Health Security (EU Exit) Regulations 2021

Baroness Merron Excerpts

Monday 5th July 2021 Grand Committee

[Baroness Merron (Lab)]

My Lords, we debate these regulations today on the 73rd anniversary of the National Health Service. I am sure that all noble Lords take great pleasure in seeing the George Cross awarded to recognise NHS staff past and present across all disciplines and all four nations; it is indeed a worthy honour.

I thank the Minister for outlining the focus and intent of these regulations, which are certainly welcomed. We welcome the focus on co-ordinating data-sharing, epidemiological surveillance and a four-nations approach to the prevention and control of serious cross-border health threats. It is certainly important to see the devolved nations’ public health agencies working in a close, collaborative relationship, which is what we hope to see following the adoption of these regulations. It is worth noting that, throughout the course of the pandemic, we have seen considerable regulatory divergence and differing communication issues between the devolved Administrations and the UK Government, particularly at a political level. As we well know, and as has been referenced in this debate, global health—in fact all—threats do not recognise borders. They do not fit that neatly.

The First Minister for Wales, Mark Drakeford, has consistently asked for a “regular, reliable rhythm” to meetings between the devolved Governments and the UK Government. Can the Minister assure us that this will become the norm? I noted his complimentary comments about the collaborative nature of his recent discussions, and I certainly wish to be assured that that will continue.

According to the Government, the UK Health Security Agency will undertake functions in five core areas in relation to future infectious disease threats. It will also

“act to strengthen health protection capability from top to bottom”

and place a “strong focus” on reducing inequalities in the way that different communities experience, and are impacted by, infectious diseases or environmental hazards. However, there is still very little information about how this will work, and it remains unclear how it will address the wider socioeconomic determinants of health. Perhaps the Minister can help us here.

To be more specific, the UK lost its elimination status for measles in 2016 and that was not about an external threat. That was about the internal competence—or otherwise—of the Government in handling public health issues. Does the Minister share my concern that the decision to subsume Public Health England into a security-focused agency may result in large areas of public health being neglected amid a focus on future pandemics?

What emphasis will be given to tackling the wider determinants of health, which have had a huge impact on the UK’s very poor outcome with Covid? Does the Minister agree that the Government cannot afford to ignore non-communicable diseases, including cancer, the wider health of the UK and those social inequalities, such as cramped housing and unequal access to care, which have exacerbated the experiences of many throughout the pandemic?

One of the big problems as we went into the pandemic was that the health of the population was poor at the outset, and in many cases getting worse. The improvement in life expectancy had stalled from 2012 onwards. Can the Minister confirm whether the agency will deal with this? One of the major failures of the UK’s response to Covid has been the inability of people to isolate. How will the agency address people in precarious occupations in the informal economy—those who do not have access to paid leave in order to self-isolate—and people who live in multigenerational homes?

We welcome the investment in tackling future infectious diseases but remain concerned that at the same time there has been disinvestment in UK Research and Innovation research funding. UKRI has warned of a £120 million hole in its budget following recent cuts. Does the Minister share my concern that this shortfall threatens to undermine overseas scientific projects seeking to understand how we can better mitigate against zoonotic diseases such as Covid-19? Will the Government commit to bringing forward their commitment to increase research and development spending to 2.4% of GDP by 2027?

Like my noble friend Lord Hunt of Kings Heath, I refer the Minister to the comments of the Secondary Legislation Scrutiny Committee on the Explanatory Memorandum, which, it said

“does perhaps overestimate the average reader’s knowledge of the UK’s plans.”

I hope the Minister will be able to assure the Committee that the department will ensure that the Explanatory Memorandum will be explicitly clear on what Parliament is being asked to agree going forward.

Coronavirus Act 2020 (Early Expiry) Regulations 2021

Baroness Merron Excerpts

Monday 5th July 2021 Grand Committee

[Baroness Merron (Lab)]

I thank the Minister for introducing the regulations and explaining the reasons for them. We certainly welcome this statutory instrument, which removes provisions that enabled local authorities to divert resources to care and support from other duties as stipulated in the Care Act 2014.

As has been acknowledged in the debate, the pandemic has been exceptionally difficult for everybody, while the most vulnerable have seen disproportionately high death rates and a profound impact on the level and quality of their care. With regard to that, I join my noble friend Lord Hunt of Kings Heath in paying tribute to those in the care sector, both paid and unpaid.

According to the guidance issued to local authorities, the easements were meant to be activated only when they were necessary to ensure safety. They were intended to be temporary, kept under review and used as narrowly as possible. An open letter of 19 March 2021, signed by at least 27 disabled people’s organisations, highlighted concerns. It said:

“At such a strained and worrying time for everyone, this unnecessary power that no Council is even using hangs over the heads of disabled people, causing only anxiety.”


Many of the people most vulnerable to the virus simultaneously faced a reduction in essential care and support. By the middle of 2020, seven in 10 people with learning disabilities had had their social care cut or significantly reduced, and 79% of family members were forced to take on further unpaid caring duties in the face of cuts. Just eight of the 151 English councils with social services responsibility made use of the easements during the first wave, and only two of these—Derbyshire and Solihull—used it to cease meeting needs that they were required to meet. According to the CQC, by July, all had stopped.

We continue to know of the loss and long-term closure of day care centres, group activities, travel training and at-home support. There is also little clarity on how local authorities will catch up on reduced assessments or deal with retroactive demands for payment. The catch-all phrase “cancelled because of Covid” remains, and there are concerns that this so-called explanation will continue to linger. Does the Minister accept that the social care easements do not appear to have eased the burden for anybody?

Of course, there is a much bigger issue here: the chronic underfunding and devaluing of the social care sector, of which the fleeting emergence of the social care easements was but a symptom. We have been waiting almost two years to see the clear plan for social care that the Prime Minister claimed to have prepared, and all we heard in the Queen’s Speech was just nine words. Does the Minister agree that a better future for our country cannot be built after Covid-19 without transforming social care? We need the Government to make a firm commitment to reforming and presenting plans to Parliament as soon as possible.

Looking forward, the emergency Coronavirus Act gave Ministers sweeping powers, many of which have yet to be used. The priority must be to use the Act and other regulations related to health protection to bring us out of restrictions safely, support the NHS in recovering from the crisis, ensure that there are measures in place to restart the economy effectively, and enable those who need to self-isolate in future to do so. Nobody wants these regulations in place for any longer than is needed but we have to make sure that this is the last lockdown.

It seems that guidance and reliance on personal choice are set to be the order of the day, with the final stage of the four-step plan out of lockdown imminent. This is despite coronavirus cases rising to their highest level since January. Does the Minister share my concern that letting cases rise with no corresponding actions means further pressure on the NHS, more sickness and more disruption to education, and risks a new variant emerging with a selection advantage?

The new Health Secretary used the weekend press to emphasise that we must learn to live with the virus as we have done with flu. Can the Minister advise the Committee what level of mortality and cases of long Covid he considers acceptable? Will he outline the measures that the Government will introduce, such as ventilation support for buildings and sick pay for isolation, to push cases down? As we know, coronavirus does not impact people and communities equally. What support will be in place for the most deprived areas, where cases are highest and vaccination rates lowest?

Covid-19: Wuhan Institute of Virology

Baroness Merron Excerpts

Wednesday 30th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I agree with the noble Lord’s appeal for more data—but, candidly, as I know he knows, it is not just quantity of data that we need; it is the right data. Where we are struggling is in getting genomic sequencing of new mutations from the furthest reaches of the virus’s spread. We need a systematic programme around the world that shares the sequences of new mutations with academics who can study and assess them. Without such a systematic programme we are flying blind. That is why we are working on the new variant assessment platform and other pandemic preparedness projects.

[Baroness Merron (Lab)]

My Lords, scientists are warning that we are in an era of pandemics, and that viruses more deadly, contagious or resistant to antibodies than Covid-19 could emerge. What steps are the Government taking to prepare themselves and the country for the next potential pandemic, and will the Minister commit to ensuring that future pandemic preparedness plans are independently assessed and reported to Parliament?

[Lord Bethell (Con)]

My Lords, I pay tribute to the Chief Scientific Adviser, Sir Patrick Vallance, who is leading the pandemic preparedness work. He is doing an enormous amount both on the international treaties through our G7 chairmanship, and on the internal domestic re-envisaging of our healthcare system. We need to invest more in public health, and we also need the data, the diagnostics and the patient behaviours that support really rigorous tracking down of diseases when they arrive. The noble Baroness is entirely right: pandemics will come, sooner rather than later.

Folic Acid

Baroness Merron Excerpts

Wednesday 23rd June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, it is my understanding that both the Department of Health and Defra have been engaged with other countries on this matter. I will be glad to write to the noble Baroness with any details that we may have on record.

[Baroness Merron (Lab)]

My Lords, I listened to the Minister’s answer where he referred to delays as a result of the Covid pandemic and the elections in the devolved Administrations. While they may be recent issues, this delay well precedes both those important events. As my noble friend Lord Rooker and others have so eloquently expressed, patience on this is long exhausted and parents-to-be cannot be expected to continue to carry such risk. Can the Minister tell the House exactly when babies will be protected? Is the delay that we have seen over decades due to any change in the Government’s position?

[Lord Bethell (Con)]

I absolutely reassure both the noble Baroness and all noble Lords in the Chamber that there is absolutely no equivocation on behalf of the Government in this matter. It is a huge undertaking to put a substance in the food of the nation. It is therefore something that has to be endorsed by all the relevant bodies, including the four nations and other arm’s-length bodies. We have to ensure that we have all the public health sign off and the industry support that we need, and we need to take the public with us. There will be a moment when we need to sell this to the public, and they will have questions and we will need to have a dialogue. When that happens, I would like to have crossed all the “t”s and dotted all the “i”s so that we are in great shape. That is why we are being as thorough as we can. I reassure all noble Lords that there is no question of us going backwards on this.

Covid-19: Vaccines and Pregnancy

Baroness Merron Excerpts

Monday 14th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Baroness points to one of the challenges of longitudinal research: the babies have not been born for very long, of course. We need to do long-term studies to understand the effect. There is no evidence at all of a negative outcome but we will need to monitor that; research resources will be dedicated to looking at it.

[Baroness Merron (Lab)]

To tackle the risk of stillbirths and emergency Caesareans among mothers who are giving birth and have contracted Covid-19, as we see the vaccination programme extend further—particularly into the younger age groups—will the Minister look at prioritising pregnant women for vaccinations? I refer particularly to women in the later stages of pregnancy.

[Lord Bethell (Con)]

My Lords, the JCVI has a clear set of prioritisation protocols, which we are sticking to. The fact of being pregnant does not seem to have a direct impact in terms of severe disease or death, so there is no clear evidence at the moment for putting in or changing the prioritisation of pregnant women. However, we constantly review that and we are naturally concerned to protect both the mother and the child.

Covid-19: Government Handling and Preparedness

Baroness Merron Excerpts

Tuesday 8th June 2021 Lords Chamber

[Baroness Merron (Lab)]

My Lords, research released for Carers Week makes sobering reading. During the pandemic, 72% of carers have had no break whatever and, of those few who have had a break, many used the time for housework or their own medical appointments. With the risk of a third wave still a cause for anxiety, what plans are in place, or indeed in development, to ensure that unpaid carers can have restorative breaks and that their needs are at the heart of the Government’s plan for social care reform?

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

My Lords, I absolutely join the noble Baroness in paying tribute to all carers, particularly unpaid carers, who have shouldered a huge burden in the past 18 months. The role that they have played has been a real example of the sense of service and commitment that characterises the social care community in this country. We have put in place a large amount of resources through local authorities and payments to local authorities to support carers. That has helped in infection control and to reduce the itinerant nature of some social care in order to prevent the spread of the disease. But it is undoubtedly true that the burden on unpaid carers remains immense, and we continue to support, both through local authorities and through charities, the work that they do.

Covid-19: Poverty

Baroness Merron Excerpts

Thursday 27th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I hear my noble friend’s warning very clearly and he is absolutely right. We must not be confused between statistical correlation and causation. However, one thing that has become clear is that in Covid personal health status, particularly obesity, has been a driver of severe illness and mortality. The environments in which people live and work have been a driver of infection. Those two are probably inescapable conclusions and will be central to our levelling-up agenda.

[Baroness Merron (Lab)]

The pandemic has brutally exposed the health inequalities that ran deep in our society even before Covid-19, and it is certainly welcome that the White Paper acknowledges that. However, even the best efforts of an integrated care system can only go so far in preventing ill health. Forthcoming legislation needs to be underpinned by national policy measures and funding to tackle overarching determinants of health. With that in mind, will the Minister comment on why the Queen’s Speech did not contain improved funding for public health, given the Government’s professed commitment to levelling up and building back better?

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right that it cannot be for either the law or the Department of Health to solve a national challenge. That is why the Prime Minister has committed to appointing a cross-ministerial board. It needs the co-ordination and focus of many different departments that handle health, social welfare and the culture of the country to tackle these tricky, long-standing and difficult challenges.

COVID-19 Variant: Travel Guidance for Local Authorities

Baroness Merron Excerpts

Wednesday 26th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, guidance for people in Bolton and Blackburn with Darwen was published on Friday 14 May. It was then extended on 21 May to Bedford, Burnley, Hounslow, Leicester and North Tyneside. That guidance has now been fine-tuned, in response to feedback from the local directors of public health and, as the noble Baroness will know, the website has been updated. The chronology of that is relatively straightforward. It could have been done better—that I have made plain to the noble Baroness, Lady Thornton—and we are with working directors of public health, local authorities and others to ensure that we get smoother systems for that kind of thing.

[Baroness Merron (Lab)]

My Lords, I share a lot of the concern in the House about the confusion that has been sown. I am somewhat shocked that the Government did not work closely with those who are dealing with Covid in the affected areas, who are at the sharp end: the mayors, public health officials and councils. They are the local experts, and I implore the Minister to work closely with them. Does he accept that what is really needed in the affected areas now is isolation support, enhanced contact tracing and the rollout of vaccine for everybody?

[Lord Bethell (Con)]

My Lords, I completely object to the false premise of the question. I cannot tell you how hard we are working in collaboration with local authorities, directors of public health and the incredible rhythm of regional partnership teams, regional team updates and the huge amount of data and interaction between all parts of government. It is absolutely phenomenal, and the characterisation by the noble Baroness is just not right. Where I completely agree with her is that we are working as hard as we humanly can to get the vaccine out to everyone, we are doing absolutely all we can to spread testing to all areas where there are outbreaks and we are working extremely hard to improve all those systems.

Covid-19 Internal Review

Baroness Merron Excerpts

Thursday 20th May 2021 Lords Chamber

Asked by

[Baroness Merron]

To ask Her Majesty’s Government whether they will publish their internal review of the handling of the COVID-19 pandemic.

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

My Lords, I start by welcoming the noble Baroness, Lady Merron, to the Bench; I am very much looking forward to working with her in the months ahead. The Prime Minister confirmed on 12 May that a public inquiry will be established on a statutory basis to consider the Covid-19 pandemic, including the Government’s handling of it. I can confirm that while DHSC officials carried out a routine internal ways-of-working review, this was absolutely for the purpose of providing advice to Ministers only.

[Baroness Merron (Lab)]

My Lords, the National Audit Office report published yesterday both highlighted the need for the Government to learn lessons at speed and advocated greater transparency. Publishing an already completed internal review of the Government’s handling of the Covid-19 crisis would support a plan to contain the threat of new variants, and I urge the Government to do so. I am interested to know whether the Minister can come to agree with me on this. With experts, including SAGE, warning that it is very much in the balance as to whether further restrictions will be lifted in June, given the dramatic rise in Indian Covid-19 variant cases, will the Government learn the lessons and urgently review travel and quarantine arrangements?

[Lord Bethell (Con)]

My Lords, I absolutely agree with the noble Baroness that we are at a pivotal moment in the pandemic; matters are on a knife-edge. There is so much good news about the effect of the vaccine that we should celebrate, but there is enormous jeopardy in the threat posed by variants. That is why we are very much focused on dealing with the pandemic before us. The inquiry promised by the Prime Minister is for spring next year, and until then we will continue to be focused on today’s pandemic.