Covid-19: One Year Report
Baroness Thornton Excerpts(3 years, 1 month ago)
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Baroness Thornton (Lab)
My Lords, we have had a fascinating debate that has highlighted the price we have all paid for this year of Covid. I will speak to the Motion in my name on the Order Paper, which is the same as the amendment being moved in the Commons by my right honourable friend Jonathan Ashworth. I will also address the statutory instruments.
I have recorded many times from these Benches our huge gratitude to all those who have kept us going throughout this year. I attended the reflection ceremony at the Whittington Hospital on Tuesday where I am a non-executive director. It was held outdoors in the grounds and was attended by many of the individuals in that excellent hospital, particularly the ITU staff who had nursed, saved and been at the side of many local people with Covid. One of those staff is a nephew of mine, who is a junior doctor there. The midwives and nurses were there who had ensured that babies were born safely, with every mother having the birth companion of her choice with her throughout. The children’s accident and emergency and ward staff were also there. They have been safely working with parents and children to make sure that they were still being treated for the serious, and sometimes not so serious, illnesses and accidents that children can have. The porters and the cleaners were there. They do the unseen but vital work. The volunteers and the donors of food and treats were there to demonstrate how much we all appreciate the work, as were the leaders of Whittington Hospital, who have worked tirelessly to organise, deliver and support all of their community so they could do the job they needed to do. They are now exhausted and they definitely deserve a better pay offer. They symbolise for me the way that society at its best has coped throughout this awful year.
I am sure that the Minister has, like me, been looking at the record of our debates on this day a year ago as we ploughed a somewhat lonely furrow here in Chamber with a few of us remaining after the country had gone into lockdown two days before, so that the emergency legislation might be put on to the statute book. The noble Lord, Lord Newby, went down with the virus the day after we rose, and I am happy to say he made a complete recovery. However, those of us who had been around with him for those few days did wonder for a week or so whether we would go down with it too. We kept texting each other asking, “Are you all right?”, but we all seemed to escape it at that point.
At the time, the Prime Minister said that it would last for 12 weeks, and here in the Lords a year ago the Minister claimed that
“Fundamentally, this Bill is about buying time.”—[Official Report, 24/3/20; col. 1649.]
Indeed, the whole country united in supporting that and in delivering the lockdown, providing essential public services and ensuring the protection of our NHS and social care services.
I hope the Minister is not going to say again that the renewal of this legislation is about buying time. The Government have had time, and the sacrifice of the people of the UK has now demonstrated that their sacrifice was worth while through the recovery, and we have to rebuild better. We already know that the number of deaths was more than was necessary and that this was almost certainly due to the delays in decision-making. Each delay cost lives. When we eventually have a proper inquiry, it will spell out the cost of the dithering and delay, and we owe it to the grieving families of those who have lost their lives to get on with it. We also know that the years of cuts to vital services such as public health meant that we were ill-prepared at this time last year. The years of austerity made for a population that was less healthy and resilient when the virus struck. Cuts have consequences and those lessons need to be learned again. The inequalities which have resulted from that were described eloquently by my noble friend Lord Davies just now.
What we need to hear from the Minister today is that the Government have learned the lessons of their handling of the pandemic in the last year. I have much sympathy with the view of the noble Lord, Lord Oates, that the Government have squandered cross-party unity sometimes during the pandemic, which was apparent this time last year and has not been built on by this Government during the course of this year.
We know that the Government will have to account for taxpayers’ money that has been spent, misspent or wasted in the last year. That reckoning is to come. We know that the billions spent on test and trace will have to be accounted for, and lessons will have to be learned, so graphically described by my noble friend Lord Haskel in his remarks. The news today does not bode well, when we learn from HuffPost:
“Private firm Deloitte is receiving taxpayer cash to help ministers to draft parliamentary answers and media ‘lines to take’ to defend the Test and Trace”.
That raises two questions. I always thought that it was at the heart of an official’s job to help Ministers to be accountable to Parliament in a truthful manner. Is it not like marking your own homework if Deloitte is receiving taxpayers’ money to answer those questions? The truth about value for money will emerge through the diligence of the NAO, the PAC and the Select Committees, including those in your Lordships’ House—and I pay tribute to the organs that we already have—and, in time, the Covid inquiry.
At Second Reading a year ago, my noble and learned friend Lord Falconer said:
“Her Majesty’s loyal Opposition support this Bill. In normal times, it would be utterly unacceptable, but these are not normal times. As long as the emergency lasts and these powers are necessary, they should be available to the Government”.—[Official Report, 24/3/20; col. 1653.]
He was followed by almost every speaker across the House a year ago saying that this legislation was inconceivable except at a time of national emergency. Speaker after speaker expressed anxiety that the powers which Parliament was ceding to the Government were huge and accountability for their use must be assured.
So, what happened? As my noble friends Lord Foulkes and Lord Liddle, and other noble Lords have said, Parliament has been marginalised. In this coming year and in future we have to go back to having proper accountability. I decided that, if we were grading the Government on accountability to Parliament, I might be generous and say C plus—the plus being recognition that the Minister has been present on an almost daily basis to account to the House, to answer questions, to take statements and to deal with dozens of statutory instruments, for which we are all grateful. But he has also had to apologise to the House on several occasions for the lack of prior accountability for regulations that should have been debated before they were enacted, and for the number of times we have debated restrictions on our fellow citizens weeks after they have come into play. This is not accountability, and it is not the accountability that the Minister promised a year ago. So perhaps the end of term report might also say “Must do better”—which is what our regret Motion seeks to achieve.
We supported the Coronavirus Act in 2020, and again at the renewal of the Act six months later, and we will support another six months’ renewal of these powers, but we have to say that the Government are absolutely on notice that this is not acceptable any longer. We have to go back to proper accountability. The Act gave Ministers sweeping powers, many of which have yet to be used. We have strongly argued that certain provisions in the Act should be turned off when no longer needed. We accept that some parts of the Act may still be needed; in practice, the health protection regulations contain many of the legal rules around restrictions and mass gatherings, so turning off sections of the Act that are not needed is a most appropriate step and is welcome. Many noble Lords have raised the question of whether it is time for a different kind of legislation. These questions were asked a year ago—the legislation already exists to take emergency powers, so do we not need to go back to using just that?
We will not be standing in the way of legislation, however, that extends the ban on people being evicted and puts statutory sick pay from day one into law. Nobody wants these regulations in place any longer than they are needed, but we must make sure that this is the last lockdown, and that means being cautious.
I turn to the regulations. I understand that the Government intend to continue the provisions in the Act in respect of the power to amend the requirements of the Children and Families Act 2014 relating to education, health and care. According to status reports, these easements have not been officially used by the authorities since July 2020, so will the Minister explain why these provisions have not been removed so that disabled children and young people are able to access the support they need for their education? That is the main point of those. We will support the renewal of the Act today.
On the statutory instruments and the 29 March changes by which six people in two households can meet, can the Minister explain why these regulations expressly exempt protest, picketing and gatherings organised by charities and political groups? This provision is most welcome, but the Minister is aware of the deeply disturbing police response to the vigil for Sarah Everard in Clapham. The Minister needs to explain what the regulations mean by
“any guidance issued by the government which is relevant to the gathering.”
Why was it not possible to make that a Covid-secure gathering at the time? The noble Lord knows that there is great disquiet about this.
Other noble Lords have raised the issue about travel. I think the Minister needs to explain what has become known as the “Stanley Johnson exemption” for travel. I think also, in terms of pubs and beer gardens, the Minister needs to clarify the Prime Minister’s intention on whether people will need vaccine passports to go to their local pub, or even to work in their local pub. This is a good example of ambiguity, and ambiguity feeds the pandemic, as we already know.
In conclusion, we on these Benches continue to support, with a heavy heart, the Government’s effort to deal with the pandemic, as we did a year ago. We are disappointed about many of the issues that were raised in this debate and we want the Government to do better, be more accountable and work towards lifting lockdown, restoring our economy and moving forwards, not backwards. We do not want to go back to business as usual. We need to look forward to building a more equal society. That is our aspiration and our objective. We will continue to hold the Government’s feet to the fire on every occasion. I will not be moving our regret Motion, partly because I think the Government absolutely understand the concerns of these Benches and of the House, and what needs to happen. If the noble Baroness, Lady Brinton, chooses to move the Motion in her name, I will be abstaining and asking my colleagues and the House to do the same.
Covid-19: Resuscitation Orders
Baroness Thornton Excerpts(3 years, 1 month ago)
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Lord Bethell (Con)
My Lords, we will address the audit points made by the noble Baroness. I completely endorse the importance of training; that is at the heart of the report and we acknowledge its importance. We are concerned about the number of people with learning disabilities who have died during the pandemic, and there will be a report on what the connections are.
Baroness Thornton (Lab) [V]
My Lords, we know that it is unlawful for DNACPRs to be imposed, and I wonder why the research has not sought to identify why physicians and care workers continue to impose them in the way that they have. Does the Minister agree that the solution must lie in completely clear, unambiguous policy to advance care planning and DNACPR decisions, and a consistent use of accessible language, communication and guidance to enable clear understanding by commissioners, providers and the public?
Lord Bethell (Con)
I will gently push back against the noble Baroness: the policy is absolutely crystal clear. Blanket DNACPR is not the policy of this Government, as was repeated time and time again in our communications, which I would list if I had more time. Training is the issue: we need to give the front-line workforce the skills it needs to apply these very delicate but critical interactions. That is the recommendation of the report, and that is where we are focused on applying the lessons.
Health and Social Care Update
Baroness Thornton Excerpts(3 years, 1 month ago)
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Baroness Thornton (Lab)
My Lords, I thank the Minister for the Statement from last Thursday. We heartily welcome the rollout of the vaccine and place on record huge gratitude to the scientists from everywhere, the NHS staff—all of them—the local government officials, the pharmacists and the volunteers who have worked so hard and seamlessly to produce such a successful outcome so far. I also take this opportunity to support the AstraZeneca vaccine. I am sure we were all very pleased with the news from the USA, which supports all the scientists in the UK and Europe, that the AZ vaccine is both effective and safe.
However, it was not great news to learn that this amazing vaccine effort will have to slow down due to supply problems, and, I have to say, that did come as a surprise. We have one of the worst death rates in the world and our economy has taken a massive hit. Many key workers under the age of 50—such as teachers and police officers—who through the nature of their work have not been at home, are going out and are more exposed to risk. I imagine that many had hoped that vaccination for them was not very far away. An update on the vaccine supply, particularly on the issues around discussions with the European Union, which seem to have become more fractious, would be appreciated.
But, specifically, what has happened to the Moderna vaccine? I understand that it will start in April. Is there any prospect that, if Moderna supplies come on stream, new appointments can be offered in light of that? Can the Minister assure the House about the second vaccine which many of us await? Will there be sufficient supply and will providing the millions of second jabs delay further the first vaccines for the 30 and 40 year-olds? It seems that the vaccination programme will need to ramp up to about 3.5 million doses a week from May to ensure that everyone under 50 is vaccinated by mid-July. Is the Minister confident that these supply issues will be fixed by May?
Adam Finn of the Joint Committee on Vaccination and Immunisation said that infection rates may rise as a result of the delays. Does the Minister anticipate that any of the stages or dates in the road map for easing out of lockdown will be pushed back, given that we are rightly judging the road map by data, not dates?
There are two other issues that we particularly need to address today. May I ask about the impact of the EU-AZ concern on vaccine hesitancy in the UK? It has been reported that there was a jump in no-shows and people questioning or refusing to go ahead with the AZ vaccine in the last week or so here in the UK.
Many poorer areas today still have the highest infection rates relative to elsewhere in the country, and at the same time their vaccination rates are below average. The worry is that places such as Oldham, Leicester or Hartlepool might be facing a double whammy: they still have high infection rates, but they are not getting the vaccination rates up to the levels needed. Not only will the disease continue to circulate there, with the risk of people catching it becoming severely ill, this also raises the question: will these towns and cities be left behind as the rest of the country eases out of lockdown? Some areas such as Leicester have endured the longest coronavirus restrictions of any part of England, remaining in lockdown since last summer. Closer to home here in London, I understand that in Enfield there are 16,000 people who do not have GPs and are in wards with high levels of poverty, high Covid rates and low vaccine rates—some as low as 55%. What are the Government’s plans to support these areas and ensure that they are not left behind?
Secondly, vaccination centres are detecting a rising number of queue jumpers as Britain prepares to face a four-week jab drought. Officials say that people pose as care or health workers to cheat their way to an early jab and fear that fraudulent bookings will soar before next month’s slower rollout. When the cheats are caught, vaccination slots that could have gone to people entitled to a jab are wasted. In addition, according to anecdotal evidence and the Times article of yesterday, it seems that some centres more recently are not being diligent about requiring proof of the eligibility of the person claiming to be a care worker.
Anyone can fraudulently book a jab on the national booking website by ticking a box to say that they work in health or social care or provide “personal care” for people in their homes. The NHS insists that those who do this but do not bring proof of that to their appointment “will not be vaccinated”. But officials say that the loophole means that rising numbers are trying to exploit a system that is “open to abuse”. Some sites are catching 15 queue jumpers a day and fear that more are slipping through. The problem is that those appointments are lost and those vaccinations wasted. The centres therefore face a “difficult balance” between wanting to avoid wasted doses and appointment slots and rigorously checking ID cards. Bhaveen Patel, who runs a Covid-19 vaccination clinic in Brixton, says that he turns away 15 queue jumpers a day.
Finally, children make up about 21% of the population. That is a large segment of the population who will lack immunity. Obviously, research and trials are ongoing, but does the Minister have a timeline for when he hopes to vaccinate children? Does he anticipate, for example, being able to vaccinate children this autumn, as Anthony Fauci in the US has suggested could well happen over there?
Baroness Brinton (LD) [V]
My Lords, from these Benches I also thank the noble Lord for the Statement given in the Commons last Thursday and thank and congratulate everyone involved in the creation and delivery of all the vaccines so far, and for their continuing work to protect the world against mutant strains of the virus. It is good news at a time when much else is still worrying.
I also start with the availability of supply. Can the Minister explain to the House what guarantee there is for people on receiving their second doses? He has reassured the House before, but I am hearing from GPs worried that they have not had confirmation that they will receive enough doses or that they are getting any supplies at all at the moment, as well as from people who have had their first dose from their GP but who have been told they cannot book their second dose via the online national system because their first dose was delivered by their GP. There are a lot of confused people around.
Today’s news about the EU-UK war of words on the vaccine supply chain gets more bizarre by the hour. Are Ministers seriously considering holding back exports of the special lipids from the UK to the EU as a proposed retaliatory action if the EU holds back doses in the Netherlands? There should not be a war of words but the best possible collaboration to ensure that the “lumpy supply”, to quote the Prime Minister, is smoothed out.
On the issue of queue jumpers, both the NHS and the care sector have an effective ID system that has been in place for some time, although obviously it was probably easier to do when they were in the first group of people to be vaccinated. What are the Government doing to ensure that every vaccine centre understands what they need to see from people presenting for vaccines from the care sector?
On the hesitancy in uptake, I too have heard of the increase in no-shows. What are the Government doing to encourage especially those from the first six groups who have not yet come forward to do so? The publicity campaign that is beginning on reassurance about the AstraZeneca dose is good, as is the test news, but we need much more than that. We know that hesitancy tends to be reduced when people, especially doctors and nurses, talk directly to their patients.
As we have said from these Benches, it is good that the UK is playing its part in funding vaccines via COVAX. However, there is a lot of discussion at the moment that the UK should support TRIPS and encourage the sharing of intellectual property rights of vaccines. I have some concerns about this approach and agree with Professor Sarah Gilbert, who said:
“If another company tries to take the IP and go it alone, they are manufacturing a different product. The regulators would see it as a different product; it would have to go through all the efficacy trials again, and that would be very wasteful and very slow. I want to get rid of the idea that we should be sharing the IP and letting everybody make their own vaccines. It does not work like that. We have a way of sharing the materials and the expertise, and that is what we have been working very hard to do. That is the correct way to do it, because that is how we get the right vaccines to as many people as possible.”
The work of places such as the Serum Institute of India are examples of how this collaboration can work at its best. Can the Minister say what the Government will do to encourage and support more examples of such collaboration worldwide? Can he also say whether the UK Government plan to donate some of the spare doses that they have ordered to less developed countries and on what timescale this might be enacted?
The Statement refers to the end of shielding on 1 April. As a shielder, I have received another long letter from Matt Hancock and Robert Jenrick which says to shielders:
“Until the social distancing rules are eased more widely, it is important that you continue to keep the number of social interactions that you have low and try to reduce the amount of time you spend in settings where you are unable to maintain social distancing. Everyone is advised to continue to work from home where possible, but if you cannot work from home you should now attend your workplace. Your employer is required to take steps to reduce the risk of exposure to COVID-19 in the workplace and should be able to explain to you the measures they have put in place to keep you safe at work … From 1 April you will no longer be eligible for Statutory Sick Pay … or Employment and Support Allowance … on the basis of being advised to shield. Clinically extremely vulnerable pupils and students should return to their school or other educational settings.”
I said last year when I received an almost identical letter that this feels very strange. You are told that shielding ends but you should continue to do all the things you were doing before shielding—unless you were in receipt of SSP or ESA, because that is no longer available for those who have to go back to work in an unsafe workplace. In response to a question about shielding I asked at a briefing the Minister kindly held for parliamentarians with Chris Whitty, he said that shielders who are immunosuppressed should continue to shield unless the results of the OCTAVE clinical trial for immunosuppressed people was available. But it has not been announced yet. There is total silence from the Government, but there are many immunosuppressed people who will have received this letter and think that they are okay to start moving around more.
The end of the Statement talks about safe discharge, and the £594 million for safe discharge is welcome, but is that to go to the NHS or the better care fund, or will part of it go to local government? Is the £341 million mentioned later in the Statement to support adult social care with the costs of infection prevention part of that same £594 million or is it in addition and completely separate? How will that money get to social care providers?
Once again, why is only adult social care getting this funding? Once again, paid and unpaid carers for young disabled people, who are often extremely vulnerable to any infections, not just Covid, appear to be excluded from this grant. Can the Minister please explain?
Health Protection (Coronavirus, International Travel) (England) (Amendment) (No. 7) Regulations 2021
Baroness Thornton Excerpts(3 years, 1 month ago)
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Baroness Thornton
That, while welcoming the Health Protection (Coronavirus, International Travel) (England) (Amendment) (No. 7) Regulations 2021, this House regrets that they were not laid until 15 February despite the warning from the Scientific Advisory Group for Emergencies on 21 January that “reactive, geographically targeted” travel bans “cannot be relied upon to stop importation of new variants” of COVID-19; further regrets that Her Majesty’s Government failed to prevent the Brazilian strain of COVID-19 entering the United Kingdom; further regrets that the policy only applies to 33 “red list” countries and that 99 per cent of passengers arriving in the United Kingdom are therefore exempt; and calls upon Her Majesty’s Government to implement a comprehensive hotel quarantine on all United Kingdom arrivals to prevent the importation of new variants of COVID-19.
Relevant document: 46th Report from the Secondary Legislation Scrutiny Committee
Baroness Thornton (Lab)
My Lords, I very much look forward to the maiden speech of my noble friend Lady Chapman, who I know will bring great experience and wisdom to the House.
This Motion is necessary because of the lack of parliamentary scrutiny and the inadequacy of the Government’s policy for preventing the importation of new variants of Covid-19 from international travel. The Health Protection (Coronavirus, International Travel) (England) (Amendment) (No. 7) Regulations 2021 were made on 12 February—I think the Minister and I agree that it would be really helpful if the numbers of these statutory instruments were put on to the agenda by the House authorities—and came into force at 4 am on 15 February 2021 without any parliamentary scrutiny.
Although the Minister will be aware that the House is concerned about the use of the emergency “made affirmative” procedure for coronavirus regulations, in this instance the Government have gone one step further by using the “made negative” procedure to introduce the powers contained in these regulations, which requires a debate—a Motion to debate them at all. Frankly, there is no emergency here, just a lack of prompt decision-making over a year when the regulations could have been in place and could have been properly debated and scrutinised. Given that the regulations create a system of mandatory quarantine backed by criminal sanction, give the police power to enter people’s houses and allow individuals to be detained, searched, and their belongings seized, these are not minor changes in the law and should not have been enacted without proper scrutiny.
Furthermore, the regulations were laid before Parliament fewer than three days before they came into force. This is a breach of parliamentary convention that a negative statutory instrument will not come into force until 21 calendar days after it has been laid. Laying these regulations under the emergency procedure at the supposedly eleventh hour, as so many other coronavirus regulations have been made, means that individuals and businesses affected by hotel quarantine had less than one working day to get to grips with the details of the scheme, raising several rule-of-law concerns surrounding the accessibility and foreseeability of the law. The Minister needs to explain to the House why these regulations were laid under the “made negative” procedure and the use of urgent powers.
I hope that the House will understand that we on these Benches do not oppose the introduction of hotel quarantine—quite the contrary—but that my Motion highlights serious concerns about the inadequacy of the scheme. Thousands of people are travelling from countries where South African or Brazilian variants of Covid-19 are circulating which are not on the Government’s red list. These people—roughly 19 out of 20 passengers—will avoid hotels and are being asked to quarantine at home, and yet only three out of every 100 people are being checked to ensure that they are complying. Is that enough, given the serious threat?
So far, the South African variant of the virus is not spreading rapidly in Britain, with 351 known cases, but there are fears that this could change as lockdown is eased. Given that we understand that both variants have the potential to resist vaccination, the Government’s failure to secure our borders risks jeopardising the fight against Covid-19 just at the moment when it looks like we are making significant process.
The Prime Minister has said in the last 24 hours that we
“can see sadly there is a third wave under way. People in this country should be under no illusions that previous experience has taught us that when a wave hits our friends, it, I’m afraid, washes up on our shores as well.”
So it is even more pressing, given Covid cases in many European countries and the inherent threat that this poses to the UK. Surely the Government’s first priority must be protecting the progress that is being made by the vaccine. This means we need a comprehensive hotel quarantine system without delay.
In addition to concerns about intermingling in transit and people failing to self-isolate on arrival, there are also major concerns about the enforcement of the policy. There has been much discussion regarding the creation of new offences punishable with up to 10 years’ imprisonment and £10,000 fixed penalty notices. As the Bingham Centre notes, the Government’s messaging has been misleading, and misleading statements of the law undermine the rule of law by creating confusion about what the law is. The reality behind these bombastic policy headlines is that there is very little emphasis on compliance and enforcement.
The JCSI has drawn attention to the related Health Protection (Coronavirus, Pre-Departure Testing and Operator Liability) (England) (Amendment) Regulations 2021, which introduce requirements for the operators of commercial transport services to ensure that passengers travelling to England from outside the common travel area complete a passenger locator form and possess notification of a negative test result. However, the Committee found that operators are not required to verify that the reference number is real or valid, as real-time verification would impose a significant burden. The report stated that
“legislation is not the place for the expression of hopes and requests”—
it is an obligation.
These regulations are due to expire at the end of the month. Can the Minister confirm that they will be, at the very least, extended to give non-essential travel bans in the UK, and that those coming to the UK must self-isolate or quarantine? We agree that it is too early to say whether there should be any changes of travel advice on 17 May. I hope that the Minister can assure the House that the Government will be led by the science and will heed the advice of their advisers to move forward. I beg to move.
Baroness Thornton (Lab)
I am assuming that the Minister is asking me to withdraw my Motion, albeit in a very kind way. I first say how much I enjoyed my noble friend’s maiden speech and how pleased I am to see her here, even if she cannot be down the other end of the corridor.
Given the support of the noble Lord, Lord Robathan, I cannot decide whether my noble friend Lord Hunt and I are more or less concerned, but I am always happy to accept support from wherever it comes. I am grateful—mostly—for all the contributions that noble Lords have made, and I thank the Minister for answering the questions with such detail and diligence. I thank my noble friends Lord Hunt and Lord Blunkett, who raised important and relevant questions, and pointed to the inconsistencies.
I am of course going to withdraw this regret Motion, but I need to put the Minister on notice. Statutory instruments No. 8, No. 9 and No. 10 are already down, and I think that we can expect No. 11 by the end of this week. I may not be quite so generous next time, because the only way that we can discuss these SIs is if someone in this House puts down a regret or take-note Motion. I am perfectly happy to accept that responsibility, but I might not be quite so generous as to withdraw it. I beg leave to withdraw the Motion.
Covid-19: Government’s Publication of Contracts
Baroness Thornton Excerpts(3 years, 1 month ago)
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Baroness Thornton (Lab)
My Lords, the Minister will be aware that 100 contracts remain unpublished, while those that have been published are so heavily redacted that it is impossible to ascertain whether the orders reflect value for money for the taxpayer. Procurement guidance, which is still in force, says that once the contract is commenced, most of the contact details should be released and that only detailed pricing arrangements should be redacted and not much else. Indeed, Cabinet Office guidelines say:
“The government is committed to greater transparency across its operations … This includes commitments relating to public procurement.”
Can the Minister explain to the House and propose how meaningful transparency can be achieved to give effect to the Government’s stated policy?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, with regard to the publication of contracts, the number of contract award notices that have been published is 609 out of 609. For contract finder notices, it is 892 out of 913—97.7%—and of the redacted contracts to which the noble Baroness refers, it is 792 out of 913, which is 86.7%. That is an enormous proportion of the contracts that exist that have already been published. The redaction is utterly according to Cabinet Office guidelines. I encourage the noble Baroness to have a look at them; it is remarkable how much detail there is in those contracts as they are published.
NHS: Pay
Baroness Thornton Excerpts(3 years, 1 month ago)
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Lord Bethell (Con)
My Lords, I completely endorse the right reverend Prelate’s point about the heroics of—and the debt that we owe—nurses, but I just cannot agree with him that the best way of recognising the contribution of nurses is to give them a pay increase. That simply is not my experience of workplace engagement. Yes, pay rises are important and a recognition of work done, but there are other, much more important reasons why people work. They work for the status of that role, for the opportunities that it gives them in their life, for the security that it gives them and for the collaboration of working with fellow members of staff. There is a whole package of reasons why people do the work that they do. We live in extremely economically challenging times. It is right that the advice given to the pay review body looks at the entire package, not just at the pay increase.
Baroness Thornton (Lab)
The Minister is quite right: it is not just about the 1% rise. A newly qualified nurse will earn £21,000 in 12 months; that is their starting salary. The consultants building the track and trace system, at £7,000 an hour, earn more than that amount in under four hours. Perhaps that will help the Minister understand why so many people are outraged at the proposed 1% so-called pay rise. Will he explain to the House what values and priorities he holds that lead him to believe that the Government’s decision is an acceptable one?
Lord Bethell (Con)
My Lords, the noble Baroness makes some vivid comparisons on completely incomparable pay differentials. The values that we have are absolutely aligned with public service values. We are determined to create a workplace that is just, fair and equitable. We are committed to giving people a fair reward for the work that they do and to giving people decent job prospects within that role. Those are the values that people go to work for and are motivated by. We need to put together a package that works across the piece and is not narrowly focused on one particular material point, such as pay. I stand by what I said previously: the package of measures that was put in our evidence to the pay review body sees all those values in the round.
World Health Organization: Pandemics
Baroness Thornton Excerpts(3 years, 1 month ago)
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Lord Bethell (Con)
My Lords, we are extremely hopeful for the IPPPR process, and we have supported the team in its desire to get to the bottom of its investigations. I do not know the specifics of the bat viruses to which my noble friend refers, but I reassure him that the British Government are leaning on the WHO as hard as we possibly can to make the most of this important investigation.
Baroness Thornton (Lab)
Given the cuts to the aid budget which have been announced, and given that experience shows that the world’s reaction to pandemics is to panic and then forget—which Covid-19 has cruelly exposed—can the Minister expand on how HMG are going to support the World Health Organization to address the immediate urgent work to fight the pandemic and to build for the future the firepower and structure to better handle an issue of global magnitude under the Government’s current budget constraints?
Lord Bethell (Con)
My Lords, the financial support of the WHO from the Government is generous, and so is our support of COVAX. When it comes to the WHO, we are looking for stronger horizon scanning and early warning, higher-quality technical guidance that is tailored to different countries and resource settings, and greater co-ordination of governance and activity across the animal, human and environmental interface. This is a really clear manifesto. The Prime Minister has laid it out clearly, and we are using the G7 process to ensure that there is support for it across the G7 countries.
Women’s Health Strategy
Baroness Thornton Excerpts(3 years, 1 month ago)
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Baroness Thornton (Lab)
My Lords, we welcome this Statement, made yesterday on International Women’s Day. We believe that the six pillars it outlines are important signals of the need to take women’s health very seriously. It is welcome that the Government want to understand the plight of women throughout the country. However, although the Statement says that this strategy is the first of its kind, that is not the case. For example, when the Government launched the women’s mental health task force in 2017, the Minister responsible for mental health at the time, the honourable Member for Thurrock, Jackie Doyle-Price, said:
“This report is a call to action for all providers, commissioners and practitioners across the health care system to drive forward the ethos of trauma- and gender-informed mental health care.”
That is absolutely right, but we have to ask: why are the Government asking exactly the same questions four years later? The three matters that I want to raise with the Minister are: the questions that arise out of the effect of Covid on women’s health and well-being; the troubling matter of breast cancer and sexual health; and the implementation of the recommendations of the Cumberlege report.
Analysis of Covid-19 data from around the world suggests that men make up a higher share than women of reported hospitalisations, intensive care admissions and deaths, but the impacts of the pandemic extend far beyond health outcomes for people who have been infected with the Covid virus. There have also been significant economic impacts from measures adopted to control the spread of the virus, and those have affected women in specific ways. For example, what support can be offered to a woman who experiences baby loss without her partner by her side?
The Statement is right to highlight the fact that black women are four times more likely to die in pregnancy or childbirth. I welcome the launch of the forum but the Government have known about these inequalities for many years. Now we need to see some actual investment and action.
Covid-19 has worsened the mental health crisis among young women in the UK. Before the pandemic, young women aged 16 to 30 had the worst mental health of any age and gender group in the population. In the last 12 months those in this same group have experienced a bigger fall in their mental health than any other. The mental health of teenage girls and young women is now a very serious health issue. This will need some investment and attention in the call for evidence launched yesterday.
I turn to the issue of working mothers and the increase in the burden of care. The Government were quite rightly criticised for their sexist “Stay at home” advert depicting women doing schooling and housework. I am very glad it was withdrawn at short order. But this is the reality of the lockdown in many households with young children. The pandemic has revealed stubbornly persistent gender stereotyping in the division of domestic labour. It has shown that men and women are not equal when it comes to unpaid childcare and housework.
Before the pandemic, women did more than 60% of home childcare. When schools and childcare closed during the first lockdown, they took on roughly the same share of the massively increased burden of additional care. Evidence from the ONS indicates that women have taken on even more of the burden of home-schooling during the 2021 lockdown. Two-thirds of mothers, compared with half of fathers, report that they have personally home-schooled their children. Half of those who have done home-schooling report that this has negatively affected their mental health and well-being.
Looking at older women, before the pandemic, those aged 70 and above enjoyed a relatively high level of mental health compared to the population as a whole. But they have experienced one of the biggest falls, far greater than that of older men. An important factor is of course that older women are likely to experience a higher level of bereavement, since older men have a higher risk of death from Covid-19. We have seen a higher level of grief following deaths, with the inability to say goodbye to loved ones. The cost of grief has received relatively little attention from economists, with some notable exceptions, but it is a very important factor in the mental health of older women in our society. The cost of grief needs to be factored into this inquiry.
Women are still being misdiagnosed in 2021, with male bodies being seen as the default body. There is a huge historical data gap in understanding women’s health needs. It is shocking that women are 50% more likely to be misdiagnosed following a heart attack, simply because their symptoms differ from those of men. The research of the government commission needs to bridge that divide.
I turn to breast cancer specifically. Almost 11,000 women in the UK could be living with undiagnosed breast cancer because of the Covid-19 pandemic, according to new analysis by Breast Cancer Now. It says that 10,700 fewer people were diagnosed with breast cancer between March and December than one would have expected. That data has to be factored into this commission of inquiry.
I turn now to women’s sexual health. Jo’s Cervical Cancer Trust said that
“600,000 tests failed to go ahead in the UK last April and May … in addition to a backlog of 1.5 million appointments missed annually.”
Thousands of IVF cycles were cancelled or postponed in the early stages of the pandemic, with many clinics then facing a backlog of patients. Again, this needs to be factored into this research.
One of the most potent symbols of how the health service fails women is that identified in the report of the noble Baroness, Lady Cumberlege, First Do No Harm. It shows decades of women being ignored and dismissed by the medical profession and all of those in it. The report talked of the
“disjointed, siloed, unresponsive and defensive”
health service not adequately recognising the needs of women over decades. Surely the best way to mark International Women’s Day would be to commit to implementing all the recommendations in that report, would it not?
Baroness Brinton (LD) [V]
My Lords, the warm words in this Statement regarding women’s health inequalities are certainly a start, but there is so much to do. Many of us in your Lordships’ House have been working on the Domestic Abuse Bill, where looking at access to health and mental health support for victims—the vast majority of whom are women—has exposed that there is a major problem.
Mental health has been brought into sharp relief, as the noble Baroness, Lady Thornton, has already said. But we know that it has been underfunded, and services pre- pandemic were already at breaking point. The pandemic has really exposed these shortcomings. What are the Government going to do to provide that parity of mental health services they committed to in 2015, which women in particular are finding difficult to access?
The Statement talks about women’s experiences of specific services. For pregnancy and maternity support, the pandemic exposed that, for far too long, pregnant women have been isolated and their partners not permitted to be with them. My own niece had a baby during lockdown and was not particularly well. When she went in for her weekly tests, not knowing whether she would have to stay in until the birth, her husband was not allowed into the hospital with her until she was actually in the delivery suite. That caused tension for far too long.
We have also seen that the vital role of health visitors and community nurses, which has been curtailed somewhat, is absolutely evident when they are not there. Community services for young mothers are really important, and I hope the Government will look at that.
The Statement talks a lot about endometriosis. I was diagnosed with endometriosis well over 40 years ago. I am pleased to say that treatment in hospitals has advanced considerably since those days. But what seems not to have changed is diagnosis and referral. I ask the Minister this: what support is there to train all GPs, primary care nurses and employers to recognise when women have these problems? They should not be dismissed as “a bit of a bother” because all women have a problem at that time of the month. It is not just an information issue for women themselves to recognise it. We need the professionals and the business community to understand that endometriosis is a very serious illness.
The Statement notes that
“77% of the NHS workforce and 82% of the social care workforce are women”.
They are absolutely on the front line but too often have been let down. Despite that enormous ratio of women in the workforce, there are still pay gaps—certainly at a higher level. It would be interesting to see the publication of the percentage of male and female staff at each level and for all trusts and CCGs to publish their pay gaps on an annual basis, as we ask large companies to.
We also know that a higher percentage of BAME women were at risk of serious Covid and death. This was particularly amplified for our front-line NHS and social care staff.
I echo the points raised by the noble Baroness, Lady Thornton, about caring responsibilities. It is not just about care for children who are home from school. The pandemic has brought into sharp relief the unpaid carers of adult family members. I would like to make a call out, and I hope the Minister will support me: when it is time for every one of us to fill in our census form in 10 days’ time, please will unpaid carers tick the box saying that they are carers? We need to know how many people out there are doing this. We know that the majority of them are women.
The Statement talks about issues facing women with disabilities. Yesterday, it was wonderful to see a series of tweets from disabled women about their lived experiences in our society. Some of it, especially on access to health services, was pretty depressing too.
Women with learning difficulties are also often at the end of the queue for health treatments. Ciara Lawrence, who is a Mencap ambassador, is an absolute shining example of how women with learning difficulties can get access to those services. She went for her cervical smear test a year ago. Since then, she has not only been promoting it among other young women with learning difficulties but is teaching the NHS how to work with women with learning difficulties to encourage and support them to have their tests. Women with learning difficulties also say that access to family planning services can often be harder too. Will the Government make sure that these issues for this group of disabled women are addressed?
The paper refers briefly to LBGT women, who also face particular difficulties in accessing services throughout their adult lives. What will the Government do to reach both these groups? I note that, towards its end, the Statement talks formally about working with women’s organisations, but so much will be missed if women who also have other protected characteristics—and their organisations—are not specifically asked.
Covid-19 Update
Baroness Thornton Excerpts(3 years, 2 months ago)
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Baroness Thornton (Lab)
My Lords, I thank the Minister for this Statement. I agree with the Statement in congratulating the NHS on its rollout of the vaccine, which continues to be a huge cause for optimism and hope, as does the science and research, in which the UK has played a leading role. However, we are still the country that has the third highest number of deaths in the world, at 124,000. Given the success of the vaccine and the strength of our science base, that is dismal. It must at least in part be attributed to decisions that the Government have taken or not taken, the failure of test and trace to do the job that we need it to do and the porous nature of our borders, on which we have again seen decisions taken too little, too late.
The concern about new variants means that, if the UK does not get on top of them, the valiant efforts of our NHS, our scientists and the vaccine could be terribly undermined. In January and February, cases here were running at tens of thousands a day and we were in lockdown, as we still are, because of our home- grown, new infectious variant. Nevertheless, people were allowed to fly in from abroad, bringing the P1 Brazilian mutation with them. Throughout history, epidemic after epidemic has exploited international travel. Surely it is obvious that tougher border controls should have been in place sooner.
The Brazilian variant cases arrived a month ago. They showed the problems of delays as well as the limitations of the pre-travel tests that did not catch those cases. Even now, 99% of the 15,000 daily arrivals are not covered by hotel quarantine. Most people can still travel home from the airport by Tube, train or even plane, mixing with others, as some of these travellers did, without being tested on arrival in the UK. Why are the Government still refusing to introduce additional tests on arrival and still allowing international passengers to travel onward on UK public transport? Does the Minister recognise that those gaps in the system will let more new variant cases spread? Is it also the case that there is a risk of cross-infection at airports where congestion is occurring? I understand that yesterday there were queues that lasted for several hours at Heathrow. What are the Government going to do about this? It is shocking that people are mixing, having arrived from a list of countries at risk, instead of going straight into hotels for isolation.
Of course, I welcome the progress that the Government have made in identifying the batch of tests from which that of the missing infected person came, but how on earth can a test be processed that does not collect contact details? What mechanisms have been put in place to fix that for the future? Some £22 billion have been allocated to this system, but it feels as though someone has vanished into thin air. How is the hunt for this person proceeding? Can the Minister assure us that this will not happen again?
Is there any information suggesting why this variant is spreading? The Minister might recall that John Edmunds from SAGE told the Home Affairs Select Committee in January that for every identified South African variant case, there were probably another 30 that had not been identified. Can the Minister tell the House, therefore, whether he has received any estimates of the number of unidentified cases in the wider community?
We are in a race against the evolution of this virus, so we have a long way to go. To be frank, nowhere is Covid-safe until everywhere is Covid-safe. None of us wants to yo-yo in and out of lockdown, so will the Minister guarantee that the lockdown easing will, as promised, be absolutely based on data, not dates, and that the assessment time between each step will not be compromised?
I welcome the extra surge in testing, but what is the current timeframe for genetic sequencing? How can it be speeded up? What steps will be taken to ensure that areas such as Ashfield, Leicester, Watford, Worthing and Hyndburn are not left behind when the national lockdown restrictions begin to lift, or will those places be put in localised lockdowns? Will the local authorities there be given extra resources to do more door-to-door testing and retrospective tracing? Will workplaces in those areas be inspected by the Health and Safety Executive to ensure that they are Covid-secure? Will people finally be given decent sick pay and isolation support?
On the Budget, it beggars belief that it did not include any detailed plans for the NHS. Indeed, the OBR highlights this, saying:
“The Government’s spending plans make no explicit provision for virus-related costs beyond 2021-22, despite its Roadmap recognising that annual vaccination programmes and continued testing and tracing are likely to be required.”
We know that the last reorganisation of the NHS cost £3 billion and that does not seem to have been put into the Budget either. Can the Minister explain how the NHS will catch up with the enormous backlog that has been created, as well as the ongoing pandemic-related costs? This is an urgent question.
It has also emerged that the Government appear to have delayed social care reforms until 2022, with the Chief Secretary to the Treasury, Stephen Barclay, telling campaigners that plans for sustainable improvement will only come next year. In January, the Prime Minister told Parliament that the Government would bring forward plans later this year, so will the Minister confirm whether it is this year or next year or when they actually intend to launch reforms on social care?
Baroness Brinton (LD) [V]
My Lords, from these Benches we, too, congratulate everyone involved in the vaccination process, including our brilliant teams of scientists, both in this country and abroad, who have been working—and continue to work—tirelessly on safe and effective vaccines for the world. We also congratulate the teams who are organising and managing the supply chains and all of those on the front line delivering jabs in arms, or supporting them to make it possible to reach the target of 20 million doses achieved this week. We will also not forget everyone working on Covid at the moment, whether front-line staff in health and social care or back-office staff who may not be visible to us but who are making sure that all these processes are working. We thank them all.
It is reassuring to hear that the second jab supply chain has been factored in, but can the Minister please tell the House if the supply chain and vaccination dose capacity is also protected for the next priority groups due to receive their first dose? This is critical to lifting lockdown.
It is good news that the clinical trials under way since before Christmas are demonstrating that the over-80s are developing good antibodies to resist the coronavirus and that this is now evident in the data. It is fascinating to see the vaccine gap in graphs, showing that there is a much steeper decline in cases in the over- 75s than there is in the under-60s. It is also encouraging to see reports that there have been very few side effects to both the AZ and the Pfizer vaccines. Can the Minister say if this information will be used to encourage those who have so far refused their first dose?
The Octave trial, funded by the Medical Research Council, is now under way, assessing whether those people with compromised immune systems are able to make antibodies. It was reassuring to read the details of this trial from some participating universities and university hospitals and I am grateful that Professor Chris Whitty was able to outline this project in a briefing to parliamentarians recently. I had understood it to be well under way already, although the press release makes it sound as if it is much more recent and still recruiting. Can the Minister say when the Octave trials are likely to publish their results, given that many people currently shielding are anxiously waiting for them?
The Statement refers to the Brazilian P1 variant and to the case of the individual who had not completed their form correctly. There has been silence over the last couple of days, and I wondered whether the Minister could update the House on the search for this individual. As I raised earlier this week, can the Minister help the House to understand why such an issue was able to happen at all? Is it correct that there are no processes in place to ensure that, as people come into the UK, border agency staff check their passports against the online forms completed in advance, so that personal details, such as addresses, are visible? The noble Lord, Lord Balfe, made it plain—as have many others travelling into the UK—that these checks are rarely made, if at all.
Is it correct that local health and resilience forums are not given any details of people quarantining in their areas? This is important to ensure that care support teams would be able to check and provide help for those quarantining if they have any concerns. That might have helped with this particular case: a traveller from Brazil feeling unwell would have had a local contact to talk to about what to do.
Finally, as we wait to see if cases, hospitalisations and deaths have reduced enough to start lifting lockdown carefully in April, can the Minister respond to the report published today showing that test and trace has barely used the check-in app data from visitors to pubs, restaurants and hairdressers, resulting in thousands of people who have been checked in not being warned that they might be at risk of infection? The report states that the Department of Health and Social Care has noted that more than 100 million people have checked into venues since it went live in the autumn, but only 284 alerts have been sent to 274 venues—not 274,000 venues, just 274. Worse, the report says that the lack of guidance for local resilience forum trace teams on how to use the data has left businesses being asked to, or volunteering to, contact customers and visitors, which is technically a breach of GDPR and leaves those businesses and venues open to potential legal challenge.
After spending £40 million on the contact tracing app, encouraging the public to act responsibly, and the department saying today:
“The NHS COVID-19 App is an important tool in our pandemic response”,
can the Minister tell us which of these statements are true? Can he confirm that the guidance given to local authority health departments on how to use the data to notify people from the app is in full compliance with GDPR legislation? Is the figure of only 274 venues receiving alerts correct—yes or no? What steps are the Government taking to remedy this before pubs, restaurants, hairdressers and non-essential retail begin to open again?
NHS: Staff Numbers after Covid-19
Baroness Thornton Excerpts(3 years, 2 months ago)
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Baroness Thornton (Lab)
I congratulate my noble friend Lord Clark on this debate. He is such a great champion of nurses; they could not have a better one. I also echo the request by the noble Baroness, Lady Bennett. Why not have a pay rise for nurses, paramedics and other NHS staff? It is a bit of a slap in the face not to have one.
At least 230 NHS staff have died during the pandemic, while thousands have been on long-term sick leave as a result of working on the front line. The Government have often cited their success in recruiting new nurses, saying that record numbers are working in the profession. However, the number of unfilled nursing posts in the NHS has barely changed. Can the Minister explain why there is not a publicly available, fully funded, long-term workforce plan for the NHS and social care to boost the numbers of nurses and NHS staff? I am sure that he would agree that the workforce remains key to the next phase of dealing with the pandemic and its aftermath.