Long Covid

Lord Bethell Excerpts

Thursday 17th November 2022 Lords Chamber

[Lord Bethell (Con)]

My Lords, I start by thanking the noble Baroness, Lady Thornton, for bringing about this important debate. She has held the Government’s feet to the fire—in fact, she held my feet to the fire—on this issue, and I absolutely commend her persistence.

Rehabilitation in general and post-viral syndromes in particular have a long history of being horribly overlooked in this country. I am afraid that this regrettable neglect has contributed darkly to the long-term poor health of many in this nation. However, before I speak about the consequences of this on long Covid, I will take a moment to recognise that Britain has done more than almost any other country to address long Covid. Professor Chris Whitty and the CMO’s office prioritised NIHR research, with £50 million going into 19 projects, giving a clear signal for other research. The NHS, and in particular the noble Lord, Lord Stevens of Birmingham, launched a welcome five-point plan, as the noble Baroness mentioned, and Amanda Pritchard has rolled out excellent long-term long Covid clinics. Treatments such as monoclonal antibodies and pulmonary rehabilitation are emerging as a result. I pay tribute to Dr Harry Brünjes, who pioneered the Breathe programme at the English National Opera, which is a fantastic example of social prescribing that has produced some very promising clinical trial results. I thank the noble Lord, Lord Darzi, who kicked off the important REACT programme at Imperial College which has generated hefty longitudinal population studies. Lastly, I pay tribute to the patient groups, who are both vocal and thoughtful in their responses, for their testimony.

Despite these considerable collective efforts, I am sad to say that the long Covid story has become a parable for how the UK health system fails to protect people’s freedom from disease and illness. It fails to properly rehabilitate our sick, and we are paying a horrible economic price as a result. The scale of long Covid is enormous, as the noble Baroness rightly pointed out, but the clinical response I referred to is sadly inadequate. The ONS says that there are 1.5 million sufferers, yet the long Covid clinics can see only 60,000 patients per year. Patient groups are frustrated that, when they do get seen, clinicians do not have the latest pathways that might lead to positive outcomes. The NIHR agrees with patients that there are a lot of unanswered questions.

We are familiar in this country with the rationing of scarce health resources and the uneven distribution of the latest research—uncomfortable though that is—but I will focus a few words on the profound economic effects of this troubling British healthcare strategy. ONS data reports that 500,000 people have left the workforce over the last 18 months, and 75,000 of those are economically inactive due to long Covid. The Institute for Fiscal Studies has a slightly different figure of 110,000, and it says that the cost is almost £1.5 billion in lost earnings a year. Another IFS study suggests that there is an average of 2.5 hours of sick leave per worker being taken due to those who have long Covid. Either way, the OBR has recognised that Covid in the round could cost around £2.7 billion in welfare benefits such as incapacity and housing. That is an absolutely staggering sum.

My point is that we cannot shrug our shoulders about the impact of conditions like long Covid on the economy. We have to take on the challenge of making this country healthier and pivot towards prevention. Andrew Haldane, chief executive of the Royal Society of Arts, put it well in his recent speech:

“We’re in a situation for the first time, probably since the Industrial Revolution, where health and wellbeing are in retreat … Having been an accelerator of wellbeing for the last 200 years, health is now serving as a brake in the rise of growth and wellbeing of our citizens.”


Yesterday, Andrew Bailey, the Governor of the Bank of England, told the House of Commons Treasury Committee that part of the reason the country was being held back was the sharp decline in the size of the workforce since Covid.

Despite this, the Treasury plan for living with Covid makes no mention of investment in rehabilitation or major initiatives for getting the workforce back to work. Finances in the UK Health Security Agency and the Office for Health Improvement and Disparities, the main legacy public health organisations—

[Lord Framlingham (Con)]

Will the noble Lord give way, please? Does he agree there is a growing concern about the serious side-effects that the booster vaccinations can have? Does he agree with me that the Government should look at this very carefully?

[Lord Bethell (Con)]

My Lords, the vaccine programme has been an astonishing success, and the uptake of those vaccines has shown the enormous public confidence in them. I will speak on another date about the profound impact this has had on the health of the nation.

My point here is that, at this moment when we are feeling the effects of Covid heavily on our workforce and economy, the finances at the UKHSA and OHID are under huge pressure. The public health infrastructure built over the pandemic has largely been dismantled. At the same time, we have an NHS straining to look after the sick and a workforce many of whom are too sick to work.

It is time that we work towards a new political settlement that prioritises the health of the nation and not just the treatment of the sick; and that we make the operational decision in health and care to move towards prevention.

--- Later in debate ---

[Baroness Neuberger (CB)]

My Lords, I declare my interests as chair of University College London Hospitals NHS Foundation Trust, chair of Whittington Health NHS Trust and a member of the North Central London Integrated Care Board, as well as other interests stated on the register. I am most grateful to the noble Baroness, Lady Thornton, a wonderful fellow non-executive director at Whittington Health, for securing this debate. I too am very grateful to the Library, which has been hugely helpful, and I am enormously grateful to all other speakers, because most have said most of what I was going to say.

I have a very specific point. At UCLH, we a run a well-known and much-admired long Covid service, which is led by the remarkable Melissa Heightman, who is also a national specialty adviser for NHS England and the co-chief investigator for the STIMULATE-ICP study, the largest long Covid trial to date. We know that the service is desperately needed; we have heard that all around the House. Those who run this particular service are working night and day; it does not have the resources to do what is needed, to the extent that those who run it are begging for bits of resource from elsewhere, mostly for people. So short is the service of staff that they recently asked UCLH Charity to fund an extra consultant for two years, which it has agreed to. I am well aware, as we all are, that today is the day of the Autumn Statement and that times are tough, but it is really serious when an NHS trust with a £1 billion turnover has to ask its charity to support an on-the-ground service led by the national lead, even for a limited period of time—particularly for a service designed to help other NHS staff across London.

Worse still, as other noble Lords have said, some 10% to 14% of reported cases are NHS staff. Although we all know that, it is not generally known among the population—but it is not really surprising, given the higher exposure to the virus that they all had. What a difference getting them well and back to work would make to the cash-strapped NHS and to the challenge over staff numbers. We have real trouble in recruiting and, as others have said, we have people leaving the service.

[Lord Bethell (Con)]

Can I personally endorse what the noble Baroness just said, in particular her testimony on Melissa Heightman and the team at UCLH? I had extensive dealings with them as a Minister, and their work is absolutely first class. I am heartbroken to hear that they are having to reach to charity for financial support.

[Baroness Neuberger (CB)]

I am extremely grateful to the noble Lord, and I shall make sure that Melissa knows about that.

Meanwhile, we have all the figures that everybody has cited, and the ONS has reported that long Covid has adversely affected the day-to-day activities of 1.6 million people—that is absolutely huge, and other noble Lords have mentioned that fact. The NHS has tried to help with that ongoing issue but, unfortunately, not enough. I want to go through that, because I think that it is relevant.

In October 2020, NHS England announced a five-point plan to support long Covid patients; it commissioned NICE to develop new guidance and established designated long Covid clinics to provide

“joined up care for physical and mental health”.

It also created the NHS long Covid task force to guide the NHS’s national approach on long Covid, and it funded NIHR research on long Covid better to understand the condition. In July 2021, NHS England published its long Covid plan for 2021-22, which included investing £70 million to expand long Covid services and £30 million in the rollout of an enhanced service for general practice, to support patients in primary care. But when NHS England published its updated plan in July this year, the previously enhanced service funding was not continued, so primary care no longer receives any ring-fenced funding for this condition—yet, as we know, it affects nearly 2 million people.

The problem is both insufficient resources to do all the work that is needed and insufficient forward planning to enable those services that do exist to build up capacity, engage in research, recruit, train, educate, and care for patients, including, importantly, the large number of NHS staff who appear to have been affected. We have a major health problem here that is likely to run for many years. Treatment is uneven across the country and research, which will need a lot of funding, is in its early days. This is an additional burden on an already very stretched NHS, both with patients with long Covid and with the large numbers of staff who have it.

What we really need is a properly NHSE-commissioned service to be put in place now, with secure funding for the next several years, even in these cash-strapped times. It feels like a hand-to-mouth, temporarily funded arrangement, so it is really hard to build a resilient service for the longer term. Can the Minister assure this House that such long-term commissioning will now be put in place, given the recent evidence of the numbers of people away from work with long Covid, the huge proportion of NHS staff affected, making other NHS backlog issues worse, the general impact on the UK economy, which others have mentioned, and of course the sheer suffering that long Covid is causing?