Commissioner for Patient Safety (Appointment and Operation) (England) Regulations 2022

Baroness Garden of Frognal Excerpts

Monday 21st March 2022 Grand Committee

The Government believe that we need to have a more patient-focused system of healthcare. The patient safety commissioner will play a vital role in promoting the safety of patients in relation to medicines and medical devices. We believe that these regulations provide appropriate arrangements to enable the commissioner to function and operate effectively once appointed. I beg to move.

[The Deputy Chairman of Committees (Baroness Garden of Frognal) (LD)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. She speaks as the Front-Bench Liberal Democrat spokesman but as there are no Back-Benchers, I invite her to speak.

[Baroness Brinton (LD) [V]]

My Lords, I thank the Minister for his introduction. He will know that across the House there have been considerable discussions, not just in recent months but recent years, on the role of the commissioner for patient safety in various Questions, debates and Statements since the First Do No Harm report of the noble Baroness, Lady Cumberlege, was published in 2020. I join the Minister in paying tribute to her, not just for her report but for her absolute persistence in holding the Government to account to deliver as many of her recommendations as possible. I too am sorry that she cannot be with us today but I know that she is pleased that this SI has been published.

This SI specifically covers the appointment of the commissioner but, once again, government actions are happening before Parliament has had a chance to scrutinise this SI. This SI sets up the role of commissioner, but the Minister has just told us that not only is the advert out, but it is closed and an imminent announcement is due. I do not think that there is anyone who does not want the commissioner to be put in place, but once again, this seems to be putting the cart before the horse in that the SI is being dealt with after the advertisement has gone out.

However, for the first time there will be an independent commissioner whose role is to stand up for the rights of patients when they have suffered avoidable harm. The three main parts of the report of the noble Baroness, Lady Cumberlege, covered HPTs, sodium valproate and vaginal mesh but there are other issues as well, and unfortunately there will be more in the future. That is why the Minister is right to say that the creation of a learning and safety culture is absolutely vital, as is an environment in which people working inside the NHS and other organisations associated with delivering medicines and medical devices can speak without fear. That is why some of us had concerns over the initial period of appointment. While the possibility of a second term is welcome, the concerns related to that first period of setting up the commission. This is not just somebody who will walk into the job and everything will be ready to go. The difficulty is that, having established themselves in the post, they will then have to gain the confidence of everybody who they might be investigating, which can take a while. It will be quite difficult to judge whether it is appropriate to appoint them for a second term if they have had probably only about 18 months when they have been able to do the job properly.

Food and Feed Safety (Miscellaneous Amendments and Transitional Provisions) Regulations 2022

Baroness Garden of Frognal Excerpts

Monday 21st March 2022 Grand Committee

[The Deputy Chairman of Committees (Baroness Garden of Frognal) (LD)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. She is speaking as the Liberal Democrat Front-Bencher but, as there are no Back-Benchers to speak, I invite her to speak.

[Baroness Brinton (LD) [V]]

My Lords, I thank the Minister for his introduction to the Food and Feed Safety (Miscellaneous Amendments and Transitional Provisions) Regulations 2022, which propose three very differing amendments to existing food safety measures. He was right to start by saying that ensuring the highest levels of food safety is absolutely vital.

The Joint Committee on Statutory Instruments has pointed out that the second and third regulations come into force on the day after the day on which these amendments are made, so once again they breach the 21-day rule. It is such a shame that SIs and regulations seem always to be dealt with as emergency items, because this reduces the time available for Parliament to effectively scrutinise legislation.

The first amendment is to Article 53 of the retained general food law, to manage a problem that has arisen as a result of the Northern Ireland protocol. I note that the Explanatory Memorandum calls it a “deficiency”. It might perhaps be more honest to call it a problem of the Northern Ireland protocol and the practical effect it has had on border issues for those living in Northern Ireland—how they have to juggle the tensions of a border in the Irish Sea when third-party goods come into Great Britain via Northern Ireland and where a serious risk to human health has been identified with those goods.

It is right that the UK Government must correct regulations that are not fit for purpose, and we note that these amendments to Article 53 do not change the purpose or function of the original provision but there is now full protection for such emergency measures, regardless of where the goods have come from.

The second amendment relates to the authorisation of provisions for feed additives and for GM food and feed, which will now be through legislation, bringing them into line with other retained EU food and feed law. That is particularly welcome. There is a lot of suspicion about GM food and feed, and it is important that there is a vehicle through which it can be scrutinised carefully. Parliament is the right place for that to take place.

The third and final change is a sensible step to ensure that businesses have a slightly longer period to move from EU to UK labelling requirements, until 30 September this year. For some time, food businesses have been asking for a longer period, as well as for labelling requirements to be as close as possible to the EU requirements. The latter is not covered by this SI, but I hope that the Minister will continue to listen to UK food businesses which want to continue to sell into the EU and which must also abide by the EU labelling requirements. I thank the Government for the extension to the period during which the EU ones can be used.

The SI brings us back to the wider issues of the Northern Ireland protocol. That is obviously not on the agenda for today, but I want to say that, from these Benches, we always warned that there would be problems for goods travelling into Great Britain via Northern Ireland and for businesses there, which continue to express real concerns about the UK’s decisions and legislation between 2018 and 2020. Whether one agrees with them or not, it is good that these three corrections and amendments will at least sort out some of those minor problems.

Health and Care Bill

Baroness Garden of Frognal Excerpts

Lords Hansard - Part 1 & Report stage
Monday 7th March 2022 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I will also speak to my Amendment 141, which would delete Clause 155. I am very grateful to the noble Baronesses, Lady Campbell and Lady Brinton, and to the noble Lords, Lord Warner and Lord Lansley, for their combined support of these amendments. Sadly, the noble Baroness, Lady Bull, and the noble Lord, Lord Lansley, cannot be here, but the noble Baroness, Lady Campbell, and the noble Lord, Lord Warner, will speak to my amendments. I understand that they will move Amendments 143 and 144A.

In the Care Act 2014, we have a carefully crafted, step-by-step, cross-party agreement implementing the key recommendations of the 2011 Dilnot commission on the cap-and-floor model of social care funding, which went through the full parliamentary processes in both Houses. It built a consensus for implementing and funding the introduction of the care cap in 2016, and enshrining the key Dilnot principles of fairness and equity across all those needing social care. However, as we know, this agreement was never implemented following two separate postponements and a final cancellation in 2019.

Instead, the short Clause 155 we have before us on the Government’s proposals is a last-minute, hastily scraped together, ill-thought-through mishmash of subsections added to an essentially NHS Bill after its Commons Committee had finished, which was then bombarded through that House without any time for close scrutiny and debate. Our own Committee session on this clause started late in the evening at 10.30 pm and lasted not much more than an hour, so we fared little better on such a major and fundamental issue that will impact hundreds and thousands of lives. Moreover, the Minister, despite his offer on the record in Committee to talk to noble Lords about their questions and concerns, has been given no authority to discuss or agree any possible changes to the clause, which is so clearly ill thought through—contrast this with the fruitful discussions that have been held on a number of other important issues in the Bill.

My Amendments 127 and 141 to delete Clause 155 would ask the Commons to think again about how it implements the care cap. It presents a key opportunity for fundamental reconsideration of the Government’s proposals. There has now been time for greater analysis and scrutiny of the proposals and their impact by key stakeholders and expert think tanks, such as the Nuffield Trust and the King’s Fund, both of which have called for the clause to be removed. Its deletion would restore the full provisions on the cap under the Care Act 2014. It would mean that there would be reconsideration of how the cap should be implemented, not whether it would be implemented. Amendment 144A would reinforce this.

Labour strongly supported the 2014 negotiated care cap, its charging package and the costs involved. This has always been in the context of the care cap as part of a much wider social care reform that is needed to address the current crisis and build long-term sustainability and growth, which the Government have yet to address. We know that the Government’s proposals for the cap were discounted by Dilnot in 2011 as unfair, because they will result in people with low levels of wealth spending the largest proportion of their income on their care. The cap at £86,000 is set too high to benefit the majority of people who need to be protected, and the bombshell of abandoning the key safeguarding Dilnot principle enabling local authority care costs to count and accrue towards the cap means that poorer people will be exposed to the same care costs as the very wealthiest in society.

Despite the pledge that nobody should have to sell their homes, the fact is that someone with assets of £100,000 will lose almost everything, whereas someone with assets worth £1 million and over will keep almost everything. This is clearly shown in the extensive modelling by stakeholders such as Age UK, Mencap, the Alzheimer’s Society and the think tanks. That was detailed during our Committee debate, particularly the impact across some of the most deprived areas in the country. The Government’s own figures show that more than one in five older people will not see the benefit of the cap at all, and poorer care users are much more likely to die before they reach the cap than someone who is better off with the same care needs. Only 19% of people with dementia will reach the cap.

Moreover, Amendment 143, which will now be spoken to by the noble Baroness, Lady Campbell, and the principle of which we strongly support, reinforces the key point that a fair cap and charging system has to provide essential support to older adults and working age disabled adults, many of whom have lifelong conditions, including those with learning difficulties and who have to draw on social care support for their daily needs and support. The Dilnot proposals recognise this by seeking to ensure that adults entering the care system under the age of 40 or who were under 40 when they first entered it would have their care capped at zero.

I commend Amendment 144A from the noble Lord, Lord Lansley, to which I added my name. This fully complements the deletion of Clause 155 in restoring the current charging provisions in the Care Act. It would add a new clause to require the Secretary of State to make regulations under the Care Act to ensure that all its provisions on the care cap—Sections 15 and 16—come into force before 1 April 2023. This would mean that there would be no delays to the implementation of the care cap based on the relevant sections of the Care Act. It also means that the uprating of the care cap value from the level fixed in 2014 could take place—the concern of Amendment 182.

What is crystal clear is that the Minister’s repeated claim—or rather, as he described it in Committee, his “hope”—that

“no one will lose out when compared to the current system”—[Official Report, 31/1/22; col. 751.]

or face “unpredictable care costs” just is not borne out by the evidence proving otherwise, which is stacking up every day. Increasing the complexity of local authority charging arrangements on personal budgets, as the government amendments to the Care Act seek to do, makes an already hugely complex and system-heavy admin and technical system even worse. How many care users will be able to understand what is happening? I was particularly interested in the comment by the noble Lord, Lord Lansley, in Committee that a number of the issues that the government amendments sought to rectify or amend were never introduced in 2014 anyway.

How much more straightforward to use the sections of the Act developed for implementation than to try to patch up the provisions and hang them on a different Bill. We support the ambitions of self-funders to pay the same rate for care as local authorities pay for the people they fund, but there is absolutely no evidence of any government intention to provide cash-starved councils with the huge costs involved in this, and bearing in mind the massive underfunding of social care over the past decade.

Clause 155 must be deleted so that the key Dilnot principles of fairness and equity across all those needing social care can be reinstated. Deletion of the clause would mean that implementation of the care cap could proceed but under the provisions of the fully scrutinised Act designed to implement it: the Care Act. Under Amendment 144A, all provisions relating to the cap would be implemented by 1 April 2023.

At the appropriate time, I shall withdraw Amendment 127 and then move Amendment 141 in its place and seek to test the opinion of the House. I understand that the government amendments to Clause 155, which come before Amendment 141, will be agreed on the nod and will then fall if Amendment 141 is carried. I beg to move.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness to speak.

[Baroness Brinton (LD) [V]]

My Lords, I thank the noble Baroness, Lady Wheeler, for introducing so comprehensively this group of amendments on care costs. Given the lateness of hour in Committee, the House needed to hear the detail of this.

Her Amendments 127 and 141, which I have signed and which we will support if she calls a Division, would remove the cap on care costs which was announced and introduced by the Government in the Commons. It was not widely consulted on, and is a deeply unfair element of the Government’s proposals for the new social care payments arrangements. Far from fixing the ongoing crisis in social care “once and for all”, which the Prime Minister said from the steps of No. 10 Downing Street in 2019 he would do, these divisive plans will not stop people needing to sell their homes to pay for care and are a breach of the Government’s promise in that election. It is very important that the Commons have the time to discuss the consequences of the detail of removing that cap now that the announcement has been better understood, especially by the professionals, including the think tanks, who are very concerned about it.

We also support the noble Baroness, Lady Campbell of Surbiton, who will speak to Amendment 143 in the name of the noble Baroness, Lady Bull, which would ensure a zero amount for personal care charges for those under 40. It is absolutely against the spirit of Dilnot and a deep injustice to those under 40 with personal care needs that they are treated the same as those whose working years are behind them. It is a huge injustice that we have an NHS that is free at the point of use and yet younger people with learning disabilities and life-limiting health conditions are charged for essential care. There are also a number of deep, practical contradictions in this arrangement that make it particularly shocking, including a survey that found that charges made by cash-strapped local authorities—made because they could charge them—had forced people to stop the care they needed or made them face difficult choices for financial reasons, with the results showing an increased reliance on family members and high levels of deteriorating mental health, including suicidal thoughts.

Amendment 144A from the noble Lord, Lord Lansley, and as outlined by the noble Baroness, Lady Wheeler, supports the principles behind both Amendments 127 and 141, which would remove Clause 155. It proposes that all provisions on the care cap are brought into force by 1 April 2023 by regulation under the Care Act, resulting in no delay to its implementation. We support that too.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, the noble Baroness, Lady Campbell of Surbiton, is also taking part remotely. I invite the noble Baroness to speak.

[Baroness Campbell of Surbiton (CB) [V]]

My Lords, I support Amendments 127 and 141 in the name of the noble Baroness, Lady Wheeler; Amendment 143 in the name of my noble friend Lady Bull; and Amendments 144A and 182. Sadly, my noble friend Lady Bull is unwell, so I will speak to Amendment 143 and do my best to encapsulate her reasons, as well as mine, for returning to it on Report. I shall not move it later when it is called.

Unfortunately, at this hour, my voice is fading because I have had to use it a great deal today, so I shall use my speech facilitator, as allowed by the House, more than I would usually.

Health and Care Bill

Baroness Garden of Frognal Excerpts

Lords Hansard - Part 1 & Committee stage
Monday 31st January 2022 Lords Chamber

[The Deputy Chairman of Committees (Baroness Garden of Frognal) (LD)]

I apologise for not forewarning noble Lords that the noble Baroness, Lady Brinton, and the noble Lord, Lord Howarth of Newport, wish to speak remotely on this group of amendments.

[Baroness Brinton (LD) [V]]

My Lords, Amendment 219 in this group is in my name and I thank the noble Baronesses, Lady Pitkeathley, Lady Watkins of Tavistock and Lady Meacher, for also signing it. Just before I speak to that amendment, can I say that I also support the other amendments in this group so helpfully introduced just now by the noble Baroness, Lady Wheeler? I find her clarification of the difference between care workers and unpaid carers particularly helpful and vital in this debate because unpaid carers are invisible.

My amendment deals with unpaid carers. I am very grateful for the briefing from Carers UK which estimates —as we heard from the noble Baroness, Lady Wheeler—that there are as many as 13.6 million unpaid carers in the UK and, shockingly, over 1.4 million people providing over 50 hours of unpaid care a week. My brother looked after my mother for eight years, probably for 40 to 50 hours a week for most of that time. It meant that he just could not work at all. He is not alone.

I am sure we all know someone who is an unpaid carer. Even if they want to fulfil this role for their loved ones, society and the Government need to recognise the difficulties this gives the carers. The census in 2011 showed that carers are more than twice as likely to be in poor health than those who do not have a caring role—and they need support too, especially if they are isolated at home with the person they are caring for, whether that is day services or short in-patient respite care. Some 72% of carers have not had any breaks from caring during the pandemic and, as a result, are exhausted and worn out.

Health and Care Bill

Baroness Garden of Frognal Excerpts

Committee stage
Thursday 20th January 2022 Lords Chamber

Amendments 55 and 56 not moved.

[The Deputy Chairman of Committees (Baroness Garden of Frognal) (LD)]

I call the noble Lord, Lord Low of Dalston, to move Amendment 56A—or the noble Baroness, Lady Hollins. Is the noble Baroness, Lady Finlay, moving Amendment 56A?

[Baroness Finlay of Llandaff (CB)]

My Lords, perhaps I might put in a slight plea to the Committee on behalf of the noble Lord, Lord Low. He has sat patiently through this debate for a long time. He was expecting that the other amendment would be moved and, on realising that it was not, has made every attempt to return to his place as fast as possible.

Amendment 56A

Health and Care Bill

Baroness Garden of Frognal Excerpts

Lords Hansard - Part 2 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I will address the amendments in what is now group 4, commencing with Amendment 18 in my name, which address the various ways in which the board of an ICB should be constituted. I thank the noble Lords who have supported the amendments in my name and will speak also to Amendments 28 and 37.

Amendment 18 covers who should be on the board and, crucially, who should not. These amendments are about the governance of ICBs. They are going to be very powerful bodies—they are already operating in a shadow way, as it were—which will allocate hundreds of millions of pounds of public funds on our behalf. The question is about who should have a seat at the table where the decisions are taken. We should perhaps begin with who should not be on an ICB. There appears to be agreement that private sector interests should not be permitted, so I see no point in repeating the debates that took place in the Commons because that principle has already been settled. However, as ever, the devil is in the detail of how that translates into legislation and the ICB constitutions. It is my belief that what is in the Bill so far is not strong enough.

The objective is that private providers cannot have any part in decisions about how NHS resources are allocated or how contracts are placed. In my other amendments, I have extended the scope of this to ban GPs with APMS contracts, as they are definitely private sector interests. How someone from a social enterprise or the voluntary sector might be regarded is an issue to address sensibly, and I very much welcome that the Minister has said on several occasions that he believes that a margin of flexibility will be needed to make that happen. We all know that there is a single example of someone from Virgin Care being on a non-statutory non-decision-making ICS, one out of the 42 ICBs and one person on a body with 20-odd other members. That is still one too many. It is the principle that matters.

Private providers are bound essentially and legally to be addressing shareholder value, which is absolutely right and as it should be for their particular business interests, but they are not the values that underpin the NHS, which is absolutely not about striving for profit and shareholder value in any way. That is not to say that the NHS at every level should not strive for value for taxpayers’ money and effectiveness, but the best service for patients and communities is surely the underpinning objective of our NHS and it should be that for ICBs. Nor is it saying that the NHS should not be commissioning or working with a variety of providers, but we need to safeguard those values and the social value that underpin the NHS.

In the Commons this has been debated and Ministers are on the record about their intention not to have private providers represented. Sadly, some of us are still sceptical. This is particularly so when one looks at the easing of the 2012 commissioning and procurement regime. I await with interest the Minister’s reply on this matter. In making appointments to ICBs we are clear that there should be some kind of test so that if someone has something in their background which a reasonable person might think makes them unreasonably favourable or disposed to the use of private providers within the NHS, then they have no role on an ICB. I suspect that one might have to see, when the Bill finally takes effect as an Act, that those tests might be brought to bear on some of the ICS/ICB chairs and non-executive directors who may fail it.

The ICBs have similar duties to the CCGs they replace, at least on paper, but the board of an ICB will be very different from the CCG GPs and sometimes, it has to be said, the rather ad hoc arrangements that existed there. ICBs will be much closer to the unitary board model of trusts, FTs and the PCTs of recent memory. We agree with the intention of more effective commissioning of health services in the new era of co-operation and collaboration and with better integration with related services, so there should be a new kind of board made up of fewer NHS insiders and more who may have a wider perspective and fit better into the new model and the aspirations of the Bill.

We have had what feels like a dozen different ways of making commissioning work, and I have been directly involved in some. My observation is that as soon as they look like they are starting to work, they get reorganised. The trouble has always been the split between commissioners and providers, which some may say is essentially bogus. Both bits are still core NHS, and the big trusts have massive influence because they are massive. There is no democratic accountability, and the big providers had all the clout, not the commissioners. The NHS commissioning operation is often in splendid isolation from the rest of the public services, disconnected even from social care, to say nothing of where primary and community care and public health come in. This Bill aspires to be different, so we need to look at how it is served differently by the ICBs.

There has been some pretence that this will all change under the Bill, just as there has been for previous ones on commissioning. ICBs are given flexibilities and can build place-based sublevels, but the reality is that, as they are constructed at the moment, they are the same old NHS cartels. They have all the freedom they are allowed, but they may ultimately be powerless. The public will have as much idea about what ICBs do as they did about CCGs, and we all remember the marches to save our PCTs in the distant past. Just to make this clear, vested interests get a place in the ICB as of right but the public, patients and staff are not given that honour and responsibility. That is what part of these amendments does. Amendment 37, in my name and that of others, sets out our view about which voices are most important, and it breaks the mould of NHS appointing.

I divert briefly to say that elsewhere we will discuss more about how those appointments are made. Our view is that some independent appointments commission ought to make a comeback. I took great encouragement from the comments of the noble Earl, Lord Howe, on Tuesday, which helped in this regard. But there is still far too much control from the top and far too little say from the bottom on all the appointments that will be made under the Bill. Amendment 37 at least offers a way to have some diversity and possibility to challenge the interests that dominate the NHS.

Surely nobody who looks at what the amendments suggest would argue that these interests do not have a right to some voice. The public, patients, staff, social care, public health, mental health—which of these can be safely ignored and which has no part to play? We know the Minister in the Commons gave a minimalist defence in the interests of the new mantra of flexibility. He rightly said that boards should be of a manageable size and that ICBs should have some flexibility—as much as NHS England would allow—to add others to the board, beyond the minimum. The NHS actually has to do what it is told and, unless a more stringent requirement is put in the legislation, it will do what it has always been allowed to do. If we really want a better care system and some change to make organisational upheaval worthwhile, let us have a go at doing something different, with a wider group of voices to be heard and take decisions.

Our Amendment 37 deals with appointing key non-executive board members to represent interests, but within a unitary board. On Tuesday, colleagues pointed out that all board members share collective responsibility, which is a tried and tested model, but we need a discussion about this. I can see from the amendments in this group that other noble Lords have views—my noble friend Lord Bradley and the noble Baroness, Lady Finlay, for example—but our amendments and others in the group, if we discuss them together, would make for a better balanced board, which does not necessarily have to be a larger board. I hope the Minister will consider these submissions carefully. I beg to move.

[The Deputy Chairman of Committees (Baroness Garden of Frognal) (LD)]

My Lords, the noble Baroness, Lady Masham of Ilton, is taking part remotely. I invite the noble Baroness to speak.

[Baroness Masham of Ilton (CB) [V]]

My Lords, I want to support the proposed new paragraph (h) in Amendment 37, which says,

“at least one member appointed to represent the voice of patients and carers in the integrated care board’s area.”

The patient’s voice should be heard throughout the Bill. What is the National Health Service for if not patients? Patients should be involved in planning, ensuring that patients’ and carers’ views continue to be represented. Their experience should be collected. They, with their carers, are the people who know what good, safe care is and what poor results are. I hope the patient’s voice will be involved. I am pleased that many Members already stated this in amendments last Tuesday. I hope the Government agree, and I look forward to hearing from the Minister.

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

Baroness Garden of Frognal Excerpts

Wednesday 15th December 2021 Lords Chamber

[Lord Davies of Brixton (Lab)]

My Lords, I have three points. First, I was struck that the noble Lord, Lord Robathan, introduced his speech by referring to the scarifying effect of the debate in the Commons yesterday. Subsequently he went on—as have other speakers—to try to scare us about these regulations. It has been, to a large extent, a scare story about these proposed regulations. In truth, they are oh-so limited in their extent. It is quite possible that we might have to introduce stronger restrictions, so what we are being scared about is a slippery slope, that sooner or later these regulations will lead to an oppressive state. Well, they do not—they are just keeping us a little bit safer.

Secondly, on the idea that omicron is milder, we do not yet know that it is milder in the UK context. What we do know is that it is much more invasive. It will infect many more people. Even if it is milder—which we do not yet know—a milder effect on a much larger number may place a heavier burden on the health service. There is even the perverse, non-intuitive effect that a milder disease could place a heavier burden on the health service because, sad though it is to say, if people do not die so quickly of this disease, they will be in hospital for longer.

Thirdly, the debate on vaccine passports has been mentioned. I do not quite understand what people are saying, because I already have a vaccine passport—I guess that the great majority of people in this Chamber have one. I have used my vaccine passport. These regulations are saying that, in certain circumstances, that is one way of showing that there are good odds of you not being as infectious. I agree that there is a slippery slope here—I am totally against ID cards—but this information is already contained in the vaccine passports. The regulations are about how they should be used.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, I am getting indications from the Chief Whip that we should move to the winding Front-Benchers. The noble Baroness, Lady Brinton, will be speaking remotely. I invite her to speak for the Liberal Democrats.

[Baroness Brinton (LD) [V]]

My Lords, I declare my interest as a chair of the All-Party Group on Coronavirus. I thank the Minister for his speech on the three SIs before your Lordships’ House today.

Plan B was published four months ago. It was absolutely evident, first from the Secretary of State for Health’s announcement on Friday and then from the Prime Minister’s speech on Sunday, that no real planning has been going on behind the scenes in the department. Before we get into the practical consequences of these regulations, from these Benches we want once again to join in the strongest objection to the slack way in which the regulations and the Explanatory Memoranda are written.

The right reverend Prelate was right to say that we accept that late legislation may need to be written at pace, but this is communication at its worst and, of course, it cannot go through the usual scrutiny from the Secondary Legislation Scrutiny Committee and others. This goes hand in hand with Ministers’ messaging to the wider public, from the Prime Minister down. All because he is worried about certain parts of his party, he has once again announced mitigations too late, which inevitably result in further restrictions and in omicron being allowed to move really fast through our society.

The noble Lord, Lord Hannan, said that he worries this will be the case with every new variant we go through. That has not been the reality so far. What is different about omicron is how quickly transmission has doubled, which, by the way, without mitigations, will have an effect on the economy, because businesses are already seeing staff go off sick. If we have 2 million people with omicron by the end of the year, and that continues to increase at the same doubling rate every two days, we will find that the economy, schools, societies, our GP surgeries, ambulances and hospitals struggle even more than they are now. On Tuesday, at the All-Party Group on Coronavirus, one GP said to us that, on the previous day, every single doctor in her practice had tested positive. That meant that there were no doctors available to work, other than by Zoom.

We are learning about omicron because it is very new to us. The evidence of its exponential growth so far is concerning. The noble Baroness, Lady Foster, said that not one patient in South Africa has had oxygen. This is not true. It is true that there are fewer people in hospital, but some have severe disease. The number of omicron critical care beds is going up. At the end of November, 291 people in hospital were on oxygen. Two weeks later, it is nearly 900. The numbers in ICU have also doubled. These figures are from the Covid dashboard on the Spectator website.

From all Benches, we have heard agreement with the Prime Minister’s confused lines in the sand—for example, face masks must be worn in shops, but not in pubs and restaurants. Even if omicron is less dangerous—by which I think the noble Lord, Lord Robathan, means that there are fewer people with severe disease—its key elements are higher transmission and the doubling of cases. If there are fewer hospital admissions per 100,000, the already beleaguered NHS will have to find many more hospital beds than were needed in January 2021. This is what the doctors are advising us.

The noble Lord, Lord Robathan, constantly repeats his mantra that the only deaths from Covid are in the over-80s or among those with underlying conditions. In a recent debate, he asked if anyone knew anyone under the age of 80 who had died. Last week, a dear friend died of Covid after just four days in hospital. She was much younger than I am. Another friend in his 40s, who had a lung transplant earlier this year, is back in ICU with Covid. He does not know where he caught it because he has been very careful. Is the noble Lord really saying that there should be no mitigations to keep the vulnerable safe? This is the consequence of removing all these mitigations.

My noble friend Lord Thomas of Gresford spoke movingly about his compromised immune system. I too am in this position, though for a different reason. My medical advice is not to come out at the moment.

The 800,000 clinically extremely vulnerable have not had one word of guidance in the last week. It is not good enough to say that shielding ended in July. This group is at high risk and needs advice. When will this be evidenced? I think that even the noble Lord, Lord Robathan, would recognise that some people are at high risk. Shame on the Government for not getting in touch with them at all.

Other noble Lords have spoken about those with long Covid, including children. On schools, we have been asking since last year for air filtration units in classrooms. This has only just happened in the last week. Until now, the Government have been talking about CO₂ monitors, but the public health need in our schools is for air filtration units.

The first regulation is about self-isolation and moving to a daily lateral flow test. If it is negative, you can leave your isolation. We say that test and trace must remain the key defence in fighting Covid—particularly omicron—not least because of the somewhat reduced vaccine efficacy with this variant. The level of transmission of omicron is so high that this is a public health precaution. We disagree, therefore, with the fatal amendment laid by the noble Lord, Lord Robathan, which would remove this vital, basic, public health rule of self-isolation and testing.

The second SI on entry to venues and events creates a broader Covid pass, vaccine or test result, than the previously proposed vaccine pass. We have consistently opposed vaccine passports—first, for public health reasons. Importantly, vaccine passes give people a false sense of security, especially as it is possible to catch Covid and pass it on, even if you are double-jabbed. People cannot tell if their vaccine immunity is waning. We just do not like the reliance on that. We also do not want vaccine passports creeping in by the back door, as the noble Baroness, Lady Bennett, outlined. Our principal concern with this SI is about public health. This hotch-potch Covid pass is a muddle.

We agree with the use of lateral flow tests. They are highly accurate. Researchers from University College London found that they are more than 80% effective at detecting any level of Covid-19 infection. They are likely to be more than 90% effective at detecting who is most infectious when they use the test. None of us wants lockdown, particularly the noble Lord, Lord Robathan, and his colleagues, but I struggle to understand why those who do not want lockdown will not accept lateral flow tests as a mechanism to help reduce transmission.

We cannot support the noble Lord’s fatal amendment on the issue of flow tests, but we are deeply unhappy that the Government are relying on the vaccine element of the Covid pass at a time when we need to reduce transmission by the tried and tested test, trace and isolate system. So, if a vote is called, we will not support the Government’s proposals for Covid passes—although for very different reasons from those of the noble Lord, Lord Robathan.

Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) (No. 2) Regulations 2021

Baroness Garden of Frognal Excerpts

Wednesday 16th June 2021 Lords Chamber

[The Earl of Clancarty (CB)]

My Lords, I have no problem with the step approach that the Government have taken. For the country psychologically, it has been a very good thing that there has been a plan, even if that plan has had to be modified. Restrictions have been a necessity even if they can be fine-tuned. I do not support the amendment in the name of the noble Lord, Lord Robathan.

The problems lie in other areas, including how quickly the Government react. We cannot afford to make another mistake like we did in letting the delta variant into the country, which is the very reason for the four -week delay. I ask the Minister the same question I asked in the helpful meeting earlier today so that it can be put on the record: how carefully are the Government watching other countries? In Vietnam, for instance, where there may be a different strain of the virus, cases are rising quickly. That country is currently on the amber list.

The Minister will appreciate that, for the arts, hospitality and night-time sectors, this delay in progressing the road map will be devastating. The live events organisation LIVE estimates that 5,000 events will be cancelled and over £0.5 billion in revenue will be lost. It is essential more than ever that a government-backed insurance scheme should be put in place for both music events and indeed for commercial theatre.

I ask the Government to provide much greater transparency over the results of their Events Research Programme, whose results should be published in full. If findings can support full reopening of similar settings as in the pilot events, we need to know this as quickly as possible. Thousands of jobs and livelihoods are at stake. Despite what the Minister said earlier, I ask the Government to look again at the restrictions on amateur choirs and the most recent scientific evidence supporting some lifting of the current restrictions, such as the Costello PERFORM study, which, somewhat ironically, allowed some opening up of professional settings in the autumn. But the many amateur choirs up and down the country are not hobbies; they are organised creative activities, often led by professionals, and should be treated as such.

Although the Government are signalling that they want to wind financial support down, we should not forget that many freelancers continue to fall through the gaps in support. Some 40% of musicians have still received no financial support. Many of the 1.3 million PAYE freelancers who have received no support now for well over a year work in the creative sector, many also in digital technologies and many in small businesses. There are two things here. There is the misery these freelancers have been going through, which anyone who attended the last Gaps in Support APPG meeting will be very well aware of. But there is also the effect this is having on the industries themselves. Highly skilled workers are being forced out of their jobs and some are leaving the country, including coders. These industries, which should be at the forefront of recovery, deserve protecting and the Government should look at this again.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

The noble Lord, Lord Hunt of Kings Heath, has withdrawn, so I call the noble Viscount, Lord Trenchard.

[Viscount Trenchard (Con)]

My Lords, I thank my noble friend for introducing this debate today and declare my music festival interest as stated in the register.

Can my noble friend tell your Lordships’ House what the Government are doing to correct the appallingly low take-up of vaccinations in some areas of London such as Tower Hamlets, where only 24% of adults have had a single dose and only 49% both doses? Indeed, in London as a whole, 20% fewer adults have had either one or two doses compared with the country at large.

Along with millions of other citizens, I could understand the logic of the Government’s original decision to introduce lockdown measures to protect the NHS from being overwhelmed, in spite of the successful rushed construction of the Nightingale hospitals, which much reduced the likelihood of that happening. There was and is a balance between protecting people from serious illness and death from the disease and avoiding serious damage to the economy and peoples’ livelihoods. Whether or not the Government have always got that balance right since the onset of the pandemic, I sincerely think that the decision to extend further restrictions is not justified, and I will support my noble friend Lord Robathan if he should decide to divide the House. I do not believe there is any real possibility of the NHS being overwhelmed by this new spike in the Indian, or delta, variant.

The information presented at the Downing Street press conference was selective and misleading. It purported to show that hospitalisations are now rising following the surge in infections. However, examination of the data on the number of patients in hospital as opposed to the number of admissions to hospital gives a rather different picture. The number of in-patients with Covid is flatlining, because most of those admitted to hospital are not seriously ill and are discharged after a much shorter period than was the case in previous waves. Is it not now unreasonable to argue that the NHS is anywhere near being at risk of being overwhelmed?

The damage to the economy and particularly to the entertainment and creative sectors is now more serious. The Government have helped many businesses survive until now, through various schemes including the Culture Recovery Fund. However, there are many among those whose survival they have assisted that are now between a rock and a very hard place. For example, music festivals scheduled for dates after 21 June but before 19 July have no alternative now but to cancel. Those scheduled for later dates must make a judgment as to whether to go ahead without insurance—a substantial risk, as they have to incur irrecoverable expenses to make necessary preparations. Can my noble friend tell the House if the Government will, at last, put in place a suitable insurance scheme, which is so desperately needed? On that point, I agree with the noble Earl, Lord Clancarty.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

The noble Baroness, Lady Andrews, has withdrawn, so I call the noble Lord, Lord Blencathra.

Covid-19 Internal Review

Baroness Garden of Frognal Excerpts

Thursday 20th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I do not think that is correct. The noble Baroness is right to ask the question because we should always challenge our systems, but track and trace has really delivered for the country when it comes to the containment of the variants. We were extremely concerned about the Manaus variant. That was why we instigated Project Eagle, an intense application of testing in communities on a very large scale and forensic tracing, putting huge resources into tracking down the movements of those who tested positive with a VOC. We then had the South African variant, which has been successfully contained. We could not have imagined that an Indian VOC of this kind could make its way into this country with such high transmissibility, and I pay tribute to those working in track and trace who have bought us an enormous amount of time so that we can bring in surge testing and surge vaccination to contain and minimise the spread of this variant.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, all supplementary questions have been asked and answered.

Covid-19 Update

Baroness Garden of Frognal Excerpts

Tuesday 18th May 2021 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, I am enormously grateful for the very detailed and thorough questions from the noble Baroness and the noble Lord, and I am also appreciative of and touched by their kind comments.

The noble Baroness asked about the Indian variant and the uptake of the vaccines. I reassure her that we are doing absolutely everything that we can to ensure that there is a thorough uptake of the vaccine among all communities. She spoke touchingly about the feeling of blame associated with those in hospital who people hear have not taken the vaccine. I hear her comments, but there is no attribution of blame meant in this. It is a simple statement of fact that if you do not take the vaccine that is offered to you, or if you do not take two doses, and you then expose yourself to the virus, that is putting yourself in substantial danger, and it is a clinical observation that many of those who have ended up in hospital with severe disease are those who have not had the vaccine, even though they may have been offered it.

The noble Baroness asked about accessibility. She is entirely right that there are some people to whom we as a healthcare system have not made ourselves accessible enough. During this pandemic we have moved on from using the phrase “hard to reach” and we now think of it in terms of people who find us “hard to access”. She makes a perfectly reasonable observation in that respect, but I reassure her that we have absolutely bent over backwards to do everything we can to put the vaccine in front of all groups in the country, particularly those in areas such as Bolton, which we recognise have in the past been places where we have not got our message across.

I personally am hugely touched by the videos I have seen of people now queueing to have the vaccine. I applaud all community leaders and those who work with communities in Bolton, who have clearly mobilised a huge amount of public sentiment behind the vaccine programme. We are seeing a transformation in the penetration rates among some very important communities.

There is more that we can do. I am open to any suggestions from noble Lords on how we can do better, but I would like to reassure noble Lords that we have strained every sinew in trying to achieve vaccine equity across all groups in the country. That is true not only in Bolton but in Bedford, and I am disturbed to hear that people in Bedford feel they may have somehow been overlooked. I do not believe that is the view of the Vicky Head in Bedford, the DPH, and we have worked extremely closely with her. I assure the noble Baroness that cluster 2, linked to 12 cases in Bedford, was targeted immediately. An MTU went to the community on 8 May, and two community sites were opened up on 10 May. We have absolutely prioritised Bedford, as we have Sefton, Leicester, Nottingham and London—all areas where clusters have broken out. There is absolutely no question of prioritising one area over another. On the availability of the Pfizer vaccine in Bedford, that is news to me. I will be glad to look into that and to write to the noble Baroness accordingly.

On children, as noble Lords will be aware, this is an area in which some of the vaccine companies are making considerable progress in their clinical trials. None is categoric yet. It is too early to have agreed policy in this area, but the noble Baroness makes a very good point. Opening up the Covid vaccine, as we have with the flu vaccine, means that not only are children with some kind of vulnerability, particularly to long Covid, put into a safe place but that the transmissibility of that important age group can be reduced.

I am afraid we cannot know for certain the long-term effect of the vaccine until time has passed, but the CMO’s view is that the indications on the body’s immune system are extremely strong. At this moment it seems the vaccine is working, and our confidence is at a reasonably high point, but we remain vigilant. VoCs could emerge that either reduce the effectiveness of the vaccine or, for instance, effect some kind of decline in protection from the vaccine. That is why we have put in place contingent plans for boosters in the autumn. Those boosters might be of the existing suite of vaccines that are proving extremely effective. We are also looking for VoC vaccines that may be used to supplement the range of immune responses so that they cover any new mutations or variants that may emerge.

I cannot immediately recognise from the Bench the data the noble Lord, Lord Scriven, gave on the India VoCs. I wonder whether it was data that emerged after we made the decisions, because a lot of the sequencing data is retrospective; it takes between a week and 10 days to emerge from the Sanger Institute. That is one of the difficulties in making these decisions, which sometimes seem so clear-cut in retrospect. When you have the data available to you on the day, the decisions are not necessarily quite so apparent.

I do not really recognise the criticisms the noble Lord makes of the red list system. The red list system we have in the UK is an incredibly important shield and is proving extremely effective. Segregation is unbelievably difficult during travel. It is very difficult to segregate amber list and red list passengers on a plane, train or ferry. Within an airport it is very difficult to segregate people, because of the physical proximity. That is why travelling is dangerous, why we tell people not to travel and why, when people do travel, we tell them to isolate. Travelling is dangerous, and that is not news to us or to the people who get on those planes in the first place. The ultimate sanction here is that, particularly as we go into the summer, we tell people: travelling is not for this year. Please stay in this country.

On the isolation pilots the noble Lord referred to, we are running a large amount of work on pilots for isolation generally. If he would like to write to me about the particular pilots he was referring to, I will be glad to give him an update. I am afraid I am not quite clear at this stage which ones he is referring to.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, we now come to the 30 minutes allocated for Back-Bench questions. We do not have that many Back-Bench questioners, but it is still quite good discipline if people keep their questions and answers as brief and relevant as possible.