Covid-19 Update

Baroness Thornton Excerpts

Thursday 4th March 2021 Lords Chamber

[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?

Independent Medicines and Medical Devices Safety Review: Sodium Valproate

Baroness Thornton Excerpts

Tuesday 2nd March 2021 Lords Chamber

[Lord Bethell (Con)]

I am grateful to the noble Baroness for her tribute to my noble friend Lord O’Shaughnessy, who has done an enormous service to us all by championing this cause, both as a Minister, when he moved this review and made a huge impact, and since then with his patient and thoughtful advocacy of this important cause. He speaks very movingly and thoughtfully, and we are greatly influenced by his persuasion on this subject. The noble Baroness should be reassured that we are absolutely looking at the recommendations for a redress agency, and we will come back with considered thoughts on it when we answer the review in the round. Until then, I welcome all thoughts and advocacy on the subject.

[Baroness Thornton (Lab)]

I have two points. First, last summer only 41% of the respondents taking valproate said that they had signed an annual risk acknowledgment form, so I would like the Minister to reflect on the fact that some GPs are not doing the job that they should be in terms of protecting women. Secondly, those affected by thalidomide and contaminated blood have a redress scheme, but it took years for that to happen. We simply cannot wait years for this to happen for those suffering from the effects of sodium valproate.

[Lord Bethell (Con)]

My Lords, I welcome the noble Baroness’s point on the proportion of those who say they have filled in the form. Phase 1 of the registry is a helpful collection of statistics, but we are putting in place phase 2, which will help us to understand exactly how many patients who are taking sodium valproate have actually filled in the form. That will give us the concrete reassurance that we seek on this matter. I recognise that there are redress payments for thalidomide and contaminated blood, but redress payments are not necessarily suitable for every single misfortune that happens in the medical world. However, we will look very carefully at the case for sodium valproate and I take the noble Baroness’s comments on board.

Covid-19: Brazilian Variant

Baroness Thornton Excerpts

Tuesday 2nd March 2021 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government what assessment they have made of the risk of the P.1 Brazilian variant of COVID-19.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, the challenge we have is uncertainty. Genomic sequencing data links the Brazilian variant to the South African variant, the so-called E484K mutation. We also acknowledge that there are anecdotes from Manaus on transmissibility, but none of this is clear cut. We are working towards getting the concrete data necessary to make a confident assessment of this mutation. Therefore, we are taking a precautionary approach and we are committed to limiting its spread by all means at our disposal.

[Baroness Thornton (Lab)]

I thank the Minister. According to a report by the World Health Organization, the P1 variant that originated in Brazil has been found in at least 15 countries which are not on the Government’s red list, meaning that arrivals from those countries are currently exempt from the hotel quarantine policy. Virologists have warned that the Government’s red list is at risk of becoming out of date at any time because of the time it takes to sequence coronavirus cases. Indeed, these six cases date back to 11 and 12 February. In the light of these facts, and given concerns that the Brazilian variant may be more transmissible and might be resistant to existing vaccines, will the Government review the red list and take urgent action to introduce a comprehensive hotel quarantine system that applies to all UK arrivals?

[Lord Bethell (Con)]

The noble Baroness is entirely right: this is not the first case of P1 in Europe. As of 11 February, P1 has been identified in 17 countries, with 200 cases reported globally. In the EU, 30 cases have been identified in five countries and areas. We keep the red list under permanent review and have an ongoing process of keeping it up to date. The fact that we have a red list and a managed quarantine programme makes further expansion of the red list possible. It puts our borders and our vaccine under a programme where we can control things, which is to be applauded.

Covid Contracts: Judicial Review

Baroness Thornton Excerpts

Monday 1st March 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, a year ago, Parliament gave the Government huge power so they could act quickly in the face of the pandemic. Unfortunately, growing evidence suggests that Ministers have taken advantage of these powers to the disadvantage of the taxpayer and to the cost of health workers and patients. The NAO report in November revealed that the Government set up fast-track systems for billions of pounds of contracts for people personally known to Ministers, Peers and MPs. They found that suppliers with links to politicians were 10 times more likely to be awarded contracts than those who had applied to the department in the normal way.

It looks like there is more to be explored here: not just a case of “delayed paperwork” as the Health Secretary has claimed but serious procurement rule breaches. Will the Government urgently publish the names of all companies awarded public contracts through the VIP lane and how much they were paid? What steps are the Government taking to recover millions of pounds of public money from companies which failed meet their contractual obligations?

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, I am grateful for the question from the noble Baroness, Lady Thornton. During those hectic days, more than 15,000 suppliers approached us. Many of them were credible, but many sadly were not. It was entirely right and the best practice to have a high-priority lane to triage and prioritise those who were the most credible. A sample of 232 suppliers in that lane reveals that 144 came from Ministers, 21 from officials, 33 from MPs and 31 Members of the House of Lords not in the Government—including many who chose to write to me personally with the names of recommendations. I am enormously grateful to those who got in touch.

Health Protection (Coronavirus, Restrictions) (All Tiers and Self-Isolation) (England) (Amendment) Regulations 2021

Baroness Thornton Excerpts

Monday 1st March 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, we will be supporting these regulations, but I have a few questions. I just have a request to the House authorities, and I hope the Minister might support me on this. When these statutory instruments are published, could the House authorities put the SI number on the agenda—the green sheets—because, as several noble Lords have mentioned, we are dealing with dozens of them? Those of us who do not have massive offices to support us have to dig into them to work out which statutory instrument we are approaching. I know that one noble Lord made a speech about these regulations the last time we had a debate about regulations, simply because no number was on them. That was just a request.

The regulations were laid before Parliament at 11 am on 29 January, under the “made affirmative” procedure, and came into force at 5 pm the same day. Could the Minister clarify why the Government felt the need to introduce them at such haste, without parliamentary scrutiny, when, as other noble Lords have said, we are discussing them more than a month later? If they were needed so urgently, it begs the question why it has taken so long to introduce them, a year into the pandemic.

This instrument amends the self-isolation regulations to provide the police with sufficient information to verify the identity of an individual, a copy of the notification sent to the individual informing them of the legal duty to self-isolate and why, following a positive test or contact with an infected individual. Regulation 4(4) limits the use of this shared information to

“the prevention, investigation, detection or prosecution of offences under”

the self-isolation regulations. The Department of Health and Social Care states that the disclosure of this information, for these reasons, is proportionate and in line with Article 8 of the European Convention on Human Rights and the Data Protection Act 2018.

Could the Minister advise the House of whether those notified by the app to self-isolate will be covered by these regulations? They were not covered by the original self-isolation regulations, which was probably an oversight, but if that has not been rectified, can the Minister explain why not?

Further, can the Minister clarify whether the regulations extend to those who have been advised by an individual in their household to self-isolate? Other noble Lords have raised that question: what is the legal liability for people in that household who might have to tell them—it may just be a flat-mate or someone they share a lease with—that they also have to self-isolate?

Regulation 2 changes the all-tier regulations to introduce a new fixed penalty notice for each individual who attends a gathering of more than 15 people. I ask the Minister on what scientific basis the magic number of 15 was arrived at. Do gatherings of 14 not attract fines? We had a similar debate about the rule of six and whether six was plucked out of the air. I would be grateful if the Minister could clarify whether children are included within that 15.

Several noble Lords questioned the issue of sharing data and expressed concern, about both how the data that are being collected will be used now and how soon they will be eliminated and will not be accessible to the police or anybody else. The heart of that question is public trust. We need assurances that sensitive health data will be kept private. Many people could be unwilling to take a test or engage with the department’s contract tracers, particularly if there is a threat of harsh punishment if we are not given those reassurances. The British Medical Association is also concerned about this.

There are concerns about the broad definition of who the information may be shared with. It can be provided not only to the police but to anyone else the Government enlist to uphold the rules. Could the Minister advise us who exactly is entitled to receive this information? For example, are volunteer Covid marshals permitted?

We are now in our third national lockdown—the longest to date. It is a very challenging situation, requiring the public to stay at home and away from their friends and family. There has been much talk about personal responsibility but, as many noble Lords have said, including my noble friend Lord Hunt, it is incumbent on the Government to do the right thing by the people who are co-operating with this and to ensure that there is appropriate support for self-isolation.

For many months, the Government have known that rates of self-isolation remain too low. The noble Baroness, Lady Harding, confirmed that 20,000 people a day were not self-isolating when they should be. This is unsustainable if we are going to see success from some of the relaxations of the current measures, which we all want. The rates at which Covid-19 cases have fallen this year are dramatically lower in some of the UK’s poorest regions compared to the wealthy ones, so does the Minister accept that this is a consequence of the failure to offer financial support to help people on lower incomes with the self-isolation requirements? This has been mentioned many times: the £500 test and trace support payment is not reaching enough people. Seven out of eight people do not qualify for it, so they will simply not get tested. If they do, they may just disappear, and that helps nobody.

Covid-19: Vaccination Programme

Baroness Thornton Excerpts

Wednesday 24th February 2021 Lords Chamber

[Lord Bethell (Con)]

We have to work with what we have. The existing register, while not perfect, is the tool that we have for our task. GPs had been encouraged to update registers in advance of the vaccine, as we had several months of knowing that it was coming. I understand that considerable work has gone into that. With regard to carers, my understanding is that they are not currently included in the clarification that came out today, but I am happy to confirm that point with her.

[Baroness Thornton (Lab)]

My Lords, we all want our children back at school on 8 March, and the Government need to do everything possible to keep children learning, with testing systems that work, ventilation and the use of Nightingale classrooms. The Government missed the opportunity to vaccinate teachers at half-term, so I ask the Minister to explain why, if our children are to be back at school on 8 March. When will teachers and support staff be a priority for vaccination?

[Lord Bethell (Con)]

My Lords, teachers are a priority in as much as they are on the prioritisation list along with other key workers, but the honest assessment of the JCVI is that teachers are not at accelerated risk of increased sickness or hospitalisation over any other member of the public. We are enormously grateful to the teaching profession for the role it is playing in getting schools back and in testing but, in terms of sickness and mortality, teachers are in the right place in the JCVI prioritisation.

Future of Health and Care

Baroness Thornton Excerpts

Tuesday 23rd February 2021 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, I thank the Minister and declare my interests as a former member of a CCG and a non-executive director of a foundation trust.

The Lords Labour health team—myself and my noble friends Lady Wheeler and Lord Hunt—are veterans of the infamous Lansley Bill, which became the Health and Social Care Act 2012. Many noble Lords will take part in the new legislation—including, of course, those on the Lib Dem Benches, who supported the Lansley Bill. I hope that they have come to their senses since then.

We cannot sweep under the carpet, as the Secretary of State and the Minister would have us do, the fact that many of us warned that the huge bureaucracies and implementation costs of something like £3 billion would be a terrible waste of public money and time. They resulted in a loss of initiatives and innovations that lies at the Minister’s door. Some indication of lessons learned would be welcome.

We are in the middle of the biggest public health crisis our NHS has ever faced. Staff on the front line are exhausted and underpaid. The Royal College of Nursing says that the NHS is on its knees. Primary care and CCG staff are vaccinating and will be doing so for months ahead. Today, we learn that 224,000 people have been waiting more than 12 months for treatment. The Secretary of State and the Government think that now is the right moment for a structural reorganisation of the NHS. It might be significant that, in the Statement, I cannot find a single explanation of how patients will benefit from this reorganisation. It is all about systems.

Apart from the timing, some very serious matters need to be addressed. This is a Conservative NHS plan, and it shows. Without the money, none of this is worth discussing seriously. Without a workforce plan funded by that money, it will not work. This Bill should not go ahead in its current breadth until the solutions for social care and public health are also set out. Although reform of the Mental Health Act is welcome, it also needs to fit into the wider solution that is missing around social care.

Why does the White Paper not include an option simply to delete Part 3 of the existing Act, thus abolishing the market and competition regimes that created the burdensome bureaucracies and which, it must be said, many CCGs and ICSs have worked hard to get round in recent times? Let us take some time to work out the rest, bring forward the promised social care reforms, let our exhausted NHS recover and have a system co-created with local government.

I suspect that the need to move powers to the centre is a poisoned chalice. Is the Minister proposing simply to dump the Lansley structures and bring back the situation where the Secretary of State has the power of direction over all and any parts of the system? Although I welcome the place-based commitment, it is woefully undefined. This plan ought to be co-owned and co-developed with local government nationally as well as locally, with real parity of esteem. Far more is needed to remove barriers, but the biggest local barrier now is the absence of any solution for social care and public health.

Looking at the NHS’s history, we should be sceptical of structural reform necessarily leading to changes in care delivery that make services more integrated and benefit patients. We know from Wales, Scotland and Northern Ireland that integrated care systems have not brought about integrated care. It is necessary to remove system barriers but not sufficient. The bigger challenges lie around culture and vested interests, which are not even mentioned in this White Paper. It is all far too complicated, with health and well-being boards and HealthWatch still in place as well as the proposed new structures. It needs a clear explanation of who controls the money. Can you have two boards at the same time and call it integrated, and be sure where the accountability sits and whether good governance can be assured?

There is little about how decisions are made on who sits on these boards. Is it proposed to bring back independent appointments commissions to guarantee the diversity required? Will staff representatives and patients have a seat where it matters? Surely there can be only one body with the power to set the local strategy and sign off the plans that bring the money. This proposal seems to have many bodies, meaning that governance and accountability are at risk. Having providers, and even independent providers, with a place in the decision-making about resource allocation is clearly unacceptable. If there are to be some contracts awarded by competition, there must be clear rules about who is entitled to compete. These organisations and companies must pay their taxes, for instance, and must offer fair and comparable terms and conditions to their workforce. For example, we know that social enterprises totally fulfil those conditions, but one must ask why we need competitive tendering when you can hand out contracts to chums from the stables, the golf course, and the pub, as we have seen in the last year.

The White Paper is silent on the future of foundation trusts, silent on the role of governors, silent on a whole range of potentially competing governance issues which will have to be resolved. How much acute and tertiary care can be brought into locality-based structures? Integration of primary, community and social care is clear, but, as everyone knows, the acute side is far more complex and a single solution, as proposed in this White Paper, almost certainly will not work. The big players such as teaching hospitals do not fit into any single locality, or even single ICS, but are vital players. Will there be extra layers of governance above the ICS, which is not defined at all?

We will of course study the legislation carefully when it is published, but the test of reorganisation is whether it benefits patients and communities, brings down waiting lists and times, widens access, especially for mental health care, drives up cancer survival rates and improves the population’s health.

[Baroness Brinton (LD) [V]]

I am grateful to the Minister for the short-notice briefing just as we were rising for recess.

If you had said to most people in the health and social care sector three weeks ago that the Secretary of State for Health and Social Care was announcing a new White Paper, virtually everyone would have assumed that it was the extremely long overdue White Paper on social care, promised by the Prime Minister in his party’s manifesto in the 2019 general election and repeatedly further promised at the Dispatch Box over the last 14 months. This Statement refers to it appearing at some point later in the year.

Instead, we have a comprehensive White Paper that focuses, despite the references to care, on the NHS and health systems, undoing some but not all of the 2012 Lansley reforms. This White Paper talks grandly of integrated systems, but you cannot integrate systems if one of the key parties is on its knees as a result of appalling neglect for many years. We agree that our clinicians, managers and associated health and social care staff have great ambitions for moving our health and care structures into the 21st century, and we compliment them, and Ministers, on their ambition, but we have been here before. A decade ago, the Government announced and legislated for a Dilnot-style cost model for social care, which, unfortunately, was later scrapped. We went from a point where all three main political parties were in agreement, but, sadly, the Conservatives withdraw from that agreement. As with manifesto promises on the care sector over the last three general elections, when will the Government start the long-promised cross-party talks to find a solution for the care sector? We remain ready and waiting.

The Statement makes the point that the pandemic has brought the structural difficulties in the care sector into sharp relief. That much is true. With more than 25,000 care home deaths, 10,000 of which have occurred since the lockdown started in January, what will it take for the Prime Minister to make good on his promise to fix social care? Why did it take weeks longer to arrange for residents and staff in care homes to get testing, whereas the NHS had reliable access as soon as it was available? Worse, the care sector’s experience of the Department of Health and Social Care taking its orders of PPE out of lorries and diverting them to protect the NHS first—which happened—and the NHS discharging Covid patients into care homes, while reassuring care staff that it was not doing that, has undoubtedly damaged trust. I do not deny that there has been a really strong attempt to get people to work cross-department, but this sort of behaviour has really not helped.

The Statement talks about making Ministers accountable again. A good step would be for the Secretary of State to come to Parliament and explain why he did not publish PPE and other contracts within the appropriate timeframe. There are concerns, too, about cronyism and possibly even corruption. So I say to Ministers: beware of what you wish for.

A further problem of the White Paper in front of us is the need to undo some of the perverse bureaucracies and expenses created by the 2012 reforms. The “internal market” was one such. I cannot see the logic of having a CCG of GPs overriding NICE and a hospital team on a medication pathway because it wants to spend the money elsewhere. The Minister told me that there will be changes and that there will be some representation from trusts, but, from what I hear, it is not enough to leave the clinicians who are expert in charge able to follow the advice of NICE.

The Statement also talks about the portrait of Sir Henry Willink, who published the 1944 White Paper from the Dispatch Box. But Sir William Beveridge’s report that led to that White Paper, and then to the post-war Labour Government’s creation of the NHS, had a clear structure. The five great evils that Beveridge, as a Liberal, set out could be tackled only by a cross- departmental approach, of which health was a vital component but not the sole driver.

When my grandfather was dean of St Mary’s Hospital Medical School, he always used to say that it took only 20 years for the NHS to move to a “national illness service”, as demand and costs in hospitals increased exponentially and any budget that was not for hospitals was squeezed. That is why, in the 2012 reforms, we in coalition wanted at least elements of public health moved to local government, where it could more effectively work with the other parts of the system fighting Beveridge’s five great evils and, through the health and well-being boards, be accountable at a local level. The examples of the excellent directors of public health during this pandemic have shown that it can and does work, despite the NHS finding it difficult to delegate to them. It is no surprise that inequality is one of the greatest predictors of serious Covid illness or death. Can the Minister reassure us that, whatever happens to public health, it will have its funding ring- fenced to tackle these inequalities?

Next week, we have the Budget, in which the Chancellor will have to face the highest levels of national debt since the Second World War. After the publication of his report, Beveridge expressed concern, saying that the Government should be bold:

“Now, when the war is abolishing landmarks of every kind, is the opportunity for using experience in a clear field. A revolutionary moment in the world’s history is a time for revolutions, not for patching.”


Now, too, is the time for such revolutions. This pandemic has left us with a health and social care system that needs not just reform but proper funding. Without it, integration and effective joint working will fail. Can the Minister assure us that there will be bold actions to ensure that any changes are fully funded? Without it, Atlee, Beveridge and Willink will be turning in their graves. Worse, these proposed reforms will fail the UK people, whether patients or just those living in their communities—the very people who need it most.

Food-related Crime

Baroness Thornton Excerpts

Monday 22nd February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am across the recent outbreak of chicken nugget salmonella poisoning across the UK. However, I point to the work of the European distribution fraud unit, which is very much focused on this kind of cross-border food crime. I will take back to the department the noble Baroness’s recommendation and will write to her if there is any update that I can provide her with.

[Baroness Thornton (Lab)]

I will be very quick because I am very keen that the noble Lord, Lord Krebs, is able to get in on this Question. Can the Minister commit to briefing parliamentary counsel to advise and bring forward these changes, and when can that happen? We on these Benches would welcome this commitment and would give appropriate support to the resulting legislative process.

[Lord Bethell (Con)]

I am enormously grateful to the noble Baroness for her support in this matter. I reassure her that we are focused and working on it, and I will bring forward an update as soon as I reasonably can.

Dentists: Covid-19

Baroness Thornton Excerpts

Thursday 11th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I confess that I did not know about that association. I am not sure whether it is correlation or causation, but I completely support the noble Baroness’s observation that oral hygiene is critical, and we should put the steps in place to improve the oral hygiene of the nation.

[Baroness Thornton (Lab)]

I think the Minister needs to go back to the drawing board, because the new NHS activity target is basically forcing dentists to choose between check-ups and helping those in pain. That cannot be right. It can only increase health inequalities, let alone deal with the gigantic pandemic backlog. In secondary care, there is the particular problem of patients needing general anaesthetic for their dental treatment. These are mostly children and learning-disabled adults. There was already a waiting list of a year before the pandemic. Could the Minister inform the House how many patients are on this waiting list now? If the Minister does not have this information, could he please write to me? Do the Government have a plan to reduce this awful, and obviously very painful, waiting list?

[Lord Bethell (Con)]

My Lords, I do not necessarily accept the dichotomy the noble Baroness refers to. I think it is reasonable for dentists to triage patients between those who can be treated with either advice, analgesics or antibiotics, and therefore do not need face-to-face contact, and those who need to be prioritised to, for example, the urgent dental care centres. I commend the dental profession for making good choices in that area. With regard to the treatment of children using anaesthetics, those are not statistics I have to hand, but I would be glad to write to the noble Baroness with whatever information we have.

Covid-19 Vaccines Deployment

Baroness Thornton Excerpts

Thursday 11th February 2021 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, it is clear that we will live with Covid-19 and its mutations for a long time, so a full vaccination programme seems the best way to get out in front of it. Obviously, everyone was very pleased to hear the study results regarding the Oxford/AstraZeneca vaccine reducing transmission and maintaining protection for over 12 weeks. While the daily cases begin to fall, it is vital that the Government do not repeat previous mistakes and take their foot off the gas just as things look like getting better. Could the Minister update us on whether he expects similar trial data to be published for the Pfizer vaccine?

Would the Minister care to comment on the—how can I put this?—forceful comments of his honourable friend Sir Charles Walker MP on “Channel 4 News” when he accused the Government of robbing people of hope and said:

“We cannot cancel life to preserve every life”—


whatever that means? Apart from the fact that, in my own view, that sounds like a petulant child, it is concerning that these are the pressures being brought to bear on the Government, and it is to be hoped that they will bear up and previous mistakes will not be repeated.

It seems that the Government are on track towards their promise of vaccinating the top four Joint Committee on Vaccination and Immunisation priority groups by the middle of this month. That is to be applauded. Regarding data, though, I think everyone is concerned about the reports of lagging take-up among black, Asian and minority ethnic communities as well as among poorer communities. We know that these groups have been the worst affected by the pandemic and we need to get them to take up the vaccine, but I am conscious that much of what we hear is based on anecdotal stories rather than hard data at community level split by ethnicity. What data does the Minister have on that? When can colleagues get council ward level data so that they can be part of the effort to drive uptake?

As the first phase is coming to an end, can the Minister update us on the number of care home staff who have received their first dose, and perhaps what the plan is to encourage those who have not done so to take up the vaccination?

It appears that one in five over-80s in London has yet to be vaccinated; that is what the latest figures suggest. Some 78% of over-80s in the capital have had a first dose, lower than for other groups, while the figures are 83% for the 75-to-79 age group and 79% for the 70-to-74 group, so we still have some way to go in London.

When we get to the beginning of April, those who have had their first dose will be expecting and needing their second one. Can the Minister give an assurance that there will be enough supply to ensure that everyone who is due their second dose will get it?

Also, we do not want the vaccine rollout across Britain to be undermined by a vaccine-resistant strain entering the country, which the Government’s failure to secure our borders risks jeopardising—but we will be coming on to that in the next Statement.

Will the Minister say what conversations are now taking place with the JCVI and what changes might be made to the priorities of the people who will be due the vaccination? For example, will the JCVI be reviewing key workers? Data has shown that those who work closely with others and are regularly exposed to Covid-19 have higher death rates than the rest of the population. By prioritising those workers alongside the over-50s and over-60s and people with underlying health conditions, surely we can reduce transmission further, protect more people and keep the vital services that they provide running smoothly—which, of course, includes reopening schools.

[Baroness Brinton (LD) [V]]

My Lords, I start by congratulating everyone working in the vaccine sector: the scientists, still working behind the scenes to ensure that there are vaccines that will be effective against the South African and Manaus variants; those involved in the manufacture and supply chain; and all those on the front line, making sure that the vaccines are delivered into arms safely and swiftly by clinicians, with administrators, staff, the military and volunteers helping. A notable reason why the UK has been able to manage this so well has been the expertise of Professor Chris Whitty and our vaccine research community, which has so many years’ experience in epidemics, including the Ebola outbreak in west Africa.

The Joint Committee on Vaccination and Immunisation has also kept our focus on who should be protected first, and the government delivery group, led by Kate Bingham, has also done well. The numbers vaccinated in the top four priority group continues to grow and I, for one, hope that the target for next week will be achieved.

The Statement says:

“We … visited every eligible care home possible with older residents in England and offered vaccinations to all their residents and staff. That means we are currently on track to meet our target of offering a vaccine to the four most vulnerable groups by mid-February.”


However, I still cannot find the actual number and percentage of social care staff vaccinated, whether those working in care homes or domiciliary care staff providing essential support to keep people living in their own homes, so please can the Minister provide the number and percentage of social care staff who have now had their first dose of vaccine? Once again I ask: why are care staff not disaggregated from NHS staff in the published data?

The target of “offering” a vaccine to those in or working in homes is, frankly, no target at all. We know that, after Christmas, an alarming number of cases were diagnosed in care homes, which has resulted in residents and staff being refused vaccine until all cases are over in those homes. With very limited visits by families, the only way that Covid could have come in is, unfortunately, via staff, who probably picked it up from others over the Christmas break. Today, the ONS has said that one-third of all Covid cases in hospital during this pandemic have been over the past month. That is truly shocking.

Was the Prime Minister’s bold statement last year that Christmas should not be cancelled and his encouragement to allow people to mix, against all the expert advice from SAGE and alternative SAGE, worth it? How many deaths will have resulted from those cases, which could have been avoided if that expert advice had been followed earlier?

There are reports of some surgery teams arriving at care homes with enough vaccine only for residents and staff being redirected to large hubs, many miles away. This is unhelpful when staff work shifts and are on low wages, with no access to the transport needed to get to a hub. What is planned to ensure that all care home staff can be vaccinated at their place of work by their local vaccination teams?

Another bit of ONS data this week has shown that there were more than 30,000 Covid-related deaths of disabled people between mid-January and mid-November last year, representing 60% of all Covid-related deaths in that period. I remain concerned that many of those under 70 who are disabled or learning disabled and live in homes are still not on a priority list. We know that those requiring close personal care are at very high risk. The ONS data proves that. When will the Government add them to the top four priority lists?

The opening of large hubs is welcome, but they must not replace very local access to vaccines, whether through GP surgeries or local pharmacies. Worrying reports are emerging of GPs running out of supplies and being told that the large vaccine hubs are being prioritised over them. I thank the Minister for the excellent briefing that MPs and Peers had earlier this week on vaccines and possible treatments for Covid-19. The Statement says:

“This trial will look at whether different vaccines can be safely used for a two-dose regime in the future to support a more flexible programme of immunisation.”


It goes on:

“I want to reinforce that this is a year-long study, and there are no current plans to change our existing vaccination programme, which will continue to use the same doses.”


However, the green book on the vaccination programmes states:

“For individuals who started the schedule and who attend for a vaccination at a site where the same vaccine is not available … it is reasonable … to offer a single dose of the locally available product”


to complete the schedule. If safety has not yet been established, why does the green book say that potentially unsafe dosing regimes can go ahead?

The Minister is correct to say that no one is safe until the whole world is safe, and it is good that the UK has made a commitment of £548 million to COVAX with match funding to provide 1 billion doses of vaccine this year to developing countries. I hope that the Prime Minister will use his chairing of the G7 to encourage other countries to donate their share to make this happen. The examples of the South African and Manaus variants are a wake-up call to all of us that we must work as a global community to protect all people and the world’s economies from Covid-19.