GPs: In-person Appointments
Baroness Thornton Excerpts(3 years ago)
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Lord Kamall (Con)
The relationship between the patient and the GP is important, so we have made sure that choice is at its centre. As they develop the relationship, they can decide on the most appropriate way to be consulted and to give advice.
Baroness Thornton (Lab)
The Government have consistently promised and failed to increase the number of GPs. Instead of the 5,000 additional ones promised in 2015, this year we have 1,300 fewer GPs. When the Health Secretary announced the £250 million winter access fund to enable GP practices to improve the availability of services to patients, where did he think those GPs would come from? Where is the magic locum tree? It is a seven-year pipeline to produce a GP. Does the Minister agree that rubbishing and attacking GPs is not going to attract medics to take up this profession?
Lord Kamall (Con)
I think we all agree that we should appreciate the work that GPs did during Covid; they were often the front line. It is important that we continue to make sure that we recruit more GPs. Some 3,793 doctors—the highest ever number—accepted a place on GP training in 2020, so I do not recognise the criticism.
Health: Chronic Fatigue Syndrome
Baroness Thornton Excerpts(3 years ago)
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Baroness Thornton
To ask Her Majesty’s Government, further to the decision to delay the planned new guidelines on the diagnosis and management of ME/CFS, what assessment they have made of the ability of the National Institute for Health and Care Excellence to carry out its functions; and when they expect such guidance to be published.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
NICE is seen as a world leader in the translation of research into authoritative, evidence-based clinical guidelines, and the Government have confidence in NICE’s ability to carry out its functions effectively. We all know that ME/CFS is a complex condition and, as we understand, a range of views about its management have been expressed during the development of the updated guidelines. To address as wide a range of views as possible, NICE is holding a round table with stakeholders next Monday to discuss these issues and will then take a decision on the next steps.
Baroness Thornton (Lab)
First, of course, I welcome the Minister to his place and his job. There is nothing like hitting the ground running, since he has got to do three Questions in a row—that does not often happen. My Question was prompted by two important issues. First, public confidence in NICE’s methodology, and indeed NICE’s own confidence in its methodology, are vital. If the Minister says that the Government have confidence in NICE, it begs the question why the Government are not demanding that the ME/CFS guidance, three years in the writing and with patient support, is not being published immediately.
Secondly, I will quote from one of the many emails that I have had about this issue: “Thank you in advance for speaking up for ME patients. No treatment is better than harmful treatment. My daughter is now bedbound with severe ME due to GET”. GET is the current medical treatment regime for ME/CFS sufferers, which these guidelines say should be reformed. Did NICE come under pressure to pull these guidelines because of medical vested interests in the delivery of GET, particularly since they believe that this is the treatment for long Covid?
Lord Kamall (Con)
First, I thank the noble Baroness for her warm welcome. I look forward to many exchanges with her and to learning from Ministers across the House and those who have been in the Department of Health and Social Care before. I know that the noble Baroness is recognised as a champion of the 250,000 people who are living with ME/CFS. As the noble Baroness knows, there are a number of complex symptoms, and experts disagree over the multifaceted way to address this.
As the noble Baroness knows, the NICE guidelines were delayed twice. They were first delayed because it wanted to make sure that it had taken on board all the various submissions that had been made; they were delayed a second time because, just as they were about to be announced, concerns were raised by clinicians and other stakeholders. If you are going to have guidelines, it is important that they are accepted and recognised by as wide a range of stakeholders as possible; otherwise, they might lose their authority.
We want to make sure that, whenever we have this situation and there are people with a range of views, we get them around a table and have a conversation, as common sense tells us, to see if we can agree on a way forward. I very much hope that, once we have had this round table, we will be able to agree a way forward.
NHS: Hospital Visiting
Baroness Thornton Excerpts(3 years, 1 month ago)
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Lord Bethell (Con)
My Lords, it is a question of balance. We certainly have to be extremely careful about people visiting those with Covid because of the obvious contagiousness of that disease. As I said, the guidance is currently to limit the size of groups to one close family member, but we are mindful of the mental health impact of that, so trusts are trying to get the right balance between contagion control and the mental health implications of people being ill and alone in hospital.
Baroness Thornton (Lab)
It is very nice to see the Minister in his place; I wish him good luck right now. May I say how much we welcome the measures relating to visits in care home premises from 16 August? Welcoming anyone into care homes poses risks and it is important that those risks are managed and mitigated. In the face of the winter plans that have been announced, is there any expectation that there will be a review of these guidelines for care homes under plan A or plan B?
Lord Bethell (Con)
My Lords, I am pleased to say that 91% of care homes in England have been able to accommodate residents receiving visitors, compared to 40% in March. That is huge progress and answers a very large amount of concern that I have heard here in the Chamber. It is our objective not to change or review these measures. We want to try to keep care homes open to visiting in a safe way, as we do presently. If it becomes necessary, though, we will take the steps to protect life.
Covid-19
Baroness Thornton Excerpts(3 years, 1 month ago)
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Baroness Thornton (Lab)
Normally, of course, we would have taken these Statements separately but on this occasion, we can take them together. I hope we are working towards taking Statements on the day they are made in the Commons wherever possible.
I looked back at this week in 2020. This time last year, the Prime Minister introduced the rule of six—and really confused the nation. Covid marshals were introduced and the offence of mingling appeared on the statute book. We had infection rates rising, from the young to the middle-aged, and we were very concerned that that meant that they would move into the older cohort of the population. I of course acknowledge that vaccine and testing regimes have made a huge difference, but the lesson we need to learn from last year, and which is signalled in the recent SAGE report, is the need to take action in a timely fashion—which, I am afraid, the Government failed to do from time to time last year.
On Monday, we had confirmation of the vaccine programme for children, and we on these Benches welcome that and support the decision and recommendation of the CMO. Children may not have been the face of this crisis, but they have certainly been among its biggest victims. Yesterday, the Secretary of State also confirmed a booster jab and again, we on these Benches welcome and support that. The obvious question is: how will all this be done? In addition to the issues of our young people, booster jabs and the flu vaccine, we have areas of the country where vaccine take-up remains relatively low. For example, in Bradford, where I am from, second doses are running at 65%; in Wolverhampton, 65%; in Burnley, 69%; and in Leicester, 61%. The first question has to be: what support will be given to those areas and others so that they can boost their vaccine take-up?
Can the Minister explain to the House what the next stage in the children’s vaccination programme will look like and by what date he anticipates that children will be vaccinated? Will it be the responsibility of parents to arrange their children’s vaccination, or will the local NHS arrange it with schools, year by year, or class by class? Will the flu vaccine, which is this year being expanded to secondary schoolchildren, be delivered at the same time as the Covid vaccine or separately? Can the Minister explain what steps will be taken to ensure that parents are informed of the benefits and risks of the vaccination? Can he confirm the Government’s position in rolling out the vaccine and whether the consent of parents will be necessary, because surely the Gillick principle will come into play here? Can the Minister explain why, 470 days since SAGE warned about the importance of ventilation in schools and colleges, it looks as though not a huge amount of action has been taken?
Yesterday, in Grand Committee, I raised the issue of anti-vaxxers demonstrating outside our secondary schools. Given the creation of safety zones around hospitals to prevent harassment and bullying from anti-vaxxers and ensure the safety of our healthcare workers, patients and their caregivers, what will we do about our schools? Can the Minister confirm that the duty of schools, their leaders and the Government is to protect vulnerable children from any form of intimidation or demonstration at their school gates? What is his view of this matter?
Despite the success of the vaccine rollout, the delta variant continues to pose a considerable threat to people. Those who are sick with the delta Covid variant are twice as likely to need hospital care as those who contract the alpha variant. Of course, the UK has not yet experienced delta in the winter. The Government have acknowledged that there is a “plausible” risk of cases rising to an extent that would place the NHS under “unsustainable pressure”. Can the Minister advise the House at what point different measures in the plan will therefore be introduced?
The Government—and, indeed, the scientists—note that
“the epidemic is entering a period of uncertainty … It will take several weeks to be able to fully understand the impact of any such changes.”
In its report, SAGE stressed the “importance of acting early” if cases rise to stop the epidemic growing. It warned:
“Early, ‘low-cost’ interventions may forestall need for more disruptive measures and avoid an unacceptable level of hospitalisations … Late action is likely to require harder measures.”
Given that deaths are currently five times what they were a year ago, with hospitalisations four times as high, why are the Government not already pursuing light-touch measures, such as mandatory masks? The CSA, Patrick Vallance, said that the UK is now at a “pivot point” where, if the situation worsens, it could do so rapidly—so would light-touch measures not be prudent?
The Autumn and Winter Plan states that the Government want
“to sustain the progress made and prepare the country for future challenges … by … Identifying and isolating positive cases to limit transmission”.
Yet the Health Secretary said that no decision has yet been taken as to whether pupils in England will continue to undergo regular testing. Does the Minister share my concern that ending regular testing for pupils is contrary to that key plank in the winter plan?
Although we are still waiting to hear what changes will be made to Covid travel rules, the Health Secretary implied that PCR tests for fully vaccinated travellers will be replaced with lateral flow tests. What will this mean in terms of possible delays in identifying cases involving variants of interest or concern to the UK?
The Health Secretary also confirmed that, although the plans for mandatory vaccine-only Covid-status certification have been shelved for now, the Government may well pursue them in future under the plan B scenario. Can the Minister provide further details about which settings and scenarios will be involved? Can he confirm whether this will require primary legislation?
Baroness Brinton (LD) [V]
My Lords, the publication of the 33-page Covid Autumn and Winter Plan, including plans A and B, rightly talks about the need to resume life as normally as is possible while Covid is still around, but to move into restrictions faster if cases surge and the NHS is pressured. The World Health Organization’s special envoy on Covid, Dr David Nabarro, has said that the UK is right to find a way to live with the virus. However, he added:
“Speed is of the essence. We’ve been through this before and we know, as a result of past experience, that acting quickly and acting quite robustly is the way you get on top of this virus, then life can go on. Whereas if you’re a bit slower, then it can build up and become very heavy and hospitals fill up, and then you have to take all sorts of emergency action.”
Why does the Statement talk about the vital importance of mitigations, such as meeting outdoors where possible, ensuring ventilation if inside and wearing face coverings? Why are there no clearer, repeated messages for the general public about all these vital interventions, especially what we can all do now to slow down the increase in cases and hospital admissions?
At the No. 10 press conference on Monday, Professor Chris Whitty said:
“Anybody who believes that the big risk of Covid is all in the past and it’s too late to make a difference has not understood where we are going to head as we go into autumn and winter.”
He is right to be concerned. The seven-day rolling figure for daily hospital admissions is now around 1,000, with an average of 8,400 Covid patients in hospital beds. These numbers are considerably greater than they were this time last year. SAGE is very concerned that, as rules are further relaxed and people start coming back into work, the number of Covid patients going into hospital is set to increase substantially. This would put the NHS under real pressure, with perhaps as many as 7,000 admissions a day in six or so weeks, so it says.
The Statement announces the final decision on the booster scheme for those aged over 50, healthcare staff and the clinically extremely vulnerable, following the third dose for the half a million people who are severely clinically vulnerable. We welcome this. However, the World Health Organization reminded us that we should also be providing doses for low-income countries, but I see that the Government are planning only 100 million doses over the next few months. That is a drop in the ocean given that only 2% of the populations of low-income countries have been vaccinated. Will the Government agree to review and increase this number?
We on these Benches welcome the news on 12 to 15 year-olds getting vaccines. We accept that this was a difficult and complex decision, but we are pleased that there finally is one. There was an excellent slot on the “Today” programme this morning, with a group of 12 year-olds asking a paediatrician some questions; he had to look one answer up on Google. I hope that all parents and children will be able to access this sort of information because we know that it makes all the difference in coming to a decision.
However, as the noble Baroness, Lady Thornton, said, anti-vaxxers are causing serious problems. Good on Chris Whitty for what he said about one celebrity who attacked the idea of 12 to 15 year-olds having vaccines. However, today, yet another celebrity attacked him on social media, saying that he should be hanged. That is disgraceful. What are the Government doing about public servants like Professor Whitty being threatened in this way? As importantly, what will the Government do about the disinformation that people are now spreading at school gates, including leaflets with the NHS logo on them?
Ten days ago, Dr Jenny Harries announced that all clinically extremely vulnerable children in England—even those still on chemotherapy—would be removed from the CEV list and expected to return to school as term was starting, regardless of their underlying condition or the fact that there are no masks, bubbles or even, in many schools, proper ventilation. Although it is really important to have all children back in school, this cohort of children is at particular risk. Their consultants and GPs are as bemused as their parents, so why is Jenny Harries’s letter to the parents of these children, explaining why they are being removed from the CEV list, not on either the NHS or UKHSA website? Will the Minister write to me to explain this decision? We are hearing confusion from parents and medics alike.
Finally, last week, I commented on the continuing farce of Ministers U-turning daily on the use of vaccine passports for clubs. It is confusing to keep up with the U-turns on U-turns; I note that the Statement is trying to have it both ways. I suspect that Ministers could do with some new flip-flops.
Flu Vaccination and Blood Test Cancellations
Baroness Thornton Excerpts(3 years, 1 month ago)
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Lord Bethell (Con)
As my noble friend knows extremely well because of her close connections with the industry, GPs and pharmacies are responsible for purchasing their own flu vaccines through the seasonal flu vaccination programme, directly from manufacturers or wholesalers. Deliveries are phased and typically take place over a long period from September to November. As I said earlier, the disruption we have had in the supply was from one supplier for one or two weeks. It has not had a meaningful impact on the supply of flu vaccines to this country.
Baroness Thornton (Lab)
The Minister and the Government need to catch up with what is going on on the ground. I think almost everyone in your Lordships’ House knows someone who has had their flu vaccine appointment cancelled. There are two such noble Lords over there. I know three people in the House whose flu vaccinations have been cancelled. Perhaps he needs to go back to have another look at this.
The BMA has called for a COBRA meeting on the shortages of test tubes and transport. The Minister might think it is scaremongering, but it actually has a right to be alarmed. First, in these circumstances, if there are further delays and shortages, will he and the Government have a system of prioritisation? Secondly, how will the NHS encourage better take-up of flu vaccination among NHS staff?
Lord Bethell (Con)
My Lords, I hear loud and clearly the very obvious feedback from noble Lords about cancelled appointments. It is not the same as the guidance that I have been given, but I will look into it when I get back to the department and will be happy to write to the noble Baroness with an update on them. With regard to test tubes, I reassure her that guidance was issued to the NHS and GPs recommending actions for medical directors, nursing directors, GPs and pathology laboratories. It required refinements that had an impact, but those with an acute need for blood were accommodated and a COBRA meeting was not needed.
Health Protection (Coronavirus, Restrictions) (Steps etc.) (England) (Revocation and Amendment) Regulations 2021
Baroness Thornton Excerpts(3 years, 1 month ago)
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Baroness Thornton (Lab)
My Lords, I thank the Minister for introducing this late regulation. As I said to him last week, there is a sort of “Groundhog Day” tendency in having to deal with these things. I would also like to register with the noble Baroness, Lady Barker, that the House needs to address the issue of the noble Baroness, Lady Brinton, being able to access these sessions in the same way that she can access the Chamber. I would even go so far as to say that it is discriminatory that she cannot. As well as that, we are missing her wisdom, words and her representation of her points of view.
The noble Baroness, Lady Barker, and my noble friend Lord Hunt have covered many of the points and have asked many of the questions that need to be asked on this regulation. As noble Lords have said, it triggers the end of most of the lockdown restrictions in England by revoking regulations and amending regulations listed in the schedule from 19 July. I echo what other noble Lords have said. Does the Minister believe that it was premature to remove face mask regulations? I have not yet read the 30-odd page toolkit document in full, so I do not know whether the option is there to reintroduce them as part of the autumn-winter Covid plans. Would that be mandatory?
At the time of lifting the restrictions, from these Benches we opposed and still oppose the decision to remove the requirement to wear a face covering indoors and on public transport. The risk of transmission inside a crowded bus or train will be high. If it is true, as the scientists say, that one in 70 of us in England has Covid, and the capacity of a double decker bus is about 70 and a full Tube train or regular train carriage can carry up to 140 passengers, that would mean that on average one person on a crowded bus and two people on a crowded Tube train will be contagious. They will have Covid, and with little ventilation and no legal requirement to wear a mask.
I travel on public transport all the time—it is how I get to your Lordships’ House and go home—and it is certainly noticeable that mask-wearing, particularly among young men, has fallen. It is true that on the Tube there are marginally more people wearing masks than on the Overground, but the number has fallen. It is very concerning and worrying, and I have got to the point where I have stopped being a mask monitor and offering people masks if they have not got one on, because there are too many of them on the Tube and on trains without masks on.
We supported the removal of restrictions on gatherings, but we thought the Government were going too far and too fast at the time. We were also concerned that the lifting of all the restrictions was confusing to businesses. Has the Minister had feedback about how effective the lifting of those restrictions was? This instrument extended the expiry date of the Health Protection (Coronavirus, Restrictions) (England) (No. 3) Regulations to the end of September to ensure that local authorities retain the power to respond to local serious and imminent public health threats as a result of the spread of coronavirus. Can the Minister confirm whether the Government intend to further extend these provisions? If it is in the winter plan I apologise, but I think we will be discussing that tomorrow or Thursday.
I suspect that the winter plan contains which bits of the Coronavirus Act are being retained and which will be got rid of. However, what worries me is whether in three or four weeks’ time, if infection rates have increased enormously as a result of the schools going back, there will be sufficient powers to deal with that, and sufficient powers if we need to go into further restrictions. The Minister must explain what will happen if the worst happens. The byword throughout the whole pandemic has been “Let’s plan for the worst and hope that we don’t have to use those powers.” If all those powers are being rescinded now, what will we do if there is a new variant further into the winter or we see a spike in the next three or four weeks? We need to know that.
In terms of mask wearing, I went on holiday to Scotland by train and it is true that as we neared the border, there was an announcement that everybody had to wear a mask, and everybody put a mask on. It was not an issue. Like the noble Baroness, Lady McIntosh, I do not regard mask-wearing as an encroachment on my civil liberties. I regard it as something that protects me and with which I protect others. We seem to have lost that message in the wearing of masks. Are the Government going to do anything about that?
Lord Bethell (Con)
My Lords, I thank noble Lords very much for an extremely helpful debate, and I very much welcome this return to the Moses Room. It is very nice to be back in the intimate and more conversational style of Committee.
The Secretary of State has been on his feet this afternoon to talk about the toolkit. My understanding is that there will be some kind of Statement repeat, and I look forward very much to going through the toolkit during that. I apologise in advance if I cannot answer every question on that right now, but I would like to tackle a couple of points that were raised. Before I do, I will say a word of appreciation for the contributions of the noble Baroness, Lady Brinton—her presence is highly valued—and for those who organised the virtual House and our current arrangements. It is all a massive compromise and uncomfortable, but I am extremely grateful for the work that has been done to make this return possible. I am hopeful that even more can be done in October.
A number of noble Lords, particularly the noble Lord, Lord Hunt, asked about the booster. The NHS will be rolling out a booster programme to protect those who are most vulnerable to Covid, as we announced previously. It will now be extended to individuals who received vaccination in phase 1 of the programme: that is, JCVI groups 1 to 9. That includes those living in residential care, all adults over 50, front-line health and social care workers, and all those aged between 16 and 40 who have underlying health conditions that put them at a higher risk of severe Covid.
This is very good news. There is very strong evidence that a booster programme such as this can have a very big impact, particularly on those who are immunosuppressed or who live with the immunosuppressed. The JCVI has advised that the booster vaccine programme is offered no earlier than six months after completion of the primary vaccine course, and that will of course affect many people. The vaccination programme has been planning booster vaccinations for some time, which means that the NHS is now in a position to offer booster doses from next week. As most younger adults will have received only their second Covid vaccine dose in late summer, the benefits of booster vaccination in this group will be considered at a later date. I think noble Lords would agree that this is a reasonable and proportionate approach to this complex issue.
Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) Regulations 2021
Baroness Thornton Excerpts(3 years, 1 month ago)
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Baroness Barker (LD)
I thank the Minister for introducing the regulations as he did, but it does not alter the fact that the current rules around self-isolation and PCR and lateral flow testing are confusing. People who are not stupid and who genuinely want to know what to do and what they should be doing for the best find them difficult. I heard about someone who had contact with a positive case last week trying to work out from GOV.UK if it was okay that they had had a negative PCR test and had no symptoms—what were they then supposed to do? It is imperative that we continue to have very clear and sustained messaging around testing and isolating.
Ministers have made great play of the fact that the front line of defence is double vaccination. Okay, but that is only as strong as it is if you continue to have the second-line defences of testing and isolating in behind it; if you do not, that places a much greater strain on the vaccination process. We know that from other countries. I know that the Minister said that there were other mitigations, and he talked about investment in therapeutic treatments, but they are not yet with us. Therefore, we need to concentrate yet again, albeit with fewer restrictions than there were before, on who is being tested and who is having to isolate.
I go back to one point on which I have asked the Minister questions for more than 12 months. What about people who are not registered with GPs? There are still such people in the country, perhaps people whose first language is not English and who—surprisingly, perhaps—do not know about what to do about going to get vaccinated. I have come across a couple of examples recently. I do not think that there are vast numbers of such people, but there is a significant cohort in some communities who are hesitant not because they have any great ideological disposition against vaccination—they just simply do not know what to do, or they may have language problems, which means that they are concerned about going to vaccination centres.
I want to talk again about schools, because we have the data that has come through from Scotland. I point out to noble Lords that mask-wearing in schools in Scotland is still in place. From talking to epidemiologists, as we did earlier this year, about the whole process of the country coming out of tight restrictions, one thing that they said to my noble friend Lady Brinton and our team is that with enclosed spaces it is not just ventilation that you have to look at—you have to look at air purification as well. The big health risk is when you have stagnant air into which people who are positive are exhaling droplets of the virus. What has been done to enable schools to look at things like carbon dioxide monitors, as a proxy for measuring stagnant air? Again, I do not think that many schools have had the resources to enable them to deal with that.
I want to make one point that my noble friend Lady Brinton would have made had she been here. We are still talking about 1,000 deaths a week and 50,000 deaths per annum. By the Prime Minister’s reckoning, that is an acceptable but very high number of deaths. The reason why these regulations are not helping is that they seem to be part of a high-level message that says, “It’s over.” A lot of people think it is over, but it is not; it will not be for a considerable time and it will continue to be very dangerous if we chip away at the side mitigations that go beyond the vaccine.
Finally, we have always said that local authorities have a key role to play in identifying those people who are in the communities that are most vulnerable, and they are the communities that need the most help to self-isolate. When will the Government produce a comprehensive report on the funding of local authorities for local self-isolation schemes and their effectiveness?
Baroness Thornton (Lab)
My Lords, my noble friend Lord Hunt made the most pertinent point, which is that, as we have acknowledged, Covid has pointed to the gross inequalities in our society. That can be seen absolutely when we look at the self-isolation regulatory regime and the impossibility of those on low incomes self-isolating because they then have to choose between feeding or not feeding their children; they cannot afford to self-isolate. We still have not solved that problem sufficiently well.
As we move into the winter, as the noble Baroness, Lady Barker, said, this pandemic is not over. If you have 150 to 200 people a day dying, it is not over. If you have half the ICU beds in our hospitals still occupied by people with Covid, it is still not over and we will never catch up with all the NHS waiting lists that have fallen so abysmally behind in the past 18 months. So it is not over.
Self-isolation is part of the toolbox, to use the Prime Minister’s and Secretary of State’s word, that will help to control the spread of this virus. What the old regulations did—do—is amend the self-isolation regulations. With effect from 19 July, they allow a person to leave self-isolation and put an antibody test in the post, and from 16 August certain people were no longer required to self-isolate if they had come into contact with a person who had tested positive for Covid. The Minister listed who those different groups are, including children under 18. I completely agree with my noble friend about the need to include children under 18, but we have to address the issue of what that means for schools.
The Minister said before the summer, when we were hearing Statements about the easing of these regulations, that people were going to have to behave “in a responsible fashion”. I had a particular issue with that last week, when a friend I was supposed to be meeting called me to say that her husband had caught Covid. Both were double vaccinated, he was not very ill—I am pleased to say. They had been at a wedding, and there was a family there who were anti-vaxxers; they did not know and he caught it. She tested negative for the next four or five days.
I was personally quite torn about what to do: should we meet or not? The idea shocked me that somebody who is living with somebody who has Covid did not have to self-isolate. I worked my way through it; I read the regulations, which I must say are complex and not completely clear. She did not say, “I am allowed to go out”; she was being very responsible, but I thought that millions of people must be facing those issues all the time. Just saying that people have to behave “in a responsible fashion” may not be quite the point.
Commonwealth Fund Report: NHS Ranking
Baroness Thornton Excerpts(3 years, 1 month ago)
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Baroness Thornton
To ask Her Majesty’s Government what assessment they have made of the report by the Commonwealth Fund Mirror, Mirror 2021: Reflecting Poorly, published on 4 August, and, in particular, the United Kingdom’s National Health Service dropping from first to fourth place in their rankings of countries’ health care systems; and what steps they intend to take as a result.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, we are very grateful to the Commonwealth Fund, based in America, for its very important report and its updated rankings. I note that the criteria in the report have changed considerably over the years. On the report’s key points, I agree that there is more that we can do on patient equity. The Government have put health inequality at the centre of their agenda, and we are working hard on implementation. On care process—the other key finding of the report—we do not recognise the report’s analysis.
Baroness Thornton (Lab)
Well, how convenient. The UK’s drop in rank in the Commonwealth Fund’s five-yearly research into the performance of the world’s wealthiest 11 countries’ healthcare systems from first to fourth still seems to be associated, as the noble Lord has said, with access to care and with equity. This is important because the key differences between the top-performing countries, of which we are still—just—one, and the worst performing healthcare systems, of which the USA is, by a long way, the outlier, concern universal coverage, removal of cost barriers, investment in primary care systems, reducing bureaucratic burdens and investment in social services, particularly for children and working-age adults. Can the Minister explain to the House how the announcement on social care last week and the current NHS reform Bill before Parliament will contribute to the UK’s healthcare performance and ranking in the next five years?
Lord Bethell (Con)
My Lords, the noble Baroness half answers her own question. When it comes to universal coverage, I am extremely proud of the NHS and the service that we provide to the British public. There is no other health system like it anywhere in the world. The report makes cogent points on equality, and we have put that at the centre of our agenda, and in the NHS long-term plan, the prevention Green Paper and the newly implemented Office for Health Improvement and Disparities. We are doing that work through the obesity plan, the NHS health checks, the tobacco control plan and the vaccination plan. We are highly committed to this agenda, and we are making an impact.
Covid-19 Update
Baroness Thornton Excerpts(3 years, 1 month ago)
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Baroness Thornton (Lab)
I hope the Minister has had a good break and I thank him for the Statement today. I regret that phrases such as “Groundhog Day” and “Here we go again” keep jumping into my mind unbidden. Obviously everybody welcomes the continued rollout of the vaccine, and I congratulate the NHS and its partners on this. However, we must not pretend and behave as if we are at the end of this pandemic. The figures still show a substantial daily rate of infection, hospitalisations and deaths. If we go into the winter with a high proportion of ICU beds still occupied by Covid patients, this will have a knock-on effect for serious elective surgery, emergency needs and flu. It will affect the ability and capacity of the NHS to deliver the beginning of the catch-up that we face in the next couple of years. The context of this catch-up is starkly illustrated by the figures concerning cancer this week. The Macmillan Cancer report reveals that
“More than 600,000 cancer patients in the UK are facing treatment delays or missing out on vital support because of a shortage of specialist nurses”.
Less than a month ago, the Health Secretary said that he wanted booster jabs to be given at the same time as flu jabs and that they would be starting this month. However, is it the case that, due to supply issues linked to a shortage of drivers, equipment and flu vaccinations, these are delayed? If so, for how long? Is it for two weeks or is it longer?
In this context, it is not surprising that GPs are at their wits’ end, forced to cancel first blood tests because of test tube shortages and now flu vaccination appointments. We need to think about what that means; for example, if you are pregnant and need a flu vaccination, the delay is a serious matter because you cannot put your pregnancy on hold while the supply catches up with you. It is especially worrying as we head into what could be one of the most difficult and challenging winters for the NHS. What steps are the Government taking to ensure that there are not further delays and to avoid a flu crisis this winter?
If the CMOs are recommending vaccination, will the Minister guarantee that our public health workforce, our health visitors and our school nurses, as well as primary care, will have the resources they need to roll out that vaccination? Can he advise what the anticipated time frame for commencement and the communication strategy will be? He Minister must be aware that many parents appear to be hesitant and that with other groups with low levels of vaccine uptake, access to accurate and trusted information is key.
Some scientists have suggested that the vaccination of children against Covid-19 is already too late to blunt an autumn wave of the infection because they will get only one dose, which is not terribly effective at preventing infection with the delta variant. What assessment have the Government made of this and what consideration has been given to limiting the minimum interval between first and second doses?
The Education Secretary has suggested that weekly Covid tests for pupils could be scrapped this month, following a review. That may be quite concerning, given that the autumn could bring a surge in cases driven by a new variant, by more mixing of people at school or work, or indeed by a drop in the levels of immunity provided by the vaccine. Does the Minister agree that testing really ought to continue?
The Education Secretary also seems to have removed many of the infection control mitigations in schools. From these Benches, we urged the Government to use the summer to install ventilation, air filtration units and carbon dioxide monitors in schools. I would like to know how many schools now have these systems installed. I also share with the Minister our concerns that the current rules seem to suggest that a child can go to school even when their parents test positive. That seems not to be a sensible way forward.
Are the Government making contingency plans for an October firebreak lockdown if hospitalisations continue to rise at their current rate? Last week, the World Health Organization designated mu as a variant of interest, adding that it can potentially evade immunity granted from a previous Covid infection or vaccine. Perhaps the Minister could update the House on that issue.
On Tuesday, the Prime Minister finally made his long-awaited social care Statement, over two years after standing in front of the steps of Downing Street proclaiming to have a plan. Now, we had a debate and discussion earlier today about whether it is actually a plan—because we think it is not—and what the tax increase means. However, the timeframe for the delivery of this plan does not seem to recognise that we already have bed blocking in our hospitals. There is already an emergency in social care and the knock-on effect of that on Covid, flu and the winter could be substantial. I would really like the Minister to address that issue.
The Deputy Speaker (Baroness McIntosh of Hudnall) (Lab)
My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness now to speak.
NHS: Nursing Workforce
Baroness Thornton Excerpts(3 years, 1 month ago)
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Lord Bethell (Con)
My Lords, as my noble friend will know, the training grant of at least £5,000 per academic year per eligible student is in place, plus a further £3,000 of additional targeted funding—for example, for childcare costs and students studying special subjects. That is the kind of financial commitment that we have made to meet his concerns. On the specific point that he mentioned, I say that not everyone is suited for the nursing profession; it is a really tough job, and not everyone who wants to be a nurse can be a nurse. I am afraid that the applications that we get and the sifting that we do reflects that point.
Baroness Thornton (Lab)
I draw attention to my interests at Whittington Hospital in the register. Thank goodness that our nurses are incredibly resilient, but the relentless nature of working for the NHS, not just in the last year but prior to the pandemic, is now taking its toll. That includes senior and experienced nurses; there must be a worry that many could take early retirement, which is a risk to the profession. The feedback that I get, to which noble Lords have referred, is that respect and regard is less evident as the pandemic continues, and I think that is exacerbated by the debate about pay. What other initiatives is the NHS considering to deal with the fragile nature of retention—for example, housing offers, travel and the working environment—and will they be funded?
Lord Bethell (Con)
The points that the noble Baroness makes are entirely right, and we share exactly the same concerns. That is why we have put in place mental health support, enhanced occupational health support, expansion of the right to work flexibly across the NHS, and the promotion of equality. On the point about older nurses, two things particularly stand out: there is significant investment in leadership through the NHS Leadership Academy, and we have bespoke support for over-50s and newly qualified nurses, recognising that they are likely to be the biggest flight risk across the NHS.