Health and Care Bill

Baroness Penn Excerpts

Committee stage
Wednesday 9th February 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I thank the noble Baroness, Lady Walmsley, for presenting this amendment. I too take the view that ambulance services play a significant role in our National Health Service, particularly in the redesign of care pathways to reduce pressure on hospitals and provide better care to patients. If that can be at the right time, in the right place, that produces the greatest benefits.

The amendment in the name of the noble Baroness, Lady Walmsley, sets out the case for a more rigorous and accessible reporting system for ambulance services on response times. As your Lordships’ House debated just last week, and as the Minister acknowledged, at present performance is below what is acceptable. I am pleased that under the amendment, the method for introducing regulations would be subject to proper review by Parliament. On the specifics, it is welcome that there is a requirement of the use of data already captured by ambulance control and dispatch systems, specifically requiring analysis by integrated care system area and by postcode. This would provide a valuable source of further evidence about inequalities in care provisions which would mean that it was possible to identify and address them.

On the proposed requirement for the recording of explanations for all incidents where the relevant response time target was missed, it would of course be important to ensure that any extra recording of data in an emergency care environment did not add to existing pressures. I look forward to the Minister’s response.

[Baroness Penn (Con)]

I thank the noble Baroness, Lady Walmsley, for bringing this short but important debate before the Committee.

The Government fully recognise the importance of ambulance response times and of patients receiving the help they need when they need it. Like other emergency care services in the NHS during the pandemic, ambulance trusts have come under significant pressure, answering almost a million 999 calls in December alone —an increase of 22% on the year before. That is why we have put significant support in place to help ambulance trusts at this time. I will not go into the detail, which we covered in the debate last week. Instead, I will respond to the specifics of the amendment.

It is the Government’s view that it is right that reporting happens at the level of ambulance trust region. Trusts are commissioned to meet response time targets at a regional level, not at a more granular part of their operating area such as postcode or integrated care board area. It is inevitable that there will be variations in response times within regional footprints from month to month. However, the existing ambulance response time standards already include a mechanism to performance-manage significant variation or long waits for ambulances. All ambulance response time categories include a 90th centile response time standard to measure the “tail” of ambulance response times. This means that trusts are measured on the response to every call they receive and cannot favour some parts of their region over others to game response time targets. Reporting response times down to a postcode level would require a massive expansion to existing reporting that would not be reasonably deliverable.

I also reassure noble Lords that the service transparently provides clinical outcomes data. These indicators were introduced in 2011 and provide detailed information on clinical outcomes for cardiac arrest, heart attack, sepsis and stroke patients. While the Government acknowledge the challenges to ambulance response times and are working hard to address them, for the reasons I set out, I hope the noble Baroness feels able to withdraw her amendment.

[Baroness Walmsley (LD)]

I thank the noble Baroness, Lady Merron, and the Minister for their responses to this proposition. I still think that somewhat more granular collection of data would be really helpful, because a region is a very big area and there are all kinds of factors that affect how quickly ambulances get to people who need them. It is particularly important in the case of category 1 incidents, where life is at stake and interventions can have the most amazing results, if only they get to the patient within 40 minutes, say, in the case of stroke.

So, it is vital that we get that granular information. I accept what the Minister said about the additional money that has been provided, but as I and my noble friends have said, the problems are both sides of the ambulance: downstream and upstream. It is a systemic problem, and it needs to be looked at as a whole. Having said all that, I beg leave to withdraw the amendment.

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[Baroness Jones of Whitchurch (Lab)]

My Lords, I thank the noble Baroness, Lady Hollins, for this amendment. Like others, I pay tribute to her tremendous work on behalf of people with learning difficulties and autism, which we all acknowledge and respect.

The amendment would reinforce and hasten the implementation of and the legislative basis for the Government’s commitment to developing a mandatory training and professional development system for health and social care staff. It would also establish a statutory code of practice, to be updated every three years, setting out guidance on the content, accreditation, delivery, monitoring and evaluation of the training.

The NHS England pilots for the modules to support the development of the training are currently under way, as the noble Baroness said. They involve key stakeholders, including Mencap and the National Autistic Society. It would be helpful if the Minister could provide the Committee with an update on the progress and timescale for completing and assessing the pilots and for moving forward and implementing the new training system.

The amendment is comprehensive in terms of both amending the 2014 regulations under the Health and Social Care Act 2008 and setting out issues that the code must address, including the relevant core education and training frameworks and strategies applying to learning disabilities and autistic people. It also contains the definitions of autism and learning disability on which the code should be based.

In this debate, we are all sadly reminded of the tragic death of Oliver McGowan, who died after those treating him medicated his autism incorrectly. His mother’s petition and determined campaign for mandatory training is thankfully coming to fruition, so that we can ensure that all staff receive proper training and can develop the skills and experience needed to provide the safest and most effective care and support for people with learning difficulties and autism. Including the mandatory training requirement on the face of the Bill would be a major step forward and I look forward to the Minister’s response.

[Baroness Penn (Con)]

My Lords, I too am grateful to the noble Baroness, Lady Hollins, for bringing the important matter of staff training on learning disability and autism for the health and social care workforce before the Committee today. Evidence tells us that there is a pressing need to improve understanding and awareness of learning disability and autism among health and social care staff and that the staff themselves want this training. Introducing mandatory training is an important way in which we can address persistent disparities in health and care outcomes for people with a learning ability and autistic people. As we set out in the Right to Be Heard publication of November 2019, the Government have committed to requiring all NHS and social care providers who carry out regulated activities to ensure that their staff have achieved the learning outcomes relevant to their role.

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[Baroness Merron (Lab)]

My Lords, this has been a very detailed debate and has explored what is at the heart of the subject before us. It has focused very much on what it is to have a safe space—something to which I will return briefly. I want to thank my noble friend Lord Hunt for leading this group of amendments and I will not repeat the points he made so ably in setting them out. As the noble Baroness, Lady Walmsley, said, I hope the Minister will take these amendments in the spirit they are intended. Clearly, they have been very carefully crafted and debated in order to improve this section of the Bill, and I believe that they are very worthy of merit.

We on these Benches also support the development of a culture where staff feel able to speak up about mistakes without a presumption of blame. Since its creation, the work of the HSIB has placed an important focus on learning and improvement when things have gone wrong. However, there must be a balance with the need for appropriate accountability and redress, for the public to be protected from unsafe practices and practitioners, and for public confidence in the system to be maintained.

This debate has been rightly supportive of the HSSIB, its mission and the concept of safe spaces—on that I think there is agreement. There is also agreement that it must be independent to be effective and trusted. However, following this debate, it seems that there is much work to be done by the Government on reviewing where, and to whom, disclosure of information can be made. Although the debate has expressed agreement that it is not appropriate for coroners, with their adversarial role, to have such access—and I share this view—there is a finely balanced debate about the issue of the ombudsman. As the noble Lord, Lord Kakkar, said, this is complex—which I think is something of an understatement. The debate reflects the reality of the world in which the HSSIB seeks to improve the delivery of service.

The noble Baroness, Lady Neuberger, and the noble and learned Lord, Lord Etherton, have put forward their view that the ombudsman needs to be able to investigate robustly. I am sure there is agreement on that. I am sure the difficulty that the Minister will want to unpick as she takes away the views of your Lordships’ Committee today is how it will be possible to allow the ombudsman to do its job and yet retain safe spaces. As the noble Lord, Lord Patel, said, it is so important to give confidence to professionals that they can contribute to the investigations into systems failure.

I say to the Minister that I hope there will be a close examination of all the points put forward in today’s debate. I feel that by further investigation into and thought about the points that noble Lords have made, this part of the Bill can certainly be strengthened.

[Baroness Penn (Con)]

My Lords, I thank all noble Lords for this debate and reassure them not only that I have listened carefully to it but that the Government will of course again look carefully at the arguments made. As the Committee has heard, HSSIB is no ordinary investigatory body. It will look at systemic risks and focus on learning lessons. It is not about blame; it is about improving patient safety incidents across the system and making a real difference to patient safety.

The Government agree that the integrity of the safe space is paramount. Safe space conditions will encourage patients, families, NHS staff and other investigation participants to speak freely and candidly. Without guarantees that this information will not be shared, except in very limited circumstances, we risk eroding the confidence of all those participating in an investigation, potentially leading to information being withheld and reducing the effectiveness of the investigation.

I turn to Amendments 311, 311A and 312A. We have sought to strike a fine balance between protecting safe space and acknowledging the need for very limited exceptions. We have allowed senior coroners to have access to information from the HSSIB, but only when it is appropriate and necessary for them to fulfil their judicial functions, and not to disclose onwards without further protections in place. Where the HSSIB has information about a death which the coroner is investigating, we need to ensure that the coroner’s judicial role is not undermined and that they have accurate and clear information. It does not mean that the coroner will have complete access to safe space information—far from it—nor that they will be able to automatically share this information. We have drafted provisions so that this does not happen. It is an intentionally limited and contained exemption.

Regarding Amendment 311, the Bill’s provisions are likely to have a very limited impact on the Parliamentary and Health Service Ombudsman’s ability to fulfil its important independent role of investigating complaints, given that it will still be able to use its existing powers to obtain material directly from the same primary sources. It will often not be investigating the same incidents as the HSSIB, as we have heard in Committee. If the PHSO felt it needed to access protected material held by the HSSIB, it could apply to the High Court. We do not envisage this being a common occurrence, as the HSSIB’s purpose will be very different from that of the PHSO. However, it means that the PHSO does have a way to gain access to protected information in certain circumstances.

We are committed to monitoring the impact that the safe space provisions may have on the PHSO’s ability to carry out its functions. We shall report to the House of Commons Public Administration and Constitutional Affairs Committee on this issue within 12 months of the HSSIB being fully operational, which we expect to be 12 months after the Bill gains Royal Assent.

A number of amendments relate to the role of the Secretary of State in relation to the HSSIB. We believe it is appropriate that the Secretary of State can direct the HSSIB to investigate particular qualifying incidents. This is an important tool available to the Secretary of State, which enables him and the HSSIB to respond to emerging or ongoing patient safety issues, which may arise at any time. It would therefore not be appropriate or prudent to limit the Secretary of State’s ability to direct the HSSIB to the first 18 months of its operation.

More importantly, the Secretary of State would not be able to direct the HSSIB on how to conduct a particular investigation. Clause 115 rightly allows the Secretary of State to intervene if

“the HSSIB is failing or has failed to exercise any of its functions, and … the failure is significant.”

The Secretary of State is accountable to Parliament for the HSSIB’s performance, and it is in the public’s best interests that the HSSIB functions effectively.

I turn to Amendments 310A and 310B. Given the broad scope of the HSSIB’s investigation function, some flexibility is needed so that the Secretary of State can set out additional circumstances when the prohibition on disclosure—safe space—does not apply. It is vital that the HSSIB can adapt as clinical and record-keeping practices change on the front line and practice evolves. This power is about future-proofing and continuous improvement, not eroding safe space.

On Amendments 308A and 309, I understand the importance of the HSSIB having predictable budgets for planning, but requiring a three-year budget would cut across the established processes of spending reviews and put it out of step with the confirmation and allocation of budgets across government and other arm’s- length bodies.

Turning to Amendment 310, I reassure noble Lords that the HSSIB’s reports will be published. Organisations will generally be required to respond to the HSSIB’s recommendations and it may publish these responses. In some cases—for example, an investigation into a private provider—it would not be appropriate for the Secretary of State to publish an additional report.

I turn to Amendment 308. In line with the Cabinet Office’s Governance Code on Public Appointments, the chair of the HSSIB will undergo pre-appointment scrutiny by the Health and Social Care Committee. However, the appointment of the chief investigator, which is not a public appointment, will be undertaken directly by the non-executive members of the HSSIB, including the chair, with the consent of the Secretary of State. We believe that this strikes the right balance between scrutiny, accountability and operational independence, without compromising the effectiveness of the board.

Finally, I turn to Amendment 309A. Whistleblowing is a distinct legal concept, with an existing legislative framework to ensure that whistleblowers are protected. The purpose of the HSSIB’s investigations is to identify risks to the safety of patients and address them by facilitating the improvement of systems and practices in the provision of healthcare services in England. A disclosure to the HSSIB concerning patient safety is complementary to but distinct from whistleblowing, so it is right that it should sit outside that legal framework.

However, I reassure the noble Baroness, Lady Kramer, that information shared with the HSSIB to alert it to a patient safety issue will be protected by the safe space provisions if it fulfils the definition of protected material. If, as mentioned in the amendment, a concern is raised that conduct is illegal, we would expect it to be raised with an appropriate person. Similarly, concerns relating to unethical conduct would not be best dealt with solely by the HSSIB. This amendment would risk blurring the lines with other organisations which may be better placed to deal with such matters.

I suspect that I have not given noble Lords as much reassurance as they would like in order not to return to this issue, but I hope I have given them enough that they feel able withdraw or not move their amendments at this time.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to the Minister—she was succinct but we certainly got the drift of the Government’s arguments. We have had just over an hour’s debate. Ideally, we would have taken this as a separate Bill, as we did in 2019, because these are clearly very complex issues. The heart of it is the tension between the purity of the safe space concept and the statutory duties of a number of officeholders, including senior coroners and the ombudsman. We will not resolve that tonight. The pity of it is that we will move to Report and probably vote on this; I cannot help thinking that there is a need for a proper round-table discussion before that to see whether we can collectively tease out a way forward. Having said that, it has been an excellent debate and I beg leave to withdraw my amendment.

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[Lord Davies of Brixton (Lab)]

My Lords, I want to speak to this group of amendments—

[Baroness Penn (Con)]

My Lords, it might be appropriate for the mover of one of the amendments in the group to speak.

[Lord Clement-Jones (LD)]

I was not being discourteous, but I thank the Minister. We just go along the line of amendments.

It is a pleasure to follow the noble Lord, Lord Hunt, and my noble friend Lady Brinton. Of course, we all recognise the benefits of using health data which arises in the course of treating patients in the NHS for research that will lead to new and improved treatments for disease and for the purposes of public health and health service planning. It has been a great benefit in helping to improve the treatment of Covid during the pandemic.

However, the track record of the department and the NHS in protecting patient data has not been a glorious one. We have heard a few examples. Let us go back to December 2019 and the discovery by Privacy International that the Department of Health and Social Care had agreed to give free access to NHS England health data to Amazon, allowing it to develop advertising and sell new products, applications, cloud-based services and/or distributed software.

My noble friend Lady Brinton talked about the successful case brought by openDemocracy and Foxglove against the department over a Covid-19 datastore deal with big data firm Palantir Technologies for failing to consider the impact of the deal on patients and the public by a consultation and performing a fresh data protection impact assessment on a new deal.

Then, of course, we had the situation last year, mentioned by the noble Lord, Lord Hunt, which has been described as

“the biggest data grab in the history of the health service”

of GP patient data. I pay tribute to the campaigners, including a group of Tower Hamlets GPs who refused to hand over patient data. Ministers first announced that implementation would be delayed until 1 September, and then in a letter to GPs in July last year put the whole scheme on hold, including data collection.

After this bungled approach—the noble Lord, Lord Hunt, used the word “debacle”, which is perhaps more apposite—more than 1 million people have now opted out of NHS data sharing. There is a deep worry here that the Government have learned nothing from the fate of the care.data project. The Government have now had to revise their approach, devise a simpler opt-out system and commit to the publication of a data impact assessment before data collection starts again. They have had to commit that access to GP data will be only via a trusted research environment and to a properly thought-through engagement and communications strategy.

Wade-Gery does acknowledge some of these concerns but if we are going to retain and build trust in the use of health data, we really need a clear governance framework. The Government must gain public trust through honesty, transparency and rigorous safeguards, and the individual must have the right to choose whether or not to share their data and understand how it will be used. I hope that NHSE—and, indeed, NHSD—will take on board the ICO’s recommendations in its audit report of NHS Test and Trace regarding governance and accountability and processor and third-party supplier relationship management, which looks at the policies and procedures that were introduced to keep data secure. There are some valuable lessons to be learned there.

As the noble Lord, Lord Hunt, has described, all health data must be held anonymously and accessed through an accredited data-access environment, designed to cover not only the promised trusted research environment but where data is used for planning purposes.

As to the detail of the amendments in this group, the noble Lord, Lord Hunt, has described them and the patient-centred intent behind them admirably. I will simply lay out the rationale for Amendment 305, tabled by me and supported, I am glad to say, by the noble Lord, Lord Hunt.

The data held by the NHS must be considered as a unique source of value held for national benefit. My noble friend Lady Brinton reinforced that. As it is, NHSE has refused to publish the list of projects and organisations to which it releases data. Retaining control over our publicly generated data, particularly health data, for planning, research and innovation is vital if the UK is to maintain its position as a leading life science economy and innovator.

Having read speeches by Ministers trumpeting the UK’s

“new, bold approach to international data transfers”,

debated the UK approach to data sharing, particularly in the context of the passage of the Medicines and Medical Devices Bill and the Trade Bill, and seen the wording of new international trade agreements, such as that with Japan, I am not at all confident about the Government’s approach to this. Emphasis in coverage of the UK-Japan agreement was placed upon championing

“the free flow of data”.

Health data in particular amounts to a significant national asset or resource with the potential to function as a dynamo in relation to research, innovation and the continued growth of the life sciences, health and care sectors.

It seems that the Government recognise this, but by the same token, we need a guarantee that our health data will be used in an ethical manner, assigned its true value and used for the benefit of UK healthcare. Any proceeds from data collaborations that the Government agree to, integral to any “replacement” or “new” trade deals, should be ring-fenced for investment in the health and care system with a sovereign health fund. It should have governance mechanisms, such as those set out by the Ada Lovelace Institute in Exploring Legal Mechanisms for Data Stewardship last year. Those are the right foundations for health data governance and that is why I have tabled Amendment 305A.

I am not greatly reassured by the recent announcement by the DCMS of the creation of the International Data Transfer Expert Council; it looks rather as though data protection will be low on its list of priorities.

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Moved by

[Baroness Penn]

231H: After Clause 133, insert the following new Clause—
“CHAPTER 2HYMENOPLASTY OFFENCESHymenoplasty offences: England and WalesOffence of carrying out hymenoplasty: England and Wales
(1) It is an offence under the law of England and Wales for a person to carry out hymenoplasty.(2) “Hymenoplasty” means the reconstruction of the hymen (with or without consent).(3) An offence is committed under subsection (1) only if the person—(a) is in England and Wales, or(b) is outside the United Kingdom, and is a United Kingdom national or habitually resident in England and Wales.(4) “United Kingdom national” means an individual who is—(a) a British citizen, a British overseas territories citizen, a British National (Overseas) or a British Overseas citizen,(b) a person who under the British Nationality Act 1981 is a British subject, or(c) a British protected person within the meaning of that Act.”Member’s explanatory statement
This new Clause creates an offence under the law of England and Wales of carrying out hymenoplasty.

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[Baroness Penn]

My Lords, it is a pleasure to hopefully conclude this Committee stage of the Bill with some government amendments, which I hope will receive a welcome from the Committee. When we announced our intention to become one of the first countries in the world to fully ban virginity testing, in the Tackling Violence Against Women and Girls strategy, we also stated that we would establish an independent expert panel to review the ethical, legal and clinical aspects of hymenoplasty, a cosmetic procedure to reconstruct a hymen. This announcement followed concerns, highlighted in an internal review into virginity testing and hymenoplasty, that demand for hymenoplasty is driven by a repressive approach to female sexuality and is closely linked to virginity testing—an abhorrent practice that the Government brought forward an amendment to ban in the House of Commons.

However, as hymenoplasty is a cosmetic procedure, we recognised that a ban on it would mark a step change that could be counter to existing regulation on cosmetic procedures. Further concerns were raised that a ban would take away a woman’s right to choose what happens to her body. The panel’s task was to carefully consider these incredibly difficult and competing issues at length. The panel has now delivered its final report to the Government, which includes a robust set of recommendations. I take this opportunity to thank the co-chairs and all the panel members for the time and commitment they have dedicated, on a voluntary basis, to this incredibly important issue.

As we announced in Our Vision for the Women’s Health Strategy for England, the Government agree with the panel’s core recommendation that hymenoplasty should be banned. It is inextricably linked to virginity testing, and failure to prohibit hymenoplasty would not only undermine the Government’s commitment to address the violence against women and girls by criminalising virginity testing but also leave women and girls at risk of further harm and continue to perpetrate the harmful myths and attitudes towards virginity.

The package of amendments brought before the House today delivers on this promise. It would create three offences: carrying out hymenoplasty, offering hymenoplasty, and aiding or abetting another person to carry out hymenoplasty in the UK or on UK nationals overseas. Each of these offences carries a maximum penalty of five years’ imprisonment and/or an unlimited fine. This sentencing reflects the long-term physical and psychological damage that this repressive practice can cause. These offences, alongside the proposed virginity testing offences, begin to tackle the harmful misconceptions that surround a woman’s sexuality.

In response to concerns that vulnerable women and girls will be taken abroad and subjected to hymenoplasty once the offence is banned in the UK, these offences also carry extraterritorial jurisdiction. These proposals have been discussed by Health Ministers across the UK, and my noble friend is working with them to ensure the whole of the UK, together, tackles this harmful practice.

These amendments are an important milestone in this Government’s ongoing mission to safeguard women and girls but our work will not stop here. The Government recognise that banning virginity testing and hymenoplasty alone will not tackle the harmful misconceptions and misbeliefs surrounding virginity. That is why we will also put in place a programme of education in community, education and clinical settings.

Finally, I give thanks to my noble friend Lady Sugg for bringing the practice of hymenoplasty to the attention of this House, and for the wider work she is doing on this issue to improve the lives of women and girls. I hope the House will pass the Government’s amendments today and allow our important work on safeguarding and improving the lives of women and girls across the UK to continue. I beg to move.

[The Principal Deputy Chairman of Committees (The Earl of Kinnoull) (CB)]

My Lords, the noble Baroness, Lady Brinton, is participating remotely and I call her to speak.

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[Baroness Merron (Lab)]

My Lords, I am very glad that the Government have heeded the calls of victims and experts alike to make hymenoplasty a criminal offence, along with virginity testing. As we have heard repeatedly both this evening and in the course of campaigning for this, the two practices are inextricably linked. It is right that those who carry out or facilitate these practices should face justice and that no woman or girl should have to suffer these abusive, intrusive and medically unsound practices. This legislation will send the strongest of messages and I am very glad that education will underpin it.

Of course, the fight to end violence against women and girls is not over, but it has taken a step forward in this measure. I add my thanks to all those who have campaigned tirelessly on this, as outlined by the noble Baroness, Lady Sugg. I thank the noble Baroness, the noble Lord, Lord Patel, and others for all they have done in your Lordships’ House to bring this forward. This is a positive point on which to bring our deliberations in Committee to a close. I very much welcome this move.

[Baroness Penn (Con)]

My Lords, I thank noble Lords for the short but constructive debate on these amendments. I add my thanks to the noble Lord, Lord Patel, for his support on this issue.

My noble friend Lady Sugg asked about the other recommendations in the panel’s report. Of course, the amendments brought forward today satisfy many of the recommendations made in the final report, including: prohibiting the advertising of hymenoplasty; the inclusion of extraterritorial jurisdiction; ensuring that women will not be criminalised for undergoing hymenoplasty; and that there should be no defence or exemption for a healthcare professional or anyone to carry out hymenoplasty. The Government are carefully considering the panel’s remaining recommendations and will provide an update on this in due course.

There were also a number of questions about implementation. Guidance will be produced alongside these offences coming into force. It will make clear that hymenoplasty is a form of violence against women and girls and lay the framework for how it can be prevented and, when it has taken place, reported. While the details of the guidance are being carefully considered, I can say that it will focus on how the Government, local authorities, social services, the police, education providers and third-sector organisations and community groups can work together to effectively safeguard women and girls.

A number of other specific points were raised, such as whether the FCDO can learn from legislation relating to forced marriage and measures to spot girls who are at risk, the religious element which may feature within this, and UK-registered practitioners conducting these practices abroad. I suggest I write to noble Lords with further detail in response to those questions.

Amendment 231H agreed.

Moved by

[Baroness Penn]

231J: After Clause 133, insert the following new Clause—
“Offence of offering to carry out hymenoplasty: England and Wales
(1) It is an offence under the law of England and Wales—(a) for a person in England and Wales to offer to carry out hymenoplasty in the United Kingdom or hymenoplasty that has a sufficient jurisdictional connection, or(b) for a person anywhere to offer to carry out hymenoplasty if the person is a United Kingdom national or habitually resident in England and Wales. (2) Hymenoplasty has a sufficient jurisdictional connection for the purposes of subsection (1)(a) if it is carried out in relation to a person who is—(a) a United Kingdom national, or(b) habitually resident in the United Kingdom.(3) In this section—“United Kingdom national” has the meaning given by section (Offence of carrying out hymenoplasty: England and Wales)(4);“hymenoplasty” has the meaning given by section (Offence of carrying out hymenoplasty: England and Wales)(2).”Member’s explanatory statement
This new Clause creates an offence under the law of England and Wales of offering to carry out hymenoplasty.

Health and Care Bill

Baroness Penn Excerpts

Lords Hansard - Part 1 & Committee stage
Wednesday 9th February 2022 Lords Chamber

Since my father’s time, much has changed in general practice. There are no night visits, no weekends, no accidents and no births. The preference is for living away from the practice area. A GP is available 40 hours a week, with the majority opting for part-time work. For the other 128 hours? Well, ring a number or go to A&E for excellent medical care. When the Royal College of GPs says that the prime duty of a doctor is triage, why bother to go to the GP when you are ill? Cut the triage. Go direct to the hospital where diagnosis and a prescription will be made. Once that has happened, follow-up care can be done by a nurse prescribing a regime. But we do not want that. We want to learn from the best of general practice, general practice prepared to give a full service with total commitment to its patients and a valued relationship. The good news is that there are many like that across the country. There are remarkable GP practices in tune with the communities they serve—inner-city, suburban, coastal, deeply rural areas that are isolated but resilient, isolated but vulnerable—

[Baroness Penn (Con)]

My Lords—

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As was mentioned, a key part of the Secretary of State’s recent big idea on future reorganisation was a plan to end GPs’ private practitioner status and bring all GPs under NHS control, even as we speak on this Bill and as we read recently in the media. How would the integrated care systems we are focusing on in this Bill fit into this further NHS reorganisation?

[Baroness Penn (Con)]

My Lords, this has been a long debate but it has touched on a number of different and important subjects. I join noble Lords in paying tribute to the work of the noble Baroness, Lady Greengross, and her work.

I turn first to Amendments 290 and 291. I reassure noble Lords that the Government are absolutely committed to the rollout of social prescribing across the NHS. We exceeded the targets in our manifesto and the NHS Long Term Plan of 1,000 new link workers by 2020-21 and are aiming for at least 900,000 people to be referred to social prescribing by 2023-24.

NHS England, the National Academy for Social Prescribing and Music for Dementia have produced guidance for social prescribing link workers to expand music prescriptions for those with dementia. The department has also published two resource guides for social workers on embedding music in personalised social care plans for people living with dementia and their carers.

While the Government are committed to promoting the benefits of social prescribing of music and arts for people living with dementia, it would be inappropriate to focus in the Bill on one form of therapy. Instead, we rightly provide scope in the Bill for the NHS to undertake a range of social prescribing.

Turning to Amendment 291 and the need for a dementia strategy, I reassure the noble Baroness and others that the Government are committed to publishing a new strategy this year. As part of this, we will be looking at arts and music-based interventions. More broadly, the strategy will focus on the specific health and care needs of people living with dementia and their carers, including looking at dementia diagnosis, risk reduction and prevention, and—importantly, as noble Lords have mentioned—research. Our priority is for the strategy to be credible and shaped by a range of experts, including people living with dementia and their carers. At the end of last year, we established a stakeholder-led task and finish group to help develop the strategy and deliver it in a timely way.

Moving on to Amendment 297D, we fully agree that visits from loved ones are of vital importance to care home residents’ health and well-being. DHSC guidance emphasises that visits to care homes should be facilitated, based on individualised risk assessments. Care home residents should also be supported to nominate an essential caregiver, who may visit in most circumstances, including if the care home has been closed to visiting for any reason.

There is an existing process in place if a resident or their family are concerned that guidance is not being followed. We encourage anyone with concerns to raise them. That can be done both with the care home, which has a legal obligation to operate a complaints procedure, and with the CQC. The CQC will follow up on concerns and take regulatory action if needed. It has provided mechanisms for people to feed back on concerns over care. The CQC responds to all concerns passed to it, and can receive concerns anonymously via representative groups, such as Rights for Residents. Where those concerns have named the provider or service in question, the CQC has followed up the cases. Some 54 concerns regarding care home visiting arrangements have been raised during the pandemic. The CQC gained reassurance in all cases that visiting is now in line with guidance. In 12 cases the CQC secured this assurance by inspecting the service.

My department has not seen any data or reports on evictions of residents following complaints against care homes. If a care home were taking such action, it would be in breach of guidance. A complaint should not lead to a resident being asked to move to a different home, and the terms of evictions and processes followed should comply with consumer law, as per the CMA guidance. People should feel confident that complaining will not cause problems for them.

I recognise this has been a difficult time for care home residents. However, the existing powers in legislation are robust and give protection to those who need it. We therefore do not feel at this time that an independent review is necessary.

I turn to Amendment 297A. Continuity and oversight of care is crucial in meeting the needs of all patients, including those aged over 65. That is why, since 2015, all practices have been required to assign their registered patients a named, accountable GP. This GP must lead in ensuring that any GP services that they are contracted to provide, and are necessary to meet the patient’s needs, are co-ordinated and delivered to that patient. Practices must take reasonable efforts to accommodate patients’ requests to be assigned a particular accountable GP and must endeavour to comply with all reasonable requests to see a particular practitioner. Practices are also required to take steps each year to identify any registered patient over 65 who is living with moderate to severe frailty. The practice must undertake a clinical review of any such patient and provide them with any other clinically appropriate interventions.

The noble Baroness, Lady Tyler, is right that delivering on this is linked to the number of GPs in the system. I assure her and others that the Government remain committed to growing the number of doctors. There were 1,841 more full-time equivalent doctors in general practice in September 2021 compared to September 2019. In 2021-22, a record-breaking number of doctors started training as GPs. I therefore consider that existing regulations already address the welcome intention of my noble friend Lady Hodgson, and I regret that the Government cannot accept the amendment for that reason.

I hope I have given noble Lords and noble Baronesses some reassurance on the amendments in this group and that the noble Baroness will feel able to withdraw the amendment.

[Baroness Greengross (CB)]

My Lords, I have listened to an extraordinary range of speeches and addresses. People have spoken from the bottom of their hearts. I am very moved myself by what I have heard. I thank all colleagues and Ministers who have spoken today. I will look very carefully at the record of today and come back, but, in the meantime, I beg leave to withdraw the amendment.

Elderly Social Care (Insurance) Bill [HL]

Baroness Penn Excerpts

2nd reading
Friday 16th July 2021 Lords Chamber

[Lord Flight (Con)]

My Lords, I, too, congratulate the noble Lord, Lord Lilley, on his Bill and on addressing territory that Governments should have addressed long before now. I agreed very much with my noble friend Lady Altmann’s speech.

The noble Lord, Lord Lilley, argued that social care provides two competing challenges to government. The first is the increased pressure on local social care budgets that comes with an ageing population, the increases in the national living wage and the risk of care homes closing. The second is resentment from homeowners and their relatives who risk having to sell their homes to pay for social care. He advises that both problems could cost billions to solve and that, where there is more placating of homeowners, less finance will be available to provide decent care for those in greatest need.

Under the Bill, a state-owned insurance company would be set up and guaranteed by the state. The cost of insurance would be calculated to be actuarially sufficient to pay for all the care. If they wished, people would be able to pay for the insurance via a charge on their homes, which would be realised when they died. That charge would typically be a modest fraction of the value of any home and nobody would be required to take out such insurance. Based on updated figures and the calculations from the Dilnot commission, the noble Lord, Lord Lilley, calculated that a theoretical premium would be approximately £16,000 and the average cost to social care, supported by local authorities, would be £25,000, as he said. I question whether the noble Lord’s insurance premium of £16,000 per annum will be sufficient.

The Bill does not address the point that there is a perceived unfairness, with those who have worked hard and saved having to pay their care costs while those who have spent all their incomes get their social care costs paid for. Those people should arguably get state-provided care, which would be of a more basic nature than the care that individuals purchase. The main objective of the noble Lord, Lord Lilley, is to weaken the political pressure from homeowners for the state to provide them with free social care, but his arrangements entail the state insurance body realising its charge on a property on the death of the insured person or the sale of that property—the charge being the fraction, set aside at the time of the purchase of the policy, of the value of the property at the time of death, net of mortgage.

The terms of the Bill do not therefore fully avoid the much-disliked arrangement of the public sector taking value from a deceased citizen’s property, even though it would be much less under the noble Lord’s system. The insurance arrangement would operate such that the insured persons would be entitled to social care from their local authority, which would be reimbursed for the cost of the care provided. The weakness here is that there is no incentive for the local authority to keep the care costs as low as possible.

The proposals of the noble Lord, Lord Lilley, are complicated and do not—

[Baroness Penn (Con)]

I must remind the noble Lord of the advisory Back-Bench time limit for this debate.

[Lord Flight (Con)]

They do not include the cost of care homes. In my view, what is needed is a less complicated and more standardised approach.

Women’s Health Outcomes

Baroness Penn Excerpts

Thursday 8th July 2021 Lords Chamber

[Baroness Greengross (CB) [V]]

My Lords, I welcome today’s debate on women’s health outcomes and thank the noble Baroness, Lady Jenkin of Kennington, for bringing this Motion to the House today in an extraordinarily moving way.

We know that there are many conditions where women are overrepresented—for example in mental health, where 26% of young women have experienced anxiety, depression or eating disorders. We know that with gynaecological conditions it often takes seven to eight years to receive a diagnosis of endometriosis, with 40% of women needing 10 or more GP appointments before being referred to a specialist.

In one area of women’s health, I became aware late last year that there was a national shortage of widely used contraceptive preparations and hormone replacement therapy products. In response to my Written Question, the Minister, the noble Lord, Lord Bethell, responded that this shortage was due to

“Issues such as regulatory or manufacturing problems, problems accessing supplies of pharmaceutical raw ingredients and commercial decisions to divest certain products”,


which

“can affect the supply of medicines.”

Throughout 2020, thousands of women were not able to access their normal oral contraceptive or hormone replacement therapy products. This is one recent example of women not having access to the pharmaceutical products they regularly used, though this also happens, as we know, with various medicines that both men and women take.

I declare my interest in the register as co-chair of the All-Party Parliamentary Group on Bladder and Bowel Continence Care. Women are five times more likely to develop urinary incontinence than men. This is something many women feel uncomfortable talking about or raising with their GP. For many women, bladder continence issues can result in a loss of independence, as they feel unable to leave their homes unless they know there are accessible public toilets near to where they are going. Much like gynaecological conditions, issues with continence care can take time to diagnose and cannot always be treated. Much greater awareness is needed of these conditions and, in particular, how they impact on women’s lives.

My final point is to draw attention to some depressing findings from the 2020 Marmot report, about which the noble Lord, Lord Rooker, spoke so movingly just now. According to Sir Michael’s 2020 report on health disparities, women living in the most deprived 10%—

[Baroness Penn (Con)]

My Lords, I am afraid I am going to have to remind the noble Baroness of the time limit for Back-Bench contributions, given the number of speakers we have in this very important debate.

[Baroness Greengross (CB) [V]]

Can I finish or not?

[Baroness Penn (Con)]

My Lords, I suggest to the noble Baroness that perhaps she is already over the time limit and that we move on to the next speaker.

[Baroness Greengross (CB) [V]]

Okay.

Coronavirus Act 2020 (Early Expiry) Regulations 2021

Baroness Penn Excerpts

Monday 5th July 2021 Grand Committee

[Baroness Brinton (LD) [V]]

My Lords, at the one-year review of the Act, we pushed for it not to be reviewed. It would have been really useful to understand why there has been such a delay. I remind the Minister that we were concerned over some of the civil liberties issues in the Act, such as on policing, protests and fines—we know the fines did not hold up when applied in practice—and over transparencies. We have raised repeated concerns about the transparency on the dashboard. We were also concerned about people not understanding the rules. Famously, where guidance versus the law happened, it was interesting to watch the Government having to retreat very fast when they realised that they were telling people in Greater Manchester that something was covered by the law, yet the people in Greater Manchester were clearly able to show that it was guidance.

There are also concerns about the enormous blank-cheque powers that this legislation has provided. I am grateful to the noble Lord, Lord Bethell, for saying earlier that the expiry of these provisions was announced on 25 March. His exact words then were:

“We made a promise to Parliament that we would not keep any provision in place for longer than was necessary, and we have made good on that promise.”—[Official Report, 25/3/21; col. 985.]


It has been 14 weeks since the Government decided that they did not need the provisions, and they have not yet removed them. They are still in place until this SI comes into force.

We also had particular concerns about the provision of social care. Part 1 of Schedule 12 and Section 15 enabled local authorities to divert resources to care and support from other duties. This was used eight times and not since 29 June 2020. We were really concerned about this provision because those who needed support for care suddenly found it was removed. The parents of disabled children who needed 24-hour care had found that their entire support mechanisms were removed from them. On the Disabled Children’s Partnership website today, one mother has been saying that the lack of that support has meant that she and her husband have had no more than two hours of consecutive sleep in over a year, because they have had to try to manage it. They are both utterly exhausted and extremely concerned that they might be making mistakes. That is because of the loss of this diversion support. What is particularly worrying is that most local authorities have not yet reinstated it.

Because we still do not know when this SI will come in, it is a little difficult to approve it until we also know the exact details about the level of Covid in our communities and its effect on the NHS. The Prime Minister famously talked about “data, not dates”, but the dialogue in recent weeks has become entirely the other way around, with cheery communications about the mask mandate being about to go. It is very noticeable that people have taken that as a signal that they can stop wearing masks already. Yet just over a year ago in June, when we lifted that first lockdown, cases were down to around 1,000 a day. This last week, it was around 25,000 new cases per day with hospitalizations increasing, even if at a lower rate, and certainly—thank goodness—ICU occupancy at a lower rate. However, GPs, doctors and nurses in hospitals all report that the NHS is nowhere near going back to being normal.

Today on LBC, a member of ICU staff at a hospital called in to say: “They can keep the medal and just get everyone to keep wearing masks, if they truly care about NHS staff”. I am with her on that one. Also today Chloe Smith, the Constitution Minister, said that some people more susceptible to infection than others may wish to carry on using a face mask. She cited her recent cancer, saying that she sympathises with those who want to carry on taking precautions.

As the Minister knows from my repeated raising of this issue, for some people this is not a matter of choice. That is so for at least 1 million people in the country: the clinically extremely vulnerable. Current government guidance to the CEV, which came out on 21 June, says:

“We are also advising clinically extremely vulnerable people to … follow the practical steps described below to minimise your risk of exposure … close contact with friends and family will be a personal choice, but you are encouraged to exercise caution”.


They were advised to work from home but, if they could not, to get their employer to make their workspace Covid-safe—I am paraphrasing because the guidance goes on at some length—and otherwise to get advice from professionals. It also says that the furlough scheme will end in September.

In addition, from 1 April there was no longer any SSP for clinically extremely vulnerable people who could not work from home. It is really important that provision is made to avoid clinically extremely vulnerable people having to go to work. Will the Government now take this up? Losing the mask mandate and lifting regulations mean that this group in our society and their immediate carers are put at risk.

I also note that the clinically extremely vulnerable advice says that pupils should be back in schools but the Department for Education lifted the mask mandate for schools some time ago. These children are still at high risk of Covid, which could indeed—

[Baroness Penn (Con)]

I remind the noble Baroness that the speaking limit for Back-Benchers is five minutes.

[Baroness Brinton (LD) [V]]

Thank you. I have finished.

Covid-19 Update

Baroness Penn Excerpts

Tuesday 29th June 2021 Lords Chamber

[Lord Hussain (LD)]

My Lords, the hotel quarantine for those returning from red-list countries is having a huge, stressful impact on those using the hotels. I have a couple of examples to share and one or two suggestions to make. The first case is family A from Huddersfield. They went to bury their father in Pakistan. On return, they had huge difficulty booking hotels. At Heathrow Airport some family members were taken to Swindon and others to Camberley, which are about 50 miles apart. They could not be put in the same hotel, for some reason. They have made a formal complaint. I have received a copy of it and I am willing to send it to the Minister as well. It shows the level of dissatisfaction people are feeling.

The second example is from my home town, Luton, where, sadly, a young teenager lost his life in a tragic incident. His father and some other relatives, including somebody who is epileptic, were in Pakistan at the time. On their return, whatever amount of stress they had, they were taken to the hotel straightaway and were not allowed out, other than just coming for the funeral.

The third example—and I would say a more tragic one—is a family who went to Pakistan before it was put on the red list. The father was under stress and there are two disabled children. The mother died there and the children are waiting to come back to the UK—

[Baroness Penn (Con)]

My Lords, the noble Lord may wish to direct his question to the Minister at this stage.

[Lord Hussain (LD)]

My Lords, the suggestion is, please can those returners be tested and those who are found to be positive asked to quarantine in their own home? To observe their quarantine, they should have some kind of electronic tag instead of being put in expensive hotels and having these terrible experiences.

Social Care and the Role of Carers

Baroness Penn Excerpts

Thursday 24th June 2021 Lords Chamber

[Baroness Uddin (Non-Afl) [V]]

My Lords, I wish to take a moment to reflect in honour of all those who lost their lives under this Government’s watch and their loved ones who mourn their absence. I want also to record my thanks to all front-line staff for their perseverance during what was a dangerous time.

I too welcome the work of the Care & Support Alliance and place on record my respect for the outstanding advocacy of Carers UK, Rethink and the Disabled Children’s Partnership. I salute the valiant leadership of my noble friend Lady Pitkeathley. I humbly thank the noble Baroness, Lady Jolly, for enabling this conversation.

Speaking as a parent, I can say that caring for someone you love is a lifelong, all-encompassing devotion. According to Carers UK, during the pandemic more than 13 million people provided unpaid care—72% without any break or support. There was a 78% increase in demand for their care, with no response. An estimated 1.2 million carers live beyond poverty. The Government cannot say that they do not know these facts. Even with the time constraint, the detrimental underfunding of social care cannot be overemphasised. It has resulted in an enormous toll on individuals not having their most basic and urgent care needs met, as well as on those who do everything they can for their loved ones.

The system is failing more than 1.5 million of those who need urgent care as a result of government policies and constraint on local authorities. Services are crippled, including voluntary organisations that have been and are a lifeline for the most disadvantaged in our communities.

I wish briefly to speak about the dire situation of hundreds of thousands of families caring for their loved ones with disabilities and autism, which was recently highlighted by the Disabled Children’s Partnership report No End In Sight. I commend it to your Lordships. I have heard first-hand testimonies from several of the parents panel families, who have felt broken, ignored and abandoned over recent years—more so over the past months because they have not received their most basic care services and cannot access what they regard as crucial physical and language therapies and mental health support, with significant adverse consequences for their families’ well-being.

In my social work career, I have had the privilege of managing care homes. I appreciate their invaluable resilience, which was so evident during the early months of the pandemic. I also am fully aware of, have witnessed and have managed at first hand the fallout of the ugliness of abuse of the elderly and the disabled, much of which remains unreported—markedly so in unregulated care homes. Will the Minister assure the House, in the light of the recent case against the National Autistic Society, on what additional safeguards and monitoring are in place to prevent such abuse occurring yet again?

The time for integrated care, free at the point of delivery, is now. As the noble Lord, Lord Forsyth, and other noble Lords have eloquently said, we need political will and leadership, as well as a willingness to work alongside local authorities and leading organisations to cherish the fundamental principles of choice, control and—

[Baroness Penn (Con)]

My Lords, I am afraid I am going to have to remind the noble Baroness of the time limit for the debate.

[Baroness Uddin [V]]

Thank you. We want the dignity of independence for those who are living with disability and their carers.

Covid-19: One Year Report

Baroness Penn Excerpts

Thursday 25th March 2021 Lords Chamber

[Lord Tyler (LD) [V]]

My Lords, the legislation we are reviewing today was passed in a genuine emergency. The concern on 19 March 2020 was not whether it was too rushed, but whether it had been delayed too long. That is obviously no longer the case. Today we have all had 12 months’ experience of its operation, and even with the two-monthly reports and the current reassessment it is by no means evident that Ministers have taken full advantage of the lessons that have been learned.

It is the constitutional duty of your Lordships’ House to check, in the light of that experience, whether the Act includes what should be there, excludes what should not be there and manages appropriately what it does include. In the first category, it is abundantly clear, as has just been said, that the regulations for awarding contracts for Covid-related purposes have been woefully inadequate and that their lack of transparency has been outrageous. Each week, there seems to be yet another excuse from the Government to the courts that publication of a contract was delayed because civil servants were distracted by other Covid commitments, but once a contract was signed and sealed what were they, or indeed Ministers, doing with that contract which required even a day’s delay?

In the category of matters that were included, but clearly need not have been, the current long list of changes is ample testimony to necessary exclusions. However, we also would have expected Ministers to have corrected much earlier the confusion that the police and public encountered with charges for infringing regulations. The fact that, as at the end of February, every single prosecution under Sections 21 and 22 of the Act seems to have been found to be unlawful displays a woeful failure. That the CPS should have had to overturn 252 unlawful charges since March 2020 is a stain on our judicial system. It is important to reiterate the fact that necessary restrictions on movement, businesses and gatherings do not depend on this legislation. The Public Health (Control of Disease) Act 1984 would continue to exercise that control even if the House decided to take more time examining the validity of the very complicated and extensive provisions of this Act.

In the third category, the way in which the Act deals with what is legitimately included, we again have to remind Ministers that they no longer have the excuse of urgency and an unprecedented emergency. The report of our excellent Delegated Powers and Regulatory Reform Committee, published just four days after the Bill was introduced in the Commons, is salutary reading. Ministers will recall that its primary recommendation was as follows:

“Whilst in no way resiling from the appropriateness of this exceptional approach, we nonetheless believe that it is important for us to state clearly that, had the country not been in the midst of a developing national emergency, there are powers in this Bill, including far-reaching Henry VIII powers, about which our commentary would have been far more trenchant and our recommendations far more robust. Given this, we have recommended that the expiry date for the Bill should be set at one year without a power to extend—not two years, with the possibility of extension—thereby enabling the Government to exercise the powers needed in the immediate future while allowing a further bill to be introduced and subject to parliamentary scrutiny in slower time.”


Tragically, Ministers resisted that powerful advice.

The committee noted a host of Henry VIII powers for a number of very significant ministerial actions. In a number of cases, it drew the attention of this House to powers which were in no sense relating only to the coronavirus outbreak. It called for an “ironclad assurance” that they would not be used elsewhere. On what was then Clause 74, the Committee warned:

“A decision to suspend or revive emergency measures might well be politically contentious. We would expect such regulations to be subject to a parliamentary procedure.”


Even when there was a process included, as with the many Henry VIII powers, the Government proposed only the very limited negative procedure.

Nearly two weeks after Royal Assent, the Minister eventually responded to the DPRRC. He blandly dismissed recommendation after recommendation on the grounds of the

“serious and imminent threat to public health.”

He argued that the Committee’s concern over Clause 74, which became Section 88, was met:

“The regular reports to and debates in Parliament provide ample transparency, oversight and potential for challenge to the use of these powers.”


Sadly, the failure of the government business managers to enable the two-monthly reports to be scrutinised effectively has made that promise worthless.

This House took into account the exceptional urgency when it gave its consent to the Bill in March 2020. It did so with the grave constitutional misgivings of the DPRRC duly noted. Unless Ministers are now claiming that they have learned nothing from the past year and that they are as unclear on how to meet the current challenge of the pandemic as they were then, there is no justification for the House to sign another blank cheque. We should insist that the rushed, rough and ready legislation of March 2020 will no longer suffice.

Finally, today I grievously miss the usual Greaves forensic analysis—

[Baroness Penn (Con)]

My Lords, I must remind the noble Lord that there is a time limit for Back-Bench contributions of five minutes.

--- Later in debate ---

[Baroness Penn (Con)]

My Lords, the advisory time limit for Back-Benchers is five minutes in this debate.

--- Later in debate ---

[Baroness Mallalieu (Lab) [V]]

My Lords, on 13 March last year, this country had a carefully prepared plan from the Department of Health, which the noble Baroness, Lady Walmsley, referred to. It was to be used in the event of a pandemic caused by a serious respiratory disease with a projected death toll of up to 750,000. It involved shielding the elderly, the sick and the vulnerable, but keeping life as near normal for the healthy and the working population. China had imposed a draconian lockdown; Italy, France and Spain followed and got away with doing it. Overnight, our plan was dropped into the wastepaper basket and we followed the others. Was that wrong? With hindsight, I believe that it was. Would I have made the same decision on lockdown then? Possibly, but knowing what we do now I would not.

Those who advised that decision, those who made it and those who subsequently supported it were doing their best as they saw it to protect the population from a highly infectious, deeply unpleasant and sometimes fatal disease. How did they persuade us to comply? How did we so readily and swiftly surrender our freedom? First, we were told that, if we did, we would beat the virus and, in the Prime Minister’s words, put it “back in its box”. Then, this nation’s affection for our National Health Service was employed mercilessly. The fact is that successive Governments have underfunded and mismanaged the NHS, so we have the lowest critical care capacity in Europe.

Fear and guilt were part of the Government’s strategy: Don’t kill your granny”, and the advertisement with the old man pictured in a mask, asking “Can you look him in the eye?” There were swingeing fines for trivial breaches and even a government Minister urging people to report their neighbours for any rule infringements, which was presented as some sort of praiseworthy, patriotic act. All this was set against a background of relentless media coverage of hospital crises and deaths. Of course we all wanted to help to beat this virus, but a great many people were also very frightened, many unnecessarily, and many still are.

The full consequences of that decision are now much clearer. I hope that it reduced the death toll, but ours is still one of the largest in the world. However, as a result of that decision, a health crisis has been supplemented by both an economic and a social one. Massive damage has been done to the education of our children and to our businesses, industry, court system, arts and culture. There is a massive backlog of people who are in urgent need of treatment for serious, often fatal, conditions, some of whom have died or will die for lack of it. Basic human needs and civilised rights were prohibited: the need to be with a dying relative, to hold a mother’s hand in a care home, to hug grandchildren. The toll on mental health is incalculable.

We were told then, and at each successive lockdown, that this would be temporary, until a vaccine came along. I am afraid that that has proved unrealistic. Now we are being told that the virus is endemic and we will have to learn to live with it. The vaccine has been brilliantly created in record time and is being superbly administered through the NHS. It may protect the vaccinated against the worst aspects. More and better treatments will also, hopefully, be found, but this virus is going to continue indefinitely.

Against that background, we must surely resolve never again to use lockdown in this way in a health emergency such as this. The noble Lord, Lord Foulkes, was right. Parliament, too, must not allow itself to be sidelined again. We have had legislation with virtually no debate; we have had ex post facto debate on legislation already in force. We have had guidelines that have been accorded the status of law, with constant changes and uncertainty, so that, as the noble Lord, Lord Lansley, said, the public, police and even parliamentarians find it impossible to keep track of the latest rules and timetables.

The police, too, have been put in an impossible position, not just in policing lawful, dignified, peaceful protests but in trying to enforce legislation, some of it so petty in its application as to be laughable. I cannot forget the image of the elderly couple with their sticks, sitting together alone on a park bench, resting briefly during their one hour of permitted exercise, being made to move on by police. It is still going on: last week, an 83 year-old woman in Cheltenham was visited by two policemen at night, having been reported for having a cup of tea with two friends in the garden of her sheltered home. She was told that she would be fined if she did it again. If you enact bad law, people lose respect for it. Look out on the streets on any fine day, or at the beaches when it is hot, and you can see it. People are making their own decisions about the level of risk that they are prepared to take for themselves, their families and their friends. If those who have never broken any rule since March were asked to put their hands up, I do not believe that there would be many in the air.

Here we are again today, doing it all again, taking a few regulations away, adding more and changing the ever-moving goalposts. These provisions go through because there are not enough people in Parliament—too few like the noble Baroness, Lady Noakes—who will stand up and say, “Enough is enough”.

[Baroness Penn (Con)]

My Lords, I remind the noble Baroness of the advisory time limit for Back-Benchers.

--- Later in debate ---

[Lord Bethell (Con)]

I very much thank noble Lords for an incredibly broad and wide-ranging debate. It has been a really honourable birthday party for the Coronavirus Act, and I hope that the Act is grateful for the tributes it has had. I confess that I am proud of the Act, and proud of the collaborative spirit in which it was drafted and passed. I am proud of the measures it supported to make the lives of the people of Britain a lot better during this awful pandemic and I am enormously grateful for the wide-ranging support here in this House during the last year. There has been scrutiny and challenge, but I am grateful to noble Lords for the general tone of support offered to the Government, and to myself in particular.

In terms of the regulations, I think the noble Baroness put it very well: the regulations we are debating today are tough but they are necessary, and I cannot think of a better way of putting it than that. On the specific question asked by the noble Baroness, Lady Thornton, on gatherings, I would be glad to write to her with an answer. On the questions that many noble Lords had on the road map, I am not in a position to do a road map pub quiz from the Dispatch Box right now. The Prime Minister has laid out a really clear schedule and there are update sessions already built into that schedule. Noble Lords will need to wait, I fear, for updates from Downing Street on that.

Instead, I should like to pick out two or three of the major themes that noble Lords raised in this broad debate. One of the most powerful came at the beginning with the comments from the noble Lord, Lord Hunt, reinforced by many other noble Lords, on the issue of health and the question of levelling up. I recognise the deep concerns, which I share, about the spotlight that the pandemic has put on the health of the nation. Without doubt, one of the reasons why we have been hit hard by the pandemic is that large parts of our population are simply not in great shape at the moment. They have either poor health, poor living conditions or poor circumstances. The noble Lord’s comments were absolutely spot on.

My noble friend Lord Moynihan put an emphasis particularly on BMI, weight and fitness in the country. They are clearly not good enough and there is widespread acknowledgement of that. That is in no way to shame any individual or section of society. It is a simple fact of life that we do not compare well to other countries. The Prime Minister has spoken movingly about his personal experience and the issue is something that the nation has to have a conversation about. The obesity strategy is a framework for that, but it is not the only thing that we will be doing in this area.

Our reach-in as government—not just as national government but in local government, agencies of government and the NHS—to some parts of society is just not good enough. This is not a BAME issue, although that is part of it; I am talking about everywhere from the sweatshops of Leicester to the apple orchards of Herefordshire. There are too many communities where we simply do not get our message across or have a dialogue, and where our services are not provided in a way that people find accessible. We have to ask ourselves tough questions about how we can do better. That is because we are only as good as a nation as the health of the most vulnerable people in our society. That includes everyone from working-class white communities in South Wales all the way through to those in the mill towns of northern England. We have to work with faith groups, on our languages and on the services that we offer in a great many ways.

We have to join up our healthcare services. That is something for which the healthcare system has been calling for a long time, which was apparent during our engagement exercise two years ago. It is well built into the NHS Bill that will be coming our way very shortly. We have to join up primary, secondary and public health across the piece. Only in that way can we address the population health issues that have bedevilled the country in the past year.

Lastly, we have to embrace technology. We have done a huge amount of good work in the past year with data, med tech and a more 21st-century approach to healthcare. There is still a huge amount that we need to do. We need to encourage people to engage with their own patient records and data and help them to understand that they can take greater responsibility for personalised medicine if they engage with their patient records and systems. I am optimistic that we can make progress in that area.

My noble friend Lady Noakes and a great number of others remarked on the impact of the pandemic, not just on those who have been ill from Covid but on all the others who have not had either elective surgery or treatment, or missed out on diagnostics and testing—those secondary impacts on the healthcare system. That does not come as a surprise. It is neither a secret nor a conspiracy. It is exactly how epidemics hit healthcare systems. It happens time and again.

[Baroness Penn (Con)]

My Lords, I am sorry to interrupt the Minister’s speech but those participating remotely cannot hear it. Therefore, the House will adjourn while we try to resolve the technical issues.

--- Later in debate ---

[Baroness Penn (Con)]

My Lords, I am afraid that the technical problem is not yet resolved. The House will therefore adjourn until a convenient moment after 6.45 pm.

Health and Social Care Update

Baroness Penn Excerpts

Monday 22nd March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am grateful for the broad and large hook that the noble Baroness has provided me with. I reassure her that not only do we have a massive amount of support already in place for social care to help it through the current pandemic and the huge amount of pressure that has been put on its staff, residents and supply chain; we also have put in place an enormous amount of financial support for local authorities to ensure that they can provide the kind of improvements to social care that are needed. One area in which we have made enormous advances is care tech—that is, digital and technologically driven support. It has taken a huge step forward in the last year and impacted enormously on the lives of those in social care of all kinds.

[Baroness Penn (Con)]

My Lords, we are having technical difficulties. I beg to move that the House do now adjourn until 3 pm.

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) Regulations 2021

Baroness Penn Excerpts

Monday 8th February 2021 Grand Committee

[Lord Winston (Lab) [V]]

First, perhaps I may apologise to the noble Lord, Lord Bethell. On Thursday 4 February, I asked about antiviral drugs: Synairgen’s compound SNG001, an inhaled interferon beta drug, and the controlled trial which had been published in the Lancet and which showed considerable success. I also mentioned ACTIV-2, research established by the National Institutes of Health in the US. With the limits on time to reply to the Statement, I muddled Synairgen’s seemingly effective trial with ACTIV-2, giving the impression that it was a different drug. This made it impossible for the noble Lord to answer my question effectively and I apologise for that.

As many noble Lords have repeatedly affirmed from across the House, we must work together, particularly at times of national emergency. While I speak from these Benches, it is good to celebrate the spirit of proper collaboration of which your Lordships’ House is proud. This is a time of global emergency. Of course, we want to be vaccinated as soon as possible. With vaccines still not plentiful, it is natural to be anxious about ourselves and our families, but we must recognise those elsewhere globally, and particularly in poor nations. It makes economic sense, just as it does with climate change. It may be costly, but it is morally right, and the global fight is essential, not least because of our self-interest.

We should learn from history. Yersinia pestis, the Black Death, caused at least three major pandemics: the plague of Justinian in 1541, the Black Death in 1347 and the Black Death in China in the 1850s. There were repeated, devastating waves in between for many decades. These were spread mostly by travel, by mixing of populations and by people in poverty with poor hygiene and inadequate public health. In 1665, when over 100,000 people in London—probably one-third or more of the population—died in the Great Plague, the greatest proportion were poor and disadvantaged. Lockdown then was rigidly imposed. People were even bolted in their houses, which were painted with a red cross.

The science community has repeatedly warned that we shall almost certainly need to live with Covid for a long time to come. This is likely for Covid-19 but is equally likely to be true of other deadly viruses in due course. So, in addition to global issues, we need everything we can muster: vaccines, better diagnostics, culture facilities, better public health—especially globally—and drugs which kill the virus. We also clearly need isolation, and that will reoccur from time to time. It is important that we do not breathe a huge sigh of collective relief at the blessing of new and better vaccines. There are still many important questions that we will need to consider. Randomised controlled trials must continue. One NIH trial, for example, done in the rhesus monkey, showed that they got protection with different vaccines, but these did not necessarily reduce the replication of the virus in nasal tissues, while some others did. Those are the sorts of reasons why we still do not know how problematic contact between people will be.

Whatever the effectiveness of different vaccines, apart from new mutations, there will be pockets of this virus in the population. If we are to reduce the presence of the virus in our communities, at what stage do we consider vaccinating children? If we eventually do, shall we ignore the serious anti-vaccination protests associated with measles, a far less clinically risky virus? We are relatively safe now from yersinia pestis, not because of vaccines but because of antibiotics. For example, a portable, easily distributed antiviral would be a real asset. Unfortunately, monoclonal antibodies, mentioned by the noble Lord, Lord Walney, in last Thursday’s debate, may not be quite as useful as a portable, easily distributed and administered antiviral, which could give safety, with fewer side-effects, at the early stages of infection. This might kill the virus before it starts to replicate rapidly. That would be useful during lockdown. An antiviral which gets access to the mucus membranes of the throat, pharynx, larynx and respiratory system, taken by mouth or as an aerosol, could be particularly beneficial because that is the route that the Covid virus generally takes. That would be another strategy to avoid the risk of mutations. This may be important, because we must remember how coronavirus is likely to have infected several animal species before moving into man. It is consequently more dangerous. In many parts of this crowded world, humans now perhaps live more closely to animals than at any time in our history.

Of course, we shall continue to jog the Government, but let us do so in the spirit of constructive collaboration that is important at this time of national emergency.

[Baroness Penn (Con)]

My Lords, I remind noble Lords that the time limit for Back-Bench contributions is four minutes.