Anaesthesia Associates and Physician Associates Order 2024

Baroness Fox of Buckley Excerpts

Monday 26th February 2024 Lords Chamber

[Lord Patel (CB)]

I hope they do find time, because that allows for better scrutiny and better ability to amend, which we always claim to be our key role—to scrutinise and amend. It is a major piece of legislation to go through using SIs, and it is inappropriate to do so. Maybe we must consider how else we could do it in a way that maintains flexibility.

Moving on from that, as the noble Lord, Lord Harris, already mentioned, if this legislation is going to be the template for future legislation to regulate all health professionals, some issues will need to be discussed. This order does not require that health is considered as a category in the regulation of physician and anaesthesia associates. The statistics show that, when the GMC or, I presume, any other regulator investigates, it is a very stressful situation for the person involved. Some statistics suggest that one in three considers suicide; they are depressed by it. If the category of health is removed as a consideration when a person is investigated, as this order does, it is a backwards step. I need to ask the Minister why health has been removed as a consideration. If this is the template, I presume that this will also apply to other regulations in the future.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, the noble Lord, Lord Patel, just said many very important things, with which I agree, far better than I would. I thank the noble Baronesses, Lady Bennett, Lady Brinton and Lady Finlay, because this debate has revealed the importance of this order: it is not a minor regulatory matter that can be put through by an SI, in a back room. That it has created so much debate outside the Chamber indicates why it is important that we discuss this and that it is not nodded through behind the public’s back. I am glad of that.

I have been embroiled in discussions about this for some time. The noble Lord, Lord Hunt of Kings Heath, made a good point when he said that the discussion has become quite toxic. I thought it was perfectly reasonable to be worried about PAs and AAs; I did not anticipate this kind of savage attack on them. There has been a real scapegoating of these individuals, which is not how we should resolve this issue. We should also remember that doctors can be guilty of clinical negligence. We do not want to wander around pointing the finger at who is more negligent.

However, if there are preventable never events as a consequence of people not being fully equipped for the roles that they are asked to do—by the way, they are being asked, very often told, what to do when they are not really up to it, through no fault of their own—it is a matter for public concern. That is the way that accountability works and why we need to be very clear and have no muddle over what somebody is supposed to be doing, what they are not supposed to be doing, and what they can and cannot do.

There were a couple of things that confused me in the arguments made in the briefings we received. I lost the will to live in the rows going on about the differences between physician associates and physician assistants, as though “associate” or “assistant” was the key difference. I think the difficulty is when people think that any of them are physicians, because that means that they think they are doctors. That is the confusing bit and it shows that people can get lost in the midst of this.

It is also worth bearing in mind some context when it comes to the public. Most patients would prefer to see anyone at a doctor’s practice than wait for two weeks in pain. That makes the public vulnerable to having a lesser service. I understand that. I also thought that the noble Lord, Lord Patel, was absolutely right about a big team: when you are in hospital, you are surrounded by people wearing a million badges, different colours and lanyards. They all introduce themselves to you in great detail, but you do not care because you are ill. You want to lie back and trust them, and assume that a division of labour is going on.

Sometimes, when I was reading the briefings, it felt as though there might be a bit of vested interest about who was regulating who and what numbers were on the badges. This seemed to miss the point of the real concerns, which are whether there is sufficient clarity about the scope of PAs or AAs, or whatever we call them; that there is not too much mission creep; and that we have a clearly defined set of protocols and specific tasks allocated. I think it important that PAs in GP surgeries have a different set of protocols and scope than in hospitals—they are not the same, even though in both instances they are called PAs.

Covid Pandemic: Testing of Care Home Residents

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Monday 6th March 2023 Lords Chamber

[Baroness Fox of Buckley (Non-Afl)]

My Lords, what is so devastating in reading the Telegraph’s WhatsApp lockdown file is that it has confirmed that the most susceptible to Covid were victims of a lack of targeted testing in care homes, while the least at risk were hectored and frightened into getting tested to reach one government Minister’s self-set arbitrary targets. Will the Minister take back that we urgently need this public inquiry? Will it scrutinise the process of target-setting that lost sight of its original aim? Also, after the revelations that Minister Helen Whately raised concerns about the inhumane policies of separating people in care from their families—so lonely and distraught that they gave up—will the Minister support the Rights for Residents campaign to enshrine in law the right to maintain family contact in all care settings? It was not just the lack of testing that killed people but some of the policies too.

[Lord Markham (Con)]

We all agree that visiting should be allowed as much as possible. I know that the policy is that people can receive at least one visitor, but I know that there are also examples where that is not happening enough. It is very clear, from our side, that it is a priority that everyone should have visitation rights, because they are vital. Can we say that that will always be the case in every circumstance in the future? Well, clearly no one foresaw the pandemic, so this is one of those situations where we can never say so definitively, but we all firmly agree that visitation is a key part of people’s care and well-being.

NHS: Access to Treatments

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Wednesday 7th September 2022 Lords Chamber

[Lord Kamall (Con)]

A number of noble Lords have already asked that question. I will take it back to department and get an answer.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, could I ask the Minister to read and circulate an article from Saturday’s Guardian by Merope Mills, a devastating account of the preventable death of the journalist’s 14 year-old daughter, Martha? Would the Minister note that Ms Mills, an erstwhile, uncritical NHS cheerleader, stressed that this

“had nothing to do with insufficient resources or overstretched doctors and nurses … austerity or cuts, or a health service under strain”?

Can the Government recognise that this crisis goes far deeper than simply listing numbers, money or technical solutions?

[Lord Kamall (Con)]

The noble Baroness is absolutely right that it is not just about money, although money does play an important role; it is also about processes and efficiency. In my conversations with people who have been in the NHS or medical services for years, many have commented that we still have the same old model: you go to see a GP, you hope to see them for five or 10 minutes and then you are referred to someone in secondary care. There is a much more efficient way of doing that in this day and age. We have to look at the whole model of both health and social care and modernise it.

Coronavirus: New Cases

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Monday 11th July 2022 Lords Chamber

[Lord Kamall (Con)]

We rely on data from the UK Health Security Agency. It monitors this, and looks at ONS data, data on hospitalisations and the capacity of the NHS to absorb the increase in patient numbers if there is one. That is where we take our advice from and that is what would trigger future action, should it be needed.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I confirm that there is anxiety about the rise in Covid cases, but less about the virus itself than a worry that politicians might reintroduce some of the over-the-top restrictions that led to such collateral damage during the past two years. Hindsight or not, I make the point that people are nervous. Very specifically, will the Minister comment on the fact that, for example, some care homes are using the rise in Covid cases to lock down homes and carry on restricting visits with relatives—which we now know is damaging the mental and physical health of so many elderly care home residents, who suffered so inhumanely, not from Covid but from our response to it? Will he encourage those care homes to open up and be a bit more confident?

[Lord Kamall (Con)]

I start by paying tribute to the noble Baroness for her championing of civil liberties issues and making sure there was a debate on them. I will, with pleasure, take back her point on care homes to my ministerial colleagues who are in charge of social care.

Health and Care Bill

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Lords Hansard - Part 2 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Baroness Sugg (Con)]

My Lords, Amendment 183 in my name, if accepted, would maintain the existing provision of at-home early medical abortion following a telephone or video consultation with a clinician. It is very late in the evening, but this is an important issue which will impact hundreds of thousands of women. The existing provisions, which the amendment simply transcribes into the Bill, were adopted in March 2020. It is a straightforward and narrow amendment with the sole purpose of retaining a service that has been in place for the last two years.

Early medical abortion, which can take place up to 10 weeks into a pregnancy, involves two medications. Previous government policy in England was that only the second pill could be taken at home, with women having to attend an abortion provider in person to take the first pill. The approval that was put in place simply enables women to take both pills at home. This was a pandemic-led shift to telemedicine, but the clinical benefits of telemedical service were known even before Covid-19, with NICE recommending it in September 2019. Sadly, following a government announcement a few weeks ago, this approval is currently set to be removed in August this year.

At this point, we should briefly be clear on what removing the existing provision would affect. It would have no impact on the requirement for face-to-face consultation, for face-to-face safeguarding, for ultrasound scans or to be seen in person by both doctors. Any of those changes would require amending existing regulations and that is not what we are debating tonight. The only thing impacted by this amendment is the requirement for women to visit a clinic and then leave again. I hope noble Lords agree that we can focus on just that.

There is no medical reason why telemedicine, alongside interpersonal appointments, should not remain a permanent option. There is overwhelming evidence that allowing women the option to access early medical abortion at home, where clinically appropriate, has created a safer and more effective service. During the pandemic, the largest ever study of UK abortion care, published by the British Journal of Obstetrics and Gynaecology, found that this service shortened waiting times and enabled women to receive care much earlier in their pregnancy. Some 150,000 women have received telemedical abortions since March 2020 and the data on the number of women presenting to NHS services with complications has shown a decrease. Renowned medical bodies support its use, including the Royal College of Obstetricians and Gynaecologists, the Royal College of General Practitioners, the Royal College of Midwives, the British Medical Association, the Academy of Medical Royal Colleges and many more. Just last week, the World Health Organization made it a key part of its global guidance on abortion care.

It is not just the medical experts who want to see this service made permanent—women do too. A recent study in the British Medical Journal found that 89% of women who have used a remote abortion consultation would choose to have treatment at home. It helps women who may struggle to find the time and travel the distance to an abortion provider. This includes those who have childcare or caring responsibilities, who struggle to take time off work, who live in remote or rural areas with little transport and many other logistical, social and economic reasons. Importantly, it can also be a lifeline for women in vulnerable situations. Maintaining the service is fully supported by women’s groups, including Women’s Aid, the End Violence Against Women Coalition and Rape Crisis, which say that it enables women in controlling and abusive relationships to access essential medical care. Removal of telemedical abortion provisions would almost certainly lead to a resurgence in women seeking to access unregulated pills bought online. Without telemedicine, waiting times will rise and current staffing levels would be insufficient.

There is a serious risk that some women would, as a result, be unable to access legal abortion care, either because the providers do not have the capacity or because increased waiting times push some women over the legal limit. Of course, face-to-face services must still be provided for all women who require or request it. However, to take away from women a service that has proven safe, accessible and compassionate, and which enables women to deal with a difficult situation in the comfort and privacy of their own homes, is not the right way forward.

This amendment follows the guidance of medical professionals and would deliver on the Government’s aim to listen to women and put them at the heart of the women’s health strategy. I believe the case is clear and hope that the Government will accept this amendment. I beg to move.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, in speaking to this amendment, I apologise for not having spoken in Committee. I want to do so because I have received hundreds of emails urging me to vote against this amendment. I want to explain why I will vote for it—if there is a vote—and why the people who emailed me are worrying about the wrong thing. I emphasise that this is not about changing the law.

I will not make a long speech because the noble Baroness, Lady Sugg, explained the amendment brilliantly and thoroughly. I will make just a couple of points. Over the past two years, the Department of Health, the Government and SAGE—everyone—have told us to follow the evidence. The truth is that this telemedicine, pills-by-post approach to termination pre 10 weeks’ gestation is simply a medical practice innovation that is safe, effective and follows the best clinical practice. So I want to follow the evidence.

About the only positive outcome of the pandemic I can see is that an enforced pilot scheme has given us evidence of the efficacy of this. We also know, as has been mentioned, that many women appreciate this option because there is no clinical need for them to attend a clinic for this procedure. I really cannot see why the Government cannot see that women who do not need hospital care or in-clinic services to access a procedure should not be forced to take up valuable appointment slots and staff time and unnecessarily squander resources that would be better used to intervene in genuine medical emergencies.

Despite all this, I understand that, for many people, the issue of abortion cannot be reduced to evidence or medical practice because they have moral concerns. I assure them that nothing in this amendment, which is literally about the location where a woman swallows a pill, touches on moral values. This is not a law change. Who can and cannot have an abortion remains exactly the same. The grounds on which abortion is legal remain exactly the same. It is common sense and pragmatic as a matter for women but, if you are morally opposed to abortion, you will still be morally opposed to abortion because nothing in this amendment will change your moral objection. Be reassured: you must have a different fight but not on this amendment, which is total common sense. The Government should accept it.

[The Lord Bishop of Durham]

My Lords, I begin by paying tribute to the noble Baroness, Lady Sugg, for her tireless work on gender equality and areas of international development. We have often been collaborators on such matters. I also apologise to the noble Baroness if she has personally received any hurtful comments on this; some of the things I have seen were shameful. She should not have been abused in this way. Nevertheless, I will oppose her amendment; I hope she understands that this in no way lessens the way in which I honour her for her work.

I declare at the outset that the Church of England’s position on abortion is principled opposition, with a recognition that there are strictly limited conditions under which it may be preferable to any available alternative. My opposition to the amendment is based on that in part but also because I believe that the amendment is functionally inadequate in providing the necessary protections. This was a temporary measure introduced during the pandemic to allow continued access to abortion services, simply to meet a need in extraordinary circumstances. I support the Government’s decision to return to the pre-pandemic system for early medical abortions from August, which was supported by many in the public consultation response.

Vaccination: Condition of Deployment

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Thursday 3rd February 2022 Lords Chamber

[Lord Kamall (Con)]

The Government continue to review the data, as other countries do. Clearly, we have vaccinated vulnerable children, and there have been moves, particularly with omicron, to look at vaccinating children. We have reduced the age, but we still need more data. Once we have that data, if it is more appropriate, we will vaccinate children, but we have to make sure we have the data because children respond differently.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I have always been opposed to this discriminatory policy on principle, so I welcome the Statement, even if it rather defensive. Will the Minister commit to dumping jabs for jobs and not sacking front-line workers? Will the Opposition roll back on the divisive rhetoric, categorising workers under moralistic labels of vaccinated equals virtuous, and traducing the unvaccinated as selfish or neglecting their professional duty? This seems unhelpful, especially as many of the NHS100k campaign are fully vaccinated, vaccine enthusiasts working in the health service, but who believe in choice and freedom of conscience. Is there any likelihood of the estimated 40,000 care workers who have been driven out of their jobs being compensated for the income lost, never mind being reinstated?

[Lord Kamall (Con)]

I begin by agreeing with the sentiments expressed by the noble Baroness that we should not necessarily be labelling people who decide not to take the vaccine. We should understand individual choice, but with freedom comes responsibility, and we always have to get that balance right. At the same time, I do not think that some of the characterisations that have been given are helpful. Having said that, if people have stopped other people being vaccinated, they should be dealt with by the law. The noble Baroness and I agree on individual choice, but, clearly, this was an emergency and people were dying and it was important that patients going into hospitals and care homes felt confident that they were being treated by staff who would not pass the virus on to them. There is always a difficult balance between liberty and responsibility.

Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 6) Regulations 2021

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Wednesday 15th December 2021 Lords Chamber

[Lord Sterling of Plaistow (Con)]

My Lords, I suggest that, if it were not for omicron, we would not be sitting here today. It is only because of omicron that we are all debating this. I have to say this. Could the messages have been better? Yes. Could the NHS have been better prepared? Possibly. But that does not matter. I completely support what my dear noble friend Lord Fowler said.

Decisions have to be made and I will finish on this point. The sooner we are able to be free—truly free—I want the opportunity for us all to get everybody back to creating wealth in this country, because that will be the real challenge before us. Unless we manage to do it, the rest, sadly, will become unnecessary.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I commend the 126 MPs in the other place who voted on their principles and conscience, despite heavy whipping, in yesterday’s rebellion. They formed an ad hoc Official Opposition while the formal Official Opposition did their—what did Keir Starmer call it?—“patriotic duty” in not opposing but endorsing every single one of the Government’s proposals.

Despite having previously opposed vaccine passports, now renamed by Ministers—as though that were convincing—and despite all the talk of preventing the NHS toppling over and lauding NHS workers as heroes, Labour voted for discriminatory employment practices and the brute force of job losses to coerce NHS staff into complying with a medical intervention or getting sacked.

In every wing of the Conservative Party there was a significant minority of MPs who, despite personal appeals from the Prime Minister, defied the Whip—and that means something important that this House might note.

This legislation has already been passed, so detailed scrutiny of each aspect of it is largely formal, with little meaning, but there are broader issues worth raising. One is trust. I am concerned that the Government’s response to omicron is eating away at trust in political institutions, and objective statistics and data have been misused recently, with examples of regular contradictions and different figures coming from Ministers with quick contradictions afterwards. We worry about misinformation on the web, but there has been a fair amount of it from official sources.

Also, can we remind ourselves that the Prime Minister, Boris Johnson, declared an “irreversible” road map out of lockdown? But that irreversible moment has now screeched to a halt and is reversing at rapid speed. Then we get shrill warnings that the UK is facing a “tidal wave” of omicron. Is that a bit like “one minute to midnight”? I am worried that there is overhype and too much hyperbole.

This is all in the real context that 95% of the population have antibodies. There has been a phenomenally successful vaccine take-up and, in the real-world international evidence—not speculative modelling—we are thankfully shown that, while this variant is highly transmissible, it is not as yet seen as a widespread, lethal threat by medics and scientists. And hyping up the potential threat can do real damage in other ways. If everything is an emergency, nothing is an emergency, and there is always a danger in crying wolf.

The speed of omicron is not the only danger. More worrying is the dangerous speed with which the Government immediately have recourse to invasive restrictions. This is no longer a last resort. It is almost the first policy idea at which they grab. It is not based on weighing up the broad social pros and cons. We are not presented with a detailed cost-benefit analysis; it is deployed just in case there is a worst-case scenario. There is always a hint of worse to come. It might be vaccine passports now, but in the new year there will be three-dose vaccine passports.

The Prime Minister offered a rare opportunity for a national debate. I was quite excited. A national debate is sorely needed on the whole question of the balance of risk and the priorities which society wants to take. But, no, the Prime Minister’s offer of a national debate was to discuss mandatory vaccination, of all things.

This Government have made national sovereignty a byword and sovereignty something which people understand. I remind them that this direction of travel is in danger of trashing the Enlightenment ideals of individual sovereignty and bodily autonomy. John Locke’s A Letter Concerning Toleration says,

“no man can be forced to be … healthful”

Vaccine passes are not inconvenient or a bother. I have one in my bag in the unlikely event that I might go to a nightclub. What does it mean? Most people will say, “I do not know what the fuss is about”, but there are far greater implications. Everyone’s freedom is limited if the state determines that it is contingent on accepting a medical treatment or providing medical information, or on a submission to public health priorities above all else. It is limited if we need a licence to go about our lives freely.

The noble Lord, Lord Scriven, has asked us to put our political philosophies to one side, as though noble Lords are raising matters of principle as if we are in some sort of sixth-form debating chamber. I understand that this is a caricatured view. If society is to be completely reorganised around public health, and dangerous, illiberal principles are to be set, debate should at least be encouraged. I should have thought that liberals and democrats—as in Liberal Democrats—might be quite keen on that kind of a debate.

I quote from a new document which the Government has brought forward in the last few days. It is a modern Bill of Rights. In the foreword, we are told,

“The United Kingdom has a long, proud, and diverse history of freedom. This stretches from Magna Carta in 1215”.


It then details all the proud freedom movements. It continues,

“Our proposals, which form the basis of this consultation, reflect the Government’s enduring commitment to liberty under the rule of law.”


What is the point of having documents declaring a commitment to liberty under the rule of law if liberty can be so easily dispensed with in the name of public health?

State power works. Of course it does. You can scare and threaten people into changing their behaviour, but is that what we want in our society? Many of my extended family have disagreed with my more liberal views on this question, throughout this pandemic, and have been enthusiastic adherents of lockdown. At the moment, they are not so much scared of the virus as of the next government press conference. They have become cynical about a lot of what they are being told. They are fearful that their way of life is being disrupted, rather than being immediately frightened of death.

In a recent pamphlet, Toxic Sociality: Reflections on a Pandemic, Josie Appleton makes the point that every pandemic has a social dynamic, as well as an epidemiological cause which structures the way the disease is seen and responded to. In many ways, my extended family has noticed that there is more to life than epidemiology. There has been a period when they have been able to meet publicly and socially to discuss what kind of priorities they want. It is important not to dismiss that social side. It seems to me that one clear and present danger is that social cohesion is now threatened by the kind of messaging that we are getting around the virus. Human interaction is presented as a contagion. All the unregulated examples of free conviviality and spontaneous social gatherings, such as going to a nightclub without showing a pass, are presented as toxic. Free association is being replaced by state-authorised association.

We are encouraged to view the unvaccinated as “the other”, as lesser, to be excluded from aspects of society and employment and discriminated against—not there to be encouraged or persuaded into the vaccine, but threatened. This is not making a positive case for the wonders of the vaccine and it promises to backfire.

The noble Lord, Lord Fowler, made a point about what he considered to be the role of this House. I thought that its role was to scrutinise and be critical. I hope that in the new year this House gives a lead, not just by going along with whatever we are told but by asking questions and potentially prioritising the importance of a free society, without having to apologise for it.

[Lord Thomas of Gresford (LD)]

My Lords, it is only about eight miles from Buckley to Gresford, but I must say that the distance between me and the noble Baroness, Lady Fox, is infinite given the views that she takes.

I want to put a personal note into this debate. Within the last two years, I have undergone a course of chemotherapy, which destroyed my immunity to disease, according to the experts. I was told a fortnight ago that I should have another booster in addition to the booster that I have already had—in other words, four jabs altogether for me. But I come here. I am sure that the noble Lord, Lord Robathan, will approve of my coming here in answer to the Writ of Summons to contribute, to try to play a part and go on as though nothing has happened. But I come here because I rely on the common sense and collegiate responsibility of my colleagues in this place, of the doorkeepers and of the staff, and of all the people here who are doing their best to protect us.

I can tell your Lordships that it is a matter of concern to me when I see, on the opposite Benches, people who are proud not to wear something but of not wearing a mask. That makes me feel unsafe. I am sure that I am not the only person here with a compromised immunity—there must be others—who come here to try to carry on, but this is only one workplace. There are workplaces throughout this country where people are trying to carry on. They need leadership; they need confidence that the advice they receive from this House, from the other place and from the Government is soundly based on the best medical science that can be brought to bear. That science tells us that we should protect ourselves and wear masks, not just for ourselves but for the people whom we move among when we travel here—referred to by my noble friend Lord Scriven —or are going about this place.

We are protecting not just ourselves by wearing a mask but everybody else, and I do not understand a philosophy which permits people to say, “I am above all this.” “Freedom!” is the great cry. That is rubbish. I shall oppose the noble Lord, Lord Robathan, if he puts his amendment to a vote, but I plead with him to think of people like me with a compromised immunity who are trying to carry on, and to withdraw that amendment.

Covid-19 Update

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Wednesday 8th December 2021 Lords Chamber

[Lord Kamall (Con)]

In many public places, advice has been posted about continuing to socially distance, but the main thing is now to wear a face mask and ventilate indoor spaces. But, if social distancing is again seen to be a factor, we will update as soon as we can.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I did not agree with cancelling Christmas last year: I thought that it was disproportionate and far too risk-averse, based on the evidence then. It was cruel, with millions of front-line workers who had worked their guts out during the lockdowns having their parties cancelled and their family celebrations snatched away. Does the Minister understand what has changed now that the public know they were taken for mugs last Christmas? How can seething citizens, including me, give any credibility to data or a risk-averse plan B being based on evidence, rather than a tactic of political crisis management, which is what it feels like?

[Lord Kamall (Con)]

I understand the frustration of the noble Baroness and a number of civil libertarians, but we have always been clear that we have to have a balance between keeping the British people safe by being cautious and making sure that we follow the data. We have always looked at a number of different factors, including hospitalisations, the proportion of admissions due to infection, the rate of growth in cases, vaccine efficacy and many others—but, quite clearly, when we see this doubling rate of the omicron variant and do not yet have enough data, we are being cautious. By doing this now, we could prevent a worse situation later.

Adult Social Care

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Thursday 2nd December 2021 Lords Chamber

[Lord Kamall (Con)]

First, I pay tribute to the work that the noble Baroness has done for carers over many years. She has personally raised with me issues with carers, both paid and unpaid, as well. The White Paper clearly raises issues of professionalising, training and recognising carers to help make this a rewarding career for many. At the same time, it looks at unpaid carers and understands that, for a number of reasons, they are not all similar. Sometimes they are school-age children. We have looked at young carers and at elderly carers—for example my mother, who, in her 70s, looks after an 80 year-old sister who suffers from dementia. They have different needs.

We are first trying to look at how we can help make their task easier, for example through technology freeing up time. We are also looking at respite and how we can make sure they have breaks. We hope that those conversations will be had at the local level, between ICSs and health professionals having meetings directly with the individuals concerned to make sure that unpaid carers have the appropriate support.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I feel torn on this. On the one hand, it is irritating that the White Paper has come out but everybody wants to bash it, when I am relieved that somebody has suggested something. On the other hand, it is not satisfactory. To ask some immediate questions, the crisis of care staff has already been referred to, but I am concerned that the White Paper is being used to avoid talking about the real crisis now. There are genuine problems in care homes in the aftermath of Covid. It is not just about staff, but the fact that relatives are still being denied face-to-face visits. There is still a climate of risk aversion and fear from some managements, with lots of people with dementia being locked in their rooms. All sorts of terrible things are happening and people do not know what to do. I do not want this White Paper to be used to bat things away.

That was the first thing. Secondly, in the longer term, can the White Paper create that vision and be used as a platform? To be honest, I think it is visionless and technocratic. We need to get talking and involve the nation in developing the vision we need. Everybody has an investment in improving this.

Coronavirus Act 2020

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Tuesday 26th October 2021 Grand Committee

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I want first to register that the no-vote on the Coronavirus Act in the other House last week, with the seemingly glib statement that the House was not in the mood to vote, was unsettling. Although a majority of the most illiberal and worrying uses and abuses of the law over the last 18 months have been acted through public health legislation, none the less the Coronavirus Act remains as a legislative symbol of the state accruing enormous and unprecedented powers to deal with the public health emergency.

To be clear, when the Act was brought in there was an emergency. Whatever my own reservations or those of fellow civil libertarians, we could see that a worldwide pandemic gave an excuse to the Government in having to act quickly and respond in the way they did, and it explains some of the extreme measures. But that was then, and whatever possible excuses there were for little parliamentary scrutiny when the Act was initially passed, since then there is no excuse for the lack of post-legislative scrutiny and for accountability being so woeful. I echo the thoughts and concerns of the noble Lord, Lord Hunt of Kings Heath.

When, every six months, the House of Commons is asked to vote for or against, there is no option to amend or expire individual provisions. Sufficient time is never allocated to renewal debates to allow detailed scrutiny. It becomes more or less a fait accompli. By the time the renewals arrive here in this House, it feels, like now, that we are going through the motions and making speeches for the sake of it, which is why I assume many of us are trying to make speeches that might say something beyond nodding something through.

Let me say this: the urgency of the initial stages of the pandemic has passed. There is no longer a public health emergency. Of course Covid is still a serious challenge and needs to be managed carefully. I do not underestimate it; a family member sadly died of Covid only recently. However, the crisis stage of the pandemic has passed, and this legislation is just not needed. Its continued existence and the Government’s reluctance to revoke it represents another kind of crisis: the undermining of the rule of law in democratic decision-making under the auspices of Covid.

It really does feel as though Ministers have grown rather too accustomed to the Covid-related ease with which laws can be made, now that the Government have enhanced legislative control and seem reluctant to relinquish newly accrued powers. To quote Big Brother Watch,

“the emergency mode and its perks—rapid law-making without scrutiny and a ratcheting of executive powers—has persisted”.

Perhaps most galling for me is that the Government seem reluctant to provide impact assessment statements for legislation, which means that Parliament has often not had the information it needs to properly scrutinise measures that have profound social, economic and health impacts—let alone assaults on our liberties.

This lack of transparency also blindsides public debate. Too often, citizens are left to speculate as to why certain laws are being introduced when there seems so little evidence of their efficacy. Undoubtedly this has fuelled conspiracy-mongering and undermined trust in politics and institutions. Look at the egregious way in which proposals to mandate vaccines for care home workers was dealt with. There was a rushed 90-minute debate in the other place and a cavalier use of secondary legislation to interfere with workers’ hard-won employment rights that is likely to create a huge staff shortage crisis in care homes. All this was done in the face of a wide range of opponents pointing out the shortcomings of the proposals—I am thinking here of everyone from trades unions to Tory Back-Bench MPs agreeing—and despite a lack of evidence that this policy will lead to any extra protection for vulnerable residents, as alleged.

Now the Government are doubling down and targeting NHS staff. Just when we are told that one reason why the Government might bring in further restrictions is if the NHS cannot cope this winter, the Department of Health and Social Care has the brilliant idea of implementing a policy that will mean effectively sacking thousands of front-line health workers, creating a staff shortage crisis that could have—guess what?—catastrophic implications for healthcare and make matters worse.

Here is my great dilemma for the Minister. We have all—or almost all—welcomed the shift from legal restrictions to public health guidelines and trusting the public to take personal responsibility for weighing up risks. That was, and is, it seemed to me, the message from the Prime Minister and the Cabinet—or that was what I thought. So it is unfortunate that, despite assurances and even promises that 19 July was the terminus date and the pledges that relaxing restrictions would be irreversible, and despite the good news of extremely high vaccine take-up and levels of antibodies, and evidence, as we have heard, of the virus being under control, Ministers keep threatening the public with really quite draconian measures again. It is totally demoralising and disorientating.

What we really need to hear from the Minister today is that the Government will no longer use the criminal law to manage public health. Instead, what we have is another attack on freedoms hanging over us in the form of vaccine passports. Despite a range of U-turns and contradictory ministerial public pronouncements on vaccine passes, despite the findings of the Public Administration and Constitutional Affairs Committee that Covid passes have no basis “in science or logic”, despite leaked but not publicly available cost-benefit analysis from the DCMS that passes will decimate hospitality, arts and sports event venues, which I read about in a newspaper rather than in anything produced by Ministers, despite the fact that the Prime Minister inadvertently admitted that immunity from vaccination was not the same as a guarantee that you cannot contract the virus or pass it on, hence rendering vaccine passes irrelevant in containing the social spread of the virus, as was well explained by the noble Lord, Lord Scriven, despite the fact that the London School of Hygiene & Tropical Medicine’s vaccine confidence project has found that the introduction of vaccine passports will most likely reduce vaccine take-up among the already hesitant and will more likely consolidate a loss of trust in pharmacological interventions in general, as well as in political institutions—despite all this, we still hear the misinformation from the Government that vaccine passports as a policy will protect others. They just will not.

Where is the opportunity for Parliament, never mind the public, to debate all this fully, without fear of being demonised or silenced by big tech, and discuss the implications of an illiberal, divisive, show-your-papers culture? As we talk here today about the renewal of the Coronavirus Act—the emergency, allegedly temporary Coronavirus Act—my dread is that we are signalling the permanence of a state of emergency embedded in law by even contemplating a two-tier checkpoint society. When Jacinda Ardern, the New Zealand Prime Minister, smirked as she stressed that vaccine passes would mean two classes in her country, I was chilled—and I realise that such open discrimination is also the new normal much closer to home, in Wales and Scotland.

The truth is that our Health Ministers need to move away from vaccine passes because they have enough on their plate. Rather than getting embroiled in these politicised rows over Covid-related laws, surely it is time to move on; goodness knows they now have some real public health emergencies to sort out. From the now-understood catastrophic impact that lockdown measures have had on the late diagnosis of everything from cancer to dementia, to backlogs, waiting lists for treatment and the unhelpful actions of GPs—not only are they seemingly hesitant to resume face-to-face contact; there is also the BMA’s truculent behaviour in instructing surgeries to close their lists to new patients and threatening industrial action—Ministers have a lot on their plate.

There are also reports in primary schools that the lack of social interaction during the pandemic will affect young children’s speech, language and general development, and that those problems are likely to persist for several years. Then there is the ongoing and frankly inhumane treatment of care home residents, who are still being deprived of normal social contact with loved ones by risk-averse, short-staffed residential homes, leading to entirely preventable extra health issues.

I have a lot of sympathy for the Minister because he has a lot on his plate. In this context, the now-diminishing threat of Covid as an emergency should be low down on the priority list. All legal sanctions brought into being to deal with Covid now need to be revoked for the sake of the health of the body politic and so that the noble Lord can get on with being a Health Minister for non-Covid health emergencies.