NHS Update

Baroness Thornton Excerpts

Thursday 22nd July 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I first record from these Benches our thanks for the hard work of the noble Baroness, Lady Penn, who has gone on maternity leave. We wish her and her baby all the very best for the future. Also, adding to the words of the Government Chief Whip, I thank the clerks, the virtual technicians, the managers and all our staff, for keeping the show on the road and for keeping us safe throughout this year. I particularly echo his words about their patience with us. We have continued to do our job and could only have done so with the support of these dedicated teams. I also thank the Lord Speaker, his predecessor, and Members of all those Committees that have been in almost permanent session this year, for guiding us through.

This is the last repeat Statement before the summer—I think this may be number 50; the Minister will know. We have three matters to deal with today: the somewhat puzzling Statement made in the Commons yesterday afternoon, the Written Statement from the Secretary of State which announced the results of the NHS pay review and—I have given the Minister notice—I will also address some of the issues raised in the Covid update given in the Commons this morning.

The Statement made by Helen Whately yesterday was an odd moment. We of course join her and the Minister in thanking Sir Simon Stevens for all his work in the NHS—he has also taken up his place in your Lordships’ House. We also join others in welcoming progress on the autism strategy, which the honourable lady talked about in her speech; although, in due course I will seek the views of the organisations who are experts in this area. However, the honourable lady gave what can only be described as a parliamentary doorstep clap for the NHS and its staff. Welcome though that might be, it does not pay the bills or provide the respect that this Government owe to our NHS staff.

The Statement was followed within hours by a Written Ministerial Statement outlining the NHS pay award. This is not a respectful way to treat Parliament or our NHS staff. As my honourable friend Dr Rosena Allin-Khan said yesterday, once again the Government have had to roll back on a shoddy, ill-thought-through position, with their 1% pay rise—a real-terms pay cut —rejected by the independent pay body. Less than an hour before, there were competing briefings on what the deal was to be and, at that moment, it turned out to be nothing. Our NHS staff deserve better than this. My honourable friend invited the Minister in the other place to shadow her in the A&E department where she has worked shifts throughout the pandemic. I suggest that she takes her up on that offer, and that the Minister here might do the same.

My right honourable friend John Ashworth has said:

“Ministers were dragged kicking & screaming to 3% for NHS staff. But after years of cuts & rising pressures, NHS staff will feel let down & disappointed especially after today’s chaos. And where is the pay rise for junior docs? Where is a fair pay rise for care workers?”


It really was not worthy of a Government. We had chaos and confusion, with the Government once again rowing back on their position. Does the Minister agree that the pay review body has done what Ministers could not and would not do in recognising that our NHS staff absolutely could not be given a pay cut? Does he accept that, after last year, this is not enough?

Does he accept that this is not an NHS-wide pay settlement? It does not cover all the health and care workforce, who do not fall under this pay review body, and it does not cover junior doctors—I declare an interest, as two are nephews of mine, both of whom were redeployed during the pandemic. We know that our junior doctors have been put on the front line, caring for sick patients, and redeployed across an understaffed, pressured NHS, and that their training has been disrupted. Will the junior doctors get a pay rise? Will all health staff employed in public health receive the settlement? Again, when we know absolutely the value of care workers, why do the Government not guarantee a real living wage for those working in social care?

How will this pay settlement be funded? NHS trusts do not even know what their budget is beyond September, and NHS employers pointed out that this settlement will cost the best part of £2 billion, so where is that coming from? Is the Minister expecting trusts to find it from their existing budgets? These Benches keep repeating this question: the Government seem not to appreciate how central this is to stopping the spread of the virus, so when will they address support for low-paid workers who have to self-isolate?

I posed many of the immediate questions yesterday to the Minister. Sometimes I felt enlightened by his answers and sometimes I did not, but the one I wish to go back to concerns the Government’s plans for September. Are they ready to reimpose safeguards? Will our schools get filtration units over the summer so that we can feel that our children will be safer? Will our teenagers be vaccinated so that, next year, this cohort can do a full year of learning without being sent home in their millions?

[Baroness Brinton (LD) [V]]

My Lords, I echo the thanks to all the staff who have made a hybrid Parliament work over the last year especially, from these Benches, to the health team, because of the high workload of health and Covid business. I also repeat the good wishes to the noble Baroness, Lady Penn, as she starts her maternity leave.

Along with colleagues in the Commons, I am unconvinced that the first half of this Statement was planned to be delivered by the Minister yesterday. In the bizarre events of this week, of Covid restrictions being lifted, a rush of announcements—Monday’s, and today’s on vaccine passports—U-turns, and No. 10 contradicting Ministers, this Statement is definitely filed under “Y” for “You couldn’t make it up”.

Yesterday morning, the press were briefed and opposition politicians heard on the parliamentary grapevine that the NHS staff pay rise would be announced in the Statement. Even Sky News and the BBC news channel were saying that there would be an announcement on NHS pay in the Commons yesterday afternoon. Yet, when the Minister stood up, there was not one word about the pay award, just an end-of-term report and a much-deserved paeon of praise about how wonderful our NHS staff are—they are, and they deserve that praise. However, an extraordinary line in the Statement says:

“But I can assure those hardworking nurses: you should feel it soon”.


Well, they did. Four hours after that Statement, a Written Ministerial Statement and a press release were slipped out, bypassing parliamentary scrutiny, presumably in the hope that it would not be spotted. NHS staff, especially junior doctors and nurses, are appalled. I am not sure this is what the Minister meant by

“you should feel it soon”.

However, it gets worse. This morning’s Times says that the 3% NHS staff pay rise will be funded by robbing the expected increase in national insurance contributions reserved for the social care proposals leaked earlier this week by the Government. That is an absolute disgrace, especially given the appalling way that No. 10 has handled the social care reform proposals. After the Queen’s Speech, Ministers told us that it would be this autumn. Last week, they suddenly said that there would be an announcement this week but, this week, they have thrown the proposals back into the long grass, with a promise—again—of later this autumn, two years after the PM promised us, on the steps on No. 10, that this was his absolute priority. His actions are showing otherwise.

I know that the Minister understands that social care needs urgent reform and that it has borne the brunt of the first year of the pandemic. Can he confirm the Times story about the funding of the NHS pay rise and whether this decision was made by the Secretary of State for Health and Social Care or by the Chancellor of the Exchequer? Can he also say when the full proposals for social care will now be published, including the funding arrangements?

Moving to the only substance of this Statement, the autism strategy, we on these Benches also pay our respects to the late Dame Cheryl Gillan MP, who was such an advocate for those with autism. Peter Wharmby, the autistic writer, speaker and tutor, says that the autism strategy sets its targets very low in saying:

“Moreover, we have been able to transform society’s awareness of autism, as … 99.5% of the public have heard of autism … which is so important in autistic people being able to feel included as part of their community.”


Peter Wharmby is right. Much of the strategy talks about continuing as usual, but if you talk to autistic people or parents of autistic children, they all say that much needs to be done in supporting those with autism, especially in education and at work. Knowing that autism exists is not the same as providing the best environment for those with autism to overcome the barriers they face in society and giving them the support that they need to succeed. The Disabled Children’s Partnership points out that the pandemic has exacerbated existing problems around support for those with autism, creating further social isolation and poor health outcomes. It is depressing that the autism strategy is so unambitious.

One particular problem that parents face when trying to get support for their autistic children is an automatic assumption that parent carers are treated as a resource—worse, their parenting capacity is often questioned. There is no mention here of support for their needs. As John Bangs, a special needs expert, points out, this deliberately ignores carers’ legal rights. It is noticeable that this autism strategy makes no real reference to ensuring that parental and familial carers are supported. When will these wider issues relating to positive support for those with autism and their familial carers be addressed?

Finally, briefly on the Covid Statement in the Commons today, page 4 says that

“two doses of a covid vaccine offers protection of around 96% against hospitalisation.”

But the key bit of information we need in the “pingdemic” at the moment is the rate of double-jabbers getting Covid. I understand that it is part of the same study that is quoted, but what is the answer and where can we find it? If the pingdemic is due to the virus spreading —we hear of police and control rooms unable to operate and empty shelves at supermarkets—perhaps it is time we actually understood how many double-jabbers are getting Covid and having to go into self-isolation, and thereby creating a problem. The Minister needs to consider whether lifting all restrictions on Monday was the right thing to do.

Animal Diseases: Future Pandemics

Baroness Thornton Excerpts

Wednesday 21st July 2021 Lords Chamber

[Lord Bethell (Con) [V]]

My Lords, the “one health” approach is moving through the G7 process at the moment. I am not sure whether a precise timetable exists. I am happy to check to see whether dates are available, and I will write to the noble Baroness accordingly.

[Baroness Thornton (Lab)]

My Lords, it is quite clear that the health and scientific world has, not surprisingly, been focused on the pandemic. The FAIRR report published today and previous reports in this area show what a threat to world health there is from antimicrobial resistance. The question is: how much of a priority is this in the Government’s work? I think that is what most speakers have asked. How much money is the department investing in this area this year and in the next five years?

Covid-19

Baroness Thornton Excerpts

Wednesday 21st July 2021 Lords Chamber

[Baroness Thornton (Lab) [V]]

I thank the Minister for this discussion on the Statement made on Monday in the Commons. In fact, even since Monday the world has moved on. The infection rate continues to rise. There are mixed messages from government Ministers about responses to the ping. For example, does the Minister share my concern that the Investment Minister, the noble Lord, Lord Grimstone, wrote to the car manufacturer Nissan, pointing out that isolating after being pinged by the app was only “advisory” and that there was no “legal duty” to isolate? I recall the noble Lord explaining this to the House some weeks ago at my prompting. Indeed, many noble Lords came to me afterwards and said that they had not realised that there was no legal obligation to isolate after the ping. There is huge confusion now about vaccine passports, and 1 million children are out of school as their term ends. Here in London, we still have some challenges about getting people vaccinated.

So let us start with the issue of the vaccination of teenagers. The MHRA has approved the Pfizer jab for all 12 to 18 year-olds. Indeed, such countries as the United States, Canada, Israel, France, Austria, Spain, Hong Kong and others have started or soon will be vaccinating their 12 to 18 year-olds. Can the Minister tell us when we might start doing the same?

The Prime Minister obviously took fright on Monday, because on Tuesday he made the announcements about vaccine passports in September. I think that even he could see that nightclubs were offering superspreader events, with music and strobe lights attached to them—talk about closing the door after the horse has bolted.

The risk of death to children from Covid is mercifully very low, but they can become very sick and develop long-term conditions and long Covid. Indeed, according to the Office for National Statistics, 14.5% of children aged 12 to 16 have symptoms lasting longer than five weeks. Will the Minister spell out in detail the clinical basis for why the JCVI has made its decision? Will he publish all the analysis and documents in the same way that SAGE has published its analysis, not just its advice? Will he guarantee that this decision was made on medical grounds, not on the grounds of vaccine supply?

The Statement talks about infection among children being disruptive. We know that infection among children is highly disruptive for learning. We have seen hundreds of thousands of children out of school. We are not vaccinating all adolescents. Can the Minister tell the House what the Government’s plan for September is, when children return to school? For example, are the Government considering using this summer to install air filtration units in every classroom in every school?

Testing is already stretched, with turnaround times lengthening, so can the Minister guarantee that through the summer, especially once contacts can be released from isolation on the back of a negative PCR test in August, and into September when schools return, there will be sufficient PCR testing capacity to meet demand? As we move into autumn and winter, we can anticipate more flu and respiratory viruses, so do we need multi-pathogen testing going forward? Is this being developed?

It has been announced that critical workers such as food, health, utility and border staff with two Covid jabs will be able to avoid self-isolation. Many ambulance and acute hospital trusts have found themselves under extreme pressure because of the combination of very high demand and very high levels of staff absence due to self-isolation.

Three weeks ago, the Health Secretary told us that unlocking would make us “healthier” and promised us it would be “irreversible”, but today we have some of the highest infection rates in the world. Can the Minister tell us what the experts say about the risk of reimposing new restrictions in future? Our already exhausted NHS staff face a summer crisis. Covid admissions are already running at about 550 a day, and hospitals are now all cancelling cancer surgery. For example, liver transplant operations were cancelled in Birmingham last week.

It is clear that more infections mean more isolation. The NHS staff released from isolation if double-jabbed will still want to protect themselves and their patients, so will the Minister ensure that the standard of masks worn in NHS settings is upgraded to the FFP3 requirement that NHS staff have called for? What is his plan for keeping the economy and public services functioning through the summer, as more and more people are asked to isolate? Can the Minister confirm reports that SAGE scientists have advised that some measures, such as mandatory masks and working from home, should be reinstated at the beginning of August?

Recent days have seen some of the lowest numbers getting first-time jabs on record, with the daily average now lower than at any point since the start of the programme—although I suspect the Prime Minister is hoping that his threat that you will need a vaccine passport to get into a nightclub might help in that direction. Unused vaccine doses are being sent back by GPs as demand for jabs slows to a fraction of recent levels, yet we still have millions of unvaccinated adults. Does the Minister share my concern that falling demand, combined with emerging evidence of the effectiveness of vaccines beginning to wane over time, may mean that we in this country will be less protected in September?

Finally, I understand that the “hands, face, space” slogan is about to be dropped in favour of a plea to “Keep life moving”, despite the fact that hundreds of thousands of people are still isolating. Can the Minister explain what this actually means?

[Baroness Brinton (LD) [V]]

I thank the noble Lord, Lord Bethell, and the noble Baroness, Lady Penn, their officials and all staff in the Lords, the Whips’ Office and the health team, as well as Members, for their extraordinary work this year on Covid-related business—mostly emergency Statements and statutory instruments. From these Benches, we particularly wish the noble Baroness, Lady Penn, a safe delivery and a happy maternity leave.

The Statement talks about enjoying “new experiences” following the lifting of lockdown and safely slowing the spread of this deadly virus, but 48 hours is a long time in politics, as evidenced by the difficulties of taking this Statement two days after it was delivered. So much has happened, much of it demonstrating that this Government are still struggling to get a grip on keeping people safe from this deadly virus.

The phrase in the Statement:

“We are cautiously easing restrictions”


is the most extraordinary thing to say, given all the rhetoric about freedom day—and it is wrong. All restrictions have been lifted—no mandatory face masks—and young people have understandably taken their lead from Ministers. There are videos of young people deservedly enjoying themselves in nightclubs in the knowledge that the Prime Minister has declared it safe to do so, yet hidden in this Statement is the bizarre announcement that in two months’ time only those who are double-jabbed will be able to go to such crowded venues, thus delivering Covid ID cards by the back door. Once again our young people, who have had to bear much of the brunt of lockdown life, are the ones targeted by this Government.

That little phrase caused chaos on Tuesday morning. Paul Scully was not clear about which other large venues might be included—for example, pubs with performance dance venues, large or small. He thought so. Two hours later, No. 10 contradicted that: no pubs. Can the Minister tell me what is the difference between a pub with a large dance venue of, say, 500, and a nightclub that can have up to 400 people and why one will require everyone to be double-jabbed but the other will not? I am really struggling to understand the difference. Perhaps the Minister can point your Lordships’ House at a safety document that sets out what the risks are for these different venues and why it is appropriate to ignore lateral flow tests and only go on double vaccination when we know that people can still get Covid after they have been double-jabbed.

The Statement is right to praise the progress of the vaccination scheme, although there is some considerable way to go, including awaiting the data on whether the booster jab can be given at the same time as the flu jab in the autumn. What plans are in place to provide support for GPs if the jabs cannot be given at the same time? We all know that the annual flu vaccine date requires a very large amount of administration by medical and admin staff alike.

The Statement says that JCVI has decided not to vaccinate all 12 to 17 year-olds yet but is keeping it under review. I too refer to today’s ONS data that was referred to by the noble Baroness, Lady Thornton, demonstrating underlying illnesses and a greater prevalence of long Covid among the young than among older people. I thank the Minister for the helpful briefing on Monday, but I remain concerned that with up to 1 million children out of school now it has been clear that the alternative to vaccinating secondary-age pupils appears to be allowing Covid to rip through our schools. We all want our children back in school in the autumn, so what are the Government going to do about that? It is good that the Government are finally allowing the children most vulnerable to Covid to receive the vaccine because they deserve protection and that those children with an immunocompromised or immunosuppressed adult in their home will also finally be able to be vaccinated. That is good.

This Statement also refers to the regulations debated in your Lordships’ House last night, and I hope the Minister has taken away the many concerns expressed by all sides of the House. The Statement refers to tradespeople, such as plumbers and hairdressers, who will also have to be doubled-jabbed to gain entry into a care home. I have two questions about these non-staff members. I am happy to receive a reply by correspondence if the Minister does not have immediate answers. First, if the registered person is not on the premises when an outside worker comes in, can another member of staff admit them and make the decision about their vaccination status? What does that do to the registered person’s responsibilities? If a plumber comes out of office hours to, say, mend a burst pipe and the registered person is not there, must they be turned away? Secondly, care homes are already reporting that some contractors are heavily ramping up the rates for care homes for their staff who have been double-jabbed. Did the hurried and inadequate impact statement published on Monday include the cost to homes of this outrageous practice, and will the Government issue guidance that it should be stopped immediately? Can the Minister say when the detail of how this is all going to work in practice will be published?

The Statement refers to the fact that we must be pragmatic about how we manage the risks we face, yet the past two days have been full of contradictions from the Prime Minister and other Ministers about the need to self-isolate when people are pinged. It has taken journalists to reveal that the only legal responsibility to self-isolate is when called by track and trace, but after the embarrassing U-turns on Sunday morning of the Prime Minister and the Chancellor about not self-isolating, the PM is confidently saying “You must self-isolate once pinged”. Apart from the irony of that statement, given his behaviour, once again we have Ministers not seeming to understand the difference between advice to people—moral guidance, perhaps— versus the reality of a chaotic series of SIs that confuse not just the police, the public and Parliament but the very Ministers responsible for them.

With a further 44,000 new cases today, making us world-beating in one league table no one wants to head, a further 73 deaths and millions of people being pinged and everything in chaos, I fear we are in for a long and difficult summer.

Medical Devices (Coronavirus Test Device Approvals) (Amendment) Regulations 2021

Baroness Thornton Excerpts

Tuesday 20th July 2021 Lords Chamber

Moved by

[Baroness Thornton]

At the end to insert “that this House welcomes that the draft Medical Devices (Coronavirus Test Device Approvals) (Amendment) Regulations 2021 introduce a quality approval process for all COVID-19 tests sold in the UK; but regrets that the regulations assume a change in policy by not making guaranteed provision for the continuation of free NHS COVID-19 tests and will therefore rely on private sector testing for which fees are charged; further regrets that private sector tests do not appear to be integrated with the NHS test and trace system, including legal requirements to report and self-isolate; notes with concern that Her Majesty’s Government have previously stated that regular testing is an essential part of the easing of coronavirus restrictions; and calls on Her Majesty’s Government to guarantee that reliable, high-quality, free NHS tests remain available to all beyond 19 July to support the effective management of COVID-19.”

[Baroness Thornton (Lab)]

My Lords, noble Lords who have read the record of the debate on this SI in Grand Committee will not be surprised that this regret amendment has been brought to the House today, given the Minister’s inability to answer the questions posed by noble Lords or indeed to reassure us over our concerns. Since then, we have had a weekend of further chaos on testing, tracing and isolating, which we will discuss tomorrow when the House takes the latest Statement on the matter. I understand that it is the 49th such Statement; it is certainly the 49th in the Commons.

For complete clarity, as the amendment states, I say that we on these Benches are in favour of guaranteeing and improving the quality of Covid tests. We also recognise that the private sector has a role to play in providing tests for those who wish to travel abroad on holiday and for business purposes. My amendment highlights the issues that were of concern to the Grand Committee and which prompted many questions, based not least on the excellent report from the SLSC, that I am afraid went unanswered.

I thank the Minister for his letter yesterday, which provided much-needed clarity on some of the issues raised and contained the kind of details that would have been helpful in last week’s debate. These regulations are not being introduced with the urgency characteristic of previous points in the pandemic, and they must be introduced and debated in a considered fashion.

This is a public health pandemic and surely no barrier, particularly a financial one, must be put in place that hinders testing and tracing, yet there has been deep unease that lateral flow tests were guaranteed to be free only until the end of July and that people could subsequently be charged under plans being considered by the Government. The Minister’s letter includes welcome confirmation that free NHS tests and universal testing will continue until the end of September. That raises the question of why the Minister could not give us that answer last week in Grand Committee. He should have been well prepared for it given the public interest, media reports and indeed the SLSC report on this instrument, which specifically raised concerns about changing policy and recommended that free testing continue. Can he confirm when that decision was made and when it will next be reviewed?

The noble Lord, Lord Scriven, asked some thoughtful questions about the supply of tests and their reliability. He asked the Minister to explain the Government’s intention on charging for tests, particularly for employers who want to institute testing regimes to bring their staff back into their premises and to protect the public and their customers while doing so. He eloquently made the point that businesses have lost significant revenue over the last week and have asked whether it is right to expect them to meet further costs at this stage. Since April, companies have been able to order rapid lateral flow tests for their workers. While we now know that individuals can still claim free tests through the NHS, at least until the end of September, there seems to be confusion as to whether the scheme for companies has closed. The Government’s website says the cut off for new orders was 19 July—the UK Government’s freedom day in England—as the requirement for masks and social distancing ended. Can the Minister confirm whether the scheme for businesses will also run until September? Does he agree that responsible employers who are ensuring their workers are regularly undertaking lateral flow tests should be congratulated on their approach rather than suddenly being asked to source tests from a private provider, which would dramatically increase costs?

My noble friend Lord Rooker, the noble Lord, Lord Moynihan, and the noble Lord, Lord Lansley, all raised the issue of the missing impact assessment, which the Explanatory Memorandum said would be published in time for the parliamentary debate, which was on Monday 12 July. Again, the Minister failed to answer this question during Committee, but his letter of 19 July reveals that the impact assessment has been red-rated by the independent Regulatory Policy Committee and withheld. Noble Lords will be aware that red-rated impact assessments are deemed not fit for purpose. This is deeply concerning. In his letter, the Minister further committed to publishing the impact assessment as it currently stands and a supporting statement “shortly”, and therefore before the parliamentary vote, following the opinion of the RPC, outlining the areas where further improvements can be made. Here we are, over a week later, about to vote—possibly—yet this important documentation has still not been published. Can the Minister explain why this has not happened, despite his assurance? Where does the buck stop for this latest failing?

Finally, the noble Lord, Lord Scriven, and I are very concerned about the seeming lack of link between test and trace and the proposed new private testing regime. While the noble Lord’s letter to me notes that it is

“vital that we introduce a regulatory regime to ensure COVID-19 tests available on the market are of sufficient quality and produce accurate results”,

it does not offer assurance in detail about how this regime and the NHS Test and Trace will work together to provide a comprehensive safe regime that the UK can depend upon. I sincerely hope that the Minister can provide some much-needed clarity.

There are many matters to regret here: the impact, or lack of it, the policy changes, the process and the timeliness. This was not an urgent matter, the Minister said. It could have been done over a month or so, and it would have definitely benefited from that. I beg to move.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very glad to support my noble friend in her Motion. I want to put two points to the Minister. The context of this SI is the poor quality of many tests. Paragraph 7.2 of the Explanatory Memorandum makes the point that, during public procurement of lateral flow tests for the NHS,

“only 25% passed through all stages of validation including assessments of performance and quality standards.”

That is a pretty shocking statistic. Can I take it that most of these tests came from China? We had an Oral Question on this from the noble Lord, Lord Alton, only a few minutes ago. That being so, can the Minister assure me that Uighur slave labour in Xinjiang was not used in the manufacture of those tests?

--- Later in debate ---

[Lord Bethell (Con) [V]]

My Lords, I thank the noble Baroness, Lady Thornton, for her support for the regulations in the round, for her supportive words about the role of the private sector in the round and for raising many important points in her amendment to the Motion, stressing the vital role of NHS testing as we continue to manage the pandemic.

I want to clarify that these regulations are not connected to the future of free NHS testing. This SI, as noble Lords have noted, is solely focused on ensuring the quality of any Covid test in the UK and that they are of the same standards as I would procure for the NHS.

It is self-evident that poor-quality tests, when used privately, could pose a risk to the health of not only the individual but the public. All that is necessary for entry of Covid test products into the UK market is controlled by EU CE marking, which, as noble Lords noted, is currently a self-declaration process for most Covid-19 tests on the UK market. The performance declaration made as part of this EU marking does not need to be independently verified ahead of sale of such tests. There is no legally binding agreed process for establishing performance. That just is not good enough. It became clear as I sought to procure tests at scale for the national effort that many kits that had passed a CE mark were not fit for the real world. I say to the noble Lord, Lord Hunt, that it is not right that the quality of tests correlated to any particular nation; this applied to all nations.

I say to the noble Lord, Lord Alton, that we have audited the supplies of medical devices and there are no current slavery or human rights concerns. We do, however, remain vigilant. I regret that his question on sourcing has not been answered, particularly because there is a very large amount of public material on the procurement framework, the suppliers to it and the arrangements we make to run that framework. I will address that gap with speed, and with regret.

I reassure the noble Lord, Lord Scriven, that there is a very large amount of published material on the internet on the validation of tests, including the protocols and the results from Oxford University and Porton Down, which conducted the validation of the tests. These validation protocols have been assessed by a very large number of experts, and I would be glad to send him links to the protocols and the assessment processes. I reassure him that our tests have been tested against alpha, beta, gamma and delta variants and successfully detect all of them.

The noble Lord, Lord Alton, referenced “kickbacks” to the Communist Party. I very kindly and respectfully ask him to remember that British officials have operated a remarkable procurement programme during the pandemic at the very highest standards of integrity. I gently ask him to provide evidence for such accusations before making them in the House.

To the question of why we buy so many tests from China and not from Britain, the simple answer is that they pass our protocol and meet the requirements of the procurement framework regarding quantity, speed and product design, for example. We buy them to ensure a good deal for taxpayers and effective tests for the public.

I completely agree with the noble Lord, Lord Hunt, that we need a strong UK manufacturing base. I reassure the noble Lords, Lord Alton and Lord Scriven, and others who have raised this point that we have a major programme on this, with subsidies, expertise and support available. I would be glad to arrange a briefing session to run noble Lords through all the measures we have in place to support the UK diagnostics industry. I believe the high-quality regulations we are discussing today provide the certainty business and investors need to invest in the UK diagnostic system. We need this market to provide additional capacity at the time of the pandemic, to ensure that we have outstanding testing capability while also encouraging innovation.

I was keen to take an evidence-based approach to developing this policy, so we ran a very successful consultation that had a broad range of respondents. Some 73% agreed that mandatory validation of tests prior to entry to the market was the best approach; 88% of those agreed that this should be legally backed; 71% agreed that a validation process would not significantly reduce supply; and 79% agreed that mandatory validation processes will increase safety.

In April this year we launched the universal testing offer, so now anyone in England can access free LFD self-tests by ordering online or collecting then at over 9,000 pharmacies across the country. To reassure the noble Baroness and all noble Lords concerned about this, our recently published road map out of lockdown made it clear that we are keeping in place key protections, including free testing for people with symptoms, but we are standing down the workplace testing regime, as the noble Baroness, Lady Thornton, rightly pointed out, from 19 July.

On the rationale for regulation, I welcome the support of the noble Baroness, Lady Thornton, for NHS tests, which have always been of the highest standard. The objective of the legislation is to ensure that the same high standards for tests that we see upheld when the Government buy them are equally reflected in the testing market for all consumers. That market already exists in this country; over 1,000 providers are already going through the UKAS accreditation process. These tests are being used to enable activity across many areas of the economy, including travel, film, TV production and sport. It is critical that we put in place processes to ensure that these tests are high quality and accurate: that is what this law does.

On the integration of private tests and the NHS test and trace system, I reassure the noble Lord, Lord Scriven, and the noble Baroness, Lady Thornton, that significant work has already successfully linked private sector testing results with the NHS Covid app, the JBC and test and trace. When a test is conducted by a testing provider, whether public or private, the result of that test, whatever the outcome, is legally required to be reported to PHE as a notifiable disease by the provider. To the noble Lord, Lord Scriven: this is true for a private test or a public test, and I would be glad to send him a copy of the long-standing regulations that make this law. This must be done within 24 hours for all positive tests. Any self-administered test provided by the Government can be reported via our online portal by members of the public. Any positive test reported to PHE will be passed on to our contact tracing system.

The draft impact assessment has now been published in the interest of transparency, as has an impact statement. It is a living document, and we want to make the best analysis available. We intend to update the impact assessment and address the RPC’s comments ahead of the introduction of the second SI in the autumn. I would like to put on record my thanks to the RPC for working so closely with us and at such pace on this matter.

I want to ensure that all tests are available in the UK, whether they are offered by the NHS, a charity or a private provider, and whether they are supplied by a British diagnostic firm or an overseas firm. I thank the noble Baroness for giving me this opportunity to respond to her important points. I beg to move.

[Baroness Thornton (Lab)]

My Lords, I start by thanking the Minister. I feel for the Minister, and I wish him well in his self-isolation, and I congratulate him on his immediate and unfussy decision to obey the ping and the trace system. I hope he is going to have a great summer, because I think he has earned it.

I thank the noble Lords, Lord Hunt, Lord Alton and Lord Scriven, for their support and the questions they have asked. I apologise to the House that we did not put this amendment down in the first place. It should have come straight to the floor of the House rather than going through the Grand Committee first. It was only the gathering concern in Committee that led me and other noble Lords to the conclusion that we needed further discussion about this.

It is not up to the noble Lord, Lord Alton, to prove the veracity of the sources of any goods we purchase through the NHS or anywhere else. If it is being bought by the Government, it is up to the Government to demonstrate that those supply lines are not exploitative and do not use slave labour. That is part of the transparency we are calling for. I do not think the Minister answered very well on that matter.

I am concerned that workplaces, as I suspected, will now have to pay for the testing regime we have. I am somewhat reassured by the noble Lord assuring us that tests have to be fed in through the test and trace system wherever they happen, but I am concerned that, given that workplaces will now have to purchase all those tests, the system will break down quite quickly over the summer. We still have many questions and regrets, so I wish to test the opinion of the House.

Organ Tourism and Cadavers on Display Bill [HL]

Baroness Thornton Excerpts

2nd reading
Friday 16th July 2021 Lords Chamber

[Baroness Thornton (Lab)]

The noble Baroness, Lady Brinton, made a very important point about our history in this country and how we have had to resolve these issues over many years. I very much welcome the comments of the noble Lords, Lord Ribeiro and Lord Moynihan, on that matter.

I start by congratulating my noble friend Lord Hunt on bringing this Private Member’s Bill before the House today and on all the work that he and other noble Lords have done. This issue has truly been a good example of the House of Lords working as one to solve what we think is a serious problem and a gap in the law. I am honoured to deal with this from the Front Bench on behalf of the Labour Party today.

I intend to speak mostly about the section of the Bill which addresses cadavers on display. My own personal view, which the people involved in this issue will know, is that exhibitions such as “Real Bodies” should be banned completely, as they are in France. Over 10 years ago, a French judge ruled to shut down a Paris exhibition of real human bodies from China, saying that exhibiting dead bodies for profit is a

“violation of the respect owed to them”.

I hate to repeat what I said in the House in 2019, when my noble friend Lord Hunt, brought an Oral Question, in February. But I said then that there was a

“much more fundamental ethical issue at play here. Leaving aside the need for cadavers and human tissue for scientific and medical training purposes”

and research, which I completely and utterly understand but which we regulate in this country through the Human Tissue Authority,

“it seems likely that all the exhibitions which use plasticised cadavers and foetuses for supposedly educational purposes could use modern materials and production to create the same exhibits. That begs the question: why use cadavers and human body parts at all? If the answer is that people want to see such things and will pay to do so, I remind noble Lords that people used to flock in their thousands to see public executions until 1868.”

There is an echo of what the noble Baroness, Lady Finlay, said about this issue. I went on to say

“Does the HTA exist to regulate what, in this case, is akin to ghoulish curiosity and its manifestations? What is the ethical position and who should be examining it?”—[Official Report, 27/2/19; cols. 228-9.]

Those were the questions that I asked in 2019.

A series of “Body Worlds” anatomical exhibitions has toured many countries worldwide, sometimes raising controversies about the sourcing and display of actual human corpses and body parts. Gunther von Hagens, the inventor and initiator, maintains that all human specimens were obtained with the full knowledge and consent of the donors before they died, but this has never been independently verified. In 2004, von Hagens returned seven corpses to China because they showed evidence of being executed prisoners. In 2002, two Russian doctors from the University of Novosibirsk were charged with illegally supplying von Hagens with 56 bodies, including convicts, homeless people and mentally ill people, without any consent from their relatives. Gunther von Hagens said that none of the body parts were used in the “Body Worlds” exhibitions, but I have to say that that raises doubts and scepticism, unsurprisingly.

Consent is not regulated worldwide according to the same ethical standards, which indeed raises concerns. Paperwork is separated from the bodies, which can be used for displays or sold in pieces to medical schools. No one will know for sure, because each plastinated corpse is made anonymous to protect its privacy. Hans-Martin Sass, a philosophy professor with a speciality in ethics, was hired by the California Science Center to investigate “Body Worlds” before the show’s US debut in 2004. He matched 200 donation forms to death certificates, but he could not match the paperwork to specific bodies that von Hagens has on display.

There is a gap in the law in the world, but there is also a gap in the law for the Human Tissue Authority. Like many noble Lords, I welcome the fact that the noble Baroness, Lady Penn, said that the Government would look to strengthen the HTA, which does not have the powers to deal with imported human material. We have to address this—and from these Benches we support this Bill wholeheartedly and hope the Government will do the same and that we will see it rapidly on the statute book.

Covid-19

Baroness Thornton Excerpts

Thursday 15th July 2021 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for taking this Statement, although I have to say—and I know this is not in his gift—that Monday to Thursday is probably too long a gap, but taking the Statement today might in this case prove useful because we have seen the reaction to the nearing of so-called freedom day, nationally and internationally. We have also seen the Government becoming progressively more cautious. That is not surprising because in England 42,000 Covid infections and 49 more deaths were recorded yesterday, hospital admissions have increased to more than 500 a day, up 50% on last week, and we now see routine operations being postponed and cancelled.

The NHS is rightly focused on waiting lists, which are at their highest level over the past decade at 5.3 million, and 336,733 people have been waiting more than a year, more than 76,000 have waited for at least 18 months and more than 7,000 have been waiting for two years. Emergency care is grappling with some of the highest summer demand ever, and this is in the context of NHS staff being exhausted and facing burnout. The NHS is also losing a significant number of staff to self-isolation, which has led to much reduced capacity due to infection control. As infection rates get worse and increase, what is the Government’s plan to deal with this situation?

Since Monday we have seen an increasing number of announcements and questions about how to safeguard against further increases in infection and the impact it is having on our NHS, schools, businesses and communities. Indeed, our own Lord Speaker wrote:

“Members are still expected to wear a face covering both in the Chamber, in indoor crowded spaces and when moving around the Estate, in line with general advice from Public Health England and the Chief Medical Officer. Members are strongly encouraged to use the testing facilities provided.”


On these Benches we intend to follow that advice, and I regret that some Members have already abandoned their masks when moving around the building and in the Chamber. We have staff to look after us who may not yet be fully vaccinated and, anyway, have no choice but to be here and who will continue to wear their masks to protect us. We should afford them the same consideration. Does the Minister agree?

On the “Today” programme a few days ago Professor Graham Medley, the chief modeller for the SAGE committee said: “Wearing face masks is worth it but only if everyone does it, not just 70%. I understand the Government’s reluctance to actually mandate it. On the other hand, if it is not mandated, it probably won’t do any good.” In other words, my understanding is that unless more than 70% wear masks, the protection for those who are still vulnerable will not work.

I fear we have been here before, with the Government back-pedalling and, in doing so, creating confusion and ambiguity—exactly the circumstances for the virus to thrive and mutate. The guidance issued by Ministers yesterday was stronger than businesses expected, many of which feel that they have been led astray, given the Government’s repeated characterisation of 19 July as “freedom day” and the end of most restrictions. The truth is that the guidance is hardly different from the current rules, except that businesses are now “encouraged” to keep many of their Covid adaptations rather than required to do so. Businesses now have just five days to decide how to implement the rules and how to communicate that to their customers. Does the Minister accept that the Government’s mixed messages have left many in legal limbo?

The new guidance gives little clarity to the 3.8 million extremely vulnerable people who are being told to avoid all unvaccinated people. How are they supposed to know whether or not someone is vaccinated? Does the Minister share the concerns raised by charities and patient groups that guidance has effectively told the extremely vulnerable to shield, without backing that up with any formal support from the Government for working or food shopping? Government advice to the clinically extremely vulnerable is to go to the shops at quieter times of the day after 19 July. I am not sure if that can be dignified as “support” for those most at risk of serious illness from Covid-19.

Is it true that the Government have not had anyone in post to deal with the clinically extremely vulnerable for three months, since Dr Jenny Harries was appointed chief executive of the UK Health Security Agency? If that is true, it is deeply concerning and it may explain why the Government have failed to prioritise support for these 3.8 million people.

What are the contingency plans for surging hospital admissions, which may remain high until the end of August, as called for by members of SAGE? The new guidance also says that businesses should encourage customers to check-in using the NHS app or otherwise leave their contact details. Can the Minister confirm reports that plans to reduce the sensitivity of NHS contact tracing have been reduced because of the surge in cases? What assessment have the Government made of the effectiveness of the app as an infection control tool, given reports that more than 20% of adults and a significantly greater proportion of young people have actually now deleted the app and many more are ignoring the advice to self-isolate?

I turn to those working from home. Despite the lifting of guidance to work from home, the Government say they expect and recommend a gradual return to offices. This is very confusing. What protection is proposed for those who are vulnerable, and for whom “freedom day” is not freedom day but a further lockdown day? If their employers demand that they return to work, even if they are immunosuppressed, for example, travel and enclosed places pose a threat to them. Under these circumstances, we need to be grateful for the good sense of the Mayor of London in following the science. Sadiq Khan has said that Transport for London will continue to enforce the wearing of face masks on services in the capital beyond 19 July.

While industry bodies said on Tuesday that no domestic train operators or major bus and coach firms will require customers to wear masks, the city mayors and others are calling for mask wearing on all public transport. Does the Minister agree with them? If Tracy Brabin, Andy Burnham and the other mayors had the power to enforce mask wearing to protect drivers and passengers, they would do so. They are doing the Government’s job for them.

What support are the Government going to give those areas with the lowest vaccination rates? Local authorities in London have, variously, 35%, 36% and 42% of their populations vaccinated. Does the Minister support the leaders of those authorities who say that they wish mask wearing to continue until they have got their populations caught up with vaccination?

[Baroness Brinton (LD) [V]]

My Lords, the Prime Minister told us 10 days ago that we were heading for “freedom day” and that all the data was going in the right direction; all restrictions would be lifted, and now was the time to take personal responsibility for our behaviour and for the Government essentially to step back. The Secretary of State’s Statement on Monday confirmed that, although with a marginally more cautious note about taking care. I echo particularly the comments made just now by the noble Baroness, Lady Thornton, about the mixed messaging in the new guidance for business and on returning to work, which conflicts with what was said both in the Statement and by the Prime Minister.

However, since the Prime Minister’s and Mr Javid’s confident assertions on Monday, there has been an outpouring of disbelief from senior scientists and doctors. Cases are currently doubling every nine days, and yesterday there were 42,000 new daily cases—a level last seen at the beginning of the January total lockdown. If there is no slowing of that doubling rate, we will have hit 100,000 new daily cases by the beginning of August. And that is before the Government’s expected extra cases as a result of “freedom day” on Monday.

Ministers constantly say that there are fewer people in hospital, that fewer people need ventilation and there are fewer deaths, but what they do not mention is that those numbers are a matter of ratios, and that with the current level of cases our hospitals are already reporting A&Es with the equivalent of a winter surge and more wards being turned into Covid wards for patients. A letter published a few days ago in the BMJ, initially signed by 1,000 doctors, is at over 7,000 signatures and still rising. The data is already clear that the surge in new cases from three weeks ago is increasing hospital admissions right now. So what are the Government doing to support and protect our NHS from this sharp increase and pressure on doctors, nurses and hospitals right now?

While many people are being responsible, still following the guidance and using their face masks, sadly there are many who are not. I was talking to a young security guard who told me that, this week, she is finding it impossible to persuade people to put masks on in their local shopping mall, despite the fact that the rules are still in place. Yesterday, my local community pharmacist told me in despair that two people arrived separately asking him for PCR tests as they each had Covid symptoms and thought all the previous rules had just finished. Not for the first time, much of this is about the Prime Minister’s muddled communication style. In the light of the fact that Scotland, Wales and Northern Ireland are going to retain the face mask mandate, and that the metro mayors, including Sadiq Khan and Andy Street, would like to do so, will the Government please reverse the lifting of the face mask mandate immediately, so that it remains in place, especially on public transport?

I turn to the new guidance for the clinically extremely vulnerable. I have to say that I have never read such an inconsistent and contradictory formal guidance note from the Government—and I have read a few. You should stay at home to be safe but if you cannot work from home, go in; you must remain socially distanced from everyone outside your bubble, even if they do not have to; you must not mix with unvaccinated people, outside or inside. I ask the Minister to tell me how on earth you know who is unvaccinated. As one of the CEV, do I stand in the doorway at opening time at my local greengrocer’s—a quiet time—and shout out to any customers and staff, “Anyone not vaccinated in here”? Of course not. The inevitable logic of this is the restart of shielding but without any of the previous support.

Worst of all, on Friday evening Public Health England put out a press release in which it mixed up advice to the clinically vulnerable and the clinically extremely vulnerable by citing vaccine efficiency research relating to the former in advice to the latter. That paragraph has been repeated in the formal guidance published on Monday. It is plain wrong. In a total administrative muddle, no one has gone through the nine pages of this guidance and updated it, so it is littered with references to the need to follow other rules and guidance for the general public in place at 17 May and 21 June, all of which goes next Monday. Please will the Minister ensure that the guidance is reviewed immediately to remove these anomalies?

All this, and the lack of answers to my questions last week about who the clinical lead is on the clinically extremely vulnerable, tells us 3.8 million former shielders that we have been not just forgotten but thrown to the wolves. Please will the Government actually review the guidance to keep the CEV group safe and provide the support that they need?

I also gave the Minister notice of the following two questions, as they both concern urgent and slightly unusual elements of lifting restrictions. First, for a couple of weeks now, Malta has said that it will not accept UK citizens who have received particular batches of the AZ vaccine manufactured in India, about 5 million doses of which have been given in the UK. Earlier this month, the Prime Minister reassured the press, saying:

“I am very confident that it will not prove to be a problem.”


However, holidaymakers are being turned away from Malta right now. When will the Government resolve this problem?

Secondly, those thousands of wonderful people who came forward to take part in the AstraZeneca clinical trials have been told that their vaccine status cannot be put on the NHS app, which means that they cannot go abroad, either to work or on holiday, or do certain jobs in the NHS that require this evidence. In early June, there was a blog on the BMJ website that set out these problems, but three months on from this issue being initially raised, there is still no resolution. It is utterly wrong that these publicly-minded people have now been left in limbo. Can the Minister say when this problem will be resolved and their vaccine details uploaded?

Medical Devices (Coronavirus Test Device Approvals) (Amendment) Regulations 2021

Baroness Thornton Excerpts

Monday 12th July 2021 Grand Committee

[Baroness Thornton (Lab)]

My Lords, the importance of this SI is underlined by the decision of the Secondary Legislation Scrutiny Committee to draw the regulations to

“the special attention of the House on the grounds that they are politically or legally important and give rise to issues of public policy likely to be of interest to the House.”

The noble Lord, Lord Scriven is quite right: this is not emergency legislation. Here we are, more than a year in. It is not an emergency. However, this is a very important statutory instrument. My noble friend Lord Rooker and the noble Lord, Lord Lansley, have outlined many of the questions that need to be addressed, but I need to put the Minister on notice that, depending on his answer to this debate, I may oppose it here in the Grand Committee and take it to the Floor of the House.

I am very concerned listening to this debate. I was concerned when I made my own notes, and I am even more concerned now listening to other noble Lords. This is not just about the quality of testing; it is about the market of testing, and that is quite different. That is why the Secondary Legislation Scrutiny Committee was concerned about a major change in public policy. Putting a major change in public policy through in Grand Committee under these circumstances is probably not a good idea and does not make for good legislation.

We absolutely support a quality approval process for all Covid-19 tests in the UK. It is important that the new process is rigorous to ensure that all tests, including those for sale, meet the relevant quality standards, especially if such tests are to play a greater role in the long-term management of Covid-19. In the meantime, it is essential that free NHS tests continue to be available. This is all the more important given the rising case numbers and the Government’s insistence on going ahead with the removal of all restrictions, including the legal requirement to wear face coverings on public transport, in a week’s time.

Given the importance of reliable high-quality testing devices for the effective management of Covid-19 in the long term, can the Minister explain why the new validation process was not introduced earlier? Given that the DHSC says that as part of managing Covid in the long term the Government will want to support

“a thriving private sector market for COVID-19 detection tests to supplement and support testing led by NHS Test and Trace”

and to

“encourage the private sector to bring a number of testing products and services to market to meet the differing needs of businesses and individuals”

and provide consumer choice, how will we ensure that all the tests available will meet the minimum performance standards? According to the department, the new quality requirements introduced by this instrument

“will make the UK private testing market more competitive, as manufacturers will need to improve the accuracy and speed of their tests in order to outcompete competitors”.

Can the Minister confirm the timeframe for shifting to a private testing model? How much will these tests cost and who will bear the brunt, employers or employees? Will there be waivers or business support for vulnerable workplaces, including hospitals, care homes and schools, as well as other key workers where frequent testing is key to protecting the vulnerable and often to things such as keeping a school open? Does he agree that it is essential that free NHS tests continue to be available, given the rise in case numbers and the Government’s insistence on going ahead with opening, as I have already said?

I would like to have some more information about the August cut-off point. During the procurement of lateral flow device tests for the NHS, only 25% passed through all stages of validation including the assessment for performance and quality standards under the current regime. The 75% of the LFD tests assessed as not meeting performance or quality standards of the NHS still qualify as fit for market. The DHSC says that rapid intervention is therefore required to address this. Does rapid mean now or a year ago?

Department of Health and Social Care data showed that six out of 10 positive rapid test results at schools between 4 March and 17 March turned out to be wrong. It is therefore legitimate to ask whether the real reason that we are backing away from them is because they do not work for self-testing and do not represent value for money. What is going to happen next? The Minister needs to set out the timescale. Can he confirm that if the third-party approach is to be considered, these contracts will go out for public tender?

Does the Minister share my concern that the department’s explanation appears to suggest that less accurate tests can be of diagnostic value for the NHS if such tests are used by clinicians who are able to consider other factors and information and therefore put any tests into a wider clinical context? Finally, what extra resources will be available to local authority trading standards teams for testing enforcement activities?

Medical Devices (Northern Ireland Protocol) Regulations 2021

Baroness Thornton Excerpts

Monday 12th July 2021 Grand Committee

[Baroness Thornton (Lab)]

I thank the Minister for introducing these regulations and for the opportunity to debate them. This debate takes place in the context of the Northern Ireland protocol, a protocol signed by this Government and now readily disowned by the very people who agreed to it. When the noble Lord, Lord Frost, says that it is not right to view the protocol as a definitive text, that does not reflect well on our country, its Government and the people who signed it at the time, said that it was excellent and denied that it would create a border in the Irish Sea. It is a bit rich of the noble Baroness, Lady Hoey, to protest, given her role in getting us to where we are.

However, I agree with the noble Baroness, Lady Brinton, that this is an attempt to find a way through on the important matter of medical devices. The SI addresses the fact that, although under the Northern Ireland protocol medical devices regulations are fully applied in Northern Ireland, the MHRA remains the Province’s regulator; there therefore needs to be provisions for enforcement, fees et cetera so that those elements of MDR that allow for national decision—such as on the reprocessing of single-use devices, custom-made devices and so on—are consistent across the UK.

What does this mean for people in Northern Ireland? What impact will there be if the EMA and MHRA depart markedly from each other’s regulatory regimes, and what would that mean for businesses? At the moment, you need a CE mark to go to market, as least as long as the Northern Ireland protocol holds. That is potentially advantageous for NI patients versus GB ones, as the vast majority of products will be CE marked and will continue to be so. However, as the ABPI has said, there are 600,000 medical devices approved in the EU and, at the moment, they are all available in Great Britain. Surely the test of the new UK regulations will be how many of them are still available in three, five or 10 years’ time. I hope that the Minister will be able to address those issues.

I seems to me that the final decision concerning the availability of a product would ultimately be a matter for the EU. Is it the case that, for those products authorised under the decentralised procedure by one member state acting as a reference for another member state, the MHRA would be able to suspend the use of a product only if one of the 27 member states had triggered a review of that product?

I have a couple of other points. I could see no mention of in vitro diagnostic medical devices. Will they come as another statutory instrument? I would be grateful if the Minister could clarify that. Can he tell the Committee what plans he has to update the House on a regular basis on the supply and regulation of medicines and medical devices in Northern Ireland to ensure that regulatory alignment and mitigation against adverse consequences are undertaken?

Finally, on enforcement, the instrument will also give the MHRA powers to serve enforcement notices for breaches of the EU MDR. How many people are these enforcement measures expected to affect? Manufacturers will need to take a number of steps to ensure that their goods can still be sold after the 2023 deadline, as noble Lords mentioned. What discussions have the Government had with the sector? Can the Minister confirm that the threshold to obtain the UKCA certification mark will largely be the same as that for the CE mark?

Covid-19 Update

Baroness Thornton Excerpts

Thursday 8th July 2021 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for the Statement today, which takes us further into the discussion that we were having on Tuesday and allows him to address some of the questions that perhaps he was not able to on Tuesday.

We all want our economy to open and get back to normal. The question is whether we do it in a controlled way or a chaotic way. The Health Secretary told the Commons on Tuesday that, under the Government’s plan, infections could go to as high as 100,000 a day. There are some huge issues that the Minister and the Government have failed to address with information and clarity about the massive change in policy contained in the announcements on Monday and Tuesday. The first of these is surely the potential 100,000 infections a day in a few weeks’ time. When I asked on Tuesday about the scientific advice, the Minister gave me what can be described only as a pick-and-mix answer, one in which he said SAGE’s advice was “interesting”. I am sure that SAGE’s advice is always interesting, but is it being taken into account in decision-making as it used to be? I specifically refer him to the most recent SAGE papers, which made it clear that with high infection rates there would be a greater chance of new variants emerging and greater pressure on the NHS. More people will get long Covid and test and trace will be less effective. As NHS Providers said today,

“current pressures on the NHS mean that the predicted rising infection rates for COVID-19 will inevitably affect the speed at which trusts can recover care backlogs.”

I quote Chris Hopson:

“Trust leaders can see the strong logic of ‘if not now, when?’ and they recognise that, as a nation, we must learn to live with COVID-19. But they want the Government to be clear about the risks of relaxing restrictions. This includes the inevitability of higher hospitalisations and mortality, albeit at lower levels than previous waves and the risk of new and more dangerous variants emerging. They are also worried about the impact of long COVID. It’s important these trade offs are clearly set out, including the impact on the NHS’s ability to bear down on the backlog.”


Indeed, a letter from 100 experts in the BMJ today raises the same issues. That is why the impact assessment is so crucial. The Prime Minister seemed to find this impossible to address yesterday, so I would like to see if the Minister with his much greater and closer knowledge of these issues could be more enlightening to the House today. Have the Government undertaken an impact assessment of the projected rate of infection? Yes or no would probably suffice. If it is yes, when will it be shared with Parliament and the public? If it is no, the Minister must explain why this has not happened and tell the House when it might. We need to know what is the number of hospitalisations and deaths; what is the number of people with long Covid, which will be the outcome of 100,000 infections a day; and what is the impact on the NHS, will it slow down the catch-up for diagnostics and treatment and by how much? I am very happy if the Minister wants to email the details of the answers to me, if he does not have them to hand–although he ought and they need to be in the public domain.

We know that the link between infection rates and deaths has been weakened, but it has not been broken. All the experts seem to agree on that. Let us be clear why infection rates are so high: it is because the Prime Minister let in the delta variant. I agree with my right honourable friend Keir Starmer that we might now change its name to the “Johnson variant”. Let us be clear why the number of cases will surge so quickly: it is because the Government are taking all protections off in one go. As my right honourable friends Sir Keir Starmer and Jonathan Ashworth have said, this is reckless.

The next obvious question is the one about the dreaded ping and the huge number of people who will be asked to isolate. If there are 100,000 infections a day, that means hundreds of thousands—perhaps millions —of people are going to be pinged to isolate. The Financial Times estimates that it could be 2 million people and the Daily Mail says it could be 3.5 million people. Either way, it is a massive number. How many people do the Government expect will be asked to isolate if infection rates continue to rise at this rate? Again, this question was asked of the Prime Minister yesterday and he clearly did not know the answer or refused to say, so I will repeat it again: how many people are going to be asked to self-isolate if there are 100,000 or more infections a day?

Does the Minister appreciate that those who are immunocompromised or for whom the vaccine is less effective will have their freedoms curtailed by ditching masks on public transport? Blood Cancer UK warned yesterday that people with blood cancer will feel that their freedoms have been taken away from them. It is quite possible that the 19th will not be freedom day. It might be the day when a record number of people will switch off their NHS app, because they will see coming down the track isolating and cancelling holidays. It is already beginning to happen. Has the Minister seen those stories? We on these Benches do not support that course of action, but does he realise that this could seriously undermine the expensive track and trace system, on which so much depends?

I have to repeat again that the biggest barrier to an effective isolation policy has been not the inconvenience but the lack of financial incentive to stay at home. If we are to live with this virus, the days of people soldiering on when unwell are over. Sick pay is vital to infection control. Will the Government please now fix it?

Business leaders are expressing very serious concerns about the loss of staff and customers. There are now 700,000 children off school per week. At my grand- daughter’s school this morning, two classes were sent home due to two teachers being pinged. After-school sports were cancelled and she is very disappointed. It is happening everywhere, as our amazing head teachers and school staff limp towards the end of term doing everything they can to deliver teaching, joy and normality to our children under the most difficult and often underappreciated circumstances.

The question I want to ask for clarity from the Minister is about the ubiquitous ping. Is the ping advisory for self-isolation or mandatory? If you get an email or phone call, does that trigger mandatory self-isolation? Finally, I ask about data in the last 24 hours or so from Israel’s Ministry of Health, which points to the Pfizer vaccine being just 64% effective at stopping symptomatic and asymptomatic transmission of the delta variant. Can the Minister tell the House about this?

[Baroness Brinton (LD) [V]]

My Lords, one year ago when lockdown was lifted, we had around 1,000 new cases a day. Yesterday it was 32,000 new cases. Equally concerning, cases are doubling every nine days; hospitalisations are going up; ventilation bed occupation is going up; NHS Providers, as the noble Baroness, Lady Thornton, has said, is talking about hospitals moving back into created-Covid wards and managing safe areas. GPs and hospitals are all reporting a worrying large increase in young people with long Covid, putting further pressure on their services, let alone the worries of an epidemic of long-term illness in the working population. Anecdotal evidence suggests that some hospitals are now considering cancelling some staff summer leave. Wonderful as yesterday’s England victory was, the sight of 60,000 fans walking down Wembley Way in very close proximity with hardly a mask in sight was concerning. As with the England-Scotland match, we must expect a surge in cases. Yesterday, the BBC asked Dr Mike Ryan of the World Health Organization about the UK proposals to lift all restrictions on 19 July. He replied:

“The logic of more people being infected is better is, I think, logic that has proven its moral emptiness and epidemiological stupidity”.


The letter in today’s Lancet from 100 senior medics and scientists echoes the WHO view. What are the Government doing to explain to the experts why their strategy is safe?

I will return to the substance of the Statement later, but I start by thanking the Minister for the meeting yesterday with other Peers, Blood Cancer UK and the Anthony Nolan trust to discuss the immunocompromised and the clinically extremely vulnerable. There are over 2 million CEV who had to shield—that is 3% of the population. So, arising from questions I have asked the Minister many times before in your Lordships’ House, I will ask the following. The CEV, of whom I am one, are worried at the total silence to them over recent weeks since shielding ended formally but, with stay-at-home advice still in place, with cases rocketing daily and all restrictions easing, can the Minister explain how advice to them is being co-ordinated publicly by government? One blood cancer patient said today to an APPG of parliamentarians that the dissonance of their safety versus everyone else’s freedom was hard to bear, especially with no advice. In particular, who has clinical responsibility for drawing together the different issues of therapies, responses to vaccines and continuing care for underlying diseases, and which Minister has overall responsibility?

Overnight, there have been some suggestions from journalists that shielding might even return. If so, that needs to be communicated very urgently to those at high risk, who have not been told about their low vaccine antibody rate. They may be planning to mix with people, or perhaps even go on holiday. Will benefit support for the CEV who have to stay at home but cannot work from home be reintroduced? If the Government are serious about the irreversibility of the lifting of all restrictions, some of the CEV will not be able to return to work for weeks, or even months.

I turn to testing. There are reports today that the Government plan to charge for the lateral flow tests from the end of this month. As LFTs are supposed to be the great self-regulators that the Government are relying on, how much are people going to be charged? You do not pay the Government for a blood test to see whether you have picked up any other infection. The level of charging for PCR tests for people returning from abroad also remains a big issue. Last week in your Lordships’ House the noble Baroness, Lady Vere, told my noble friend Lady Ludford that PCR tests could be obtained at a price of £85 for two. My noble friend’s local pharmacy is charging £398 for a test on the same day, or £240 for the next day for two tests. I know other members of the public have reported similar problems. Can the Minister say how the pricing of PCR tests is being managed and, perhaps more importantly, where one can find the “£85 for two” tests?

On Tuesday, I set out what we from these Benches seek in a return to normal life. We want people to return to work as soon as possible, to be able to mix with family and friends and for our children to be able to have consistent access to education without interruption. We also agree that now is the time to start to do some of that but—and it is a big “but”—we cannot get rid of all the safeguards that protect people mixing together while the virus is still live. An effective test, trace and isolate system is essential. This Statement makes it clear that that is being dismantled. Can the Minister explain why that makes any sense?

Last night, Sebastian Payne of the Financial Times reported the re-election of Sir Graham Brady MP as chairman of the 1922 committee, and tweeted:

“Brady’s re-election is … a reminder of why Johnson is dropping masks and nearly all other … restrictions on July 19: ministers privately say the government no longer had the … votes to keep the measures in place. Relying on Labour would have been … difficult for the PM.”


Are the Prime Minister and the so-called Covid Recovery Group now putting health and lives at risk for their own principles?

Finally, with the threat of 100,000 cases by the end of the month, with hospitals saying they are already worried about the increase in patients and with the threat of the new lambda variant and new north-east variant under investigation, please will the Minister confirm that these changes are not irreversible and that the protection of the NHS, and the safety of all the people in this country, remain the Government’s priority?

Women’s Health Outcomes

Baroness Thornton Excerpts

Thursday 8th July 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I declare my interest as the maternity champion for Whittington Health, of which I am a non-executive director. I congratulate the noble Baroness, Lady Jenkin, on bringing forward this debate, which has been of very high quality. Her introduction was both comprehensive and—although I am not sure that I would say Shakespearean —encompassed the whole of life.

I am particularly proud of my nine or 10 noble friends who took part in this debate. My noble friend Lady Massey talked about young women; my noble friend Lord Rooker talked about health inequalities and Marmot; my noble friend Lady Chakrabarti talked about our international responsibilities; my noble friend Lord Hunt talked about heart attacks and discrimination —I will come back to that later—my noble friend Lord Boateng talked about the higher rates of mortality for black people and racial disparities within healthcare; my noble friend Lord Brooke talked about learning the lessons of domestic violence; my noble friends Lord Sikka and Lady Bryan talked about the misdiagnosis of symptoms and inequalities in health; and my noble friend Lord Young talked about single-sex wards. But contributions have come from all sides of the House. I welcome the women’s health strategy consultation: I very much look forward to seeing what comes out of that.

As did the noble Baroness, Lady Jenkin, I want to address the systematic discrimination against women and the gender data gap. She and several other noble Baronesses mentioned Caroline Criado Perez and her work in this area. She said that medical research has traditionally been based around the male body. Indeed, my noble friend Lord Hunt pointed out that women were 50% more likely to be misdiagnosed following a heart attack, but they make up only 25% of the participants across the landmark trials for congestive heart failure. Given that we have a Minister in this House who is very enthusiastic and keen about data and its use and all those things, this issue is very important.

Most medical trials are done on male cells; even female cells react differently. For millennia, medicine has functioned on the assumption that male bodies represent humanity as a whole. As a result, we have a huge historical data gap when it comes to female bodies. That means that women will be dying when they do not need to. The medical world is complicit in this and that needs to change. I am pleased that this was referred to in the women’s health strategy. I hope that it is going to be followed up when the strategy comes to fruition after the consultation process.

It is interesting; I learned, for example, that the first production of the Fitbits that we are all so keen on did not include menstrual cycles in their data, so over 50% of the world was not properly recognised. I am assured that that is absolutely no longer the case. The tech world, of course, is designing the future, so we have to acknowledge the need for diversity in that. If tech is designed by white, middle-class men from America, the future might look very nice to them but not for everybody else. Diversity in the teams and ideas is vital. Artificial intelligence that helps doctors with diagnoses and scans, and with conducting job interviews and so on, is vital, but it all depends on the datasets. If those datasets are designed by those white males in America, then we are all—or at least half of us are—in serious trouble. If you tell an algorithm what a heart attack is based on male symptoms, how are we going to make sure that it recognises female symptoms? These are the issues on which I am particularly interested to know the Minister’s thinking.

I turn briefly to women and Covid. We know that Covid-19 did not strike the sexes equally. Globally, for every 10 Covid-19 intensive care unit admissions for women, there were 18 for men. While men over 50 tended to suffer the most acute symptoms of Covid, there is evidence that women seem to be disproportionately affected by long Covid; one study suggested that women outnumber men by as much as four to one. A study led by the University of Glasgow concluded that

“women under 50 are seven times more likely to be breathless and twice as likely to report fatigue than men, seven months after seeking medical assistance for Covid-19.”

Some academics have linked this to the fact that women have a higher lifetime risk of inflammatory immune conditions such as chronic pain, chronic fatigue and autoimmune diseases. Can the Minister assure us that these issues are a standard part of the ongoing research on the effects of Covid?

A key point that came out when the strategy was first announced by the Government was the need to listen to women’s voices. That is absolutely vital. The House has been active in expressing the need for this, particularly in support of the report by the noble Baroness, Lady Cumberlege. We have made significant progress in implementing some of her report and I hope that we will see more of it included and embedded in the forthcoming legislative programme on health and social care.

To conclude, I thank all speakers who have taken part in this debate, and I look forward to the Minister’s speech. We live in a patriarchal and deeply unequal society. Covid has highlighted those inequalities, particularly health inequalities, and it must be said that, since 2010, the noble Baroness’s Government have been guilty of cuts and underfunding across the whole of our health system, which has disproportionately affected the poor—and that means it has disproportionately affected women. I hope that the noble Baroness, Lady Jenkin, and the Minister will agree that having the best possible women’s health strategy in the world will, as it were, butter no parsnips if it is not properly resourced and funded.