COVID-19 Variant: Travel Guidance for Local Authorities
Baroness Thornton Excerpts(3 years, 5 months ago)
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Baroness Thornton
To ask Her Majesty’s Government what plans they have to ensure local authorities are informed of new travel guidance on areas where the COVID-19 variant B.1.617.2, first identified in India, is spreading.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, we are always looking to see how we can communicate more effectively with local authorities. We will have discussions with local authority colleagues this week to make sure that everyone is clear what the expectations are and how we can improve communications going forward.
Baroness Thornton (Lab)
My Lords, to paraphrase Matt Lucas as the Prime Minister: “Don’t go to work—go to work. If you can stay indoors, go outside. Don’t go outside—go on public transport. Don’t go to work and then—something or other will happen.” It would be laughable if it were not so serious. I have two questions for the Minister. The amended guidance asks people to minimise travel into and out of the eight hotspot areas. The previous version asked them to avoid all non-essential travel. What is the difference between those two things or is it like the amber countries—you can go there but you should not? If the Government want people to heed their advice, guidance or instructions, why were the notices posted on a website during the night without consultation or accompanying dissemination to people and organisations such as public health, councils and mayors? That does not seem the most effective way to communicate with people.
Lord Bethell (Con)
My Lords, the characterisation presented by the noble Baroness is unfair. We are trusting people to be responsible and to act with caution and common sense, as they have done throughout this pandemic, and to make decisions on how best to protect themselves and their loved ones. We are seeking to avoid bringing these measures into law and instead are using guidance. The communication of that guidance could have been done better but we are working extremely hard with regional partnership teams, Public Health England, local authorities, JBC colleagues and the incident management teams to ensure that these communications are done in the most effective way possible.
Osimertinib Cancer Treatment
Baroness Thornton Excerpts(3 years, 5 months ago)
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Lord Bethell (Con)
My Lords, we estimate that there are currently just eight patients in Northern Ireland who would benefit from the expanded use of Tagrisso for early-stage disease. Perhaps I may reassure my noble friend that they will all have the same access as in the rest of the United Kingdom without any delay or restraint on that access.
Baroness Thornton (Lab)
My Lords, we should all wholeheartedly welcome the news of the agreement to enable early access to Osimertinib for early-stage lung cancer patients in England and I absolutely recognise that it is also available to patients in Northern Ireland. However, early diagnosis is as important as access to treatment. It is therefore deeply concerning that the number of people in England and, presumably, across the UK being seen by a specialist for suspected cancer, following urgent referral from their GP, has dropped dramatically. What steps are the Government taking to bring those waiting lists down? We certainly cannot wait for a reorganisation of the NHS, as proposed this year. Does the noble Lord acknowledge that reorganisations tend to have a chilling effect on the recovery of our NHS?
Lord Bethell (Con)
The noble Baroness is entirely right to be concerned about the backlog of oncological diagnostics. It is of grave concern to all of us. That is why the NHS has massively prioritised the tests she described. We are working extremely hard to get through the backlog. GPs are extremely focused on identifying those most at risk and those who are late for their tests are being followed up with great energy and endeavour. I pay tribute particularly to the role of NHS D, which is using the kind of data gains that we made during the pandemic to mobilise all the technology we can to get the right people into tests at the right time.
Covid-19 Update
Baroness Thornton Excerpts(3 years, 5 months ago)
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Baroness Thornton (Lab)
My Lords, I thank the Minister for being here to take this Statement. We keep meeting like this; it is over a year now. I wonder whether our relationship needs to move on.
The Covid variant first detected in India looks as though it has now seeded in 86 areas and is set to become the dominant strain in the UK within the next few days or weeks. Indeed, many experts think that it was a mistake for the Government to go ahead with the easing of lockdown restrictions implemented yesterday. I suppose that there must be increasing doubt about whether the further lifting of lockdown measures will be able to go ahead as planned next month. I will not ask the Minister to give any definitive answers on that because I absolutely accept that uncertainty is the name of the game. However, I quote one of the four tests that the Government set out for proceeding with the road map out of lockdown, which is if
“our assessment of the risks is not fundamentally changed by new Variants of Concern”—
in other words, if there are new variants of concern, that may be the issue. Is this still the case?
The Royal Statistical Society, which promotes the proper use of data, is concerned that the Government have failed to publish the information justifying their decision that stage 3 of lockdown easing should go ahead because the new variant threat has been met. Will the Government publish the framework for that decision and the data that fed into it so that people can be assured that the facts justify the policy? Can the Minister confirm reports in the Times that officials have drawn up plans for local lockdowns modelled on the tier 4 restrictions introduced last year, and that, under these measures, people will be advised to stay at home and non-essential shops and hospitality will be closed, if the new strain is not brought under control?
On Bolton and Bedford, I regret to say this, but it seemed that the Secretary of State reverted to a blame game yesterday, perhaps to deflect from the fact that the Government did not do enough to protect us from this new variant. He said that people infected by the new variant in hospitals in Bolton had refused or not taken up the vaccine and had chosen not to take the jab. I felt that was very unfair.
My honourable friend the MP for Bolton, Yasmin Qureshi, says that the vaccine is not easily accessible to some of the poorer and BAME communities in Bolton: for example, some people have to take three buses to get to the vaccine centre in the centre of the town. If you are not mobile and do not have flexibility in your working hours, or are a key worker and have caring responsibilities in a multigenerational household, you are not refusing the vaccine if you cannot get to it.
Turning to Bedford, the Secretary of State, Matt Hancock, has said that Bedford is now to be among the areas given surge testing, as the borough recorded the second highest rates of Covid-19 infection in the country, and that cases were doubling every five days. This comes after the MP, the mayor and the health chiefs all called on the Government to act quickly to prevent further spread of the variant in Bedford. For days they have felt ignored. They have felt that the Government wanted to recognise the new variant as a northern problem, which clearly is not the case because it is in Bedford. My honourable friend Mohammad Yasin MP said that, after a fair bit of dither and delay, he welcomes surge testing in Bedford.
Can the Minister tell us whether it is true that Bedford has no access to the Pfizer vaccine at the moment? This must limit a comprehensive vaccine campaign in that town; you cannot do a comprehensive vaccine campaign, especially if you are dealing with the under-40s, if you do not have two or three of the vaccines that are available. I am aware also that reports of many people choosing to delay their jab were about concerns over side effects and whether they would be available for work or might struggle to manage their responsibilities. So the Government must give resourcing and support on these issues and improve the flexibility, information and understanding at a local level.
The Minister is also aware that achieving the truly remarkable vaccine take-up among adults will still leave 20% of the wider population—our children—unvaccinated, meaning of course that the virus can still spread. So can he update the House on any plans to vaccinate the under-18s? It also remains unclear for how long vaccines prevent Covid-19. Initial studies suggest that it may be six months, or possibly longer. Well, those who were vaccinated in December are rapidly approaching that. So we need to know whether there will be declining protection from Covid and what assessment the Minister has made of this risk. Can he update the House on plans to roll out booster shots this autumn?
Finally, at this critical time when we need to work internationally, why are we the only G7 nation cutting our aid budget? How can the Government defend cutting our contribution to vital science and research projects? Given the Government’s total silence on President Biden’s support for the temporary lifting of patent protections to increase vaccine production, should we assume that the British Government do not agree with the President?
Lord Scriven (LD)
My Lords, I too thank the Minister for coming before the House to deal with this Statement, and also for his work ethic in dealing with Covid-19 over the last 14 months.
From these Benches, we have always said that we will support whatever is proportionate and follows evidence to keep people safe. The more that you delve into the Government’s reason for not including India on the red list at the same time as Pakistan and Bangladesh, the more it feels like a big ball of candyfloss that initially seems tempting but disintegrates on touch. Yesterday, both the Minister and the Secretary of State said that India was not put on the red list at the same time as Pakistan and Bangladesh because of the positivity rate.
Looking at the figures for the two weeks before Bangladesh and Pakistan were put on the red list, the positivity rate for India was 5.1%. For Pakistan, it was slightly higher at 6.2%, yet for Bangladesh it was lower, at 3.7%. The same data—the Government’s test and trace data—shows that in the same two-week period, 50% of all new variants entering the UK, including those of concern, were from India: the largest country by far. Therefore, variants of concern and positivity rates show India to be on a par with, or ahead of, Bangladesh and Pakistan. So what data were the Government actually using, if it was not their own test and trace data? Can the Minister place on the record that data and the raw data which made him, and the Secretary of State, say that India’s positivity rate was three times higher?
Another area of concern is people entering the UK being huddled together at the border with people entering from red-list countries. One needs only to look at the significant Twitter feeds from yesterday of people arriving from green or amber countries, who were spending up to four hours in queues to get over the UK border and having to stand next to and mingle with people entering from red-list countries. Heathrow and Manchester Airports were responding that, despite asking the Government for more border staff to deal with the issue, none had been forthcoming.
This was planned. We knew that international travel was allowed and the Government knew that the traffic-light system was being introduced, so why have the Government not carried out the wishes of the airport operators to ensure that more border staff and more guidance are available to segregate those entering from red-list countries? This is a clear public health crisis at our border, and the Government have not, to date, solved it. So, as a matter of urgency, when will this public health breach right at our borders be solved?
Finally, as variants of concern continue to enter the country and replicate at speed, “isolate, isolate, isolate” becomes vital. Yesterday, the Secretary of State in another place indicated to Munira Wilson MP that the Government were worried that isolation might not be as robust as required, and that some pilots were taking place. Can the Minister outline where they are, what the parameters of the pilots are and when the results will be made public? Also, overwhelming evidence now shows that people on lower salaries must be paid their full wages and given support to ensure that they can comply with full isolation requirements. Will the Government now look at this as a matter of urgency?
Eating Disorder Services: Referrals
Baroness Thornton Excerpts(3 years, 5 months ago)
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Lord Bethell (Con)
My Lords, undoubtedly, the increase in referrals is something of concern. It is something we are monitoring closely, with the round table and the ministerial group dedicated to looking at this. That shows the seriousness with which we regard it. The reduction in the impact of community services, which is the best way of addressing these kinds of issues, has undoubtedly had an effect on urgent needs. During this period, there has also been a large increase in the number of young people who have started treatment, which is encouraging. If the noble Baroness has evidence that measures such as nutrition information on packaging has an effect on anorexia, I would welcome correspondence from her.
Baroness Thornton (Lab)
My Lords, as the noble Baroness has said, we know that eating disorders among children and young people have increased during the pandemic. There is a very welcome increase in the grant of £11 million from the grant in 2018-19. Despite this, total spending by CCGs on children and young people’s community eating disorder services increased by just £1.1 million, from around £54 million in 2018-19 to £55 million in 2019-20. This increase is cancelled out if you adjust for inflation, and this means that total spend flatlined in real terms. What are the Government going to do to ensure that this money is spent on what is growing into an epidemic of eating disorders and the suffering they cause?
Lord Bethell (Con)
My Lords, the noble Baroness is entirely right that community eating disorder services are critical. They are the backbone of our measures to address these difficult cases. But money for the treatment of eating disorders comes from many different pots. During 2021, a total of 10,695 children and young people started treatment, which is up from 8,034 children in the year before. So, clearly, resources are getting through to cope with a large number of people, and that is an encouraging sign.
Health Protection (Coronavirus, Restrictions) (Steps and Local Authority Enforcement Powers) (England) (Amendment) Regulations 2021
Baroness Thornton Excerpts(3 years, 5 months ago)
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Baroness Thornton (Lab)
It is regrettable, as my noble friend Lord Rooker said with a certain amount of robustness, that yet again the House is being asked to retrospectively approve significant legislation that impacts on individual liberty, well-being and livelihoods, five whole weeks after it came into effect and after it was further amended, on the day when a new lifting of restrictions is taking place—I suppose we will get to discuss that some time in the next month.
The regulations state that
“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”.
Nothing in the regulations or in what has been said by the Minister today justifies using the emergency procedure to introduce previously announced policy changes at the 11th hour. We are now well over a year into the pandemic and, while we encourage the Government to be proactive and driven by data, that does not prevent or exempt them from following parliamentary procedures. The Minister will be familiar with this repeated complaint.
The countrywide road map for lockdown lifting announced on 22 February advised that England would enter stage 2 on or after 12 April. This date was confirmed at a government press conference on 5 April, yet these regulations were not laid before Parliament until 9 April, coming into force three days later. While that is definitely an improvement on the three hours’ notice that we have had for some regulations in the past, there is simply no excuse for the Government’s continuing indifference to the importance of parliamentary scrutiny.
We have so many errors in the regulations given to us; that is another reason why they need to be subject to proper scrutiny before they become law. According to the Explanatory Memorandum, alongside the stage 2 easements the instrument also makes
“minor drafting changes to remove superfluous wording and to amend references”
in the original steps regulation. I am not sure that these are minor. The Minister will be aware that the JCSI report raised a number of serious concerns about these regulations: first, because of their unusual or unexpected use of enabling powers; secondly, because of defective drafting; thirdly, because they required elucidation; and, fourthly, because they failed to comply with proper legislative practice. Frankly, you would have thought that after a year the Government would have got used to all this, that they would be experts and certainly that they would not be making mistakes in the drafting of legislation.
That is quite a sad list of failures for one statutory instrument whose purpose is to see us safely opening society following lockdown. In one instance, the regulations are so unclear that the Joint Committee said that the law being laid down was unsatisfactory in terms of the rule of law. If a committee of legislative experts is unsure what is or is not meant by certain regulations and does not believe that they give sufficient certainty and clarity, how will the rest of us fare, and how can an average person expect to understand them? This is deeply unfair on those required to enforce the rules and on the businesses grappling to comply so that they can safely resume trading. I fully expect the Government’s use—or misuse—of the emergency procedure and the impact of defective drafting to be covered by the inquiry, but I sincerely hope that the Government will get a grip on this now, especially given the continued threat posed by new variants and the risk of a third wave, which many noble Lords mentioned.
Noble Lords will be well aware that the steps regulations have been further amended, with provisions to move England into stage 3 coming into force today. It is therefore important that the Minister addresses those changes, especially given the growing concern about the B16172 Indian variant in the UK and calls from leading experts to postpone the planned easements. I will not repeat the information given by other noble Lords, because that has been very well covered. However, can the Minister confirm how many people to date have been hospitalised with the Indian variant of concern and how many of those had been partially or fully vaccinated? Over the weekend, the Health Secretary suggested that many coronavirus in-patients in Bolton had not been vaccinated, despite being eligible. I would like the Minister to address how that is being tackled. He has already mentioned that, and I know that my honourable friend Yasmin Qureshi, the MP in Bolton, has been very active on this. Surge vaccinations have been introduced in many hot-spot areas, with some bringing forward second doses and others extending eligibility to younger age groups. Can the Minister confirm whether that is happening and what is the JCVI’s position on this?
It is clear that it was a mistake to delay adding India to the travel list and not to implement a comprehensive hotel quarantine policy. This morning, the Health Secretary, Mr Hancock, said that people should not travel to amber countries except for essential reasons and “certainly not” for a holiday, because of the risk of coronavirus. This is not what the regulations state. The Minister needs to confirm whether the regulations will be updated to reflect the Health Secretary’s comments or whether this is yet another case of the Government’s mixed messaging.
Office for Health Promotion
Baroness Thornton Excerpts(3 years, 6 months ago)
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Lord Bethell (Con)
My Lords, there is already considerable co-ordination between the department, DCMS and DfE on exactly that. I highlight the money that has gone from the tax on soft drinks to contribute to funding outdoor activity in schools, which has had an enormous impact. My noble friend is entirely right that physical activity is linked to better health outcomes; that is why it will form part of the agenda for the Office for Health Promotion.
Baroness Thornton (Lab)
My Lords, the policy paper does not reference the measures proposed in the childhood obesity plan and the recent Tackling Obesity strategy released last July. I hope that omission is not significant. Can the Minister confirm—I was slightly concerned by his response to the noble Baroness, Lady Jenkin—that the ban on online adverts for foods high in fat, sugar and salt has been watered down? In awaiting the consultation from the advertising industry, is that a “whether” or a “how”?
Lord Bethell (Con)
My Lords, consultations are there to have an honest conversation. It would be wrong for me to try to pre-empt the outcome of that consultation from the Dispatch Box.
Northern Ireland: Flight Passengers and Covid-19
Baroness Thornton Excerpts(3 years, 6 months ago)
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Lord Bethell (Con)
My Lords, I recognise the challenge to which the noble Lord refers. It is, of course, a fact that coronavirus restrictions in Northern Ireland are determined by the Northern Ireland Executive as part of the devolution settlement, as I am sure he would recognise. The Secretary of State for Northern Ireland has raised the issue with the Irish Foreign Minister on a number of occasions to press for a resolution, and while the UK Government continue to work closely with the Executive to drive this virus down, we respect that healthcare is a devolved matter. This is a complex issue to resolve, but we are extremely grateful to all parties who are working hard to resolve it.
Baroness Thornton (Lab)
My Lords, the truth is that the Northern Ireland Health Minister, Robin Swann, found out that there were cases of the Indian variant of the virus in the Republic of Ireland only from media reports. This is deeply concerning, as was raised by the noble Lord, Lord Dodds. Northern Ireland is part of the UK, so we have the same responsibilities to our fellow citizens in Northern Ireland and therefore it is very concerning. Is the Minister confident that, going forward, mutually beneficial data-sharing processes are in place to ensure that new variants are controlled and do not become seeded and spread in any of our communities?
Lord Bethell (Con)
My Lords, I am enormously grateful to the Irish Government for the very large amount of informal clinical data-sharing that goes on. CMOs of both countries exchange data on such matters as VOCs the whole time, and that kind of day-to-day clinical exchange of on-the-ground information works extremely well. The specific question of travel information is a lacuna that needs to be closed, I recognise that it needs to be shut, a lot of work is going on to shut it and I am grateful to those involved.
Folic Acid
Baroness Thornton Excerpts(3 years, 6 months ago)
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Lord Bethell (Con)
My Lords, I would be glad to take the noble Lord’s recommendation back to the department; he puts it extremely persuasively. As I said, we have looked at the substantial point closely and it is extremely persuasive, as the noble Lord rightly put it. We hope to come forward with recommendations as soon as the elections are over.
Baroness Thornton (Lab)
I reinforce what my noble friend Lord Rooker said. I may be addressing this with my third or fourth Minister. I am not certain whether the noble Earl, Lord Howe, dealt with it when I was opposite, but he may have done, which would make the noble Lord my fourth Minister on this issue. It is even more irritating that it was research in the UK that led the United States and other parts of the world to adopt this policy. I think The Minister has run out of road on this one, and I would like to hear what the timetable to implement this policy is.
Lord Bethell (Con)
I completely endorse the tribute of the noble Baroness to those who have worked on this policy. She is right: the science that has gone into this has been persuasive around the world. I thank those in industry who worked with us on our pilot, which proved extremely successful. We are in good shape when it comes to thinking through the implementation of such a policy. My hands are tied at the moment, because of purdah, but I hope to return and fulfil the noble Baroness’s wishes.
National Health Service (Charges and Pharmaceutical and Local Pharmaceutical Services) (Coronavirus) (Amendment) Regulations 2021
Baroness Thornton Excerpts(3 years, 6 months ago)
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Baroness Thornton (Lab)
Like my noble friend Lord Hunt, I welcome the purpose of the 2021 regulations, as community pharmacies are contracted and commissioned in England under the national community pharmacy contractual framework, which sets out the services that need to be provided, how quality is assured and other expectations, such as safety.
As has been said, the CPCF is negotiated nationally between NHS England and NHS Improvement, the Department of Health and Social Care, and the Pharmaceutical Services Negotiating Committee. As has also been said, the latest CPCF runs from 2019-20 to 2023-24, but it has not been able to be reviewed, due to Covid. It makes it easier for pharmacies to dispense certain medicines under specific circumstances. If those medications to help treat coronavirus outside hospitals are found, the regulations aim to allow them to be dispensed in such a way as to maximise take-up—this must be the right thing to do.
Community pharmacies makes up one of the four pillars of our primary care system in England, along with general practice, optical services and dentistry. They must often feel that they are the poor relation—the wonky leg on this particular table, perhaps. I will not list all the contributions that they make to our primary healthcare system because that has been adequately covered by many speakers—in fact, all of them, in different ways—in this debate. They are an important feature and fixture on our high streets, in our rural communities and, often, in our supermarkets.
When Covid struck, community pharmacies did not close; they stayed open and served their communities. They continued to deliver medication to people who could not leave their homes. They have been a huge asset to our NHS throughout this whole period; they have been vital. We depend on them at a local level, in both rural and inner-city communities; as people have said, their expertise saves hundreds of thousands of GP and hospital visits. Indeed, the Government have encouraged people to go to their pharmacy before they do anything else—quite rightly.
I support the housekeeping point made by the noble Baroness, Lady Brinton, about the instrument breaching the 21-day rule, with its provisions coming into place before that. The noble Lord knows that a bit of forward planning would be appreciated, but I do not deny it is clear that, because of the rollout of the vaccine, it was necessary to ensure that no one paid for their vaccine, or any treatment in another pandemic situation, to support the maximum take-up of treatment.
However, why would the Government underfund and behave in such a fashion as to undermine and put at risk these businesses? That is the basis for my noble friend’s regret Motion. I have a further question about the uncertainty over the hub and spoke proposals that were in the recent MMD Act: does the Minister have an update on how implementation work is progressing and when we can expect the consultation process to commence?
I finish by asking three questions. Can the Minister advise the House when community pharmacies can expect a final decision on the reimbursement of their extra Covid costs? Like the noble Baroness, Lady Wheatcroft, I agree that the likes of Greensill are not an answer to this. Can the Minister explain why the NHS is refusing to increase investment in community pharmacies to support the NHS? Given the vital role they play, as everybody has acknowledged in this debate, they need certainty about their ability to play their full part in tackling the Covid healthcare backlog, for example. Finally, would the Minister willing to meet me, my noble friend Lord Hunt, other noble Lords, and representatives of pharmacy associations, for instance the Company Chemists’ Association, to discuss long-term funding for this sector?
Alcohol Harm Commission: Report 2020
Baroness Thornton Excerpts(3 years, 6 months ago)
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Baroness Thornton (Lab)
My Lords, I thought I would read out all the recommendations very quickly. They are:
“1. A new comprehensive strategy… 2. Alcohol harm should be a specific part of the remit of the new Domestic Abuse Commissioner … 3. All professionals who have regular contact with children and families must have a core competency to intervene and provide support in cases where alcohol harm is evident … 4. Action to prevent, identify and support Foetal Alcohol Spectrum Disorder … 5. Reduced price promotion of cheap alcohol through increased alcohol duty and minimum prices with regular reviews of prices in relation to inflation and income … 6. Restrictions on availability of retail alcohol through reduced hours of sale and reduced density of retail outlets … 7. Comprehensive restrictions on alcohol advertising across multiple media, including restrictions on sponsorships and activities targeting young people … 8. Alcohol labelling to provide consumers with information about alcohol harm … 9. Treatment and care for alcohol use disorders and co-occurring conditions … 10. Brief psychosocial interventions for people with hazardous and harmful alcohol use, with appropriate training for providers at all levels of healthcare … 11. Action to reduce drink driving”.
Almost every one of those has been mentioned in some way or other during this brief debate, so I hand them all over to the Minister, asking whether the Government agree with them. Will they enact them, and in what timeframe?