Health and Care Bill

Baroness Pitkeathley Excerpts

Lords Hansard - Part 2 & Committee stage
Thursday 13th January 2022 Lords Chamber

I recognise the difficulty of outlining and detailing names in the Bill, but I would be interested to know from the Minister how the voice of patients and empowering them and giving them agency is threaded through this Bill.

[Baroness Pitkeathley (Lab)]

My Lords, like the noble Baronesses who have spoken before me, I recognise the difficulty of being too specific about board membership, but I think that paragraph (h) in Amendment 37 in the name of my noble friend, to which the noble Lord, Lord Patel, has added his name, is wide enough to enable patients and carers to be represented. Indeed, given the Government’s commitment to the voice of patients and carers, I find it difficult to understand how they could not accept such an amendment. I know the Minister is extremely committed to that patient and carer voice.

I want to extend that a bit to making sure that we do not forget the vital contribution that charities and community organisations make to health and social care services through their well-documented ability to be innovative and flexible. Your Lordships know that in the course of the pandemic, they immediately operated better delivery mechanisms than the statutory sector was able to because they were able to be flexible. One million volunteers were recruited, and many people had experiences similar to mine, with people saying that it was only through the services of voluntary organisations and charities that they had any kind of support at all, particularly during the first few weeks of the pandemic.

When the Public Services Committee of your Lordships’ House did its inquiry into how public services had reacted to the pandemic, time and again we received examples of where charities were ignored by public service providers. Even if they were consulted at a later stage in planning, it was not to take account of their experience and skills but to assume they would co-operate in whatever role was doled out to them. That is not the way to make the best use of the untold amount of good will, experience and skill that exists in charities, especially in the areas of health and social care. This is a waste of scarce resources and must be recognised in the new structures as they are set out. There are many examples of where these partnerships work well, recognising the different skills on offer, and of where charities are treated as partners, but they must be involved in planning at the earliest stages and be supported financially if appropriate. They will always give a good return on resources.

The other area where charities make a significant contribution is in representing the patient and carer voice. Voluntary sector organisations are often the services that have most contact, especially with vulnerable people. Your Lordships will have endless examples of that. Much is made of how important the voice of the user, patient and carer is when planning or delivering the services. Co-production, co-design and the other buzzwords we hear all the time absolutely depend on being in touch with users and patients. Almost inevitably, the easiest way to access users and patients is through local or national charities which make users their focus, both in the planning of services and the governance of the organisation.

Proper involvement of users, patients and carers often throws up surprises, even pleasant ones, about money. If you really take the views of users and patients, you will often find that what they want from health and social care services is not what is being provided. They will often ask for less provision than we expect, so long as it actually meets their needs, not the needs estimated by the providers. This is a valuable fact when resources are short. It is one more important reason to forge partnerships with the voluntary sector when the memberships of ICBs and ICSs are being set up. Organisations in their areas should be considered as partners which have a great deal to contribute and will do so willingly and productively.

[Baroness Finlay of Llandaff (CB)]

I have two amendments in this group, so I will try to address them very briefly because of time. I am most grateful to the noble Baroness, Lady Thornton, for the way that she introduced this and would like to return very briefly to the issue of public/private potential conflict when public money is being spent, because there is an issue of probity around that. Having shared corporate accountability for the delivery, functions and duties of the ICS could be in conflict with the legal duties of company directors, as has already been pointed out, and therefore creates problems.

I know that the Government recognised this in the other place, but their amendment seems to fall short in two respects. It leaves to the appointed chair of the board the decision on whether a person with interests in private healthcare is incorporated into an ICB. The difficulty is that it provides a condition that their interests in private healthcare could undermine the independence of the health service, but it is very unclear how that will actually be measured. I can see that it would be a fantastic area for legal argument that a precedent had been set in one area that was being worked against by the chair of another ICB. I think this needs to be clarified, because they will be dispensing public money and there are examples already where different decisions have been taken. I will not go into those now because of time.

I turn briefly to the reasons behind the amendments I have put down and declare that I am president of the Chartered Society of Physiotherapy. I am most grateful to the noble Lord, Lord Bradley, for co-signing my amendments. There is a role in recognising that the allied healthcare professionals are the third-largest part of the workforce—the workforce is not just doctors and nurses—and are critical to the long-term plan for the NHS. They work across the health and social care boundary and out into the community. They are integral—physiotherapists in particular—to primary care, and speech and language therapists are essential for children and young people, particularly those with communication difficulties, and that of course includes those with autism and learning difficulties.

I also recognise, though, the problem that you cannot have everybody listed on a board and everybody wants their own so-called representation on it. It will be important that the terms of reference and the metrics by which the function of the board is measured and compared are very clearly laid out, to make sure that there is appropriate consultation at all times with those who are on the receiving end of healthcare, and that people such as allied healthcare professionals are appropriately involved in decisions for the patient groups on which they can have a major impact. Quite often they have a much more major impact than medicine or nursing will do in terms of a patient’s long-term quality of life, and rehabilitation in particular.

So I hope that the Government have listened to this debate and in particular will heed the important warning from the noble Baroness, Lady Thornton, in opening this debate and in the content of the amendments that she has tabled.

Health and Care Bill

Baroness Pitkeathley Excerpts

Lords Hansard - Part 1 & Committee stage
Thursday 13th January 2022 Lords Chamber

The system that I am describing is one of our very best but they would openly admit that they are still in the early stages of that change, which is why it is so important that we put this in the legislation. I know that the Minister and the Secretary of State care deeply and passionately about addressing health inequalities; both have been very public about their commitment. I urge them to hear the spirit of the cross- party agreement in this Committee today and accept the amendments.

[Baroness Pitkeathley (Lab)]

My Lords, I support all the amendments in his group but particularly Amendment 68, in the name of the right reverend Prelate the Bishop of St Albans, about health inequalities faced by those living in rural areas. When you live in a rural area, it is often difficult physically to access a GP practice—if you do not have a car, try getting a bus in a rural area whose timetable coincides with the opening hours of your surgery—and to access health information if your internet is not up to scratch. There are many rural areas where connectivity still leaves a great deal to be desired. Pharmacies, too, can be difficult to access; although some run outreach services, they are by no means universal.

In rural areas, the important non-clinical services mentioned by my noble friend Lord Howarth are largely dependent on the voluntary sector. During the pandemic, when village halls, with their plethora of exercise, dance, art and social support services, were closed, many older people in rural areas were cut off completely, with disastrous effects on their mental health.

The problems of delivering social care in rural areas are also well known. When care workers are paid for home visits only for the time when they are in the home and not for travelling time—time that will of course be extended by the spread-out nature of those visits—it is no wonder that many private and voluntary agencies are handing back social care contracts to local authorities because they simply cannot deliver them.

Poverty, the underlying cause of inequality, is more widespread in rural areas than is often acknowledged. Escaping to the country is a nice idea, but unless you recognise the particular inequalities faced by country residents, it is not as you see it on the television. Moving as a couple approaching retirement is a different picture when one—usually the husband, both the gardener and the driver—dies, leaving an isolated widow in declining health. The cost of fuel is also more acute in rural areas, and you will find many older people who may own a nice-looking cottage having to choose between heating and eating, with consequential effects on their health and future dependency.

I very much hope that when the Minister replies, he will emphasise that when integrated care boards are considering the provision of services for the purposes of achieving equality of access for patients, they will consider those living in all parts of the board’s area.

[Lord Scriven (LD)]

My Lords, this is my first intervention on the Bill. I draw the Committee’s attention to my relevant interests in the register, namely as a vice-president of the Local Government Association and a non-executive director of Chesterfield Royal Hospital NHS Foundation Trust.

I support this suite of amendments—particularly Amendments 11, 14, 65, 94, 186 and 195—which explicitly puts the issue of health inequalities in the Bill and makes it central to the aims of the NHS. It also deals with reporting and holding people to account for helping to reduce health inequalities.

The reason for my support is simple. I speak as a former NHS manager who, as a rookie many years ago, in the very early 1980s, was on the general management trainee scheme. For the first three months, our aim was just to go around. I remember asking the very naive question: “Who’s responsible for quality?” I expected the person who was showing me around to say, “Everyone”, but he said, “Follow me.” We went in his car for five miles outside the hospital to the health authority. We then went into a lift, down into the basement and through lots of corridors, and finally came to a door at the end of the corridor. The door was opened and in a dimly lit room was a middle-aged woman, surrounded by piles of paper. I said, “Who’s this?” I was told, “This is Gladys. Gladys is responsible for quality.” It was seen as someone else’s job.

That is why I have cringed a little when the Minister has said, in previous debates and Answers on health inequalities, that the Office for Health Improvement and Disparities is being established. That is well and good, but that office is not responsible for reducing health inequalities; everyone in the healthcare system and its partners must work together to reduce health inequalities. That is why it is really important that this is explicit. It is not just about health issues; it is about people’s income, work, environment, green space and transport. It should be explicit in the Bill as part of the triple aims—which will become four aims—and become part of monitoring. This issue must become central because something that I have learned about the health service is that unless the centre asks for it, and asks for it to be monitored, it just does not get done because it is not seen as important. That is why monitoring this at both local and national level will hold people to account so it does not become Gladys’s responsibility.

The Bill gives us a once-in-a-lifetime opportunity not just to put health inequalities centrally in the Bill but to make them explicit in the way that the NHS and its partners work. With a little extra legal push to the mill, so to speak, as well as the monitoring, the data and holding people to account, I believe that we can finally start to deal with these issues in a systematic way that shows improvement and will allow the NHS and its partners to know where to push a bit harder to get this done. That is why I support the amendments.

Health and Care Bill

Baroness Pitkeathley Excerpts

Committee stage & Lords Hansard - Part 1
Tuesday 11th January 2022 Lords Chamber

Furthermore, all candidates are required to declare actual or potential conflicts of interest during the recruitment process, which can then be explored by an advisory assessment panel. On appointment and subsequently, candidates publicly declare their interests in a register held by the public body. The Commissioner for Public Appointments regulates these appointments to ensure they are upholding the values of the governance code. I hope that is helpful and that I have reassured the noble Baroness, Lady Merron, sufficiently, at least at this stage of the proceedings, to enable her to withdraw her Amendment 2.

[The Deputy Chairman of Committees (Baroness Pitkeathley) (Lab)]

My Lords, I remind the Committee that I must call the noble Lord, Lord Howarth, who is taking part remotely, to respond to the debate on Amendment 3.

[Lord Howarth of Newport (Lab) [V]]

My Lords, I very much appreciate the recognition by the noble Earl of the validity of the concerns put forward by the proponents of these two amendments, and his acknowledgment that the board of NHS England must contain balance and diversity. I also recognise the force of the points made by the noble Baroness, Lady Harding, and the noble Lord, Lord Mawson: it is essential that the chair should have power to ensure that the board is cohesive. I noted that the noble Baroness, Lady Walmsley, had reservations about the principle of representativeness which is stated in Amendment 2.

We have had a very useful debate. In light of the reflections put forward in the debate, particularly what the Minister, the noble Earl, Lord Howe, has said, I beg leave to withdraw my amendment.

Hospital Beds and Social Care

Baroness Pitkeathley Excerpts

Thursday 6th January 2022 Lords Chamber

[Lord Kamall (Con)]

All noble Lords will appreciate the work and dedication of all our social care workers, especially in these challenging times and with the extra pressure that omicron has brought. Throughout the pandemic, we have provided different types of funding. In December 2021, we announced an extra £300 million to support local authorities working with care providers to recruit and retain staff throughout the winter. This funding is in addition to the £162.5 million announced in October 2021. We recognise the issue, and it is about working with local authorities and others to make sure that this money gets into the system and achieves what it is intended to do.

[Baroness Pitkeathley (Lab)]

My Lords, following on from the question from the noble Lord, Lord Jones of Cheltenham, does the Minister agree that it will be important for the discharge team to also look at the reasons for admission, since many people would not have been in hospital at all—they would never have been admitted—if there had been adequate domiciliary care services? Will the task force focus on those issues as well as the issues for not discharging?

[Lord Kamall (Con)]

The noble Baroness makes an important point. The task force, working with all the various partners, is looking at the different pathways. Most patients can be discharged from hospital to their own home, but a number are held back because they should be discharged from hospital to their own homes but with a new additional or restarted package, which may take time. Patients might be discharged to residential care within the independent and community sector, but one issue is that a number of our care homes are owned privately and are not necessarily as joined up in the system. Patients may also have been discharged to a care home, but sometimes the family may not appreciate or approve of the first venue given and may push back and ask for another one. There are a number of issues that we are looking at; it is very complicated, which I am sure all noble Lords understand. We are trying to really push and get to the bottom of this. Another thing is to make sure that there is education across health and social care staff so that they really understand the needs of particular patients.

Health and Care Bill

Baroness Pitkeathley Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, it is a privilege to follow the noble Baroness, with her wealth of experience in this field, both personal and professional. I too welcome the noble Lord, Lord Stevens, and look forward to working with him again.

It has always been my role in your Lordships’ House to remind colleagues that, whatever reforms we make to health and social care, however many new acronyms we have, and however many new structures we set up, the bulk of health and social care in our society is provided not by paid professional services of any kind but by the so-called informal sector, the unpaid army of family, friends, neighbours and communities on whom we all rely.

Carers play an essential role in supporting the NHS and social care systems. Without their support, our systems would not have been able to cope with the increased demands they have seen during the pandemic. For many years, we have used the estimate of 6 million unpaid carers. During the pandemic, about 4.5 million people took on new caring responsibilities. Their total contribution is now estimated to be worth £193 billion every year—more than the cost of the NHS itself.

My test of any new legislation on health and social care is: how does it affect carers and will it help them be recognised for the vital role they play? The answer to that question is only partly positive. Carers welcome greater integration and collaboration between health and care services—the stated aims of this Bill—since their lives are made even harder when services are not joined up and data is not shared effectively and efficiently. I very much welcome the duty in Clause 6 to consult carers, and the duty on integrated care boards in Clause 20 to consult them around planning and commissioning.

There are some large omissions in the Bill which will have to be rectified if carers are not to suffer as a result of its introduction. For example, I suggest that a new duty should be placed on the NHS to have regard to carers and to promote their health and well-being. Carers are not systematically identified, supported and included throughout the NHS, although good practice does exist. In most social care systems, carers are legally recognised, but this does not apply to the NHS. For effective integration to be achieved across the system, there needs to be a statutory duty to have regard to carers and to promote their well-being. I remind your Lordships of the negative effects of caring on carers’ own health, with three-quarters of them reporting that their own physical and mental health is affected as a direct result of caring responsibilities.

Clause 80 is of great concern. This has been extensively debated in the other place. Incredibly, it actually removes rights from carers—rights which were hard fought for by me and many others during the passage of the Care Act 2014 and in other legislation. This Bill repeals the legislation that gave carers a fundamental right to an assessment and ensured that services were provided to make sure that hospital discharges are safe. There are endless horror stories about unplanned discharges with which I could regale your Lordships if time permitted. Some 68% of carers say that they were not asked whether they were willing and able to care at the point of discharge. Some 61% report that they were not given the right information and advice to help them care safely and well. Surely we must, at the very least, maintain carers’ rights, not reduce them—so this must be amended. I am sure that the Minister, with his understanding of carers’ needs, will be sympathetic.

I have two other areas of concern. The first is about the definition of “carer”. This is not defined in the Bill. Since the NHS is an all-age service, we assume that the definition that already exists under previous legislation will apply and that young and parent carers will therefore be included—but this must be defined and clearly stated in statutory guidance.

I also share the concern mentioned by many other noble Lords about the cap. Research by Carers UK found that 63% of carers were contributing financially in their role. For some, the contribution was relatively modest but, for others, it ran into hundreds of thousands of pounds. These proposals without the cap will leave many carers with low or modest assets very worried indeed.

I know that many of your Lordships recognise the contribution of unpaid carers. Indeed, many of us will be carers at this very moment, will have been carers in the recent past, or expect to be carers at some point in the future. I am confident therefore that we shall be able to amend this Bill to make it another important step in the hard-fought process of getting unpaid carers the recognition and support they so richly deserve.

Adult Social Care

Baroness Pitkeathley Excerpts

Thursday 2nd December 2021 Lords Chamber

[Lord Kamall (Con)]

The Government are in conversation with local authorities at the moment to look at the short-term issues. That is why we have announced increases in funding, particularly as part of the winter plan. The White Paper we are talking about today looks at the longer term, but we have also recognised the short-term issues, which is why we have announced these increases in spending.

[Baroness Pitkeathley (Lab)]

My Lords, we have been waiting for four years—sometimes I think I have been waiting 40 years—for a White Paper that contained a vision for social care that would, once and for all, rescue it from its Cinderella role in public services. I did not get that, but I am a glass-half-full person and am relieved by how many times unpaid carers are mentioned and how many warm words there are about identifying, recognising and involving carers. I thank the Government for that.

But family carers are at breaking point now. As my noble friend said, most have not had a single break since the start of the pandemic. They need immediate help, so will the Minister tell the House how the proposals in the White Paper will help stressed carers now? My second question is about integration between health and social care services, which is the only hope for real reform. It is frequently referred to in the White Paper, but there is no vision for how it will be delivered. We understand that another White Paper about integration is being prepared; I wonder why that is necessary when it could have been tackled in this one. Could the Minister update the House on progress and assure me that carers will be consulted as that paper on integration is written?

[Lord Kamall (Con)]

First, I pay tribute to the work that the noble Baroness has done for carers over many years. She has personally raised with me issues with carers, both paid and unpaid, as well. The White Paper clearly raises issues of professionalising, training and recognising carers to help make this a rewarding career for many. At the same time, it looks at unpaid carers and understands that, for a number of reasons, they are not all similar. Sometimes they are school-age children. We have looked at young carers and at elderly carers—for example my mother, who, in her 70s, looks after an 80 year-old sister who suffers from dementia. They have different needs.

We are first trying to look at how we can help make their task easier, for example through technology freeing up time. We are also looking at respite and how we can make sure they have breaks. We hope that those conversations will be had at the local level, between ICSs and health professionals having meetings directly with the individuals concerned to make sure that unpaid carers have the appropriate support.

NHS: Primary Care Surgeries

Baroness Pitkeathley Excerpts

Wednesday 24th November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for her speech. In answering, as this is for judicial review, I am sure she understands that I cannot comment on it. But I saw an interesting documentary over the weekend, so let me just read some words from it:

“Yes the NHS is a public service but how it spends its vast procurement budget, how it uses IT, how it fashions new processes and pathways for patients, plainly benefit from private sector experience.”


I admit I have plagiarised these words from Tony Blair, the last Labour Prime Minister to win an election.

[Baroness Pitkeathley (Lab)]

Is the Minister familiar with the research that shows that the longer the relationship between a patient and a GP, the less likely the patient is to need out-of-hours care or emergency hospital treatment, or to die, within 12 months? Are patients not right to be afraid that profit-making will interfere with those important relationships?

[Lord Kamall (Con)]

The standards of care that CCGs expect are clear in the contracts that they sign with GPs. However it is provided, patients should continue to expect the same standards of care.

Covid-19 Update

Baroness Pitkeathley Excerpts

Wednesday 10th November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Lord for that question and other noble Lords for their questions. I am not the Prime Minister’s keeper; it is as simple as that. We all decide for ourselves. I wear a mask whenever I can and when I talk to different people, I make sure that we are seen to be wearing masks. I thank noble Lords across the House who are leading by example by wearing a mask.

[Baroness Pitkeathley (Lab)]

Patients in care homes and hospitals suffered very badly from not receiving visitors during the three lockdowns. Family ties were strained and a lot of extra distress was caused. From next April, if all, or the majority of, health service staff are vaccinated, what plans do the Government have for ensuring that visitors do not bring Covid into hospitals and care homes?

[Lord Kamall (Con)]

In many cases, that decision will be left to the individual trust or care home. We know that a number of care homes and different trusts are already concerned about unvaccinated visitors. Many will know already that during the previous lockdowns it was very difficult to visit your loved ones in hospital. I was not able to see my father between January last year and when he died last September. It was incredibly challenging, but we understood the reasons given by the care homes.

Social Care

Baroness Pitkeathley Excerpts

Wednesday 27th October 2021 Lords Chamber

[Lord Kamall (Con)]

It is quite clear that, if we want to make sure that the social care system is fit for purpose, we have to make sure that, in the model, enough money is going in to reform the system. Part of the funding does go to helping local authorities push for reform, but, at the same time, it is true that some of the additional productivity as a result of digitisation will help make the NHS more efficient.

[Baroness Pitkeathley (Lab)]

My Lords, is it not an unfortunate fact that not a single penny from the levy will actually go to the front line of social care to relieve those overworked and underpaid staff making 15-minute visits, which is the real urgency? Even when the money does come to social care, some way down the line, will not much of it be taken up with bureaucracy, in making assessments and testing eligibility for the cap that the Government have put into the system? Surely that is something that we have to look at. How much of the money is actually going to go to the front line, not just now but in three or four years’ time.

[Lord Kamall (Con)]

The noble Baroness makes a very important point: we have to see reforms in the social care sector. The spending of £5.4 billion includes £1.7 billion for wider system reforms, including at least £500 million to support the adult social care workforce in professionalisation and well-being. We are also working closely with providers of care, local government charities, the unions, professional bodies, and users of care and their representatives, and will respond to their views in the forthcoming adult social care system reform White Paper, later this year.

Coronavirus Act 2020

Baroness Pitkeathley Excerpts

Tuesday 26th October 2021 Grand Committee

[Lord Naseby (Con)]

My Lords, I declare an interest in that I am married to a doctor, a former GP who ran a big practice in Biggleswade.

[The Deputy Chairman of Committees (Baroness Pitkeathley) (Lab)]

I am sorry, there is a speakers’ list. The noble Lord, Lord Scriven, is next.

--- Later in debate ---

[Lord Robathan (Con)]

My Lords, I certainly do not oppose these measures since I believe them to be going the right way. I am pleased with that.

I want to concentrate on face masks. The noble Lord, Lord Scriven, mentioned them quite a lot because he believes that everybody wearing them would save lives; they were mentioned in the Minister’s final words as well. They have become a bit of a totem for both sides of the argument on coronavirus restrictions. They divide society, actually. On the one hand—I find myself on this side—I do not believe them to be effective so I do not wear one. It is an act of individuality, if you like; you might even call it an act of rebellion against being told what to do. On the other side of the argument, where the noble Lord, Lord Scriven, is, believers in further restrictions believe that wearing a mask shows virtue and solidarity and provides reassurance to others. That is a perfectly reasonable position, I suppose.

Whatever the opinion polls say, I reckon that about 40% of people on the Tube do not wear a mask now—not 13%, as the noble Lord suggested. That 40% has given up, basically. Children are not required to wear them, of course, but they obviously cannot pass on the virus; I will come back to that later.

In the Chamber of the House of Commons, there is a great political divide between the Government on the one hand, wearing hardly any face masks, and the Opposition on the other, where practically everyone wears one. Last month, I went to a packed memorial service in the Brompton Oratory. It is a huge church—perhaps not the biggest Catholic church in London, but huge. One person was wearing a face mask. None of the clergy was. However, last week, I went to David Amess’s memorial service, where probably about 20 masks were being worn in the congregation. All the bishops and clergy, as they processed behind the unmasked choir, were wearing them. We almost have a Reformation divide now, with Catholics versus Anglicans.

My question for the Minister is simple. Are masks effective? We have, I fear, had some mixed messaging from the Government over the past 18 months. Either masks work or they do not. I am certainly not an expert; I do not pretend that they will or will not do good because, unlike the noble Lord, Lord Scriven, I do not know whether they work.

However, full surgical masks worn in operations presumably work. All the doctors and nurses wear them and have done so for some time—but they are proper surgical masks. Flimsy paper masks are being worn by several people in this Committee, and by the general public. I do not know whether those masks do any good, but I suspect that they do not. What I do know is that Jenny Harries, who is now the chief executive of the UK Health Security Agency and was the Deputy CMO previously, said in March last year that it was “not a good idea” for the general public to wear them. She also said that they “trap the virus” and cause people to start breathing it in.

I have a series of quotes, if the Committee will bear with me, that show the confusion in this matter. I am not saying that I am right. Professor Jonathan Van-Tam, who noble Lords will know, said on April 4 last year that the wearing of face masks by those who are not sick was not recommended by the British Government. He said that there was

“no evidence that the general wearing of face masks by the public who are well affects the spread of the disease in our society.”

That is his view—or it was in April last year. I do not know. Sir Patrick Vallance, who, again, we have got to know well over the past 18 months and is the Chief Scientific Adviser to the Government, told MPs last May:

“The situation with masks … is that the data and the evidence are not straightforward”.


In this House, the then Minister, the noble Lord, Lord Bethell, said on 21 April last year that

“the British Government have been sceptical about the efficacy of face masks. We do not want to be in a position of misleading or providing false reassurance for the public when there is not sufficient scientific evidence for the relevance of face masks.”—[Official Report, 21/4/20; col. 22.]

The following month, on 19 May, he said:

“There is an instinctive human belief that face masks make a difference, but the scientific proof that they do so is not crystal clear.”—[Official Report, 19/5/20; col. 1096.]


Then on 11 June he quoted the World Health Organization and said that

“‘the widespread use of masks by healthy people … is not yet supported by high quality or direct scientific evidence’”.—[Official Report, 11/6/20; col. 1908.]

On 22 June, 11 days later, he said that the mandatory of wearing of face masks was not recommended by the Government.

Now I genuinely do not know, but the situation is certainly confusing; I think everybody can agree on that. I am willing to accept that I am a bit confused. At the Labour Party conference, everybody wore face masks in the hall—we saw them all on television—but they did not wear them at the karaoke parties or receptions. The Liberal Democrat conference was of course virtual, so that was fine. However, they would not have had to wear them because it would not have been very crowded.

So what is the evidence now? Can the Government publish the evidence that made them change their position of last year, with the quotes I have given, to encouraging people to wear face masks? Perhaps there are studies. If they are conclusive, I will wear a mask. That is a promise—but I warn the noble Lord, Lord Scriven, who has just spoken, that one should not rely and base one’s policies on opinion polls.

All the calls that we hear for a return to restrictions should, again, be based on evidence. Are things getting worse? The vaccines certainly seem to work. Indeed, I had a message today to get my booster jab. Deaths are actually right down on what they were a year ago. Can the Minister tell us the percentage of deaths from the virus among those who are over 85? I understand that the average age of death is 85, which is actually higher than average life expectancy.

The Office for National Statistics shows that about half of all new infections are among school-age children—in other words, the unvaccinated young—with few lasting ill-effects. Is that true? Perhaps the Minister can enlighten us on that. Is it the case that there are now studies predicting that cases are likely to fall sharply in the winter? That was in a study from the London School of Hygiene & Tropical Medicine, which was covered in the press yesterday. Is that the case?

We have now heard one or two doctors panicking about flu and calling for the wearing of face masks because there will be flu around. Wear face masks for ever. Every year, on average—it varies dramatically—about 11,000 people die from flu. That is about the same number who are dying every week. So will the Minister reassure me that the Government will not be panicked into reintroducing any dramatic restrictions, or plan B, without basing the decision on very serious evidence?

[The Deputy Chairman of Committees (Baroness Pitkeathley) (Lab)]

The noble Baroness, Lady Wheatcroft, is not with us, so I call the noble Baroness, Lady Foster.

--- Later in debate ---

[Lord Balfe (Con)]

My Lords, I start with a quote from the front page of the regulations which I find quite over the top:

“These Regulations are made in response to the serious and imminent threat to public health which is posed by the incidence and spread of severe acute respiratory syndrome coronavirus”.


Presumably this threat arose in the week between Parliament rising for the Conference Recess—

[The Deputy Chairman of Committees (Baroness Pitkeathley) (Lab)]

My Lords, there is a Division in the Chamber. The Committee will adjourn temporarily.

--- Later in debate ---

[Lord Balfe (Con)]

I shall go back to the beginning because I cannot remember where I stopped.

I start with a quote from the regulations, which

“are made in response to the serious and imminent threat to public health which is posed by the incidence and spread of severe acute respiratory syndrome coronavirus”.

This could not have occurred in the week between the session we had in September and the Minister making this instrument on 22 September. The text carries on,

“the Secretary of State is of the opinion that, by reason of urgency, it is necessary to make this instrument without a draft having been laid before, and approved by a resolution of, each House of Parliament.”

The first thing I ask the Minister is to get an agreement to discontinue this way of making legislation. It may be some time before the Government repeal all the Acts but they could certainly give an undertaking. I realise that the Minister cannot do that today, because he has to consult the department, but the department could give an undertaking that future regulations will be made after consultation with Parliament.

This pandemic has shown me something. The noble Baroness, Lady Foster, referred to her travels around the world. I have done a lot of lecturing on history, particularly the history of western Europe. I will not castigate any country in particular, but all countries have an undertow of authoritarianism in their public dimension. The pandemic has brought that out in this country. We have seen a level of authoritarianism in the way that people have used their power which is totally unacceptable. It can be seen in the way that the doctors have rewritten national health protocols, and the way that the police decided that they would or would not enforce parts of the law. Let me stress that “would not”; I sometimes wonder why we are here, when I look around and see how much of the law the police decide is not worth enforcing.

So we have an authoritarianism problem in this country but, as we move forward, we will have to learn to live with this. It will perhaps decline, as Spanish flu did in 1920-21, but it will not go away, and the possibility of further viral attacks is on the horizon. I echo the call made to the Minister that the Government should look at viral—and electronic—warfare and attacks as part of their defence capacity, because we could be liable to those sorts of attacks. It is important that we move forward from thinking that our defence consists of sailing a battleship round the Black Sea to a point where we accept that there is a much wider area in which public good can be interrupted for malicious reasons.

We have heard a fair bit about the number of people who have been vaccinated and the various plans that have come forward. I am an occasional subscriber to and regular reader of the Daily Sceptic, which I receive by email. It has put another view on some of the material that has been released about Covid. For instance, we hear very little about the Oxford group and a group of people who have looked carefully at all the evidence and concluded very similarly to the noble Viscount, Lord Ridley, on matters such as face masks. Not all the evidence is being presented; indeed, some outlets take great pride in saying that they are Covid-friendly and, basically, supply you only with government propaganda.

So I welcome the new Minister and the new Secretary of State, because they have an opportunity to move us forward towards a better situation. I have mentioned the problem of GPs in the past, but that situation also covers the rest of the National Health Service. I live in Cambridge, which could probably claim to be the medical capital of Britain. I live in a street that is packed full of doctors, because only doctors and former MEPs can afford the houses there. Some of my best friends are doctors, as they say, and some of their stories about what has been going on are, shall we say, not in line with what we have been led to believe is going on. One of them said to me, “I don’t know what the GPs are doing. We haven’t seen any of them in our hospital, I can tell you that”.

So we must get the health service and private hospitals back to work. Our local private hospital was bought out by the NHS and basically stood empty for the best part of a year, with the consultants doing their consultations at home. It was absolutely ridiculous. The way to get a consultation with your specialist relied on knowing their home phone number and getting on to them and going to see them at home. So they were finding a way round the regulations, and the hospitals were closed but still earning large amounts of money from the NHS.

So the Minister is going to find that there are a lot of themes to unravel. On the subject of vaccination, I counsel the Government not to take on battles that they are probably going to lose. If they take on this battle of trying to get vaccination certificates and vaccination approvals before people can do certain things, they will end up in a morass of bureaucracy and in the end they will lose. Leave it to the market. If a venue wishes to say it requires proof of vaccination to enter—as, for instance, some restaurants in France require—let it administer it and look at the certificate. All I would do is say, “Please put a notice on the door”. Do not get involved in what could turn out to be a terribly authoritarian effort.

There is one question I would like to ask the Minister. We are constantly urged to get lateral flow tests. How much do these cost? I was asked to get a lateral flow test before I went to David Amess’s memorial service. Why? I also question whether they should be free and whether it is our priority as a health service to carry on spending this amount of money. How much does it cost and, more importantly, what plans does the Minister have to wind it down or at least make it a paid-for service, which seems a quite reasonable thing to do?

My final words are that I am pleased that we are moving forward. I hope this will be the last SI we have to debate that is laid in this way, and I hope we will move forward, end this image of a terrified country and continue getting back to normal, so that we can start to get back to where we were some years ago, as normal human beings in a normal society.

[The Deputy Chairman of Committees (Baroness Pitkeathley) (Lab)]

My Lords, before the noble Baroness, Lady Brinton, joins us remotely, the noble Lord, Lord Naseby, will speak briefly in the gap.