Health Protection (Coronavirus, Restrictions) (Steps and Local Authority Enforcement Powers) (England) (Amendment) Regulations 2021

Baroness Wheatcroft Excerpts

Monday 17th May 2021 Grand Committee

[Baroness Wheatcroft (CB)]

My Lords, I thank the Minister for his thorough introduction to these regulations. These amendments were necessary at the time, and therefore need approval, albeit retrospectively, as we go into step 3 of the journey. But journeys are rarely irreversible, and the road map may at some stage, at least in part, have to be reversed.

What analysis is being conducted of the effectiveness of the various regulations and restrictions so far? We cannot wait for the eventual inquiry to produce its results; we need to know now what has been effective and what has not.

Step 2 saw the opening of non-essential retail and gyms. Personally, I have always thought that gyms had to be a risk if the virus was around, but I would like to see some analysis of whether gyms have been responsible for carrying Covid. As the Minister knows, I really do not understand why non-essential retail could open and galleries and museums could not. Can we have some analysis of that? It would be useful, in case we have to return to level 2-type restrictions.

Can the Minister give us an indication of where the Government really stand on the importance of continuing to work from home if one can work from home? For instance, what guidance has been given to civil servants? It is important for our town centres that people return to the office. Are we really to wait until step 4 before that happens?

On travel, my understanding was that having an amber code for a lot of countries meant that those who wished to travel there and were prepared to quarantine on their return could do so. But we now hear the Foreign Secretary say that people should certainly not take holidays in amber-list countries. Understandably, the travel industry is unhappy about this and would like firm guidance on the Government’s position on foreign travel.

Finally, I read over the weekend that the Government are in talks with airport operators about how to deal with travellers coming in from red-list countries. Surely, at this stage, to be in talks with the authorities is fairly ridiculous. The stories from Heathrow about the intermingling of travellers are quite terrifying. Can the Minister give us some indication of when talks might turn into action?

[The Deputy Chairman of Committees (Lord Haskel) (Lab)]

The noble Lord, Lord Robathan, has withdrawn, so I call the noble Lord, Lord Rooker.

National Health Service (Charges and Pharmaceutical and Local Pharmaceutical Services) (Coronavirus) (Amendment) Regulations 2021

Baroness Wheatcroft Excerpts

Monday 26th April 2021 Lords Chamber

[Baroness Wheatcroft (CB) [V]]

My Lords, as others have said, community pharmacies make a huge contribution to life in the UK. I support this narrow statutory instrument but I deplore the position in which so many pharmacies have been left.

Let us look at what community pharmacies do and what they could do. They already take a huge weight off GPs and the accident and emergency services, effectively providing a triage service in many cases but often dealing with the problem all the way through. They provide emergency out-of-hours services, particularly for those who are terminally ill and need special medication, perhaps at night when other services are shut. They provide screening services, which are essential if we are to keep our population on the right side of healthy. They deal with minor ailments. They provide obesity management, which we all know is absolutely crucial for the future. They also provide phlebotomy, taking quite a lot of the effort of blood tests out of hospitals, which are so overstretched at the moment. They can provide stop smoking clinics; again, these are essential for modern life, where we need to kill tobacco before it kills people.

As we have seen in the past 18 months, pharmacies can also provide vaccination services. This is going to be increasingly important because it appears that vaccination is going to be not a matter of getting through this particular Covid epidemic but an annual event. We will need all the vaccinators we can find. How much more could our community pharmacies do?

If ever we are to see the combination of health and social care that has long been seen as the holy grail for a healthy, comfortable and happy society, community pharmacies must be a crucial part of it. They can straddle the ground where local government and the NHS meet. They can broker understanding and they can broker solutions, to make it sensible, convenient and comfortable for people to live in the community, rather than being sidelined in homes. But what is happening to those pharmacies? The EY report published last September, commissioned by the National Pharmacy Association, found that the current network in England is

“unsustainable under the current financial framework”.

EY projected that by 2024, 72% of pharmacies will be in deficit, with an overall shortfall to the sector of £43,000 on average to each pharmacy and concluded that no industry is sustainable with so many operators in default. Already 28% to 30% are in default and, according to the survey, 52% are planning to sell their businesses. If the businesses are in deficit, there will not be people queueing up to buy them, yet a hit of 52% to our network of community pharmacies would be completely disastrous. The National Pharmacy Association, which commissioned the survey, called on the Government to take a “public interest focused safeguards” approach against the pharmacy network collapsing. Can the Minister commit to re-examining the funding model with that public interest safeguard central to the thinking?

Pharmacists undergo long training and bring vast medical expertise to their dispensing role, but they dispense far more than just medicines. They are there to provide advice and they offer humanity. For many elderly people, the visit to the pharmacy is one of the major points of contact with human beings during their week. They provide centres for communities. In many cases, they are core to the continued survival of a viable high street.

We have seen so many shops closing due to Covid and not reopening. The trend was already under way with internet shopping, but it has been exacerbated by the virus. In many cases, however, the community pharmacy continues to draw people into an area and therefore provide footfall to sustain the other shops and cafés which bring life to an area. They do not have the type of footfall that appeals to the major chains. In many cases, the major chains have a business model that depends on large sales of make-up, toiletries, photographic equipment—you name it. That is what keeps them trading, while the pharmacy just draws a few extra customers into the business. However, the pharmacies that are hubs to so many communities have only minor add-on sales. They are at the heart of the communities because they provide an essential service to the people who live locally. If those streets are to survive, they need the pharmacies to survive.

Therefore, while I support this statutory instrument, I also support the call from the noble Lord, Lord Hunt, for the Government to re-examine the funding and to make a short-term £350 million improvement to the way these pharmacies survive; otherwise they will simply die in front of us, and we cannot afford to see that happen. Already, the Government have indicated that they would prefer to use a firm such as Greensill to provide these pharmacies with the speedy payments that they need, rather than speeding up the payment itself. So many pharmacies had to opt to use that service because they needed the cash flow immediately and could not wait for the Government to pay their bills. Those who have tried to sign up since the middle of March have been unable to. Therefore, my final question not the Minister is: can he undertake to ensure that the Government pay pharmacies promptly for the service that they provide, so that they do not have to resort to external factors to get their money on time?

Body Mass Index

Baroness Wheatcroft Excerpts

Thursday 22nd April 2021 Grand Committee

[Baroness Wheatcroft (CB) [V]]

My Lords, I am grateful to the noble Lord, Lord Addington, for introducing this debate and delighted to follow the noble Baroness, Lady Jenkin of Kennington. She takes food extremely seriously. I remember going to dinners with her when she took her own meagre dinner with her, because she was raising funds for charity by living on a very small amount to demonstrate not only that it is possible but the miserable lives that so many lead.

When we think of that sort of poverty and lack of food, to think of people in this country deliberately starving themselves is particularly difficult. Nevertheless, BMI is only part of identifying eating disorders. It is, however, a very important public health measure, and I agree with the noble Lord, Lord Brooke of Alverthorpe, that we should not throw out a measure which works helpfully as a public health guide. For instance, the shielding during Covid that was brought into play for those who had a particularly high BMI has proved effective.

Nevertheless, when GPs or other specialists use BMI it should be only part of an armoury of tools at their disposal. It is certainly not the only way in which eating disorders could or should be discovered. What is painfully clear is that people with anorexia are obvious just on sight; no GP needs to look at a BMI reading to spot anorexia. All too often, though, I fear that GPs are reluctant to diagnose eating disorders, in part because of the lack of services to deal with those conditions quickly when they need to be dealt with immediately. Anorexia is one of the most, if not the most, pernicious forms of mental illness and extremely hard to treat, but it is better caught early, as with so many diseases. Doctors use judgment and have to be relied upon to use it when wielding BMI as part of their armoury of tools.

Most important, though, is coping with the outbreak of obesity that has now hit this country, as the noble Baroness, Lady Jenkin, pointed out. Excess weight is a huge problem and really needs to be dealt with as a matter of urgency for this country. It was highlighted by Covid but it will become much worse, as many have put on weight during the lockdowns. BMI will be part of the measures for dealing with that.

Covid-19: Resuscitation Orders

Baroness Wheatcroft Excerpts

Wednesday 24th March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, we could not be moving more quickly. We got the report out before the end of the pandemic; we have acknowledged the issue and written numerous letters into the system, as I have mentioned; and we are putting in place the resources needed to support the necessary training and interactions. We are taking this extremely seriously and we are moving as quickly as we possibly can.

[Baroness Wheatcroft (CB) [V]]

As the Minister has suggested, decisions on end-of-life care are best taken long before they are necessary, so could he encourage GPs to offer all patients the opportunity to make an advanced decision to refuse treatment, properly witnessed by two individuals, if it is to become effective?

[Lord Bethell (Con)]

The noble Baroness is entirely right, and a growing number of people do take that kind of pragmatic approach. But we have to be realistic: many people are not prepared to put those sorts of arrangements in place until much later on in their lives, and it is often the family and relatives of those in care who have to be part of those important conversations.

Health Protection (Coronavirus, International Travel) (England) (Amendment) (No. 7) Regulations 2021

Baroness Wheatcroft Excerpts

Monday 22nd March 2021 Lords Chamber

[Baroness Wheatcroft (CB) [V]]

My Lords, if these regulations were intended to pull up the drawbridge and prevent new strains of Covid-19 entering the country, they fail. I support the arguments of the noble Baronesses, Lady Thornton and Lady Walmsley, on the inadequacy, and indeed inconsistencies, of these regulations. For a start, only those coming from red-list countries are forced to self-isolate in government-approved hotels, yet those arrivals inevitably will have travelled on the same flights as people coming from non-red- list countries, as direct flights are cancelled. Bugs do seem to circulate freely on aeroplanes, so can the Minister explain why those who may have been sitting for many hours in a crowded plane with a collection of potential Covid carriers are able to disembark and head straight on to public transport to go and quarantine in a place of their choosing? Indeed, can the Minister explain the logic of allowing any traveller who arrives in this country to travel on public transport, potentially on several different vehicles, before going into quarantine?

For those who do have to go into hotel quarantine, the rules are, rightly, very strict, but are the hotel workers who look after these people being properly protected? What are the risks of them contracting the virus and then spreading it into the community? Many hotel workers have several different jobs. Can the Minister assure us that this is not the case with those working in quarantine hotels?

Finally, perhaps I can ask the Minister a question on quarantine that I put before but which I think time prevented him from answering. If test and trace contacts an individual and instructs them to self-isolate, there can be a hefty fine for disobeying—but test and trace counts as having been contacted for this purpose all the individuals living at the same property as the person instructed to self-isolate. If these people fail to self-isolate, can they be fined?

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

Baroness Wheatcroft Excerpts

Monday 1st March 2021 Lords Chamber

[Baroness Wheatcroft (CB) [V]]

My Lords, I welcome these regulations. It is essential that those who could transmit this devastating disease should isolate. Although I listened to what the noble Lord, Lord Balfe, had to say, I believe that the majority of people in this country, whatever their class or role, understand the importance of testing and isolating and are doing their best to comply.

The Minister introduced these regulations in his normal straightforward manner, for which I thank him. It is important that the Government should be consistent in dealing with the disease. It is harder for people if they are asked to comply with inconsistent regulations. I declare my interest as chairman of the Association of Leading Visitor Attractions. As others have said—although not this afternoon—it seems completely inconsistent that non-essential retail will open for business on 12 April, but indoor visitor attractions will not be able to open on this date. They will have to wait at least five weeks longer, which means that, once again, they will miss the crucial Easter trading period. All the evidence we have is that visitor attractions can enforce social distancing much more effectively than non-essential retail, so can the Minister explain this difference in approach?

I now refer to the detailed regulations presented today. I understand the need for the police to have access to data and to be able to levy fines on those who do not comply. Those who have to isolate are told to do so by test and trace, yet test and trace acknowledges that when it notifies someone of the need to self-isolate, it relies on that individual telling those who live with them that they too must self-isolate. They are not contacted directly by test and trace. So can the Minister say whether those who are simply told by someone with whom they live that they need to isolate can be subject to fines if they fail to do so? Those people will not have been notified directly by test and trace.

Finally, the SI refers to gatherings. How does the law define a “rave”? The Minister is certainly better qualified than most to help us on this point.

Covid-19: Self-Isolation

Baroness Wheatcroft Excerpts

Wednesday 10th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, we are extremely concerned about the mental health impacts of Covid on all those who are feeling the effects most harshly. A substantial amount of money has been invested by NIHR into the mental health effects of Covid, and it is up to the institute to find out the impacts to which my noble friend refers.

[Baroness Wheatcroft (CB) [V]]

My Lords, it is a legal requirement to self-isolate if you test positive or are told to self-isolate by NHS Test and Trace. However, Test and Trace counts as having been traced those who live with someone who tests positive. I believe that this is a dubious method of counting. Will the Minister tell the House whether those people who have not been contacted directly by Test and Trace can therefore be penalised if they fail to self-isolate?

[Lord Bethell (Con)]

The method of counting is done in the way that it is at the moment because we did try the way that the noble Baroness recommends and that led to all sorts of confusion. It led to people having dozens of SMSs and being called relentlessly by the same staff because other members of their household had been identified. It led to a very large number of complaints, including from noble Lords on the Opposition Benches who read to me at great length the complaints of their contacts. We rationalised the system along the lines we currently implement, and that has led to a much more effective system. The feedback from our questionnaires to households is entirely positive. Having isolated myself, with my considerable household of seven people, I can tell noble Lords that it is a huge relief that the account management system is now around households rather than individuals.

Health: Eating Disorders

Baroness Wheatcroft Excerpts

Tuesday 19th January 2021 Lords Chamber

[Baroness Wheatcroft (CB) [V]]

My Lords, parents of adult children suffering from the most extreme eating disorders say they are often desperate to help but powerless because of an insistence on patient confidentiality. The desire to give autonomy to patients too often extends to those whose sickness with eating disorders makes them unable to take sensible decisions for themselves. Will the Minister agree to examine the conflict between these two wishes and how it could be resolved?

[Lord Bethell (Con)]

My Lords, the noble Baroness alludes to a conflict for which there is no easy answer. I completely sympathise with any parent whose child is exhibiting eating disorder issues. It is the most awful and frustrating situation for any parent to see their child in a self-destructive loop for which there seems to be no intervention possible, but patient safety is patient safety, and this is the conundrum that faces any mental health situation. The Mental Health Act is undergoing review at the moment—I am grateful to Sir Simon Wessely for his report, which we debated yesterday—and these are exactly the kinds of issues that we are looking at. I express profound sympathy for all those who find themselves in this awful situation.

Mental Health Act Reform

Baroness Wheatcroft Excerpts

Monday 18th January 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I confess that the noble Baroness has me on the hop there, because I had not noticed that LGBT issues are not mentioned in Sir Simon’s report. I share the noble Baroness’s surprise about that. Let me return to the document and I will address her point in correspondence.

[Baroness Wheatcroft (CB) [V]]

My Lords, Sir Simon found excessive use of restrictive practices in mental health institutions. Many of us will be familiar with the appalling case of Bethany, the autistic teenager who spent three years in what can be described only as a cell, in an appallingly inhumane regime that kept her locked up in solitary confinement and with no physical contact with other people. Only when her father went to court did she escape, and she is now living happily in an open-plan institution. Can the Minister assure us that such treatment will never be condoned again? We cannot wait for legislation on this.

[Lord Bethell (Con)]

My Lords, I certainly do not condone that treatment in any circumstances, but I acknowledge the noble Baroness’s point: there have been some instances in the past—reasonably rare but consistent—where those with autism and learning difficulties have been subject to the most inappropriate regimes and where a completely different type of support, therapy and accommodation from the kind found in mental health institutions was needed. The campaign to which the noble Baroness alluded is entirely right and we are moving quickly to address those points.

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

Baroness Wheatcroft Excerpts

Thursday 7th January 2021 Lords Chamber

[Baroness Wheatcroft (CB) [V]]

My Lords, the rules are clear. Those who can work from home must do so. Businesses must do everything that they can to ensure that remote working is made possible. However, there is no doubt that some organisations still prefer to have their staff in the office where they can see them. Some estate agents, for instance, are keeping staff in the office when it is hard to see why that is necessary.

If the Government tell people that they should work from home but employers insist that they travel to the workplace, will they choose to obey the Government or risk disobeying their employer and losing their job? There are penalties for individuals who flout the rules, but can the Minister say what sanctions there are on an employer who puts their staff and the community at risk by insisting that they attend the office?

I echo the question of the noble Lord, Lord Berkeley of Knighton—[Inaudible.] Today, for instance, there are 13 Back-Benchers speaking in this debate from the Chamber, but parliamentary staff have done a remarkable job in ensuring that Peers can work from home. Of course, it is a privilege to debate from the Chamber, but is it essential that so many parliamentarians must work from Westminster?

Finally, on test and trace, could the Minister tell the House just how many people have been traced via the app, and what the average cost of each successful contact is? If he does not have the information to hand, perhaps he could write to me.