Health Protection (Coronavirus, Restrictions) (All Tiers and Self-Isolation) (England) (Amendment) Regulations 2021

Baroness Tyler of Enfield Excerpts

Monday 1st March 2021 Lords Chamber

[Baroness Tyler of Enfield (LD) [V]]

My Lords, these regulations, dealing with the sensitive issue of medical confidentiality and data sharing with the police, are being debated 30 days after they came into force. This has become a regular pattern in our scrutiny and a very unwelcome one, not least in this case because of the centrality of medical privacy to an effective public health system. We all understand the urgency of responding to the pandemic, but democratic accountability should not suffer in the process. When considering these issues, we must surely remember that we are first and foremost dealing with a public health crisis, not a public order crisis, and our responses should be viewed through that lens.

As we have already heard, these regulations were introduced to increase compliance, which I very much support. We know that a small number of people flout the rules—compliance is estimated at about 90%. However, the issue for most people is self-isolation and the support needed to adhere to the rules. Where people can comply, generally they do. Increased support, particularly financial support, is most urgently needed, as my noble friend Lord Scriven so compellingly set out. As the human rights group Liberty has said, supporting people and helping people follow guidance is the best way to keep everyone safe. That must be right. It is worrying that, owing primarily to a lack of support, a study by UCL this January revealed that 38% of respondents said they were not isolating for the recommended number of days when they had developed symptoms, with 13% not isolating at all.

As others have pointed out, these regulations will give the police more ammunition in enforcing the rules, but, in reality, are we clear how much capacity the police have to enforce this? Also, do we know what impact data sharing and increased fines have had on improving isolation rates, and can the Minister supply the House with those figures?

I turn finally to wider issues. Having had my first dose of the vaccine earlier today, I want to thank all involved in the rollout of the vaccination programme. It has been a great success. I pay particular tribute to the volunteers who are doing such a wonderful job at the vaccination centre I attended. However, despite all this, and the much-needed morale boost that the rollout has given the country, this morning’s news of six cases of the Brazil variant comes as a serious blow. Were we not far too late in introducing the new quarantine and testing on arrival requirements? One person who did not even give basic contact details has slipped through the net completely, and this was not picked up by a basic check. Surely that suggests that the system is not working and needs some urgent re-engineering. What assurances can the Minister give us on this absolutely critical matter?

Covid-19: Vaccination Programme

Baroness Tyler of Enfield Excerpts

Wednesday 24th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I recommend that my noble friend and the Daily Telegraph look at the large amount of conditional material that the Prime Minister articulated in his Statement. There were no firm dates. He made it clear that data would drive decisions and he made a lot of his indicative programme remarks reliant on passing the four key tests that he laid out very clearly in his programme.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, at Monday’s Downing Street press conference, Professor Chris Whitty expressed his view that front-line health and care workers had what he termed a “professional responsibility” to get vaccinated to reduce the risk that Covid poses to patients and care home residents. With studies indicating that in many care homes well in excess of 30% of care workers have not yet taken up the vaccine, what plans do the Government have to make getting vaccinated a condition of employment?

[Lord Bethell (Con)]

My Lords, the Chief Medical Officer was entirely right. As the noble Baroness probably knows, there are already important requirements on health care workers who, for instance, do surgery or are in certain risky clinical situations to have the right vaccines, hepatitis being one in particular. Having up-to-date vaccines is a condition of engagement for some medical staff. The noble Baroness is right to raise the question of social care. We are looking at the right policy in that area. We want to tread carefully and to take social care workers with us. We are aware of the risks in social care, but we do not want to provide barriers for employment. Getting that decision right will be one of the most important things that we do.

Covid-19 Vaccines Deployment

Baroness Tyler of Enfield Excerpts

Thursday 11th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, my noble friend is entirely right that there are many mysteries of immunity that we do not fully understand. While we have some strong evidence on the transmissibility of the disease after vaccination, it is not crystal clear. The evidence we have is that it reduces infection by two-thirds, but that still means that a third of people who have the vaccine might get the disease and be able to pass it on. That is an extremely serious risk when the vast majority of the population have not been vaccinated at all. We do not want a situation where a small minority of the population might be spared sickness and death, but a very large amount of the population become infected with a disease that might hospitalise them or lead to other infections. That is why we are cautious. We are also conscious of variants of concern, which remain a potent threat as long as the vaccine has not been rolled out.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, I will press the Minister a little further on the low take-up of the vaccine by some care home staff, which has already been raised by other noble Lords. Recent research from the National Care Forum has shown that some of the significant factors accounting for this low take-up include vaccinators coming to homes with enough vaccines only for residents, and staff being expected to travel to vaccination centres if they are not vaccinated in the home, but not being given time off. Those not on shift when vaccinators come, such as night shift staff, are missed, and some fear having to take unpaid time off if they develop a reaction to the vaccine. Could the Minister say what steps the Government are considering taking to tackle these very specific barriers?

[Lord Bethell (Con)]

My Lords, I do hear the noble Baroness and I would be happy to look into this matter further. However, my understanding is that the vaccination rates among care home staff are much higher than she describes. It is not unusual for care home staff to have their health provided for by the local NHS, and for them to be required to travel to receive that support. That is quite normal for anyone getting a vaccine, even if they work in social care. It is entirely in our interests to make sure that social care staff are vaccinated, so there is no way that there is any kind of policy or deliberate effort to avoid vaccinating care home staff. However, I will be glad to look into this further and, if I may, I will copy the noble Baroness into the correspondence that will clearly result from this debate.

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) Regulations 2021

Baroness Tyler of Enfield Excerpts

Monday 8th February 2021 Grand Committee

[Baroness Tyler of Enfield (LD) [V]]

My Lords, I greatly welcome the speed at which the vaccine programme is rolling out and the boost to morale that it has provided. However, news over the weekend regarding the South African variant makes it clear that we need to be constantly vigilant and prepared to adapt our response. The vaccine is no silver bullet.

I want to focus on the impact of lockdown on the mental health and well-being of both young and old, particularly those living alone who may be socially isolated and for whom lockdown has been especially tough. We have, quite rightly, thought a lot about the impact on families, but, in my view, not thought enough about the impact on those living alone. For many, their mental health has suffered, not least due to anxiety that if they catch the virus they will have no one to look after them and check they are okay. Local community groups, charities and local authorities have played a valuable role, but they are unable to meet all demand.

Reports in the press over the weekend talked of post men and women taking on the role of checking up on the elderly, something that has been trialled in the Channel Islands. I would welcome such a trial on the mainland but was very concerned to hear that people might have to pay for this service. Surely the Government should step in to fund any such scheme, particularly for the less well-off and those living in deprived communities. What plans do the Government have in this area?

Last week, I asked the noble Lord, Lord Bethell, a question about recent scientific findings from Cambridge University showing that one dose of the Pfizer vaccine may not produce sufficient antibodies to kill off the virus, particularly for the over-80s. The scientists involved suggested that rapid antibody tests could be used to identify older people who had responded less well to their initial jab and prioritise them for a speedier second jab. What plans do the Government have to carry out such tests on older people and residents of care homes, who are currently having to wait 12 weeks for their second jab?

Like other noble Lords, I continue to be concerned about reports of care home staff not taking up the offer of a vaccine. While I understand that no one can be compelled to be vaccinated and that education and reassurance are the key, equally care homes have a duty of care towards their residents, including their well-being. I recently heard a union representative say that one reason some care home staff were refusing the vaccine was that they were fearful of having a reaction which would mean they had to take time off work. Surely the Government should be able to underwrite the pay of any care worker in this situation to encourage take-up. Unless action is taken, residents and relatives who have had a vaccination and had time to develop their immunity may still find that they are unable to visit their loved ones, which feels so unfair—a point made powerfully by the noble Baroness, Lady Massey.

The pandemic has put a huge strain on many young people who were already struggling with their mental health due to bereavement, social isolation, a loss of routine because of school closures or a breakdown in support. What plans do the Government have to provide additional funding for the rest of this academic year and the school year beginning in September to allow schools to invest in mental health and well-being support, including school counsellors, but, crucially, without having to divert resources away from academic catch-up funding which the Government have already announced?

This lockdown must be the last. The public would never forgive this Government if, by coming out of lockdown too soon or without a comprehensive strategy to defeat the virus, we once again found ourselves in a full national lockdown.

Covid-19 Update

Baroness Tyler of Enfield Excerpts

Thursday 4th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am not sure whether we are completely stepping back from the production of monoclonal antibodies. I am extremely grateful to the noble Lord for the briefing that he shared with me last month and for the opportunities to look at how we can onshore the manufacturing of monoclonal antibodies. He is entirely right: this is a critical area of life science production where Great Britain is frustratingly massively behind. In the resilience of our healthcare supply chains, we have a huge gap in this country, and it is one that we are keen to address. The Therapeutics Taskforce is looking at monoclonal antibodies as a way of supporting our response to Covid and we have, through Project Defend, a workstream to look at how we can encourage onshore manufacturing of these essential healthcare supplies.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, recent laboratory tests by scientists at Cambridge University show that one dose of the Pfizer vaccine may not produce sufficient antibodies to kill off the virus, particularly for the over-80s, leaving them at risk of catching the South African variant. Will the Minister say what assessment the Government have made of these findings and what plans they have to speed up the second dose of the Pfizer vaccine for the over-80s and all care home residents?

[Lord Bethell (Con)]

My Lords, I am grateful for the reminder from the noble Baroness. The analysis we have done of the Pfizer vaccine, and indeed of all vaccines, is extremely encouraging and the impact it has on the body’s antibody production rate is profound. In fact, for many vaccines it might be that a longer delay, of 12 weeks, to the second dose might have an improved impact on the body. The second dose is really important for longevity rather than for efficacy, and therefore, with the data we have at the moment, we do not have any plans to change the pace of the rollout, but we are making sure in absolute terms that the second dose is delivered to all those who have had a first dose, promptly and on time.

Social Care Funding (EAC Report)

Baroness Tyler of Enfield Excerpts

Thursday 28th January 2021 Grand Committee

[Baroness Tyler of Enfield (LD) [V]]

My Lords, I commend the noble Lord, Lord Forsyth, and his committee on this excellent report, proposing clear recommendations in what is a very complex area. I agree with many of them and underline the strong sentiment that we do not need further reviews, consultation or Green Papers; we need government action now or a White Paper with a clear implementation timescale.

Covid has cast a harsh spotlight on a highly fragmented, fragile and underfunded sector reliant on unpaid carers and piecemeal local arrangements, with care providers going out of business or handing back contracts. Other serious flaws in the system include a widespread lack of awareness that social care is not free at the point of use, underpaid staff with little career progression or professional development—leading to high vacancy rates and turnover—and a postcode lottery which leads to unjustifiable variations between places in access to care and its quality, often depending on a local authority’s ability to raise revenue.

The adult social care winter plan commits to providing free PPE to care homes until after the pandemic. What plans do the Government have to extend this pledge until at least late spring? Despite some short-term injections of government funding since 2017, years of significant underfunding, coupled with rising demands and costs, have combined to push adult social care services to breaking point. The Select Committee report points out that funding for adult social care in 2017 was below 2010 levels. It calls for an immediate injection of £8 million to restore care quality and access to 2010 standards, with free personal care available universally by 2025. I fully support these recommendations.

Any long-term reform must take account of the needs of working-age adults, who account for nearly half of the total social care budget, and unpaid carers as well as older people. Many working-age disabled people do not own their own houses—which, unfortunately, is how this political debate is mainly couched—and have not been able to save for care costs.

When it comes to paying for a new system that includes free personal care as a universal entitlement, it will have to be a partnership of public funding and private contributions by the citizen. Like the noble Lord, Lord Lansley, I believe that we should look for a solution through the prism of intergenerational fairness—a way in which all generations contribute but no one generation feels unfairly burdened. The Select Committee report touches briefly on this issue, which is to be applauded.

However, there is one aspect on which I take a different view from the committee. Rather than our relying primarily on raising the money needed from general taxation, I would like to see a funding solution with some element of hypothecation. I had considerable sympathy with the recommendation of the Barker commission that an additional percentage point of employee national insurance contributions for those aged over 40, raising some £2 billion in total, be earmarked for adult social care. This is similar in concept to the proposal put forward by the Intergenerational Fairness Forum of a new system of social care insurance contributions, at a rate of 1%, from the incomes of all working adults from the age of 40 until they stop working. Looking to the over-65s, as I argued in our debate earlier this week on inter-generational fairness, the case for individuals who continue to work beyond state pension age continuing to make national insurance contributions should also be part of the equation.

The shockingly high number of deaths in care homes in the first wave of the pandemic is a matter of national shame. We owe it to those who died and their families to ensure that a properly funded social care system, providing quality care to all, is a fitting legacy.

Health: Eating Disorders

Baroness Tyler of Enfield Excerpts

Tuesday 19th January 2021 Lords Chamber

[Lord Bethell (Con)]

My noble friend is right to remind us that this is not a gender-specific condition and that many men have eating disorders of one kind or another. The culture we live in does nothing but encourage that and I think we have to address the underlying causes, both psychiatric and the pressure of social media. We will be putting in place the resources necessary to support that kind of initiative.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, NHS Digital has reported that admissions for eating disorders have almost trebled since 2007, but there has been very little investment into in-patient treatments since then. With only 400 NHS beds for adult eating disorder sufferers in England, and capacity currently further reduced by the pandemic, what are the Government doing about this chronic shortage of in-patient beds for those suffering from serious eating disorders, which particularly affect young women?

[Lord Bethell (Con)]

The noble Baroness may not have heard my answer to the previous question, where I cited the large number of beds opened in the last year, totalling more than 30 across the country. I recognise that more beds are needed for those who have particularly acute disease, but the large prevalence of the disease among hundreds of thousands of young girls and boys also means that community care has to be at the heart of our response to this condition.

Mental Health Act Reform

Baroness Tyler of Enfield Excerpts

Monday 18th January 2021 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, the whole House will welcome this White Paper. The overhaul of the Mental Health Act has been long awaited. It is also to be welcomed that the Government have accepted the majority of the recommendations from Sir Simon Wessely’s independent review of the Mental Health Act. As Sir Simon Wessely’s report highlighted, there is a great need for patients to be heard, for their choices to be respected and for them to be supported to get better in the least restrictive way.

Although legislative changes are important, the best way to prevent people being detained under the Mental Health Act is to prevent them reaching a crisis point in the first place. This means bringing reality to equality for mental health, bringing in investment and training, and introducing a culture change in the NHS.

My first question is whether the investment detailed in the long-term plan will be sufficient to achieve that. Many of the organisations which have championed mental health doubt that it will. Surely we will require greater investment to implement the proposals of the White Paper.

The Government accept almost all the review’s recommendations on advocacy and tribunals, including the funding that will be required to implement them. These are key reforms affecting people’s liberty and will play an important part in making other improvements to people’s rights effective. Can the Minister assure us that planned reforms will be fully funded?

The independent review was published over two years ago. Since then, the murder of George Floyd and the growth of the Black Lives Matter movement have brought the impact of structural racism into greater focus. Among the five broad ethnic groups, the known rate of detention for the black or black British group—321.7 detentions per 100,000 of the population—was over four times that of the white group, which was 73.4 per 100,000. Men and women from African-Caribbean communities in the UK have higher rates of post-traumatic stress disorder and suicide risk and are more likely to be diagnosed as schizophrenic. Does the White Paper go far enough in tackling the racial disparities within our use of the Mental Health Act? It is very much to be welcomed that the Secretary of State has announced the new patient and carer race equality framework, which was recommended by Sir Simon Wessely. Can the Minister tell us the timetable?

On health inequalities in general, children from the poorest 20% of households are four times as likely to have serious mental health difficulties by the age of 11 as those from the wealthiest 20%. Half of LGBT people—52%—have experienced depression in the last year. One in eight LGBT people aged between 18 and 24 say that they have attempted to take their own life in the last year. Almost half of trans people have thought of taking their own life in the last year, and 31% per cent of LGB people who are not trans say the same. People living in the most deprived areas are more likely to be referred to an IAPT service by their GP but are substantially less likely to receive a complete course of treatment or make a successful recovery. Long-term funding decisions will be needed in the next spending review. What will they look like? Will the Government make a long-term commitment to invest when this is required?

I am sure we all welcome the aim to improve how people with learning difficulties and autism are treated under the Act. Will there be limitations to the scope for detention where their needs are due to learning disabilities or autism alone? Do the Government accept all the review’s recommendations on advocacy and tribunals, including the funding that will be required to implement them? These are key reforms affecting people’s liberty and will play an important part in making other improvements come about.

The emergency legislation of the Coronavirus Act 2020 represented a concerning reduction in patient rights and safeguards. While we understood the reasons for their initial introduction, I am sure that everyone is glad that they were never enacted and pleased that they have now been dropped. However, Covid-19 will prove a defining moment for the way in which we discuss and protect our mental health. A rising tide of people who have not previously experienced mental health problems now find themselves in that position. For a lot of people, the pandemic has seen a shift from merely “struggling” to becoming clinically unwell. Funding and reform will be needed more than ever.

Finally, can the Minister tell us when the legislative programme will commence? Is there to be a joint pre-legislative scrutiny committee? I believe the Minister’s right honourable friend the Secretary of State suggested that that might be the case. That would be very welcome and I hope that it will start very soon indeed. When, finally, will we see the draft Bill?

[Baroness Tyler of Enfield (LD) [V]]

My Lords, there is much to be welcomed in this White Paper, for which we have waited so long. I am pleased to see patient voices being put front and centre of plans and proposals to address the current shocking disparities in the rates of detention of people from black and minority-ethnic backgrounds. However, the issues that were highlighted in the Wessely review two years ago have continued to scar the lives of too many people during the extremely long gestation period of this White Paper.

The original legislation is 40 years old now and out of date. It is shocking, frankly, that it has taken us so long to amend archaic processes, such as an individual’s father automatically being their advocate in a mental health crisis, whatever the nature of the relationship or preference of the individual patient.

I understand the importance of getting the details right. However, I was concerned by the lack of urgency shown by the Secretary of State when responding to questions from MPs on the Statement last week. Why do we have to wait another year before the legislation can even begin? Can the Minister give us a concrete timeframe for the further consultation? What is the timetable for taking forward the non-legislative reforms in the Wessely review, not least to achieve wholesale cultural change in mental health services?

I am similarly very concerned about workforce issues facing this sector. Many of the workforce aims laid out in the NHS Long Term Plan are not on track to be met, with 12% vacancy levels in many mental health services. Between 2016 and 2019, demand for services increased by over 20%—and that takes no account of the exponential growth in mental health problems during the pandemic. Recent forecasts suggest, for example, that only 71 additional consultant psychiatrists will be added to the NHS workforce by 2023-24, against a requirement of more than 1,000 to deliver the long-term plan. What measures are the Government taking to address the additional workforce requirements of reforming the Mental Health Act?

We then come to the issue of funding. The short-term injection of £500 million is, of course, welcome, but it is sustainable and long-term investment in services—covering the full spectrum from preventive to crisis care—that we so badly need. We need a comprehensive plan for funding all existing and new mental health services, rather than one-off injections of short-term funding. Above all, this means investment in community services. In a survey of Royal College of Psychiatrists members, insufficient access to community health services was cited as the greatest cause of increases in formal admissions. The best way to prevent people being detained under the Mental Health Act is to prevent them reaching crisis point in the first place.

Like the noble Baroness, Lady Thornton, I am deeply worried about the impact of the pandemic on the nation’s mental health. In October last year, the Centre for Mental Health estimated approximately 10 million extra people with mental health needs due to the pandemic—a staggering figure. While it is understandable that we have been focusing on the physical threat of the pandemic and protecting our acute services, when will the Government come forward with proposals to address what some are now calling a mental health emergency?

It is an unpalatable fact that black people are currently 10 times more likely to be placed on a community treatment order. In these situations, patient voices become even more important, ensuring that culturally appropriate services can be provided. The patient and carer race equality framework is a good start; I look forward to hearing more on this issue. I note that cultural advocates are currently being recruited, but can the Minister confirm how many patient and carer advocates will be involved in both the advancing mental health equalities task force and the patient and carer race equality framework steering group? Also, why are the Government not proposing to legislate for a CTO to have a maximum duration of two years or to allow tribunals to change the conditions imposed on an individual by the order, as recommended by the Wessely review?

I end by returning to the issue of prevention. The courses of action covered by this legislation represent the worst-case scenarios for individuals experiencing severe mental health problems. We have so much evidence telling us that investments in preventive measures are highly cost-effective interventions and avoid the trauma of crisis scenarios for patients. While we debate this White Paper, it is vital that we do not lose sight of the bigger picture.

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

My Lords, I thank both noble Baronesses for their incredibly perceptive, thoughtful and detailed questions, some of which I am afraid are beyond the brief in front of me. I reassure them, particularly the noble Baroness, Lady Tyler, that I will write with detailed answers to some of their more perceptive and searching questions.

We are all enormously grateful to Sir Simon Wessely for his thoughtful, persuasive and thorough report. It has taken some time to work on it, but now that it has arrived we will act on it. I reassure the House that it is an enormous priority.

I reassure both noble Baronesses that funding is absolutely in place for mental health. If I may briefly run through that, an extra £2.3 billion a year for mental health services is committed by 2023-24. Some £500 million in mental health investment in the NHS workforce was announced in the spending review, and it will go towards addressing waiting times for mental health services.

The noble Baroness, Lady Tyler, referred to the challenge of recruiting psychiatrists. As she knows, that area is extremely challenging. The employment brand of mental health services is not as strong as it is for, say, surgeons, but we have done an enormous amount through HR and the people plan to find new ways of attracting people to rewarding and challenging roles in psychiatry, and those investments are beginning to pay off.

We have invested more than £10 million this year in supporting national and local mental health charities to continue their vital work in supporting people across the country. I will move on to the mental health effects of the pandemic in a second. We have invested £8 million in the Wellbeing for Education Return programme, which will provide schools and colleges all over England with the knowledge and resources to support children and young people, teachers and parents. We have announced more than £400 million over the next four years to refurbish mental health facilities to get rid of dormitories in such facilities across 40 trusts.

The noble Baroness, Lady Tyler, asked me about urgency and whether the Government were truly committed to moving quickly. I reassure her that money has already been announced and plans are in place to address some of Sir Simon’s most urgent recommendations.

Both noble Baronesses asked about the timetable for legislation. I reassure them that the consultation began last Wednesday; it is a 14-week consultation and we have committed to responding to it this year. If I may advertise to noble Lords, this is a terrific opportunity for all those with views on mental health to contribute to that important engagement. It is our plan to publish the Bill next year on the back of that consultation and for legislative scrutiny to take place next year. The question of whether that will be joint legislative scrutiny is not clear to me right now, but I undertake to both noble Baronesses to inquire and press the case for joint scrutiny when I return to the department. I shall write to both of them accordingly.

The noble Baroness, Lady Thornton, raised the impact of the racial dimension highlighted in the report. The numbers in Sir Simon’s report are incredibly striking and it is crystal clear that this is an issue that we absolutely have to deal with. Will we go far enough? Yes, indeed we will. The framework recommended is extremely powerful and we are already putting it into place. We have learned an enormous amount from the report. The ability for those with mental health issues to nominate their own advocate is an extremely powerful innovation that I think will have a big impact on this issue, but we still have further to go. We are engaged with those who are both representative and expert in this area to ensure that we are challenged to go far enough.

Likewise, on learning difficulties and autism, noble Lords will remember that we have had powerful and moving debates in this Chamber in the last few months on that very issue. I reassure the noble Baroness, Lady Thornton, that we note Sir Simon’s recommendation in his report for a 28-day cap on the detention of those with learning difficulties and autism. It is just not good enough for those with learning difficulties and autism to be detained under a Mental Health Act restraint for an interminable period. That point is thoroughly recognised, and the report’s recommendations are extremely well made.

On the question of the pandemic, the noble Baroness, Lady Thornton, put it extremely well: there has been a shift in many people’s response to the pressures and the isolation of lockdown, from being stressed and anxious to having genuine clinical challenges. The full effects of that have not worked their way through the system so it is difficult to get a nuanced and complete view from the numbers today, but we are very much on the balls of our feet to understand and react to the pressures

If I may draw out one issue, young girls seem to be a demographic who have particularly felt the loneliness, anxiety and uncertainty around the pandemic and lockdown. We are particularly concerned to ensure that support goes to families and individuals who present clinical mental health issues as a result of the pandemic.

On the other, very detailed questions asked by the noble Baroness, Lady Tyler, I undertake to answer them in writing at the earliest possible opportunity.

Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020

Baroness Tyler of Enfield Excerpts

Thursday 7th January 2021 Lords Chamber

[Baroness Tyler of Enfield (LD) [V]]

My Lords, as we debate these regulations—after the event, as ever—we are in the throes of a national emergency the like of which I have not witnessed in my lifetime. We must learn lessons from the handling of the pandemic so far. The overriding need is to act fast, early and with consistency of message. We need to treat the population like grown-ups who prefer to hear it straight, even if the news is bad.

With the new, more aggressive strain of the virus, we are in a race against time, as my honourable friend Munira Wilson said yesterday, and we need a military-style response. Above all, we must introduce a 24/7 vaccination programme, bringing the vaccine to every high street in the country, including on Sundays. We must make maximum use of volunteers for all the nonclinical tasks involved and remove unnecessary barriers to recruitment. Critically, we must make full use of the roughly 11,400 local pharmacies that already administer millions of flu jabs every year. They have the capacity to vaccinate about 1.3 million people each week, which will save the lives, particularly, I suggest, of people who are not registered with a GP. What assurances can the Minister give that this will now happen?

The next few weeks will put huge strain on the mental health of millions, particularly the vulnerable, the marginalised and young people. What assurances can the Minister give that mental health services will be fully resourced and will stay open to respond to the ever-growing mental health need?

Finally, with the number of Covid patients in UK hospitals topping 30,000, and having witnessed the harrowing scenes in last night’s news coverage of the intensive care unit at University College London Hospital, will the Minister say what specific steps the Government are taking to support the mental health needs of front-line health and social care workers who are suffering from exhaustion, burnout and flagging morale? You can only stretch a piece of elastic so far, and many are close to breaking point.

HIV: Ending Transmissions

Baroness Tyler of Enfield Excerpts

Tuesday 1st December 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Lord speaks with great humanity and compassion, but I perhaps need to give a bit of perspective. I am not sure if our UK aid budget is enough to solve all the problems that he describes. The UK remains extremely committed to international aid. In the Covid epidemic and recession, we have reduced our commitment in a small way and have promised to revisit it at a later date. That commitment is very clear, and we will do that in due time.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, cuts to local authority public health budgets of some £700 million in real terms over the last five years have led to sexual health budgets being cut by 25% in this period. The King’s Fund has estimated that restoring spending to the former level

“would require additional investment of £1 billion.”

Given the Government’s commitment to zero new HIV transmissions by 2030, will the Minister tell the House what plans they have to increase investment in HIV preventive services delivered by local authorities? Can the Minister also confirm that there will still be national funding for a prevention programme?

[Lord Bethell (Con)]

The Covid epidemic has disrupted things, but I reassure the noble Baroness that in the spending review 2020 we have confirmed that the public health grant will be maintained into next year, enabling local authorities to meet pressures and continue to deliver important public services. DHSC will confirm final allocations in the coming week, including the position on HIV PrEP. I reassure the noble Baroness that PrEP has proved to be an enormously valuable contribution to our fight against transmissions, and we continue to back it.