Health Protection (Coronavirus, Restrictions) (No. 2) (England) Regulations 2020
Baroness Thornton Excerpts(4 years, 4 months ago)
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Baroness Thornton (Lab)
Can I just say for clarification that as we were discussing these SIs, the news came through on my technology that we will have a ministerial Statement on Monday? I am sure that the Minister is aware of this, but we are indeed three Statements behind. The noble Baroness, Lady Brinton, is quite right that it is quite shocking. I need to give the Minister notice that I will take the Statement on Monday as if it is three Statements. I will address the questions that relate to all three Statements made in the Commons during the last three weeks.
A noble Lord
Baroness Thornton
I have asked for extra time for the Back-Benchers but it is not in my gift; it is probably not in the Minister’s gift either. However, I hope that the usual channels will take note of that and agree.
I thank the Minister for introducing these SIs. Let me say at the outset how much I agreed with the noble Baroness, Lady Bull, on the issue of disability, as I did with the noble Baroness, Lady Anelay, and my noble friend Lady Andrews on the points that they made.
Leading the news today, and this week, is the legal obligation to wear face masks in shops, takeaways and so on. This morning, the police, the CBI, retailers and many others expressed their astonishment, scepticism and anger that the regulations and rules were laid only yesterday, even though the announcement was made on 14 July. Even more ridiculously, Parliament will not discuss these regulations until September; in the case of your Lordships’ House, because it will go through normal scrutiny, possibly not until late September. Who knows, they may have changed even before we get to talk about them. Does the Minister recognise that delays in laying regulations have significant implications for enforcement, given that they are often unclear on what precisely is and is not permitted, according to the law, until they are in place? This is a confusing U-turn, particularly in relation to the wearing of face masks.
The regulations we are discussing and the issues of concern today are reflected in this debate. However, this is not a debate because, with one minute per Member, the Minister can choose whether he answers the questions in a meaningful way without any further challenge. He can read his prepared script and there is nothing that we in this House can do. The noble Lord, Lord Cormack, is quite correct: this is a travesty of parliamentary scrutiny. I am not saying that this is the responsibility of the Minister because I know that he works very hard. However, it is really unacceptable. This House is not carrying out its duty of scrutiny at the moment.
I have twice written to the Minister asking for answers to questions I asked that have not been answered. They remain unanswered and I put him on notice that I will continue to do that, because these are the issues that we face. It is very disappointing that we are only just considering these regulations. Yet again, we find ourselves in the absurd situation of having one set of regulations that amend another, and which are about to be amended again, given further policy changes that have been announced—and we are about to go into a month’s Recess. The House cannot be in any doubt that the responsibility for this delay lies with the Government, who may have made a deliberate decision to wait until the last possible moment to lay regulations before Parliament, using the affirmative procedure. It is deeply concerning and unsatisfactory to make regulations in this way, and is indicative of this Government’s cavalier attitude to parliamentary scrutiny. Will the Minister inform us when we will find a better way of ensuring that these regulations are debated in a timely fashion?
The Government’s decision to delay making regulations also has real-world implications. Many businesses are unable to open at the earliest opportunity; this includes outdoor swimming pools. Many of them, along with community groups and charities, have been very critical of the Government’s communication on lockdown relaxation measures. They say that the lack of preparation time has made a short summer season unviable. Other businesses began preparations to open, following headlines on government announcements, only to find subsequently that they are unable to offer certain services. I hope that the Minister will apologise to these operators, their staff and the communities they serve for the Government’s shambolic failure to communicate with industry and provide clarity and guidance in a timely fashion.
On Monday, my honourable friend Justin Madders said:
“As I said last Thursday, parliamentary scrutiny is not something that can be ditched because the timing is inconvenient”.—[Official Report, Commons, Second Delegated Legislation Committee, 20/7/20; col. 5.]
He is absolutely right. The Secondary Legislation Scrutiny Committee has also called on the Government to ensure that the information is provided. We are not being given the scientific information we need to back up these regulations. We need full transparency so that we can have confidence that this Government’s scientific advisers support the measures we are debating. A week or so ago, the Government’s Chief Scientific Adviser said that there was “absolutely no reason” to change the Government’s current guidance on working from home; the very next day, the Prime Minister announced that guidance on working from home would be changed. My noble friend Lord Reid referred to this; it is not acceptable.
The Opposition will again not oppose these regulations —of course we will not, as we welcome the opening up of our society and businesses—but we are concerned that we are entering another critical moment without having available the full information on which decisions are being made, without a clear understanding of the risks and with a test and trace system that is not working. My final question to the Minister is: where is R at the moment? Is it going up or down?
Smoking
Baroness Thornton Excerpts(4 years, 4 months ago)
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Lord Bethell [V]
My Lords, I completely recognise the power of the smoking bans, as well as the threat of young people taking up smoking and sticking with the habit for a long time. We are on track to meet our national ambition of reducing under-15 smoking from 5.3% in 2018 to 3% or less by 2022. However, even that seems too high and we will continue to work on our efforts.
Baroness Thornton (Lab)
My Lords, it would be nice if, on his birthday, we could get to my noble friend Lord Simon, so my question is very short—fewer than 75 words. Inequalities in smoking remain the largest cause of life expectancy gap between the rich and the poor and are the main reason for the lives of people with serious mental illness being shortened by up to 20 years. Does the Minister agree that the smoke-free ambition may be achieved only by the most advantaged and will the Government’s further proposals address this inequality?
Lord Bethell [V]
Health inequalities are one of the most pernicious and difficult aspects of modern life and the Government are focused on them. Smoking is a graphic example of the worst of our inequalities. That is why the prevention Green Paper focuses on these kinds of inequalities and why our response will be muscular and determined.
Covid-19: Personal Protective Equipment
Baroness Thornton Excerpts(4 years, 4 months ago)
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Lord Bethell [V]
My Lords, turnover of the test and trace team is an inevitable consequence of an organisation that was set up using temporary staff, many of whom are on short contracts and need to return to their previous roles. It is regrettable, but I owe them a huge debt of thanks for the work they have done. The work of McKinsey is focused on governance, not on HR. It was commissioned some time ago and it is an entirely proper and regular appointment.
Baroness Thornton (Lab)
My Lords, I refer back to what the noble Lord said about the amount of PPE that is needed. It is actually the case that in the 2016 report it was signalled that we would need a gigantic quantity. I am sure we would all agree that we need better organised and effective preparation if there is to be a second wave, and the centralised purchasing of PPE, managed by local public health agencies, will ensure effective distribution. I want to ask about the care sector. Does the noble Lord believe it is acceptable or wise for care homes to have to pay over the top prices and compete for PPE? Does this not put the wider public health interests at risk? What steps is the Minister taking to end discrimination against the care sector in the supply of PPE and ensure essential protection for care workers, residents and visitors?
Lord Bethell [V]
My Lords, it is a reality that the cost of PPE has gone through the roof. There is nothing that I or the Government can do about that. It is something we are going to have to live with and budget for: it is part of the new reality. As to the procurement of PPE, as the noble Baroness knows, within the care sector it was previously the arrangement that local providers would source their own PPE. The Government have stepped in to bring resilience and confidence to that supply chain and to offer alternative sources of supply to local care homes. We have moved emphatically and sought to bring both affordability and resilience to the supply chain.
Independent Medicines and Medical Devices Safety Review
Baroness Thornton Excerpts(4 years, 4 months ago)
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Baroness Thornton (Lab) [V]
My Lords, I thank the Minister for the Statement. I start with the words of the chair of the review, our colleague, the noble Baroness, Lady Cumberlege, who said when she launched the report last week that she was shocked by the sheer scale and intensity of suffering. She said:
“I have conducted many reviews and inquiries over the years, but I have never encountered anything like this … Much of this suffering was entirely avoidable, caused and compounded by failings in the health system itself.”
I congratulate the noble Baroness on conducting an inquiry over the last two years that has been praised by everyone concerned, particularly the patient groups and those affected.
Some of us have been discussing the problems addressed in this report for many years. We have heard about the hormone pregnancy test Primodos, the anti-epileptic drug sodium valproate and, in recent years, use of vaginal mesh in surgery. It is important to pay tribute to the bravery and persistence of the patients and patient groups, but also to the parliamentarians whose work helped to persuade the Government to establish the inquiry two years ago. The All-Party Groups have been vital, as have Yasmin Qureshi MP, Norman Lamb MP, Owen Smith and Sharon Hodgson MP, to name but a few.
On the surface, the three medical issues are separate. What links the medicines and devices is that they were all taken or used by women—in two cases, by pregnant women. As my honourable friend Alex Norris MP said last week in the Commons,
“these cases reek of misogyny from top to bottom—and ageism and ableism as well.”—[Official Report, Commons, 9/7/20; cols. 1148-49.]
We also have to look at the reaction of the healthcare system, which, according to the report, failed to monitor the use of these medicines and medical devices, then failed to identify and acknowledge the things that had gone wrong, then failed to work to improve. The review sets out the missed opportunities when something could or should have been done to prevent harm. Instead, there was a culture of denial, disjointedness and defensiveness that failed to listen to patients’ concerns.
Our NHS failed to protect these women and their families. It is therefore right and welcome that the Minister’s first reaction has been immediately to offer an unqualified apology, which is the first of the nine recommendations in the report. The Secretary of State said that listening and humility are in order. That is right, but it now needs to be followed by action to make the process worth while and to address the suffering. I hope that in this discussion the Minister will be able to outline what the Government will do to implement the rest of this report and to what time- scale. The most sensible way forward is the ninth recommendation, which is to set up a task force to implement the other recommendations. Will this be done, and by when?
On recommendation 2, I can see that progress has already been made. But can the Minister explain what legislative underpinning would be needed for a patient safety commissioner? Some of us are very puzzled as to where the delightfully named HSSIB is—the patient safety Bill—and whether that would have been a good complementary vehicle.
Recommendation 3 calls for:
“A new independent Redress Agency for those harmed by medicines and medical devices”
to create a new way of delivering redress in future. It suggests that manufacturers and the state should share the costs. Would the Minister care to tell us how that might be achieved?
Recommendation 4 suggests:
“Separate schemes … for each intervention—HPTs, valproate and pelvic mesh—to meet the cost of providing additional care and support to those who have experienced avoidable harm”.
How might that be achieved? I also have one question relating to mesh and all other implants. How will the Government ensure that they are safe to use? A register is obviously a good step forward and is in the Bill that we will discuss in the next few months, but why do the regulations on implants not provide for trials, as with medicines?
On recommendation 6, will the Minister commit to amendments to the Medicines and Medical Devices Bill to strengthen the Medicines and Healthcare products Regulatory Agency’s regulatory regime? On these Benches, we are committed to implementing the nine recommendations in this excellent report. We will seek to use the forthcoming MMD Bill to do so, and we wish to work with the Government to explore how best to achieve that.
Baroness Brinton (LD) [V]
My Lords, on behalf of the Liberal Democrat Benches, I too thank the noble Baroness, Lady Cumberlege, and her team for such an outstanding report. It is not only comprehensive but blunt in its language, so that no one can misunderstand the failings of all levels of the healthcare system, whether in our NHS or other health and research settings, over many years. We too pay tribute to those women, and their children and families, for continuing against all the odds for years when too many ears, including the Government’s, were deaf. I also pay tribute to the many parliamentarians, including Norman Lamb, who over the years supported them. They pushed for this review in Parliament and raised it in any way they could.
Ministers have apologised for these failings, including for the system not listening and for not acting soon enough, over the decades since patients first started to raise the problems with these three medical interventions. Last week, when I asked the Minister about the timetable for implementing the recommendations, he said that
“it will take some time for the Government to study these recommendations … and to come back on the timetable”.—[Official Report, 9/7/20; col. 1224.]
The noble Baroness, Lady Cumberlege, says in her letter introducing the report:
“Over the past two years we have found ourselves in the position of recommending, encouraging and urging the system to take action that should have been taken long ago.”
She also said:
“Implementation needs to be approached with a new urgency and determination, founded on the guiding principle that our healthcare system must first do no harm.”
When the interim report was published, leaving this House in no doubt about the direction in which the review group was proceeding, many people expected action at that point.
I am grateful to Epilepsy Action for its briefing, which demonstrates exactly why urgent action must be taken now. Epilepsy Action, the Epilepsy Society and Young Epilepsy jointly surveyed over 500 women and girls who had taken sodium valproate since the pregnancy protection plan was introduced two years ago. One in 10 were unaware of the possible risks of birth defects. Almost half said that they had not discussed the risks of taking medicine with their health professional in the last 12 months, and only four in 10 said they had signed the annual risk acknowledgement form. For patients and families who have suffered as a result of these interventions, urgent action needs to be taken on government departments such as the DWP regarding the way it assessed the damage caused, and on how government as a whole compensates them for this gross injustice.
So I ask the Minister again: when will the Government return to those affected and to Parliament with clear recommendations and a timetable to do honour to the report and to all those affected? And when will the various bodies in our healthcare sector be set a deadline to publish the list of recommended actions that they will take that will not need parliamentary action? Last week, the Minister told your Lordships’ House that the Government had moved ahead on one of the recommendations—the creation of a patient safety commissioner—but their version is not independent, as asked for in the report.
So much of this report is about changing cultures: we still have not learned from Mid Staffordshire, East Kent and Shrewsbury maternity care, all of which Ministers have rightly been appalled by. For all the excellence and commitment of the individuals who, singly and collectively, provide our unique healthcare in the United Kingdom, there remains an unhealthy culture in some parts that does not listen to patients, does not understand conflicts of interest and resists change. That must change, it must change soon and it must be led from the top by the Government.
The report quotes Professor Ted Baker, chief inspector of hospitals for the CQC:
“I have to say 20 years later it is very frustrating how little progress we have made. It’s clear to me we still have not got the leadership and culture around patient safety right. As long as you have that culture of people trying to hide things, then we are not going to win this.”
Armed with this blunt and excellent report, I hope that the Minister can demonstrate the Government’s support with firm actions and dates, and not just with warm words that will drift away. The hopes of patients and their families and the future safety of our healthcare system depend upon it. When, Minister, when?
Medical Teaching and Learning: Ethnic Diversity
Baroness Thornton Excerpts(4 years, 4 months ago)
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Baroness Thornton
To ask Her Majesty’s Government what steps they are taking to ensure that ethnic diversity is fully reflected in all aspects of medical teaching and learning.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, the Government understand the importance of racial equality and diversity within the NHS and are committed to ensuring that this is reflected in medical training. We think we could do better, which is why the General Medical Council sets standards to ensure that students and doctors in training have the opportunity to understand the needs of patients from diverse social, cultural and ethnic backgrounds. That is why Health Education England provides a learning module on equality, diversity and human rights for all health and social care staff.
Baroness Thornton (Lab) [V]
Thank you, my Lords. I thank the Minister for that Answer. We live in a multiracial society; our NHS serves everyone and is staffed by everyone. However, the training of our doctors, nurses and medical technicians appears not to reflect this fact. We do not know whether current clinical language and learning has exacerbated the dangers to patients from a BME background during the pandemic, for example.
I pay tribute to Malone Mukwende, a student at St George’s, University of London, who published Mind the Gap as guidance for healthcare professionals, showing how skin conditions manifest on darker-skinned patients. This is a question of medical training, not a question of options that people might opt in to. We have to integrate these issues into our medical training to ensure that all healthcare professionals are able to recognise, diagnose and treat all our citizens from all ethnic backgrounds. Are the Government going to act on that?
Lord Bethell
My Lords, I welcome the noble Baroness’s point. She is entirely right that we live in an extremely diverse community, and this has an impact not only on the way people present their disease but on how they could and should be treated. This is why we build diversity awareness into our training and why we will build extra programmes into the People Plan that will be published shortly, and that is why we remain committed to this agenda.
Independent Medicines and Medical Devices Safety Review
Baroness Thornton Excerpts(4 years, 4 months ago)
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Lord Bethell
Health records are absolutely key—that is why we have tabled an amendment on them. That amendment enjoys the support of the Government and of me personally.
Baroness Thornton (Lab) [V]
I think we can see that we need a longer discussion on this report. It is quite clear that some of its excellent recommendations will require primary legislation and I hope the Minister may have identified them already. We on these Benches are keen to co-operate with the Government and across the House to bring forward the necessary amendments to the Medicines and Medical Devices Bill.
Lord Bethell
The HSSI Bill is an incredibly important part of our agenda. It is not currently on our schedule, but we hope to bring it back at some date, or incorporate its contents in another vehicle.
Social Care
Baroness Thornton Excerpts(4 years, 4 months ago)
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Lord Bethell
My Lords, the precise remit of any review will be the choice of those doing the review when it comes, but I entirely endorse the noble Baroness’s sentiments that the social care workforce is worthy of our respect, particularly for its hard work and commitment during the epidemic. Workforce remuneration has improved since the introduction of the national living wage in 2016. Flexible contracts suit many workers, so a blanket commitment to annual wages is not necessarily suitable, but I endorse a focus on solutions that encompass all aspects of the social care industry, including the workforce.
Baroness Thornton (Lab)
My Lords, following on from what the noble Baroness, Lady Brinton, said, the Minister’s party has form for not honouring cross-party co-operation on this issue. To mitigate that, given that the Prime Minister has said that he is currently finalising plans, perhaps the Minister could commit the Government to setting a firm date and a timetable that could be published before the House rises for the Summer Recess? Does he accept that we need a plan to be delivered within a year?
Lord Bethell
The noble Baroness is kind to think that I am in a position to articulate a timetable from the Dispatch Box—that is beyond my abilities. However, she is entirely right to focus on the urgent need to focus on this area. The Prime Minister and the Secretary of State could not have been plainer that when the time is right and we have dealt with the epidemic, social care reform will be uppermost in our mind and will be the focus of our attention.
Covid-19
Baroness Thornton Excerpts(4 years, 4 months ago)
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Baroness Thornton (Lab)
Last Wednesday, the Minister advised noble Lords that the lockdown in Leicester was being carried out under the Public Health (Control of Disease) Act 1984 and that regulations would not be brought to the House. However, on Friday, Leicester regulations were laid. Can the Minister clarify that and explain why there was some confusion and whether this has any practical consequences for implementation and enforcement in Leicester? Will this apply to other cities such as Bradford, Barnsley or Oldham? At Prime Minister’s Questions just now, the Prime Minister stated that the risks associated with asymptomatic transmission were unknown until recently. This is not the case. I am very happy to provide the Minister with SAGE minutes from 4 February, for example, when precisely that was recorded. Can the Minister clarify that statement for the House?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My understanding regarding the 1984 Act is that the regulations are published under the appropriate section. They have been published as is appropriate, but they are not brought to the House for debate. If I am wrong, I will be happy to write to the noble Baroness.
Independent Residential Care
Baroness Thornton Excerpts(4 years, 4 months ago)
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Lord Bethell [V]
The noble Baroness puts her question extremely well, but I am afraid it is beyond my ability to predict as she asks exactly what the shape of the national care provisions will be. What I can say is that the role of agency staff was always, from the very earliest stage, one of the gravest concerns we had. The CMO flagged it very early, and we moved as quickly as we could to tackle the difficult issue of itinerant staff, and to put in place both the funding and the procedures to anticipate problems of infection around staff who move from one home to the next.
Baroness Thornton (Lab) [V]
My Lords, I return to the question raised by my noble friend Lady Armstrong and the noble Baroness, Lady Brinton, because, while it is obviously welcome for the Minister to thank those who work in care homes for the sacrifices that they have made, he needs to acknowledge the hurt that the Prime Minister has caused with his words. Will the Minister clarify which procedures care homes are accused of disregarding? Are they procedures related to the Government’s policy of allowing hospital patients to be discharged without testing, to the failure to provide the required PPE or, perhaps, to setting up the testing programme so late?
Medicinal Cannabis
Baroness Thornton Excerpts(4 years, 4 months ago)
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Lord Bethell
The noble Baroness will not be surprised to learn that I have just spent three and a half months looking at drugs that might make a difference to Covid, only to find that many of them are not helpful and often quite dangerous, so I do not share the optimism bias that many have towards unlicensed drugs. We remain conservative in our approach to clinical trials. I agree with the noble Baroness and others who have suggested that progress on this should be quicker, and I am leaning into the subject to try to bring that about as soon as we can.
Baroness Thornton (Lab)
My Lords, it is deeply concerning that no new NHS prescriptions for full extract cannabis oil have been issued since the medicinal use of the drug was legalised more than 18 months ago. This leads to a health inequality: 313 private prescriptions for unlicensed cannabis medicine items, including full extract oil, have been issued. Does the Minister share my concern that only wealthy families and those who can successfully raise funds in the region of £2,000 a month have access to cannabis medicines, while children from poorer families who are unable to afford the prescription are going without? What does he think needs to happen next?
Lord Bethell
The noble Baroness shines a spotlight on an uncomfortable but realistic fact of life in our medical service: those with money are able to pay for treatments beyond the reach of those who rely on the NHS for absolutely everything. Another area that concerns me is that those who have relied on fundraising have found that Covid has restricted the amount of money coming from donors. That is why we have put money into medical research charities and support charities that can help support those fundraising for their medicine.