this flow needs to be urgent, reliable and consistent if they are able to knock the local spikes on the head.
I echo my noble friend Lady Barker’s questions about the slowness of getting data to the local authorities and my noble friend Lady Walmsley’s concerns about care homes. Today’s Public Accounts Committee report recognised that care homes were “thrown to the wolves”, so what are the Government doing to protect care homes from now on, given that the Prime Minister and others say that there is not a second wave and that we are already in it?
This Saturday sees the guidance to 2.2 million shielders change. I and other Members of your Lordships’ House are shielding. On 22 June Matt Hancock and Robert Jenrick wrote to us all to set out the changes for shielders that would take place on 6 July and this Saturday, 1 August. We are told that shielding “will be paused” on 1 August, but throughout the four-page letter shielders are warned that they must continue to adopt strict social distancing as they are
“still at risk of severe illness if you catch Coronavirus, so the advice is to stay at home where possible”.
As I said on Friday, this letter also warns shielders who live alone that their government and local government support—for example, food parcels and medicine deliveries—will cease. For those who work, if your workplace is Covid-safe the Government say you should return to work. Alongside this, furlough and other payments will cease, so even if you cannot get to work or work from home, you have to throw yourself on the mercy of your employer.
I am grateful to the Minister for writing to me overnight to set out the Government’s position. I have also seen the recently updated guidance on the department website, which reiterates the points I have just made.
If I thought that the 22 June letter was contradictory and confusing, I am now even more confused. Only yesterday the Prime Minister said:
“Let’s be absolutely clear about what’s happening in Europe, amongst some of our European friends, I’m afraid you are starting to see in some places the signs of a second wave of the pandemic.”
Overnight, Oldham has joined the list of towns with local constraints and lockdowns, and Stockport is on notice. The World Health Organization says countries that relax arrangements because they are waiting for the second wave need to realise that this is the second wave and cases are popping up all over Europe. We lifted our lockdown later than these countries and so are a few weeks behind them, but I am afraid the trajectory looks clear.
For shielders, the Government say in one breath that you must avoid contact and strictly socially distance at all times, but in the new advice the onus is put on the clinically most vulnerable to leave home and go to work, the pharmacy and the supermarket. They have to be ultra-cautious about seeing people and preferably not do it. Medical charities and NGOs are getting calls from concerned shielders to ask what on earth they should do with this contradictory information, so I ask the Minister the following questions: has he formally raised with the Chancellor of the Exchequer the extension of furlough and other payments to shielders who cannot work? Does he recognise that this small, vulnerable group are highly likely to lose their jobs without continuing support? Is it safe for people whom doctors believe to be at extreme clinical risk to go to supermarkets and pharmacies when these places have little power to enforce the wearing of face coverings by other people? Will shielders be notified as a matter of extreme urgency if there is a local or partial lockdown? Will the emergency support be immediately reinstated for them?
(4 years, 4 months ago)
Lords ChamberMy Lords, I gave the Minister notice on Friday that, because we had not taken a Statement about Covid for three weeks, I will need to address the three Statements that are outstanding.
Parliament entrusted this Government with huge powers to deal with Covid-19 when we put the emergency powers on the statute book in March. Certainly, in this House, at the time of the passage of the emergency legislation we sought and received undertakings from the Minister and the Government about the need for effective scrutiny, timely debate, consultation and trust. So how will accountability be achieved during the Recess and the autumn in this fast-moving world? All three Statements raised vital issues that deserve more time and scrutiny than we were able to give them, and I am grateful for the extra time that the usual channels have found for Back-Bench colleagues.
Before I address these Statements, I want to ask Minister about the sudden announcement this weekend of quarantine measures for those returning from Spain. These Benches have made it clear that we support evidence-based protective measures at the border. We have long called for the scientific evidence to be made public and for track, trace and isolate systems to be in place, to avoid the need for the blunt tool of 14-day quarantine. Does the Minister agree that the latest decision-making process regarding Spain and the short notice for travellers have created a sense of panic and suggest a loss of control? Will he agree that proper contingency plans should be in place to support people coming home where there is no guarantee that their employers will allow them 14 days of work flexibility? Why do the measures apply to the whole of Spain? As my honourable friend Jon Ashworth MP said yesterday, “We’ve got an outbreak here in Leicester, but the whole of Leicestershire is not locked down and the whole of the East Midlands is not locked down, so why are the Balearics and the Canaries included when their infection rate is so low?”
On the announcement on 14 July about face masks and shopping—a month after it became mandatory to wear masks on public transport—why did it take so long and why was the messaging so confusing? We have long known about airborne transmission. The Secretary of State warned long ago about asymptomatic transmission. The Secretary of State’s own advice published on 11 May advised in favour of wearing face masks, so it is a shame that it took two months to make that advice mandatory; it came into force last Friday. How will it be enforced? As a former member of USDAW, I am very concerned for shop workers. USDAW says:
“We are also deeply concerned that enforcing the wearing of face coverings could present a further flashpoint for abuse against our retail members.”
It makes the point that full government guidance was released only hours before the changes came into effect, so how were employers to have adequate time to put the policy in place to support their staff during these changes?
On the Leicester lockdown announced on 16 July, the people of Leicester are now in the 17th week of lockdown. We will discuss that issue on Wednesday, but will the Minister confirm what lessons the Government have learned from what they did and did not do in Leicester, for when they face other local flare-ups? Will the Minister guarantee—I would like a yes or no answer—that local authorities will now get the specific data that can facilitate action, that it will be timely and in the form of person-identifiable data, not just postcodes, and that it will include not just positive but negative results so that they can understand the overall infection prevalence? Will they receive the contact tracing data so that they will know who has been asked to isolate by test and trace and can follow them up? Will they receive the data on a daily basis? Once a week is not good enough. The virus does not wait a week, so why should local directors of public health have to wait a week?
Moving on, the financial Statement said that £10 billion had been allocated to test and trace. It would be helpful if the Minister could itemise what that £10 billion has been spent on and with whom. A letter to me lodged in the Library would probably suffice for that question. On 20 July last week, the Secretary of State made a comprehensive Statement—a sort of end-of-term report; I can pick out only one or two important matters and hope that other noble Lords will cover the rest. The news about vaccine progress was very welcome and exciting, but will the Government ensure that there is equitable access to a vaccine when it is developed? The Minister knows that we stand shoulder to shoulder with the Government in taking on poisonous anti-vax propaganda. However, if a vaccine does not become available, what scenario planning is taking place right now, should we be confronted with that awful prospect? Will the Minister take this opportunity to update the House on R? Are we still below 1? Which parts of the country are not?
On social care, we welcome the fact that families are now able to visit their loved ones in care homes and we also welcome the extra funding for the NHS announced by the Prime Minister. But there was no extra funding for social care. Will social care get any more resources this winter? This is underlined by the Government’s failure to reimburse care homes properly for PPE and testing costs during the pandemic. They will actively have to meet the additional costs of ensuring that care homes stay safe for residents, staff and visitors. It must be cost-effective that they do so. The Local Government Association has today called for a social care reset after reflection on the Prime Minister’s pledge to fix social care a year ago. That representative body has urged the Government to publish their timetable for social care reform prior to Parliament’s return from the Summer Recess in September. Will the Minister tell the House whether that is possible?
My Lords, from these Liberal Democrat Benches, I thank and congratulate all the millions of people, whether paid staff or volunteers, who have worked tirelessly over the last five months to combat this pandemic, serving people and providing support during what is the most extraordinary health crisis in 100 years. As the noble Baroness, Lady Thornton, outlined, it is very disappointing that the Government Whips’ Office has resisted giving your Lordships’ House the opportunity to have a timely discussion on each of the three Covid Statements, on 14, 16 and 20 July. Each covered different, urgent and serious matters for our country that should be scrutinised by your Lordships’ House, so I too will use all three Statements as the basis for my questions to the Minister today.
First, given that the report of 20 July has a strategic and end-of-term report feel, we have an overarching concern about the Government’s repeated mantra in Statements about protecting the NHS at all costs, including the preparations for a second wave. Unfortunately, it appears that lessons have not been learned from the consequences of that single priority, not least those from throwing our care sector to the wolves without adequate testing, PPE or financial support for its massively increased costs. So I ask the Minister again: do all parts of the care sector now have repeat and regular testing, the PPE they need to practise new standards of infection control and continuing financial support for the consequences of both?
As I mentioned on Friday in the debate on the coronavirus regulations, a further group feel they have been left high and dry: people who shield, whether they are disabled, elderly or have serious underlying conditions. So I again ask: will the Minister explain why the letter to shielders dated 22 June insists that shielders lose all the support for shielding from 1 August? The letter instructs recipients to follow strict social distancing at all times and to stay at home where possible but, in complete contradiction to that, also instructs people to return to work if it is Covid-safe and removes access to furlough pay and sick pay, so if it is not safe to return to work and shielders cannot work from home, they are now at high risk of losing their jobs. Blood Cancer UK is extremely concerned about this risk for people who have been shielding as from August they will face an impossible choice between returning to work and risking their health or staying at home and risking unemployment. It asked the Government to extend the furlough scheme for the small number of people involved for up to three months or to provide alternative financial support to protect them from life-threatening ill health, and we agree. Will the Minister undertake to raise this with the Chancellor of the Exchequer as a matter of urgency and write to me?
Lifting the lockdown also brings into sharp relief how much real progress has been made by the Government on testing, tracing and isolating as a key tool to manage outbreaks. To that we must again add quarantine arrangements. On the news today, following the Spain quarantine regulations, we heard the Government say that they will not be monitoring any quarantine arrangements. They are still experimenting with temperature screening at airports and are not routinely testing people as they arrive in the country. If we are serious about having a proper system for people arriving in this country and quarantining safely, when will that be put in place?
We also hear that testing capacity will shortly reach 500,000 a day, which is welcome, but there seems to be no routine to test that capacity to the full. It is still not universal, despite repeated requests, regularly to test NHS and care staff to keep them safe. We hear that many local testing centres are closing down and that the test at home system is to stop. Can the Minister reassure your Lordships’ House that a full test, trace, isolate and quarantine policy is in operation, not least to test the larger-scale, effective system that we will need in the event of a second wave? How many people were tested on Friday?
Finally—the Minister can probably recite my next question as I have asked it so often, but I will be grateful if he could answer my actual question, not repeat the usual mantra because just saying that local authorities are being given more data at postcode level is not enough—when will all local authorities and directors of public health get the full data that they have requested and signed data protection releases for on a daily basis and at a more granular level than postcode, without which they cannot effectively tackle spikes in cases swiftly? The Minister saying that he is giving them more data is not enough. It must be the data that they need and for which they have already signed data protection releases.
My Lords, I thank the noble Baronesses, Lady Thornton and Lady Brinton, for their detailed questions, which I will go through as speedily and thoroughly as I can.
On accountability during the Recess, there are long-standing precedents on this and we will obey them, as is normal.
On the arrangements for Spain, I reassure the noble Baroness, Lady Thornton, that there is a very thorough system of regular meetings to assess the exemptions on travel. This is done at several levels of government and detailed intelligence from the front line is provided to those meetings. However, the situation in many countries is fast changing, and the Spanish situation is a good example. The information we had at the beginning of last week was quite different from the information we had by the end of the week. Fast turnaround decisions are not a sign of panic or weakness; they are a sign that the system works and is working well. We are trying to be as flexible as we can and we respect the country’s desire to travel, but when the infection rate in overseas countries moves, we have to move quickly as well. Within individual countries, there is no way for us to control intra-country transport. It is therefore very difficult and challenging to have a regional exemption list. That is why we have not been able to give exemptions to the Balearics, and I say that with a personal interest in the matter.
Our guidance on face masks is based on trust. There is no compulsion and they are not mandatory. In some countries they are mandatory, but not in this country. That is why the science is so important to us, and it is one reasons that we may have moved behind some other countries. The guidance we now have on face masks is extremely clear. I pay tribute to the large and growing number of people wearing them. I believe this country is moving in the right direction.
We are concerned about shopworkers. USDAW makes a good case for the need to protect shopworkers who may be put in an awkward situation. That is why we work closely with the police to ensure that the right protections are in place.
I say a profound thank you to the people of Leicester, who have done an incredible amount in a difficult situation. The signs are that the prevalence of the disease has come down a long way in Leicester thanks to their commitment. The lessons we have learned include some of the most obvious lessons you could learn, but there is no replacement for local contacts and the involvement of local communities. However, there are hard-to-reach communities where our message has not got through and we need to do more to reach them. In particular, I am grateful to faith leaders in Leicester who are working with us on preparing for Eid and ensuring that the message on social distancing gets through in time for that important celebration.
Full details of the budget for NHS Test and Trace will be published when the time is right, and when that time arrives I will be glad to place a copy in the Library as requested.
I completely agree with the noble Baroness. Having an equitable distribution of the vaccine in this country and overseas is key to the Government’s policy. That is why we are working hard with the World Health Organization, GAVI and others to ensure that vaccines are shared as a global resource. We hope that a vaccine can be found, and the indications from Oxford are encouraging, but we recognise that vaccines for coronaviruses, particularly those affecting the respiratory system, are difficult. That is why we are making a massive investment in the test-and-trace programme and in therapeutics and why we remain vigilant over local lockdowns—to rid this country of this horrible disease.
Both noble Baronesses spoke about social care. I do not recognise the phrase used by the noble Baroness, Lady Brinton, that the care sector has been “thrown to the wolves”. I find that an unhelpful characterisation. I say yes to regular testing, yes to PPE and yes to financial support—we have given £3.7 billion to local authorities to help them pay for the cost of Covid-19, and on 2 July we gave a further £500 million to the social care sector. We remain vigilant with regard to the financial resilience of the social care system and we are working very closely with social care providers on the ongoing costs of both testing and PPE, as well as the financial resilience of the entire sector.
On shielders, the noble Baroness, Lady Brinton, makes a very good case. The handling of those who need shielding is one of the most delicate challenges that we face. Those who through no fault of their own are particularly vulnerable to the effects of the disease are put in an invidious situation, and we are extremely grateful to all those who have gone through the hardship of extreme shielding during this long and difficult time. I take on board all her comments and extend my profound thanks to all those concerned. I will look into the question of the parcels that she raised in the debate last week. My inquiries are ongoing on that, and I will respond to her, as I promised to last week.
On the arrangements for travel, it is true that the current medical advice is that we are currently sceptical whether temperature testing is effective and therefore we have not imposed it.
On testing, it is a frustrating but unavoidable truth that a test today does not necessarily mean that you do not have Covid and that you may not display both the symptoms and contagiousness of Covid in the days ahead. That is why snap testing at airports cannot be a sure-fire and safe route for protecting the country, which is why we have to look at isolation as a way of protecting the country.
On the mandation of isolation, as in other matters to do with Covid, we apply a voluntary principle because we believe that trust is the best way to keep the public on side, and we have neither the legal nor the other resources necessary to impose mandation.
On the questions from the noble Baroness, Lady Brinton, about the state of the testing programme, I reassure her that testing at home is not stopping and that NHS staff are regularly tested. There is a very clear plan, that plan is heavily resourced and we are continuing to invest in it with innovation, manpower and legal support where necessary.
(4 years, 4 months ago)
Lords ChamberMy Lords, many Members have spoken again about the frustration at the delays of three weeks or longer in this House being able to debate the regulations. All sides of your Lordships’ House have repeatedly said that they understand the pressure that Ministers found themselves under earlier in the pandemic, but I respectfully remind the Minister that now that the urgency is easing, surely arrangements to debate regulations could begin to return to a more realistic timetable.
I add the frustration from these Benches that we are now three Statements behind the House of Commons, and it looks as if the usual channels—or the Government Whips—will not allow Statements, which of course explains why so many people spoke earlier in this debate on the regulations.
The noble Lord, Lord Robathan, spoke eloquently, in his brief minute, on contradictory advice, and my noble friend Lady Tyler referred to the last-minute guidance on face masks, published only one day before the new rules came into force this morning, despite the announcement about 10 days ago. The guidance seems much less definitive than the Prime Minister’s announcement. This raises a recurring problem that lies squarely at the feet of Ministers: a blurring of distinction between what is law and what is guidance means that the all-important communications strategy once again lies in tatters. This is not just confusing to the public, shopkeepers and takeaway owners; it also puts the police in an invidious position about how to police this requirement. Surely, as other noble Lords have pointed out, we need people to wear masks to protect the wider community from either local spikes or a second wave.
There remain other contradictions. For those who are shielding, and therefore not able to take advantage of the regulations that we are looking at today, all formal support ceases on 1 August, yet the letter to shielders says that
“you can go to work, if you cannot work from home, as long as the business is COVID-safe”.
Three bullet points later, it says that
“you should remain cautious as you are still at risk of severe illness if you catch coronavirus, so the advice is to stay at home where possible and, if you do go out, follow strict social distancing”.
However, from 1 August there are no emergency food packages and no financial support for those who cannot return to work nor work from home. Worse, this has not been communicated more widely, so everyone else apart from shielders assumes that shielders will be just the same as everyone else. Saying that new guidance will be published on 1 August is too little, too late, and once again shows that shielders, especially disabled people, are being left isolated.
In his introductory remarks, the Minister referred to Leicester and Oadby and Wigston. I am sorry to say that the leader of Oadby and Wigston had to write to Matt Hancock on 22 July, saying:
“I would like you to correct the inaccurate statement you made in the House of Commons this afternoon. You stated that you had consulted all Council Leaders. This is clearly not true as you and I have never spoken. As you will see from the attached email I was not consulted by the Leader of the county council either. The decision not to include other areas of the county is flawed. Either there is an objective measure by which”
the lockdown
“is judged or there is not. The Borough is in a better position regarding Covid than some of the areas you released today. If you release them so you should release us.”
This is extremely concerning. Once again, we have a Minister making Statements and talking about strong communications with local government while the reality is anything but.
I note that these and other regulations say regarding “Impact”—this is paragraph 12 in the Explanatory Memorandum on the first set of regulations—that there is no need for impact assessments, as these regulations are a short-term measure and have sunset clauses. However, on Monday 20 July, government lawyers admitted that the Government had been in breach of testing and tracing data protection laws since the test and trace system was introduced in May because they do not adhere to privacy regulations. Despite the Open Rights Group asking repeatedly for answers to questions, the Government came clean only after legal letters were sent. Government lawyers said on Monday that impact assessments were being worked on. Can the Minister tell the House when the DPIAs that meet legal requirements will be in place for testing and tracing?
I echo my noble friend Lady Benjamin’s concerns about protection for our BAME communities who are at such high risk, especially as the success rate for tracing in these communities is consistently lower than for others. In Leicester, it is down to 65%, whereas 80% is the level deemed necessary for safety.
Finally, in the last two hours, the ONS has released statistics with shocking mortality data, showing that from 1 March to the end of May, those living in the most deprived areas had a death rate of 139.6 per 100,000 whereas those in the least deprived areas had a death rate of 63.4 per 100,000. What specific resources are being given to councils, directors of public health and local resilience forums to ensure that they can support our people in the most deprived areas, most particularly the data that they, I and many other parliamentarians have asked for time after time?
(4 years, 5 months ago)
Lords ChamberI completely reject the implications of the noble Lord’s question. While British companies have stepped forward and we are pleased to have made many contracts, there are not, I am afraid to say, thousands of domestic producers capable of providing the billions of items we need in the British health service. I pay respect to all the companies that moved quickly and contracted under difficult circumstances for major contracts. I also salute the companies overseas with which we have good relationships, and which remain our trusted partners.
My Lords, alongside PPE we must have a comprehensive test and trace system to prevent a second wave. Today, the Health Service Journal reports that virtually all the top team of test and trace are leaving, and that McKinsey is contracted to review the governance and entire form of test and trace. Why would the Government bring in a multimillion-pound consultancy firm to review a so-called world-beating test and trace system?
My Lords, turnover of the test and trace team is an inevitable consequence of an organisation that was set up using temporary staff, many of whom are on short contracts and need to return to their previous roles. It is regrettable, but I owe them a huge debt of thanks for the work they have done. The work of McKinsey is focused on governance, not on HR. It was commissioned some time ago and it is an entirely proper and regular appointment.
(4 years, 5 months ago)
Lords ChamberMy Lords, I thank the Minister for the Statement. I start with the words of the chair of the review, our colleague, the noble Baroness, Lady Cumberlege, who said when she launched the report last week that she was shocked by the sheer scale and intensity of suffering. She said:
“I have conducted many reviews and inquiries over the years, but I have never encountered anything like this … Much of this suffering was entirely avoidable, caused and compounded by failings in the health system itself.”
I congratulate the noble Baroness on conducting an inquiry over the last two years that has been praised by everyone concerned, particularly the patient groups and those affected.
Some of us have been discussing the problems addressed in this report for many years. We have heard about the hormone pregnancy test Primodos, the anti-epileptic drug sodium valproate and, in recent years, use of vaginal mesh in surgery. It is important to pay tribute to the bravery and persistence of the patients and patient groups, but also to the parliamentarians whose work helped to persuade the Government to establish the inquiry two years ago. The All-Party Groups have been vital, as have Yasmin Qureshi MP, Norman Lamb MP, Owen Smith and Sharon Hodgson MP, to name but a few.
On the surface, the three medical issues are separate. What links the medicines and devices is that they were all taken or used by women—in two cases, by pregnant women. As my honourable friend Alex Norris MP said last week in the Commons,
“these cases reek of misogyny from top to bottom—and ageism and ableism as well.”—[Official Report, Commons, 9/7/20; cols. 1148-49.]
We also have to look at the reaction of the healthcare system, which, according to the report, failed to monitor the use of these medicines and medical devices, then failed to identify and acknowledge the things that had gone wrong, then failed to work to improve. The review sets out the missed opportunities when something could or should have been done to prevent harm. Instead, there was a culture of denial, disjointedness and defensiveness that failed to listen to patients’ concerns.
Our NHS failed to protect these women and their families. It is therefore right and welcome that the Minister’s first reaction has been immediately to offer an unqualified apology, which is the first of the nine recommendations in the report. The Secretary of State said that listening and humility are in order. That is right, but it now needs to be followed by action to make the process worth while and to address the suffering. I hope that in this discussion the Minister will be able to outline what the Government will do to implement the rest of this report and to what time- scale. The most sensible way forward is the ninth recommendation, which is to set up a task force to implement the other recommendations. Will this be done, and by when?
On recommendation 2, I can see that progress has already been made. But can the Minister explain what legislative underpinning would be needed for a patient safety commissioner? Some of us are very puzzled as to where the delightfully named HSSIB is—the patient safety Bill—and whether that would have been a good complementary vehicle.
Recommendation 3 calls for:
“A new independent Redress Agency for those harmed by medicines and medical devices”
to create a new way of delivering redress in future. It suggests that manufacturers and the state should share the costs. Would the Minister care to tell us how that might be achieved?
Recommendation 4 suggests:
“Separate schemes … for each intervention—HPTs, valproate and pelvic mesh—to meet the cost of providing additional care and support to those who have experienced avoidable harm”.
How might that be achieved? I also have one question relating to mesh and all other implants. How will the Government ensure that they are safe to use? A register is obviously a good step forward and is in the Bill that we will discuss in the next few months, but why do the regulations on implants not provide for trials, as with medicines?
On recommendation 6, will the Minister commit to amendments to the Medicines and Medical Devices Bill to strengthen the Medicines and Healthcare products Regulatory Agency’s regulatory regime? On these Benches, we are committed to implementing the nine recommendations in this excellent report. We will seek to use the forthcoming MMD Bill to do so, and we wish to work with the Government to explore how best to achieve that.
My Lords, on behalf of the Liberal Democrat Benches, I too thank the noble Baroness, Lady Cumberlege, and her team for such an outstanding report. It is not only comprehensive but blunt in its language, so that no one can misunderstand the failings of all levels of the healthcare system, whether in our NHS or other health and research settings, over many years. We too pay tribute to those women, and their children and families, for continuing against all the odds for years when too many ears, including the Government’s, were deaf. I also pay tribute to the many parliamentarians, including Norman Lamb, who over the years supported them. They pushed for this review in Parliament and raised it in any way they could.
Ministers have apologised for these failings, including for the system not listening and for not acting soon enough, over the decades since patients first started to raise the problems with these three medical interventions. Last week, when I asked the Minister about the timetable for implementing the recommendations, he said that
“it will take some time for the Government to study these recommendations … and to come back on the timetable”.—[Official Report, 9/7/20; col. 1224.]
The noble Baroness, Lady Cumberlege, says in her letter introducing the report:
“Over the past two years we have found ourselves in the position of recommending, encouraging and urging the system to take action that should have been taken long ago.”
She also said:
“Implementation needs to be approached with a new urgency and determination, founded on the guiding principle that our healthcare system must first do no harm.”
When the interim report was published, leaving this House in no doubt about the direction in which the review group was proceeding, many people expected action at that point.
I am grateful to Epilepsy Action for its briefing, which demonstrates exactly why urgent action must be taken now. Epilepsy Action, the Epilepsy Society and Young Epilepsy jointly surveyed over 500 women and girls who had taken sodium valproate since the pregnancy protection plan was introduced two years ago. One in 10 were unaware of the possible risks of birth defects. Almost half said that they had not discussed the risks of taking medicine with their health professional in the last 12 months, and only four in 10 said they had signed the annual risk acknowledgement form. For patients and families who have suffered as a result of these interventions, urgent action needs to be taken on government departments such as the DWP regarding the way it assessed the damage caused, and on how government as a whole compensates them for this gross injustice.
So I ask the Minister again: when will the Government return to those affected and to Parliament with clear recommendations and a timetable to do honour to the report and to all those affected? And when will the various bodies in our healthcare sector be set a deadline to publish the list of recommended actions that they will take that will not need parliamentary action? Last week, the Minister told your Lordships’ House that the Government had moved ahead on one of the recommendations—the creation of a patient safety commissioner—but their version is not independent, as asked for in the report.
So much of this report is about changing cultures: we still have not learned from Mid Staffordshire, East Kent and Shrewsbury maternity care, all of which Ministers have rightly been appalled by. For all the excellence and commitment of the individuals who, singly and collectively, provide our unique healthcare in the United Kingdom, there remains an unhealthy culture in some parts that does not listen to patients, does not understand conflicts of interest and resists change. That must change, it must change soon and it must be led from the top by the Government.
The report quotes Professor Ted Baker, chief inspector of hospitals for the CQC:
“I have to say 20 years later it is very frustrating how little progress we have made. It’s clear to me we still have not got the leadership and culture around patient safety right. As long as you have that culture of people trying to hide things, then we are not going to win this.”
Armed with this blunt and excellent report, I hope that the Minister can demonstrate the Government’s support with firm actions and dates, and not just with warm words that will drift away. The hopes of patients and their families and the future safety of our healthcare system depend upon it. When, Minister, when?
My Lords, I start by reiterating the tributes from both noble Baronesses, Lady Thornton and Lady Brinton, to my noble friend Lady Cumberlege and her team, who have worked indefatigably on a high-quality report that does justice to this important cause. Most of all, I pay tribute to the patient groups, the specialist groups and those who campaigned on these important issues and who have brought attention and a huge amount of official focus to causes that had been overlooked for years and decades. I pay tribute to their patience, their expertise and their stamina in bringing these important causes to attention. It is entirely right that the Minister, my colleague Nadine Dorries, made an apology to those groups, and I reiterate that apology on behalf of the healthcare system to all the families affected by the report, for the time it has taken to listen and to respond to their concerns.
Both noble Baronesses referred to the culture that led to these issues being overlooked. I think that that is one of the most important learnings from this report. As Nadine Dorries said, I thought very movingly, in her speech in the House of Commons, the system has to learn to listen much more clearly. Listening must happen not just from the top but also at the level at which patients engage with the system itself. I think that trying to change that culture is one of the most important challenges facing us today. It is not just a question of bringing in punishment and retribution for those in the professional world who have failed; it is trying to create a culture where mistakes are recognised and accepted and where people address and take on board the concerns of patients themselves—and on that important cause we are hugely focused.
The noble Baroness, Lady Brinton, asked what we are doing. Already, much has been done. There has been progress in lots of areas. We already have 12 different types of patient safety function in place within the NHS: the Patient Advice and Liaison Service; commissioners of NHS services; the Parliamentary and Health Service Ombudsman; Healthwatch; the NHS Complaints Advocacy service; the CQC; the NHS Friends and Family Test; the professional regulators; the Healthcare Safety Investigation Branch; the Professional Standards Authority; the National Director of Patient Safety; and the complaint systems within individual trusts.
That patchwork quilt of patient safety and patient advocacy is an enormous function within the NHS. The report teaches us that it has not been enough to identify the major themes of failures—in this case, involving medical devices—and there has not been the patient advocacy necessary to see complaints through when they have really mattered. It is that question which we are turning to: how do we make these considerable and important efforts to put patient safety at the heart of the NHS more effective?
The noble Baroness, Lady Thornton, asked about the regulatory implementation of that response. The most important legal implementation is the registry of medical devices, which was in an amendment to the Bill on Report in the House of Commons, and it has enormous support from the Government. That registry, which is an incredibly important source of accountability and of clinical information, is the key to preventing such terrible events concerning medical devices in the future.
The report was published only last week, and it will take some time to focus on all its other recommendations. I can update the House on the specialist centres that the report quite reasonably recommended should be set up: NHS England is assessing bids from NHS providers to be specialist centres for mesh inserted for urinary incontinence and vaginal prolapse.
The noble Baroness, Lady Thornton, also asked about the MHRA regulatory review. The MHRA has begun a comprehensive and far-reaching programme of change, which will include enhancing its systems for adverse event reporting and medical device regulation. The MHRA has taken important steps to put patient advocacy at the centre of the work that it does.
There is nothing we can do today to make good the harm done in the past. However, as both noble Baronesses have rightly pointed out, there is much we can do to put patient safety at the heart of the NHS and to ensure that we have the technology, the systems and the culture to make sure that these mistakes never happen again.
(4 years, 5 months ago)
Lords ChamberYes. The next speaker is the noble Baroness, Lady Brinton.
My Lords, the country owes an enormous debt of gratitude to the many campaigners who have fought tirelessly over decades to get their issues raised and to ensure that this never happens again. It is good that the Government have apologised on behalf of many Governments, and it is reassuring to hear that there will be some amendments to the Medicines and Medical Devices Bill, but the people who are affected need redress urgently. Can the Minister give us an indication of when this will happen?
I share with the noble Baroness, Lady Brinton, my personal respect and admiration for the campaigners, who are described in the report as having lived through the most awful experiences and who, through personal commitment and determination, have brought attention to these huge failures and have pursued their cause with enormous patience. We owe them a huge debt of gratitude. In terms of commitments on the individual recommendations, I have mentioned what we have done so far and what we have on the near horizon. However, it will take some time for the Government to study these recommendations—to understand from my noble friend Lady Cumberlege herself her detailed recommendations—and to come back on the timetable that the noble Baroness requested.
(4 years, 5 months ago)
Lords ChamberMy Lords, the role of carers during the epidemic is one of the great stories of commitment and sacrifice. I pay tribute to all those who have given up their time and taken the risks necessary to perform this important community role. On encouraging people to stay home, there are clear guidelines on who is recommended to stay at home. It depends on clinical need and people’s precise circumstances, according to their GP’s recommendations. I urge all people to follow those guidelines.
My Lords, I remember that there was cross-party support 10 years ago for the Dilnot review’s proposals. I support warmly the comments of the noble Baroness, Lady Pitkeathley, about the need for a national care service. Will this review and White Paper also look at matters that are often forgotten in a care setting: housing standards for life, and sheltered and community settings, to make sure that we do not yet again end up looking at just adult social care and care homes?
The noble Baroness is quite right to shine the spotlight on those who are in social care but not necessarily aged over 65. Half of all social care costs are now dedicated to those under 65. Housing standards is an important question. The stock of housing for social care will be considered in any forthcoming review. It is imperative that we have a modern and up-to-date industry.