Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020

Baroness Thornton Excerpts

Thursday 7th January 2021 Lords Chamber

[Baroness Thornton (Lab)]

So, here we are. If the country is weary, I suspect parliamentarians are too. I am trying to work out how many regulations we have done in the last 10 months; perhaps somebody somewhere might be able to tell us. We have four regulations of increasing relevance before us today; all are post implementation. I declare my interest as the non-executive director of a foundation hospital in London.

We on these Benches will support the regulations. We do so while recognising the devastating impact that restrictions will have on our economy, our way of life, our mental health and the well-being of everybody. If we are to restore freedoms for the future and save lives, we all have to behave as if we are infected. I had some sympathy with the noble Lord, Lord Berkeley, when he talked about that because this virus is out of control.

As before, the Government are reacting later than we would have liked. However, unlike before, we now have the vaccines. The Prime Minister did not mention test and trace in his Statement. I would like to know whether this, which was a game-changer for us in the summer, features in the plans for the next six or seven weeks and thereafter. My noble friends Lord Winston and Lord Reid asked this question, as did the noble Baroness, Lady Jolly, and the noble Lord, Lord Mann.

We can only be devastated by the prospect of weeks and weeks—perhaps longer—of people in isolation feeling anxious and lonely. I think that it will be worse this time. I note that the flow of food and gifts to the front line in our hospitals seems slower in appearing this time than in the spring, when the need is actually greater. Our front-line staff are more exhausted and overwhelmed than they were in the spring, as my noble friend Lord Hunt and the noble Lord, Lord Liddle, said.

We can and must rejoice at every care home staff member and resident vaccinated and every older person made safe. We need to focus on getting our unpaid carers vaccinated. I very much welcome the fact that they are now included as priority 6, but there needs to be some discussion about the implementation of that particular priority. We should rejoice when our paid social carers are vaccinated. We have to get clinical NHS workers, auxiliary staff and teaching staff vaccinated as soon as possible. Only when we know they are safe can we breathe more easily.

In the months following the long lockdown last year, 19.6 million prescriptions for antidepressants were issued—a 4% increase on the same period the year before—to more than 6 million people in England, which is the highest number on record. If we are to support lockdown, we need assurances that mental health services will be fully resourced, will stay open and respond to peoples’ needs throughout the lockdown. Can the Minister clarify the conclusion about the amount of funding for mental health created by his right honourable friend the Prime Minister?

The lockdown will have a huge impact on the well-being of our children. The plan to get children safely back to school is a priority, which is why I believe that it is a priority to vaccinate teachers and school staff as soon as we are able. There are thousands of children out of school in overcrowded, cramped accommodation who are unable to access learning properly from home. There are thousands who still do not have access to technology, as my noble friend Lady Massey said. We need to recognise that Covid has exaggerated the inequalities in our society and that we do not want to return to business as usual as this year moves on. We know that there are children at risk of abuse and violence. Many children face the prospect of being locked in their homes with parents who abuse drink and drugs.

Over 62,000 cases were reported in England yesterday —one in 50 have the virus. We know that it is one in 30 of us here in London. There were 3,300 hospitalisations yesterday and it is going up in every region. There were 2,645 people on ventilators and, tragically, over 1,000 died. According to an official briefing given to the capital’s most senior doctors this afternoon, London’s hospitals are less than two weeks from being overwhelmed by Covid in the best-case scenario.

This is a national emergency. The national lockdown is necessary. As my noble friend Lord Foulkes put it —possibly more robustly than I am doing—we should have locked down sooner. The Commons voted this lockdown through on Twelfth Night, yet in the run-up to Christmas, the alarm bells should have been ringing. The Secretary of State reported on the new strain on 14 December. The Prime Minister learned of the rapid spread of the new variant on 18 December. On 21 December, the Chief Scientific Adviser, Sir Patrick Vallance, said that the new strain was everywhere and would rise after the inevitable mixing at Christmas. SAGE met on 22 December and concluded:

“It is highly unlikely that measures with stringency and adherence in line with the measures in England in November … would be sufficient to maintain R below 1 in the presence of the new variant.”


Here we are, two weeks later, with 500,000 infections and 33,000 hospitalisations since 22 December. Why does the Prime Minister, with all the scientific expertise at his disposal and all the power to make a difference, always seem to be the last to grasp what needs to happen? He has not been short of data. He has been short of judgment and, yet again, we are all paying the price.

We will ultimately be released from these restrictions through vaccination. I pay tribute to everyone involved in helping to distribute and administer the 1.3 million vaccine doses so far. It is a great achievement but, as many noble Lords have said, we need to go further and faster if the Prime Minister’s promise that almost 14 million people will be offered the vaccine by mid-February—that is 2 million doses a week—is to be reached. The many solutions offered by noble Lords today need to be taken on board and considered. I did not know that there was the idea that vaccines would not be delivered on a Sunday. How ridiculous is that? I hope the noble Lord will clarify that that is not the case.

Logistics are key to this. From the front line, a doctor’s surgery in the south of England says:

“My group of practices was initially told we would get our first delivery on 28th December. Then 4th Jan. Then 11th Jan. Now we are ‘6th wave’ and it will be 13th, 14th or 15th Jan. We are raring to go, but have no vaccines. WHY?”


In Waverley—in Jeremy Hunt’s constituency—a massive mess-up with the vaccine, which had been outsourced to a company called Procare, meant that 1,100 vaccine appointments were cancelled because there was a manufacturing error and they did not have the vaccine to administer. Of course there will be teething problems, but anecdotal evidence from the debate today suggests that those teething problems are actually quite significant.

How many of the ordered doses have been manufactured? How many have been delivered to the NHS? How many batches are awaiting clearance from the MHRA regulatory clearing process? It would be fantastic to vaccinate 2 million people a week, but we should not limit our ambitions. As other noble Lords have said, we need to scale up to three, five, six million jabs over the next weeks and months.

As my honourable friend Jonathan Ashworth said yesterday, the rule in politics is that it is always better to underpromise and overdeliver, which is certainly a lesson that the Prime Minister needs to learn. Let us hope that 2 million doses is an underpromise and that the Government aim to overdeliver, because would that not be great? Our big target must be to vaccinate more, particularly among NHS staff. Do we have a clear date by which NHS on the front line will receive the vaccine? They need to know. Not only are they exhausted, but it is a matter of morale. They deserve to know when they will be vaccinated.

We support this lockdown today because we know that we have to reduce transmission. That is why we are asking people to stay at home. Not everybody can work from home: there are 10 million key workers in the United Kingdom, of whom only 14% can work from home. Many are low paid and often have to use public transport to get to work in jobs that, by necessity, involve greater social mixing, and they are exposed to risk. Their workplaces need to remain Covid-secure and they need income support if they have to stay at home.

The British public have done so much over the last year and have made great sacrifices. We are a great country, and our people can and will rise to this occasion. All anyone asks is that the Government do the right thing at the right time: make workplaces Covid-secure; vaccinate health workers as soon as possible; introduce decent sick pay and support to isolate; and roll out a mass vaccination programme like we have never seen before. This is a race against time. We will support this lockdown today.

Obesity

Baroness Thornton Excerpts

Tuesday 5th January 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I can give my noble friend no such assurance. The decrease in sugar in soft drinks, as he knows full well, between 2015 and 2019, was 43.7%, and the increase in soft drink sales during that time was 14.9%. With six out of 10 adults and more than one in three children between the ages of 10 and 11 technically obese, clearly more needs to be done.

[Baroness Thornton (Lab) [V]]

My Lords, I think that the noble Baroness, Lady Boycott, is quite correct, and I did appreciate the Minister’s last answer to his noble colleague. But perhaps the Government need to consider healthy food where they can actually influence this, such as in hospitals, schools and care homes, and reinstate standards for healthy foods in those places.

[Lord Bethell (Con)]

Yes, I entirely agree with the noble Baroness. There are parts of the Government’s estate where more could and should be done in order to promote healthy foods. I pay tribute to the work of Prue Leith, who has done a lot to champion healthy food in hospitals. Progress has been made; I visited Southampton hospital with her earlier last year and saw her bringing healthy food direct to the patients, and the use of trolleys in order to ensure that warm food is delivered and that food does not have to come out of a plastic bag. More can be done, but I reassure the noble Baroness that we are working hard at it.

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 2) Regulations 2020

Baroness Thornton Excerpts

Wednesday 30th December 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I join with other Noble Lords in giving wholehearted welcome to the approval of the AstraZeneca vaccine which, for once, will be a game-changer in defeating this horrible virus. I thank and pay tribute to our scientists and the volunteers who came forward to be tested. It means, crucially, speeding up on vaccination. This is now a race against time. I ask the Minister how many of those over 80, and how many care home residents, have been vaccinated? As for the substantive issue before us today, as ever the Government are behind the curve in their control of the virus and our debates on them, as we will see later when the Statement that is likely to extend tier 4 is made in the Commons.

The major changes to Christmas provision were late but welcome. But they were devastating for many. The Prime Minister announced the changes on Saturday 19 December at 5 pm. Why was guidance not published at the same time to give people much-needed clarity? People who were due to attend funerals or get married the next day were unsurprisingly desperate to know and very anxious. Why were the Government not better prepared, given the rapidly rising infection rates and the identification of the new strain? It was known in September that we had a new strain; this was not news. The Government knew that the three-tier system was not enough and should have had contingency arrangements and communications ready to go.

We all saw the scenes of chaos following the announcement, with packed trains leaving London. Does the Minister accept that the appalling communication strategy contributed to this, and will have contributed to the spread of the virus? That is to say nothing of the issue of face masks raised by my noble friend Lord Faulkner. What assessment has the Government made of compliance over the Christmas period? What additional support is available in tier 4 areas? Is there access to testing and income support? There is a need to incentivise people on low incomes whose jobs are in jeopardy to stay at home. The events of 19 December were totally typical of the procrastination, the constant overpromising and underdelivering, the opaqueness of information, the refusal to release SAGE advice in a timely fashion, a Prime Minister who seems incapable of taking timely decisions and a pandemic out of control.

Yesterday, we learned that all the hospitals in Essex were 48 hours away from having to refuse any more patients, Covid or otherwise—so, if you broke your leg, you would be refused entry. This is because over 700 staff in south-west Essex alone were off isolating with symptoms, with no strategy to get temps in from tier 2 areas, no vaccines for the staff and no lateral flow tests, as promised in October. Today, the leaders of the councils in Essex have declared a major incident—so how quickly, and how, will the Government give Essex hospitals the urgent support they need?

We on these Benches support the regulations, but we must ask ourselves, as we have so many times before: can the Minister tell us if this is enough action necessary to contain this virus? As the noble Baroness, Lady Watkins, and others asked, what is going to happen in the next 24 hours? How will the Government seek to control people going out to celebrate the new year?

This virus is out of control. Yesterday, over 50,000 cases were reported, and there are now more patients in hospital in London than at any other time in the pandemic—and, last week, 3,000 people died. So far, tier 4 areas show no sign of slowing down, and the NERVTAG minutes of 18 December suggest that this strain could add 0.4% to the R number. This new variant means that it will be harder to bring infections under control, so harder measures are needed. Will the Government publish, in real time, the advice they are now receiving from SAGE? As other noble Lords have asked, do they really intend to move people from London hospitals, with the new variant virus, to other parts of the country? I would like a yes-or-no answer to that question.

This takes us to the Nightingales. Is it true that the ExCeL Nightingale in London has been mothballed and its equipment removed? Again, a yes-or-no answer would be appreciated. There have been white elephants, stunts and overpromising, and getting the army and others to work their socks off, thinking they were helping their country—absolutely typical of the handling of this pandemic, where national interests and people’s lives seem to have been secondary to political expediency, the threat of Tory backwoodsmen and a photocall for the Prime Minister and the Secretary of State. This is very serious indeed; for the sake of our country, we need to get this under control.

I finish by talking about our children and young people. The way this Government have treated our teachers and headteachers with such contempt is shocking. There are five questions that the Minister needs to answer. What does the science tell us about Covid in schools? What is the plan for next week that we do not know? Will all students have IT for home learning? What is the plan on support for mass testing? When will school staff be vaccinated? How much worse does this have to get before further action is taken?

ONS: UK Life Expectancy

Baroness Thornton Excerpts

Thursday 17th December 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Lord makes his point extremely delicately and politely, but he is entirely right. We have a commitment for five extra healthy years by 2035, and the combination of the Marmot review, the ONS figures and Covid make that seem an extremely daunting challenge indeed. I am not sure if I have the complete answer standing at the Dispatch Box right now. I would be glad to write to him and explain how we will undertake the Green Paper on prevention, the response to which will be published next year, as an opportunity to outline the kind of strategy he calls for.

[Baroness Thornton (Lab)]

The Minister’s response to my noble friend Lord Davies of Brixton was an abrupt one, which kind of suggested that it was an accident that we are where we are with life expectancy and that the Government’s policies have no impact on that. My question actually follows very neatly from that of the noble Lord, Lord Patel. Do the Government intend to establish life expectancy and well-being as a strategic marker and measure for the whole nation’s well-being and welfare in all Acts? How will that feed into reforms for the NHS?

[Lord Bethell (Con)]

My Lords, I think that healthy living and life expectancy is a strategic marker. We are naturally focused on it and, in particular, the disparities between communities, which have been alluded to by a number of noble Lords. The huge gap between life expectancy in Blackpool and west London is extremely disturbing, and something that the Government are highly focused on. These are complex issues. They involve government policy—as the noble Baroness quite rightly points out—but also personal behaviours, and it will very much form part of the NHS plan going forward and the rebooting of the NHS in a post-Covid world.

Covid-19: Vaccinations

Baroness Thornton Excerpts

Thursday 17th December 2020 Lords Chamber

[Lord Bethell (Con)]

I hear the concerns of both the noble Lord and his mother very clearly but I assure him that, to date, the rollout has very much focused on the 70 hospital hubs where we are getting the protocols and practices about getting this extremely difficult vaccine into people’s arms correct before we roll out distribution to all GP services. It is not at all my expectation that every GP service in the country will have the vaccine, nor that they will necessarily be ready to deliver it this week, but that guidance has been distributed. If the noble Lord would like to send me the details, I will ensure that that GP practice is up to speed on this important matter.

[Baroness Thornton (Lab)]

My Lords, my concern is about NHS staff. They may need to deal with a third wave in the new year, they will be required to work through the Christmas period dealing with the current spike and they will be co-ordinating the vaccine—so they might be completely overstretched in January and February. Would it be a good idea to ensure that at least front-line, high-risk clinical area staff are vaccinated immediately? Does he agree that this would make sense from an operational point of view? I know from my work as a non-executive director of a London hospital that it would be a huge morale booster for the staff to whom we owe so much.

[Lord Bethell (Con)]

I take on board the noble Baroness’s points on the NHS. Its staff have been under huge pressure, which is likely to be sustained into the new year. I pay tribute to their hard work. The JCVI has looked extremely carefully at the prioritisation. The most important thing is to avoid pressure on ICUs and the threat of mortality. That has been done by prioritising age over role. I also pay tribute to the St John Ambulance service, which has done an amazing amount of work in gathering 40,000 inquiries for training on delivering the vaccine. By undergoing training, those people will relieve NHS staff of an enormous amount of the pressure that the noble Baroness rightly describes.

Covid-19 Update

Baroness Thornton Excerpts

Tuesday 15th December 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for the debate today. A total of 34 million people will be living under tier 3 Covid rules from midnight tonight after London, parts of Essex and Hertfordshire were placed under the most severe level of restrictions. My first question for the Minister is: what have been the criteria for deciding these tiers, and will the Government commit to publishing the rationale for their decisions?

It was noticeable during the Statement yesterday that the Secretary of State spoke with firmness and confidence when he announced the new restrictions and why he was making them, and spoke about the worrying new strain of the virus. It was only when he was pressed on the effect of, and scientific story behind, the Christmas relaxation that he became less sure. One has to ask why that might be the case.

Talk of acting decisively and boldly seemed to go out of the window. In its place came fudge and obfuscation, dither and blather. Professor Chris Whitty, when commenting on the Christmas rules, said:

“This is, in a sense, a limited relaxation which will have some impact on the upward pressure on the coronavirus.”


Well, yes. The Government’s answer seems to be to fall back on ‌the idea that this is all about “personal responsibility”—about the public taking a minimalist interpretation of the rules, not a maximalist one. The Health Secretary eventually gave a vague bit of concrete advice on Christmas, coming close to saying that we should self-isolate for a few days before meeting grandparents.

“The best thing you can do if you want to see elderly relatives at Christmas is to be extremely careful now about who you see”


was how he put it.

I therefore have to ask the Minister whether the Christmas relaxation is being reconsidered. What is the Secretary of State’s plan to keep people safe through Christmas and avoid huge pressures on the NHS in January? What is his plan to support an exhausted, underfunded and understaffed NHS through January to deliver the care that patients will need? Is he confident that our NHS will not be so overwhelmed in January that it impacts on the vaccination programme? Will the Government publish an impact assessment on their decision to allow a temporary relaxation that will allow three households to mix over the festive period?

This is a virus that, without adequate restrictions in place, spreads with ferocity. Case rates are increasing again, hospital admissions are climbing and the R is edging up. Last week, the England-wide rate was 159 per 100,000; now it is 188 per 100,000. That is a 20% increase. Across London, cases have increased by 30% and across the east of England by 36%. None of us is therefore surprised at the action that the Secretary of State took yesterday. Indeed, he was warned that tier 2 would not be enough to contain the spread of the virus in many places. It looks as though in some areas, such as Kent, tier 3 is not enough to contain the spread there.

Elsewhere in the country, tier 3 appears to be forcing the virus to flatline. Indeed, in the north-west it is trending down. However, overall, cases in the increasing areas are rising faster than those in the decreasing areas are falling. As things stand, we are heading into the Christmas easing with diminishing headroom. As my honourable friend Jon Ashworth said yesterday:

“The buffer zone that the tiers were supposed to provide is getting much thinner.”—[Official Report, Commons, 14/12/20; col. 25.]


London, like other parts of the country, will now suffer dreadfully from these further restrictions, which we support, but we think there are some serious problems. Businesses and livelihoods will suffer and there will be a cost to mental health and our NHS. The Minister has often praised Liverpool, but is not the biggest lesson to draw from Liverpool that people still struggle to isolate if they do not have the financial means to do so? The eligibility criteria for the £500 payment are still too tightly drawn: people need decent sick pay, people in some circumstances need alternative accommodation and people need help with their shopping and medicines. Surely, some of the £22 billion spent on test and trace could be reallocated to offer people adequate isolation support—as has happened elsewhere in Europe and the world?

Why is there still not a plan to make lockdown easy for people to do? Will the Government address the wide gaps that exist in economic support for the self-employed, for example? The IFS has noted that many would

“fall through the gaps completely”

and estimated that nearly two in five people with some self-employed income were excluded from the Government’s support schemes—this is not adequate.

I turn to the vaccine. Can the Minister update us on how many people have received the vaccine? Can he set out exactly when unpaid carers will be given the vaccine, given that they spend their time caring for extremely vulnerable people and could pass on the virus? I echo what my honourable friend Jon Ashworth said in the other place yesterday, when he asked whether priority could be given to those who are terminally ill to get the vaccine as soon as possible.

Can the Minister also explain what guidance is being put in place for autistic people, for example, in in-patient settings to go home for Christmas? Autism charities have warned that autistic people in residential care will have to isolate for 14 days when they come back from visiting their families—that is not fair on those who need routine and support. The Government must make their guidance autism-friendly.

The PHE report last month found that people with learning disabilities had a death rate 4.1 times higher than the general population, and this could be 6.3 times higher—what steps are being taken to protect them as infections rise? In November, the Minister in the other place said she was asking SAGE to review this report and make further recommendations; what is the outcome of that?

[Baroness Jolly (LD) [V]]

I support the points made by the noble Baroness, Lady Thornton, on lockdown; she and I have repeated them regularly in these debates, and yet there is no change. My points will be around vaccines, acute hospitals and their staffing, and Christmas. I thank the Minister for repeating the Statement and join him in welcoming the news about vaccines. Anyone in need of a real feelgood story should watch last night’s “Panorama” programme about the development of the Oxford team’s AstraZeneca vaccine.

How confident is the Minister of 100% vaccine coverage, for those that are entitled, by Easter 2021? This is a lot of people, and we are not certain of all vaccines being available by that time. Could he explain to the House what determines who receives the AstraZeneca vaccine and who the Pfizer—or indeed any other vaccine that may come along? Is he confident that the new vaccines will be effective against the new variant that is emerging?

Can the Minister give us a statement about acute hospitals in tier 3 areas? At the moment, it looks as though the rise in cases in the London area and the south-east is almost matched by the rise in hospital admissions—they are just a percentage point apart. Are the Government confident in London’s hospital capacity? We know that, in some areas, there are Nightingale hospitals; is the NHS intending to bring them into use if necessary? Are there the clinical and other staff to run them?

For many of us, an in-person Christmas may not be possible. We need to look at the impacts that Thanksgiving had on the US Covid-19 figures and assess our risk. Many of my contemporaries have decided not to travel to celebrate with friends and family, and our children have told us that this is what we are going to do as well, so it looks as if many will be resorting to whatever is their favourite conferencing software to catch up with family.

Finally, will the Minister outline the Government’s communication strategy for Christmas? Clear messaging is imperative but many of the public who have been interviewed are unclear. Will ads be used in newspapers, broadcasts and online social media? Christmas is 10 days away, and people would appreciate a clear steer from the Government. This needs urgent and professional communications attention.

Ockenden Review

Baroness Thornton Excerpts

Monday 14th December 2020 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, I first declare an interest as a non-executive director for a London hospital trust. I thank the Minister for the debate today. This is a harrowing report, and the latest in a series of reports over recent years. It follows on the heels of the Morecambe Bay report, and we know that the East Kent report was launched earlier this year to investigate 54 babies dying between 2014 and 2019.

I first congratulate Donna Ockenden on this interim report. As she rightly says in her letter to the Secretary of State,

“we want to bring to your attention actions which we believe need to be urgently implemented to improve the safety of maternity services at The Shrewsbury and Telford Hospital NHS Trust as well as learning that we recommend be shared and acted upon by maternity services across England.”

The scale of the findings in this interim report is distressing in the extreme. The relentless campaign of parents Rhiannon Davies and Richard Stanton, and Kayleigh and Colin Griffiths, must be recognised, and we must pay tribute to and thank them. At a time of greatest grief—the loss of a baby—they have done something vital to ensure that other parents do not suffer the losses they have.

Babies suffered fatal skull fractures from forceps use; women were left screaming in agony for hours; infants developed long-term disabilities as a result of terrible maternity care. There were baby deaths, high maternal deaths, and a catalogue of incompetence, neglect and cruelty. There was failure to handle high-risk cases correctly, an overzealous pursuit of natural, vaginal births leading to a reluctance to perform caesarean sections, and inadequate consultant supervision. Struggling mothers were mocked and called lazy. Mothers were blamed for their baby’s death. Parents were not listened to; legitimate questions were not responded to and blocked; responsibility was not taken.

There was poor assessment of risk and no discussion of risks with mothers. Practice in assessing ongoing risk was poor. Escalating problems were spotted too late, leading to delay in transfer to hospital and death. There was poor ability to spot the refusal to acknowledge. Escalation was seen by midwives as a slight on their ability, not a prudent response to risk. As bad was the internal culture which allowed this to carry on without proper, effective management or regulatory oversight. There were adversarial attitudes between doctors and midwives. Perhaps the Royal Colleges need to talk to each other about the lack of mutual respect for their particular expertise and experience, and the value placed on these.

This is an interim report because Ockenden is rightly concerned that change needs to start immediately. One hopes that it has already been happening in the trust, rather than waiting for the full report and for the Government to take time to consider it. That might literally cost lives. It might mean more babies suffering damage, which means disability for the whole of their lives. This concerns not only deaths but sometimes severe disabilities, which cause huge suffering for the child and have a huge impact on and cost for their families and, indeed, for the state.

It is now clear that the Ockenden review will be far larger and take far longer than was originally intended. Can the Minister assure the House that the review has the resources necessary to complete the final report as soon as possible? There are seven immediate and essential actions outlined in this interim report. What progress is being made to implement these recommendations? What actions is NHS England taking to implement these interim recommendations across England? The turnover of leadership at board and officer level in this trust was surely a warning sign that something was amiss. Why was there not earlier support and intervention by NHS England? I know how appointments are made at senior level; they have to be signed off by NHS England. It must have known. What happened? One needs to ask the same questions of the CQC, both in terms of leadership instability at the trust and why the glaringly obvious warning signs of infant and maternal death were not acted upon sooner.

More broadly, can the Minister explain what action is being taken to ensure that there are enough staff in all maternity units? Perhaps the Government can, this time, commit to legislating for safer staffing levels. What is being done to tackle the current estimated 3,000 midwife vacancies?

Finally, for the vast majority of us who give birth in NHS hospitals, it is a wonderful experience, and a very safe one. We want that to be available to all women.

[Lord Scriven (LD)]

I declare an interest, as my husband is a medical director for NHS England, but not in the region where this hospital is located.

From these Benches, I want to start by sending our heartfelt love and admiration—as, I am sure, do many across the House—to those parents and families who will have an empty place in their home this Christmas, due to the poor care they received at Shrewsbury and Telford Hospital NHS Trust maternity services. This report is distressing and shocking to read. It is hard to comprehend that it describes a care system in this country, in this century. It describes everything from the lack of basic things like human empathy, compassion and support, to poor medical practice and lack of carrying out best practice and adhering to agreed professional standards. This has led to grief, long-term disability, lifelong complications and the unnecessary deaths of newborn children and mothers.

This is not the first case of poor practice in maternity care that has come to light after brave families and parents have refused to be cowed and silenced. Morecombe Bay should have been a wake-up call for ensuring that systematic, integrated changes took place. It is clear that cultural and systematic change at scale and in depth has not happened, despite previous warnings. The healthcare regulator this year reported that four out of 10 maternity services do not meet the safety threshold of care. I ask the Minister why, in 2020, that is an acceptable statistic.

In 2017, the £8.1 million national maternity training fund was withdrawn. Does the Minister now, in hindsight, regret this, and will he seek to re-establish this fund urgently? Will the Minister inform the House who is responsible—politically and managerially—within NHS England for ensuring that, this time, the changes highlighted are implemented, particularly in the seven areas seen to be urgent? What is the timetable for implementing the seven immediate and essential actions required across the NHS? What resources will be allocated to implement the 27 local and 7 immediate and essential actions required?

This must not be another report that gets sympathetic words from those with political and managerial responsibility but then ends up on a shelf gathering dust. That is why the Minister needs to outline a timetable for implementation, what resources will be allocated and who, ultimately, is accountable for ensuring that the systematic, deep changes happen, so that no family has to deal with the kind of grief and trauma that so many families in this report have had to deal with.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2020

Baroness Thornton Excerpts

Thursday 10th December 2020 Grand Committee

[Baroness Thornton (Lab)]

My Lords, it is quite clear that the smaller first statutory instrument is a tidying-up regulation and I thank the Minister for introducing it. The other regulation is, as the Minister put it, about developing a private market for testing. The questions that have been addressed to him in this short debate will have told him that there are some concerns about how that works.

My first question is: why is the CQC not the obvious body to do this? What has led to it being the UKAS? The time it takes to be accredited does not seem that different.

That leads to my next question, which was raised by my noble friend Lord Hunt: what additional resources and staffing has the UKAS been given to carry out this new responsibility? I looked at its website. Obviously, it is a creditable and important body. I am not undermining it at all, but I am questioning it taking on this new responsibility, which involves more expertise and more funding. Because it is a public health issue we are talking about here—the spread of Covid—what are its responsibilities when somebody gets a negative result? What happens when someone is infected with Covid? I would like to know what responsibility is being placed on the UKAS for it to place on the private sector deliverers of this service when they test someone who tests positive for Covid? It seems absolutely vital that that person is placed in the test and trace system. Can the Minister explain to the Committee what the “trace” bit of this is?

The noble Baronesses, Lady Wheatcroft and Lady Altmann, raised the potential for fraud and testing scams. How will the Government make the public aware of the need for test providers to be properly accredited? Also, how will they ensure, as part of the monitoring and regulation, that the certificates that are issued cannot be falsified or sold on, and what are their powers to intervene if they suspect or it is reported that that is happening? It is inevitable that some investigative journalist or programme will indeed try to do that in order to test the system. If it is found wanting, it will be a very serious undermining of what should be safe private testing.

There are a number of commercial providers offering Covid-19 “fit to fly” tests in the UK. As other noble Lords have mentioned, Which? found that the costs varied considerably, from £60 at London’s Gatwick Airport drive-through test—the cheapest test—up to £214 at a clinic in London. Of course, for a family of four going on holiday, that is a significant amount of money. Is there an intention to cap the price of these tests to make sure that individuals and families are not priced out? I think it is important for the Minister to explain the link and relationship between public sector procurement of these tests and the private services. We now have a long list of procurement problems—to put it mildly—in the testing and tracing regime and possibly billions of pounds of public money have been wasted; we will find out. We do not want to add to that with this new regulatory framework.

Covid-19 Vaccine Rollout

Baroness Thornton Excerpts

Wednesday 9th December 2020 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, I thank the Minister for the update today, and for the all-Peer Zoom this morning. Yesterday was indeed a happy day. Like many—including, it has to be said, the Secretary of State—I was very moved watching 90 year-old Margaret Keenan get her jab. However, the challenges of the next period are as acute as, if different from, those of the period we have been through. What is the timeline for the vaccine for people who are housebound or shielded and cannot attend a surgery, whether in a hospital or anywhere else? It seems that the easy distribution of the vaccine will depend on the new vaccines coming down the track: communications will be vital. So what communications will people receive, from whom? Will that be centrally controlled or will it be done locally—through primary care networks, for example?

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

My Lords, the JCVI has laid out a clear prioritisation, putting great emphasis on those who are older—the over-80s—and those in social care. The vaccine will come to those who are shielded and living alone in due time. There are some practical issues with getting the current Pfizer vaccine: as the noble Baroness undoubtedly knows, it has to be kept in cold storage and comes in substantial batches, which are difficult to break up. The initial cohort consists of 6 million people—those over 80, and the health and social care workers who support them. As for future vaccines, those looking forward to being vaccinated should wait for a letter. Those letters are being organised through their doctors, who have access to a central database to ensure that the right prioritisation takes place.

HIV: Pre-exposure Prophylaxis

Baroness Thornton Excerpts

Tuesday 1st December 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Lord makes a completely fair point. There is absolutely no question of there being a social stigma associated with taking PrEP or any kind of moral cloud over those wishing to take this important therapy. That is not in any way our purpose. He makes a valid point that there are good arguments for the supply of PrEP to be not just through GUM units but also through GPs and perhaps pharmacists. These are arguments that we hear and that we are looking at very closely. I hope that, at some point, I will be able to update the noble Lord on our progress on this matter.

[Baroness Thornton (Lab)]

I remind the Minister, with regard to his last answer about funding, that just because you cannot solve all the world’s problems does not mean that you should not try to solve some of them. On that basis, can the Government provide an update on the rollout of PrEP in England? Is the Minister aware that there are local authorities that are still not providing the drug? When the ring-fenced funding for PrEP runs out in March 2021, will the Government commit to at least the £16 million per annum to make this happen for the future?

[Lord Bethell (Con)]

The noble Baroness makes a fair point. The rollout of PrEP has reached a great many local authorities but not all of them. The funding for it, at £11 million, has made a big impact but it has not covered all the ground. We are aware that this funding package runs out next year and we are in active engagement with local authorities in order to find a new mechanism going forward before July, when the funding will change. That said, our commitment, as I said earlier, to the principle of PrEP and its impact on reaching our targets for transmission remains resolute. I look forward to being able to announce a resolution of this funding formula.