Covid-19: One Year Report

Baroness Finlay of Llandaff Excerpts

Thursday 25th March 2021 Lords Chamber

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, the National Mental Capacity Forum, which I chair, recently ran its eighth fast-track webinar during the pandemic. We called it “The good, the bad and the ugly”. I will focus on those three categories: good things we want to keep, bad things we should change and ugly things we must never see again.

The speed with which medical and public health research has been approved, instigated and reported shows that past bureaucratic systems can be abandoned. The speed of innovation has been impressive. The rapid return to clinical registers of doctors, nurses and other healthcare staff from retirement was commendable, but many were underutilised. Their knowledge and wisdom should be retained to mitigate shortages in NHS manpower by employing them to what they can do well to provide support to patients through availability for remote consultations and hundreds of other roles.

We should commend those who coped with the very difficult task of the terrible catalogue of deaths. Absolutely nobody wanted to see what we have seen. The bereaved will live with those memories for the rest of their lives. One of the greatest failings has been inappropriate rigidity and inflexibility over visiting when people were dying. We must balance risks and ensure that infection control and emotional support are achieved without compounding the anguish that so many have experienced. The inability to be with the person you love and to say goodbye has been awful. We never want to see it again. Blanket policies failed. The term DNAR, or do not resuscitate, is dangerously imprecise. The Care Quality Commission emphasises respect, open discussion and clarity over CPR.

Many of our simplest public health measures have been far too slow to roll out, compounded by mixed messaging. As a Bevan commissioner in Wales, I supervised the Distance Aware project—a simple prompt now adopted wholesale in Northern Ireland. We need to remain distance aware, probably for years to come, using the protective function of face masks and handwashing as basic infection control. Westminster must work better with the devolved Administrations for recovery.

We must also avoid vaccine complacency, maintain infection control and embrace new ways of working through the rapid rollout of technology, with working, voting, consultations and even mental capacity assessments online. But online living risks promoting loneliness, which has become an enormous problem. Safe meeting places, such as the hospitality sector, sports facilities or the myriad voluntary sector support services, are an important part of our infrastructure. In doing all this we must tackle head-on inappropriate use of alcohol and recognise the associated harms with its links to violence. Nutrition policies need to change to recognise the links between malnutrition, obesity and loss of life years.

We will never go back to where we were. In easing restrictions, consistent UK-wide messages based on evidence are essential. We face difficult decisions. We need to tackle social inequities far better, respect local and devolved services, which know their own communities, and build resilience for the next generation.

Folic Acid

Baroness Finlay of Llandaff Excerpts

Tuesday 23rd March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I think my noble friend alludes to the rollout of the vaccine, which has been the consummate preventive medicine programme that the country has ever seen. It is, I hope, an inflection point in the whole country’s approach to its healthcare. We have for too long emphasised late-stage, heavy- duty interventions, and we have not focused enough on preventive early-stage interventions. Folic acid is a really good example, as are the vaccine and fluoridation, and the kinds of population health measures we hope to bring in will address all of those.

[Baroness Finlay of Llandaff (CB) [V]]

I too commend the noble Lord, Lord Rooker, for his tenacity on this important aspect. Do the Government recognise that 90% of women of childbearing age have low folate levels? If these were corrected by the dietary addition of folate to flour, we could see up to a 58% decrease in neural tube defects. These are massive numbers and cannot be ignored. The clock is still ticking and there are women getting pregnant today who have low folate levels.

[Lord Bethell (Con)]

The noble Baroness’s figures are not quite the same as the ones I have in front of me. The mandatory fortification of bread flour with folic acid in Australia resulted in a 14.4% overall decrease in NTDs—although that is still a really important number, and if we are running at 1,000 a year in the UK, 50% of which are due to unplanned pregnancies, there are clearly important grounds for this measure to be considered seriously.

World Health Organization: Pandemics

Baroness Finlay of Llandaff Excerpts

Tuesday 9th March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I share the noble Lord’s passion for international travel. Like him, I cannot wait for global travel to restart. I also see the connection between the promise of a vaccine certificate of some kind and taking up the vaccine itself. Plans for vaccine certificates for global travel are emerging as we speak. We have a Cabinet Office programme which is co-ordinating across government initiatives on vaccine certification, and a review is in progress which will pronounce shortly.

[Baroness Finlay of Llandaff (CB) [V]]

[Inaudible]—excellent record in research, are the Government able to work through the WHO to promote research into recyclable PPE to avoid the environmental hazard of an enormous pile-up of plastics and discarded PPE? Can the Government work on a public education programme of basic hygiene, with clean water and soap available across the world, so that the very basic principles of hygiene can be maintained?

[Lord Bethell (Con)]

My Lords, the environmental consequences of the pandemic are indeed severe, as the noble Baroness rightly points out. We are working with colleagues in Defra to try to figure out answers to this tricky problem of the legacy of all this PPE. With regards to hygiene education around the world, we have a number of programmes in place, through ODA and our various international development plans, and hygiene is very much at the centre of those.

Covid-19 Update

Baroness Finlay of Llandaff Excerpts

Thursday 4th March 2021 Lords Chamber

[Lord Bethell (Con)]

I am grateful to my noble friend for his question and I echo his comments on Kate Bingham. However, my Lords, we are not post-vaccine; we are, at best, mid-vaccine. Vaccinating 20 million people is an enormous achievement but there is a hell of a long way to go. There is still an enormous amount of infection in this country; nearly half a million people, or thereabouts, have the disease. There are variants of concern being generated in this country, such as the Kent virus, and overseas, such as the Manaus virus. Until we are truly through this, we have to show restraint and make uncomfortable decisions, and we must ensure that the NHS is preserved and we save lives. That, I am afraid, remains our priority.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, British science is indeed to be celebrated, as is government support of it, in vaccine development, genome sequencing and disease-specific registries such as UK Biobank. Will the Government use that experience to establish a national Covid registry to bring together the four main groups of data referred to by the Minister in his reply to the noble Lord, Lord Taylor, to inform long-term planning to reveal links between new variants found on sequencing, different long-term complications, including long Covid, the risk factors behind it and other matters such as body-mass index, vaccine history and any associated other contagious diseases? Such a registry could act as a long-term public health research tool.

[Lord Bethell (Con)]

My Lords, I am grateful to the noble Baroness for her insightful question about the obscure but vital question of data architecture. If there is going to be one powerful legacy of this awful disease, it will be the way in which data helped drive medical research, medical insight and the treatment of individuals. I am not sure if we need a new registry, a national Covid registry; what we need is for our existing data to be able to talk to itself. I can tell the Chamber that we are making enormous progress on that. I pay tribute to the unsung heroes, the CTOs who meet weekly at the NHS data architecture meeting, an obscure but vital forum where an enormous amount of good work is done by NHSX, NHSD, test and trace and others in primary and secondary care who are working incredibly hard, so that if one takes a test today, it goes into one’s patient record tomorrow and can be used the day after by a researcher looking at long Covid, dexamethasone, recovery or whatever. This is how modern healthcare should work. We have not done it well enough to date. We are making great progress on it tomorrow and we must not stop.

Covid-19: Brazilian Variant

Baroness Finlay of Llandaff Excerpts

Tuesday 2nd March 2021 Lords Chamber

[Lord Bethell (Con)]

I am grateful to the noble Lord for flagging the Brazilian connection with Ireland, which I did not know about. I reassure him that there is an enormous amount of collaboration between Whitehall and Dublin on this matter. There are strong links on the managed quarantine programme within Ireland in order to close the “Dublin backdoor”, as it is sometimes called. I pay tribute to colleagues in Dublin for their collaborative approach. We do not currently have a five nations unified approach, but it is of interest. We are definitely keen to ensure that there is no backdoor entrance for VOCs through Dublin, or in the other direction.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, given the inevitability of variants and that some will evade antibody responses, what plans do the Government have for unified messaging, across the whole of the UK, that long-term distancing, mask-wearing and other measures are essential, and to tell the public that this is not like flu and we need to live differently?

[Lord Bethell (Con)]

The noble Baroness is entirely right, which is why the Prime Minister struck such a cautious tone when he unveiled the road map. We are not through this yet. A substantial proportion of the country is vaccinated, but we have to protect the vaccine. For those who have not been vaccinated, there are risks, and that is why we still have in force a “do not travel” alert and why we are maintaining marketing and communications at every level on the restrictions that are still in place.

Covid-19 Update

Baroness Finlay of Llandaff Excerpts

Thursday 4th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I pay immense tribute to the test and trace system, which, at 11 am, published remarkable performance figures, as the noble Lord probably knows; 92% of tests were turned around before the next day, and 86% of contacts were traced. This is an incredible performance. On his specific point, the creation of a variant-of-concern tracing group that is targeted at those rare appearances of VOCs in the community is the important development that we have put in place in reaction to the mutant variants. I pay tribute to Steve McManus, who is running that programme, for the impact that he has already made on the problem.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, with the emergence of new variants, questions over vaccine-induced antibody response to these and the risk of children as asymptomatic carriers, will the Government ensure that schools’ policies are flexible, adapted to each child’s needs, so that children shielding a very sick parent or sibling at home will be able to continue with home schooling and not be forced back through punitive threats on parents; while children needing the security of school can continue to access school as at present and when the majority have the benefit of being able to return?

[Lord Bethell (Con)]

I reassure the noble Baroness that we are absolutely putting the arrangements for pupils in the hands of schools themselves, because they know best how to look after their pupils and their teachers. The role of test and trace is to provide testing facilities and the resources to make schools safe, but it is up to the Department for Education, the local authorities and the schools themselves to protect those who need special arrangements, either because they are shielding or because they have other needs.

International Year of Health and Care Workers

Baroness Finlay of Llandaff Excerpts

Monday 1st February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the Minister for Vaccines has been clear on this: the Government are not currently undertaking work on vaccine certification. However, the noble Baroness makes the case well. Certainly, those who have had the vaccine are very anxious to ensure that they have the correct documentation, and we will ensure that that is in place.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, I declare my roles at Cardiff University. Will the Government create a range of funding streams as overseas aid to ensure that UK universities’ successful distance learning programmes in practical health and care specialities and generalist care are affordable and supported in those countries? Will they work with me and others to invest in better provision of public health, infectious disease control, maternity services, dermatology, palliative care and other services around the globe?

[Lord Bethell (Con)]

My Lords, I pay tribute to the work of the noble Baroness in this important area. Her implied insight is exactly correct. We cannot be healthy and safe here in Britain if there are diseases raging around the world. It is both in our pragmatic self-interest and aligned with our values of partnership with other countries that we should indeed invest in the kind of training and support to which the noble Baroness alluded. I will definitely look into how we could do this better.

Social Care Funding (EAC Report)

Baroness Finlay of Llandaff Excerpts

Thursday 28th January 2021 Grand Committee

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, I declare that I chair the National Mental Capacity Forum and am a Bevan Commissioner. This commendable report provides a way forward, recommending that there must be an appropriate national funding formula. That formula must be fair, recognising that areas of high costs are often in areas of less business buoyancy, meaning that the desire to make local authorities more fiscally self-reliant risks widening gaps in provision and worsening the postcode lottery.

The report was prophetic. The pandemic has shown that social care cannot be used as a pressure valve for the NHS. It has also revealed to the nation, as the report points out, that social care sector staff providing direct care are underpaid and undervalued and that their personal well-being has often been overlooked.

Personalised care has two distinct roles. One is providing all the personalised care underpinning and integrated with healthcare interventions, often delivered by health and social care staff working together. Any division based on budgets creates an artificial split, with expensive bureaucratic processes if a person’s care moves from one sector to another, either geographically or by diagnostic category.

The other role of personal social care is to support people—often working-age adults—in their own homes, to allow them to live well and contribute in our society. A key part of this role is in the prevention of healthcare problems arising. Yet this prevention role has been chronically undervalued, even though it saves avoidable expenditure from the health budget. The future of public health in social care needs much greater emphasis.

During the pandemic, some charities have instigated innovative programmes to deliver social care and support, several seeing great results in improving mobility and independence. But current funding difficulties for charities have revealed our overreliance on this sector over years.

The report highlights the workforce—without a workforce any structure will fail and there will certainly be no resilience. Will the Government urgently look again at a proper career structure with parity of esteem and of pay for those in social care? Percentage pay increases simply widen the gap between the lowest paid, who do the work with the most vulnerable, and others. Staff need their travel time between homes recognised and to be able to park on arrival. They need ongoing training and supervision, with support for their own well-being—if they feel cared for, they are better able to care for others. Those receiving social care are potentially very vulnerable, which is why a proper registration and revalidation process of social care staff would set a national standard and could provide a focus—to nurture staff, helping them feel pride in their work and more respected. Their work is highly skilled and low paid, and their indemnity needs sorting out across the sector in the long term as part of an integrated system.

Form must follow function in a fair national funding formula that recognises our duty to each other in society. In this way, we might be able to move forward. To not heed this report will worsen our problems.

Medicines and Medical Devices Bill

Baroness Finlay of Llandaff Excerpts

Report stage & Report: 2nd sitting (Hansard) & Report: 2nd sitting (Hansard): House of Lords
Thursday 14th January 2021 Lords Chamber

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, I declare that I am vice chair of the NICE review committee. Amendment 66, moved by the noble Lord, Lord Hunt of Kings Heath, aims to ensure early access for NHS patients to medicines and medical devices. This must also involve ensuring that results of safety and efficacy from devices in real-time use—as well as in trials—are registered, published and then considered again in real time, a process that I hope will be helped and promoted by the patient safety commissioner role.

Noble Lords will remember that in Committee I tabled, along with the noble Lord, Lord Hunt of Kings Heath, an amendment to ensure provision for the development of a new rapid provisional two-year licensing procedure. The intention behind that amendment was to ensure that patients could more quickly access potentially life-saving medicines and medical devices.

I sincerely thank the Minister and his team for meeting with me on this, and for the other meetings they facilitated. I am reassured that the approval processes from the MHRA over device development are due to be revised completely over the coming year, with improved and streamlined processes, and I hope that today the Minister can confirm this, even with a timeframe, so that we can move forward quickly.

We have a unique opportunity to develop devices and roll them out to the NHS, but it is important that approval processes do not slow down or block patient access to improvements in treatment and management over a wide range of conditions, particularly rare disorders. Evidence from real-time use is crucial, and development and improvement can become a virtuous circle when that is rapidly fed back—so we become the intellectual innovation hothouse for our future prosperity, while also benefiting our patients. The UK can then be seen as a favourable place to develop, approve and supply medicines and medical devices.

Speeding up and widening approval processes, including two-year provisional licensing that I have been advocating with the Royal College of Physicians, would ensure that developing a new device from beginning to end—taking an idea from conception to supply—all in the UK is seen as an attractive prospect. Otherwise, we continue to risk new devices beginning their innovation journey in the UK, then being taken abroad part-way through the development process and marketed back to the UK. Keeping the entire process in the UK, with different models of fast-track approvals and provisional approvals, will allow better oversight of the safety and efficacy of devices during early access, with ongoing monitoring in real-time use. That would then facilitate moving into appropriately costed long-term approval processes.

We can innovate in the UK and stop intellectual capacity being outsourced. We can protect the safety of patients while getting them access to the latest treatments. It is patients who will suffer if we do not get this right, which is why the proposals in this amendment are so important.

Covid-19: Variant

Baroness Finlay of Llandaff Excerpts

Wednesday 13th January 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, PHE weekly seroprevalence data suggests that antibody prevalence among blood donors aged 16-plus in England is 6.9%, which is consistent with other data that we have. The MHRA has considered this and has decided that vaccinating is just as important for those who have had Covid-19 as it is for those who have not.

[Baroness Finlay of Llandaff (CB) [V]]

How are demographic and NHS outcome data and test results from patients across the UK being collated to identify patterns suggesting further new variants, reinfections, changes in risk factors to severe disease, such as malnutrition, and planning for managing long Covid and modelling ICU provision?

[Lord Bethell (Con)]

The noble Baroness alludes to a world of analytical complexity, which is very much what we have to look forward to. The way in which this new variant has popped up and has been dramatically more transmissible presents a wholly different level of threat compared with the one that we were dealing with just six weeks ago. It is a matter of grave concern to all of us that this mutation has happened. However, I reassure noble Lords that we have very strong genomic capability in this country. Roughly 5% of all tests are analysed. It is only 5% but that is more than in most other countries, and we are putting in the analytical muscle to be able to process that data.