Covid-19: One Year Report

Lord Beith Excerpts

Thursday 25th March 2021 Lords Chamber

[Lord Beith (LD)]

My Lords, I shall concentrate on what I see as the danger that practices and habits developed during the crisis may turn into long-term changes to our democracy. In no way do I underestimate the seriousness of the pandemic threat or the need for decisive government action to lead our response to it, but there have been serious mistakes and there are serious dangers.

First, it has become a habit of government to bypass even the very limited processes for parliamentary scrutiny of secondary legislation with a statement asserting that

“by reason of urgency, it is necessary to make this instrument without a draft having been laid before, and approved by a resolution of, each House of Parliament.”

That is true of one of the statutory instruments that we are debating today. The Government did that even when the changes involved had been announced days or even weeks in advance of the instrument being laid. Emergency and urgency are not the same thing.

The Government are assisted in that habit by the decision not to use the Coronavirus Act for the main provisions that restrict individual liberties but to rely instead on the Public Health (Control of Disease) Act 1984 as amended in 2008. One of the results of that was that hundreds of people were wrongly given fixed penalties, charged or even convicted because the police did not understand the new laws, and in some cases the Crown Prosecution Service appeared not to either. If Parliament had been told during the passage of the Coronavirus Act that different, earlier legislation was going to be used—I do not remember that being mentioned at all during the discussions on the Bill—some of those problems would have been anticipated and avoided. That is one of the benefits of parliamentary scrutiny.

Secondly, the police were left confused and misdirected on both the extent of the law and how to enforce it. That is compounded by the multiple, overlapping and sometimes erroneous legislation they are expected to digest and enforce. The problem is made even worse by a repeated, and probably deliberate, blurring of the line between law and guidance. The term “rules”, which is widely used by Ministers, is one recent example of that, where it was unclear whether he was talking about things which were law or things he was recommending as guidance. The Prime Minister at one point said, “I am instructing you to stay at home”. Prime Ministers do not have a power of instruction.

I have no problem with Governments in a situation like this issuing very strong advice, calling on people to behave responsibly and setting out the dangers to all of us of not doing so. But we will have a problem if the police treat ministerial advice and guidance as if it has the force of law. That is government by decree and government by press conference, and we saw where it can lead at the Clapham vigil.

The problem is made even more serious by legislating that it is an offence for an English citizen to be outwith his or her home in their own country unless covered by specific exemptions, which an officer of the state has to interpret if there is a challenge. That is very different from, for example, a requirement to wear a face mask, a ban on gatherings or a restriction on business premises where there is considered to be a high risk. It is a national curfew, a system of house arrest, which changes the relationship between the state and the citizen. That part of the legal framework expires at the end of this month, and I hope never to see it again.

Returning to the issue of the Clapham vigil and those disgraceful scenes which were witnessed across the world, it is clear that the Government should never have removed from the regulations the right to democratic protest and demonstration, subject to police guidance and existing law. It is far better to facilitate a regulated demonstration with social distancing and control of numbers, with action under existing law to deal with those who subvert peaceful protest by violence, as happened so disgracefully at Bristol.

A further, less well-known feature of the pandemic legislation is that it allowed the Scottish Government to close the border between England and Scotland, effectively achieving a partial reversal of the Act of Union and breaking up the common travel area. There has not been much enforcement because the police do not have the resources to do that. It may be argued that there was an overriding public health need to impose such a restriction, but I find it curious that neither England, nor the United Kingdom Government and Parliament, had any say in the matter at all.

I return to my central question: what are we doing to rebuild the structure and principles of good governance? We need updated legislation to deal with emergencies, which must be given thorough parliamentary scrutiny and have scrutiny built into its operation. Parliament in both Houses must assert its right to scrutinise secondary legislation without being habitually bypassed by the urgency provision. We must end the confusing language which has the effect of extending law enforcement into advice enforcement and rule by decree. Citizens are entitled to know, and to be correctly advised on, what is legally required of them and what, in the Government’s view, it is socially responsible for them to do. They are not the same thing.

Covid-19

Lord Beith Excerpts

Thursday 11th February 2021 Lords Chamber

[Lord Bethell (Con)]

I am extremely grateful for the noble Viscount’s kind remarks. They are rightly directed at those responsible for the deployment of the vaccine. The NHS itself has been a central player in all that, as have our academic colleagues, particularly at Oxford University but also Imperial, as well as others who have contributed. I will take his remarks back to the Department of Health and Social Care. It has been a very tough year, and I am extremely grateful for his remarks.

[Lord Beith (LD) [V]]

My Lords, the Minister is right that there must be a penalty for lying about which countries you have been to in these circumstances, but I am surprised at how confident he is that the Forgery and Counterfeiting Act 1981 is a good tool for this purpose. Some offences under it do not attract a ten-year maximum but a two-year maximum, and it seems unlikely that a court would impose a substantial custodial sentence when comparing this with other offences. Does he not recognise that all the headlines about a 10-year prison sentence undermine credibility in the Government’s strategy at a time when we need to support and encourage it?

[Lord Bethell (Con)]

My Lords, I am enormously grateful for the noble Lord’s legal insight and will leave it to the courts to decide whether he is right or wrong.

Health Protection (Coronavirus, Local COVID-19 Alert Level) (High) (England) Regulations 2020

Lord Beith Excerpts

Wednesday 14th October 2020 Lords Chamber

[Lord Beith (LD) [V]]

My Lords, I am addressing the House from Berwick-upon-Tweed. Here, local businesses and families are subject to the high level of restriction chosen for the needs of Newcastle and Tyneside, but that is 65 miles away. Berwick is not part of the Tyneside travel-to-work area. People who travel to or from work in Berwick do so mostly from the nearby towns in the Scottish Borders. There is no university or college bringing students into the area.

We have the data on the issue to which I want to draw the Minister’s attention. The Government publish figures for every area of the country in population units of 7,200. The number of new cases in the last week per 7,200 people in Newcastle Central was 335, a horrifying figure. In Berwick, the equivalent figure per 7,200 people was between zero and two—so small that it is not specified whether it was nought, one or two. In the area around Berwick, there were a further five cases. No logical system would treat these two areas in exactly the same way; it is the result of relying on the boundary of the huge Northumberland unitary authority, which we were pushed into against our will, and the North of Tyne Combined Authority. It is challenging enough for local businesses being in the “high” category; it would be grossly unfair if, with so few cases, we were put into the “very high” tier or subjected to other restrictions designed to fit areas showing the very highest increase in cases.

The Minister used the words “local dialogue” in his remarks. I would like an assurance from him that, if Berwick remains so very far below Tyneside in the incidence of new cases and if consideration is given to raising Northumberland into the “very high” category, careful consideration will be given to excluding the relevant local government boards in and around Berwick. Public confidence in dealing with this crisis requires a system that is sensitive to such huge differences. Clearly, if a decision is made that there should be a short circuit-breaker lockdown, which has been the subject of much discussion in the media today, we will accept it. However, as long as there is a tiered system designed to fit the situation in particular areas, that system should operate logically and I ask the Minister to ensure that it does.

Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 4) Regulations 2020

Lord Beith Excerpts

Tuesday 6th October 2020 Lords Chamber

[Lord Beith (LD)]

My Lords, I thank the noble Lord, Lord Lamont, for tabling his amendment to focus attention on the deficiencies of process which have attended these and related regulations. I very much welcome the fact that my noble friends Lady Bakewell and Lady Walmsley, the noble Baroness, Lady Wheatcroft, and others have pointed out some of the awful inconsistencies that are resulting from these kinds of regulations. The noble Baroness, Lady Massey, quite rightly pointed to the failure to consult closely with local government in a number of instances where, if proper consultation had taken place, it could have made a real difference.

Confusion is widespread, as is inconsistency. A resident of Berwick, where, according to the Government’s dashboard figures, there are three cases per 7,000 people, is being subject to the same restrictions as those in parts of Tyneside 60 miles away, where in one area there have been more than 280 cases per 7,000 people. The regulations lack any ability to distinguish. Indeed, a citizen of the north of England, whether the north-east or the north-west, having secured a copy of the regulations we are debating today, might think that they would be able to glean what the law is, but they would be mistaken because they would also need to look at a series of other regulations. They would find themselves bound not just by the rule of six but by the rule of two, which is actually the rule of not meeting anybody else at all. You are not even allowed to meet one other person; you are the only person you are allowed to meet under those regulations.

To understand the law, the citizen would also need to look at the Health Protection (Coronavirus, Restrictions) (North of England, North East and North West of England and Obligations of Undertakings (England) etc.) Amendment Regulations 2020, which were made on 29 September and came into force at midnight on that day, but were laid before Parliament only at 10.30 am the following day, and therefore accessible to us—10 and a half hours after they had come into force. As far as I could establish, they were not on the Government website at 8 am that day. The Prime Minister had no idea what the provisions were anyway, while the previous statutory instrument relating to the north-east had to be amended within hours of being made.

I welcome that the Government have promised parliamentary votes on major orders of national application, but I have to say that the loss of freedom in Berwick, Blackburn or Bolton is no less significant than the loss of freedom in London and other parts of the country. Some of these local orders are of massive significance in terms of the civil liberties they abrogate.

I agree with the noble Lord, Lord Hutton of Furness, who made a related point, that we need to question the Government’s attitude to the made affirmative procedure under which orders come into force before Parliament has considered or approved them. They have been overused. I recognise that sometimes there is a case for using them to guarantee that an order will come into effect quickly if there is a very serious need for it, but Parliament can act quickly if the Government are prepared to co-operate. I hear criticisms of Parliament, such as by the noble and learned Baroness, Lady Hale, for not having considered and debated these matters, but the Government control the agenda in the House of Commons, so Parliament’s inability to act quickly is a matter for the Government to resolve. I am glad to see that the Minister has noted that point because it can be the Government who hold up debate.

I do not see why new restrictions which have been announced many days—or even a week or more—before they come into force cannot be debated. When they are announced, the order should be laid before Parliament and strenuous efforts made in the days before they come into force to have at least the short debates for which our procedures provide. The capacity for democratic control over major incursions into people’s freedoms should not be diminished because not enough resources have been made available to draft the orders in time.

Parliamentary scrutiny can identify bad drafting and increase the chance that at least some people inside and outside Parliament will actually understand what the law is. There are several threats to the effective application of emergency measures: when the public do not understand them or the reasons behind making them, a point which has been illustrated in this debate by a number of noble Lords; when those responsible for enforcing them do not know what is the law and what is guidance, a mistake which has even been made by police forces and the Crown Prosecution Service; and when the measures are themselves defective to the point that even those responsible for carrying them out have failed to recognise that they are, so that prosecutions have to be abandoned or fail. All these problems would be addressed and reduced by parliamentary scrutiny. As the noble Lord, Lord Lamont, has argued, there needs to be a clear government strategy and we need to know what it is.

Health Protection (Coronavirus, Restrictions on Gatherings) (North of England) Regulations 2020

Lord Beith Excerpts

Friday 25th September 2020 Lords Chamber

[Lord Beith (LD) [V]]

My Lords, two minutes is an impossible amount of time in which to analyse this stack of superseded orders, although noble Lords have made some very telling points. For example, the noble Lord, Lord Forsyth, spoke about the use of the Public Health (Control of Disease) Act 1984—a chillingly appropriate name for an Act giving very sweeping powers, which I think have been wrongly used in some instances in this matter.

These orders restrict civil liberties because of the seriousness of the emergency, but Parliament must have the ability to scrutinise and consent to each and every incursion into civil liberties. The Government have to act quickly, but Parliament can also act quickly if, and only if, the Government co-operate in enabling it to do so. However, the present way of doing things causes confusion in the public’s mind and a lack of understanding of what is law and what is merely guidance. Ministers use terms such as “rules”, which seem to fall somewhere between the two. There is no place between the two; there is law and there is guidance.

In this country, announcements on TV by Ministers are not the law. Parliament makes laws and is part of the process of securing public assent and co-operation, which are absolutely essential in dealing with the present crisis. This House has a major part to play in constructive scrutiny. Parliament as a whole really must get a stronger grip on this process, but the Government can facilitate or obstruct that. They should begin to recognise that public support and willingness to co-operate will steadily dissipate if there is a belief that Ministers are just making it up as they go along without any proper process of scrutiny or approval.

NHS: Specialist Services in Remote Areas

Lord Beith Excerpts

Tuesday 11th December 2018 Lords Chamber

Asked by

[Lord Beith]

To ask Her Majesty’s Government what work is being carried out within the National Health Service to improve access to specialist services in areas which are remote from main hospitals.

[Lord Beith (LD)]

My Lords, despite the temperature, I beg leave to ask the Question standing in my name on the Order Paper.

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

My Lords, NHS England, which is responsible for overseeing the commissioning of specialised services, is committed to considering the centralisation of such services, such as stroke provision, where it will raise clinical standards and improve outcomes. However, in doing so, NHS England is bound by its statutory duty to reduce health inequalities, including for people living in remote areas. A series of adjustments to funding allocations for clinical commissioning groups are designed to deliver that obligation.

[Lord Beith]

My Lords, I am grateful for that Answer. As the Minister indicated, many specialist treatments and emergency admissions now take place in major hospitals for patient safety and better outcomes, but what about the communities that are 50 miles or more from those hospitals? Some patients must travel for three or four hours at a time for follow-up consultations and treatment. Does the Minister recognise that, in remote areas, community hospitals need to provide a wider-than-usual range of services and treatments—such as the chemotherapy we have in Berwick—including follow-up consultations, examinations and radiography, using modern technology to link the patient to the clinician at the distant hospital?

[Lord O’Shaughnessy]

I absolutely agree with the noble Lord that while it is important to specialise those services because they have been demonstrated to deliver better outcomes, we need to make sure that ancillary services can be delivered as close to the community as possible. In preparing for this Question, I was delighted to see that Northumbria Healthcare NHS Foundation Trust and the county council are building a new hospital in Berwick to provide that sort of care. That is welcome, but we also need to make sure that we protect community hospitals elsewhere in the country and that they can continue to deliver out-of-hospital care.

Vaccine Damage Payments Act

Lord Beith Excerpts

Tuesday 24th March 2015 Westminster Hall

[Mr Brown]

I thank my hon. Friend for his intervention. He is exactly right. It was absolutely astounding to hear the heartbreaking stories at our last meeting and to think that a young woman who had been fit and healthy now suddenly finds herself asleep for most of the day and has to be awakened on an ongoing basis to be fed. That is no quality of life at all. Something is seriously wrong. The worlds of these young women have been turned upside down. For some of them, to spend a few hours at school in a week is a major challenge. That issue could probably merit an Adjournment debate on its own. I am aware that the hon. Member for Reigate (Crispin Blunt) held a short debate on the topic back in May 2009. It is worth pointing out that there are serious concerns about the manner in which an individual’s allergic reaction to a vaccine is recorded—it might be better put as “not recorded” in many cases. Where there is an allergic reaction, it is only right that it is properly recorded, so that we can not only determine what is happening to the individual but get a broader perspective.

In October 2011, a proposal paper was produced by the vaccine victim support group—an unincorporated association with more than 300 members—and the all-party group for vaccine damaged people. They came together and were looking for reform of the Vaccine Damage Payments Act, which established in the UK a statutory no-fault system of a single lump sum payment from public funds for cases of proven serious permanent disablement resulting from vaccination. Most developed countries have established such systems. The scheme in this country is administered by the Department for Work and Pensions, with appeals being resolved within Her Majesty’s Courts and Tribunals Service. We are now 36 years on, and the system has continued, with relatively minor changes only.

The vaccine victim support group and the all-party group contend that reform of the system is highly desirable to deal with anomalies that now exist in the system, to reflect the changing landscape of today, to reassure the public about the safety and efficacy of vaccination, to reduce litigation and to promote and extend the uptake of vaccination to promote health and the elimination of disease. Both groups support the UK national vaccination programme and recognise that the benefits of vaccination outweigh the risks. Vaccines have significantly contributed to the elimination of disease, the increase in life expectancy and the improvement in public health.

Reform of the UK system of statutory vaccine injury compensation has the prospect of achieving important tangible benefits for the UK that mean that it would be irresponsible not to explore and effect reform through consultation with all relevant stakeholders, which include the pharmaceutical industry, the Department of Health immunisation team, the DWP and, via support groups, affected individuals.

The Act was brought into being by Parliament to put on a statutory footing a system of ex gratia awards of compensation for vaccine injury that had developed during the 1970s, largely as a result of whole-cell whooping cough and smallpox vaccine injury. The Department of Health had made a number of ex gratia awards to individuals who had suffered serious permanent disability as a result of catastrophic brain injury that they had suffered as infants shortly after DPT—diphtheria, pertussis and tetanus—vaccination.

The Government had commissioned Professor David Miller to conduct the national childhood encephalopathy study—NCES—a large-scale epidemiological study of incidents of brain injury and onset of seizure disorders following DPT vaccination. The study, published in May 1981, found a significant association between DPT vaccination and severe neurological injury and death.

The statutory scheme initially required an 80% and permanent level of disability to have been suffered, but later that threshold was reduced to 60%. Awards were initially £10,000. That was increased, in various changes, to £20,000, then £30,000 and then £40,000. The level of payment was largely based on the understanding that that was interim compensation pending the outcome of the litigation against the Wellcome Foundation.

In 1986, the United States enacted the National Childhood Vaccine Injury Act. That established a system of compensation in the US court of federal claims. Until four years ago, that had awarded compensatory damages in 2,806 cases, of which 1,266 involved the DPT vaccine, use of which ceased in 1996. That involved an outlay at that time of $2.2 billion. The fund to administer the scheme is established from a small tax on each dose of vaccine. That has proved relatively successful in the United States, and our all-party group has wondered for a long time why we do not in the UK, for every vaccine that is given, put into a fund a couple of pence. That is all it would take to deal with this issue. However, that has been rejected not only by this Government, but by the Labour Government in the 13 years for which they were in office. I think that we need to reconsider where we are.

In 1988, the court in Loveday v. Renton and the Wellcome Foundation dismissed the claimants’ claims. The judge found that the claimants had failed to establish causation to the required standard of proof. That was based on his findings of flaws in the data analysis of the NCES. Professor Miller and his NCES team subsequently published a follow-up study, in November 1993, which addressed the judge’s criticisms of the original study. The conclusions of the follow-up study were essentially the same as those originally: on rare occasions, the vaccine can cause severe neurological injury. Then in 2000 the Government decided that the initial awards should be “topped up” to the real-terms equivalent of £100,000.

It had been suggested that anyone deemed to be vaccine damaged was carrying the SCN1A gene. That has been disproved by testing victims: they have all proved negative.

In 2010, the Legal Services Commission agreed in principle to fund a further review of the prospects of success of the surviving DPT claimants. Further litigation is therefore pending in that respect against the manufacturers and/or the Department of Health. The award now made for a successful application for vaccine damage payment is a single lump sum of £120,000. However, the majority of applicants—approximately 750 —have received only £78,000, because they received an initial payment of some £10,000. The payment is invariably made into a personal injury special needs trust, so that it is excluded, by statutory provision, from any assessment for means-tested benefits. That is done to ensure that it is received in addition to means-tested benefits such as incapacity benefit and disability living allowance, including components for care and mobility.

According to information supplied by the vaccine damage payments unit in 2011, a total of 931 awards had been made under the 1979 Act, of which 570 were related to the DPT vaccine. There were 89 applications to the unit in 2010 and 71 in 2011. One award was made in 2010, and no awards were made in 2011. So far, 3,983 applications have been rejected on medical grounds and 814 have been rejected for non-medical reasons—because the application was made either out of time or out of the scope of the scheme. The operation of the system has settled down, and after a flurry of historic awards in the early years, very few awards are now being made. The unit at one point consisted of two part-time members of staff. An appeal against the decision to refuse an award is made to the social security lower-tier tribunal, which is part of Her Majesty’s Courts and Tribunals Service.

The fact that surprisingly few awards are being made probably reflects the withdrawal of the DPT wholesale vaccine, the improvement in vaccine technology and the increased levels of safety and efficacy of vaccination. During the past few years, more vaccines, such as HPV and meningitis C, have been added to the national programme. It is likely that further vaccines—for example, varicella, H1N1, swine flu and hepatitis A and B—will be added in coming years. Many new types of vaccines are likely to become available in future years, because they are being developed to combat many sources of disease, such as malaria, candida, chlamydia, E. coli, genital herpes, hepatitis E, strep, rheumatoid arthritis, various cancers and numerous others.

There have been episodes of public concern about adverse reaction to vaccinations such as DPT in the 1970s, MMR in the late 1990s and early 2000s and, more recently, the HPV vaccine. Those episodes of concern have led to litigation, media sensationalism and public anxiety, and they have significantly reduced uptake of the vaccination, which has reduced the level of herd immunity on occasions and increased the incidence of outbreak of pandemic disease among unvaccinated populations. Those episodes of public concern caused anxiety and confusion to the public and resulted in considerable legal defence costs for pharmaceutical corporations and considerable cost to the UK legal aid purse. Litigation resolved few of the disputes, because hardly any cases reached trial. The public health programme was damaged by falling levels of vaccine uptake, and diseases in some cases were resurgent.

In 2003, uptake of the MMR vaccine fell to only 82%, largely as a result of Wakefield’s discredited autism theory. Even by the end of the MMR litigation, uptake had not fully recovered. In contrast, the United States achieves 98% vaccination uptake, possibly because all claims have to be brought in the federal courts under the vaccine programme rather than against a manufacturer. That shows that a proper safety net can boost the numbers of people who take part in a herd immunisation programme. Other countries have avoided the problem by enabling disputes over vaccine injury to be efficiently and proportionately resolved within a statutory compensation scheme, where individual cases can be thoroughly investigated and adjudicated. The lack of a fully comprehensive system for determining vaccine injury applications in the UK has contributed to the problems we face, so all stakeholders have an interest in reform.

The UK’s vaccine injury compensation scheme, as established in the 1979 Act, contains a number of serious anomalies. Not all vaccines are covered. Vaccines for swine flu, smallpox, hepatitis A and B, and yellow fever are not covered. A separate scheme for smallpox vaccine compensation had to be set up by the Department of Health for workers to encourage front-line health workers to participate in vaccination. The vaccine programme is no longer just for children, as it was initially. Many people in their professional careers need to be vaccinated, otherwise they cannot work.

The influenza vaccine is not covered. The safety net has holes in it, and the vaccine victim support group and the all-party group submit that the gaps should be addressed. We believe that everyone who is resident in the UK and is vaccinated should be able to have recourse to the compensation scheme in the event of a serious adverse effect. The current scheme is aimed mainly at compensating children, although adults are also, on rare occasions, covered. The coverage is therefore patchy and not comprehensive. Given the very small numbers involved, the scheme could easily cover children and all adults.

Children who die before the age of two are not covered. That exception is difficult to justify, because losing a child at 18 months is as tragic and devastating as losing a child six months later, at the age of two. That exception should be abolished. The 60% injury threshold is a real issue. An arbitrary distinction is made in the scheme for injuries that are still significant, but that amount to 59% or lower. The refusal of any compensation for someone with a 59% permanent disability cannot objectively be justified, bearing in mind the very small number of awards that are made. To qualify for criminal injury compensation, the minimum threshold value of injury is £1,000, and a similar level should apply in vaccine injury cases.

The current compensation award of £120,000, rather than compensatory damages, creates anomalies. A child with catastrophic injury resulting from clinical negligence in the administration of a vaccine—in other words, in breach of contra-indication—may receive £3 million. A child with a similar injury resulting from an adverse reaction to a vaccine would receive only one twenty-fifth of that compensation. That means that the burden of caring for the disabled person falls largely on their families. The current vaccine injury award amounts to the cost of care for a seriously disabled person for less than one year. That cannot properly be described as compensation; it is only a token.

[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

I welcome the attention that the hon. Gentleman has brought to this matter, as he has on previous occasions. The root of the problem is the distinction between compensation for negligence, which rightly exists to ensure that a negligent organisation pays a penalty, and the provision of the help that people who have suffered vaccine damage ought to get, even if there is no possibility of proving negligence. The hon. Gentleman has identified that that is a no-fault system. We really need to have such a system, which meets the genuine need of those who have faced such consequences without their having to prove negligence.

[Mr Brown]

I thank the right hon. Gentleman for that intervention. The point is the balance of probability, as I indicated earlier in relation to the United States. I know that we do not always like to compare our health service with that in the United States, but theirs is definitely based on the balance of probability. We need to be much more realistic and consider what that could mean for us in relation to vaccination and a vaccination programme. The level of award cannot be justified. Instead, the system should provide common-law damages. The numbers of awards made are such that that would place little burden on the public purse. Similarly, the scheme should also meet reasonable legal costs, so that clients do not have to enter damages-based contingency agreements to fund appeals.

There should be provision in the scheme for some flexibility on the date by which an application has to be made. The current scheme allows no extension of the time limit, even when the applicant does not have knowledge of the scheme or that they have a claim. Earlier today, the families made it abundantly clear to me that if a child suddenly becomes vaccine-damaged, the trauma that runs through the household and the family is such that they probably cannot think straight about what the future holds. It is about recognising the extremely difficult and traumatic time that families are going through. There should not be time bars that mean people get the response, “I’m very sorry, but you’re out of time for any kind of claim.” That just is not the way we should be operating in the 21st century.

The current scheme does not contain any table of injury where causation may, in certain circumstances, be presumed. The absence of such a table leaves open to doubt—and litigation—the question of causation, which makes the system more difficult to administer. The table under the US scheme recognises, for example, that if someone has a severe allergic reaction within four hours of receiving the tetanus vaccine, it is presumed that the tetanus vaccine caused the injury if no other cause is found. That goes back to the point raised by the right hon. Member for Berwick-upon-Tweed (Sir Alan Beith) and my response—that the absolute probability is that the tetanus vaccine was the cause. The table in the US is periodically revised after independent expert review, such as the reports published by the Institute of Medicine on the causality of injury by vaccines in 1991, 1994 and 2011.

The UK system of vaccine injury compensation has now existed for 36 years. It was created as an interim solution, but it has become a permanent one. There are many anomalies in coverage, and it does not fulfil the safety net function that would promote confidence in the uptake of vaccines. Fortunately, cases of serious permanent disablement and death caused by vaccines are extremely rare. The cost of extending the scheme to give comprehensive coverage and provide compensatory damages would be extremely low. If one award of medium severity is made in an average year, for example, the cost might be in the order of, say, £500,000. There would be some initial additional expenditure in paying a further top-up, in line with the level of compensatory damages, for the 931 cases that received a £100,000 top-up payment in 2000. However, that would mean no further ongoing litigation in respect of historical cases. The current award of £100,000 is difficult to justify in cases involving catastrophic injury and a lifetime of care and loss of earnings.

Vaccines have become safer, but the number of vaccines has grown and is likely to continue growing. The vast majority of adverse effects are mild and/or temporary, and only on extremely rare occasions are they serious and permanent. However, it is likely that there will always be a small number of casualties, and a no-fault safety net of compensatory damages will relieve the unfair burden of care and support from victims’ families and redistribute the cost across society. Crucially, it would avoid the need for litigation, promote confidence in the national vaccination programme and increase vaccine uptake, thereby reducing the incidence and cost of disease.

I hope the Minister will consider the points that she hears today. The timing of this debate might be wrong, but I have attempted to raise the profile of this issue over the past 12 months. In the dying days of this Parliament, perhaps the timing could not be better because, with both the Minister and my hon. Friend the shadow Minister in attendance, the next Government might want to consider this issue more closely. The electorate deserve a better deal than they have had previously.

There should have been significant publicity for this debate, and the families tried to encourage such publicity. They came close to getting support from the BBC, but the plug was apparently pulled at the last minute. The families are becoming increasingly suspicious that people do not want to discuss this issue, but it is an issue from which we cannot run away. The families lead their lives as best they can under extremely difficult circumstances. There is no escape for them. On a daily basis, life can be troublesome to say the least, and I suspect that life can often be very trying indeed. They have fought for decades, and they deserve some kind of light at the end of the tunnel, if that is possible. I gave an indication of this earlier, but is it reform of the legislation that we need or is it now time, 36 years after the original legislation was introduced, that we as parliamentarians sat down with the families and the pharmaceutical companies and asked, “Is there a better way of doing this?”? I honestly believe that we require not reform but a whole new concept of where we are going.

My right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr Clarke) and I attended a meeting a few years ago when our good former colleague Ian Stewart was chair of the all-party group. We asked for a meeting with the pharmaceutical companies, which brought their legal teams with them. Those who know my right hon. Friend will recognise him as a placid and tolerant individual, but he walked out of that meeting, which he had not previously done in his entire political career. He was so disgusted with what the legal representatives of the pharmaceutical companies were saying that they tried his patience and he immediately left the room. He and, I hope, everyone in this room recognises the challenge that the families are going through. There is a better way of doing it, and I hope that today’s debate can be a starting point for us all.

Oral Answers to Questions

Lord Beith Excerpts

Tuesday 25th November 2014 Commons Chamber

[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

T9. Do Ministers agree that the patient transport guidance should be interpreted with an understanding of rural needs, rather than telling my elderly constituents to report to a hospital 60 miles away and to get three buses there and three back that do not connect with each other in order to have treatment or consultation?

[Dr Poulter]

It is particularly important in rural areas that patients with complex medical needs who have difficulties mobilising or who perhaps do not have access to a car are supported by the local NHS to access the services they need. There is provision for local hospitals, as well as for CCGs, to give financial assistance to support patients in accessing services and to give them lifts to hospitals, as appropriate.

Oral Answers to Questions

Lord Beith Excerpts

Tuesday 21st October 2014 Commons Chamber

[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

10. If he will take steps to encourage greater co-operation between the NHS in north-east England and in Scotland.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

Of course, it is important that the national health services in all four parts of the UK work together. Good examples of that are happening at the moment on major public health issues, as my right hon. Friend can imagine. Providers in England can and do treat patients referred from Scotland, Wales and Northern Ireland. In England, we put emphasis on enabling patients to choose where they will be treated, not on restricting that choice to providers in England.

[Sir Alan Beith]

Does my hon. Friend agree that if someone’s nearest hospital or health centre is on the other side of the border, the health bureaucracy should not set up artificial barriers to access and any advice the Department gives should reflect that principle?

[Jane Ellison]

I am aware that this concern has been highlighted for my right hon. Friend by a very difficult constituency issue with regard to Northumberland clinical commissioning group. To be clear, the CCG is free to commission services from Scottish providers if it wishes to do so. No one instructs a CCG on where to commission services from—that is a decision for the CCG and one of the strengths of the system. Convenience may not be the most important factor in making that decision, but CCGs need to be assured of quality and standards. I am happy to talk to my right hon. Friend further about his particular case.

Oral Answers to Questions

Lord Beith Excerpts

Tuesday 10th June 2014 Commons Chamber

[Jane Ellison]

I understand the right hon. Gentleman’s frustration, but the review is very important. NHS England has confirmed that it will not be able to consult quite as early as it had wished, but it should be appreciated that this review is more comprehensive than the last one. For example, NHS England has developed a comprehensive set of commissioning standards which have never existed before. For the first time, the whole patient pathway will be covered, from foetal detection through childhood, into adult services and all the way to palliative care—on which one of my hon. Friends led a debate relatively recently—and bereavement.

It is always frustrating when things do not happen according to schedule, but what really matters is getting this right and being as transparent as possible. The level of engagement with stakeholders has been much more satisfactory than before, and we continue to make progress.

[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

13. If he will bring forward proposals to widen the range of services and treatments available in community hospitals in rural areas.

[The Minister of State, Department of Health (Norman Lamb)]

Responsibility for the commissioning of local NHS services lies with clinical commissioning groups. Community hospitals have an important role in achieving more integrated care across health and social care services in rural areas by providing better out-of-hospital care, particularly for frail older people and those with long-term conditions.

[Sir Alan Beith]

A new community hospital is to be built in Berwick, which is 50 miles from major hospitals. Will it be free to offer a wider range of services, along the lines envisaged by the NHS chief executive in his recent comments?

[Norman Lamb]

I know that my right hon. Friend has been campaigning for that hospital. I welcomed the comments of the chief executive of NHS England, who has argued for a much more flexible and adaptable NHS, and for ensuring that GPs locally, working with community services, can offer the maximum range of health services to the local community as close to them as possible.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

That is certainly something that we will look into.

[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

T6. The new specialist emergency hospital is nearly 60 miles from Berwick. Given the serious delays in ambulance attendance in recent cases in Northumbria, how can we be sure that serious cases will get paramedic attendance and delivery to the hospital within the critical hour?

[The Minister of State, Department of Health (Norman Lamb)]

My right hon. Friend is right to raise concern. The North East ambulance service has traditionally been a good performer, but any deterioration that has been identified needs to be addressed very speedily. I urge him to monitor this closely, and if he wants to talk about it further with me, I will be happy to do so.