Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2021
Baroness Noakes Excerpts(2 years, 4 months ago)
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Baroness Noakes
Leave out from “that” to the end and insert “this House declines to approve the draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2021 because Her Majesty’s Government have not published a full impact assessment”.
Baroness Noakes (Con)
My Lords, I thank my noble friend the Minister for introducing this order with his customary clarity. I tabled my amendment because when I read the excellent report of your Lordships’ Secondary Legislation Committee, I saw red. This was yet another set of regulations from the Department of Health and Social Care that came without an impact assessment. My amendment asks the House to decline to approve the regulations as a full impact assessment has not been published. I was informed by the Printed Paper Office yesterday afternoon that the impact assessment was in fact laid on Friday, which I had discovered online over the weekend. So, to an extent my amendment has been overtaken by events and I do not expect to press it to a Division. The Department of Health and Social Care is, however, still seriously in breach of its obligations in relation to impact assessments with this late document, and I shall move my amendment so that the issues can be debated.
The department published a so-called impact statement alongside these regulations, but noble Lords should be in no doubt that there is a big difference between an impact assessment and an impact statement. The impact statement amounted to nine pages and was in a rather large font size. The impact assessment amounts to 69 pages in a normal font size. The arrival of this impact statement so late is all the more shocking because it has been rated red and not fit for purpose by the Regulatory Policy Committee, which carries out the independent reviews of impact statements required by the Small Business, Enterprise and Employment Act 2015. It is a very unusual for the RPC to rate statements not fit for purpose, so this is a serious issue.
While my instincts are against the compulsion these regulations introduce, I was prepared to be persuaded if a good case had been made. In the absence of the analysis and evaluation accompanying the regulations, the case was not made. The very late impact assessment, together with the RPC’s views, raise many questions that cannot simply be answered by a couple of sentences from my noble friend the Minister at the Dispatch Box or, indeed, by revised papers put on websites late in the day. It suits the Government to operate in this way. They have become accustomed to making sweeping changes to our lives without meaningful challenge from Parliament.
The 21st report of the Secondary Legislation Committee is excoriating in its criticism of the regulations and the quality of the supporting material accompanying them. The noble Baroness, Lady Thornton, had tabled a regret Motion that captured many of these criticisms, and I am sorry she has pulled it, doubtless for political reasons. I agreed with it and would have supported it had she chosen to divide the House. My amendment focuses on impact assessments because this strikes at the heart of effective policy-making and, importantly, effective parliamentary oversight. On effective policy-making, it is a clear requirement on the Government that the development of policy should be subject to rigorous analysis and evaluation of options, set out in a Green Book. There is little evidence that this has taken place.
Secondly, the Government’s better regulation framework builds on that foundation and requires impact assessments to be prepared at the consultation phase for policy development, as well as at the final policy implementation stage—the stage we are now at. Regulatory impact statements at the final stage have to be independently appraised by the Regulatory Policy Committee, but it is voluntary at the earlier consultation stage. It came as no surprise to find that when the DHSC issued its consultation on this policy in September, it did not include an impact assessment, let alone have it independently assessed.
All this raises serious questions about the quality of analysis underpinning the Government’s policy formulation, which has been a concern throughout the pandemic. Some on these Benches have regularly challenged the lack of impact assessments for the policies pursued under the Covid banner. Regulatory impact assessments are required in order to evaluate burdens on business, primarily, but the bigger issue is whether the Government have considered the broader costs and benefits of their Covid policies. We have been particularly concerned about the lack of analysis of the non-Covid health harms as well as the non-health harms—in particular, to education and to the economy. Certainly, there has been little government analysis of this in the public domain.
The Government’s line has always been that they are not required to produce regulatory impact assessments for policies expected to last less than one year—an excuse not available for these regulations. That is technically correct, but it entirely misses the point, which is that good policy formulation requires a comprehensive analysis of costs and benefits, however long the policy is expected to last, and that is what the Green Book requires.
Baroness Noakes (Con)
My Lords, I thank all noble Lords who supported the points I made about needing better information for parliamentary scrutiny of government policy. This was very ably led by my noble friend Lord Cormack who put it very well when he talked about treating Parliament with contempt. That was echoed by a number of noble Lords. It was very good to hear from the noble Lord, Lord Cunningham, from his perspective on the Secondary Legislation Scrutiny Committee, which has served this House very well, particularly in relation to this order.
I am sorry that the noble Lord, Lord Rooker, questioned my sincerity in bringing these points to the House. I am a mere Back-Bencher; I was trying to make the kind of points that Back-Benchers should be making about effective parliamentary scrutiny. I cannot be held accountable for what the Government do in bringing legislation in the future, so I would encourage him not to try to use my speech as a checklist against future primary legislation brought to your Lordships’ House. This will not be my fault.
I am grateful for what my noble friend the Minister said. He accepted my criticisms with good grace and did not seek to defend the indefensible. As to the future, I would have hoped to have something a little more encouraging than that he hoped they would do better in the future and that he would take the matters back to his department. I hope he will take the matters raised back to his department but with a stern resolve to get them dealt with better next time. With that, I beg leave to withdraw my amendment.
Health Protection (Coronavirus, Wearing of Face Coverings) (England) Regulations 2021
Baroness Noakes Excerpts(2 years, 5 months ago)
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Baroness Neville-Rolfe (Con)
My Lords, it is a pleasure and a surprise, as we are discussing an SI, to follow the noble Baronesses, Lady Thornton and Lady Brinton. Although I do not agree with much, I do agree that it is very helpful that we are discussing these SIs so quickly, so I thank my noble friend the Minister. I also agree that we must not put retail workers at risk, as we are in the process of discussing in our debates on the police Bill, and that air filtration systems can be valuable in many settings.
The background to this debate is that we have taken major steps to limit the impact of Covid-19, with 115 million vaccine doses now injected in arms across the country. The more vulnerable and elderly have received boosters now totalling over 18 million, and the race is on to double this quickly. This has been well done and we must all be grateful.
We now face the challenge of the omicron—I am told that is stressed like omega, if you studied Greek, which I did not—and I rise to offer modest support for, but also some concerns about, the new regulations on masks. In particular, I agree that it is right to limit their compulsory scope to transport, shops and services such as hairdressers and banks. I am less happy with the regulation on self-isolation, which is potentially much more onerous and lasts, as we have heard, not for three weeks but until 24 March. I have some questions for my noble friend the Minister.
First, how will all this end? What virulence criteria in relation to omicron will lead to the removal of the restrictions? Can this be done at speed like their imposition or, as we have seen before, will such regulations linger on?
Second—and I have a family interest here—can there be an opt-out from travel quarantine testing for those who have recently recovered from Covid and registered as such? This is very important for children at school, where the virus continues to spread fast. I know that the travel PCR requirements are not covered in these regulations, but I hope that the Minister will answer anyway and make sure that further regulations are clear. There is so much confusion.
I would like to record my belief that both sets of regulatory proposals have a serious defect: we do not have the benefit of an impact assessment or anything like it. It may be technically true that there is an exemption for rules lasting less than a year, but it is a highly unsatisfactory state of affairs. An assessment of the cost and economic impact of such measures is essential to good government and the future well-being of our country, and should inform all decisions such as these. Take the first instrument on masks; the analysis in Paragraph 12 of the Explanatory Memorandum is embarrassingly inadequate and does not even mention small business. What studies have the Government conducted into children wearing masks, the negative and the positive? What is the evidence that they will help with the infectious omicron variant?
Let us consider the second set of regulations. The new self-isolation controls will have a huge impact on work, schools, health, social care and other services, as case numbers rise and the “pingdemic” of last summer returns. They also deal a body blow to the already struggling transport industry, with billions wiped off its value since last week. Do the Government prepare proper assessments to inform their actions? I hope they do; they should summarise or publish them for debates such as these. Doing so would serve to limit overreaction. The last couple of days have been full of rumours of possible overreactions, such as masks being required in theatres and restaurants, and school plays and Christmas parties cancelled. Government spokesmen should be calming matters, not encouraging people to close things down.
We have been partly saved by vaccination, but we have encountered needless damage across the economy and society over the last two years, because of our lack of attention to economics. Saturday’s BBC coverage helped me to understand why. At his press conference, the Prime Minister was sensible and serious, but the lead commentary afterwards came from a member of one of the SAGE committees, Susan Michie. She is a professor of health psychology at UCL and a well-known communist, and she wanted to go much further. Why are there a number of psychologists on SAGE and not economists—although I think there is a leading statistician? Indeed, you might ask why communists are involved at all.
On my final point, perhaps my noble friend could say whether he and the Secretary of State, both of whom are more aware than their predecessors of the importance of growth and economics to the well-being of everyone in the country, might look at the composition of SAGE and add an economist or two, now it looks as though, sadly, Covid is continuing to be more extensive than we all hoped.
Baroness Noakes (Con)
My Lords, I first support what my noble friend Lady Neville-Rolfe said about impact assessments. In fact, I have tabled a Motion on a later coronavirus order regretting the lack of impact statements, which I look forward to debating with the Minister in due course.
I start by recording what Reuters reported today from a World Health Organization official. He said that, to date, most omicron cases have been “mild” and that there is no evidence yet of reduced vaccine effectiveness. On that basis, we may find that these orders have been overhasty and that we do not see an extension of them.
I will concentrate my remarks on the mask-wearing order, because I continue to believe that there is insufficient scientific evidence on which to base requirements for people to wear masks. Much attention was paid, a week or so ago, to a meta-analysis that was published in the British Medical Journal. Its headline was that masks showed a 53% cut in the transmission of infection. When one looks at the detail of that meta-analysis, the case falls apart. Of the large number of studies included, only six related to mask wearing, of which two had a critical and four had a moderate element of bias. Of those four, only one was a properly randomised trial and its results were inconclusive. There is no evidence that scientifically supports the wearing of masks.
I will not oppose this order and I hope it runs out in a few weeks’ time, but I hope that the Minister ensures that the right messaging is put out. I have heard that the noble Baronesses, Lady Thornton and Lady Brinton, want it extended, including to theatres. They may like to know that this is already happening. I reveal one of my hobbies by saying that, yesterday, I received emails from both the English National Opera and the Royal Opera House telling me that, as of yesterday, they were mandating masks. I have to put up with a mask for the sake of listening to Wagner, this weekend, but the messaging that this order relates only to shops, transport and the close personal services that were referred to earlier is not out there.
In addition, when I got back to my apartment block last night, the management company had splattered the place with “Masks now required”. I challenged that today and of course there is no legal basis for that prohibition, so I have asked it to remove or alter the messaging. Unless the Government give clear messages to the public at large that this is a very limited measure for very good reason, and there is no need for it to be extended further, it will carry on spreading like some kind of virus throughout all social activity. We must not let that happen.
Lord Robathan (Con)
My Lords, I would like to add to the words of my noble friends Lady Noakes and Lady Neville-Rolfe. I am afraid the Government have got themselves in a muddle over this. This is a “worrying new variant”, as the Minister rightly said, and I think he quotes from the WHO. But while sitting here, I got an alert from the news that said exactly as my noble friend Lady Noakes just said:
“Most Omicron cases are ‘mild’ and there's no evidence to suggest vaccines may be less effective against the variant, says WHO official”,
speaking on behalf of the organisation. He specifically said that people should
“apply an evidence-informed and risk-based approach”
to travel measures and that
“Blanket travel bans will not prevent the … spread”
of the new omicron Covid variant.
We should look at the evidence, not opinions. What is the number of deaths that this or Covid are causing? I am going to yet another memorial service tomorrow for a Member of this House who died of cancer, not Covid. I think I have been to six memorial services so far this year of people who have died from cancer—nobody from Covid. All Peers should ask themselves how many people they know who have died from Covid under the age of 85.
We need to show some understanding of risk and should not be scaring people. As my noble friend Lady Noakes said, we are just scaring people into running around like headless chickens, worried about what on earth this variant means. I regret to say that I think the Government are trying to look decisive after what has not been an extremely good month or so for them. They are responding to the accusations of the Opposition that they must be more decisive and take firm action. We are keeping people scared, not keeping them safe. We are damaging children’s education and hugely damaging the economy, and cancer waiting lists are stretching. I heard today that waiting lists for hospital treatment may extend to 12 million by the end of next year. This is shocking.
My noble friend Lady Noakes asked to see the proof about face coverings, because we do not actually know if they work. Of course surgical masks work, but these flimsy paper or cardboard things we are all wearing are not effective. Since, according to the noble Baroness, Lady Brinton, we have to wait for the scientific advice, let us listen to the advice that Jenny Harries gave us in March last year that, in fact, if you wear a face mask you are more likely to increase the severity of any Covid you have, because you would trap all the germs and keep them there. As late as August last year, she was saying that she did not think there was any point in us wearing face masks.
Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021
Baroness Noakes Excerpts(2 years, 9 months ago)
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Baroness Noakes (Con)
My Lords, whether or not noble Lords agree with the intent behind this statutory instrument, they ought to share my deep sense of outrage at how Parliament is being treated.
We have become inured to the cavalier way in which the Department of Health and Social Care uses secondary legislation to interfere with citizens’ lives but this instrument reaches a new low. For the first time since the Victorian era, vaccination will be mandated by law. I believe that it is wholly inappropriate to use unamendable secondary legislation to cross that line. It raises deep issues of civil liberties and human rights and should have been fully scrutinised in primary legislation. Furthermore, the department’s contempt for Parliament is demonstrated by the lack of accompanying operational detail or an impact assessment, as has been pointed out.
The department has doggedly resisted releasing full impact assessments on Covid instruments. Whenever possible, it has hidden behind the small print of Cabinet Office rules on impact assessments to claim that they are not required. The small print does not cover today’s statutory instrument so the department has instead resorted to—there is no easy way to say this—lying. The Explanatory Note and the Explanatory Memorandum state that a full impact assessment has been prepared and is available. The Minister in the other place admitted last week that it has not even been prepared. As we heard last night, a flimsy document called an impact statement appeared on the website, but this falls far short of an impact assessment, and an impact assessment published after Parliament has considered an instrument does nothing to contribute to parliamentary scrutiny.
The department has rightly drawn the condemnation of the Secondary Legislation Scrutiny Committee of your Lordships’ House, which recommended in its eighth report on the instrument that this consideration be delayed until both the detailed impact assessment and operational guidance were available. Yesterday’s 10th report emphasised the many questions left unanswered. The department has cocked a snook at Parliament by ramming this instrument through now.
Allowing proper parliamentary debate in September would do nothing to delay the implementation of the policy. It already has a 16-week implementation gap built into it. The consultation showed that more people opposed the policy than supported it. UNISON does not support it. The Government cannot claim that they are acting in uncontroversial territory. I suspect that the real truth is that this policy would never survive the scrutiny that a fully informed debate would bring. It is also far from clear that the policy solution is the right one. As the Minister pointed out, 96% of residents of older-age care homes and 92% in working-age care homes have had a first vaccination dose, with the figures for staff being 86% and 83%, which is well in excess of the SAGE guidelines of 90% for residents and 80% for staff, so in aggregate there is no problem.
The Minister has said that only 65% of older-age care homes were meeting that guideline, falling to 44% in London, although he gave no figures for the two-thirds of care homes in that sector that cater for working-age adults. These limited data do not provide support for the intrusive rules in these regulations; rather, they speak to the need for more targeted interventions on a local basis and with smaller care homes to level them up to the very great achievements that have been made so far at national level.
None of this is explored, because we have no impact assessment, in particular in relation to care home staffing. Last night’s impact statement came up with a central estimate of a one-off cost of £100 million in respect of the recruitment of 40,000 staff who would be lost because of the instrument, but I do not think that that estimate will stand up to much scrutiny.
If some staff decide not to be vaccinated—as is entirely their right to do—they will be forced out of employment in the sector, but the Government have no evidence presented that there are people willing and able to come into the sector to replace that large number of people going out of it. There is no excess capacity in the market for care home staff, as many care home operators will testify. The impact of the loss of care home capacity is simply not addressed in the impact statement, along with a host of other consequential issues.
While I agree with the amendment from the noble Baroness, Lady Wheeler, I shall not be voting for it this evening, because it is a mere gesture and it does not defend the role of Parliament; but neither shall I vote for the Government.
Covid-19: One Year Report
Baroness Noakes Excerpts(3 years, 1 month ago)
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Baroness Noakes (Con)
My Lords, I am sorry; I was carried away by the previous speaker.
Baroness Noakes (Con)
It is some time since I have spoken in a coronavirus debate in your Lordships’ House but my issues with the Government’s policies are fundamentally unchanged. The Government continue to make policy in a coronavirus vacuum as if the only thing that matters is the virus and its impact on the NHS. There are clear non-Covid health harms, which are almost too many to mention. The physical health harms include mistreatment, misdiagnosis and elevated non-Covid deaths. There is a huge backlog of NHS work. Mental health issues include 80% of teenagers suffering a mental health symptom, with a disproportionate impact on those from lower socioeconomic backgrounds. We will be living with—and dying from—the impact of these health harms for a generation.
Similarly, our economy will pay a heavy price for many years, with public sector net debt over 100% of GDP and the threat of higher taxes to pay for that. Unemployment data are being dampened down by the various financial support schemes, but we will inevitably see further business failures and job losses when that support ceases. It is already having a big impact on younger employees, and those entering the job market face an uncertain future.
In policy terms, getting the balance right is inevitably a highly complex judgment. However, it should not be the preserve of a few in Whitehall. The Government have not had a grown-up conversation with the country about trade-offs and priorities; nor have they put any meaningful data and analysis in the public domain. I have often wondered whether the Government have the analysis and have suppressed it or there is wilful blindness at work. We probably will not know until there is a full inquiry in due course.
The non-Covid health harms and excessive economic damage are bad enough but I have been shocked at the loss of civil liberties, coupled with heavy-handed and insensitive policing. The sad thing is that too many seem to enjoy these new powers over ordinary people. I never thought I would live in a country where a police officer intervenes because two old women are having a cup of socially distanced tea, or because sitting on a park bench to rest was not permitted. Although I completely understand the need to be able to place restrictions on those entering the UK in case they are carrying the virus—especially new variants of it—I completely reject the notion that the Government should stop its citizens leaving the UK and fine them if they try to do so. Whoever thought that up should be sacked. It is just not British. We have travelled too far into totalitarianism.
The noble Baronesses, Lady Brinton and Lady Thornton, have tabled Motions that compete to name the most politically motivated regrets. I will support neither of them. However, I agree on the 252 cases of wrongful prosecution. It is shameful that the Government are not removing Schedule 21 to the Coronavirus Act today; as we have already heard, it has led to a 100% unlawful prosecution rate. It must be a modern-day record for bad legislation.
I regret that the road-map regulations are based on dates, not data, and seem to be immovable by data. They ignore, or largely ignore, the impact of the vaccination programme on those who are the most vulnerable to Covid-19. We should have been completely unshackling the population by now. Instead, the token freedoms offered in April are an insult. I predict that they will be increasingly ignored; I shall not condemn people for doing so.
Today, the Government should not be renewing the temporary provisions of the Coronavirus Act, as the other place is being asked to do. It would not, as the Government have misleadingly suggested, strike down the coronavirus support schemes, because they do not rely on one of the temporary provisions, nor would it affect the main regulations before us today, which are made under public health legislation. It is time for the Government to get out of how we live our lives. We have to learn to live with the virus, which means that individuals have to be trusted to make their own risk assessments and take responsibility. That is the only route back to the country that I thought I lived in.
Health Protection (Coronavirus, Restrictions) (All Tiers) (England) Regulations 2020
Baroness Noakes Excerpts(3 years, 5 months ago)
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Baroness Noakes (Con)
My Lords, I am angry about the main instrument before us today. I am particularly angry—and hereby declare my personal interest—that the whole of my home county of Kent has been placed in tier 3.
Last Tuesday, the chairman of the Science and Technology Committee in the other place asked the Secretary of State for Health whether real patterns of community and movement, including the fact that in Kent movement is typically east-west and not north-south, would be reflected rigorously in decisions made on tiering. Three times in formal evidence he said, “Yes.” Two days later, the decision announced clearly did not reflect that. If that does not amount to misleading Parliament, I do not know what does.
The Government continue to take Parliament and the country for fools. Before the last lockdown, they used some graphs to scare us into submission. The basis of those graphs disintegrated once the underlying models and assumptions were forced into the public domain. It was so bad that the Office for Statistics Regulation issued a strongly worded rebuke. This time we have again been told that, unless the new tiered version of lockdown hell is voted through, NHS hospitals will be overwhelmed. This is clearly not a fact, as our hospitals are not currently overwhelmed. They are operating much as usual for this time of year, and the Nightingale capacity remains unused.
I was not surprised to hear the noble Lord, Lord Hunt of Kings Heath, telling a different story, but I just say to him that the NHS never says that it is not under pressure: it is almost a badge of honour to be under pressure at all times. Not only is it not a fact, it is not even a reasonable forecast, because when the R rate is already below 1 and cases are falling and not rising, nobody could forecast an overwhelming. The Chancellor of the Duchy of Lancaster tried an elaborate defence of that over the weekend, but it has already unravelled.
It looks quite likely that infections were already falling before the last lockdown, and they are certainly falling now. We were promised that if we complied with the current lockdown and got the R rate down below 1, things would be better from this week. That was a false prospectus. The vast majority of the population of the country from tomorrow will be in a worse position than at the end of October because of the indiscriminate use of tiers 2 and 3.
Many of us have complained, as my noble friend Lady Neville-Rolfe has elaborated, about the lack of a proper impact assessment for the various Covid measures. This impedes Parliament’s ability to decide whether the Government are making the right decisions. Late yesterday afternoon, the Government released a document which was supposed to provide this analysis. It is difficult to find the right words to describe that document.
Baroness Noakes (Con)
“Uninformed” and “superficial” are the most polite that I could find. The document does not even scratch the surface of what Parliament ought to be given. It ducks the question of whether alternative policies would have resulted in better or worse outcomes. It proceeds on the basis that the only alternative is one of no action, which is a deeply flawed counterfactual advocated by no one. There is nothing concrete on costs and benefits in terms of health, the economy or the wider societal impacts. The lack of economic analysis, apart from a bit of lift and shift from the OBR last week, is really frightening. We learned from the Times this morning that further analysis does exist in Whitehall on the impact on business sectors, but that has been suppressed.
The hospitality sector has been brutalised by the various lockdowns and restrictions since March. Those still standing wonder whether they can survive tier 2 or 3, which will wholly or partly kill the profitable Christmas trading period. This morning the Government have promised £1,000 for pubs forced to close—but it would be a Christmas miracle if that had more than a marginal impact.
Nobody is pretending that it is easy to decide on the trade-offs between Covid and non-Covid health outcomes, the economy and wider impacts. The Government have a difficult task. But they are letting everyone down by constantly framing the arguments in terms of modelled extremes, such as overwhelming the NHS or exaggerated numbers of Covid deaths. We need a grown-up conversation. Society may well be better served by outcomes which increase short-term Covid deaths but do less long-term harm to the economy and to non-Covid health outcomes.
I wanted to be able to support the Government, as I normally do with enthusiasm, but I cannot do so in this case and will support my noble friend Lady Neville-Rolfe if she chooses to divide the House.
Covid-19 Update
Baroness Noakes Excerpts(3 years, 5 months ago)
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Lord Bethell (Con)
I thank the noble Lord for his characteristically detailed and forensic question. The lateral flow test, as I am sure he knows, has the terrific advantage of giving very few false positives, but we do not pretend that it gives a clinical-level analysis of all the negatives. We therefore do not use it in a clinical setting as a symptomatic test; we use it as a screening test for asymptomatic cases. That is why it has been so valuable in a mass testing environment such as Liverpool. We can back up the tests of those who are positive with a double test, either with another lateral flow test or with a PCR test, to ensure that we do not create a problem with too many false positives. We are working on the protocols now to figure out exactly what kind of rate of second testing we need to get a fair analysis.
The noble Lord is entirely right that the vaccine will be a game-changer, but not everyone will take it immediately and we are not sure how long each vaccine will last for, so there will be a role for testing even after the vaccine has been deployed. In the meantime, testing is very much focused on social care, clinical workers, schools and universities. Those are the four areas where we are focused at the moment, but we hope it can be used further to enable the opening of the economy, as he alluded to.
Baroness Noakes (Con) [V]
My Lords, there have been estimates that hospital-acquired Covid infections are as high as one-quarter of all hospitalised Covid patients, which seems pretty shameful and is likely to be a major contributor to the Covid death statistics. What do the Government currently estimate the impact of hospital-acquired Covid infections to be, and what action are they taking to deal with it?
Lord Bethell (Con)
My noble friend is entirely right; in any epidemic, nosocomial infection is one of the greatest challenges faced. If you want to find a recent infection of Covid, the best place to find it is where there is someone already with the disease, because that is the way that epidemics work. Hospitals necessarily have a high concentration of those with the disease. It is true that during the early months of the epidemic, when there were challenges with PPE and when practices within hospitals were not as disciplined as we would have liked, nosocomial infection, as it often is in epidemics around the world and throughout history, was a big challenge in hospital care and social care. That has been extremely well documented. However, I pay tribute to colleagues in the NHS who have come a very long way in the administration of PPE, confinement practices and infection control. The nosocomial infection that we are seeing is at dramatically lower rates than it was in the past, and that is due to the hard work and science of those in the healthcare sector.
Health Protection (Coronavirus) (Restrictions) (England) (No. 4) Regulations 2020
Baroness Noakes Excerpts(3 years, 6 months ago)
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Baroness Noakes (Con)
My Lords, my amendment is about the evidence for the lockdown in the order before us. The Government have no easy task in finding the optimal policy responses to the virus. They deserve the best advice they can get, but I am not sure they are getting it.
I hope that at least some noble Lords have read the book published earlier this year by the noble Lord, Lord King of Lothbury, and John Kay, entitled Radical Uncertainty. It warns of excessive reliance on probabilistic reasoning and modelling. Its core insight is that we need to face not knowing the answers when confronted with massive uncertainty. Instead people should stand back and ask themselves, “What is going on here?”. If that had been the focus of policy discussions, I do not believe this destructive lockdown would have been the solution.
On Monday, my right honourable friend the Prime Minister said in the other place that the data now suggest that our health system will be overwhelmed. The so-called data on which he was relying were not facts but modelled numbers. Modelled outcomes are only as good as their base data and assumptions.
As we have heard, last weekend the Chief Scientific Adviser showed a slide that suggested a scenario of 4,000 deaths per day in December. According to that chart, there should have been 1,000 daily deaths last weekend. There were fewer than 300. Four thousand deaths per day is virtually impossible, even using SAGE’s inflated infection fatality rate of 0.7%, and implies that around 600,000 people will be infected every day next week. None of the data points that we have on infection levels come anywhere close to that.
The adviser then showed something called the SPIM—medium-term projections of hospital admissions, deaths and NHS bed usage. These indicated bed demand later this month apparently shooting way ahead of the March-April peak and ahead of the assumption that only about 20% of NHS beds can be used for coronavirus patients. However, the detailed modelling assumptions have not been made public. Instead, the small print says that this is a consensus forecast, based on several models, none of which assumptions has been made public. Does that sound like a good basis for a momentous decision to close the country down?
We learned yesterday from evidence given to the Science and Technology Committee in the other place that these models were based on earlier, not up-to-date, data. The assumptions took no account of the recently introduced tier system, despite those areas already showing reduced infection rates and hospital admissions. Leaked NHS data show that, despite a few local hotspots, intensive care bed capacity is around normal for this time of year.
Some have suggested that those scenarios and forecasts were deliberately calibrated to produce the maximum fear in the general public and thereby generate support for another national lockdown. The Daily Mail has also called out the way in which last Saturday’s presentation cherry-picked data and presented it in a way that would make even Liberal Democrats blush. Is this all a deliberate plot to provide cover for the curtailment of our liberties? I could not possibly comment. However, I know that the Government should be alert to dangers of groupthink and the self-reinforcing nature of scientific cliques. The history of science is littered with views, such as whether the earth is flat, that remained widely held beliefs long after clear evidence to the contrary emerged.
There is no independent challenge to the SAGE analysis. There ought to be a place for techniques such as red teaming that robustly challenge house views. There certainly are scientists out there, for example in the Oxford Centre for Evidence-Based Medicine, who could provide that challenge. Was anyone asking, “What is going on here?” I do not think so. Otherwise, they would have compared infection rates and R numbers in the models with the latest data points and would have noticed that the models use R numbers that are ahead of current numbers, even though the R numbers from the ONS data have been falling. As we heard, the Liverpool R number is already below 1. The Prime Minister said several times in the other place on Monday that an R number of 1 or less was the aim of the lockdown. As we have heard, the latest ZOE survey data show that infections are past their peak and the R rate is already at the magic number, 1.
If the Government had sought independent challenge, they might well have concluded that this heartless order was unnecessary and, as a minimum, dialled back their scary charts. The Prime Minister cares sincerely about civil liberties but I suspect that he has more of a way with words than numbers and is in thrall to a tightly knit group of scientists with a single world view. It is time for him to ask, “What is going on here?”, and take back control of the coronavirus agenda.
Baroness Noakes
At end insert “but that this House regrets that the modelling used to support the claims that (1) the National Health Service would be overwhelmed, and (2) daily deaths from COVID-19 would be 4,000 or more, has not been subjected to independent review and challenge.”
Health Protection (Coronavirus, Local COVID-19 Alert Level) (Very High) (England) Regulations 2020
Baroness Noakes Excerpts(3 years, 6 months ago)
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Baroness Noakes (Con)
My Lords, I congratulate my noble friend Lord Moylan on his maiden speech, and I particularly welcome a fellow Brexiteer to our ranks.
I have my name down to speak on all three sets of regulations this afternoon. I would have preferred to take all three together, as was done in the other place, so that we could make more considered interventions, but the horrible hybrid House rules prevent this.
I support the amendment put forward by my noble friend Lord Robathan. The Government have said that they base their decisions on scientific evidence, but it is not clear that they are doing this. The advice from SAGE on 21 September was a shopping list of immediate interventions that included a circuit-breaking lockdown and the immediate closure of all pubs, restaurants and hairdressers. The Government very wisely ignored that advice.
The most interesting thing in the record of the SAGE meeting was as follows:
“Overall, the evidence base on which to judge the effectiveness and harms associated with different interventions is weak”.
There we have it. There is no real evidence for the biggest infringements of civil liberties in peacetime, no real evidence for a harsh penalties and enforcement regime, no real evidence for the biggest act of self-inflicted economic harm, and no real evidence for the actions which have caused so much collateral damage for the mental and physical health of non-Covid patients. I shall be saying more about that in the next debate.
Health Protection (Coronavirus, Local COVID-19 Alert Level) (High) (England) Regulations 2020
Baroness Noakes Excerpts(3 years, 6 months ago)
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Baroness Noakes (Con)
My Lords, in the previous debate I supported my noble friend Lord Robathan’s amendment because of the lack of scientific underpinning for the Government’s Covid restrictions. I should like to say a little more about that in the context of the hospitality sector.
Many businesses have been hard hit by the lockdown but the hospitality sector has been particularly badly affected. In my village in Kent, we used to have four pub-restaurants and two cafés. Half have closed for good since March. Those of us who spend time in London are well aware of the number of venues that are boarded up.
At some stage, an inquiry will reveal whether the decision to lock the whole economy down was right and whether the harms it caused were justified by the gains in dealing with the virus, but I am not concerned with that today. What concerns me is that the hospitality industry remains a target for government interventions and that those interventions are evidence-free.
We know that the Government’s aim is to reduce the rate of transmission of the virus. Public Health England issues a weekly coronavirus report. In its latest update, to the end of September, contact tracing shows that households and household visitors are by a country mile the biggest source of exposure to the virus, as the Minister said. Leisure and community are the next largest source of exposure but the sector accounts for only around 5% or 6% of the total—a massive category that covers everything from restaurants to playgroups. The data in the report on where acute respiratory infection incidents take place shows that food outlets and restaurants represent only around 5% of the total and pubs do not show up at all. It is much more dangerous to go to work than to go out to socialise.
Yet, the Government have piled restrictions onto this sector. Social distancing means that it is hard to make money. There are fierce rules on record-keeping, which we should have considered today, but for some reason that debate was cancelled. More importantly, the 10 pm curfew was announced last month with no evidence to support it. It was not even supported by SAGE. The puritans are having a field day with prissy remarks about alcohol and social distancing not mixing, but whoever dreamed up the 10 pm rule clearly had no understanding of human behaviour. It simply created a perfect storm for social distancing, with huge numbers exiting pubs and restaurants at the same time.
The best that can be said for these regulations is that they are less punitive on the hospitality sector than those applied to “very high” alert areas—but that is not saying much.
Health Protection (Coronavirus, Collection of Contact Details etc and Related Requirements) Regulations 2020
Baroness Noakes Excerpts(3 years, 6 months ago)
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Baroness Noakes (Con)
My Lords, the regulations are one more proof point that the Department of Health and Social Care is suffering from Covid derangement syndrome. The syndrome features an obsession with just one thing: Covid-19. The department seems to have forgotten that it is not the Department of Covid, it is the Department of Health and Social Care. Since March this year, non-Covid patients have been largely ignored. There is a huge backlog of elective surgery and diagnostic tests. Cancer treatments were not started or were paused. My right honourable friend the Secretary of State for Health said this week that cancer patients may be guaranteed the treatment that they need only if Covid-19 stays under control—whatever that means.
There is a legitimate debate to be had about how the use of NHS resources should be prioritised. The costs and benefits of treating Covid-19 patients should be set alongside what is happening to other patients. The department has refused to analyse whether its Covid-dominated strategy is the best outcome in health terms, let alone in the broader economic context.
Another symptom is the inability to connect to reality. The Secretary of State for Health has said that the strategy is to suppress the virus until a vaccination arrives. But the Secretary of State should know that an effective vaccine may not in fact arrive, or may not arrive any time soon. Even if one does, by some miracle, get through all the testing and approval processes in the next few months, the chairman of the department’s own vaccination task force has said this week that less than half the population would be vaccinated.
Sufferers from Covid derangement syndrome seem convinced that all solutions must be authoritarian and backed by enforcement. Thanks to the Prime Minister, we got some freedoms back after lockdown, but for every freedom granted, the department plots some other restriction or tightening. That brings me to the regulations before us today.
Back in July, hospitality and other venues were allowed to have a crack at rebuilding their businesses which had been wrecked by the lockdown policies. They were asked to keep records of their customers and visitors. Consumer surveys—not business surveys—reported 67% compliance on being asked for contact details, which is pretty good, as some businesses would already have the contact details of their clients and customers on their databases. But that was not good enough for the department. It turned to evidence from contact tracing and focused not on the thousands of contacts which are household-related, accounting for 70% of contact tracing, but on the category of food outlets, where tiny numbers in double digits were identified. Yes, they were rising, but they were still small. The department got its blunderbuss out and fired off this order, piling more restrictions on all businesses which are desperately trying to get back on their feet while complying with all of the Covid-19 restrictions, such as social distancing and now a 10 pm curfew. Small and medium-sized businesses will rightly question why they should have to bear the burden of feeding a test and trace system that is still so dysfunctional.
I hope that a new vaccination will be developed soon, but this time to deal with Covid derangement syndrome. It should be compulsory for everybody in the Department of Health and Social Care to be vaccinated.