Covid-19 Update
Baroness Finlay of Llandaff Excerpts(4 years, 2 months ago)
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Lord Bethell (Con)
My Lords, I thank the noble Baroness and the noble Lord for their perceptive and thoughtful questions. On the noble Baroness’s questions about the level of alert, to my knowledge it has not changed. It was reduced from four to three on 19 June; it remains subject to review on a weekly basis, but we are not in a position to raise it at the moment.
The noble Baroness asked about the rule of six and why we had committed to six as opposed to anything else. The short answer is that we are seeking to have rules that are simple to understand and straightforward to apply. We accept that during the last few months the guidelines have grown increasingly complex and difficult to understand in all their detail. Across the board, with “Hands, Face, Space”, the rule of six and other measures that we are seeking to publish, there is a genuine effort to engage the public in a really simple lexicon of how we can beat the coronavirus.
Sir Mark Walport, the head of UKRI, was right in his warning that the jeopardy is enormous. If we do not get this communications challenge right, and if people think they are confused and think they have a way out because it is in some way complicated, we will fail, the disease will come back and we will have tens of thousands of deaths; we will have an NHS that is challenged; we will have an economy that is shut down; and we will have a generation that is lost to education. Those are the stakes, so we are determined to get it right. I am happy to stand here for as long as it takes and be pub-quizzed on “What about this? What about that?” if it means that we get it right.
However, the public seem to understand these simpler rules. The response from the public in our planning focus groups and in the response since their publication has been extremely positive, and we think we are on the right track. This is advice that was informed by SAGE and we went through its models in great detail.
The noble Baroness and the noble Lord, Lord Scriven, asked why children are included. The bottom line is that we want to keep it simple. Children are vectors of infection; they can pass the disease from one generation to the next. Time and again, in city after city, we have seen an infection that starts with a young person, moves to mum and dad, then to grandma and grandpa. It takes weeks or sometimes months for that progress to take place but, as I have said at this Dispatch Box before, as night follows day, the infection moves through the generations unless we take steps to break the chain of transmission. The rule of six is a critical, unambiguous step in the Government’s strategy for doing just that.
The noble Baroness and the noble Lord, Lord Scriven, asked about marshalls, so let me just say a word about that. This measure came from our engagement with local authorities. Local authorities are looking for ways in which they can implement the right measures to disrupt crowds forming and, as the noble Lord, Lord Scriven, said, mingling—a concept which, frankly, I do not think needs much description and nor do members of the public. In order to break things up, they are looking for ways in which they can have both the authority and the personnel to do that, and we have responded by putting in the right regulations to do that and by providing the right resources. But it will be up to local authorities to implement that in detail.
The noble Baroness asked about shooting and hunting. My understanding is that guidelines on all sorts of sports and activities where the rule of six is in any way ambiguous will be issued in the coming days.
The noble Baroness asked about Hammersmith, and I am extremely grateful for the tip-off. I will look into it, as I have done when other noble Lords have alerted me to concerns they might have. I am extremely concerned that there might be a breakdown in the asylum centre in Hammersmith. However, I reassure the noble Baroness and the House that directors of public health are responsible for this kind of implementation, and the benefit of directors of public health is that they work across all departments. Some directors of public health have a health background, some have a police background and some come from a leisure background, but they all hold the ring when it comes to local implementation of local measures, and therefore they are the best-placed people to ensure that situations like this are not overlooked.
The noble Baroness asked whether we should be reviewing the current measures for pubs, clubs and workplaces. The simple answer to that is yes, absolutely; we should be reviewing it—and we do review it every single week. We are on tenterhooks because, if we get this wrong, the jeopardy is enormous. We are working as hard as we can, with regulatory measures such as the rule of six, marketing measures such as “Hands, Face, Space” and containment measures such as the test and trace programme, in order to keep the economy open, to keep our educational institutions open and to keep life as normal as we possibly can. If we do not—if we fail—it will go back to where we were before, and I hope memories are not so short that people do not remember quite how imposing and draconian the former lockdown was.
On test and trace, the noble Baroness quite reasonably asked about the capacity and about demand. I can reassure her that the capacity has literally never been higher. We are up 7% week on week and—if I can provide the right figures here—we will have a capacity of 500,000 by the end of October. We have 500 centres, including five major laboratories, 236 mobile testing units, 72 walk-through testing sites, and more sites opening all the time. For every 1,000 people in this country, we test 2.43 a day; that compares with Germany at 1.15, Spain at one and France at 1.15.
We are throwing everything we can at the test and trace system, but it is true that demand has gone up. Part of that demand is through children returning to school. I welcome enormously the return of children to school, but it is an un unambiguous fact that this has led to a very large increase in the number of children being sent to testing centres—often bringing their parents and other household members with them—and that has put an enormous pressure on the system.
Another feature is asymptomatic testing. Estimates are that between 20% and 25% of those turning up for a test are currently asymptomatic. If we had all the tests in the world, that would not be a problem and I would welcome it, but right now we are building the system, we are under pressure and we need to communicate more clearly to the public that asymptomatic testing is not supported by our current testing system.
The noble Baroness asked about social care—quite rightly, as this is a major feature; we are concerned about it, and I know that noble Lords are concerned about it. I reassure the noble Baroness and the House that care homes are absolutely our number one priority. This was reiterated in meetings with the Prime Minister last week. Some of the capacity challenges in places such as walk-in and drive-in centres are because we have put care homes front of the queue and because those tests are taking priority.
The noble Lord, Lord Scriven, asked a number of extremely detailed questions, some of which I have touched on. He asked why we have included children. He is entirely right that, in Scotland, they have not included all children and in some other countries they do not do so either. We have taken a different view. Partly, that is on the epidemiological advice from SAGE; partly, that is on the marketing advice from our communications department, which is insistent that we are clear and unambiguous with the population; and, partly, that is the CMO’s advice—he rightly identifies children as potential vectors of infection, particularly in intergenerational households.
The noble Lord, Lord Scriven, asked for consistency. Well, we are consistent in that we are determined to break these chains of transmission. The science is not simple; if it were, the disease would have been beaten. It bounces around, and we are doing our best to fight it. We are communicating as best we can on all the science we have.
In terms of collaboration, I pay a massive tribute to all my colleagues at the department, in other departments, in local authorities, at PHE and in the NHS. It is difficult for me to explain in great detail in a short amount of time the immense amount of cross-departmental, inter-agency collaboration that has sprung up around Covid. The amount of data that is shared, the number of Zoom calls and the working together are absolutely phenomenal. The noble Lord cited that the LGA did not know about the marshalls plan until the last minute; I am afraid to say that it must have been the last one on the list.
The Deputy Speaker (Baroness Finlay of Llandaff) (CB)
My Lords, we now come to the 30 minutes allocated for Back-Bench questions. I ask that questions and answers be brief, so that I can call the maximum number of speakers.
Lord Bethell (Con)
My Lords, policymakers around the world are facing exactly the same dilemma. We are determined to have the schools back, because the long-term effects on young people—particularly the least advantaged—will be profound if we shut the schools. The noble Baroness is entirely right to say that parents are naturally concerned that the safety of children, and other generations that they may come into contact with, is at risk. That is why we are massively prioritising the return of schools and introducing measures such as the rule of six to break the chain of transmission and thereby protect the schools from closure.
The Deputy Speaker (Baroness Finlay of Llandaff) (CB)
I apologise to the noble Baroness, Lady Verma, who I should call now.
Baroness Verma (Con) [V]
Thank you, Deputy Lord Speaker. My noble friend has talked about Covid, but I think it is important in the same debate to talk about the flu injections that are available to help people reduce their ability to catch Covid. Will my noble friend ask the pharmacies that are distributing flu injections to step up their communications, in particular to people with south Asian backgrounds, who are slightly resistant to going into pharmacies to get flu jabs? I know from my experience of having to persuade my mother that this is an issue, and it would be helpful to get the communications about getting flu injections out as quickly as possible, so that people build up their immunity as quickly as possible.
Medicines and Medical Devices Bill
Baroness Finlay of Llandaff ExcerptsWednesday 2nd September 2020
(4 years, 2 months ago)
Lords ChamberRead Full debate Medicines and Medical Devices Act 2021 View all Medicines and Medical Devices Act 2021 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Consideration of Bill Amendments as at 23 June 2020 - (23 Jun 2020)
Baroness Finlay of Llandaff (CB) [V]
My Lords, I declare my registered medical and university interests, and that my son is developing cardiac medical devices.
The Bill could either cripple UK medical devices development or enable the UK to become a major player in advancing new devices and medicines for the world market. There must be safety—the report First Do No Harm is aptly titled. Its recommendations must be fast tracked. I will address the proposed information centre, the need for a provisional licensing system for medical devices development, and our duty to uphold international standards.
The information centre that will be formed to collect data on medical devices must establish a level playing field, as a four-nation institution, with representatives from each nation on the board to ensure governance oversight and strategic direction, equal access to data analysis and data sharing, and reporting to all four Health Ministers. The model exists in the joint biosecurity centre, yet the lop-sided power base currently proposed will bleed the devolved Administrations of funds and information. Parity of funding and powers is essential. Clause 41 needs strengthening to require consultation with UK devolved Governments and health bodies impacted by the medical device information system.
Others have stated how EU-UK clinical trials for medicine must continue, with regulation that is compatible worldwide and rapid reciprocity in licensing. The UK must be attractive to medicine and device development by ensuring efficient streamlined systems that provide economic benefit to international investors.
We must catalyse medical device development pathways in the UK, as happened in Galway in Ireland. The UK—a small part of the world market—must grasp the opportunity to become a medical devices development and production hub by being worldwide-compatible and attractive to start-ups. Currently start-ups have the initial brilliant idea and do the safety studies required by the MHRA, but often cannot fund the utility studies in the second phase of licensing. The start-up is then bought out by overseas manufacturers, which market the device back to the NHS at great profit. A provisional MHRA licence would allow the start-up to sell to the NHS when safety studies have been completed as the utility data is gathered. A provisional licence would allow marketing to the NHS with post-marketing surveillance. I think that that reflects the proposals made by my noble friend Lord Kakkar. Patients would benefit more rapidly, with high monitoring standards in place, and it would stimulate the manufacturing infrastructure if the second stage of development happened in the UK.
Regarding China’s organ harvesting and experimentation on detained citizens, the Minister wrote to me last night, citing the WHO’s view as reassuring. It is not, as many noble Lords have already pointed out. Consent documentation for tissues from outside the UK is required only on an advisory basis. It must be statutory. There are now reports of Covid vaccine experiments in China being carried out on prisoners without consent. The UK cannot ignore increasing evidence of abuses, so I will co-sign an amendment to close the glaring gap. The Government can then prove that they really take this extremely seriously.
Smoking
Baroness Finlay of Llandaff Excerpts(4 years, 4 months ago)
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Lord Bethell [V]
My Lords, I believe that the annual cost is £2.3 billion. It is far too much and we must do more to get it down. Huge progress has been made but we are still committed to a smoke-free 2030.
Baroness Finlay of Llandaff (CB) [V]
Do the Government recognise the particularly high addictive potential of tobacco among the young and that two-thirds of 100,000 youngsters who took up smoking last year went on to become long-term smokers? Without banning passive smoking in open areas, all the public health gains to date will be lost. There is strong evidence that smoking bans have been most effective in improving health.
Lord Bethell [V]
My Lords, I completely recognise the power of the smoking bans, as well as the threat of young people taking up smoking and sticking with the habit for a long time. We are on track to meet our national ambition of reducing under-15 smoking from 5.3% in 2018 to 3% or less by 2022. However, even that seems too high and we will continue to work on our efforts.
Independent Medicines and Medical Devices Safety Review
Baroness Finlay of Llandaff Excerpts(4 years, 4 months ago)
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Lord Bethell
I completely agree with the noble Lord, Lord Greaves, that this is an important report. I pay tribute to my predecessor my noble friend Lord O’Shaughnessy, who commissioned it. We take it extremely seriously. No one could possibly read about the hardships suffered by the women described in this report without wanting to move swiftly on it. It has only been a few days so I cannot announce a strict timetable for every measure, but I assure the noble Lord that it is taken seriously and we will be moving on it in the very near future.
Baroness Finlay of Llandaff (CB) [V]
My Lords, this important report must become core in every curriculum, because patients must be listened to. It is correct to say that there must be a culture change, but I would like to focus on the third recommendation about establishing a redress agency. How quickly will the Government progress that? Without that, and without changing the whole culture of compensation and complaints, we will not get the openness and listening whereby if somebody comes forward with something they should expect the answer, “Thank you for telling us,” not “Oh well, we’ll look into it.” Until that changes and every comment is welcomed and patient- reported and family-reported outcomes are used to move services forward, we will not get the culture change that is needed.
Lord Bethell
The noble Baroness is right about culture change, but we are aware that having a big, clunking fist of financial threat hanging over individuals who are considering the admission of mistakes is not the right combination to create a culture of self-awareness and acknowledgement. We have to move extremely delicately to encourage people and make them feel safe enough to acknowledge the mistakes that might have happened and to embrace the kind of dialogue with patients that is necessary to deal with these results. That delicate balance is one of the most important things to get right in our reaction to this report.
Covid-19: Test and Trace App
Baroness Finlay of Llandaff Excerpts(4 years, 5 months ago)
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Lord Bethell
My Lords, in all aspects of our battle against Covid, we have sought a four-nations approach. We hope to work together for one solution. I am aware that other nations are looking at their own options, but it is our hope that, in time, they will all come together for one solution.
Baroness Finlay of Llandaff (CB) [V]
What were the governance processes behind the decision to abandon rather than complete the last stages of development of the NHSX app and where are they published, given that the NHSX app had MHRA and security clearance and was days away from being finalised?
Lord Bethell
My Lords, the decision to change strategy was taken ultimately on operational grounds. The regulatory environment was not necessarily relevant for that. We cannot avoid the fact that there have been technical issues with both the Apple and the NHS apps. We are still some way from resolving those issues, but we hope to overcome them, in partnership with Apple, and the House will be updated when we do.
Social Distancing: Two-metre Rule
Baroness Finlay of Llandaff Excerpts(4 years, 5 months ago)
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Lord Bethell [V]
No, I do not accept my noble friend’s analysis. In fact, social distancing, which is central to our strategy, has had an incredible impact on saving lives and protecting the NHS. You have only to look at the spike that is occurring in places such as Texas, Florida and, according to today’s news, Beijing to see what happens if you do not tackle the underlying prevalence of the disease and you allow the lockdown to end too early.
Baroness Finlay of Llandaff (CB) [V]
My Lords, do the Government recognise that if the blanket rule is relaxed for some, such as most primary school children, who appear to have a lower rate of infecting others, people who are shielding someone will be terrified that reducing the distance will endanger the life of the person they are protecting? Their need to maintain a greater physical distance will need to be clearly signalled—for example, through an officially issued lapel badge or lanyard, as I suggested yesterday—and they will need to have antibody testing.
Lord Bethell [V]
The noble Baroness is entirely right. The kind of differential shielding that she suggests may well play an important role in what we do going ahead. We must do our utmost to protect those who are shielded. However, we are also aware of the challenge of having confusing regulations. That is why we are currently holding the line. We are aware of the effects on the economy, and that is why a review is on the horizon, but until then we are focused on reducing the prevalence rate and protecting those who are most vulnerable.
Health Protection (Coronavirus, Restrictions) (England) (Amendment) (No. 2) Regulations 2020
Baroness Finlay of Llandaff Excerpts(4 years, 5 months ago)
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Baroness Finlay of Llandaff (CB) [V]
As regulations change rapidly, I want to focus on PPE, particularly the supply of FFP3 high-level protection masks for clinical staff. The Royal College of Physicians—I declare my interest as a fellow—has conducted four surveys of members about their continuing experiences, and the latest, on 3-4 June, has shown welcome improvements, but problems persist. Just 10% feel ready for services to return to normal, while 31% think it would take a year to 18 months for the NHS to get back on an even keel. Access to PPE and testing have improved but 16% of doctors still report being unable to access the PPE they need for managing patients with Covid-19, and almost a third report not having been properly fit-tested. Shortages continue: 11% found themselves in the last two weeks unable on occasion to access the PPE that Public Health England advises. Only 26% have had access to antibody testing, and of those, 30% report the results as positive.
As Test and Trace gets established, the requirement for contacts to self-isolate for two weeks risks returning to the pressures of staff absences. Current guidance about PPE is that staff should always wear a mask, which decreases the risk of asymptomatic spreaders and protects the patients. But staff are not adequately protected. An FFP3 mask is only allowed in high-risk areas and for certain procedures. Patients on ordinary wards, waiting for admission and on whom results of tests are not yet back, often cough, splutter or vomit and it is inevitable that clinical staff are showered with droplets. Can the Minister say how secure are supplies of FFP3 masks, are we now producing them in the UK, and will they be issued to all front-line clinicians to try to ensure that a second peak does not pull down staffing numbers to critical levels as the lockdown eases? As people move around more, the risks to those shielding or with visual difficulties will make them more anxious. Will the Minister explore with me the idea of Dr Iliff, an anaesthetics Bevan Health Technology Exemplar trainee in Wales, for a lapel badge that those who need more protection can wear to make them visible to others when in public places, and which could go on a lanyard?
The Deputy Speaker (Baroness Garden of Frognal) (LD)
I understand that the noble Baroness, Lady Hussein-Ece, has scratched, so I call the noble Lord, Lord Holmes of Richmond.
Covid-19: Cancelled Medical Operations
Baroness Finlay of Llandaff Excerpts(4 years, 5 months ago)
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Lord Bethell [V]
The noble Baroness is entirely right to focus on those who are the most vulnerable. Data for March 2020 shows that cancer referrals began to drop although treatment levels did remain high, with 15,363 patients starting treatment following an urgent referral. That is the highest figure on record in a single month. So, although some treatments may have been cancelled, as she rightly describes, what I would like to convey is that a large number of treatments did continue, and we will be working hard to address any backlog.
Baroness Finlay of Llandaff (CB) [V]
My Lords, following on from a previous question about bed capacity, I declare an interest in that my son was involved in setting up the Nightingale Hospital Excel. What assessment has been made of bed requirements to keep non-surgical care completely separate from surgical care that needs to happen in Covid-light or Covid-free areas, and to ensure the frequent testing of staff, in particular highly skilled trauma surgical staff who may be moving between these two zones, so that they do not themselves become a cause of transmitting infection?
Exercise Cygnus
Baroness Finlay of Llandaff Excerpts(4 years, 5 months ago)
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Baroness Finlay of Llandaff (CB) [V]
My Lords, after operation Cygnus were estimates of the requirements for PPE checked against the 2006 influenza pandemic stockpile, given that this store was found to contain no gowns or visors, and 21 million protective FFP3 masks were missing when the store was opened for the current pandemic?
Lord Bethell [V]
The noble Baroness is right—if I understand her correctly—that the needs of PPE for a flu pandemic were quite different from those for Covid. It is also true that the planning did not anticipate a breakdown in global trade and a failure of the business-as-usual supply of PPE. No one could have imagined that flights would be grounded and factories shut and that the global supply chains for these key and vital products would have ground to a halt in the way that they did.
Covid-19: Care Homes
Baroness Finlay of Llandaff Excerpts(4 years, 6 months ago)
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Lord Bethell
The noble Lord makes a comparison that history will have to judge on, I am afraid to say. I think that I am making a fair point when I say that Britain can really only benchmark itself against its close neighbours. The experience of Asian countries taught them an enormous amount, but it is not one that has seemed proximate or relevant to us in recent times. I am afraid that I can only leave it to history to judge whether we made mistakes. It would be wrong for me to prejudge that at this moment.
The Deputy Speaker (Baroness Finlay of Llandaff) (CB)
My Lords, I must apologise because I allowed everybody to come in. I had mistaken the timing and had allowed this to run for 15 minutes instead of 10. I must make it clear that this does not set any precedent. It was my error.
The Virtual Proceedings will now adjourn until a convenient point after 7 pm for the second Urgent Question repeat.