NHS: Independent Investigation

Baroness Thornton Excerpts

Tuesday 8th October 2024 Lords Chamber

[Baroness Merron (Lab)]

I begin by agreeing with the noble Lord, Lord Patel, in his assessment of the noble Earl, Lord Howe, as I am sure your Lordships’ House does. On the issue of capital, the total maintenance backlog stands at £11.6 billion, an increase of nearly 14% on the previous year. As I mentioned in my opening comments, this is holding back the productivity, ability and capacity of the National Health Service. Our financial situation is well documented, but we have asked the department and NHS England to review the health service’s capital requirements, and that includes NHS England’s assessment of long-term estate needs across a range of areas. We will have to establish the position and where we are to go from there, but I assure the noble Lord of the importance of this matter.

[Baroness Thornton (Lab)]

My Lords, I should declare an interest as a non-executive member of Whittington Hospital, and indeed as its maternity safeguarding champion. I have huge admiration and regard for the noble Lord, Lord Darzi, with whom I worked when he graced these Benches as a very successful and effective Minister. I agree with his analysis of the Health and Social Care Act 2012; I was opposite the noble Earl, Lord Howe, when we were debating that legislation—for what felt like many years—before it reached the statute book, and I agree that despite the challenges to the NHS, the vital signs remain strong.

Page 38 of the report addresses the question of inequality in maternity and neo-natal mortality, which is described. Does the Minister agree that after East Kent, Morecambe Bay and Shrewsbury, we do not need further research into understanding the challenges in our maternity services? What we need is leadership, attention and focus, so that our maternity services can benefit from the proposals in this report and the 10-year plan.

[Baroness Merron (Lab)]

I agree with my noble friend. I am pleased to inform the House that just this week I announced a number of pilot programmes, through which maternity staff will be taught and supported to better identify the signs of a baby in distress in labour, so that action can be taken more quickly, and which will help staff deal with obstetric emergencies during caesarean sections. Such actions help to avoid preventable brain injuries and are right for the baby and the mother. We also need to tackle the issue of the more than £4 billion cost of the lawsuits that have been brought over a number of years.

I have seen good examples of teamwork in Bristol and Surrey, to name just two, and there are many things that can be learned. We know what strategies work—one of which is listening to women—but the challenge is, how do we roll out what is successful, including from the pilot programmes? Following the recent report, which showed a devastating situation in maternity and neo-natal care, that is a high priority for this Government.

HIV Care: Access

Baroness Thornton Excerpts

Wednesday 11th September 2024 Lords Chamber

[Baroness Merron (Lab)]

The noble Lord’s campaign in this area is very well regarded, and for good reason; I certainly agree with him. The fact is that engagement in care is strongly affected by a number of factors, including a person’s well-being and quality of life, discrimination and, as the noble Lord says, stigma. That, alongside accessibility of service, will define how successful we are. I am keen that our new plan will absolutely take account of stigma.

[Baroness Thornton (Lab)]

My Lords, the crisis of people lost to HIV care is of course underpinned by serious health inequalities. Are the Government taking account of the pilot work by the Elton John AIDS Foundation in south London, which has successfully returned people to care through case-finding, focus follow-up and wraparound support for people when they return to clinics, thus saving the local NHS millions in the care that would be necessary if they were not receiving it?

[Baroness Merron (Lab)]

I can confirm to my noble friend that we are, and say how grateful we are to a number of charities, including the Terrence Higgins Trust and the Elton John AIDS Foundation. As she says, there have been pilots for emergency department HIV opt-out testing since 2018. A pilot that began in April has expanded that to 47 additional sites, and we will be looking closely at the impact of that.

Covid-19 Inquiry

Baroness Thornton Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I was keen to participate in this debate today because I was the shadow Health Minister in your Lordships’ House during the pandemic and for many of the years leading up to it. I thank my noble friend Lady Merron for the opportunity for this debate and for her brilliant introduction to it. I would just like to point out this this is the first module of many—we are at the beginning of a process, not at the end of it.

I have been following the work of the commission of the noble and learned Baroness, Lady Hallett, since it started because I believe that this level and depth of inquiry is essential. As my noble friend said, not least we owe this to the tens of thousands who died, the thousands who suffer still the effects of long Covid and those who have yet to recover from the trauma that they experienced either while working in our emergency services in the NHS or in witnessing deaths and illness in their families or, indeed, their patients.

As Sir David Spiegelhalter said:

“The 2017 National Risk Register did include an ‘emerging infectious disease’ such as SARS and MERS, but the ‘reasonable worst case scenario’ was only ‘several thousand people experiencing symptoms, potentially leading to up to 100 fatalities’. This was the underestimate of the century – by the end of 2023, over 230,000 people in the UK had died with ‘Covid-19’ on their death certificate”.


I want to make two reflections today about this report, but I particularly welcome recommendation 10 in this module, which calls for:

“A UK-wide independent statutory body for whole-system civil emergency preparedness and resilience”


to be set up within 12 months, which would consult with the

“voluntary, community and social enterprise sector”.

As patron of Social Enterprise UK and founder of its all-party group and having worked and supported the voluntary sector for most of my working life, I think this is very important. With particular reference to the questions raised by the RNIB in its very helpful briefing, I ask my noble friend the Minister to provide us with an update on the Government’s plans for setting up such a body and the ways in which disabled people and other groups could be represented. A letter would certainly suffice to answer that question.

The first issue I particularly want to mention and to perhaps explore is how to avoid groupthink, as the noble Lord, Lord Evans, said. If I might interject a moment of political dissent into this, I was waiting for him to say that they got it wrong with that at some point in his remarks. I will just leave it at that, because his Government were in charge of what happened next. The report says that:

“The provision of advice … could be improved. Advisers and advisory groups did not have sufficient freedom and autonomy to express dissenting views and suffered from a lack of significant external oversight and challenge. The advice was often undermined by ‘groupthink’”,


which, of course, added to the lack of preparedness. Vital “what if?” questions were not asked, either in the flawed pandemic preparations prior to the pandemic or during the engagement in dealing with the pandemic in those vital early days.

That means that questions of the preparedness did not take account of health inequalities, or of on-the-ground issues such as care homes and local preparedness. I saw this in action myself, because I was a member of a local clinical commissioning group in my borough that was about to be abolished at the beginning of 2020. At our last meeting that March, our local GPs assumed that they would have a vital role to play with the public health teams in our area in dealing with what was clearly shaping up to be a serious infectious disease. However, there was no information flowing from the centre about step-down facilities for those who needed to be moved out of hospitals—because everybody recognised that people needed to be moved out of them—and all those present knew that they should not be placed in care homes immediately. No questions were being asked, and our public health experts were not being listened to. There was no collecting of data locally and no flow of information, so a serious lack of leadership happened at that time.

The background to this was that the committee that might have led on these matters—the threats, hazards, resilience and contingencies sub-committee—had last met in February 2017. In July 2019, the sub-committee was formally taken out of the committee structure, with the suggestion that it could be “reconvened if needed” but an acceptance that in fact it was abolished. As a result, immediately prior to the pandemic, there was no cross-government ministerial oversight of the matters that were previously within that sub-committee’s remit. I say to my noble friend that the need to challenge groupthink means that there have to be external voices and expertise in our pandemic preparedness. Can I be assured that that will happen and that there will be a commitment to partnership working with scientists, researchers and vaccine manufacturers to ensure future pandemic resilience?

My second reflection is about parliamentary and constitutional readiness for national emergencies. In many ways, this is covered in the first recommendation of the report, which is a

“radical simplification of the civil emergency preparedness and resilience systems”

and

“rationalising and streamlining the current bureaucracy and providing better and simpler Ministerial and official structures and leadership”.

Since the report was commissioned, there has in fact been an Independent Commission on UK Public Health Emergency Powers, chaired by the right honourable Sir Jack Beatson. The commission reviewed the UK’s public health legislative framework and institutional arrangements. Several Members of your Lordships’ House, including myself, gave evidence to that commission about what actually happened on the ground in terms of parliamentary accountability and governance. How do we build into our resilience structure our need for accountability, transparency and parliamentary control of executive action? That was what the independent commission was talking about; I am sure that its evidence has gone into the public commission, but it explored those issues.

When we build our new resilience framework, it has to take account of the role of Parliament and what happened. I think the then Minister and I were in agreement, along with lots of other noble Lords, that it was completely unacceptable that we were having to deal with decisions two or three weeks after they had been taken, or even longer. This Parliament found itself in a ridiculous situation, so we need to build into our new plans that that should not happen. One way might be that if we are faced with a national emergency, there should be a national political response that the Government have to lead and that takes account of all the different political voices that should be heard in that process.

I have been dismayed that some parts of the press and others have denigrated the inquiry as a waste of time and money, or as some form of petty personality dispute. We have lived through the worst disaster of our recent history, with upward of 230,000 deaths, as I have said, making us one of the most badly affected western nations. In terms of responsible governance, if we had lost that number of people in, say, a tsunami, we would have a huge inquiry to investigate all the nuts and bolts of future mitigation and best practice. Why would we not do the same in the event of the likelihood of another viral pandemic? Such events, stress-testing the machinery of our democracies to the maximum, seem to be part of this process.

I again congratulate my noble friend Lady Merron and look forward to many more discussions about future modules.

--- Later in debate ---

[Baroness Brinton (LD)]

My Lords, I declare my interest as a vice president of the Local Government Association. The report by the noble and learned Baroness, Lady Hallett, UK Covid-19 Inquiry Module 1: The Resilience and Preparedness of the United Kingdom, is an effective and thorough distillation of the difficulties, and of the failures by Ministers, officials and perhaps even by wider society as well. She and the Minister remind us that we must always remember the bereaved, those who lost their lives, survivors and those on the front line who dedicated their lives, sometimes literally, to dealing with the crisis that we perhaps failed to deal well with. From these Benches, I start by remembering the hundreds of thousands who died, including some Members of your Lordships’ House, families and friends, those who survived and those whose lives changed for ever as a result. This inquiry and its reports must be the action we need to take to ensure that we do not make the same mistakes again.

My noble friend Lady Tyler reminded us of the scandal of hospitals releasing patients into care homes, bringing Covid with them. I remember the “do not resuscitate” orders placed on disabled patients’ files without their or their family’s knowledge, until that was stopped. I thank Ministers for dealing with that as soon as it appeared to be an issue. We also want to thank the many NHS front-line staff as well as the people in public health, local government, transport and food chains, who, in those earliest and darkest days in March and April 2020—often without PPE, and, for many, with enormous sacrifice—ensured that everything could be done to keep the country going. These people were selfless and are our heroes. I thank the noble Baroness, Lady Fraser, for her focus on those with cerebral palsy and other disabilities. She is right that they are still living with the consequences.

This inquiry has got the measure of those issues. Recommendations must be accepted and acted on as soon as possible. As others have said, who knows when the next pandemic will arrive? The noble and learned Baroness, Lady Hallett, is clear, from the evidence, that it will.

Politicians, civil servants and public officials got it wrong. The noble and learned Baroness, Lady Hallett, says in the report that

“the UK was ill prepared for dealing with a catastrophic emergency, let alone the coronavirus … pandemic”,

assuming that it would be like flu, as in the 2011 strategy and later: the wrong pandemic. Worse, Ministers instructed civil servants and officials to focus all their efforts on preparations for a no-deal Brexit, so pandemic exercises did not happen at the highest levels and those that did happen were ignored in Whitehall.

The report talks about the lack of leadership, appropriate challenge and oversight. I shall contrast our experience with what happened in Taiwan. I use this as an example to the noble Lord, Lord Frost, of how it is possible to have not just a learning Government but a learning society. That country learned from its previous experience of SARS and other national emergencies, and its pandemic system moved swiftly into action. The key was reminding citizens of what was expected every day and taking them with them. The spread was so low that Taiwan did not have to lock down. Every single day, there was a Minister and an official on TV not doing press conferences, but taking questions live from the public until all the questions were finished every day. Taiwan had six deaths in the first year.

I want also to raise a point on Sweden. Although I have heard the noble Lord, Lord Hannan, make many points about Sweden in the past, the one thing he never mentions is that Sweden’s culture is very like that of the Taiwanese in that the relationship between the governors and the governed is much more trustworthy than we have in this country. I am sure that is one of the main reasons that things worked.

The Taiwanese version of test, trace and isolate, including universal masking being totally accepted and digital technology helping people to isolate, was operated locally. If people were asked to isolate, they had a call every day from someone in their local council or nearby to ask what they needed from the shops or the chemist, and it was brought to their door. People knew they were supported—no civil emergency but a nation working together—and the key to their success was learning from SARS.

So I ask: have we learned from Covid? The noble Lord, Lord Bilimoria, recounted the Premier League arrangements made possible by regular testing. He is absolutely right; that is an example of where we did get it right in this country, but we needed to get it right for everyone.

I believe that the recommendations must be accepted and acted on as soon as possible; that is one of the reasons why we need a module now that reports so that work can proceed, advising government, Civil Service, the NHS and other public bodies.

I am so pleased to see the noble Baroness, Lady Thornton, in her place. She and I were the two Opposition Front-Benchers in January 2020 and, between us, we saw Covid through with the support of our colleagues. We covered over 580 pieces of legislation in Parliament, and well over 300 of those were on health. I give way to the noble Baroness.

[Baroness Thornton (Lab)]

I think that, possibly, I saw the noble Baroness and the Minister more than I saw my husband for several months.

[Baroness Brinton (LD)]

I confess that I was probably in the same position. The noble Baroness, Lady Thornton, and I were always commentating on the regulations, but it was always post-event. One issue we need to look at is emergency legislation being enacted with us being able to see it only after it has happened. I understand that that was the case at the start, but we were still seeing emergency legislation only two years on. That is unacceptable.

My noble friend Lady Tyler talked about vulnerable people at risk because of poverty. The noble Baroness, Lady Coussins, rightly made the point, as she always does, about language support being so vital. Your Lordships will not be surprised to hear me say that clinically vulnerable people have expressed concern that the modules outlined at the start of the inquiry seem to ignore their plight. The noble and learned Baroness, Lady Hallett, said that the experience of vulnerable people would be threaded through her inquiry and its reports. I want to thank her for her clear recommendations in relation to clinically vulnerable people as well as those who are vulnerable for other reasons. Six of the 10 recommendations specifically mention them. I may mention them again later.

Can the Minister assure the House that the recommendations will be implemented at pace throughout all levels of national, state and local government and public agencies? Nobody has mentioned that the inquiry reprinted the extraordinary spidergrams that constituted the departmental and structural response to the emergencies. The report also noted that many with civil emergency pandemic preparedness responsibilities had full-time roles in their departments, meaning that planning and review were easy to push into the future. Will key staff with this responsibility now have time to read, think and do the regular reviews and exercises to ensure that, as and when an emergency occurs, a smoothly run system will kick into place as it did in Taiwan and Sweden?

It was also egregious that preparing for Brexit knocked everything else out of the way in Whitehall, including postponing those regular pandemic exercises. As other noble Lords have asked, how will this new Government remove groupthink from their and officials’ behaviour? As the noble Lord, Lord Harris, pointed out, we may need a change in system thinking too.

Interestingly, groupthink has also come up in the Horizon Post Office inquiry and the Infected Blood Inquiry; I am sure it will also come up in the Grenfell Tower inquiry tomorrow. This is a massive undertaking for government. The comments from the noble Baroness, Lady Thornton, about the role of Parliament were important as well: about how important our role of scrutinising government becomes at times like this. Can the Minister tell us what success will look like to the Government about how things have really changed, because groupthink about success is also sometimes part of the problem? I am very pleased that the Government are proposing a duty of candour. I think such a duty will help change the practice of Ministers being told what civil servants think Ministers want to hear.

The report is clear that the local directors of public health were not utilised effectively. They and their teams of local government environmental health officers were often ignored and dictated to, and they were ignored in their roles in local areas. The Association of Directors of Public Health continued to do all that they could throughout. I remember a conversation with one of them about 10 days after the February half term in 2020. It was evident to him at that point that a number of families had picked up Covid in northern Italy, and it was spreading swiftly into his local schools. They could not get this taken seriously further up the line despite needing powers to be able to close down independent schools—they could close down state schools but not independent schools. As a result, independent schools and the families of those attending them had a faster spread than elsewhere.

The noble Lord, Lord Lansley talked about the 2011 plan thinking only about schools in high-impact areas. Our early experience post that February 2020 half term may have guided people to say, “If we can’t control spread in schools, we’re going to have to do something else”. There was no test, trace and isolate at that point, and spread was just not contained.

The Minister talked about flexible systems, but will they also be local? Directors of public health and their teams in local councils and local NHS are well placed to help. Please can we guarantee that they will be involved?

The noble Lord, Lord Frost, was unhappy with module reporting. I disagree with him because the major changes that have to happen, and which are recognised by many past Ministers and the new Government, are major and will and should take time to get right. We do not know when the next pandemic will happen; perhaps it is brewing already. There is not just anti- microbial resistance, as outlined by the noble Lord, Lord Lansley, but the person-to-person transmission of avian flu, now happening in parts of the US, Texas in particular. Time is not on our side.

The Minister said in the previous Statement in late July, following the publication of this report, that the previous Government had changed the way they accessed, analysed and shared data. It is essential to get that right but the last Government and UKHSA have cancelled wastewater testing for Covid, which is essential for early detection and monitoring. It continues in Scotland, which is one of the differences there, and in the USA and other countries. This makes it difficult for officials to spot early signs of increased cases and outbreaks.

The cancellation of Covid testing unless you are in hospital or in a care setting means that it is very difficult to gauge the level in the community. The ONS and ZOE data were helpful. Will the Government reconsider that background data? The noble Lord, Lord Hannan, said that Covid is endemic. It is not endemic yet. I hope we are out of a pandemic but Covid is not everywhere and safe for everybody. It is not endemic.

Knowing what is happening becomes important. We have hospitals telling clinical staff not to wear masks, even though there is Covid in their hospital. One academy school is saying this week that it is fine for symptomatic Covid children to return to school immediately, and we have schools still refusing to provide ventilation in classrooms that would allow clinically vulnerable children to return to school.

In July, the Minister said in the Statement that the Government’s first responsibility is to keep the public safe, so can the Minister assure your Lordships’ House on the urgent and outstanding issue of PPE, masks and ventilation being provided and encouraged where necessary to help reduce spread. I am not talking about everywhere, but where necessary.

I am also glad that the noble Lord, Lord Reid, referred to mpox. I am pleased that the noble Baroness, Lady Chakrabarti, raised TRIPS waivers and Gavi as well. They are really important. I know somebody who is going to the DRC next week. They will be working in the refugee camps and their doctor went to UKHSA to ask whether they could have a vaccination. They were told that the UK is not issuing any vaccines. Unfortunately, there are no vaccines in Goma in the DRC at all. This is not on. Perhaps the Minister could find out what is happening and why this Government are not taking this report seriously.

I wanted to talk about other things such as the longer-term effect of long Covid. I want to mention very briefly that the NHS has fired many of its front-line clinical staff who got severe long Covid because they could not prove they got the Covid in the hospitals. That is a disgrace and I think it will come back to bite the NHS in the future.

I want to end by referring to Pale Rider by Laura Spinney, published in 2016, on the Spanish flu. In the final chapter, on memory, she says:

“Memory is an active process. Details have to be rehearsed … But who wants to rehearse the details of a pandemic? … Instead, there was silence and a loss of memory”.


Are we sure that we will not have a loss of memory in the next three to five years? Will the recommendations from the noble and learned Baroness, Lady Hallett, make us become that new learning for government and society so that next time we can respond like Taiwan and Sweden?