Covid-19: Rise of Positive Tests

Baroness Thornton Excerpts

Wednesday 9th September 2020 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government what assessment they have made of the rise in the number of people testing positive for Covid-19.

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

My Lords, our assessment of the recent rise in positive tests is that we are deeply concerned, particularly about rates among young people, and particularly at a time when children are returning to schools and people are returning to the workplace. We are constantly looking at the latest data on the spread of coronavirus and have worked hard to contain outbreaks early to reduce the spread, protect the NHS and social care sectors, and save lives.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. I was finding it difficult to know in which direction to point myself in framing a question about our testing system, but he has given me the two issues that I want to raise. First, can he tell the House what effect the increase in Covid infections is having on R? What is SAGE advising? The second question is to do with schools. What is a head teacher to do when they have successfully got their pupils back into school and then inevitably have pupils who have symptoms, are at home and need a test—as do their families—but are unable to get one because the nearest centres are either not carrying out tests or have run out of them, the labs cannot process them, or they have been offered testing many miles away and may not even have a car? How are our schools to remain open and safe if the national testing system is not working as it should, and when will this be resolved?

[Lord Bethell (Con)]

My Lords, the impact on R is not entirely clear at the moment. ONS and REACT figures will be published shortly, and they will have the statistical analysis that the noble Baroness asks for. However, it is safe to say that R is up. With regard to schools, the Government have made it clear that our support for the return to schools is completely emphatic. However, I remind the noble Baroness that the average distance travelled for tests, even at this stage, remains 6.4 miles. Ninety per cent of people who book a test travel less than 23 miles, and 90% of tests undertaken in our mobile sites are still converted in 24 hours.

Suicide

Baroness Thornton Excerpts

Tuesday 8th September 2020 Lords Chamber

[Lord Bethell (Con)]

I remind the noble Lord that, in July 2018, the standard of proof used by coroners to determine whether a death was caused by suicide was lowered from criminal to civil. That has had a meaningful effect on the number of suicides recorded. I am afraid the numbers for Yorkshire and Humber are not available to me.

[Baroness Thornton (Lab)]

My Lords, we need to return to statistics. Last week, the Health Secretary Matt Hancock told the House of Commons that new figures from the ONS showed that the number of suicides in England fell during the peak of the coronavirus pandemic. Could the Minister confirm to the House that this was mistaken? While the figures cited by the Health Secretary are the latest reported by the ONS, the ONS also clearly said that those figures

“cannot be used to show the number of suicides with a date of death in 2020, including those that occurred during the COVID-19 pandemic”.

It is likely, it continues, that it

“reflects delays to inquests … due to the impact of the COVID-19 pandemic”.

As government statistics show, the last time the suicide rate was this high was 1988. I would like to know what government resources are being applied to this and that they will not be cut back.

NHS Counter Fraud Authority (Establishment, Constitution, and Staff and Other Transfer Provisions) (Amendment) Order 2020

Baroness Thornton Excerpts

Monday 7th September 2020 Grand Committee

[Baroness Thornton (Lab)]

My Lords, first, I need to declare my interests as a former member of a clinical commissioning group and a current non-executive member of a hospital trust—because, of course, we get trained in fraud when we take up these non-exec positions. So I have been diligent in doing my online training with the NHS fraud authority. It is very rigorous and it makes you think very carefully about the whole range of fraud that might occur in the NHS, including in recruitment, procurement and so on. So I will just say that it is very useful that it is so diligent in this. Of course, it is part of the whole audit process that goes on within NHS foundations and NHS bodies all the time.

I thank the Minister for introducing these provisions, which we will of course be supporting. Fraud is by definition a hidden crime and those who commit fraud are of course in a minority. But we are talking about significant sums here. The 2018-19 estimates say that fraud cost the NHS about £1.27 billion. So fraud is not and never has been victimless, and in this case it impacts directly on patient care. I commend the work of the fraud authority in uncovering scams and ghost patients, but there is still quite a long way to go.

Unfortunately, Covid-19 presents a heightened risk of fraud, and it does so across the whole of society. As someone who had to have their bank cards changed three times during lockdown, I say that unscrupulous crooks are seeking to exploit the fact that systems are not working and in particular that our health system is under unprecedented pressure—and they are doing it for their own financial gain. I think all noble Lords will agree that robust response is imperative to safeguard the reputation and resources of our health service, so we welcome these provisions and the extension of their lifespan for a further three years.

The disruption caused by Covid-19 has seen a reported spike in fraud cases across health and social care, ranging from fake PPE to recruitment, as well as cybersecurity attacks. I think noble Lords will agree that this is deeply concerning, so what assessment have the Government made of reports that levels of fraud have been increasing during the Covid-19 crisis, and is the noble Lord able to share any preliminary figures with us today?

Like my noble friend Lord Jones, I say that it is imperative that the fraud authority has the resources it needs to investigate, detect and prevent fraud. So could the Minister assure the Committee that the resources that it does need to investigate, detect and prevent fraud are there, and that there has been increased funding, commensurate with the increased risk?

An urgent concern is the relaxation of recruitment rules and practices to allow NHS bodies to hire staff working across the health and social care sector. I completely accept that this has been necessary at a time of emergency, but I wonder what assessment the Government have made of these exceptional circumstances and the unique pressures that may impact on methods of preventing fraud in recruitment. What advice and support is the fraud authority giving to NHS organisations to help them prevent fraud in these difficult times?

PPE has already been mentioned in this debate, and we have talked a lot about it in the last few months. It is of enormous concern that amounts of public money have been directly awarded outside the usual tendering process, with no competition. What steps is the authority taking to prevent fraud linked to PPE procurement? Given that PPE procurement for Covid-19 is now centrally managed, can the Minister confirm whether this falls outside or inside the remit of the authority? Who will be investigating this as we move forward? Are cases being referred to the Department of Health’s anti-fraud unit, supported by the authority? I hope that the Minister will also take the opportunity to confirm that there will be an inquiry into PPE procurement as we move forward.

The Minister has already mentioned something of vital importance: cross-working. The most recent annual report identifies a number of challenges and potential barriers that affect the ability to tackle fraud against the NHS and highlights the fact that the level of understanding of the nature of fraud in the NHS continues to be uneven across the health system. So if there is underreporting of fraud and suspicious activity, that is of continuing concern. Can the Minister expand on what the authority intends to do to improve cross-NHS working?

In June, as has been mentioned, the Cabinet Office published the Counter Fraud Functional Standard, which is intended to be introduced across the NHS by the end of the financial year. We certainly welcome this move towards a common counter approach across the public sector. But what steps is the NHS Counter Fraud Authority taking to support the NHS organisations to implement this change? Can the Minister confirm that this will be introduced across the NHS by the end of this financial year, as intended, or will it need to be delayed? Perhaps he could explain that.

So we welcome this order and I think that these are all questions that will probably need to be answered in due course.

Covid-19

Baroness Thornton Excerpts

Thursday 3rd September 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for the Statement and the Covid update that the House will discuss today. We are, of course, all on the same side in fighting this virus. I hope the Minister will understand that when we raise issues it is to urge the Government to improve their response to fighting the virus which, as he said earlier today, remains lethal and leaves many with serious, debilitating sickness. Everything must be done to drive down and eliminate infections and suppress the virus completely.

Given the news today about testing availability and the aspirations of the Secretary of State in that regard, I start by asking the Minister about the current state of testing and tracing. From the news this morning, it would seem that coronavirus testing was being prioritised in high-risk areas, leading to shortages in others. This has led to some people with symptoms being asked to drive significant distances for a swab. The Government say that areas with fewer Covid-19 cases have had their testing capacity reduced to cope with outbreaks elsewhere. Is this within the 300,000 tests which the Secretary of State has mentioned as being his aspiration? As the Minister will be aware, public health experts warn that this could miss the start of new spikes, so I would be very grateful if he could clarify the exact position on the rollout of mass testing.

Saliva testing is being used in Hong Kong, as we know. Would the Minister be able to ensure a quick turnaround of these tests? Has he seen the study from Yale which suggests that saliva testing could be as sensitive as nose and throat swabs? What is his attitude towards pool testing, which surely could increase capacity in areas of low prevalence? Does the Minister have a plan to introduce pool testing? Will we now allow GPs to carry out testing or, at the very least, arrange tests for their patients directly? They currently have to ask patients to log on to the national system, which may be causing huge delays.

A testing problem came to my notice in an email I received from an English family on holiday in Northern Ireland. They went there to have a break and did everything they could to ensure their safe passage—they did not stop for toilet breaks, they packed lunches, they booked the shortest ferry crossing, and they were heading to a house that had not been occupied for a week. However, something went wrong, and the father became ill. He said: “Getting a test should be easy, right? Well, wrong. When we first tried to get a test, the booking system was completely down. It was not working online or by telephone. When it eventually resumed, I was offered a test appointment 460 miles, and a ferry journey, away in Scotland. I was worried about having potentially to drive 20 or 30 minutes with a raging fever, so we ordered the home tests. The kits took 48 hours to arrive. Remarkably, there seems to be no test-kit storage site in Northern Ireland itself, so they have to come from the mainland, even though one of the companies than manufactures tests—Randox—is based in Northern Ireland.”

This person had the usual problems that lots of people have when doing a self-administered test and returning the results. They were in an isolated place, so they chose to use the specially designated postal box, which meant his wife driving 25 minutes. That box was inside a building. It did not seem to cross anybody’s mind that potentially infectious people should not be entering a building full of people. When the wife talked to someone about their concerns, they said that they were not allowed to handle parcels and she should put the results in another post box. It took six days from the husband developing the fever and seeking a test to getting the result. When it came, it was not absolutely conclusive. We know that these tests can sometimes be only 70% accurate. This person is still very ill and still in Northern Ireland. He is an academic who, as it happens, is also a scientist. He is very disappointed with the 111 service, which he called to ask for another test. He was told that he could not have one, that he probably did not have Covid, and that he should go back to work. It seems to me that this system is not working terribly well. What is the Minister’s view of this sorry tale, which raises all sorts of issues about testing and tracing, at least in Northern Ireland?

I move on to the cancer plan and whether a task force will be in operation. The number of new cancer patients presenting is down by one-quarter this year, the number of appointments for specialist cancer treatment is now also falling, and the amount of money available for clinical trials has fallen through the floor. This means that people will die. What are the Government’s plans to move this forward?

We know that a vaccine is our best hope to stop this pandemic. It will save hundreds of millions of lives. We on this side of the House have offered to work with the Minister on a cross-party basis to promote uptake and challenge the poison of anti-vax myths. That offer remains in place. We would work constructively with the Government on any proposals that they bring to the House to deal with those myths.

On Public Health England, the Minister is aware that we on this side of the House think that embarking on a distracting restructuring of Public Health England in the middle of a pandemic is very risky. Conservative MPs seem to like to blame Public Health England and this will sap morale even further. The UK has suffered the highest per capita death rate of any major world economy. To get through this winter safely, our NHS and public health services need resources, staff, protective equipment, fair-pay security and the support of this Government. I hope they will be able to deliver that.

Finally, the Minister said a few minutes ago that the folic acid issue would not be dealt with until after the pandemic. He needs to write to the House about exactly what that means and what the timeline is.

[Baroness Jolly (LD)]

My Lords, yesterday it was raining when I left the house, so I decided to catch a bus. I donned my mask and got on. There were signs to say that only 30 passengers would be allowed, but I was disappointed that not only was that number exceeded, but masks were not universally worn. Some came off when the individual wanted to use their phone or talk to a friend, and there appeared to be no awareness of the reason for wearing one. I was glad to get off. It raised as many questions as it answered.

I appreciate that there is positive movement in some parts of the country. In my own part of the world, the far south-west, despite many visitors from elsewhere—the locals were anxious that they would bring the virus with them—they mainly kept to themselves and only left their footprints in the sand behind. Areas have been locked down in north-west England, Yorkshire and Greater Manchester, as there have been many cases identified. Will the Minister outline how these cases were identified?

Social distancing is difficult when you are young. We all might remember when we felt immortal; many young people catch the virus, are barely unwell but are spreaders among their generation. They then take it home and pass it on to their older family members. Mass testing would avoid this.

What is the Government’s policy on testing key workers? Do they have to book their own tests, or are some professions automatically tested or encouraged to book a test? I was contacted by text quite out of the blue by my local authority to take a test, which I dutifully did. No reason was given; perhaps it was a contact trace. I therefore looked at where the local testing stations were located and no station was nearer than 50 miles, so I ordered a postal test. Easy, excellent directions came with the test and the result came back quickly, so I had a completely different experience from that of the person who wrote to the noble Baroness, Lady Thornton. Could the Minister outline where test and trace is being used and what system is in operation? I know that it is going well in Northern Ireland. Have the Government considered using this in England?

The Government pay-to-isolate scheme also seems a good idea for those who cannot afford to miss work. Will the Minister tell the House what the take-up is and where the department might use it in future?

When do the Government expect to roll out a vaccine? I would like to know how many volunteers are taking part in the programme and how that number compares with the development of any other new vaccine that would be working to the usual timetable. I would expect Public Health England to organise vaccinations when it is ready. Now that Public Health England’s future is uncertain and it is being disbanded, how will this happen? What clinical personnel would the Government consider capable to deliver the vaccine? Presumably, as local pharmacies deliver flu vaccines, they would be capable of delivering coronavirus ones as well. Would this be something paid for by the patient, as with flu, or paid for by the Government? Has the department had conversations with the pharmacy profession about doing this work?

May I ask the Minister a question about numbers? In the Statement, it was mentioned that 84.3% of contacts were reached and asked to self-isolate. Do we have any certainty that they did so? Are local authorities or call centres checking on this?

My final point is about nurse numbers. I am delighted that they are higher, although we will still be far off full complement. Will the Minister comment on care-worker numbers? In the new year, some EU-origin workers might not be able to afford to stay under the new system. The Home Secretary suggested that we could use British care workers. Is the Minister confident that they will exist in sufficient numbers?

Covid-19: Local Restrictions

Baroness Thornton Excerpts

Thursday 3rd September 2020 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government what plans they have to publish the scientific advice which informs decisions to lift restrictions put in place to address Covid-19 in specific local areas.

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

My Lords, data is the key scientific commodity in our fight against Covid. We started with very little; now we have lots, and we are sharing it with our local partners as quickly as the legal, technical and privacy constraints allow. This shared intelligence informs collaborative decisions on local restrictions.

--- Later in debate ---

[Baroness Thornton (Lab)]

I thank the Minister. On the ministerial Zoom, I witnessed the Conservative MP for Shipley having what looked like a hissy fit when the Bradford lockdown was announced. Despite recommendations to the contrary from the leader of the council and local public health officials, a month later Shipley has been lifted out of lockdown when other parts of Bradford still in lockdown have lower infection rates. On Friday, the Health Secretary announced that restrictions in Bolton and Trafford would be eased on Wednesday, despite leaving Labour constituencies with lower infection rates in lockdown. It seems that the Government were again lobbied by local Conservative MPs to lift restrictions. However, yesterday, the Health Secretary, with what might be called a skidding U-turn, announced that current restrictions would remain following a significant increase in infection. Will the Minister commit to publishing the scientific evidence behind decisions to impose, maintain and lift lockdown restrictions? Would it be better if discussions with local MPs were on the record? Does he agree that political neutrality and transparency are essential to securing public trust and support for measures locally to prevent a national lockdown?

[Lord Bethell (Con)]

My Lords, I entirely agree with the noble Baroness that local support, trust and collaboration between actors from all political parties are essential to fighting Covid effectively. I pay tribute to the very large number of dialogues and collaborative interventions we have had across the country with local actors from all political parties. Yes, local lockdown decisions are not always popular. They are tough choices and elected representatives find them difficult, but we have found that politics does not play a part in those decisions and we stick to that.

Health Protection (Coronavirus, Restrictions) (England) (No. 3) Regulations 2020

Baroness Thornton Excerpts

Thursday 3rd September 2020 Lords Chamber

[Baroness Thornton (Lab)]

I agree with everything that the noble Baroness, Lady Barker, has just said. We shall get to that point by the end of this month. I congratulate the Minister on the marathon session that he has done today. I have just agreed to almost three days this month of statutory instrument conversations like the ones that we are going to have today about things that have already been enacted. They all have to be done by 25 September, so for two Fridays and a Thursday the Minister and I and many noble Lords here will be in the Chamber having similar conversations. The time has come when we actually need to review the whole process. I say that for a number of reasons.

The Minister has said a few things today that I completely agree with; for example, he says that the population are getting a bit exhausted, that we definitely have a second wave coming and that there are things that we therefore need to think seriously about. The Minister has also said that we now know a great deal more about Covid, what happens and how to deal with outbreaks than we did at the beginning of March. When you put all those things together, it should say to us that we do not need the urgent legislation on the statute book that we agreed back in March. It needs to be reviewed. There is now time to plan for the next wave if it is going to happen. There is time to have discussions in Parliament about what needs to be done, what local authorities should be doing, what resources are needed, how the NHS can function and continue cancer and other treatments at the same time as manage a Covid outbreak. We have time to do that. It is about time to ask the Minister to say to the Government that we need to end the emergency legislation. We need to review it and we need to stop it. We now need proper scrutiny of the regulations that we are discussing today.

These regulations should have been debated two months ago. I put on the record again that this process needs to be reviewed as a matter of urgency. If we are to believe the Minister and his colleagues about testing and tracing, the readiness of the NHS, the scientific basis for local lockdowns, the strengthening of local public health efforts, and the greater understanding of the virus, we do not need emergency legislation to facilitate and to avoid a national lockdown. The question that the Minister needs to answer is: when will we see a proper review and revoking of these powers instead of just rolling forward, with Parliament unable to play its part in the legitimate scrutiny of this legislation?

Another legitimate concern which the Minister has heard from several parts of the House is that this piece of legislation can be used to stop legitimate political activity. Can the Minister say whether the legislation has indeed been used to stop legitimate political protest, which this country prides itself on allowing to happen, even in its most bonkers forms?

The noble Baroness, Lady Bull, and others raised important questions about the equality issues raised by this legislation. I would like the Minister to address those questions.

Can the Minister expand on the criteria for serious and imminent threats to public health and the necessary precautions? According to the Local Government Association, local authorities are unsure of the circumstances in which they can use these powers and the threshold for meeting these two tests. For example, many councils have been grappling with the lack of social distancing in venues, including licensed premises, such as pubs, but found that a small minority ignored the requirements to ensure social distancing altogether.

Where areas are on the Government’s watchlist, and there is a clear imminent public health ground to take action, councils feel confident in taking enforcement action under the regulations. However, where there is not a known spike of Covid cases locally, councils have advised that they are less certain about whether they can take enforcement action under the regulations to prevent a local outbreak. Does the Minister believe that a lack of social distancing in itself constitutes a serious and imminent threat to public health?

Hesitancy is not helpful in the fight against Covid-19. The clarity for which we have been calling for months remains a priority. I think that these regulations give a Secretary of State the power to require a local authority to make or revoke a direction after consulting with the CMO or deputy CMO. Can the Minister advise whether the Secretary of State has given any such directions and, if so, where has he done that? Can he confirm whether the CMO or deputy CMO were consulted and whether their responses were shared with the appropriate authority?

I would be grateful if the Minister could explain how this particular set of regulations interacts with the Government’s guidance on other legislative regimes. However, basically, the Government need to take a thorough look at the appropriateness of these regulations and the way in which they are carried out.

Childhood Obesity

Baroness Thornton Excerpts

Wednesday 2nd September 2020 Lords Chamber

[Lord Bethell (Con)]

Health checks in the early years of childhood are an incredibly valuable opportunity to intervene in a number of health inputs. Diet and exercise are two of those. Training is in place for health visitors to provide dietary advice but, when back at the department, I will ask whether we are working on any new initiatives at the moment and write back to my noble friend.

[Baroness Thornton (Lab)]

I have two questions for the Minister. Could he explain to the House why Professor Dame Sally Davies’ 2019 report on childhood obesity, which made 49 recommendations, seems to have been lost? Given that Public Health England plays a crucial role in addressing obesity, as my noble friend Lord Dubs said, and the obesity team seems to be homeless at present, how will the Government ensure that its expertise, accountability and leadership is retained and relevant bodies are sufficiently funded?

[Lord Bethell (Con)]

My Lords, the report from Professor Sally Davies has not been lost; the July obesity strategy leans extremely heavily on the insight and advice of Sally Davies, who continues to have a strong presence in the department and informs all our decisions, as does the public health team at PHE. Professor John Newton had an extremely high profile during the launch of the obesity strategy in July and continues to have an important voice at all levels of the department.

Medicines and Medical Devices Bill

Baroness Thornton Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Wednesday 2nd September 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for introducing the Bill, all noble Lords for their contributions and all the organisations, including the Library, that have sent us briefings. I particularly thank the Delegated Powers and Regulatory Reform Committee and the Select Committee on the Constitution for their reports, produced in a timely fashion at the beginning of the recess, thus giving us all time to digest and reflect upon the issues concerning powers contained in the Bill.

We on these Benches recognise that this is an important Bill; indeed, the issues that it addresses are vital. I will concentrate on two or three, or maybe four, issues, most of which have been mentioned in the debate.

As the noble Lord, Lord Blencathra, said in his stirring contribution earlier, it seems that most of the Brexit Bills between now and Christmas will contain the same or similar constitutional challenges, so I think that we can anticipate some serious learned and constitutional debates throughout the autumn.

I am not sure whether I want to describe the Bill as a Trojan horse—something that has a seemingly innocent and benign exterior hiding huge and serious dangers within. Perhaps it is yet another example of the Prime Minister’s cavalier disregard for both timeliness and accountability, combined with our own Health Minister’s self-confessed aptitude for hustling, or perhaps it is all those things combined. However, it is worth recalling the words of one of our most distinguished Cross-Bench colleagues, the noble Lord, Lord Wilson, during the passage of the international healthcare arrangements Bill in February and March last year. On 19 February, he recounted his time as a junior civil servant when he went to discuss a Bill with our very much respected parliamentary counsel. He said:

“My assistant secretary was asked why we needed a particular power, and he rather flippantly replied, ‘Because I thought it might be useful’. Parliamentary counsel gave him a withering look and said, ‘I am not going to draft a clause for you simply because it might be useful. You have to know what you want it for’. He did not know, and we did not get that power.”—[Official Report, 19/2/19; col. 2185.]


It feels as if it is the same with this Bill. Powers have been thrown in just in case they might be useful. The Minister called it “agility”. We agree that agility can be useful, but if it is not linked to policy and what you want to do with it, it is a power that can be abused.

Do the Government know what they want, or are they are putting these powers in simply because they might be useful later? I suggest that they do know what they want: they want the power to do exactly as they decide, whenever they decide it, without scrutiny, accountability or due consideration. For our NHS and care services the important matters are whether medicines are available and how much they cost, the future of scientific research, fake medicines, proper safeguards for medical devices and putting patients at the heart of this. They deserve our full scrutiny and the best constructed Bill possible.

As my noble friend Lord Hunt said—this risk was amply illustrated in the stark narrative of the noble Earl, Lord Devon—leaving the EU’s medicines regulatory regime poses a significant risk to the UK. The Bill is crucial for maintaining the attractiveness of the UK’s life sciences sector and ensuring that patients continue to benefit from the excellent clinical research that takes place in the UK. Therefore, it is vital that we fully understand what constitutes “attractiveness” on the global stage.

Will the Minister reflect on the rumour that leaving the EU is likely to see the UK drop down the list of markets that companies will choose to trial and launch medicines in if mitigating steps are not taken? It is crucial that this legislation carefully defines what the Government mean when they talk about the UK’s attractiveness as a place to conduct clinical trials or supply human medicines. Does “attractiveness” equate to the speed of decision-making at every stage of the medicine pathway? How will patient safety be assured? Will the Minister set out what the Government mean when they talk about attractiveness, how they will apply this to medicines access and what he is doing to ensure that patients in the UK can access new therapies on the NHS as soon as countries such as France can?

The British Medical Association asked about the potential divergence in standards and suggested that this must be kept under constant evaluation to ensure that such changes do not negatively impact the timely supply of safe medicines to UK patients, as my noble friend Lord Turnberg said. The new EU regulation on medical devices is an example of a change coming through from the EU that the UK should seek to capture in the future regulatory framework around medical devices, as facilitated by the Bill. Expected to come into force in 2021, the revised rules were drafted in the aftermath of the metal-on-metal hip and PIP implant scandals. They will introduce stricter requirements on the bodies authorising medical devices and ensure greater post-market surveillance. Will UK patients benefit from changes such as these, which were orchestrated at EU level, when we are no longer part of the EU’s processes? How will that happen?

The impact of moving away from the existing collaborative approach between the UK and the EU could be substantial. The centralised processes that we are currently part of reduce the burden on the regulatory authority in each member state, create a larger European market for the pharmaceutical industry and medical device manufacturers, and thereby facilitate timely access to new therapies and technologies to patients across the EU and EEA. As many noble Lords have said, the EMA accounts for 25% of world sales of medicines, second only to the United States. By comparison, the UK accounts for only 3%.

On medical research, negotiating a formal agreement to maintain access to EU funding programmes, ensure alignment with clinical trials regulations and secure the participation of the MHRA in clinical trials that cross the EU and the UK to maximise collaboration between researchers in both is particularly important if UK researchers are to benefit from the EU’s new clinical trials regulation, which is due to be introduced in 2022 and is expected to significantly improve the current research climate via the introduction of a single clinical trial database and a centralised clinical trial portal. I have been talking to your Lordships’ House about this portal ever since the Brexit vote. It looks like we will not be part of it. I would like the Minister’s comments on that and an explanation of the disadvantage that this will bring to UK patients.

As many noble Lords have said, the Bill presents an opportunity to address the issues raised in the excellent report First Do No Harm, launched and led by the noble Baroness, Lady Cumberlege, whose remarks were very moving indeed in addressing the terrible sufferings of women at the hands of the NHS and the regulatory regimes that failed them so comprehensively. Surely we need to take this opportunity to provide for its recommendations. As other noble Lords have said, we need to consider amendments that will fall within the scope of the Bill and cater for the nine recommendations in the report. At the heart of the Bill lies the issue of patient safety in terms of medicine and medical devices, so it must be an appropriate vehicle with which to implement the report’s recommendations. Will the Minister bring forward amendments to remedy these omissions?

It is rumoured that there are mutterings, possibly among officials, about burying the proposed patient safety commissioner. I would really appreciate it if the Minister could take this opportunity to refute such rumours and commit to working with colleagues across the House—I include these Benches—to make sure that the necessary amendments happen.

I briefly turn to other issues. We are very supportive of extending the prescribing rights to additional healthcare professionals, as the noble Lord, Lord Ramsbotham, and my noble friend Lord Bradley outlined. It is time that this issue was resolved. We intend to support or table amendments in Committee requiring proposals and a timetable for additional prescribing rights.

We will seek clarification about Northern Ireland and regulatory divergence. We will probe the changes to the hub-and-spoke proposals. We will look closely at the work of the proposed patient safety commissioner, the medical devices register and, of course, the impacts of the Bill on animal medicine and veterinary regulation.

Although only 46 clauses, the Bill is a veritable cornucopia of medical and other proposals. We hope to work with the Minister, the Bill team and other noble Lords to improve it and make it worthy of the importance attached to it.

Health Protection (Coronavirus, Restrictions) (Leicester) Regulations 2020

Baroness Thornton Excerpts

Wednesday 29th July 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister and other noble Lords for their remarks. Here we are again. I do not intend to rehearse the absurdity of this debate; we need to look on it as an opportunity that has been offered. I think the Minister has picked up, today and before, the dissatisfaction in the House and the statutory instruments committee with the current arrangements for scrutiny and accountability.

Leicester remains in lockdown, a situation that I believe is due to be reviewed tomorrow. Can the Minister explain what metrics will be used to decide what happens next in Leicester? I ask this because the people in Leicester seem to be asking exactly the same question, as my noble friends Lady Massey and Lord Clark said.

New measures to stop the spread of Covid-19 were introduced in Oldham yesterday. Can the Minister confirm whether the new rules in Oldham are guidance or a legal requirement? If the latter, how will it be enforced? How is the new local policy being communicated to residents in Oldham, which has a higher proportion of ethnic minorities among whom English may not be the first language? Oldham Council’s deputy leader, Arooj Shah, said the new measures are essential to prevent a strict local lockdown like in Leicester. Can the Minister confirm that national lockdown relaxations, including the reopening of gyms, cafés and pubs, remain applicable in Oldham? What advice have the Government received regarding the increased risk these relaxations pose in Oldham? Can he advise what the threshold of new cases is for introducing local lockdown regulations in Oldham? Can he confirm whether Oldham has been categorised as an area of intervention alongside Leicester and Blackburn and will receive increased national support, capacity and oversight accordingly?

This debate offers an opportunity for the Minister to update the House on how life in Leicester is and what lessons can be learned from this citywide lockdown. As my noble friends Lord Harris and Lord Liddle said, lessons need to be learned from this. In particular, as my noble friend Lord Harris asked, what happens in a large area such as a London borough? What is the impact of the extended lockdown on children who are missing out on school, local businesses and jobs, universities and voluntary groups and the mental and other long-term health consequences for the people of Leicester?

Have the Government learned the lessons about data? We know from the launch of the NHS Test and Trace system at the beginning of May that Leicester’s director of public health repeatedly asked Public Health England for the results of the data from the pillar 2 tests. Although the Minister has assured the House that all data is now being made available, there is a dissonance between what he and the noble Baroness, Lady Dido Harding, tell us and the anecdotal local-level evidence. For example, Katrina Stephens, director of public health for Oldham Council, said she was being given incomplete data about the occupation and recent location history of people who had tested positive. Can the Minister explain why this information was not available from the start?

As other noble Lords have said, many weeks ago the Leicester director of public health asked week after week for postcode-level details and was assured week after week by Public Health England and regional public health that there was nothing to worry about in Leicester. He was told that on 15 June. Three days later, the Secretary of State announced in a press conference that there was an outbreak in Leicester. In such an urgent situation, with a dangerous virus that spreads so quickly, you would think that data sharing would not be an issue. Is the director of public health in Leicester now receiving all the information he needs to do his job? Are they receiving the contact-tracing data? Is the data made available daily?

Let us look at communications. Over the weekend of 27 and 28 June it was briefed in the Sunday Times by the Home Secretary that Leicester was to be subjected to a lockdown, without warning or the involvement of the city council, local police or the NHS. I hope the lesson has been learned that this is completely unacceptable. We should record gratitude to the local MPs, the mayor, the city council, the Leicester police and local community groups for handling the situation with calm confidence, patience and skill. Does the Minister believe it acceptable that a local lockdown that affects hundreds of thousands of people should be announced in a national newspaper and in the national media? Have the Government learned that lesson? If so, what have they learned?

Finally, I ask about the extra costs that come with the lockdown. Can the Minister tell the House whether the Government will meet all these costs and in other areas where there is a spike? The Leicester MPs are saying that, frankly, the Prime Minister has failed businesses in Leicester and put local livelihoods and jobs at risk. I would be grateful if the Minister clarified what support local businesses are receiving. I am sure the Minister will agree that Covid challenges can be terribly difficult to deal with, but it is vital if the Government want to close down a city that they do it with respect and transparency for the local civic community.

Covid-19: Response

Baroness Thornton Excerpts

Monday 27th July 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I gave the Minister notice on Friday that, because we had not taken a Statement about Covid for three weeks, I will need to address the three Statements that are outstanding.

Parliament entrusted this Government with huge powers to deal with Covid-19 when we put the emergency powers on the statute book in March. Certainly, in this House, at the time of the passage of the emergency legislation we sought and received undertakings from the Minister and the Government about the need for effective scrutiny, timely debate, consultation and trust. So how will accountability be achieved during the Recess and the autumn in this fast-moving world? All three Statements raised vital issues that deserve more time and scrutiny than we were able to give them, and I am grateful for the extra time that the usual channels have found for Back-Bench colleagues.

Before I address these Statements, I want to ask Minister about the sudden announcement this weekend of quarantine measures for those returning from Spain. These Benches have made it clear that we support evidence-based protective measures at the border. We have long called for the scientific evidence to be made public and for track, trace and isolate systems to be in place, to avoid the need for the blunt tool of 14-day quarantine. Does the Minister agree that the latest decision-making process regarding Spain and the short notice for travellers have created a sense of panic and suggest a loss of control? Will he agree that proper contingency plans should be in place to support people coming home where there is no guarantee that their employers will allow them 14 days of work flexibility? Why do the measures apply to the whole of Spain? As my honourable friend Jon Ashworth MP said yesterday, “We’ve got an outbreak here in Leicester, but the whole of Leicestershire is not locked down and the whole of the East Midlands is not locked down, so why are the Balearics and the Canaries included when their infection rate is so low?”

On the announcement on 14 July about face masks and shopping—a month after it became mandatory to wear masks on public transport—why did it take so long and why was the messaging so confusing? We have long known about airborne transmission. The Secretary of State warned long ago about asymptomatic transmission. The Secretary of State’s own advice published on 11 May advised in favour of wearing face masks, so it is a shame that it took two months to make that advice mandatory; it came into force last Friday. How will it be enforced? As a former member of USDAW, I am very concerned for shop workers. USDAW says:

“We are also deeply concerned that enforcing the wearing of face coverings could present a further flashpoint for abuse against our retail members.”


It makes the point that full government guidance was released only hours before the changes came into effect, so how were employers to have adequate time to put the policy in place to support their staff during these changes?

On the Leicester lockdown announced on 16 July, the people of Leicester are now in the 17th week of lockdown. We will discuss that issue on Wednesday, but will the Minister confirm what lessons the Government have learned from what they did and did not do in Leicester, for when they face other local flare-ups? Will the Minister guarantee—I would like a yes or no answer—that local authorities will now get the specific data that can facilitate action, that it will be timely and in the form of person-identifiable data, not just postcodes, and that it will include not just positive but negative results so that they can understand the overall infection prevalence? Will they receive the contact tracing data so that they will know who has been asked to isolate by test and trace and can follow them up? Will they receive the data on a daily basis? Once a week is not good enough. The virus does not wait a week, so why should local directors of public health have to wait a week?

Moving on, the financial Statement said that £10 billion had been allocated to test and trace. It would be helpful if the Minister could itemise what that £10 billion has been spent on and with whom. A letter to me lodged in the Library would probably suffice for that question. On 20 July last week, the Secretary of State made a comprehensive Statement—a sort of end-of-term report; I can pick out only one or two important matters and hope that other noble Lords will cover the rest. The news about vaccine progress was very welcome and exciting, but will the Government ensure that there is equitable access to a vaccine when it is developed? The Minister knows that we stand shoulder to shoulder with the Government in taking on poisonous anti-vax propaganda. However, if a vaccine does not become available, what scenario planning is taking place right now, should we be confronted with that awful prospect? Will the Minister take this opportunity to update the House on R? Are we still below 1? Which parts of the country are not?

On social care, we welcome the fact that families are now able to visit their loved ones in care homes and we also welcome the extra funding for the NHS announced by the Prime Minister. But there was no extra funding for social care. Will social care get any more resources this winter? This is underlined by the Government’s failure to reimburse care homes properly for PPE and testing costs during the pandemic. They will actively have to meet the additional costs of ensuring that care homes stay safe for residents, staff and visitors. It must be cost-effective that they do so. The Local Government Association has today called for a social care reset after reflection on the Prime Minister’s pledge to fix social care a year ago. That representative body has urged the Government to publish their timetable for social care reform prior to Parliament’s return from the Summer Recess in September. Will the Minister tell the House whether that is possible?

[Baroness Brinton (LD) [V]]

My Lords, from these Liberal Democrat Benches, I thank and congratulate all the millions of people, whether paid staff or volunteers, who have worked tirelessly over the last five months to combat this pandemic, serving people and providing support during what is the most extraordinary health crisis in 100 years. As the noble Baroness, Lady Thornton, outlined, it is very disappointing that the Government Whips’ Office has resisted giving your Lordships’ House the opportunity to have a timely discussion on each of the three Covid Statements, on 14, 16 and 20 July. Each covered different, urgent and serious matters for our country that should be scrutinised by your Lordships’ House, so I too will use all three Statements as the basis for my questions to the Minister today.

First, given that the report of 20 July has a strategic and end-of-term report feel, we have an overarching concern about the Government’s repeated mantra in Statements about protecting the NHS at all costs, including the preparations for a second wave. Unfortunately, it appears that lessons have not been learned from the consequences of that single priority, not least those from throwing our care sector to the wolves without adequate testing, PPE or financial support for its massively increased costs. So I ask the Minister again: do all parts of the care sector now have repeat and regular testing, the PPE they need to practise new standards of infection control and continuing financial support for the consequences of both?

As I mentioned on Friday in the debate on the coronavirus regulations, a further group feel they have been left high and dry: people who shield, whether they are disabled, elderly or have serious underlying conditions. So I again ask: will the Minister explain why the letter to shielders dated 22 June insists that shielders lose all the support for shielding from 1 August? The letter instructs recipients to follow strict social distancing at all times and to stay at home where possible but, in complete contradiction to that, also instructs people to return to work if it is Covid-safe and removes access to furlough pay and sick pay, so if it is not safe to return to work and shielders cannot work from home, they are now at high risk of losing their jobs. Blood Cancer UK is extremely concerned about this risk for people who have been shielding as from August they will face an impossible choice between returning to work and risking their health or staying at home and risking unemployment. It asked the Government to extend the furlough scheme for the small number of people involved for up to three months or to provide alternative financial support to protect them from life-threatening ill health, and we agree. Will the Minister undertake to raise this with the Chancellor of the Exchequer as a matter of urgency and write to me?

Lifting the lockdown also brings into sharp relief how much real progress has been made by the Government on testing, tracing and isolating as a key tool to manage outbreaks. To that we must again add quarantine arrangements. On the news today, following the Spain quarantine regulations, we heard the Government say that they will not be monitoring any quarantine arrangements. They are still experimenting with temperature screening at airports and are not routinely testing people as they arrive in the country. If we are serious about having a proper system for people arriving in this country and quarantining safely, when will that be put in place?

We also hear that testing capacity will shortly reach 500,000 a day, which is welcome, but there seems to be no routine to test that capacity to the full. It is still not universal, despite repeated requests, regularly to test NHS and care staff to keep them safe. We hear that many local testing centres are closing down and that the test at home system is to stop. Can the Minister reassure your Lordships’ House that a full test, trace, isolate and quarantine policy is in operation, not least to test the larger-scale, effective system that we will need in the event of a second wave? How many people were tested on Friday?

Finally—the Minister can probably recite my next question as I have asked it so often, but I will be grateful if he could answer my actual question, not repeat the usual mantra because just saying that local authorities are being given more data at postcode level is not enough—when will all local authorities and directors of public health get the full data that they have requested and signed data protection releases for on a daily basis and at a more granular level than postcode, without which they cannot effectively tackle spikes in cases swiftly? The Minister saying that he is giving them more data is not enough. It must be the data that they need and for which they have already signed data protection releases.