Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) Regulations 2020
Baroness Finlay of Llandaff Excerpts(4 years, 1 month ago)
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Baroness Finlay of Llandaff (CB) [V]
My Lords, these regulations read as punitive. Currently, around 18% of people self-isolate after developing symptoms, but only 11% of people in contact with them quarantine for 14 days. It seems that one in 10 with Covid is a high spreader, inadvertently passing the virus to around 80% of the subsequent cases. Containing these outbreaks requires very rapid testing and tracing, because in two and a half days each will have doubled in size.
Non-adherence is associated with men, younger age groups, having a dependent child at home, lower socio- economic grade, greater hardship during the pandemic and working in a key sector. We hear of those who cannot miss work for financial reasons, whose housing makes self-isolation impossible, whose caring responsibilities mean that self-isolation would cause disproportionate suffering for others, whose mental health and welfare are deteriorating, or whose cognitive difficulties mean that they cannot understand why they are being punished by being kept away from the activities and people they depend on.
Crippling fines and a police record will only disincentivise people to seek testing and disclose their contacts. The criteria behind the instruction to self-isolate are not transparent and there is no appeal mechanism for those who feel they have been inappropriately instructed. That runs counter to the principles of co-production and the findings from the CORSAIR study, which showed that practical support and financial reimbursement, with targeted messaging and clear policies, are likely to improve adherence. Punitive measures set up blame and division, not supportive collaboration. Any instruction must help people understand the benefit to them and those they care for, not jeopardise health by driving people to conceal their symptoms I am sure that is a risk that our hard-working Minister recognises and does not want to take.
Cancer Task Force
Baroness Finlay of Llandaff Excerpts(4 years, 1 month ago)
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Lord Bethell (Con)
My noble friend is entirely right. The impact on cancer from Covid is extremely concerning. However, the backlog is being dealt with more quickly than the immediate figures perhaps suggest. The investment in radiotherapy is incredibly important; we have new treatments coming in all the time, and I reassure my noble friend that we will be retiring redundant machines as soon as they reach the end of their natural lifespan. I want to mention in particular stereotactic ablative body radiotherapy for small cell lung cancer and oligometastatic indications: I am told that this is a particularly exciting radiotherapy treatment
Baroness Finlay of Llandaff (CB) [V]
Following on from that, does the Minister recognise that about half the machines in the country are currently beyond their 10-year lifespan and urgently need replacing—including upgrading to provide stereotactic radiotherapy, which has lower side effects and better outcomes—and that there therefore needs to be at least £230 million ring-fenced for innovation in radiotherapy, quite apart from the other investments?
Lord Bethell (Con)
The noble Baroness puts her case extremely well. We have a massive investment in the NHS that spans physical infrastructure and staff, hospitals and investment in nurses. This will have a big impact on the diagnosis of cancer, which we are committed to getting as early as possible, as well as on treatment for cancer. Treatment with radiotherapy will form an important part of that.
Health Protection (Coronavirus, Local COVID-19 Alert Level) (Very High) (England) Regulations 2020
Baroness Finlay of Llandaff Excerpts(4 years, 1 month ago)
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Baroness Finlay of Llandaff (CB) [V]
My Lords, government gets harder by the day, but the released SAGE report is shattering because all that it predicted is being seen. Will the Government use half-term as a circuit break and stress, over and over again, the two-metre rule for all places, avoiding indoor shared workplaces?
How many complaints have been received about test and trace? With local lockdowns happening, is all testing and tracing now being handed over to local public health with a transfer of funds from the current outsourced system? Is accompanying the seriously ill and dying still allowed, especially if the relatives have either had Covid clinically or want to take the risk? The guidance seems silent on this. The mental health harm of banned visits will haunt us for years. I declare that I chair the Commission on Alcohol Harm; we have heard how pushing alcohol consumption into homes with cheap supermarket booze pushes up domestic violence.
What of the app? Some 79% of adults are thought to own smartphones, but the figure falls to 40% for the over-65s, and not all smartphones are compatible with the Test and Trace app. In tier 3 areas, what proportion of the population have a smartphone that is compatible with the Test and Trace app versus the old NHSX app? Of the 1.5 million QR codes registered with the Test and Trace app, why has only one notification to isolate been sent? Is the app failing? How much money has been spent on trying to get this Google/Apple app to work?
Two-metre distancing, proper mask wearing, soap to wash hands and a circuit break will be far cheaper in the long run and could cost fewer jobs and fewer lives.
Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place and on Public Transport) (England) (Amendment) (No. 2) Regulations 2020
Baroness Finlay of Llandaff Excerpts(4 years, 1 month ago)
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Baroness Finlay of Llandaff (CB) [V]
My Lords, I declare that I am on the BMA ethics committee. I want to consider what we know, what we are doing and where our duty in society lies.
Masks are increasingly reported to be protective. I thank the Minister for his brief summary, but I add to it that no evidence has emerged that they are harmful in Covid transmission. The coronavirus is tiny, 0.1 micrometres across, less than one-800th of a human hair in diameter, but it does not leave the body on its own; it relies on aerosols and droplets to spread, and it goes however far that mist takes it. Think of tobacco smoke spreading; once you get beyond two metres and are not downwind, you are less likely to inhale much of it, even though the aerosol lingers in the air for a long time. Do not forget that in indoor spaces that can be for many hours, which is why the BMA wants masks worn in offices even when alone.
This aerosol, often minute droplets of around double the width of the virus itself, is partly caught in the fibres of a mask. Masks made of double layers of tightly woven mixed fabrics, such as silk and fine cotton, seem to decrease aerosol transfer by up to about one-fifth. The standard mask for use in healthcare settings with aerosol-generating procedures is the N95 respirator mask, which is designed to protect the wearer by filtering out 95% of airborne particles that measure 0.3 micrometres or larger. A review of observational studies estimates that such surgical and comparable cloth masks are around 67% effective in protecting the wearer. That figure may be even higher for the G variant of the virus that seems to transmit faster, but we do not yet know that.
The other protective effect of a mask is that it can cut the viral count inhaled by up to 60%. Where masking reduces the dose of virus that a wearer might receive, it seems that the resulting infection is milder or even asymptomatic, whereas a large viral load results in a more aggressive inflammatory response. So wearing the suitable mask protects the wearer as well as protecting others if the wearer is excreting virus. In Hong Kong a new type of reusable fabric mask, CuMask+, will be issued to all citizens. This patented six-layer mask is washable 60 times and incorporates copper as a key filtering component, although there is some dispute over the extent of claims of efficacy.
What of mask deniers? I am afraid that they are still out there. The inconvenience of wearing a mask is tiny for most of us. Those who lipread for whatever reason need to see a person’s mouth and a very small number of people cannot tolerate a mask, so exceptions are appropriate. For the rest of us, it is only a slightly increased effort to breathe through the mask and cope with fogged-up glasses—although proper eye protection is associated with less infection. However, we all have a duty to others—the ethical principles of justice and that we do not cause harm. We have no idea if the person that we passed in the shop, the street or elsewhere is in a high-risk group and should be shielding.
Thin, disposable masks are not adequately protective, and there are now more masks than jellyfish in some seas. It is predicted that 75% of throwaway masks will end up in landfill or in oceans. The ecological effect will be long-lasting, as these masks last 450 years before degrading. What is the Government’s policy to radically decrease mask litter? Why are we not providing advice on how to recycle masks—for example, by hot-ironing cloth ones?
I stress, as I have before and as Distance Aware aims to stress, that the most important measures are social distancing and hand washing. Is the word “space” used simply because it rhymes with “face”? Is there evidence that the public know that this means the two-metre rule? Will the Government make it crystal clear that the two-metre distancing rule is more important than anything else, and that masks can be an adjunct of that but no substitute for it? Other than fines, what is being done to empower those who deserve to be protected when confronted by someone who is simply too selfish to wear a mask properly and thinks it is funny to hang it around their chin or off one ear? I hope we are at the end of mixed messages and that social duty towards each other will define what we do.
Covid-19: Local Restrictions
Baroness Finlay of Llandaff Excerpts(4 years, 1 month ago)
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Lord Bethell (Con)
My Lords, I completely recognise the importance of stakeholder engagement, building alliances and collaboration. I emphasise our commitment to the partnership between local and national government. When it comes to Parliament’s engagement in these measures, I can only repeat what I said earlier: my right honourable friend has made it very clear that for significant national measures with effect in the whole of England or UK-wide, we will consult Parliament and, wherever possible, hold votes before such regulations come into force. Until then, it is through the usual channels that the schedule of the House of Lords will be arranged.
Baroness Finlay of Llandaff (CB)
Building on the Minister’s commitment to locally led decision-making, will the Government confirm that they will now consult daily with the devolved Administrations and share evidence prior to any press release, as confused messages have undermined public confidence? That way, they may avoid some of the debacles that have happened when local authority decisions have been undermined by leaks to the press.
Lord Bethell (Con)
I completely defer to the noble Baroness’s expertise in matters to do with the devolved Administrations, but I reassure her that there are numerous calls every day between Whitehall and the DAs on Covid. We very much celebrate the achievement of a four-nations approach. There are divergences in some procedural matters between the different countries; that is entirely to be expected—indeed, celebrated—as it enhances the effectiveness of our measures. But I completely take on board the noble Baroness’s points and we will endeavour to ensure that communication between Whitehall and the DAs remains firm and solid.
Hospitals and Nursing Homes: Do Not Resuscitate Notices
Baroness Finlay of Llandaff Excerpts(4 years, 1 month ago)
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Lord Bethell (Con)
My noble friend puts it all very well. It is my birthday today, so I am feeling a little bit older and thoughtful on these subjects. On a serious point, living wills have enormous benefits and give peace of mind to those who enter nursing homes and hospitals, and their loved ones. We will look carefully at this important point and I will share my correspondence with the noble Baroness, Lady Wheatcroft, with my noble friend.
Baroness Finlay of Llandaff (CB) [V]
Happy birthday to the Minister. Given the dangers of the shortcut abbreviation of DNR, which can result in essential care decreasing, has the Department of Health considered adopting NHS Wales’s concept of a natural, anticipated and accepted death—NAAD? In five years, this has had no problems reported and gently and sensitively leads to DNACPR conversations with patients and those who love them.
Lord Bethell (Con)
My Lords, I welcome the testimony of the noble Baroness. We often keep track of Wales’s use of innovative health measures and, while I am not aware of this concept in particular, I will be glad to take the advice back to the department, recommend it and return to the noble Baroness with a response on how we are going to take it forward.
Covid-19: Tracking
Baroness Finlay of Llandaff Excerpts(4 years, 1 month ago)
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Lord Bethell (Con)
My Lords, we are looking carefully at the Apple express system. It does not contain the substantial investment in the algorithm from the Alan Turing Institute that gives our own app the sensitivity and protection that phone users are seeking from such a device. We have looked carefully and worked extremely intensely with Apple on the battery and our understanding is that the app does not have a large impact on battery use.
Baroness Finlay of Llandaff (CB) [V]
When will the equality impact assessment be published for the trial in Newham of the test and trace app that uses the Google-Apple technology?
Lord Bethell (Con)
The results of the Newham trial are analytical rather than about the privacy assessment, which has already been published. What we learned from Newham was that security concerns among that community were profound and, therefore, we shaped our marketing in order to address those concerns.
Covid-19 Update
Baroness Finlay of Llandaff Excerpts(4 years, 2 months ago)
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Lord Bethell (Con)
My Lords, I have said on other occasions that we publish a lot of data, and I would be glad to share a full list of our data sources with my noble friend. To put a different perspective on the point she makes, the biggest challenge we have is to persuade people that their personal health is not a private matter that affects only them; it is a public matter that affects the people they love, the people they are standing next to and everyone else. This is particularly challenging for young people, quite understandably. Young people may have very few symptoms or none at all. They may carry the disease without any personal implications whatever but are vectors of disease who carry it to the vulnerable, ill or elderly. Persuading the country that their health is a public matter is our number one priority. My belief is that we are making great progress, but there is some way to go.
Baroness Finlay of Llandaff (CB) [V]
To break the chain of transmission, people must isolate if carrying the virus. Therefore, people have to understand that a negative test means only that they were not carrying the virus at the time the test was taken. The new contact tracing app being launched tomorrow has the potential to interrupt the transmission of the virus, but in order for it to work, a large proportion of the population will need to download and use it. Is it true that only just over half the mobile phones currently in circulation in the UK are compatible with the new app?
Lord Bethell (Con)
My Lords, the noble Baroness is entirely right that a test today only proves that you have not got it this morning; it does not necessarily prove that you might not have it in a couple of days’ time, when you go and see your loved ones. However, she is not correct on two points concerning the app. First, all the epidemiological data suggests that even small numbers of downloads—even two people, but certainly 10% of the population—can make a difference. Our aspiration is much higher than that, but it is not true that a large proportion of the population needs to use it for it to be effective. Nor is it true that that it works on only half the phones: our belief is that it will work on a very large majority of phones.
If I may take a moment, I shall use it to advertise the “Distance Aware” badge sponsored by the noble Baroness. It is a really good device for encouraging people who are near those who are shielding to respect the social distancing rules.
Covid-19 Update
Baroness Finlay of Llandaff Excerpts(4 years, 2 months ago)
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Lord Bethell (Con)
My Lords, I entirely agree with the noble Lord’s sentiments. The economy and education are critical. I reiterate the Government’s commitment to ensuring that the economy survives in the best possible way and that our children get the education they need. However, it is not quite as binary as he describes. If the public abide by the behaviours recommended in the guidelines, we can enjoy a far greater range of activities than would be the case under a major lockdown. Either way, we are committed to protecting the most vulnerable. I point to the substantial financial investment in protecting those who are shielded and in social care.
Baroness Finlay of Llandaff (CB) [V]
My Lords, I declare my role in the Distance Aware programme in Wales, intended to help people coming out of shielding. We must focus on breaking the chain of transmission. Oxford University reports that the Isle of Wight Test and Trace pilot with the NHSX app broke transmission rates from among the worst in the UK to zero in three weeks. That app was withdrawn. Now the Google/Apple app trial on the island and in Newham is failing to stop R rising after five weeks. As the NHSX app is the only intervention shown to break the chain of transmission, will the Government now urgently roll it out nationwide?
Lord Bethell (Con)
My Lords, the noble Baroness is correct inasmuch as the statistics published for the original app would suggest. However, new statistics about the new app will be published after its launch on Thursday. I reassure her that the circumstances between then and now have changed considerably. The impact of an app that is widely downloaded and implemented across the country can be profound. We are extremely optimistic about its impact.
Health Care: Guidance
Baroness Finlay of Llandaff Excerpts(4 years, 2 months ago)
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Lord Bethell (Con)
My Lords, I reiterate the point I made earlier in response to my noble friend’s quite reasonable remarks on the importance of fairness when it comes to age: blanket age restrictions play no role in the NHS and are overtly against the constitution.
Baroness Finlay of Llandaff (CB) [V]
My Lords, I declare that I chair the National Mental Capacity Forum and am an elected member of the BMA ethics committee. All treatment decisions must be individualised based on the likelihood of benefit to the person, considering their wishes and feelings, without prejudice of age, disability or other pre-existing conditions. Will the Government continue to work with the forum to ensure this is known and understood properly across health and social care in all sectors?