Health and Social Care
Baroness Thornton Excerpts(2 years, 11 months ago)
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Baroness Thornton (Lab)
My Lords, I first declare my interest as a serving non-executive director on a local hospital board, which is in the register.
I thank the Minister for the Statement from Friday concerning the winter and the NHS. If the House will indulge me for a moment, I put on record what a pleasure and privilege it has been over these years to have had my honourable friend Jon Ashworth, former Shadow Secretary of State for Health and Social Care, as my boss. I welcome Wes Streeting MP to that position; his huge talent will challenge the health team in the Commons and keep them on their toes, I have no doubt, and I look forward to it.
Today, the Daily Telegraph carried a story saying that 10,000 hospital beds were taken up by patients waiting for home care. NHS Providers has done some research and warned that those beds are mostly currently occupied by elderly people who are medically fit to be discharged, but no care is available to look after them at home. The chief executive, Chris Hopson, said that hospitals are now having to deploy their own staff to take on care duties in the community in order to free up hospital beds.
The lack of social care surely lies at the heart of whether the NHS can cope with the winter pressures, deal with ambulances stacking up, tackle the backlog and deal with whatever Covid, and particularly the new variant, may throw at it. When Professor Stephen Powis, NHS National Medical Director, said:
“NHS staff have pulled out all the stops since the beginning of the pandemic, treating more than half a million Covid patients, while continuing to perform millions of checks, tests and treatments for non-Covid reasons”,
he could have added that they are exhausted and need our support and that of the Government to move forward.
We need to add in the fact that about one in 60 people in private households in England had Covid in the week to 27 November—up from one in 65 the previous week, according to the Office for National Statistics. One in 60 is the equivalent of almost 900,000 people. Although it is true that, thankfully, fewer people are hospitalised and even fewer are in ICU, that is still a significant number. But this rate of infection, with the new variant possibly being even more infectious, means that, apart from anything else, there will be a surge in people being off sick, including NHS and care staff.
It is too easy for the Government to say that the winter crisis and the huge waiting lists are simply the result of the challenges of Covid. The reality is that the entire health and social care system has been left dangerously exposed by this Government’s choices over the past 11 years. Before the pandemic, there were waiting lists of 4.5 million, staff shortages of 100,000 and social care vacancies of 112,000. This week, the National Audit Office starkly detailed that things are set to get even worse: waiting lists might double in the next three years.
Those NHS waiting lists stand at 6 million. Almost one in 10 people in England waits months, or even years, sometimes in serious pain and discomfort, because the Government have failed to get a grip on the crisis. Everyone understands that we are in the midst of a global pandemic that has placed the NHS under unprecedented pressure, but that does not excuse or explain why we went into the pandemic with NHS waiting lists already at record levels and with unprecedented staff shortages.
Of course, the investment described in the Statement is welcome, and the plan recognises the many challenges that the whole sector has faced over the past 18 months. Can the Minister say that the Statement is a credible plan to meet those enormous challenges? If it was a genuine plan to prepare for the winter, why did it arrive on 3 December? For example, I noticed that on one of the hottest days of the year, in August, people from GP practices, primary care networks and federations gathered to start to think creatively about managing their winter pressures in a session hosted by the NHS Confederation. When I served on a clinical commissioning group, we did our winter planning in June—it started in the early summer. The board on which I currently serve has been discussing winter pressures and our winter plans for months.
A serious plan to bring down waiting lists would have the workforce at its heart and would have clear targets and deadlines. A serious plan would recognise that, unless we focus on prevention, early intervention and fixing the social care crisis, there is no chance of bringing waiting lists down to the record low levels we saw under the previous Labour Government. A credible plan to tackle the NHS winter crisis—which was foreseeable and foreseen—would have been published long before 3 December. Without a serious strategy to build the health and social care workforce that we need, the plan is not a plan at all.
The Deputy Speaker (Lord McNicol of West Kilbride) (Lab)
I call the noble Baroness, Lady Brinton, who is taking part remotely.
Ambulance Response Times
Baroness Thornton Excerpts(2 years, 11 months ago)
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Baroness Thornton (Lab)
My Lords, it seems clear that the problem is a symptom of system pressures and will require a whole-system approach to resolve it once and for all—Covid, social care packages to help with discharges and local factors, and the fragility of the NHS infrastructure going in to the pandemic. The Minister has explained some of the short-term emergency plans literally to save lives, but in the absence of an NHS workforce strategy, how will the Government produce a system-wide resolution of this matter?
Lord Kamall (Con)
The noble Baroness makes a very important point: we should be looking at this in a systemic way. In fact, I did my PhD in a department of system science, where you look at problems in a holistic way—rather than analysing individual problems, you look at the whole system. We found odd unintended consequences. For example, a friend forgot his inhaler, could not get one from the chemist, could not get one from the A&E and, in the end, had to call out an ambulance. There are a number of times when ambulances are called out needlessly, and that is on top of the pressures we are already facing due to Covid. We are tackling the backlog, which, hopefully, will also reduce ambulance waiting times.
Health Protection (Coronavirus, Wearing of Face Coverings) (England) Regulations 2021
Baroness Thornton Excerpts(2 years, 11 months ago)
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The Deputy Speaker (Lord Brougham and Vaux) (Con)
I call the noble Baroness, Lady Brinton. No? I call the noble Baroness, Lady Thornton.
Baroness Thornton (Lab)
I was happy to wait for the noble Baroness, Lady Brinton, to speak before me. I thank the Minister for introducing and explaining the content of these statutory instruments. As we discussed on Monday, the omicron variant is a sobering reminder that this pandemic is not over. I think we all agree that we need to act with speed to bolster our defences to keep the new variant at bay and to keep each other safe through the difficult winter period.
We on these Benches were critical of the Government’s slow response to the delta variant—slow to protect our borders, slow to act to reduce transmission in the community—so we welcome swifter action regarding this variant. It is right to be acting urgently given the seriousness of the threat. While it is sad to be debating these statutory instruments after the fact again, it is definitely an improvement on discussing them after Christmas or weeks later.
Turning to the regulations and starting with the Health Protection (Coronavirus, Wearing of Face Coverings) (England) Regulations 2021—I still have a problem with all the numbers on these, but this is number 1340—as I said on Monday, it is right to reintroduce masks on public transport, in shops and other settings including banks, hairdressers and post offices for those who are not exempt. However, we believe this measure should never have been abandoned. While mask wearing in public spaces forms part of the Government’s plan B, as far as we are concerned it should have been part of plan A rather than an emergency measure, as should encouraging working from home.
Now we have the issue of building confidence for compliance in the new law. The guidance will be important. When will the guidance about wearing of face masks be issued? USDAW, for example, the shopworkers union —in fact, the union I was a member of when I worked for the Co-op—said:
“Shopworkers aren’t police officers and shouldn’t be expected to act like them. They’re key workers who have kept our country going during these tough times. They deserve our respect.”
I also congratulate my friend and Co-operative colleague Paul Gerrard, who was on “Good Morning Britain” yesterday. He said on Twitter:
“We’ll make sure customers know rules & we’ll help them to follow them but we won’t put colleagues at risk”.
The Co-op is a responsible retailer, as are most of our retailers, but they all need the Government’s support. Have the guidelines been issued yet and what are the Government’s plans to support retailers?
As I said, we think these regulations are too modest and will not provide the protection the Government have described. For example, you will wear your mask to go into the off-licence to get some booze, and then you will go to a party indoors where no one will be wearing a mask. If you attend the theatre, you may get a taxi to the theatre and will wear your mask, and in the theatre some of the people in the audience may be wearing a mask but some will not. Will the Minister explain the scientific justification for those differences?
Lord Kamall (Con)
Sorry, was that offensive? I apologise for any offence caused to my noble friend. I just assumed that because I like teacakes, my noble friend also does.
I will start with some of the questions. On the question of how many people have been helped by some of these financial services, as of 17 November 2021, local authorities have reported 362,573 successful claims since the start of the scheme, totalling £181 million in test and trace support systems.
Despite the easing of the restrictions at step 4 of the road map, the Government have continued to recommend that face coverings are worn in crowded and enclosed spaces. We accept that there is wide support for reintroducing mandatory face coverings, but we have always tried to balance these issues. As I said in previous debates, we look at a number of factors, not only medical but economic and social. Also, within health itself, many mental health experts are very concerned that we might go for more lockdowns and about some of the measures that a number of noble Lords have mentioned.
As we saw in the debate, there are noble Lords who believe that we have gone too far and noble Lords who feel that we have not gone far enough unless we effectively enter a second lockdown. That shows the range of views here and the difficulty, as my noble friend, Lady Altmann, said, that the Government are damned if they do, damned if they do not, but we accept that.
So, do face masks actually work? This is where there is still a debate. I thank my noble friend Lady Noakes for pointing out the article by Professor Simon Wood, who is professor of statistics at the University of Edinburgh, in which he analysed the BMJ paper. It is in effect a meta-analysis. A number of newspapers have taken a line saying that wearing a mask cuts Covid by 53%. I encourage noble Lords to read the article, in which he takes apart the statistics as a statistician and looks at, as those who have done statistics will understand, whether we have a significant number of samples to make it statistically sound. In addition, Professor Naismith of Oxford University has been quoted as saying that
“the Scottish and English approach to masking, although formally different since July, has made no meaningful difference to delta.”
Once again we see that there is a whole range of views, but we have listened to those views. Because we do not yet know enough about this variant, we will continue to review the data. For example, some say that it is very mild in South Africa so we should not be overly concerned about it, but we also have to remember that South Africa has a different demographic in terms of younger people. We know that when the virus first struck it disproportionately affected older people—as my noble friend Lord Robathan said, people aged over 85. On the balance of the data at the moment, we believe that wearing face masks works but we have always been very careful to make sure that it is proportionate where we do it.
On the expiry of some of these measures, as the Prime Minister said on Saturday, all the provisions that have been voted on will be reviewed in three weeks. They are necessary and proportionate while we learn more. I refer to the economics Nobel laureate Friedrich Hayek, who talked about humans having limited knowledge. He talked about the conceit of knowledge. The way to understand a lot of complex problems is to allow the discovery process to take hold and to look at what we can learn from that process. We should be very careful not to imagine that we have total knowledge. What we have to do is assess it proportionately.
It is our hope that these regulations will no longer be necessary in three weeks’ time and that we can return to the system that we lived under last week, but in the event that we need more time to understand the effect of the variant, or that the data shows that we need to take a different approach that requires new regulations, the House will return to Parliament ahead of the Christmas Recess for a debate and vote on the regulations ahead of their coming into force.
On regulations expiring, the international travel regulations will expire at the end of 16 May 2022. The face covering regulations will expire, unless extended, at the end of 20 December 2021. The self-isolation regulations at the moment expire at the end of 24 March 2022, but we will continue to review the data. Almost daily the data is being reviewed and conversations are going on. We will also continue to review the data on the new variant and we hope to update Parliament on the review in the week commencing 13 December.
A number of noble Lords asked about facilities. We are told that setting up dedicated testing facilities at border entry points such as airports is logistically difficult at the moment, and risks delays to passenger journeys and operations. Given the turnaround for a PCR test, passengers would still have to travel to their home or the place they are staying and isolate there before receiving a result. The Government are taking a measured and proportionate response. We want to try to protect the UK from omicron while allowing continued safe travel.
A number of references were made to points made by Dr Jenny Harries. As the Prime Minster said, the guidance remains the same as the measures that were in place to fight delta. We have now brought in tougher measures, but we continue to take advice from a number of experts. Individual experts are free to give their viewpoint but we look at the balance—some of it medical, some of it clinical, but also economic and social factors—and getting that proportionate.
Baroness Thornton (Lab)
I need to ask the Minister about the fact that our most senior adviser on these matters gave advice that was then completely denied by No. 10 and the Government. That will at least cause confusion. It is not a question of balancing this and that; Jenny Harries was very clear in her advice about what she thought should happen. It was quite the opposite to what the Prime Minister said should happen. The Minister needs to acknowledge that that will cause confusion.
Lord Kamall (Con)
I thank the noble Baroness for raising the point, but it depends on how it is reported. The real issue here is that a number of different experts are advising. Of course, you can pick and choose which expert you decide to listen to. A few weeks ago, noble Lords were picking up on comments made by the NHS Confederation. That is not a scientific body, but noble Lords claimed that it showed that we need to lock down. It is very easy to pick and choose your experts, but we continue to listen to a wide range of experts.
One of the great things about science that we should remember is that there is no such thing as “the science says”. Science should remain contestable. Can you imagine if science was not contestable? We would still be saying, “You can’t challenge the notion that the solar system revolves around the earth.” Scientists challenged that, and that is how we advance knowledge. It is really important that we continue to contest. Scepticism is one of the most important factors in science to make sure we make progress. We will listen to a range of experts.
I ask those noble Lords who really want to lock down more, and who say that we not only have not done enough but should do more and lock people down, to look at the impact that has on people’s mental health and on our economy. I ask them to think about the wider impact and to remember that we are not in the same place we were a year ago. We have been absolutely clear that vaccines work and that the best thing we can do to get through this is to get vaccinated. It is not too late to get your first or second vaccine. I am grateful to noble Lords who have asked questions—
Baroness Thornton (Lab)
The Minister is now saying that there is absolutely no doubt about the science behind vaccinations. That is not a matter of opinion; there is no doubt about the need for vaccinations. He is straying into dangerous territory when he says that there is science on this side and science on that, because the Government have rightly said that vaccination is the way forward.
Lord Kamall (Con)
I thank the noble Baroness for agreeing with the Government’s line that vaccination is the most important way forward.
Baroness Thornton (Lab)
The Minister is being patronising. We have always—always—supported the Government on vaccination; I am sorry that the Minister feels he needs to be sarcastic about that.
Lord Kamall (Con)
I apologise to the noble Baroness if I came across as sarcastic.
In terms of hospitality settings, quite rightly, as a number of noble Lords have said, even though we have mandated it in certain settings, it is being left to settings to decide. This is in line with property rights, but also something that people have been asking for—a number of noble Lords have asked “Why not just let the establishments themselves decide, so people can make a decision whether they go to somewhere where masks are mandated or somewhere where they are not mandated?” We are looking really hard at this and we want to make sure that we are proportionate. It could be that we find out that omicron is not that dangerous, but we have to make sure that we have the data and that we sequence it all. It could be that it affects us more in the UK that it would in South Africa because of the change in demographics. That is a really important point.
In terms of who is responsible for enforcement, the police and Transport for London officers have powers to issue fixed penalty notices for non-compliance with the regulations. They are using the four E’s in a proportionate way: engaging, explaining and encouraging before enforcement, just to remind people, if they can, to make sure that they wear a face mask.
The Health Secretary has also asked the JCVI to consider giving boosters to as wide a range of people as possible. If you are boosted, your response is likely to be stronger, so it is more vital than ever that we get our jabs.
On helping the rest of the world, the UK remains committed to donating 100 million doses by mid-2022. We are also extremely grateful to the South African Government; we have been talking to a number of partners, including South Africa directly, to make sure that we do not disincentivise other countries for doing the right thing by reporting the outbreak in the first place. We are doing all that we can.
I am trying to make sure that I answer all the questions; I apologise if I am not able to. My noble friend Lady Neville-Rolfe asked about exemptions for children under the age of 11 and those unable to wear a face covering due to health, age, equality or disability reasons. In terms of the impact to the economy, we do not know the extent to which the variant escapes the vaccine, but as soon as we do, we will be able to make a better measure. We do not at the moment expect there to be significant economic disruption. We have said that we believe face coverings are effective at reducing transmission indoors. The recent UKHSA study suggests that all types of face coverings are, to some extent, effective, but we also welcome challenges to that data. The advice remains the same: we believe that, on balance, it is better to wear a face mask. Many noble Lords have agreed and disagreed with that, but we have to balance these things.
Proportionate measures remain in place in schools. Face coverings should now be worn in communal areas by older students and teachers. The Department for Education is looking at how we make sure that there are clear guidelines on that. We advise staff, visitors and pupils to wear face coverings in communal areas.
I turn to the point from the noble Baroness, Lady Tyler, and that very personal case; it highlights—this should sober us up—those very powerful words that this is not over. We have said that consistently. It is not over. If we believed it was over, we would have removed all restrictions. It is highly likely, but not definite, that we may have to continue to get boosters. Just as we have an annual flu vaccine, we may in the future end up with an annual Covid vaccine, including looking at other strains.
We have said who is responsible. In answer to a point made by my noble friend Lord Cormack, may I suggest that he takes his point about continuous committees up with the Lord Speaker? That is not really in my remit as Minister for Health. My initial reaction is that it seems a good idea, but let us see what the Lord Speaker says.
I again thank all noble Lords for their contributions and for continuing to challenge. That is really important. I can assure my noble friend Lord Cormack that today I asked my department for a list of potential or forthcoming regulations so that we can lay them as early as possible, as my noble friend and other noble Lords suggested. I am grateful for the acknowledgement that we laid these regulations as quickly as we could, and I pledge that we will try to improve that as much as we can, I too, believe very strongly in procedure and the Government and the Executive being held to account. It is really important.
Covid-19 Update
Baroness Thornton Excerpts(2 years, 11 months ago)
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Baroness Thornton (Lab)
My Lords, I thank the Minister for repeating the Statement from today and for the Statement from Friday. I add my thanks to the scientists in South Africa for their prompt sharing of this information, as unwelcome as it may be.
We understand that scientists believe that it will take two to three weeks before they can establish whether the omicron Covid variant is more transmissible, causes more severe disease or can make vaccines less effective than was the case with delta, or all three. We support the Government’s strategy of tougher travel restrictions and mandatory face masks, as far as it goes. It seems that there is already real-world evidence from South Africa and Hong Kong that omicron is highly infectious, which begs the first question: why are the Government limiting the mandating of mask wearing to travel and to shops, and not extending it to indoor meetings and social events? Mask wearing is the single most effective public health measure in tackling Covid according to the first global study of its kind, which found that the measure was linked to a 53% fall in the incidence of the disease. As Dr David Nabarro said recently:
“We know that wearing a face mask reduces the risk. We know that maintaining physical distance reduces the risk. We know that hygiene by regular hand washing and coughing into your elbow reduces the risk. We should do it all, and we should not rely on any one intervention like vaccination on its own.”
On these Benches, we support taking swift action and the inclusion of new countries on the red list. We do not want a repeat of the inertia that saw the delta variant run rampant through the country and, as the Minister said, we must protect the progress that we have made. We welcome an increase in the availability of the booster jabs. The only question that I would ask him is about the capacity of the NHS to deliver the massive increase that the Government have reported today.
We support the move to PCR testing, but there are still holes in the testing programme. Ministers have not introduced pre-departure testing and there is little, if any, follow-up on PCR test results, so we need action on this if we are to take it seriously.
The Government could, of course, go further to keep people safe. Fixing sick pay, improving ventilation and properly utilising antivirals remain crucial to ensuring that we reduce the spread of this deadly disease. Do any of these feature in the Government’s plans?
I agreed with my right honourable friend the former Prime Minister Gordon Brown when he said:
“Whatever happens to this particular variant, we’ve got to realise our failure to vaccinate the rest of world … is going to come back to haunt us.”
He said that the new variant was a “wake up call” for rich nations with surplus vaccines. There seem to be surplus vaccines which will expire within the next month. How many vaccines in the UK will pass their use-by dates before Christmas, and will these be destroyed? I am afraid that Ministers have not met the commitments made at this summer’s G7 to roll out the vaccine to other parts of the globe. There is now sufficient vaccine to reach almost every adult in the world. I agree with the Minister that we need to play our part in ensuring that everyone around the globe has access to vaccines to stop the emergence of new variants.
This variant is indeed a wake-up call. The pandemic is not over. We need to act with speed to bolster our defences to keep the virus at bay. In that context, I ask the Minister about preparedness for new Covid variants in general. Both Clive Dix and Kate Bingham, former chairs of the Vaccine Taskforce, have expressed worries about our preparedness for dealing with new variants. Mr Dix has said of a paper that he sent to No. 10 in May:
“I wrote a very specific proposal on what we should put in place right now for the emergence of any new virus that escaped the vaccine.”
It seems that, thus far, No. 10 has not responded, so perhaps I can ask on Mr Dix’s behalf what the Government’s plan is for an escape variant? What is the plan for resistance for the future? The country needs to know. He suggested that a strategy should involve a co-ordinating team to seek out new vaccines and give the company involved a fast track to a swift trial, access to the data and regulatory approval in return for early access to vaccines. If that sounds familiar, it is exactly what the Government did at the start of the pandemic, and it needs to be repeated. Is this in the Government’s plan?
Reports from South Africa and other places indicate that the new infection seems to manifest itself with nausea, headaches, fatigue and a high pulse rate, but not the original and distinguishing features of loss of taste or smell, nor the headaches, sore throat, runny nose, fever and persistent cough which have been the most common in the delta variant. Will the NHS stick to the old symptom guide or will it update it to allow those running test and trace to recognise that they are not necessarily looking for things like loss of taste and smell but for other symptoms?
If the Government intend to report again in three weeks’ time, if not before, it takes us into the Recess, so I would like the Minister to ensure that colleagues will be briefed appropriately. On Saturday evening, the Secretary of State held a Zoom call to brief MPs about the new world that we now entering. I hope that the Minister will do the same for all Members of your Lordships’ House.
We must all be concerned that any spike in serious cases from this new variant could coincide with the NHS’s peak winter period, particularly given that the service is already at full stretch. We all want to enjoy Christmas but, most of all, we all want to stay safe.
Baroness Brinton (LD) [V]
My Lords, I thank the Minister for repeating today’s Statement. The World Health Organization and many globally respected scientists and doctors have been warning us that variants of Covid-19 might pose a serious risk, especially when a Government think that we are winning the war against the virus and that we can all afford to relax. Omicron reminds us that the battle is not won until it is won across the world. From these Benches, we also thank the South African scientists for their genome sequencing that has alerted the world, and I hope that the UK and the other G7 countries will offer them not just gratitude but countries in southern Africa more practical support.
I echo the comments of the noble Baroness, Lady Thornton, about arrangements for international travel and test and trace. I also support her request for a briefing for Peers. For some bizarre reason, the Liberal Democrat MPs were not included in the MPs’ briefing. Please could the Minister make sure that we are included in any such meeting in the Lords.
In April, before the Minister was appointed, we warned Ministers that the Government were responding far too late to the reports of the delta variant in India. So we warn again. While the face mask mandate in shops and on public transport is welcome and well overdue, we are absolutely bemused that it excludes hospitality and that the advice to schools excludes classrooms. Professor Chris Whitty said in Saturday’s No. 10 press conference that when there is a risk we should go in hard, so can the Minister explain how the virus will be kept at bay in those indoor settings where masks are not required? Why is there no encouragement for people to work from home where possible? Trains and buses are crowded and unventilated. Risks will remain there too, even if lessened with masks.
I have said before that I am in the clinically extremely vulnerable group. I have had my third dose of the vaccine and now look forward to my fourth, or booster, dose. But many of those who should be getting the third dose still face a series of problems in the NHS about who should get it, as opposed to a booster, and how it is recorded. Indeed, today, in response to a Written Question to my honourable friend Daisy Cooper about the recording of a third dose, the Minister, Maggie Throup MP, replied:
“Work to assess the need to include boosters in the NHS COVID Pass is ongoing and we will provide a further update in due course”,
so even the records cannot distinguish. Can the Minister say when “in due course” is? I am afraid this is symptomatic of the way the clinically extremely vulnerable have been ignored and left to fend for themselves.
I will ask a question that I have asked the Minister’s predecessor repeatedly since June of this year. In May 2021, Jenny Harries left Public Health England to set up the UKHSA. For the preceding 12 months she had specific responsibility for co-ordinating all the different elements of Covid issues for the CEV and for shielding. When she left, no one was given that responsibility, and it was noticeable that all communications with CEV people and the different parts of the NHS on Covid just stopped when shielding stopped. Can the Minister tell us which senior person in the NHS has that managerial responsibility? It has been five months since I first asked and there are 3.7 million worried people still waiting for answers. It would be good to know which Minister has the responsibility to co-ordinate all Covid matters for the CEV or former shielders. This is important, because the last letter from the Secretary of State tells the CEV not to go into any environment where people have not been double-jabbed. There is no mention of boosters, and obviously no mention yet of omicron.
Is there a confirmed register that distinguishes between the CEV and the severely CEV? Unlike in Scotland, hospital consultants in England do not have access to individual patient records that GPs use or even to the Covid app data. Can the Minister say how NHS England will be able to communicate directly with eligible people if they do not have a register? Is there a specific communications plan to ensure that primary care, secondary care and the 119 vaccine helpline are fully aware of plans and processes for this group? Reports are coming back of blood cancer patients being told at vaccine centres that they do only boosters—there is no knowledge or understanding of the third dose.
I recognise that I am asking the Minister a large number of questions on the immunocompromised. I really do not expect answers to them today—written answers are always very welcome—but please will he agree to meet with me, Blood Cancer UK and the Anthony Nolan Trust to discuss these key questions, not least because we are now in a different situation, with the 3.7 million, which is 5% of the country, left in limbo?
As the noble Baroness, Lady Thornton, said, it is too early to say whether omicron is more dangerous than delta or beta, or whether treatments such as Ronapreve and the current vaccines might not be as effective. The Government are right to be cautious. I echo her comments about Clive Dix, the former head of the Government’s Vaccine Taskforce. What plans are in place for vaccine development for an escape variant?
At a time when manufacturing is one of the key issues slowing down the delivery of vaccines worldwide, why is the Vaccine Manufacturing and Innovation Centre at Harwell, which has received in excess of £200 million of public funding via UK research and development, now up for sale, long before the pandemic is over? We still need its expertise. Selling off a publicly funded, not-for-profit organisation during the pandemic, if at all, seems, frankly, bizarre.
Finally, the Statement has a passing reference to test and trace domestically. It says:
“We have a much greater capacity for testing, enhanced ability for sequencing”.
Genome sequencing in the UK has been a real strength of UK science and has undoubtedly helped us considerably in this pandemic. But, in recent weeks, with the Government’s determination to open up and return to normality, test and trace has been scaled back, with reduced centres and reduced hours for those that remain open. Can the Minister say what plans there are to increase these back as needed? Are directors of public health and their local resilience forums receiving funding for the current omicron problem? It also appears that there is no Covid funding for them next year at the moment. If omicron is a viable variant, we must plan to fund them to keep these safety nets of test and trace in place, because without an effective test, trace and isolate system, including proper payments to those who need to isolate, we will not manage, let alone control, this virus. Defences are not defences when there are large holes in them.
NHS: Primary Care Surgeries
Baroness Thornton Excerpts(2 years, 11 months ago)
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Lord Kamall (Con)
I am sure that we all want to pay tribute to the work of GPs, who are at the front line and, quite often, are the gateway to many services across the NHS and the wider healthcare system. It is important that we recognise some of the pressures they are under, but also work out how to help them and, indeed, patients. As I have said in the past, I will be a champion of patients and it is important that patients have access to their GPs, as a gateway to further services.
Baroness Thornton (Lab)
Notwithstanding the fact that the Minister says that the NHS is not up for sale, would he care to speculate what would motivate an American health insurance company to buy into a UK primary care GP market? Was this procurement carried out under the Covid relaxation that allowed contracts to be awarded without competition, or the usual procurement regime?
Lord Kamall (Con)
I wish I could read the minds of those who bid to run these services, but I am afraid I will have to admit that I cannot. The contracts are awarded at the local level by CCGs. It is their decision and it would be inappropriate for the Government to intervene.
New Hospitals
Baroness Thornton Excerpts(2 years, 11 months ago)
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Lord Kamall (Con)
Each of the building projects will be a new hospital that will deliver brand-new, state-of-the-art facilities. One thing that we must be careful of is that if we say, “Well, you can’t call that a new hospital, even though it is a new facility, because it’s on an existing site”, we do not create perverse incentives, where the local NHS or the local ICS says, “We mustn’t build it there, because we will be accused of not having a new hospital”. Surely what we should be focusing on is outcomes, not inputs, and the fact that we are delivering modern, digital hospitals for the future.
Baroness Thornton (Lab)
My Lords, leaving aside the dubious and overinflated claims of 40 new hospitals, many of which are, in reality, upgrades—as welcome as they are—I and others in the House raised with the Minister’s predecessor but one in 2019 that there was an alarming repairs and infrastructure crisis, which was then in the region of £3 billion. Could the Minister explain to the House which part and how much of the new hospitals programme will address the immediate and urgent matter of crumbling wards, sewer leaks in wards and old and dodgy kit?
Lord Kamall (Con)
The noble Baroness will recognise that we need not only to build new hospitals but to upgrade existing infrastructure and this is all part of the capital programme. The decisions on individual hospitals and upgrades will be taken in local communities in consultation with clinicians and local ICSs.
NHS England: Waiting Lists
Baroness Thornton Excerpts(2 years, 11 months ago)
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Baroness Thornton
To ask Her Majesty’s Government what steps they are taking to reduce NHS England waiting lists.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
I thank the noble Baroness for raising this. It is a top priority for the Government and for the NHS. This year we are providing a record amount of funding to the NHS, with an extra £34 billion. This includes £2 billion this year plus £8 billion over the next three years to step up activity to tackle long waiting lists for elective care and to transform elective services. This funding could deliver around 9 million more checks, scans and procedures.
Baroness Thornton (Lab)
I thank the noble Lord for that Answer. I figured that that was what he would say. It is not about how much the Government intend to put in but how it is being spent. That is particularly important in the absence of any workforce strategy. If the billions were directed immediately at investing in social care and care workers, for example, both domiciliary and care homes, how many beds does the Minister believe could be freed up in the next eight weeks? What effect would that have on the throughput for elective surgery and accident and emergency departments?
Lord Kamall (Con)
When you look at the data on the waiting lists, what is interesting is that 75% of patients on the list do not require surgical treatment. Most actually require diagnostics. Some 80% of patients requiring surgical treatment could be treated without an overnight stay in hospital, and 20% of patients are waiting for either ophthalmology or orthopaedic services. That shows where you can target the spending to cut the waiting lists.
Dementia: Fuelling the Moonshot
Baroness Thornton Excerpts(2 years, 11 months ago)
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Baroness Thornton (Lab)
My Lords, I first thank the noble Baroness, Lady Greengross, for this short but very important debate today. It is some time since we addressed the issue of dementia in your Lordships’ Chamber, and it is something which noble Lords have had an interest in for many years. I also thank her for her very comprehensive introduction to the debate.
If the Minister has not worked it out by now, he is being asked to pick up the dementia moonshot and champion it in Government and with his colleagues because, at the moment, as other noble Lords have said, the Government have not brought forward the promised funding or set out a timetable for when it will be met.
We all have had experience of dealing with this awful condition and losing the people that we love to its ravages—or at least losing the essence of them, long before they die. In my case, it was an aunt and also a brother-in-law, who was the same age as me and who I had known since we were both involved in student politics. He sadly spent the last few years of his life in a nursing home and died during lockdown, but he had not known any of us in the family for quite some time.
I congratulate the APPG on the Fuelling the Moonshot report, following its inquiry into dementia research and the potential impact of the Government’s manifesto commitment to double funding for dementia research. The primary recommendation in the report is, of course, that the Government deliver on their manifesto commitment and double funding for dementia research. I think we all strongly support this recommendation.
How do the Government plan to address the three main areas that Alzheimer’s Research UK believes this additional funding should be channelled towards if we are to accelerate progress in dementia research? The first of these three areas is to help dementia research recover from the impact of the pandemic. Dementia research lacks capacity compared with other disease areas, as other noble Lords have said. It is vital we do not let the financial impact of Covid-19 reduce funding opportunities, leaving researchers with no choice but to leave the field. Indeed, a survey by Alzheimer’s Research UK found that more than one-third of dementia researchers were considering leaving, or had left, academic research due to the financial uncertainty created by the pandemic.
The second area is transforming early detection and diagnosis. An early and accurate diagnosis of dementia can empower people to access the support they need at an earlier stage, as well as to ensure that they can enrol into clinical trials for new treatments. At the moment, people living with dementia are often diagnosed at a stage when the disease that caused the condition has progressed too far for potential future treatments to be effective. Patients in many parts of the country do not have access to the latest diagnostics that provide the most accurate results and often experience long delays before receiving a diagnosis, even today. Alzheimer’s Research UK’s dementia attitudes monitor found that there was an appetite for earlier diagnosis, with 73% of the public saying they would want to know if they had Alzheimer’s disease before the onset of clinical symptoms.
Thirdly, I am sure the Minister would absolutely want to see the UK be the world leader in dementia clinical research. Given the world-leading institutions and researchers in the UK, this country has the potential to be a leading location for dementia clinical trials, which would allow patients here to be among the first to benefit from potential new treatments. The UK Government should invest in the development of a network of high-performing dementia clinical trial sites. They should look to emulate the success of the Covid-19 trials, for example, using lessons learned to speed up the approval process and generate a cohesive network of sites with a single point of entry for trial organisers. Given the Minister’s brief in the Government, I would have said that this absolutely played to his strengths.
It is a great shame that the comprehensive spending review was a missed opportunity for the Government to deliver on the moonshot commitment and harness the power of research to tackle one of the world’s major health challenges. The CSR announced £95 million for the delivery of the Government’s life sciences vision and £2.3 billion to transform NHS diagnostic services, but we need to see more detail on how that funding will benefit those living with dementia and the dementia research community.
On 7 September the Prime Minister was asked in the Commons whether the Government would fulfil the commitment in the Conservative manifesto to a dementia research moonshot. He replied:
“I can certainly confirm that the moonshot programme that was begun by my right honourable friend the former Secretary of State for Health—one of his many moonshots—continues.”—[Official Report, Commons, 7/9/21; col. 166.]
That is slightly ambiguous and certainly flippant. I hope the Minister will rectify that flippancy.
The Autumn Budget and the spending review published on 27 October did not include a reference to a dementia moonshot funding pledge. Reacting to the Government’s spending commitments, the director of UK DRI, Professor Bart De Strooper, said that the omission was a setback to those working to deliver cures for dementia. The absence of a dementia moonshot today is a major blow to UK neuroscientists racing to find cures for this devastating disease, not to mention the 885,000 people living with dementia in the UK and their friends, families and carers. I look forward to the Minister’s response.
Covid-19: UK Arrivals
Baroness Thornton Excerpts(2 years, 11 months ago)
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Lord Kamall (Con)
Last night I took part in a debate that involved the issue of the Covid pass, particularly with the boosters. I was frustrated because I thought I had a date I could announce. That was pulled at the last moment, but we are very close to a solution. The technical point on test and trace is that, at the moment, it is unable to validate the vaccination status of people whose vaccines are not registered on the database. We are looking at whether that can be done on trust, or whether that would open a loophole for getting around the system. I have been assured when pushing the NHS on this that it is looking at an answer.
Baroness Thornton (Lab)
The Minister must accept that this a very confusing area for everybody. Perhaps he would like to clarify the Prime Minister’s comments yesterday on what impact tougher overseas travel rules and self-isolation for those without a jab might have. He mentioned those yesterday in the press conference. I think they are linked to the Question my noble friend asked. It is very important that the NHS app shows the booster as soon as possible, because it is going to cause a lot of trouble for Christmas travel.
Lord Kamall (Con)
I welcome questions from noble Lords, particularly on getting the booster on the app, because when I am talking to officials in the department and the NHS it shows how important it is that we do this as quickly as possible. One of the tasks is to be accountable and to push the NHS and others to make sure that we are doing this. Sadly, when I ask what the problem is on test and trace, I am told that it is unable to validate the vaccination status of people whose vaccines are not recorded on a national immunisation management system. I have asked about passenger locator forms and whether we could use a similar technology. At the moment that is done on trust, but you face a very high fine if you are misleading; maybe that could be a solution. I assure noble Lords that I really am pushing.
Covid-19
Baroness Thornton Excerpts(2 years, 11 months ago)
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Baroness Thornton (Lab)
My Lords, I thank the Minister for actually reading the Statement today and for updating the House on the latest JCVI recommendations. I have to question the last statement that the Minister made. When you have nearly 40,000 infections, as we have today, I wonder if we are one step ahead of the infection or not.
We still see people who are keen to come forward to receive their booster dose but who are still experiencing difficulties in getting it. Does the Minister have an age breakdown by region? I repeat a question that I asked last week. What are the Government doing to fix the ongoing problems with the stalling of the vaccination programme? It is obviously exactly right to accept the JCVI recommendations about extending the programme, but my questions are about how effective we are being in delivering that. Not only is there some confusion about the booster vaccinations, we have also seen some stalling in giving the second dose. There are areas of the country where the second dose vaccine rates are as low as 52%—which is what they are in Westminster.
While we welcome the JCVI decisions to extend Covid booster vaccinations to those aged between 40 and 49, and second doses to 16 and 17 year-olds, there is still a large challenge. As I say, infection rates remain high. Today’s figures show 39,705 cases. Can the Minister give the demography of those being hospitalised and whether this is changing? Can he inform the House, either tonight or by letter, the demography of patients admitted to hospital with Covid—their age, vaccination status and the gravity of their illness? Do we yet know the incidence of genome sequences of the new cases and what has been learned about this?
The Government’s commitment was for all children to be offered a jab by half-term, yet only a third of children have been vaccinated. That means we are quite a long way behind. When does the Minister believe we might catch up? When will all the children who should be vaccinated at least have had their first jab, if not their second?
Last week, the Secretary of State said that he could not rule out the policy of over-65s being banned from all public places if they have not had their third jab, as they have been in France. He said, “We’re not looking at it yet but I can’t rule it out.” Can the Minister confirm whether the Government are considering locking down pensioners who cannot show proof of a booster on an iPhone?
The Minister would expect me to raise the issue of the terrible pressure on our NHS. Today we heard from ambulance chiefs about 160,000 patients coming to harm every year because ambulances are backed up outside hospitals. Thousands of patients will suffer terrible harm. All 10 ambulance trusts are on high alert. We know that NHS staff are stretched and tired, and that there are not enough of them. We know that one in five beds is occupied by an older person who should be discharged and who needs care, but because of the crisis in social care, both domiciliary and in care homes, there is nowhere for many of them to go and no one to look after them.
I am sure the Minister will tell the House about the extra expenditure and the tax rise, but the truth is that the Secretary of State failed to secure a new funding settlement for long-term recruitment and training in the Budget, so how will we recruit the extra staff the NHS needs? The noble Lord’s boss failed to secure the investment needed to fix social care in the Budget. Public health failed to get serious attention in the Budget. We are at the beginning of the winter period and it looks bleak, so what is the plan to get the NHS through this winter without compromising patient care?
I have another few matters to raise. Why does the NHS app still not recognise booster jabs? Apparently, the Prime Minister said at a press conference earlier that this would happen, but he did not say when. Does the Minister have any further information about that?
Indeed, on border controls, Ministers insist that vaccinations are the UK’s main line of defence, but the Conservative Party chair, Oliver Dowden, said this morning that the situation was being kept under review, with alarm over a spike in cases on the continent. As we have seen, Austria has imposed a draconian new lockdown on unvaccinated people after a dramatic increase in infections, and Germany, France and Italy are seeing a significant uptick in outbreaks. Do the Government have a contingency plan for travel restrictions given the fears of a rising fourth wave in Europe?
Finally, and shockingly, we learned today that Covid rates in Parliament were four times the London average in October. Does the Minister believe that this relates to the time when many Conservative Members, particularly in the Commons, were shunning wearing masks and presumably allowing their staff to do the same? I understand that a team from his own department turned up at a Standing Committee without masks a few weeks ago and had to be supplied with them by the clerk of that committee. This smacks of arrogant leadership, led by the Prime Minister last week on his hospital visit. Unfortunately, it is not only unattractive arrogance but dangerous, because it will cost lives.
Baroness Tyler of Enfield (LD)
My Lords, I thank the Minister for repeating the Statement. At this afternoon’s No. 10 press conference, Professor Chris Whitty made it very clear that doctors and scientists are increasingly concerned about the average of 37,500 cases over the last week and the high number of Covid cases in hospitals. Professor Whitty said that it would be a tough winter and added that, in addition to the nearly 9,000 Covid patients in hospital, all other areas of the NHS are under growing and intense pressure. He recommended that, in addition to getting their vaccinations, everyone should use face masks and ventilation to help reduce the number of cases.
This morning, Oliver Dowden, who was just referred to, said “It is in our hands” whether further restrictions in plan B are put in place this winter, but clearly the Government’s current communications on just encouraging using face masks and ventilation indoors and on transport are simply not cutting through. It certainly was not on my Tube journey in today, where distressingly few people were wearing a mask. Even if the Government do not want to implement the whole of their plan B, why will they not at least mandate face masks and improving ventilation on public transport and indoors when so many people across the spectrum are crying out for this to happen?
Leaving it to individual choice and personal responsibility is far too weak and inconsistent a message. It is crystal clear that the Prime Minister does not want to implement plan B, but is the reality not that he is far more likely to have to do so—or, indeed, move straight to plan C, a total lockdown—if mask-wearing is not made mandatory immediately? Does the Minister agree with me, and the point just made by the noble Baroness, Lady Thornton, that all parliamentarians and most particularly Ministers have a duty to set a clear example of mask wearing inside and on public transport?
Professor Whitty highlighted the stark figure that 98% of pregnant women admitted to hospital had not been vaccinated, and that same ratio applied to those in intensive care. What specific steps are the Government and the NHS taking to talk directly to pregnant women to encourage them to have their vaccinations?
It was worrying this afternoon when the Prime Minister said that he “hoped” that booster and third jabs could be logged on the online system “soon”. We have been asking questions about this system for weeks now. Can the Minister look into Pinnacle, one of the systems that logs people’s Covid status, to find out why practitioners are not yet able to record a third jab for the clinically extremely vulnerable, as well as a separate listing for booster jabs for everyone else over 40? As the Prime Minister said this afternoon, evidence of booster jabs will be required for travel this Christmas, but because third vaccinations and booster doses are still not appearing separately on the NHS Covid app, there is a great deal of anxiety and frustration among people who will need not only to have had the jabs but to be able to provide the evidence. Can the Minister say—I underline the point made by the noble Baroness, Lady Thornton—when all third doses and boosters will be on the online system?
Finally, although I welcome the announcement that it is safe for 16 and 17 year-olds to receive a second dose, can the Minister explain where 16 and 17 year-olds will be able to get that second dose? Too often, young people wishing to have their initial jab were put off because they had to travel to a centre some way away, often by bus, train or car, often involving parents providing the transport. Will the Minister undertake to look into ensuring that there are centres in town centres and other easily accessible places so that young people can more easily access their second dose?