Covid-19 Update
Baroness McIntosh of Hudnall Excerpts(3 years, 6 months ago)
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Lord Kamall (Con)
Yes. Given the advice on testing, especially if you are pinged and have to test, clearly we will make sure that there are sufficient tests available.
Baroness McIntosh of Hudnall (Lab)
My Lords, can the noble Lord say a word about enforcement? In my observation of the use of face masks on London transport, for example, compliance has increased significantly in the past week, so there is a disposition on the part of many people travelling to comply. But there are still a significant minority—and that minority is important—who do not comply and do not appear to carry or exhibit any evidence of exemption. Will people whose job it is to ensure that people on public transport or elsewhere are wearing masks get the help and guidance they need to understand where the limits of their powers might be?
Lord Kamall (Con)
Enforcement has been a constant concern throughout, and workers have been concerned about having to enforce. The police and certain transport operators may issue fixed penalty notices to those who refuse to wear a face covering when required to do so and are not exempt or do not have a reasonable excuse. This will be used only as a last resort. The fines will start at £200, which will be halved if paid within 14 days. For repeat offenders, the second offence will be £400, the third £800, the fourth £1,600, the fifth £3,200, and the sixth and subsequent offences £6,400. The price mechanism will be used as a deterrent, but I am sure that the authorities will exercise discretion, so they may give an informal warning first, as has happened. They can also take measures if members of the public do not comply with this law without a valid exemption. They can deny access to public transport services, and direct someone to wear a face covering or leave a service if they are not wearing one without a legitimate reason.
HIV and AIDS
Baroness McIntosh of Hudnall Excerpts(3 years, 7 months ago)
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Lord Kamall (Con)
The noble Baroness makes a very important point of which we should all be aware. It is great that we are all living longer and, as I am sure noble Lords agree, that we are being sexually active for longer. The HIV plan sets out how we look at different—for want of a better word—segments or parts of different communities where there are issues, and how we target messaging there. That is the most important thing, rather than trying to have a one size fits all that others could ignore.
Baroness McIntosh of Hudnall (Lab)
My Lords, there has been a huge amount of progress in the last 30 years since—I think I may say my noble friend—my noble friend Lord Fowler did his good work. But there is still work to do in this country. I noted that the Minister proudly referred to there being perhaps less stigma in this country than elsewhere. It is true that we have no room for complacency in this regard and that this is still one of the main reasons why people who should be tested are not being tested. Can the Minister tell the House the Government’s current assessment of the infected but untested rate of HIV/AIDS in this country?
Lord Kamall (Con)
I am afraid I do not have a specific figure for the noble Baroness, but the action plan sets out how we are going to increase access to and scale up HIV testing, by focusing on populations and settings where testing rates have not been high to ensure that we tackle them, that new infections are identified rapidly and that people receive the necessary treatment faster to prevent complications. We will operate the annual HIV Testing Week between 7 and 11 February 2022, and the campaign will be called “It starts with me”. During that week we will open self-sampling HIV testing services for all residents of England, and we want to make sure that lots of different programmes are raising awareness. I know that a number of noble Lords across the House take this issue seriously and I would welcome their advice.
Food (Promotion and Placement) (England) Regulations 2021
Baroness McIntosh of Hudnall Excerpts(3 years, 7 months ago)
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The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)
My Lords, the noble Baroness, Lady Brinton, will contribute virtually as the Liberal Democrat Front-Bencher at the appropriate point in the debate.
Lord Brooke of Alverthorpe (Lab)
My Lords, I am grateful to the Minister and the Government for the initiative, which I would describe as making tentative moves to try to reduce the growth of obesity. I declare an interest as vice-chair of the All-Party Parliamentary Group on Obesity, and I am grateful to the Obesity Health Alliance, which has recently produced a very wide-ranging and thorough examination of the problem. I am grateful to it for the briefing.
It is worth remembering that the last serious attempt to tackle this was after the coalition Government came into power in 2010-11, when an alcohol strategy was drawn up and there was an engagement between government and the private sector, and the many representatives of the health business, if I can describe it like that, who were anxious to see changes effected. We had the creation of the responsibility deal, which ran from 2011 through to 2015, when it collapsed. The health officials were unhappy about the way in which the agenda was being run, and in 2013 many of them withdrew because they felt that the private sector—the manufacturers and retailers—were controlling the agenda and that public health was rather lower down the line than profits. So it went in 2015, and since then we have had very little change, apart from a growth in obesity.
On the alcohol front, on which we have spoken from time to time, apart from with youngsters there continues to be a problem there, with more and more people going into hospital and more and more people dying from liver problems. The real concern here has been with the growth in obesity among youngsters. We have been at this since 2006, when the Labour Government first kicked it off with the national measurement scheme. Initially, the idea was that we would engage over a very wide area, but because of the continuing cuts that have taken place in public expenditure at local level, it has not really made a great deal of headway. We have had a fallow period, with many of us complaining over the years, but it would be churlish not to say that I welcome this move, although that is not to say that I am going overboard over what the Government are proposing.
I have a number of questions. It has taken us six years—seven years, really, since it will be 2022 by the time we finish the consultation with the parties involved and this is put into effect—but the document talks about waiting another five years to do a review. Unless I have misunderstood, it will be five years before it is fully reviewed again. Could you correct me if I am wrong or, if I am right, explain why we have to wait another five years, which means that we will have run from 2010 to 2027 before we really look at some of the serious proposals made by the Government?
Secondly, I would like to know who is covered by the square footage provision. Obviously, hypermarkets and supermarkets are covered, but I would like to know whether convenience stores are also covered. I live in Battersea, near the bridge, and next to us we have a local co-op that does extraordinarily good business. Would it qualify to be covered by the changes that are proposed? I cannot remember the figure, but it may be 1,200 square feet. I would be grateful if the Minister could say whether convenience stores fall into it, because they are major retailers in this context as they sell nearly half as much as the supermarkets do. If they are not covered, it will be a major omission and something that we would want to return to.
Thirdly, I listen carefully to everything the Minister says as he finds his way with his new brief. At his first Questions, he talked about unintended consequences and said that it is very important when we are making changes that we try to foresee them. I am particularly interested in seeing how retailers effectively drive a coach and horses through so many areas of legislation with their ability to place their goods in a position which sells them best for them but on the other hand brings them to the attention of children, in particular.
Again, I mention my local Co-op. No longer can people see cigarettes. They are hidden. It took years to get that changed, but it is a worthy development that was put through by the Government. When I go in, I am now surrounded by alcohol. We have all this about advertising, thresholds and the rest of it, yet when children stand in the queue to buy their Mars bars in the Co-op, they are surrounded by alcohol and, on the other side, by doughnuts and a host of sweeties which are attractive to them and which, as we know, are at the heart of the growth of obesity. I wonder whether the Government have thought through what will go in place of the movement of some of these articles which are presently being sold, which have been identified as being very risky from a health point of view. If they do not cover it, I suspect we will find, for example, that alcohol goes there, which is what has happened previously. I know that is not about child obesity, but none the less it relates to obesity, as 10% of all obesity comes from the sugar in alcohol. So we are continuing with the same problem, especially given that we still do not have any indication on alcohol. You queue there, and there is no indication of the sugar content or the calorific effects in the drinks. Perhaps the Minister might say what the Government are intending to do about that. I know it is not in this document, but it is all interrelated with obesity, and we cannot separate it too much.
In another initiative, trying to be as positive as I can be with the Committee, Sir Keith Mills, who was responsible for Air Miles and Nectar points, has been doing a special piece of work for the Prime Minister and has come up with a number of trials. Is there a correlation between the work that will be put in place in this document and what he is endeavouring to do in incentivisation? I may sound negative, but I believe in incentives to encourage people to eat and drink better and I believe in trying to find incentives in which the private sector, particularly retailers, will not to try to take advantage but will work together so that we will see positive incentives offered to them to effect changes in the formulation of food and the way in which they present drink and food in retailing terms. Is there a link between the activities he is undertaking?
Finally, can we see more experimentation? I am very pleased that Sir Keith Mills is doing that. Wherever we can try to engage with those who are interested in the private sector, we should try to get joint working taking place where, if the Government see it works yet the private sector does not want it, they will do what they are doing today. I hope they will stick to their guns, legislate and make the changes stick rather than change their mind and run away under pressure from the industry.
Covid-19 Update
Baroness McIntosh of Hudnall Excerpts(3 years, 7 months ago)
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Lord Kamall (Con)
I start by thanking the noble Baroness, not only for her question but for the conversations that we have had to help my understanding of the subject and the consequences of some of these actions. I welcome the expertise from across the House when it comes to a number of health-related issues.
The consultation quite clearly said that many felt that vaccines remain our best defence against Covid-19 and that the vaccination programme has prevented thousands of hospitalisations and deaths in the UK. The more staff who are vaccinated against Covid-19, the more likely it will be that vulnerable people in their care, and other colleagues, are protected. Several studies have provided evidence that vaccines are effective at preventing infection and transmission—and beyond preventing infection have an additional benefit of reduced transmission by those individuals who become infected despite vaccination because of a reduced duration or level of viral shedding.
On the specific question, I am sure that the noble Baroness recognises—as I know from when we discussed these issues—how complex this issue is. There are ethical and health issues, and the concerns of patients and their families, who feel much more comfortable about being treated by staff who are vaccinated.
Baroness McIntosh of Hudnall (Lab)
My Lords, I think that there are probably very few people, apart from hardened anti-vaxxers, who do not accept that vaccination is good and that it has done a huge amount to reduce the impact of the pandemic, which has had such devastating effects. However, following on from the question from the noble Baroness, Lady Watkins, it would appear likely that there will be not unintended but predictable and intended consequences as a result of this policy, which is that some NHS staff, and, more immediately, some social care staff, will simply give up doing what they do. In those circumstances, what advice is the Minister or his Government offering, particularly to private sector care homes, as to what they should do if faced with staff losses other than simply to reduce their capacity to take in new patients?
I noticed that the Minister did not pick up the question from the noble Baroness, Lady Brinton, about the example that people in public life—I name nobody in particular—can set by wearing their masks, appropriately, on all occasions when it is sensible to do so. What encouragement can he offer to the rest of us about further examples being set on that front?
Lord Kamall (Con)
There clearly are concerns. These were expressed in the stakeholder engagement that occurred with both the social care sector and other sectors that will need to bring this in from March next year—we are bringing it in now but with a grace period until next March. A lot of this engagement and consultation discussed how we can support staff who are unwilling to be vaccinated as well as understanding their concerns and whether employers see these as legitimate.
Thinking back to the beginning of the crisis, one of the reasons this was called for in care homes as quickly as possible was the data from the early part of the pandemic, when there were a disproportionate number of deaths in care homes. A number of people, including patient groups and families of patients, were quite adamant that if their relatives were in a care home, they wanted to make sure that they were being looked after by staff who had been vaccinated.
There is another vaccine that is a condition of deployment, that for hepatitis B. I have asked medical staff whether they are concerned about this and a number have said no, because they are already compelled to have the vaccine for hepatitis B. That is a condition of deployment and staff see this vaccine as just as essential. That assuaged some of the concerns I had over compulsion. These are difficult, unprecedented times. We would not ordinarily want to go with compulsion, but the health of the nation is at risk and many people want to feel much more reassured that they, or their family members who are receiving care, are looked after by people who have been vaccinated.
Lord Kamall (Con)
I thank the noble Lord for pressing on that point, as a number of others have. I am assured that the Prime Minister and his team followed all the rules that they were required to follow in that hospital, whether about face masks or otherwise. This is what I have been informed and it is all I can report.
Baroness McIntosh of Hudnall (Lab)
Since we have a little time left, could I ask the Minister to go back to the question of the support that care homes, hospitals and other healthcare settings may need in the not unlikely event that they will lose staff as a result of this policy? I completely understand that vaccination is highly desirable and that the intention is to encourage people to be vaccinated. However, it is pretty clear that some will not be and that will have an impact. What support will be on offer in healthcare settings to people who are having to cope with the impact of losing staff as a result of this policy?
Lord Kamall (Con)
In consultation with the social care sector and the wider NHS, including trusts, discussions have looked at the impact and what would happen, but also how to make the message more positive, how to encourage staff to take up vaccines and how to listen to their concerns. In some cases, employers have said that they do not feel that staff have given a legitimate reason for not taking up the vaccine, but they are also under pressure from patients’ families to make sure that they employ care staff who have been vaccinated. They are trying all the different areas of persuasion, including targeted campaigns and one-to-one conversations in some cases, to encourage them as much as possible. At the end of the day, even before the introduction of vaccinations as a condition of deployment, many care homes were already trying to push their staff to take vaccinations because they are concerned about their patients.
Covid-19: Plan B
Baroness McIntosh of Hudnall Excerpts(3 years, 8 months ago)
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Lord Kamall (Con)
I am sure the noble Baroness will appreciate that all these issues are not necessarily binary, and that there are often a number of trade-offs, not only between economic and health factors but also within the health community itself. For example, there have been warnings that if we go down the route of more restrictive measures, we will see an increase both in patients who are unable to have the surgery that they had planned and in mental health cases.
Baroness McIntosh of Hudnall (Lab)
My Lords, taking the Minister back to the answer he gave to my noble friend Lord Rooker, on the issue of mask wearing, the evidence seems to be that wearing a mask does have an impact on whether viruses are transmitted, and in this case there is efficacy in respect not only of Covid-19 but of other viruses which could be circulating at this time of year and themselves putting pressure on the NHS. What is it that the Government cannot bear about asking people to wear masks? It has no economic cost, costs very little in terms of inconvenience and has a very significant impact.
Lord Kamall (Con)
I assure the noble Baroness that plan B does involve legally mandating face coverings in certain settings, such as public transport and shops. I am sure many noble Lords will have recognised, when they are travelling in by public transport, the number of people wearing masks on public transport, even though advice by the transport companies has dropped.
Covid-19 Update
Baroness McIntosh of Hudnall Excerpts(3 years, 9 months ago)
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Baroness Thornton (Lab)
I hope the Minister has had a good break and I thank him for the Statement today. I regret that phrases such as “Groundhog Day” and “Here we go again” keep jumping into my mind unbidden. Obviously everybody welcomes the continued rollout of the vaccine, and I congratulate the NHS and its partners on this. However, we must not pretend and behave as if we are at the end of this pandemic. The figures still show a substantial daily rate of infection, hospitalisations and deaths. If we go into the winter with a high proportion of ICU beds still occupied by Covid patients, this will have a knock-on effect for serious elective surgery, emergency needs and flu. It will affect the ability and capacity of the NHS to deliver the beginning of the catch-up that we face in the next couple of years. The context of this catch-up is starkly illustrated by the figures concerning cancer this week. The Macmillan Cancer report reveals that
“More than 600,000 cancer patients in the UK are facing treatment delays or missing out on vital support because of a shortage of specialist nurses”.
Less than a month ago, the Health Secretary said that he wanted booster jabs to be given at the same time as flu jabs and that they would be starting this month. However, is it the case that, due to supply issues linked to a shortage of drivers, equipment and flu vaccinations, these are delayed? If so, for how long? Is it for two weeks or is it longer?
In this context, it is not surprising that GPs are at their wits’ end, forced to cancel first blood tests because of test tube shortages and now flu vaccination appointments. We need to think about what that means; for example, if you are pregnant and need a flu vaccination, the delay is a serious matter because you cannot put your pregnancy on hold while the supply catches up with you. It is especially worrying as we head into what could be one of the most difficult and challenging winters for the NHS. What steps are the Government taking to ensure that there are not further delays and to avoid a flu crisis this winter?
If the CMOs are recommending vaccination, will the Minister guarantee that our public health workforce, our health visitors and our school nurses, as well as primary care, will have the resources they need to roll out that vaccination? Can he advise what the anticipated time frame for commencement and the communication strategy will be? He Minister must be aware that many parents appear to be hesitant and that with other groups with low levels of vaccine uptake, access to accurate and trusted information is key.
Some scientists have suggested that the vaccination of children against Covid-19 is already too late to blunt an autumn wave of the infection because they will get only one dose, which is not terribly effective at preventing infection with the delta variant. What assessment have the Government made of this and what consideration has been given to limiting the minimum interval between first and second doses?
The Education Secretary has suggested that weekly Covid tests for pupils could be scrapped this month, following a review. That may be quite concerning, given that the autumn could bring a surge in cases driven by a new variant, by more mixing of people at school or work, or indeed by a drop in the levels of immunity provided by the vaccine. Does the Minister agree that testing really ought to continue?
The Education Secretary also seems to have removed many of the infection control mitigations in schools. From these Benches, we urged the Government to use the summer to install ventilation, air filtration units and carbon dioxide monitors in schools. I would like to know how many schools now have these systems installed. I also share with the Minister our concerns that the current rules seem to suggest that a child can go to school even when their parents test positive. That seems not to be a sensible way forward.
Are the Government making contingency plans for an October firebreak lockdown if hospitalisations continue to rise at their current rate? Last week, the World Health Organization designated mu as a variant of interest, adding that it can potentially evade immunity granted from a previous Covid infection or vaccine. Perhaps the Minister could update the House on that issue.
On Tuesday, the Prime Minister finally made his long-awaited social care Statement, over two years after standing in front of the steps of Downing Street proclaiming to have a plan. Now, we had a debate and discussion earlier today about whether it is actually a plan—because we think it is not—and what the tax increase means. However, the timeframe for the delivery of this plan does not seem to recognise that we already have bed blocking in our hospitals. There is already an emergency in social care and the knock-on effect of that on Covid, flu and the winter could be substantial. I would really like the Minister to address that issue.
The Deputy Speaker (Baroness McIntosh of Hudnall) (Lab)
My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness now to speak.
Baroness Brinton (LD) [V]
My Lords, yesterday 38,486 new daily cases were reported. That is equal to daily cases in mid-January and there are now just under 8,000 people in hospital, with 1,000 on ventilators—and yesterday 191 deaths were also reported, equal to the daily numbers at the beginning of March. The consequence of removing all mitigations and life returning to the new normal means Covid is still very much with us, especially the delta variant. Members of SAGE appear, according to the press, to be advising that preparations for an October lockdown should now be made.
It appears that Ministers are reliant on vaccination as the main mitigation, until the NHS is overwhelmed again. But we are already hearing of hospitals having to dedicate more wards just to Covid, with the complexities of double staffing for hot and not-hot wards. These numbers also make it much harder for the NHS to catch up on the long waiting lists, which have been talked about a great deal during the week, with the health and social care announcements.
The Statement talks about test and trace being another pillar. That is right, but the advice to the public is complex and there is evidence that many are not taking tests even when they have symptoms or have been in touch with a positive case. For example, you have to hunt quite hard online if you have had a negative PCR test but still have some residual symptoms to find out whether you should release yourself from self-isolation. Are there plans to make it clearer exactly what people should do, because we all know that sometimes the first PCR test is a little early and a second one is necessary?
Are the news reports true that there is about to be an announcement that anybody double vaccinated will not need to take a PCR test if they come into contact with a Covid-positive person? The delta variant can and is being caught by double-vaccinated people, and—importantly—they can transmit it too. That can have difficult consequences for those not vaccinated, or those who are clinically extremely vulnerable. The noble Baroness, Lady Thornton, referred to the mu variant. If it is true that the Pfizer vaccination is ineffective in holding it back, that is serious and we may need to think about mitigations again sooner rather than later.
The Statement explains the partial changes on policy for vaccinating 12 to 15 year- olds with underlying conditions. It is good to see that those with blood cancers, sickle cell, type 1 diabetes, congenital heart disease and poorly controlled asthma are now added to the list. Actually, it is vital, given Gavin Williamson’s removal of all mitigations in schools. But other children are omitted from this list, who may be on immuno-suppressants or immunocompromised, and who are now expected back in school. The Statement refers to
“no more home schooling, no more bubbles, teachers vaccinated, and all 16 and 17 year-olds offered a first dose”.
But the removal of bubbles and facemasks, and the Government’s shameful lack of movement on providing proper ventilation interventions in classrooms, means that Covid can and will spread, and not just among the children—they may well take it home. While most children will not have a problem, some—those with underlying conditions—will.
Can the Minister explain why all children with serious underlying conditions have been removed from the clinically extremely vulnerable list of shielders? Parents are already getting threatening letters from schools, yet their questions about why their at-risk child has been taken off the list have not yet been properly answered. The evidence in America is that these children are occupying more paediatric hospital beds and more intensive care beds.
Turning to clinically extremely vulnerable adults, it is good that the 500,000 severely clinically extremely vulnerable are to get a third dose as soon as possible. But delaying the decision on a booster jab for the remaining clinically extremely vulnerable, who number just over 3 million, is worrying. Guidance online for them is still 10 pages long, muddled in with advice to the general population, but the key parts are still not to go into any environment with people who are not yet double jabbed or might breach social distancing, and if they come inside your home they should have had a lateral flow test first. As I have said, that amounts to a stay-at-home order but without the support that government provided before. When will the booster decision be made for this particular group of people?
Care home providers are warning that they are already losing staff ahead of the 11 November deadline for all staff to be double vaccinated. This is in addition to the staff shortages that they are already trying to manage, which include the perfect storm of losing staff through Brexit and increased pay in retail and agriculture. Losing more staff who are unvaccinated will be catastrophic. They have asked for a delay to the start of the scheme, particularly now that a new consultation has started for NHS staff on a scheme which would start at a later date. What plans are there to delay this implementation date?
Finally, the Minister for Vaccines came a real cropper in the House of Commons yesterday when trying to justify Covid vaccine passports, when he was on record in the past as not supporting them. Can the noble Lord update the House on the Government’s plans regarding vaccine passports in light of yesterday’s debate, which demonstrated that the relevant Minister could not even explain his own policy credibly?
Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) Regulations 2021
Baroness McIntosh of Hudnall Excerpts(4 years ago)
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Lord Bhatia (Non-Afl) [V]
My Lords, this SI has been prepared by the Department of Health and Social Care. The instrument revokes and replaces the health protection regulations 2020 and contains the legislative framework that will implement steps 1 to 3 of the Government’s road map out of lockdown in England. This instrument enables a number of public measures to be taken to reduce the public health risks posed by the spread in England of severe acute respiratory syndrome coronavirus 2, which causes the disease Covid-19. The SI also amends a number of other coronavirus regulations.
This SI is made under the emergency procedure set out in Section 45R of the Public Health (Control of Disease) Act 1984. Furthermore, this instrument is made without a draft having been laid and approved by a resolution of each House of Parliament. It is the opinion of the Secretary of State that, by reason of urgency, it is necessary to make this instrument without a draft being laid and approved, so that public health measures can be taken in response to the serious and imminent threat to public health posed by the incidence and spread of severe acute respiratory syndrome coronavirus 2.
This instrument was laid and published and came into force on 29 March 2021, and the measures will expire at the end of 30 June 2021. This instrument will cease to have effect at the end of the period of 28 days, beginning on the day it was made, unless during that period it is approved by a resolution of each House of Parliament. The Secretary of State must review the need for the restrictions imposed by this instrument at least every 35 days, with the first review taking place by 12 April 2021.
I support this SI as put forward by the Minister.
The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)
My Lords, the noble Baroness, Lady Gardner of Parkes, has withdrawn, so I call the noble Baroness, Lady Brinton.
Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020
Baroness McIntosh of Hudnall Excerpts(4 years, 5 months ago)
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Lord Mann (Non-Afl)
There is huge support out there for the lockdown, although everyone I know is asking, as am I, why our borders are open, because one thing is certain: if Donald Trump is allowed in during the lockdown, there will be a significant problem for the Government with public opinion.
Looking at the pace at which they are vaccinating, what is Israel doing right that we are not? Can I suggest some reasons to the Minister? My own GP service today is vaccinating for flu but is not allowed to vaccinate for Covid because of new Public Health England rules. I suggest that this is the same reason why pharmacies are not being allowed to vaccinate. It is not because they cannot, since they are vaccinating for flu at the moment, but because of Public Health England rules relating to Covid. I know a nurse, retired after 30 years, who has been re-recruited this week as an assistant and is allowed to vaccinate for flu, but despite that 30 years is not allowed to vaccinate for Covid because of Public Health England rules. Who will get on top of Public Health England? It strikes me that people keep attacking the Government, but the problem I have is with some of the actions of Public Health England, and this demonstrates that. This overcautious approach is delaying and will delay further.
I end not by talking about what is rightly going on with the prioritising of the most elderly and vulnerable, because that is appropriate. In the next stage, I predict that Public Health England will not allow workplaces to vaccinate but will allow the employer to take on the costs, the hassle and the administration. In an area such as the district I live in, 10,000 could be done in a day if they were done in the large workplaces. Then we would really be getting on top of the problem. Which Minister will take on and sort out the bureaucracy from Public Health England?
The Deputy Speaker (Baroness McIntosh of Hudnall) (Lab)
I call Lord Bhatia. He is not there. I call Lord Bourne of Aberystwyth.
Covid-19: Restrictions
Baroness McIntosh of Hudnall Excerpts(4 years, 5 months ago)
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Lord Bethell (Con)
The noble Baroness makes the point well. My observation is that the British public are extremely supportive of both the lockdown and the measures involved. Of course, we all see highly visible exceptions in our travels and when we work, but by and large the British public have massively complied with the measures without any severe form of compulsion, and for that I pay an enormous amount of tribute. In the first lockdown, we had to behave as though the person we saw near us might have the disease; the suggestion now is that we should behave as though we have the disease. It is that discipline that we all need to apply.
The Deputy Speaker (Baroness McIntosh of Hudnall) (Lab)
My Lords, the time allowed for this Question has now elapsed.
Coronavirus Act 2020 (Expiry of Mental Health Provisions) (England and Wales) Regulations 2020
Baroness McIntosh of Hudnall Excerpts(4 years, 7 months ago)
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Lord Hunt of Kings Heath (Lab) [V]
My Lords, it is a great pleasure to follow my noble friend and I congratulate him on a fine maiden speech. As he said, he brings to your Lordships’ House a wide range of experience in the trade union movement, service on the GLC and as chair of ILEA, where he was a forceful champion of comprehensive education. However, I rather think that his being the first actuary to enter the Lords for more than 50 years will cause the most challenge to your Lordships. He will discover that we float figures around the House like confetti to justify whatever position we happen to take. Happily, this usually goes unchallenged, yet with my noble friend in place I suspect that we will need to be on our mettle and to expect robust scrutiny in the future.
As my noble friend said, it has not been necessary to use the powers in the regulations and their removal is warmly welcomed. Although the regulations are concerned with the requirements under the Mental Health Act 1983, this debate inevitably raises wider issues in relation to mental health provision during the pandemic and beyond.
We know that the pandemic has had a significant impact on the country’s mental health and well-being. What is the Minister’s assessment of this and what measures are being taken to restore services and deal quickly with the backlog of patients? Does he agree with the assessment of Scientists for Labour that there has been a stark decline in the availability of services? Research by Mind from May 2020 reported that the restrictions on seeing people, being able to go outside and worries about the health of family and friends are the key factors driving poor mental health. The Centre for Mental Health predicts that at least half a million more people may experience a mental health problem as a result of the pandemic. Does the Minister agree?
As part of the lockdown in March, dramatic changes were made by NHS mental health services, including discharging patients from in-patient community services and moving to online provision. Has the impact of that been measured? Does he accept that eye contact often plays an important role in cognitive behaviour therapy? We need to reflect on that before assuming that services can always be online in the future. Will the Minister agree to publish a comprehensive plan to restore levels of service, including a thorough assessment of what changes in demand for services are arising from the pandemic?
The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)
My Lords, the noble Baroness, Lady Warsi, has withdrawn from the debate and so I call the next speaker, the noble Baroness, Lady Fox of Buckley.
Lord Bethell (Con)
My Lords, I thank noble Lords for a thoughtful and at times very generous debate, for which I am enormously grateful. I thank the noble Lord, Lord Davies of Brixton, for a remarkable maiden speech and offer him a sincere welcome. He laid out his stall very clearly, first as a man of numbers—as many have noted, the debates of the House of Lords benefit from those who are numerate and articulate with numbers as well as words—secondly, as a supporter of the trade union movement, and I look forward to his interventions as a trade unionist; and thirdly, as a man of compassion. He spoke movingly about mental health and the provisions in these regulations, and has marked himself out as someone who I hope will make an important contribution to our health debates—he will be extremely welcome indeed.
We are aware that many people are facing unprecedented strains due to the pandemic and the measures to contain it. The mental health of everyone is absolutely critical in these unprecedented times. We know that some people will experience exacerbated mental health problems as a result of the pandemic, as has been noted by the noble Baroness, Lady Barker. Moreover, people with existing mental health conditions and front-line workers are particularly susceptible.
The noble Baroness, Lady Tyler, noted that self-reporting has gone up. Public Health England’s Covid-19 mental health and well-being report concluded that the UK population’s self-reported mental health and well-being worsened during the pandemic. The largest decline was in April 2020.
Average levels of mental distress have been reported as going up, as the noble Baroness, Lady Fox, noted, although by 8.1% measured by GHQ 12, not the high levels that some noble Lords have referred to, indicating an increase in the severity of mental health problems overall. A robust follow-up survey from July 2020 of children and young people aged five to 16 who were interviewed for the national mental health prevalence survey in 2017 suggests that rates of probable mental health disorder have increased from one in nine in 2017 to one in six in July 2020—a very regrettable development.
We understand that there is increasing evidence of significant mental health consequences for people who have contracted Covid and evidence that Covid itself impacts the central nervous system, which can affect mental health and well-being. Survivors of Covid appear to be at increased risk of psychiatric disorder. For patients with no previous psychiatric history, a diagnosis of Covid was associated with increased incidence of a first psychiatric diagnosis in the following 14 to 90 days, compared with six other healthcare events.
I reassure all noble Lords who have spoken that mental health continues to be a priority for this Government. We are doing our utmost to ensure that our mental health services are there for everyone who needs them during the pandemic. I reassure the noble Lord, Lord Blunkett, that that is why in today’s spending review the Government have announced £500 million more for mental health support for new specialist services for children and young people, plus extra assistance for people with severe mental health illnesses and faster help for those afflicted by depression and anxiety.
The well-being and mental health support plan for Covid-19 published this week is a demonstration of the Government’s firm commitment to support the mental health of everyone throughout this winter and beyond. It outlines the support available to people over the coming winter. This is just one element of our work to deliver a modern mental health service and meet the demands created by the pandemic. We have announced two new commitments to support individuals: first, a winter discharge support package backed by £50 million, which will boost capacity and support good-quality discharge from mental health in-patient settings to help reduce pressures on in-patient beds and keep patients safe over the winter. Secondly, we are taking action to support the physical health of individuals with serious mental illnesses this winter, including support for systems to deliver local, system-level tailored engagement with patients and to develop national thought leadership on outreach.
We are absolutely committed to continuing our investment in expanding and transforming mental health services in England. This will amount to an additional £2.3 billion of extra funding a year on mental health services by 2023 to 2024. I reassure the noble Lord, Lord Hunt, that we are taking a range of steps to support mental health services to be able to manage pressure over the winter period.
Above all, it is essential that the message is heard loud and clear across the country that NHS mental health services remain open for business and will be available throughout the winter. The earlier people receive support on their mental health, the more likely they are to benefit. However, in April this year, only 57,000 referrals were made, compared to 133,000 in April 2019. While figures for more recent months show that referral rates are recovering, they are significantly below last year’s. To help address this, last week we launched a new phase of our NHS Help Us, Help You campaign to encourage anyone suffering from anxiety, depression or other issues.
We will continue to make sure that mental health services, including hospitals providing in-patient treatment get equal access to PPE. All health and social care staff can access priority testing when they show symptoms, including those providing mental health services in hospitals. NHS staff without symptoms can also be tested at the discretion of their NHS trust. Hospitals can test patients, including those admitted with mental health conditions, even if there is a higher prevalence of Covid-19 in their area.
GP surgeries have been requested by NHS England to make improvements to ensure that the physical health of those living with severe mental illness is protected this winter. This includes asking practices to identify people with severe mental illnesses who are clinically vulnerable and offering those people comprehensive physical health checks and follow-up interventions, free flu vaccines to those eligible and a care plan review as appropriate.
The NHS has worked hard to keep mental health services going during the first peak, using technology where needed, but also face-to-face appointments where appropriate. All mental health trusts have established 24/7 urgent mental health helplines, where people experiencing a mental health crisis can access support and advice. In addition, we have provided £10.2 million of extra funding to support mental health charities, including the Samaritans and the Campaign Against Living Miserably.
Talking therapies will continue to be made available remotely, so that people can access help safely from home. The NHS will work to ensure that the option of face-to-face support, quite rightly alluded to by the noble Baroness, Lady Barker, and the noble Lord, Lord Walney, is provided to people with serious mental health illnesses where it is clinically safe to do so.
Public Health England has published its surveillance tracker to monitor the impact of Covid-19 on the population’s mental health. This is a proactive step which will help to ensure that our response to the effects of Covid-19 on mental health and well-being is shaped by emerging data.
The Government have committed more than £400 million over the next four years to refurbish mental health facilities, getting rid of dormitories in mental health locations and benefiting the patients of 40 trusts across the country. We are committed to supporting our staff and investing in the workforce. NHS England and NHS Improvement are also investing £15 million to ensure that all staff get rapid access to expanded mental health services. Staff who are referred will be assessed rapidly, will be treated by local mental health specialists and, where appropriate, will be referred to specialist centres of excellence.
A number of noble Lords, including the noble Lord, Lord Davies, and the noble Baroness, Lady Tyler, asked about Sir Simon Wessely’s independent review of the Mental Health Act. I reassure noble Lords that work is well under way to respond to the review, and we will publish our White Paper in due course. This will pave the way for far-reaching reforms to the legislation and practice, strengthening the rights of patients and upholding the principles of dignity, autonomy and choice, which were enshrined in the review’s recommendations.
Since the Coronavirus Act was introduced, the Government have remained committed to keeping all elements of it under close review and to sunset any provisions that are no longer needed. As I set out earlier, the emergency modifications to the Mental Health Act made by the Coronavirus Act were designed to protect patients by supporting services to be able to continue if unprecedented constraints in the mental health sector put patients’ safety at risk during the pandemic. These provisions were only ever to be used as a backstop, as I told the Committee earlier.
The noble Lord, Lord Blunkett, referred to the very moving speech of the noble Baroness, Lady Grey-Thompson. I remember her words extremely well. Decisions, over which we have no control whatever, about our uselessness will be taken by someone else in the next few months. I am very pleased that the provisions have not been switched on. I reassure noble Lords that at all times the Government have remained conscious of the need to balance those provisions against the rights of individuals detained under the Mental Health Act.
Those provisions have not needed to be switched on due to the adaptations that have been made because of the resilience and commitment of NHS staff. As a result, we believe that now is the right time to remove them so that it is clear to patients, carers, staff and stakeholders that they will not be used. The approval of these regulations by this House to remove these emergency provisions is an important milestone on the journey towards much-needed reforms to the Mental Health Act. These reforms—
The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)
The Division Bell is ringing. I wonder whether the Minister is coming to the end of his remarks.
The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)
If the Minister would like to finish, I will then adjourn the Committee and there will be plenty of time for noble Lords to vote.
Lord Bethell (Con)
These reforms, which will see that patients have greater autonomy and control over their care and treatment, will be set out in the Government’s forthcoming White Paper on this subject.
The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)
The Grand Committee stands adjourned until 5 pm. I remind noble Lords to sanitise their desks before they leave the Room, and to vote, should they wish to do so.