Health and Care Bill

Baroness McIntosh of Pickering Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, I refer to my declaration of interest in the register: I currently work with the Dispensing Doctors’ Association and my father was a dispensing doctor. I congratulate my noble friend the Minister on introducing the Bill, which I broadly support—particularly its emphasis on greater collaboration between GPs, hospitals and local authorities.

If I can paraphrase the noble Lord, Lord Stevens, whom I congratulate on an excellent maiden speech, I agree that all health services are local. However, I disagree with him on his support for the fluoridation of the water supply, and refer him to the case of the petitioner, Mrs McColl, against Strathclyde Regional Council. You might say that I cut my legal teeth on this case because I spent nine months as a Bar apprentice and the remaining time as a devil; my devil master was one of the advocates for Strathclyde Regional Council. Crucially, Mrs McColl had dentures; she had no teeth. She argued that fluoride is a carcinogen and that the action Strathclyde Regional Council sought to introduce, which the Bill also seeks to introduce, was unsafe, ineffective and illegal. I agreed with her. She won her case. I cannot see how it is appropriate to prescribe such an interventionist action that could be achieved by other means: either regularly brushing children’s and adults’ teeth with toothpaste containing fluoride or reducing sugar in the diet. So, on that, we will disagree, but I warmly welcome the noble Lord to the House and congratulate him on his excellent maiden speech.

I am grateful to my noble friend the Minister for the meeting we had to discuss these issues, at which he heard me argue that the NHS and the Department of Health and Social Care tend to be urban-centric. A lot of that has been proved in many of the speeches this evening. Dispensing doctors have a unique role to play. They are general practitioners who are permitted to dispense medicines—in effect, a GP and a pharmacy rolled into one—for patients who would otherwise have difficulty accessing one or both, not least due to the distance from their home. All these services are in rural areas only. I pay tribute to the role that dispensing doctors play as an integral part of the health service in rural communities, building strong relationships with their patients. They are crucial to the delivery and promotion of preventive services and well-being, which is so dear to the heart of the Conservative manifesto.

I will focus on delivering healthcare and social care in a rural setting. I urge my noble friend to confirm that he will redress the inequalities already identified in this Bill, particularly by the right reverend Prelate the Bishop of St Albans, to restore the balance in favour of spending on rural areas as opposed to urban areas and in favour of spending on primary care as opposed to secondary care. Does he share my concern that the ICSs will be full of secondary care practitioners and that primary care practitioners may not be as well represented as they might be?

I share the concerns expressed by others this evening about the number of GPs, many of whom are facing retirement in the next five or 10 years and have real concerns about their pensions. Again, I regret the fact that the Government—as shown both this evening and with the Health Secretary’s acceptance to the health Select Committee next door in the other place—have not kept their commitment to increasing the number of doctors in the next four, five or six years. That is deeply regrettable.

Will my noble friend the Minister use this opportunity to redress the balance in spending between urban and rural areas? Rural areas are facing issues with isolation and the distance that patients have to travel to access healthcare; they also have disproportionately higher levels of older people with chronic conditions. This is a golden opportunity to address these issues; I warmly invite my noble friend to do so.

Coronavirus Act 2020 (Early Expiry) (No. 2) Regulations 2021

Baroness McIntosh of Pickering Excerpts

Tuesday 30th November 2021 Grand Committee

[Baroness McIntosh of Pickering (Con)]

My Lords, I welcome the opportunity to debate the provisions in the regulations before us and I congratulate my noble friend on bringing them forward. I thank him for the meeting that I had in the last 10 days with him and his team, which was most useful. I endorse enthusiastically his invitation for those who have not yet been vaccinated to come forward. This would be an opportunity to ask where we are, particularly with those under 18. Have they had their second vaccinations and at what age will the vaccine programme be rolled out?

I remind the Committee of my interest as an adviser to the Dispensing Doctors’ Association, which may or may not pertain to the comments that I make this afternoon. I seek my noble friend’s guidance on whether one area that I am particularly interested in, as I know are all general practitioners, is covered in the provisions before us. If it is not, can he write to me? I understand that one of the reasons why GPs are unable to have as many face-to-face appointments as they would wish is that they have been constrained by the regulations passed by both Houses of Parliament. I cannot remember whether the provision was in the original Act or in supplementary regulations in the form of statutory instruments that we have adopted. However, I understand that specific regulations regarding the square footage or meterage of a waiting room were set out at the beginning of the pandemic, limiting the number of patients who could be accommodated in person in a waiting room during the pandemic. I think that it was the same for dental practices.

Are these provisions still in place? If they are not part of these regulations, I would be grateful if my noble friend could write to me. It could be extremely important to advise the public that that is why doctors are not able to see as many patients physically as they would wish to do. I am sure that the regulations were brought in for good reasons—that we should not be mixing and should be masking and that we should respect the ventilation to which my noble friend referred, while self-distancing—but it is important that patients understand the constraints under which general practitioners have to operate.

To turn to the specific remit of the regulations before us, my noble friend just stated, and I think that it is on page 5 of the Explanatory Memorandum, that the Government are minded to expire and lift the regulations relating to the power in Schedule 22

“to provide powers to issue directions relating to events, gatherings and premises in England and Northern Ireland respectively.”

With the greatest respect, mindful of the fact that we might have difficulties once we know more about the omicron variant, is this the right time to be lifting those restrictions? Can my noble friend put my mind at rest that powers exist elsewhere, either in subsequent regulations or still in the original Act? It seems a little premature to be expiring those provisions at this time.

--- Later in debate ---

[Lord Kamall (Con)]

I apologise if I was not clearer before. I thank the noble Baroness for taking advantage of the opportunity to ask that question and finding the urge to do so irresistible. On theatres and cinemas, one of the things that was put to us was that in a restaurant, you are constantly taking a mask on and off, whereas in a cinema or theatre you are not really eating that much. Okay, you might well go to buy your ice cream—I do not know whether they still sell ice cream and jelly babies in theatres, or whatever it used to be; this will look very odd in Hansard when someone reads it—but you are not constantly doing and you are more or less constantly wearing your mask. However, I will take that back. It is a fair point, and one thing that I do when I am being briefed is to challenge because I know that noble Lords will rightly challenge me on this issue.

In response to the comments by Jenny Harries, I hope I have been clear that we take advice from a range of advisers and there is not yet consensus, but we have been relying not just on making mask mandatory when necessary as a precaution, but at the same time on people’s individual behaviour and them acting responsibly. It is about getting that balance right. We listen to Dr Jenny Harries, but she is one of a number of experts whom we listen to. We weigh up the different views; it is as simple as that. As we have been clear, there is no one trigger for any of these measures. We always consider a range of measures, including capacity in the NHS, the trends et cetera. I have listed them in previous debates. It is not one person whom we listen to. We listen to a range of experts.

[Baroness McIntosh of Pickering (Con)]

Will my noble friend undertake to write to me about waiting facilities in GP waiting rooms? That would be helpful. I am also prompted by a question that I do not think he responded to from the noble Baroness, Lady Brinton, on the welfare aspects of staff shortages in meat-processing plants and the massive cull of pigs. While I appreciate it might not be the direct responsibility of his department, this is an animal welfare disaster about to happen.

One thing that I did not like to raise—I am sure it will go no further than the Grand Committee, which is why I feel confident to raise it now—is that my noble friend will be aware that there is PPE equipment which was deemed not fit for use, but it is in the system and is, to a certain extent, clogging up the supply chain by taking space which should be used for other goods. Will he undertake to use his good offices to look into this? Perhaps we could have a word about it afterwards because it is contributing to shortages and delays in the supply chain, particularly in storage terms.

[Lord Kamall (Con)]

First, I apologise for missing that point earlier. Regarding the supply chain provision, an SI was laid under the draft affirmative procedure on 21 April 2021. It was debated and approved by both Houses, came into force on 16 July and expired the provision. As the noble Baroness rightly acknowledged, some of her questioning was not within the scope of these regulations. However, given that she has asked a question, I will endeavour to find out the answer. Clearly, that will include going across departments, so I hope that she will be patient as I try to get that answer as quickly as possible.

On GP access, we recognise the pressure that general practitioners are under, especially in the upcoming and challenging winter period. We are investing £250 million in the winter access fund to improve GPs’ practice capacity. I will take the noble Baroness’s specific question about square metres and areas back to be answered; I hope she understands that I do not have those facts to mind.

The issue of measures was also raised. We must remember that one of the counterpoints put is that the country is in a very different position to the one it was in last year, due to the vaccination programme. Some of the restrictions that might have seemed appropriate last year are not as appropriate this year because we have reduced the link between cases and hospitalisations, as well as between hospitalisations and deaths. Clearly, we have the vaccine. I am sorry if I sound like a broken record but we continue to push the vaccine because it helps to break that link; it is part of the reason why we will not have to go back to some of the restrictions—those similar to last year’s—that many noble Lords are pushing for.

All I will say is that the Government’s autumn and winter plan set out how we will sustain and strengthen some of the progress made so far. We all know that winter will be a challenging period, but more so over the next few months. We all have a role to play in fighting the virus. There is much that government can do but sometimes, even when we mandate things, we know that there will be people who do not obey, so we must get the balance right and decide how to get the appropriate enforcement. Together, we believe that we can protect the progress that we have made, protect the NHS in the months ahead and help friends, loved ones and ourselves by being vaccinated against Covid-19, getting a flu jab if eligible and sticking to the advice on how to keep safe.

I thank noble Lords for their contributions to this debate and previous ones on the Coronavirus Act; I also thank them in advance for future contributions. I welcome noble Lords’ expertise and contributions, and I commend the regulations to the Committee.

NHS England: Waiting Lists

Baroness McIntosh of Pickering Excerpts

Tuesday 16th November 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Lord made a very perceptive intervention last night when asking us to think outside the box, and I gave an example of someone who I know suffers from asthma and forgot to take his blue inhaler with him to another city. His wife went to a number of places to try to get an inhaler from the pharmacy and from A&E, while telling him to stay in his hotel room. In the end, he was told that the only way to get an inhaler was to call the ambulance. We need to think outside the box and be more creative about when those situations occur—it is not necessarily political, but we need to be creative.

On technology, one of my jobs is Minister for Technology, Innovation and Life Sciences. I have been forceful, when talking to the NHS, that we have to digitise and share data. I accept that there are some concerns over sharing data, but the way to have an NHS that is fit for purpose is to make sure that we digitise and share data.

[Baroness McIntosh of Pickering (Con)]

I refer to my work with dispensing doctors. Will my noble friend join me in paying tribute to all the workforce of the NHS? Does he recognise that they are absolutely exhausted? The BMA has forecast that thousands of doctors will leave the profession in the next few years. Will the Government undertake to reinstate the commitment to have 6,000 more doctors by 2024?

[Lord Kamall (Con)]

In our conversations with the NHS, we are talking about the workforce plan. We are looking at ways to improve the way in which the NHS and social care plan for their workforce. We have committed to continuing to reflect very carefully on points made by noble Lords across the House. honourable Members in the House of Commons and many stakeholders. It is important that we value the workforce of doctors, nurses and other healthcare workers whom people often forget about. We should also value all those other workers who have provided services to us during lockdown, such as delivery drivers, postal workers, Amazon workers et cetera. They have all played a vital role, and we should not forget the role of civil society organisations.

Alcohol Duties

Baroness McIntosh of Pickering Excerpts

Tuesday 2nd November 2021 Lords Chamber

[Lord Kamall (Con)]

The World Health Organization and a number of other organisations have criticised the current system of taxation of alcohol, and urged the Government—and the EU when we were a member of it—to move toward taxation based upon the volume of alcohol. To answer the noble Baroness’s specific question, there are no current plans to implement minimum unit pricing in England, but the Government continue to monitor the impact of minimum unit pricing as evidence emerges from Scotland and Wales. It has been in place in Scotland for more than three years, and the Scottish Parliament will not consider its extension until April 2024. In all my conversations with various public health experts, one of the things that they make quite clear is that this has to be evidence-led, and we want to look at evidence from elsewhere.

[Baroness McIntosh of Pickering (Con)]

I declare my interest as chairman of the PASS Proof of Age Standards Board. I also chaired the Select Committee on the Licensing Act 2003. Does the Minister agree with the Committee when it said:

“It is in our view unarguable that an increase in the price of alcohol will decrease consumption.”?


Does he further agree that, by increasing the taxation on stronger alcohol as the Budget aims to do, that will have a better chance of reducing alcohol intake and dependency than the minimum unit pricing that we have seen in Scotland?

[Lord Kamall (Con)]

I thank my noble friend for that very important point. This is why the new system of taxation has been introduced. It will more directly align the volume of alcohol with the taxation on it. That will feed through to higher prices for drinks with higher alcohol content.

Health Protection (Coronavirus, Restrictions) (Steps etc.) (England) (Revocation and Amendment) Regulations 2021

Baroness McIntosh of Pickering Excerpts

Tuesday 14th September 2021 Grand Committee

[Baroness Barker (LD)]

My Lords, I am speaking in this debate because my noble friend Lady Brinton cannot be in her place to take part. We have the technology to enable remote participation in debates in the Moses Room, but the House authorities have not yet permitted that for contributions in Grand Committee, so virtual participation in these proceedings is unfortunately not possible, even though we have seen in this last week that the very few participants who need to take part remotely can be managed very effectively without recourse to extensive speakers’ lists.

It is also a loss to the Committee, because my noble friend Lady Brinton cannot take part for one very important reason, about which she has been quite public: she is clinically vulnerable, and one thing she cannot do is travel on public transport, which she cannot do because people are not wearing masks. Of all people, she should have been able to be here to make that point.

Yet again, these SIs were tabled very late. They came in just before the recess in late July, so yet again we are back to debating things that are long in the past. We have repeatedly asked the Government to respect the House and timetable SIs when they are not genuinely urgent. However, these are, as the noble Lord, Lord Hunt of Kings Heath, said, quite pertinent in view of the Statements being made this week.

This statutory instrument mostly deals with the revocation of statutory instruments on 21 July, which confirmed a number of the changes in the Prime Minister’s so-called freedom day. However, there is one extension, in Regulation 4, to the expiry date of the Health Protection (Coronavirus, Restrictions) (England) (No. 3) Regulations, which are now to end on 27 September. The Explanatory Memorandum says that this

“will ensure that local authorities retain powers to respond to local serious and imminent public health threats as a result of the spread of coronavirus. The No. 3 Regulations will continue to act as an important public health tool for local authorities in their local coronavirus outbreak management, compliance and enforcement activities. This is particularly important in light of the revocation of the other restrictions mentioned above”.

As we have said all the way through this pandemic, it is important that local authorities have the power to manage local outbreaks. Simply extending that power in law, but not making sure that they have the resources, will not work. As epidemiologists have said to us in terms, there will inevitably be points when it is important to close all the pubs in a certain area, simply because an outbreak has to be contained. While we welcome that, it behoves the Minister to say something about local authorities such as Croydon, which is insolvent, and how it will have the resources to manage this significant and enduring public health problem.

We regret the removal of face coverings on public transport and other crowded venues. I can say, as somebody who travels on the London Underground every working day, that fewer and fewer people are wearing masks and, as more and more people are on the Tube, I am certain we will see a spike in infections as a result. I also point out to noble Lords that the bad messaging on this does not help. There is genuine confusion. One of my colleagues was on a train to Scotland in the summer and, when it got to the border, there was an announcement that the law now required everybody on that train to wear a mask, and they did, as they should have done all the way.

It is now clear that the Government, and in particular the Prime Minister, have been so desperate to place emphasis on the vaccination programme as our primary defence that they have forgotten to look at the role of other mitigations against the disease. Although we support the passing of these regulations, we need to make the messaging clearer as a matter of urgency, so we can avoid the confusion that is now prevalent among people in England.

[Baroness McIntosh of Pickering (Con)]

My Lords, I welcome the regulations and congratulate my noble friend on bringing them before us. To a certain extent, my comments echo those that have already been made by previous speakers. I was fortunate enough to visit my family in Denmark and Scotland this summer, and the guidance in each place was much clearer. Speaking as an older person, I prefer to keep my mask on, on all forms of public transport. I am sure my noble friend will recognise that one of the reasons why there was not a high incidence of flu last year was, in large measure, because we followed the example of the Asians after the SARS epidemic in the late 2000s of masking up. Even the common cold was kept under control.

I understand the Department of Health and Social Care’s concern about a high incidence of flu this year, but I am sure we can encourage people to mask up, particularly in areas of close proximity. The noble Baroness, Lady Barker, mentioned the Tube. I am still reluctant to go on the Tube at busy times, but even the trains on the east coast main line are incredibly busy now, and you can find yourself next to someone who you are not normally accustomed to seeing.

To me, wearing a mask is not an infringement of my liberty; it is my passport to health and keeping safe. I hope that it will keep others safe as well. Does my noble friend imagine that the guidance will be revisited? It is in stark contrast to what has applied in Denmark and in Scotland.

Flu Vaccination and Blood Test Cancellations

Baroness McIntosh of Pickering Excerpts

Tuesday 14th September 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, it is not my understanding that appointments have been cancelled. If the noble Lord has any anecdotes, reports or evidence of that, I would be very grateful if he could send me that material. Seqirus, the company concerned, brings its vaccines in from overseas.

[Baroness McIntosh of Pickering (Con)]

I remind the House of my interest, in working with the Dispensing Doctors’ Association. If my noble friend reads the BMA website for 4 September, he will see that it reports numerous cancellations of appointments for meticulously planned routine flu vaccinations. Obviously, that has caused great disruption. Will he undertake to treat this matter with the utmost urgency, to ensure that GP practices are not left to face the music, and that the Government will do their utmost to roll out the vaccine programme?

Care Home Occupancy Rate

Baroness McIntosh of Pickering Excerpts

Wednesday 28th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, we have written to local authorities to make it clear what the funding is there for and to make recommendations on the sort of financial support that may be needed to bridge this moment when occupancy levels have been reduced because of concerned families taking their loved ones out of care homes. That funding is in place, and it is up to local authorities to make their decisions on the matter.

[Baroness McIntosh of Pickering (Con)]

My Lords, what has the impact of the pandemic been on those who choose to receive care in their own homes? With the rise of closures of private care homes and fewer public sector beds being available, have we got the balance in provision right?

[Lord Bethell (Con)]

My Lords, there is an important area of support for those who decide to have care at home. During the pandemic, we did an enormous amount to ensure that there were infection-safe procedures and to reduce the use of itinerant care workers in order to provide safety for those who were at home. Support for those who choose to be cared for at home should be increased. I do not recognise the idea that the number of beds in local authority care has reduced so far, but I am happy to look into the matter.

National Health Service (Charges and Pharmaceutical and Local Pharmaceutical Services) (Coronavirus) (Amendment) Regulations 2021

Baroness McIntosh of Pickering Excerpts

Monday 26th April 2021 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, I start by declaring my interest with the Dispensing Doctors’ Association, as in the register of Members’ interests.

I welcome the regulations before us this afternoon; the instrument makes a permanent change to broaden the existing arrangements for the supply of prescription items for pandemic disease or in other serious emergencies. As indicated by the Secondary Legislation Scrutiny Committee, there really are no downsides to this. The instrument

“allows specified medicines to be issued free of charge either on prescription or in response to a patient group direction (PGD), a pandemic treatment protocol (PTP) or serious shortage protocol (SSP) authorised by the Department for Health and Social Care.”

I welcome the opportunity to discuss the regulations before us. I also pay tribute to the role that community pharmacies have played in this regard—both generally and particularly during the pandemic. I would link to the role of community pharmacies the particular role that dispensing doctors have played. I once again ask my noble friend the Minister if, in the course of the afternoon, we could focus particularly on delivering medical care and pharmaceuticals in a rural setting, and ensuring that all aspects of rural life, including health policy, are delivered in a way which has clearly been rural-proofed.

I am delighted to join the noble Lord, Lord Hunt, and the noble Baroness, Lady Barker, in paying tribute to the role that community pharmacies play. But I would also like to pause for a moment and set out, as is referred to in the Explanatory Memorandum, the role that dispensing doctors have played. This is something of a lifelong interest for me because my late father was a dispensing doctor and my brother is a retired dispensing doctor. Dispensing doctors exist in rural areas because a pharmacy is not commercially viable. They date back to the time of Lloyd George and the National Insurance Act 1911.

It is important to appreciate that the income from dispensing cross-subsidises the medical service. Dispensing doctors do not have access to EPS—electronic prescription services—for their dispensing patients, over a decade since the system was introduced. That would seem to be a sign that perhaps rural-proofing in England is not working as well as it is in Wales, where they will be included for dispensing patients. Pharmaceutical needs assessment can place a dispensary under threat if a pharmacy application is made, unlike in Wales, where dispensing doctors are a full part of the pharmaceutical service, thanks to the Welsh department listening to the actions requested by the Dispensing Doctors’ Association.

Dispensing doctors are buying drugs in the same marketplace as pharmacies, yet their system of reimbursement and fees are different from community pharmacy. Despite this, as I understand it, NHS England and the department exclude dispensing doctors—in particular the DDA—from discussions on these matters. I ask my noble friend: why is that the case? The noble Lord, Lord Hunt, also mentioned that community pharmacies are excluded from these decisions as well. It strikes me that, immediately, the DDA, representing dispensing doctors and community pharmacies, should be at the table when these matters are discussed.

Most dispensing practices have vaccinated their patients against Covid as there is no scope for large centres in remote and rural communities. It is extremely difficult in areas such as sparsely populated parts of north Yorkshire for patients to access any such urban remote centre. Also, a lack of rural proofing harms rural communities. Primary care networks are being set up yet most dispensing practices are, in effect, their own primary care network given the large practice areas and dispersed populations that they serve.

As I mentioned previously, dispensing doctors are NHS GPs who are permitted to dispense medicines in designated rural areas where a community pharmacy is not economically viable. As I also said previously, dispensing practices use any profits that they make from the purchase of the drugs that they dispense to cross-subsidise the provision of the medical practice. That is often overlooked. There has never been any formal acknowledgement of this in England, although I understand that Scottish officials have done so before the Scottish Parliament.

In making the specific request to have regard the role of dispensing practices as well as community pharmacies in the dispensing of drugs under the regulations before us this afternoon, may I make a more general request to my noble friend that his department practise proper rural proofing? This will ensure that the work of, and reimbursement of, dispensing doctors in dispensing to their patients—often in rural, remote and sparsely populated areas—is properly addressed in the terms I have set out.

In that regard, I shall support the Motion to Regret before us this afternoon if the noble Lord, Lord Hunt, presses it to a vote. I hope that my noble friend the Minister will look sympathetically on the arguments I have made in favour of dispensing doctors specifically and the rural proofing of health policy more generally.

Covid-19: One Year Report

Baroness McIntosh of Pickering Excerpts

Thursday 25th March 2021 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

I thank my noble friend the Minister for presenting the regulations before us. I declare my interest in working for the Dispensing Doctors’ Association. The importance of these regulations is the consistency and clarity of the message, so that the public and others can fully understand what we are being required to do.

I turn first to the regulation requiring the wearing of face coverings, the Explanatory Memorandum for which tells us what the road map outlining the four steps will be. They are:

“The vaccine deployment programme continues successfully; Evidence shows vaccines are sufficiently effective in reducing hospitalisations and deaths in those vaccinated; Infection rates do not risk a surge in hospitalisations which would put unsustainable pressure on the NHS”


and

“Our assessment of the risks is not fundamentally changed by new Variants of Concern.”


The problem I have is that we have been told to expect a third wave and that we will have to adapt to any serious mutations and variations. We have now seen such a third wave in many continental countries, along with what they call the British variant, which I rather take offence to—I think we call it the Kent or the South African variation here. What are the plans to deal with a third wave, and with more serious variations and mutations? Should these not have been put into the regulations? I am not convinced that we have that information before us today.

I also support the conclusions of the Secondary Legislation Scrutiny Committee. In particular, it highlights that subsequent steps may not be brought into effect if

“local hotspots of infection … delay the lifting of national restrictions.”

I shall press my noble friend the Minister on this. What will the circumstances be under which those restrictions would not proceed?

In its report, the committee also talks about the fact that

“these Regulations impose a ban on all travel from England to a destination outside the UK”,

in which I have an interest because I have family in Denmark. To be honest, I would rather see them while they are alive than have to attend a funeral, which would be too late an event.

We are then told by the scrutiny committee that:

“A fine of £5,000 is imposed on anyone leaving England or being present at an embarkation point for the purpose of travelling outside the UK, without a reasonable excuse or an exemption”


and that

“Changes to these provisions are separate from the Steps and will be linked to reviews by the Global Travel Taskforce which will first report on 12 April”.


Are we going to have further regulations after that review? Since many of these things, as my noble friend Lord Lansley pointed out, are dealt with in the schedules to the steps regulations before us, it would be helpful to know that while we debate them today.

I pay tribute to all those involved in the success of the vaccination programme and congratulate my noble friend for being with us and appearing before us on so many occasions to facilitate our greater understanding of the regulations as they have been rolled out.

I would like to pause for a moment to look at the rural aspect not just of this but of so many parts of health policy and ask whether we can learn from recent experience. I hope that my noble friend will agree that vaccination delivery in rural areas has outstripped that in urban areas, and I think that the main reason for that is because primary care has taken the lead—they have outperformed and we should recognise that. The large, urban vaccination centres, which often cannot be accessed by those most in need, the vulnerable and the elderly, have not been as successful, and I understand that they have had many vaccinations left over at the end of the day.

That leads me to my general final point, which recurs in every aspect of policy but particularly in health policy. We are told that all health policy is rural-proofed, but we have it on record from the Department of Health that, in its view, Defra is responsible for rural-proofing. I ask my noble friend: have the regulations before us been submitted to Defra, or have they been rural-proofed by the department officials themselves? It is extremely important that vaccinations and testing take place as close as possible to where the patients live to enable us to drum down on any further outbreaks or mutations.

Health and Social Care Update

Baroness McIntosh of Pickering Excerpts

Monday 22nd March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I could not agree more heartedly; the vaccination of staff is a massive priority. Those figures give us cause for some reflection on how we can increase them. The adoption rate of vaccines by all healthcare workers has been much more impressive than on previous vaccine rollouts, so we are encouraged overall, but we are determined to hammer out all the last rock pools where people have not been persuaded. As I alluded to my noble friend Lord Cormack, we are looking at all methods to make sure that we get there in the end.

[Baroness McIntosh of Pickering (Con)]

I welcome the Statement, in particular the reference to the future discharge programme for hospitals. Does my noble friend agree that it is essential to rural-proof this policy? Will the Government look favourably on establishing health hubs in rural towns, to provide treatment and test availability and to allow the potential to avoid hospital visits?

[Lord Bethell (Con)]

My noble friend hits the nail on the head; who could think that a return to the previous regime of turning up at a GP’s surgery or a hospital every time you feel ill could possibly be a wise way of going about your healthcare system? Professor Sir Mike Richards has done an extremely good report on community health hubs, which we are looking at very closely; it has some very wise words that we are minded to follow up.