Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 4) Regulations 2020
Baroness Noakes Excerpts(4 years, 1 month ago)
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Baroness Noakes (Con)
My Lords, I endorse everything that my noble friend Lord Lamont said and I shall list as many of my concerns with the regulations as I can in the two minutes that we are allowed.
First, the rule of six is not based on science. Indeed, the Minister revealed its basis when he said on 14 September that the Government had relied on
“marketing advice from our communications department”.—[Official Report, 14/9/20; col. 1000.]
He also referred to focus groups. The Minister might think that that is science-based but most would disagree with him.
Secondly, Ministers would double down by encouraging snitching. That is not the kind of society I want to live in. Thirdly, the rule lacks logic. It is illegal for seven children to gather together to feed ducks, but it is perfectly okay for 30 adults to go out shooting them—the ducks, that is.
Fourthly, the order lacks precision. It makes mingling yet another way to break the law, but does not define it. On 14 September, the Minister said that it was
“a concept which, frankly, I do not think needs much description”.—[Official Report, 14/9/20; col. 999.]
Frankly, I think that that is an unacceptable way to legislate. Fifthly, as usual, there is no analysis of impact or alternatives and no attempt to explain the balance between the competing interests of our economic future, non-Covid mental and physical health matters and the narrow Covid impact.
I could go on, but sadly I have run out of time. I regret that my noble friend Lord Lamont is no longer pursuing his earlier fatal Motion. That would have had my vote.
The Deputy Speaker (Lord Haskel) (Lab)
The noble Baroness, Lady Uddin, has withdrawn, so I call the noble Lord, Lord Hutton of Furness.
Coronavirus Act 2020: Temporary Provisions
Baroness Noakes Excerpts(4 years, 1 month ago)
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Baroness Noakes (Con)
My Lords, we have heard two excellent maiden speeches so far, and I look forward to that of my noble friend Lady Morrissey. I particularly welcome my noble and learned friend Lord Clarke of Nottingham to your Lordships’ House. Some 20 years ago, my noble and learned friend sent me a very nice letter on my appointment to your Lordships’ House, but he said that, while an honourable exception could be made for me, he did not approve of an appointed House of Lords. So I was just a bit surprised to find that he had accepted his own appointment—but I am sure that the whole House will be very glad that my noble and learned friend has allowed himself an honourable exception. We will certainly benefit from his considerable wit and wisdom in the work of our House.
Turning to today’s debate, I barely know where to begin. The Coronavirus Act has allowed the Government to set us on a path to a totalitarian regime, with a constantly shifting and confusing patchwork of rules and guidance. Some, such as the rule of six, lack any scientific basis. They are backed up by fines and penalties, busybody marshals, and police diverted from their core tasks of tackling serious crime.
I particularly grieve for young people. Some are even imprisoned in solitary confinement in universities. Most are facing an uncertain future, with job losses falling heavily on the young. They are the group least likely to be affected by the virus, even if infected, yet they are the worst hit now and will be in the future, when they will have to pay for the accumulating public debt burden that is coming.
The needs of non-Covid patients in the NHS have been deprioritised. Waiting lists for both diagnostics and treatment are massive. Many have died or will die for lack of proper and timely treatment, but, unless they have also tested positive for Covid-19, their deaths will be an unremarked statistic. As other noble Lords have said, the mental health impacts of lockdown are likely to be huge but are barely discussed.
Our economy has suffered major damage. The virus did not crash our GDP; as my noble friend Lord Lamont pointed out, the lockdown policies did that, and they are continuing to have a negative effect. I admire the economic support orchestrated by my right honourable friend the Chancellor of the Exchequer, but I am far from convinced that we needed to hit the economy so hard in the first place.
Notions of personal responsibility and responsible citizenship have just disappeared. Instead, we have an increasingly bossy Government telling people what to do and what not to do. Group think has overtaken decision-making. There is an obsession with rising so-called case numbers, even though those cases are based on the problematic PCR tests, rather than medical diagnosis. False positives, which are extremely significant when a disease has very low prevalence, as Covid-19 has, are ignored. Hospital admissions and deaths remain subdued, yet apocalyptic modelling of them is driving policy.
Worst of all, as we have heard, Parliament has been sidelined. Multiple overlapping statutory instruments, under cover of the Coronavirus Act, have imposed increasingly draconian laws without a minute of parliamentary scrutiny. We have been given neither impact assessments nor analysis of alternatives. We need a proper debate on the balance being struck between the economic, societal and health impacts of the Government’s policies. It pains me that I shall be voting with my noble friend Lord Robathan if he decides to test the opinion of the House.
Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place) (England) Regulations 2020
Baroness Noakes Excerpts(4 years, 2 months ago)
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Baroness Noakes (Con)
My Lords, I support what the noble Baroness, Lady Thornton, said about delays in making regulations and parliamentary scrutiny. However, I cannot support her amendment, because it starts by welcoming the regulations, which I do not.
The Government have been all over the place on face coverings. Way back in March, the Government’s scientific advisers, led by the Chief Medical Officer, were clear that masks should not be worn. Not only was there no evidence of widespread benefit from wearing masks but the disbenefits were acknowledged—for example, that they trap the virus close to the face. As I understand it, the CMO and his team still believe that, at best, the evidence is ambiguous, although as the noble Earl, Lord Clancarty, showed us earlier, a variety of scientific views is available.
The World Health Organization—another body which has not covered itself in glory in the coronavirus outbreak—did not recommend the widespread use of masks until early June, and even then its advice was firm only in relation to the wearing of medical-grade masks by health professionals and those who are symptomatic. In relation to the general public, there was merely a recommendation for Governments to encourage the wearing of masks where community transmission could occur. The WHO said that there was still no firm evidence that the wearing of non-medical-grade face masks was effective and that social distancing and hand hygiene remained the key defences.
As is typical of this Government’s response to the virus, they were not content with guidance or encouragement, but went the full distance with legal requirements and fines. They started with public transport in June and went on from there in July and August with the orders before us. They have even increased the maximum fines.
The results are not logical. I cannot be fined for not keeping a two-metre distance in a supermarket queue or for not washing my hands, both of which are said to be effective actions in containing the spread of the virus, but I can be fined for not wearing a face covering, even though the evidence for efficacy is lacking. In addition, the regulations allow any old face covering, even though it could be dangerously soiled or inherently ineffective, such as a single-layer gauze face covering. This is policy-making at its worst.
Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 2) Regulations 2020
Baroness Noakes Excerpts(4 years, 2 months ago)
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Baroness Noakes (Con)
My Lords, I will make three points. First, neither the regulations before us nor the original provisions being amended have had an impact assessment or been underpinned by any similar analysis. We only ever get a single view—the Government’s—on the coronavirus impacts but never an analysis of the impacts on the NHS beyond the virus, or a considered view of the economic impact, and we certainly never get anything on the wider societal impacts of the Government’s actions. Crucially, we never get an analysis of alternatives. This is arrogant and undermines parliamentary accountability.
Secondly, while the original regulations might have justified the made-affirmative procedure on the grounds of a serious and imminent threat to public health, it is perfectly ludicrous to suggest that the regulations which relax the restrictions are urgent on health grounds. This is an abuse of the statutory power in order to bypass normal parliamentary processes.
Lastly, the rules restricting gatherings are profoundly illiberal. I welcome anything which will stop disruption such as that caused by Extinction Rebellion, but the rules introduced by the regulations have a chilling effect on the type of society I thought I lived in. We now have the crazy rule of six, which several noble Lords have already referred to. I am grateful to my noble friend Lord Lamont for tabling his motion to decline approval of that provision, and I look forward to a fuller debate on the extent to which society will allow the Government to interfere in the ordinary lives of citizens.
Covid-19 Update
Baroness Noakes Excerpts(4 years, 2 months ago)
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Lord Bethell (Con)
My Lords, we are hopeful that this season the number of flu injections will be a massive increase on previous seasons. We will, therefore, be putting huge responsibility on the shoulders of pharmacies and pharmacists to deliver them. I take on board completely the very good advice from my noble friend about the reputation of pharmacists compared to GPs, particularly in certain communities. I trust that the pharmacy profession will be doing an enormous amount to promote the flu injection itself, and to reassure its customers about the efficacy of its service. It is, however, an idea that I will take back to the department.
Baroness Noakes (Con) [V]
My Lords, when we had questions on the Statement last Thursday, I asked the Minister two questions that he did not answer. I have another opportunity now. Can the Minister say what evaluation the Government have made of the economic and societal impact of alternative responses to the spike that we are seeing in infection rates? Secondly, will they publish that evaluation?
Lord Bethell (Con)
My Lords, we have a very clear example of what will happen to the economy if the infection comes back. We will have to close down society as we did before, and the economy will suffer profoundly as a result.
Covid-19 Update
Baroness Noakes Excerpts(4 years, 2 months ago)
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Lord Bethell (Con)
The noble Baroness is right, but it is sometimes difficult to know whether you have the symptoms of Covid, the flu or something else. That is why it is a complicated matter. What we have seen through our engagement with the public in the last few weeks is people who show no symptoms of anything but who seek a test to provide themselves with reassurance. It is not a question of blame, but rather of clarification: we simply do not have the national resources to support that kind of activity.
Baroness Noakes (Con) [V]
My Lords, as a Conservative, it grieves me that the Government are pursuing policies, such as the rule of six and Covid-secure marshals, which belong in a police state. The Government have chosen a highly risk-averse approach, driven by guesstimates of hospitalisation and mortality rates, and doubtless derived from mutant algorithms. In the meantime, the economy is tanking. Can the Minister say what evaluation the Government have made of the economic and societal impacts of different responses to the small spike we have seen in infection rates? Will they publish that evaluation?
Lord Bethell (Con)
My Lords, it is not a mutant algorithm that is sending people to hospital in France, Spain, Belgium and other countries up and down Europe, and it is not a desire to introduce a police state that is seeing prevalence leading to hospitalisation and death in many countries in Europe. It is our fear that Britain is going that way that leads us, regretfully, to put these measures in place; it is not any desire to exert state influence.
Health Protection (Coronavirus, Restrictions) (England) (No. 3) Regulations 2020
Baroness Noakes Excerpts(4 years, 2 months ago)
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Baroness Noakes (Con) [V]
My Lords, these regulations are authoritarian and disproportionate. Under the banner of responding to Covid-19, the Government’s default position is to take sweeping powers to tell citizens what to do and to punish them if they do not do it. Recruiting local authorities to this cause does not make it any better. The only good thing about the regulations is that they have a sunset clause.
Covid-19 may well have been a major public health danger in the early part of this year, but it is not one now. Hospitalisation rates and deaths are extremely low, despite a rising number of recorded infections. However, we now have two massive problems that are exacerbated by the obsession with Covid-19.
First, the NHS has virtually abandoned most patients. Access to primary care, undetected and untreated cancer patients, massive hidden waiting lists for consultations and diagnostics, and a huge backlog of elective surgery are just some of the problems.
Secondly, we have a very great economic crisis. Lockdown has had a huge, negative impact on the economy. Government borrowing is at levels not previously seen in peacetime. Businesses are struggling to get back to anything like normal and many will not survive.
These regulations are nothing to be proud of. The Government need to prioritise the real problems facing our country.
Health: Neurological Services
Baroness Noakes Excerpts(7 years, 9 months ago)
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Baroness Noakes (Con)
My Lords, I congratulate the noble Baroness, Lady Gale, on securing this evening’s debate on neurological services. This is a large and important topic, and I shall focus my remarks on just one neurological condition: motor neurone disease. I thank the Motor Neurone Disease Association for providing me with a briefing for this evening.
The Minister is relatively new to his brief as a Health Minister, and he might not be aware of this devastating condition. In fact, the low prevalence of motor neurone disease, affecting around 5,000 adults in the whole of the UK at any one time, means that it is not well understood within the NHS. In turn, the services provided by the NHS for motor neurone disease sufferers are often inadequate.
While its prevalence is low, those who encounter the disease among family, friends or colleagues—as I did over 30 years ago—will never forget it. It is a horrible and rapidly progressive neurological disease that affects the brain and spinal cord. Muscles fail, leaving sufferers unable to walk, talk and eventually breathe. It can also affect thinking and behaviour. Most are fully aware that their bodies are failing and that they will die from the disease. There is no cure for MND: one-third of sufferers are dead within one year of diagnosis and half are dead within two years. This is why the availability of high-quality neurological services is vital.
It is clear that neurological services have been downgraded by NHS England at the national level. There is no longer a national director for neurological services, and this has led, as the Public Accounts Committee in another place predicted in 2015, to a loss of clinical leadership and accountability. With neurology not embedded in the leadership structures and accountability frameworks of the NHS in England, it is not surprising that there is disengagement at the local level within clinical commissioning groups. Without national leadership, clinical commissioning groups will not focus on services for lower-prevalence, complex diseases with the same urgency as those for services which have vocal national champions.
The result is clear. Fewer than one in six CCGs has assessed costs relating to the provision of neurological services, while only around one in five has assessed the number of people using those services and the prevalence locally of neurological conditions. Only one in three bothers to ask patients what they think about the services. The Minister should not be surprised that the Neurological Alliance found that nearly 60% of patients had experienced problems in accessing the services or treatments that they needed.
I do not generally get concerned about the so-called postcode lottery in the NHS. I believe that it is an inevitable part of a devolved NHS, with power in the hands of local clinicians and organisations, that there will not be a uniform service across the NHS. Local areas will set their own priorities. But I cannot begin to defend what is happening in neurological services. It is shocking. One-fifth of CCGs have no local consultant neurological services whatever and the majority do not provide more than 80% of appointments locally. I ask the Minister to contemplate what this means for a motor neurone disease sufferer seeking a diagnosis or specialist treatment against the background of a progressive and fatal disease.
The story does not end there. The most recent attempt to look again at what the NHS does, via sustainability and transformation plans, seems largely blind to neurology and had little input from specialists in this area. These plans will be driving service provision in the future, and unless NHS England wakes up to the lack of focus on neurological services, the future will be even more bleak for those with MND.
There are also problems with specialised commissioning, which impacts MND sufferers who at times need to rely on nationally commissioned services. The Health and Social Care Act 2012 brought in a definition of a specialised MND clinic, and the NHS is required to provide clinics throughout England to that standard. NHS England has failed to do this and many of the clinics would not exist without the Motor Neurone Disease Association, which has been forced to fund what the NHS should unambiguously have been funding.
Those suffering from motor neurone disease face many other problems within the NHS in England, in particular as continuing healthcare packages are often delayed. Delay is a common strategy in the NHS for keeping financial pressures at bay. I am well aware that the financial pressures facing the NHS are acute, but financial pressures must not excuse delaying CHC assessments for progressive diseases. The Continuing Healthcare Alliance found that only 14% of the CCGs which responded to its survey last year kept to the 28-day timeframe and that the longest delay was 255 days. People with motor neurone disease cannot wait that long.
Motor neurone disease may not affect many people—but when it strikes, the consequences are terrible. This is precisely when the NHS is most needed and neurology services are essential. I am clear from the briefing that I have received that the NHS is failing MND patients with these services. I hope my noble friend the Minister can tell the House this evening that the Government understand the problems, that they recognise that these are very real issues and that they will tell NHS England to sort neurological services out.
Health and Social Care Bill
Baroness Noakes Excerpts(12 years, 11 months ago)
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Baroness Finlay of Llandaff
My Lords, this has been an interesting short debate because the whole business of the cap has imposed wide variations on trusts. Where trusts cannot have any private activity, there has been an unintended consequence if some staff, particularly consultants, undertake private work. They have carried out that work offsite and not been available if there has been an emergency onsite, and travel times also have worked against patient care.
I can therefore completely understand why these amendments are before us and why the Government wish to act as has been outlined. Perhaps in his closing remarks the Minister can provide us with an assurance that any guidance—it is not necessary to include this in the Bill—will ensure that trusts do not inadvertently double-pay staff. The point of splitting private and NHS treatment was precisely to ensure that staff do not carry out private work in their NHS time and receive double pay, and that the accounts are clear. There are advantages to staff doing private work on NHS premises and to a flexible interpretation whereby, when there is a medical emergency, staff can run down the corridor. Private patients completely understand when someone has to be called away because there is a life-threatening emergency. They are happy to wait until the staff return. That system operates at the hospital in which I work. Although I do not do any private work, some of the oncologists have clinics in the evenings.
There is a need for clarity and I hope that some reassurance will be given that in removing the cap there will be good husbandry of public money.
Baroness Noakes
More than 20 years ago, I was director of finance of the NHS, on secondment from my firm, as some of my noble friends will recall. One of my areas of responsibility was something we called the income-generation initiative. It was sponsored wholly by the Department of Health which was to encourage NHS hospitals to maximise their assets and to generate income for the purposes of the NHS. The origins of the private patient income lie with the Department of Health wanting to ensure that the NHS maximised the returns from its assets and took opportunities to generate income solely for the NHS. Those of us who were involved in developing that initiative would regard all these discussions as a mark of success of the initiative, as it has generated so much income that other questions are now asked.
I never supported any kind of cap, because the circumstances of individual foundation trusts vary so significantly that any cap would never be effective. The way in which income can be structured to flow into a trust can markedly change the impact of the cap. By structuring your relationships with partnership organisations, for example, you can massively change whether a cap bites or does not.
I support the amendments in the name of my noble friend, because perhaps it now needs stating that you should concentrate largely on the NHS—although, as I said, those of us who started this find it a rather surprising conclusion—and I support transparency. If I ever had one concern about the income-generation initiative, it was that costing was never particularly well understood in the NHS, and, therefore, neither was the net result from the activity nor how that activity was used. It is important to have transparency. I hope that other noble Lords will not encourage the Government to keep any limits which constrain the NHS from maximising its assets for the purposes of the NHS.
Lord Warner
My Lords, I was not going to speak in the debate and I certainly do not want to speak on the subject of the cap, in case I get into too much trouble from my Front Bench. I would like to pick up the point made by the noble Baroness, Lady Noakes. We are moving into a world in which the NHS will have to look at how it uses its assets. As I have said in earlier discussions, the NHS footprint on its sites and its utilisation of buildings is relatively small given the size of the sites.
We are also moving in a direction where, across the House, we favour integration of health and social care. It would not be surprising if, in the next few years, on some sites of district general hospitals, there were nursing homes run by the private sector which had self-payers as well as state-funded payers. The way the Government are approaching this creates flexibility in how income might be generated. I hope we will not be so prescriptive in how we meet the legitimate concern that NHS trusts should concentrate on their core business, if I may put it that way, that we shoot ourselves in the foot again by having a cap that actually works against the best interests of the NHS.