Folic Acid
Debate between Baroness Hayman and Lord Bethell(2 years, 9 months ago)
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Lord Bethell (Con)
My Lords, I completely understand and appreciate the sense of frustration and urgency that my noble friend expressed, but I emphasise that this is a massive national measure. It has to be conducted in a way that takes the nations with us, that people feel confident that the right processes have been adhered to and that there is no doubt about the safety of the measure. This is not a question of foot dragging, quite the opposite. We are doing this in a thorough way that reflects the practicalities and realities of the machinery of the United Kingdom Government.
Baroness Hayman (CB) [V]
My Lords, I understand the frustration the Minister must feel being brought to the House again and again on this issue, but can he understand the frustration just expressed by the noble Lord, Lord McColl of Dulwich, that British science of 40 years ago has influenced the activities of countries across the world, New Zealand being the latest, and yet somehow in this country we have not managed to act on the science that was produced here and families have paid the price for that? Will the Minister understand the urgency and the frustration of those of us who have been raising this issue for years and will he look again at a timetable for implementation?
Lord Bethell (Con)
My Lords, I completely understand the frustration. I pay tribute to all noble Lords who have campaigned assiduously for this measure. It speaks extremely highly of this House that it is so focused on getting over the line an important and emblematic measure that puts preventive medicine at the heart of our healthcare system. Personally, I do not feel any disappointment or anger. I am completely committed to this measure, as are the British Government.
Folic Acid
Debate between Baroness Hayman and Lord Bethell(2 years, 10 months ago)
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Lord Bethell (Con)
I agree with my noble friend; she is right that this is a priority. However, it is not within my gift to simply grant a decision on it; it needs to be worked through both industry and government. We are making progress on this. It is a huge national undertaking for us to put substances literally in the bread of the nation. The public deserve to feel confident that that decision has been made thoughtfully and responsibly, and it is entirely right that we take care to dot the “i”s and cross the “t”s.
Baroness Hayman (CB) [V]
My Lords, the Government have had an awfully long time to dot the “i”s and cross the “t”s. When the MRC research first came out, my children were the age that my grandchildren are now. Some 80 other countries have moved more speedily than the UK on the evidence provided by the UK-funded MRC research. As well as the noble Lord making progress on this before the Summer Recess, will the Government look at what the barriers were that made us as a country so slow to come to the decision to fortify flour?
Lord Bethell (Con)
My Lords, this Government’s progress on this really came to a head in the consultation in September 2019, and we have been on course to implement these measures since then. It is unfortunate that the Covid pandemic intervened at that point and we had to put work on this project on hold until April of this year. Since April, we have had to deal with the elections in the devolved Administrations. That, unfortunately, creates an insuperable barrier to taking the measures through all the necessary checks and alignments. I reassure the noble Baroness that we are totally committed to this policy, we are moving at pace and I look forward to further progress shortly.
Folic Acid
Debate between Baroness Hayman and Lord Bethell(3 years ago)
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Lord Bethell (Con)
I reassure the noble Lord and others who have pressed this point that it is a departmental priority. There has of course been a pandemic and that has slowed things down. I cannot avoid that fact, but we are very much returning to the prevention agenda in the round and the issue of folic acid in particular.
Baroness Hayman (CB) [V]
My Lords, the Minister will understand the frustration in the House at the repeated delays in implementing a policy that has the opportunity substantially to reduce the scale of suffering that goes on, because of our failure to implement the implications of research that, I remember and as has been said, showed the benefits of fortification in the 1980s. It is desperately dispiriting to know that that research has been taken up by other countries, but not the UK. I press the Minister and suggest that it would be extremely helpful if the meetings that he has said need to take place with the devolved Administrations could be arranged now. Perhaps he could write to the noble Lord, Lord Rooker, copying the letter to other noble Lords, to tell us exactly when the meetings that he has described are scheduled.
Lord Bethell (Con)
I hear the frustration loud and clear and reassure the noble Baroness that we are working on this at pace.
Health and Social Care Update
Debate between Baroness Hayman and Lord Bethell(3 years, 1 month ago)
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Baroness Hayman (CB) [V]
My Lords, a descent into a tit-for-tat vaccine war would obviously be disastrous, given the global nature of both vaccine supply chains and the pandemic itself. Given the worrying developments that we have seen in this area, what research has been done and consideration given to the possibility of mixing and matching second doses with a different vaccine—something which was talked about originally and might become necessary in the light of particular difficulties in supply chains?
Lord Bethell (Con)
My Lords, I completely agree with the noble Baroness that a descent into some type of vaccine war would be extremely regrettable, and the British Government are doing everything they can to continue in a spirit of partnership with overseas Governments. We have not reached the possibility of taking on a mixing and matching approach. We believe that the supply chain we have in place is ample to achieve the targets we have already published. However, to answer her question directly, there is some evidence that mixing and matching may prove to be even better than having two of the same vaccine—that it may stimulate the immune system in ways that give you a more developed response to the virus. Therefore, we continue to look carefully at this possibility.
Covid-19 Vaccines Deployment
Debate between Baroness Hayman and Lord Bethell(3 years, 2 months ago)
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Lord Bethell (Con)
My Lords, I am afraid that is not the view of the scientists at the moment. I am extremely glad about all those who have had their first jab, but the very strong recommendation is that everyone has to abide by the lockdown rules at the moment. The transmissibility is still there: a person who has had the jab can still, and often may well, be infected by the disease, carry it and communicate it to someone who has not had the jab. They remain a danger to the community and, until a very large number of the population have had the jabs, those protocols will remain in place.
Baroness Hayman (CB) [V]
My Lords, I will first follow up on an earlier question. I am not sure that the Minister managed to reply on the issue of when and if we are expecting evidence on the interval levels between doses on the Pfizer, rather than the AstraZeneca, vaccine?
My main question is about how, given the impressive and successful vaccine programme, we have to recognise that it has mobilised enormous effort and resources. There is growing evidence that Covid will be with us long-term, so it is not a one-off exercise. Can the Minister share government thinking on the sustainability of the programme—for example, the potential for future programmes to be combined with the annual flu vaccination drive or for a single bivalent vaccine against both diseases?
Lord Bethell (Con)
My Lords, I reassure the noble Baroness that the interval protocols for the Pfizer vaccine have been completely endorsed by the JCVI, the CMO and the MHRA. They are extremely clearly endorsed by the British authorities, and she should feel enormous confidence in our approach to that.
However, the noble Baroness is right: I do not know, and cannot say for certain, what the long-term prognosis is. We do not know what the transmissibility of the disease will be with the current vaccine. We are working on new versions of it that should address the South African variant, but we do not know for sure whether that will prove dominant in the UK. It is the view of the CMO, Jon Van-Tam, that it will not beat either Covid classic or Covid Kent—but it is not certain whether that is the case right now.
We do not know whether there will be a rolling programme of mutations that roll on to the shore and require us to update the vaccine regularly—or whether we will have to hold our borders as they are now until we have the kind of vaccine development programme that can turn around refreshed vaccines within, say, 100 days. Those are all possibilities; we are putting in place the necessary plans in case that should be required, but it is my confident hope that the current vaccine will have a massive impact on Covid and that we can return to something that approaches normal in the very near future.
Vaccine Rollout
Debate between Baroness Hayman and Lord Bethell(3 years, 3 months ago)
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Lord Bethell (Con)
It is not a question of one place taking precedence over another. I take a moment to applaud and pay tribute to GPs in Sheffield, and to all those who have proceeded at pace and got through their allocation as quickly as they could. That is absolutely the right priority and the right approach, and it is how we are going to get through the population very quickly. However, some people will get through their list more quickly than others, and it would be a mistake then to start asking them to move down the list when there are still those with very high priority who need to be vaccinated. Although I understand that it may be frustrating for a GP to stand idle, those are the practicalities of what we are doing. The mass vaccination centres are essential to deal with the very large numbers of people that we plan to vaccinate over the next few months. That is why the Sheffield vaccination centre is such good news.
Baroness Hayman (CB) [V]
My Lords, I support the Government’s utilitarian public health approach to the spacing of vaccine doses, but does the Minister accept that the argument is dependent on an understanding of the full implications of different dosage regimes, and that a lack of specific data on this particular point in relation to the Pfizer vaccine is fuelling concerns? Will the Government now undertake research on this specific point as part of a vaccine rollout programme, to underpin robust and well-supported policy implementation, both here and in many other countries that could benefit from this data?
Covid-19: Vaccine
Debate between Baroness Hayman and Lord Bethell(3 years, 3 months ago)
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Lord Bethell (Con)
I congratulate my noble friend and Lady Eccles on their double vaccinations. It is one of the most heartening experiences of a pretty dreadful year to witness the rollout of this vaccination and the joy and reassurance it brings to those who have been vaccinated. I reassure my noble friend that the NHS is absolutely putting the resources in place not only to roll out the single and second vaccinations to everyone over 18 who will step up for those but also for the pharmacovigilance to ensure that any adverse effects are recorded through the Yellow Card scheme and that those records are analysed and acted upon so that any changes or tweaks, as sometimes happen, are enacted by the NHS to get the best possible outcome for as many people as possible.
Baroness Hayman (CB) [V]
My Lords, may I ask the Minister another question about evidence? When do the Government expect to have clear advice on the possible transmission risk from those who have been vaccinated? Everyone I know who has received the vaccine—they have been delighted to do so and impressed by the efficiency of the NHS—is now talking about meeting their Pfizered friends, seeing grandchildren and returning to volunteering or to your Lordships’ House. Does the Minister acknowledge that there will need to be cogent and clearly communicated advice for those who have been vaccinated, many of whom have been in virtual isolation for nearly a year?
Lord Bethell (Con)
The noble Baroness delivers tough news to her friends and to the Chamber, and I completely agree with her analysis. The frustrating truth is that, while the efficacy of the vaccine has been tested on hundreds of thousands in clinical trials, and we can lean on that data extremely well, the transmissibility of those who are immune is not yet clear. We have put in place trials and testing regimes to understand and get to the bottom of this point. But she is entirely right: it is possible, although not proven at the moment, that those who are themselves immune are not sterile but vectors of infection. Were they, for instance, to return to this Chamber, they would potentially infect those of us such as my noble friend Lord Parkinson, who is extremely young and does not qualify for the vaccine any time soon, and who could catch the virus off an octogenarian noble Lord in an instant.
Covid-19 Regulations: Assisted Deaths Abroad
Debate between Baroness Hayman and Lord Bethell(3 years, 5 months ago)
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Lord Bethell (Con)
The noble Lord is entirely correct; the Director of Public Prosecutions’ policy for prosecutors in respect of cases of encouraging or assisting suicide sets out factors which prosecutors in England and Wales will consider, in addition to those already outlined in the code for Crown Prosecutors when deciding whether it is in the public interest to prosecute in cases of encouraging or assisting suicide. Among the public interest factors tending against prosecution are that the victim had reached a voluntary, clear, settled and informed decision to commit suicide and that the suspect was “wholly motivated by compassion”. I completely take on board the noble Lord’s encouragement of this review. There is no review planned, but we all acknowledge the changing tone of this debate and I will take his suggestion back to the department. On the point about Scotland and data, I acknowledge different circumstances in Scotland and the remarks on the importance of collecting data from my noble friend in the other place. That is indeed our intention.
Baroness Hayman (CB) [V]
My Lords, the Minister’s response to the second question today was more reassuring than his response to the first. I am sure he would agree that these are desperately difficult situations for families, and to have the uncertainty about whether someone would have to undertake alone a journey that should never be undertaken alone because of a wish to protect their relatives from prosecution is frankly unthinkable. On the wider point, could he assure the House that some urgency will be given to this issue of collecting data and seeing in the round the problems that are being caused? We have had piecemeal changes such as the changes from the DPP, but we need to understand more comprehensively the exact implications of what is going on.
Lord Bethell (Con)
The noble Baroness is entirely right; Covid has, in a very sad way, thrown a spotlight on the circumstances of those dying alone. That is one of the harshest and most heart-breaking dimensions of this awful pandemic. It throws a spotlight in particular on the way in which the law is applied in this country. The collection of data is a very important component of our review of this important area and I will definitely ensure that the indication given by my right honourable friend in the other place is picked up back at the department.
Covid-19: Local Restrictions
Debate between Baroness Hayman and Lord Bethell(3 years, 6 months ago)
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Lord Bethell (Con)
My Lords, where the department has used secondary legislation to put in place measures to tackle the coronavirus pandemic, these regulations stipulate that a review of the measures will take place within 28 days. In making a decision on how to proceed, we comply with our legal duties, and all the relevant Acts—the Equality Act, Public Health Act, National Health Act and the family test. We keep the situation under continuous review to consider whether the measures contained in the regulations are still a necessary component of our effective response.
Baroness Hayman (CB) [V]
My Lords, Covid is not a one-off, short-term emergency. There will be difficult judgments and hard decisions to be made for many months ahead. Does the Minister accept that it is imperative that we find a way to ensure legitimacy for those decisions by gaining parliamentary assent before, not after, they are taken, and that parliamentary assent before should be the rule, not the exception? Does he further accept, as I believe, that those decisions would actually be improved and better accepted by the population because of the challenge they would receive in public, in Parliament?
Lord Bethell (Con)
Well, my Lords, our rule—if there is a rule—is that we are clear that our measures should be locally led. We work with local leaders first and communities to take swift action to prevent and manage outbreaks, ensuring that our responses work for them, supported by a national service which they plug into. It is for that reason that we are considering local tiers. Local alert levels or tiers are designed to standardise the interventions in place in local areas across England to make it easier to communicate what restrictions apply, and in what areas, to the public.
Coronavirus (COVID-19)
Debate between Baroness Hayman and Lord Bethell
Lord Bethell
This question arose in the debate last week and I followed it up with the Chief Medical Officer. As far as I understand it, there is no issue with the testing. It is possible that some people seemingly recover—their symptoms fade from view—but they are still infected with the virus. We are working hard to understand how this works.
Baroness Hayman (CB)
My Lords, first, as I understand it, currently the test is laboratory-based. How much emphasis are the Government, in their research, putting on a rapid diagnostic test that can be used at the bedside or immediately? The differential diagnosis between diseases that manifest with high temperature and a cough is absolutely essential in this area. I say this based on my experience: I was in Sierra Leone during the Ebola outbreak. Secondly, the one piece of behavioural advice that is very clear is about washing hands. If you were in Sierra Leone or west Africa during that time, you did not enter a public building without washing your hands. It was fairly crude—it was a bucket of water with disinfectant in it—but it was in the high commission and every hotel and office. The idea that the only kind of handwashing that is acceptable is conventional handwashing in circumstances that people expect might not be sufficient if this goes further.
Lord Bethell
The noble Baroness is absolutely right to emphasise the question of diagnosis. I know from my own experience that the delays that people experience create huge anxiety and prevent them making the important decisions they need to make for themselves and their families about how to do the right thing—self-isolating if necessary and making provisions for their other family members. A ferocious race is under way at the moment. The Government have instructed six private companies, which are all seeking to build exactly what the noble Baroness describes: a bedside testing kit that can be rolled out across the country to provide swift, on-the-spot diagnosis. We are hopeful that that will come shortly. On handwashing, I too have travelled in Africa and know exactly the kinds of provisions she talks about. The advice from the CMO is that we are not there yet but nothing is off the table.