Health and Social Care Update

Lord Bethell Excerpts

Monday 22nd March 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, from these Benches I also thank the noble Lord for the Statement given in the Commons last Thursday and thank and congratulate everyone involved in the creation and delivery of all the vaccines so far, and for their continuing work to protect the world against mutant strains of the virus. It is good news at a time when much else is still worrying.

I also start with the availability of supply. Can the Minister explain to the House what guarantee there is for people on receiving their second doses? He has reassured the House before, but I am hearing from GPs worried that they have not had confirmation that they will receive enough doses or that they are getting any supplies at all at the moment, as well as from people who have had their first dose from their GP but who have been told they cannot book their second dose via the online national system because their first dose was delivered by their GP. There are a lot of confused people around.

Today’s news about the EU-UK war of words on the vaccine supply chain gets more bizarre by the hour. Are Ministers seriously considering holding back exports of the special lipids from the UK to the EU as a proposed retaliatory action if the EU holds back doses in the Netherlands? There should not be a war of words but the best possible collaboration to ensure that the “lumpy supply”, to quote the Prime Minister, is smoothed out.

On the issue of queue jumpers, both the NHS and the care sector have an effective ID system that has been in place for some time, although obviously it was probably easier to do when they were in the first group of people to be vaccinated. What are the Government doing to ensure that every vaccine centre understands what they need to see from people presenting for vaccines from the care sector?

On the hesitancy in uptake, I too have heard of the increase in no-shows. What are the Government doing to encourage especially those from the first six groups who have not yet come forward to do so? The publicity campaign that is beginning on reassurance about the AstraZeneca dose is good, as is the test news, but we need much more than that. We know that hesitancy tends to be reduced when people, especially doctors and nurses, talk directly to their patients.

As we have said from these Benches, it is good that the UK is playing its part in funding vaccines via COVAX. However, there is a lot of discussion at the moment that the UK should support TRIPS and encourage the sharing of intellectual property rights of vaccines. I have some concerns about this approach and agree with Professor Sarah Gilbert, who said:

“If another company tries to take the IP and go it alone, they are manufacturing a different product. The regulators would see it as a different product; it would have to go through all the efficacy trials again, and that would be very wasteful and very slow. I want to get rid of the idea that we should be sharing the IP and letting everybody make their own vaccines. It does not work like that. We have a way of sharing the materials and the expertise, and that is what we have been working very hard to do. That is the correct way to do it, because that is how we get the right vaccines to as many people as possible.”


The work of places such as the Serum Institute of India are examples of how this collaboration can work at its best. Can the Minister say what the Government will do to encourage and support more examples of such collaboration worldwide? Can he also say whether the UK Government plan to donate some of the spare doses that they have ordered to less developed countries and on what timescale this might be enacted?

The Statement refers to the end of shielding on 1 April. As a shielder, I have received another long letter from Matt Hancock and Robert Jenrick which says to shielders:

“Until the social distancing rules are eased more widely, it is important that you continue to keep the number of social interactions that you have low and try to reduce the amount of time you spend in settings where you are unable to maintain social distancing. Everyone is advised to continue to work from home where possible, but if you cannot work from home you should now attend your workplace. Your employer is required to take steps to reduce the risk of exposure to COVID-19 in the workplace and should be able to explain to you the measures they have put in place to keep you safe at work … From 1 April you will no longer be eligible for Statutory Sick Pay … or Employment and Support Allowance … on the basis of being advised to shield. Clinically extremely vulnerable pupils and students should return to their school or other educational settings.”


I said last year when I received an almost identical letter that this feels very strange. You are told that shielding ends but you should continue to do all the things you were doing before shielding—unless you were in receipt of SSP or ESA, because that is no longer available for those who have to go back to work in an unsafe workplace. In response to a question about shielding I asked at a briefing the Minister kindly held for parliamentarians with Chris Whitty, he said that shielders who are immunosuppressed should continue to shield unless the results of the OCTAVE clinical trial for immunosuppressed people was available. But it has not been announced yet. There is total silence from the Government, but there are many immunosuppressed people who will have received this letter and think that they are okay to start moving around more.

The end of the Statement talks about safe discharge, and the £594 million for safe discharge is welcome, but is that to go to the NHS or the better care fund, or will part of it go to local government? Is the £341 million mentioned later in the Statement to support adult social care with the costs of infection prevention part of that same £594 million or is it in addition and completely separate? How will that money get to social care providers?

Once again, why is only adult social care getting this funding? Once again, paid and unpaid carers for young disabled people, who are often extremely vulnerable to any infections, not just Covid, appear to be excluded from this grant. Can the Minister please explain?

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

My Lords, I am enormously grateful for the questions from both noble Baronesses. I will try to address them and if I omit any, I will be happy to write to them with more details.

I will speak first about supply and its importance to the rollout of the vaccine. We have always said that a vaccine programme of this pace and scale may have lumpy interruptions in supply. Noble Lords will be aware that we have done incredibly well to get to the kind of rates that we saw over the weekend in the way that we have; more than 800,000 in a single day is an absolutely astonishing figure. However, delays are envisaged. This is in part due to a delay to a shipment from the Serum Institute of India, which is doing a herculean job of producing vaccines in such large quantities, and because of a batch that we already have in the UK that needs to be retested. We will receive slightly fewer vaccines in April that we did in March but that is still far more than we did in February, and the supply that we have will still enable us to hit the targets that we have set. I emphasise that point. That means that by 15 April we will be able to offer a first dose to everyone over 50 as well as those who are under 50 but clinically vulnerable. It also means that we will be able to give second doses to everyone who has had a first dose within the 12-week window, which means around 12 million second doses in April. It also means that we will be able to offer a first dose to every adult by the end of July. I hope that provides the reassurance that the noble Baronesses, Lady Thornton and Lady Brinton, are looking for.

On the Moderna vaccine, it is a fantastic achievement that the British Government have secured 17 million doses. These will come into play by mid-spring, and my understanding at this stage is that they will be in time to help supplement the rollout of the vaccine to some of the cohorts 1 to 9 at the end of April.

The noble Baroness, Lady Brinton, asked about our approach to EU relations. I reassure her that the British Government are utterly committed to a spirit of partnership and to respect for contract law in all our dealings. If the noble Baroness has good networks and friendships in Brussels and other EU capitals, it would be much appreciated if she could communicate those values to those in her network.

On those without GPs who would like to have the vaccine, I reassure the noble Baroness, Lady Thornton, that it is possible to get the vaccine without a GP, an NHS number or an NHS login. There are systems in place, and if anyone turns up at a vaccine centre without any of those materials, they will be guided and given the assistance they need to get the vaccine they need. I emphasise that the vaccine has proved to be a terrific opportunity for a lot of people to get to know their NHS number a bit better, to bring their GP records up to date and for many to register with an NHS login in order to get to know their patient records a bit better. It will be a massive inflection point in the digitalisation of the NHS, and that is an opportunity we are grabbing with both hands.

I will take some of the noble Baroness’s questions about queue jumping back to the department. I do not know the specifics of the stories that she described, but I reassure her that NHS records are matched against those for the vaccine, as are those for social care. We do not take a blind or naive approach to the rollout of the vaccine, but it is true that it is not the role of vaccine centre staff heavily to police those who come forward for the vaccine. I am not aware that this has been a material issue, but I should be glad to find out more for her.

Of course we are fully aware of the dangers that the European rhetoric on the AstraZeneca vaccine might lead to a rise in hesitancy here in the UK, but I reassure the noble Baroness, Lady Brinton, that the signs are not there yet. It would seem that the British public remain incredibly committed to the vaccine rollout, the numbers coming forward remain astonishingly high and the public attitude surveys that we are doing seem reassuringly concrete.

We are extremely keen to nut through the last remaining numbers in the cohorts 1 to 9. These few weeks will give us a really good opportunity to give time to GPs and other healthcare staff to spend time in dialogue with those who have legitimate questions. That principle of dialogue and answering questions has been the way we have approached the entire vaccine rollout, and we will continue to use that dialectic method in order to get people over the line. We are also very keen to get the vaccine rolled out among younger people, including, perhaps—if the clinical advice is affirmative—children. It is of course the case that children are eligible for and encouraged to take the flu vaccine, not because they are particularly in danger of hospitalisation or severe disease from flu but because they are transmitters of flu. Exactly the same principle applies to Covid. That is why we are extremely keen to get the message across to young people, and it is extremely reassuring that the rollout of the vaccine among older people may have a profound effect on loved ones in the same family unit. We are hopeful that that will be a big influence on younger people.

On our international approach, I reassure the noble Baroness, Lady Brinton, that Britain is as collaborative as a country possibly could be on the vaccine. I take my hat off to AstraZeneca, which has an extremely collaborative approach and, as she knows, a no-profit protocol for the vaccine. The MHRA has led the way in transparency and sharing of data. On therapeutics and clinical trials, we have shared an enormous amount of data around the world. We remain enormous financial sponsors of all the major vaccine programmes, including COVAX, Gavi, ACT and the others. This approach will continue, and we remain convinced that Britain should take a leading role in the global rollout of the vaccine. We will be using our chairmanship of the G7 to play that role.

Lastly, I hear and appreciate the comments of the noble Baroness, Lady Brinton, on the shielding letter. Those who are shielding are in a very awkward position, but I am afraid that it cannot be solved overnight. The OCTAVE programme is extremely ambitious: it is looking carefully at extremely complex and difficult questions about those who, for one reason or another, have suppressed immunity, and that includes a very broad range of conditions. Professor Paul Moss at Birmingham University Hospital, who is leading that programme, is doing a terrific job, and I pay tribute to him and all his team. We are looking at whether they have the right amount of resources. I had reassurances very recently that everything was in place, but we are looking extremely closely at this area, because the noble Baroness is right: those who have suppressed immunity are in a very special case and we need to be absolutely sure that they have the right vaccine delivered at the right time and the right information to make the decisions necessary to go back into life. Those decisions simply cannot be rushed. A passage of time is necessary to understand the effect of the vaccine on the human body, but we are doing everything we can to answer those important questions.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, we now come to the 30 minutes allocated for Back-Bench questions: it is 30 minutes, not 20, which was printed in error on today’s list. Even with that extra time, I ask that questions and answers are brief so that I can call the maximum number of speakers. The noble Lord, Lord Lansley, has withdrawn, so I call the noble Baroness, Lady Hayman.

[Baroness Hayman (CB) [V]]

My Lords, a descent into a tit-for-tat vaccine war would obviously be disastrous, given the global nature of both vaccine supply chains and the pandemic itself. Given the worrying developments that we have seen in this area, what research has been done and consideration given to the possibility of mixing and matching second doses with a different vaccine—something which was talked about originally and might become necessary in the light of particular difficulties in supply chains?

[Lord Bethell (Con)]

My Lords, I completely agree with the noble Baroness that a descent into some type of vaccine war would be extremely regrettable, and the British Government are doing everything they can to continue in a spirit of partnership with overseas Governments. We have not reached the possibility of taking on a mixing and matching approach. We believe that the supply chain we have in place is ample to achieve the targets we have already published. However, to answer her question directly, there is some evidence that mixing and matching may prove to be even better than having two of the same vaccine—that it may stimulate the immune system in ways that give you a more developed response to the virus. Therefore, we continue to look carefully at this possibility.

[Lord Faulkner of Worcester (Lab) [V]]

My Lords, the Minister is right to draw attention to the success of the vaccination programme, but does he not agree that last Thursday’s Statement is rather light on advice on what people should do to protect themselves and others until the lockdown ends? In particular, there is no reference to the need to continue wearing face coverings. The Minister will recall that he kindly wrote to me about this on 28 January. His letter included the advice that, “The public should not challenge people for not wearing a face covering.” Will he now consider changing that advice as, surely, the wearing of masks is as important as social distancing and avoiding large gatherings?

[Lord Bethell (Con)]

I am extremely impressed by the noble Lord’s perseverance on this issue. I know that he feels very strongly about the need for members of the public to be involved in policing the wearing of masks. However, that is simply not the way in which the British administration of guidelines is handled in this country; it is for those who are put in positions of badged authority to implement them. I simply cannot advocate that members of the public should intervene on one another to insist on, or apply any form of retribution regarding, the wearing of masks.

[Baroness Jolly (LD) [V]]

My Lords, I welcome the Statement and the Government’s ambition. At the end of the Statement, there is a commitment to building 40 new hospitals, hiring 50,000 more nurses and backing the NHS and social care. Can the Minister outline what sort of backing the social care sector can expect, and by when?

[Lord Bethell (Con)]

My Lords, I am grateful for the broad and large hook that the noble Baroness has provided me with. I reassure her that not only do we have a massive amount of support already in place for social care to help it through the current pandemic and the huge amount of pressure that has been put on its staff, residents and supply chain; we also have put in place an enormous amount of financial support for local authorities to ensure that they can provide the kind of improvements to social care that are needed. One area in which we have made enormous advances is care tech—that is, digital and technologically driven support. It has taken a huge step forward in the last year and impacted enormously on the lives of those in social care of all kinds.

[Baroness Penn (Con)]

My Lords, we are having technical difficulties. I beg to move that the House do now adjourn until 3 pm.

--- Later in debate ---

[Lord Forsyth of Drumlean (Con) [V]]

My Lords, what contingency plans do the Government have in place should the EUC/EU pursue its outrageous threats to prevent the export of vaccines under a legal contract with the NHS? In that event, can my noble friend say what estimate he has made of the delay, if any, to completing the undertaking he gave earlier that all adults in the UK will have had their first dose by the end of July?

[Lord Bethell (Con)]

My Lords, from the beginning, we have put in place arrangements for the UK manufacture of vaccines, which, in the light of events, has proved to be a pragmatic and sensible move. We are hopeful that the EU will continue in the spirit of partnership and will respect contract law. I stand by the statement I made on our expectations on the supply of the vaccine to cohorts one to nine and all adults that I articulated earlier.

[Baroness Greengross (CB) [V]]

My Lords, what is the Government’s response to the 2020 report from Amnesty International which suggests that the Government, while knowing the vulnerability of many older people, failed completely to protect care home residents? People were discharged into care homes without testing, which, according to Amnesty, breached their human rights and contributed to the fact that the UK had the highest death toll in Europe at the time.

[Lord Bethell (Con)]

My Lords, I simply do not recognise the characterisation that the noble Baroness has just presented. The view of our treatment of the elderly and vulnerable taken by Amnesty during the pandemic is completely inappropriate and inaccurate. Huge steps have been taken to protect those who are vulnerable and elderly. I cannot think of a country that could have done more under the circumstances. I therefore reject its analysis.

[Baroness Warwick of Undercliffe (Lab) [V]]

My Lords, this is a Statement on health and social care. I am astonished that the Minister has confined the Government’s policy on adult social care following the pandemic to a couple of sentences. He must know that most of the adult social care in this country is provided by family carers. They are regularly ignored in such Statements, but many of the 6 million carers looking after vulnerable adults, including those with learning difficulties, have been pushed to breaking point by the pandemic. Is there nothing to say to them about access to support services or respite care and nothing on carer’s allowance? Without support for these essential carers, policies such as enhanced hospital discharge, as mentioned in the Statement, will not be feasible. What is the Government’s strategy for dealing with this crisis in care?

[Lord Bethell (Con)]

My Lords, I endorse completely the noble Baroness’s remarks that we depend on the generosity, public spirit and kindness of family carers who provide an enormous amount of support for their loved ones. Without them, the system could not possibly exist and the world would be a much graver place. I recognise that many carers have been pushed very hard by the pandemic. We have put a huge amount of resource into local authorities, which are responsible for providing support for those families, and that includes the kind of respite support that the noble Baroness has rightly pointed to. I am sure that more could be done and I would welcome any correspondence on this by way of follow-up that she would like to send my way.

[Baroness Sheehan (LD)]

My Lords, the Serum Institute of India is producing a billion doses of the Oxford/AstraZeneca vaccine this year. However, we hear that the rate of production may be compromised because of delays in the supply chain of essential items from the US. What dialogue have our Government had with their US counterparts at all levels about how these delays might be overcome?

[Lord Bethell (Con)]

My Lords, the noble Baroness is right to say that the Serum Institute of India is the world’s biggest vaccine manufacturer by far and we are enormously grateful for the strong relationship that this country has with the institute and the contribution that it is making to our vaccine rollout. The supply chains for the world’s vaccine production are unbelievably complicated, with ingredients and individual supply items coming from many different countries for each and every vaccine. It is not possible to provide a running commentary on the progress of each one; nor would it be wise to have a bilateral conversation with the country of origin of every vaccine ingredient. Our relations with India, America and the EU will, I am sure, return to the spirit of partnership and the respect of contract law that have characterised those relationships in the past.

[Lord Cormack (Con)]

My Lords, I shall quote from the Statement:

“Last Monday, we reopened care homes to visitors, with a careful policy of a single regular visitor … we hear each day of more and more residents safely reunited with people they love.”


My wife and I have a dear friend whose mother is 99. She is indeed excited at the prospect of holding her mother’s hand for the first time in a year, but that excitement is overshadowed by the knowledge that several of the workers in the care home where her mother is being looked after have refused to take the vaccine. I urge my noble friend yet again to press forward on this.

[Lord Bethell (Con)]

My Lords, I hear my noble friend’s message loud and clear and he has made the case both persuasively and thoughtfully. He is a little ahead of events. It is not possible for us to put in any form of certification or mandation until the vaccine has been offered to absolutely everyone in the country. However, he will know that the Cabinet Office has a review process in place that is looking at exactly the dilemma he has spoken to.

[Lord Singh of Wimbledon (CB) [V]]

My Lords, I congratulate the Government on the success of their vaccination programme. We should also applaud the way that the NHS has responded to the pandemic in reorganising priorities and efficiently facilitating the vaccine rollout. Does the Minister agree that the controversially privatised NHS Supply Chain has done less well in the provision of PPE and that the Government’s track and trace programme has also been found wanting? According to the National Audit Office, some of its consultants have been paid thousands of pounds a day for sitting at home with very little work.

[Lord Bethell (Con)]

My Lords, I am grateful to the noble Lord for his tribute to the NHS, both the front-line staff and those who have organised the vaccine rollout. He is right to say that this has been a huge national achievement. However, I do not accept the characterisation he has made of other aspects of our pandemic response, including the provision of PPE, which, by the way, involved a huge global competition for extremely rare materials and led to a massive increase in domestic production. I also do not agree with his characterisation of the test and trace programme, which has developed into becoming one of the largest testing programmes in the world. It is now extremely effective, with tracing completion rates above 90%.

[Baroness Andrews (Lab) [V]]

My Lords, further to Minister’s exchange with the noble Lord, Lord Forsyth, can he update the House on plans to increase the manufacture of vaccine in the UK and when and where that might happen?

[Lord Bethell (Con)]

My Lords, I am not sure that I have at my fingertips the precise rollout plan for domestic manufacturing. All I can do is reassure the noble Baroness that we are exploring all options equally hard and are working 110% on every opportunity we have for delivering vaccines into the UK. I reassure the noble Baroness and all noble Lords in the Chamber that we are doing all we can and that at this stage we are hopeful and confident that the supply chain will deliver the vaccines we need in order to vaccinate all adults by the end of July.

[Lord Haselhurst (Con) [V]]

My Lords, as it may not be possible to maintain the remarkable number of vaccinations currently being achieved over the next few weeks, and noting the pent-up desire of people for an overseas holiday, is the trickiest task now facing the Government not to persuade people to hold off a bit longer? There is still too great a risk of importing strains of Covid-19 and spoiling the progress that their sacrifice has achieved to date.

[Lord Bethell (Con)]

My noble friend is entirely right: this is a considerable dilemma not just for the Government, but for everyone. We in the UK have an enormously valuable project in our vaccination programme. Who does not relish the potential freedom from this horrible disease that it gives us? Yet we need only look overseas to see infection rates rising and the variants of concern spreading. The bottom line is that we do not know the impact of the variants of concern on the vaccine. Anyone who says they do for sure is simply not representing the truth. We have to be patient and figure out and fully understand the threat from the variants of concern. When we have that information, we can make a pragmatic, sensible and informed decision on foreign travel, as the Prime Minister has promised.

[Baroness Hollins (CB) [V]]

My Lords, I am so pleased that all people with learning disabilities who are known to their GP are now in either group 4 or 6 for vaccination. Will the noble Lord commit to reporting on the take-up of Covid immunisation for people on the register, both nationally and locally? Will he also report on the implementation of visiting policies for people with learning disabilities in both supported living and residential settings, and whether those residents are able to choose their one visitor?

[Lord Bethell (Con)]

Those were two extremely thoughtful and well-informed questions. I do not have the statistics at my fingertips, but I would be glad to go back to the department and write to the noble Baroness with the information she has asked for.

[Lord Liddle (Lab) [V]]

My Lords, I add my congratulations to the NHS on the tremendous success of this vaccination programme, but we should now be doing more to look forward to how we can address the social and public health inequalities that led to Britain having one of the largest death rates from Covid in the world. I speak in the context of being a Cumbria county councillor. The public health grant is what we use to tackle issues such as obesity, inactivity, smoking and alcohol, which greatly reduce people’s chances of surviving deadly disease. Next year’s public health grant is a mere £19 million—an increase of just 1.4%. Not only is this, frankly, a pathetic response to the social problems that led to all these Covid deaths, but it is unfairly distributed. Central London authorities such as Kensington and Chelsea, and Westminster, receive three to five times the amount per head that our authority in the north receives. How do the Government explain this and how does it square with their levelling-up agenda?

[Lord Bethell (Con)]

My Lords, we are committed to both our levelling-up agenda and the kind of population health measures to which the noble Lord alludes. That is why we are bringing the NHS and social care Bill before the House later this year. I hope that the noble Lord engages with it to bring his insight to the debate.

[Lord Dobbs (Con) [V]]

My Lords, I assume that my noble friend shares with me a profound sadness at what is going on in the EU. Will he, instead of following their appalling example or indulging in tit for tat, remind the world that Britain after Brexit does things differently? We prefer the rule of law to knee-jerk protectionism, we pursue free and fair trade, and we honour our commercial contracts. Does he agree that this makes Britain one of the most attractive places in the world for pharma, biosciences and anyone to do business with?

[Lord Bethell (Con)]

My noble friend has just made a fantastic pitch for my job. He articulated the case for investing in Britain to pharmaceutical and medical devices companies around the world. Which company cannot be looking at Europe, right now, wondering whether Britain is not, by far, the best destination for their investment and research? I completely agree with my noble friend; my head is in my hands when I look at Europe and what is going on there, but my hope is that good sense will return. In the meantime, if anyone wants to invest any money in life sciences, please give me a ring.

[Lord Loomba (CB) [V]]

My Lords, the vaccination milestone of 25 million in 100 days is commendable. However, we must be very careful that we do not undo or undermine our good work thus far. Will the Minister tell us why the Government do not consider it important—imperative, even—to ban all overseas holiday travel this summer, as many countries are now suffering from a third wave of Covid-19 due to new variants becoming apparent, and there is an increased risk of them being transferred to the UK via travellers?

[Lord Bethell (Con)]

My Lords, the noble Lord puts the situation well. I do not agree with every aspect of his assessment, but his concerns are shared by the Government. We keep the whole situation under review, but the bottom line is that we do not know the impact of the variants of concern on the vaccine and vice versa. We keep the situation very closely monitored. The measures in place are entirely proportionate to the threat we face but, should that escalate, we will not hesitate to take the necessary decisions.

[Baroness Ritchie of Downpatrick (Non-Afl) [V]]

My Lords, in commending the rollout of the vaccination programme, could the Minister indicate whether the Government have made arrangements for its continuation in subsequent years? What discussions have there been and potential arrangements made with the devolved Administrations on this?

[Lord Bethell (Con)]

My Lords, we very much hope that the vaccination programme being delivered today will lead to an inflection point in the whole country’s approach to vaccinations overall. That is not just for Covid, but for flu, HPV and other prophylactics. We are on the brink of a massive change in our mindset regarding preventive medicine. There is an opportunity here for us to completely change the way in which we do healthcare—from an emphasis on late-stage and acute medicine to preventive early-stage medicine. The stakes are enormous. We are determined to grab this opportunity with both hands and we will take our friends in the devolved authorities with us.

[The Deputy Speaker (Lord Haskel) (Lab)]

The noble Baroness, Lady Blackstone, and the noble Lord, Lord Lucas, have both withdrawn, so I call the noble Lord, Lord St John of Bletso.

[Lord St John of Bletso (CB)]

My Lords, I would like to probe the Minister outside the question of the vaccine supply and its admirable rollout. While welcoming the Government’s workplace testing scheme, in which lateral flow tests will be given to businesses until the end of June, what established workplace testing infrastructure is in place? What measures are being taken to ensure the high uptake of this strategy and that it is as safe and accurate as possible?

[Lord Bethell (Con)]

The noble Lord is entirely right to emphasise this incredibly important aspect of our toolkit to manage infection rates down. The workplace is an area of infection threat and asymptomatic testing is a way to keep workplaces safe. We have put in place until the summer the free provision of lateral flow tests for those who wish to do workplace testing, and we are looking at ways in which we could potentially extend that, particularly in circumstances where the infection rate crept up again. We are working very closely with BEIS colleagues to look at the kind of regime that would be necessary. I pay tribute to DfT colleagues who have trail-blazed this area with the test to release programme, which uses private testing capacity for that important transport corridor, and to colleagues at UKAS who have put in place the accreditation necessary to create an independent, private ecology of the kind that the noble Lord refers to.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I come back to the point raised by the noble Lord, Lord Cormack: the SPI-M-O consensus statement of 24 February showed that while 95% of care home residents had had the vaccine, only 70% of staff had. We really must do better on this; does the Minister agree?

[Lord Bethell (Con)]

My Lords, I could not agree more heartedly; the vaccination of staff is a massive priority. Those figures give us cause for some reflection on how we can increase them. The adoption rate of vaccines by all healthcare workers has been much more impressive than on previous vaccine rollouts, so we are encouraged overall, but we are determined to hammer out all the last rock pools where people have not been persuaded. As I alluded to my noble friend Lord Cormack, we are looking at all methods to make sure that we get there in the end.

[Baroness McIntosh of Pickering (Con)]

I welcome the Statement, in particular the reference to the future discharge programme for hospitals. Does my noble friend agree that it is essential to rural-proof this policy? Will the Government look favourably on establishing health hubs in rural towns, to provide treatment and test availability and to allow the potential to avoid hospital visits?

[Lord Bethell (Con)]

My noble friend hits the nail on the head; who could think that a return to the previous regime of turning up at a GP’s surgery or a hospital every time you feel ill could possibly be a wise way of going about your healthcare system? Professor Sir Mike Richards has done an extremely good report on community health hubs, which we are looking at very closely; it has some very wise words that we are minded to follow up.

[Baroness Uddin (Non-Afl) [V]]

My Lords, I congratulate the Government on the rollout of the vaccine programme. I have two questions. First, what steps are being taken to ensure that local authorities are making progress to resume assessments of the needs of adults with learning disabilities and autism, many of whom were forced to depend on their inadequate amount of disability benefit? Secondly, what steps have been taken to speak to family members who lost loved ones with the instruction for staff not to resuscitate? I raise this point as I have raised it before. Will the Minister assure this House that the practice is no longer applicable to residents in care homes and people with learning disabilities, unless in agreement with patients and their families?

[Lord Bethell (Con)]

My Lords, the CQC has pronounced its report on do not resuscitate orders, which is absolutely crystal clear. I wholly endorse its findings and recommendations.

[Lord Moynihan (Con)]

My Lords, I warmly congratulate the Government on the management of the vaccine programme. As we emerge from the epidemic, will the Government commit to a major health policy initiative to ensure that all young people engage in a more active lifestyle, participate in sport and recreation, gain affordable access to gyms, swimming pools, leisure facilities and dual-use school facilities used by local communities, and to tackle what is the least fit generation of young people in over 100 years? Does my noble friend agree that affordability and access are the critical components in this context?

[Lord Bethell (Con)]

My Lords, the policy on sports is best left to colleagues at the Department for Digital, Culture, Media and Sport, but on a personal level I emote complete sympathy with my noble friend’s sentiments. I may be naive in this matter but I cannot help hoping that this pandemic will have led to a feeling across the country that the health of the nation has to change—it has to change emphatically, not only through diet but the amount of activity taken. This nation has an opportunity to embrace a lifestyle with more outdoor activity and exercise and a greater commitment to healthy living. That is a reasonable ambition, not just for my noble friend but for the whole country, and I support it entirely.

[The Deputy Speaker (Lord Haskel) (Lab)]

My Lords, that completes the questions.

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

Lord Bethell Excerpts

Monday 22nd March 2021 Lords Chamber

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

I start by saying a profound thank you to the noble Baroness, Lady Thornton, for this regret Motion. If is not often a Minister thanks the Opposition for a regret Motion, but I completely recognise that this is one of the top questions of the moment. I value the opportunity to air these important issues and to try to answer some of the probing and challenging questions asked in this debate.

Several noble Lords, including the noble Baroness, Lady Brinton, have called for clarity. I am afraid that clarity is the one thing I cannot bring noble Lords in this instance because there are so many unknowns about the virus itself. I am not trying to hide behind the vagaries of the virus, but it is an unavoidable truth that we do not know about the body’s response to the new variants that have emerged.

We do not know whether the Manaus or South African variants of concern will somehow evade and escape the AstraZeneca, Pfizer or Moderna vaccines and dramatically increase the severity of disease, hospitalisation and death rates in those who have been vaccinated. A small change in some of those percentages can make a dramatic difference to the impact of the disease on this country and other countries.

Therefore, while we wait for the evidence to become clearer and more conclusive, we have to balance. On the one hand, there is the very natural, reasonable and pragmatic instinct to pull up the drawbridge and use our island status to protect ourselves from the unknown, to ape the precedent set by Singapore, Iceland, New Zealand, Australia and Taiwan—other island states that have extremely strict green zone measures in place to keep out travellers. On the other hand, there is accommodating the very reasonable, natural and human desire of the British public and those who live overseas to travel in and out of the country. It is a matter of national identity, economic value and diplomatic heft that we keep our borders open during this period.

Under these circumstances, in a difficult, unknown situation, we have sought to put in the most thoughtful and balanced system possible. We have embraced a 21st-century approach to a 21st-century pandemic. That means we have used technology, testing and all the data systems available to us to ensure that we know exactly who is coming in and going out of the country. We are using that investment to protect the massive national project of the vaccine.

From a standing start, we have created an incredibly complex managed quarantine system that tracks everyone coming into the country, identifies two tests for them at two and eight days, double-tests any positives against genomic sequencing, and immediately applies rigorous tracing protocols to all those who may have a variant of concern.

The statistics speak for themselves; it has been enormously successful. Unlike other countries, where the South African variant, for instance, has been transmitted in the community, in the UK we have kept a lid on the Brazilian and South African variants. I speak with hope and prayers that that long continues.

The amount of travel coming into the country is now 5% of what it was in normal times. For those who say we are not doing enough, I remind them that we have taken an absolutely draconian approach to travel. For those who say that the arrangements are not clear, as my noble friend Lord Robathan did, I will be honest—I think the rules are very clear: it is illegal to travel abroad for leisure purposes. We even have a declaration form on international travel to ensure that people travel abroad only for permitted purposes. It could not be clearer.

It is possible that we will have to go further. We are watching with enormous sadness our European neighbours rejecting the vaccine policy. They are not embracing the opportunity a vaccine provides for driving down infection rates and protecting their populations. I do not know how that will play out. It is certainly above my pay grade to speculate. But we are all aware of the possibility that we will have to red-list all our European neighbours.

That would be done with huge regret because we are a trading nation, we work in partnership with other countries and we depend on other countries for essential supplies—not only medicines but food and others. Although we could put a haulier programme in place to protect our trade routes, it would be an enormous diplomatic blow and a decision that we would take with huge regret.

That is the reason for the system that we have in place at the moment. We have 35 red-listed countries, and we look at the statistics on the spread of variants of concern extremely closely indeed. We have some of the country’s best analysts working through all sorts of intelligence routes to understand exactly what is going on in the world, and we have mobilised the largest genomic sequencing resources in the world, not only to understand what the prevalence is of VOCs in this country but to look at samples from all around the world. We are absolutely on the balls of our feet, should the situation change. That practical approach entirely suits the style of this country and the challenge that we face. The Prime Minister has made it crystal clear that, should the circumstances change, for the worse or the better, we will either upgrade or downgrade those arrangements.

A number of Peers have referred to the circumstances in which these regulations were put in place. I have been at the Dispatch Box enough times over the last year to understand the difference between a pressing situation and one that is not. I reassure noble Lords that these regulations were brought on to the statute book at pace because we had absolutely no choice. I remind those whose memories are short that it was only 12 weeks ago that the threat of the Kent variant became so apparent that we had to bring in new lockdown measures on 14 December. It is only relatively recently that we have understood more fully the potential threat to the vaccine of the Manaus and South African variants. In fact, in both cases, the evidence either way is not yet conclusive.

We are dealing with a fast-changing situation, and we have extremely worrying epidemiological updates from South America that suggest that there may be other variants out there that we have not yet sequenced. As such, we brought in these regulations at pace, with regret that they were brought in late. I reassure noble Lords that we would not have done it otherwise.

I give major thanks to the Joint Committee on Statutory Instruments for its report into the Health Protection (Coronavirus, International Travel) (England) (Amendment) (No. 7) Regulations 2021. I reassure the noble Baroness, Lady Scott—whose remarks were extremely well made and very generously made, under the circumstances—that the drafting errors referred to in paragraph 7.3 of the report have all subsequently been corrected. The use of the term “variant of concern” in the regulations is being reviewed as a matter of priority.

To the noble Lord, Lord Empey, I say that we have given £7 billion of government support to the air transport sector, but we completely appreciate the pressure that it is under. I reassure the noble Lord, Lord Dodds, that we absolutely have a collaborative approach with the Irish Government; there are no issues of principle here, and we have a pragmatic approach to sharing data.

I draw the attention of the noble Lord, Lord Addington, my noble friend Lord Bourne and others who asked about the passport to the Cabinet Office reviews of certification. There is one on major events, one on social care and healthcare, and one on international travel, with the DfT. They are all looking to report very soon.

There was unanimous support across the Chamber with regard to the maiden speech of the noble Baroness, Lady Chapman of Darlington, who spoke so warmly and generously, and she is clearly going to be a very benign and generous addition to these Benches. We really appreciate the way in which she gave her maiden speech. She spoke particularly kindly of Darlington. I note that the Treasury has made a massive commitment to move Treasury North there, which I hope the noble Baroness welcomes. I hope that she will enjoy the opportunity to spend more time with the Chancellor in the months and years to come.

I repeat my sincere gratitude to the noble Baroness, Lady Thornton, for bringing this regret Motion; it is a major and important issue, and one that we will debate again in the future because the issues that we are tackling this afternoon will not go away any time soon. I reassure all noble Lords that we take this matter extremely seriously indeed, and we are absolutely doing our best.

Covid-19: Government’s Publication of Contracts

Lord Bethell Excerpts

Thursday 11th March 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, the Minister will be aware that 100 contracts remain unpublished, while those that have been published are so heavily redacted that it is impossible to ascertain whether the orders reflect value for money for the taxpayer. Procurement guidance, which is still in force, says that once the contract is commenced, most of the contact details should be released and that only detailed pricing arrangements should be redacted and not much else. Indeed, Cabinet Office guidelines say:

“The government is committed to greater transparency across its operations … This includes commitments relating to public procurement.”


Can the Minister explain to the House and propose how meaningful transparency can be achieved to give effect to the Government’s stated policy?

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

My Lords, with regard to the publication of contracts, the number of contract award notices that have been published is 609 out of 609. For contract finder notices, it is 892 out of 913—97.7%—and of the redacted contracts to which the noble Baroness refers, it is 792 out of 913, which is 86.7%. That is an enormous proportion of the contracts that exist that have already been published. The redaction is utterly according to Cabinet Office guidelines. I encourage the noble Baroness to have a look at them; it is remarkable how much detail there is in those contracts as they are published.

[Baroness Brinton (LD) [V]]

My Lords, the inevitable public inquiry will eventually set out the truth of what has happened with contracts during the Covid pandemic. In the meantime, given that the Urgent Question Statement says that the Government

“have always been clear that transparency is vital”,

can the Minister say how many of the private meetings that the noble Baroness, Lady Harding, held on test and trace matters were with companies or their directors or staff who won contracts subsequently?

[Lord Bethell (Con)]

I do not know about a public inquiry; that will be for others to decide. I absolutely re-emphasise the Government’s commitment to transparency. As for my noble friend Lady Harding’s meetings, I do not have a full account of them in front of me, but I remind the noble Baroness that of course she met suppliers of test and trace. That is part of her role and that has been an important part of the engagement necessary to put together a very large organisation from scratch, and she has done a terrific job in the way that she has done it.

[Baroness Pidding (Con) [V]]

My Lords, crisis situations such as the present pandemic require action, not paper. Does the Minister agree that, during a national emergency, the British people want a Government who focus resources on saving lives over prioritising red tape?

[Lord Bethell (Con)]

I am grateful for my noble friend’s remarks. Absolutely—the public expected us to act, not to push paper. I pay tribute to officials from the Department of Health and in particular from the Crown Commercial Service and the MoD who stepped forward in unbelievably difficult circumstances, particularly around PPE, to transact on a very large amount of extremely complicated and very difficult procurements that ensured that our front-line healthcare workers were safe.

[Lord Young of Norwood Green (Lab) [V]]

My Lords, I declare an interest as I am on the advisory board of a local clothing manufacturing company in Haringey in an unremunerated capacity. Can the Minister explain why a high-quality SME capable of supplying reusable, RFID-tagged PPE gowns which can be laundered 70 times at a cost of 80p per wash—compared to disposable gowns which cost £10—and which are better for the environment and support local employment has not been given a contract?

[Lord Bethell (Con)]

My Lords, I personally share the noble Lord’s frustration over the subject of reusable gowns. It strikes me as sensible and good for the environment for us to be able to use reusable gowns wherever we can. However, those who do the procurement understand fully what is required of a fully sterile gown and, unfortunately, with the amount of moisture and liquids that are involved in operations and in the front-line healthcare service, quite often it is not possible to have reusable protocols in place. That is why we use so much disposable PPE kit. It is a huge regret to me, and I share the noble Lord’s frustration. If he would like to write to me with details, I would be glad to pass them to the right people.

[Baroness Warsi (Con) [V]]

My noble friend will recall the large number of offers made last year to assist the Government to respond to the pandemic, and he will be familiar in particular with the high- priority lane that was established for offers that came as recommendations from Ministers, officials and parliamentarians. This is not a party-political issue but, quite rightly, questions have been raised about the way in which the process gave preferential treatment to those connected to Ministers and indeed the Conservative Party, and about the quality of products contracted for. Can my noble friend therefore commit to an independent inquiry to ensure that public trust in public procurement using public funds is not severely damaged?

[Lord Bethell (Con)]

I completely and utterly reject the suggestion that priority was given to people who had connections in the right place. Priority was given to those who had plausible products that they were able to sell to us. I take this opportunity to thank in particular Ian McKee, the noble Lords, Lord Evans and Lord Hunt, and Richard Baker for their recommendations, which were picked up by the procurement team, put into the high-priority lane and made a valuable contribution to our efforts to get PPE.

[Lord Harris of Haringey (Lab) [V]]

The noble Lord told the House on 1 March that he was content to be in legal breach, as the ends justified the means. That is a very slippery slope for a Government. Was it acceptable for Sitel to ignore GDPR by instructing staff to put patients’ personal details on their private emails because their computer systems could not cope? If that was not justified, the implication is that it is only Ministers who are above the law. But if it was okay, does he accept that it gives a green light to every dodgy or crony contractor to enrich themselves by breaking or bending the law?

[Lord Bethell (Con)]

My Lords, the noble Lord’s imaginative reach is to be applauded. I will be absolutely categorical about what I said on 1 March. I never said that the ends justified the means or that I thought that Ministers were above the law. I always said that this Government champion transparency and that we would try to be within the law wherever we could be. I do not wish to make this point too many times: the public expect us to deliver safety for front-line workers, and that meant securing PPE. If we were a few days late on the publication of some contracts, then I think the public would definitely take our side in that decision.

[Baroness Redfern (Con) [V]]

My Lords, during the Covid-19 pandemic, the fundamental aim of government has been to save lives and to do whatever is necessary to continue saving them. At the beginning of the pandemic, only 1% of PPE was produced here, whereas nearly 70% is produced here now. Will the Minister assure the House that the Government will do all they can to support this newly acquired manufacturing base for PPE and not return to relying totally on imports?

[Lord Bethell (Con)]

The noble Baroness is right: it has been the most amazing turnaround—an achievement that has surprised me. This has absolutely turned on its head some of the assumptions about what Britain’s manufacturing base can achieve in terms of affordability, technical ability and return on investment. I am enormously proud of that achievement, and I can reassure the noble Baroness that we are absolutely doubling down on it. It has made us rethink our entire manufacturing strategy for medicinal, pharmaceutical and health products and medical devices.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, given that we are not now in an unpredictable emergency situation but in a long-term continuing pandemic, can the Minister reassure me that all treatments of future contracts will meet the legal reporting requirements and that the Government might even eventually publish the full structure of test and trace?

[Lord Bethell (Con)]

We absolutely endeavour to fulfil the Cabinet Office guidelines on the publication of contracts, and I can provide that reassurance to the noble Baroness. It is my understanding that the structure of test and trace has been published. I will look into finding a link to that and would be glad to send it to her.

[Lord McNicol of West Kilbride (Lab)]

My Lords, it feels a bit like déjà vu. The Minister complained on Tuesday about my use of rhetoric. At the end of this, he might wish that I had stuck to rhetoric rather than moving on to facts, so here are some facts. Fifty million facemasks could not be used as they did not meet the specifications: fact. Britain’s safety watchdog felt political pressure to approve the use of PPE suits: fact. One million hybrid masks were withdrawn as unusable: fact. There was contract inflation of 1,392% for the same product: fact. The Government have got this wrong, and I would simply ask: if they have nothing to hide, will they put all the facts about the contracts into the public domain?

[Lord Bethell (Con)]

My Lords, there was a global epidemic: fact. There was a breakdown in the global supply chains: fact. There was a need for PPE on the front line of healthcare: fact. We were prepared to do whatever it took to make people safe: fact.

[The Deputy Speaker (The Earl of Kinnoull) (Non-Afl)]

My Lords, the time allowed for this Question has now elapsed.

NHS: Pay

Lord Bethell Excerpts

Tuesday 9th March 2021 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government, further to the assumption set out in the NHS Long Term Plan Implementation Framework, published in June 2019, of a 2.1 per cent pay rise for National Health Service staff in the 2021/22 financial year, what plans they have to review their submission to the NHS Pay Review Body.

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

My Lords, our written evidence to the independent pay review body set out what is affordable. We have increased the size of the NHS workforce over the last decade and have committed a record-setting additional £33.9 billion by 2024-5 for the NHS to meet the rising demand for services. With strides being made in recruitment and retention, an enormous effort is under way to make the NHS a more inclusive and enjoyable place to work, with excellent well-being support for all staff.

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, the Government say that they cannot afford to give nurses a decent pay rise, yet they have managed to squander billions of pounds on management consultants, fly-by-night companies and friends of Ministers. The long-term plan built in a 2.1% pay rise for NHS staff next year; it was factored into the funding settlement and enshrined in legislation. It is one thing for the PM to be filmed applauding his appreciation for NHS staff, but no amount of clapping will help pay for rising living costs. Does the Minister agree that the Government should reverse this evidence and give staff in the NHS the increase they deserve?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I start by saying how much nursing staff and all healthcare staff are appreciated, not only by the Government but by the entire public. Of course we stand by that appreciation, and there is no way that the Government have anything less than the most enormous amount of appreciation for all those who have committed so much during Covid. On test and trace, I remind the noble Lord that that is an essential service which delivers value for money and, of course, pay increases are recurring and last for a long time. However, the evidence to the pay review body is clear: affordability is a key challenge for the whole country and we wait for the pay body to review that evidence.

[Baroness Brinton (LD) [V]]

My Lords, last year, at the height of the first lockdown, we on these Benches argued that all NHS and social care staff should receive a one-off payment from the Government as thanks from a grateful nation for their tireless dedication and sacrifice. Not only have they not received this but the Government are now reneging on this year’s pay rise as set out in the NHS 10-year plan. What on earth do the Government plan to do to retain and recruit staff after letting them down so badly?

[Lord Bethell (Con)]

My Lords, I am not sure that retention is necessarily the challenge that the noble Baroness suggests. There has in fact been a 26% increase in acceptances to nursing and midwifery courses when compared to last year, and 1,290 more applications were made in 2020 compared to 2019. The truth is that nursing is a challenging job but one that many people want to take up. There is a long queue of people who want these positions because they are rewarding in many different ways. We appreciate the contribution made by nurses and the whole healthcare sector, but there is no disguising the fact that these are attractive jobs, which many people wish to take up.

[Lord Balfe (Con)]

Does the Minister accept that it was not a 2.1% increase but a 2.1% addition to the bill, which included a number of emoluments that are added each year? It was not 2.1% for everybody; it was a whole package. The Government need to get their case across a bit better, particularly with what the Minister just said about recruitment. I suggest that the Government pay attention to getting their case across. As the Minister said, nursing, with its lifetime pension, is a very attractive proposition at the moment.

[Lord Bethell (Con)]

My Lords, the percentages are unbelievably complicated. It is difficult to stand by one single number to represent pay that goes to hundreds of thousands of different nurses under different circumstances. However, I agree completely with my noble friend. What is at stake here is not just one pay rise in one year but the entire package of circumstances in which nurses do their job. We are determined to ensure that that workplace package is as good as it can possibly be. We acknowledge that there are cultural challenges of working in the NHS, which we are fighting hard to improve. We recognise that training opportunities for nurses should be better and we are working hard to improve those. We recognise that nurses have little capacity for holidays, which is why we are recruiting a very large number of new nurses. It is the entire package that we are focused on, which is why we have put forward the affordability argument as we have.

[Lord McNicol of West Kilbride (Lab)]

My Lords, Ministers have time and again stated that supporting our nurses is a top priority but, as unions have pointed out, an offer that amounts to £3.50 per week looks more like a kick in the teeth than a top priority. I am sure there is one thing we can all agree on: nurses and other healthcare professionals have had to work in some of the most difficult, demanding and dangerous circumstances, and they have done so with astonishing care, compassion and commitment. The Government have got this badly wrong, and I urge them to reconsider their meagre, miserly, measly 1%.

[Lord Bethell (Con)]

My Lords, I reject the rhetoric of the noble Lord. We absolutely do support nurses, which is why we are focused on recruitment, training, culture and opportunities. It is not right to think that one pay rise represents the entire and sum contribution to the welfare of nurses. That is the response we get from nurses themselves, what the public understand, and what the Government’s guidelines are about.

[Lord Willis of Knaresborough (LD) [V]]

My Lords, could you imagine any employer, other than those of the sweatshops of the Far East, seeing their workers perform heroics to save the business and, in the process, the lives of millions of their clients, only to be rewarded by having their wages actually cut? Does the Minister agree with the Health Minister Nadine Dorries, who expressed surprise at the generosity of the Government’s offer, or with the view that a good employer would first offer a substantial bonus to its staff before taking time to negotiate a fair and sensible pay award? If we can pay a bonus to local publicans for sourcing easily obtainable files, surely a bonus to those who have saved our lives should be a no-brainer for this Government.

[Lord Bethell (Con)]

My Lords, I agree with the noble Lord on the point about heroics—we appreciate those—but I do not agree that this represents a pay cut. On the broad thrust of the noble Lord’s point, I gently remind him that millions of people are out of work off the back of this pandemic. Lots of people have had an extremely tough time and face a period of unemployment. Nurses are well paid for the job, which is a secure job, and they have other benefits. There are many people in this country who look upon professional jobs in the NHS with some envy; we should not forget that some public sector jobs are, in fact, extremely well-paid.

[The Lord Bishop of Worcester]

My Lords, I appreciate the immense, unprecedented and unforeseen pressure that the Government are under as they struggle with the devastating effects of the pandemic on public finances. At the same time, as has been noted, we all want to recognise the huge debt of gratitude that we owe to nurses and other health workers. Recognising that would best be done by a pay increase. We are told that a 1% increase is all that can be afforded. Can the Minister comment on whether he thinks tackling the estimated £2 billion lost annually through inefficiencies related to unnecessary A&E attendance and GP consultations might give more wriggle room?

[Lord Bethell (Con)]

My Lords, I completely endorse the right reverend Prelate’s point about the heroics of—and the debt that we owe—nurses, but I just cannot agree with him that the best way of recognising the contribution of nurses is to give them a pay increase. That simply is not my experience of workplace engagement. Yes, pay rises are important and a recognition of work done, but there are other, much more important reasons why people work. They work for the status of that role, for the opportunities that it gives them in their life, for the security that it gives them and for the collaboration of working with fellow members of staff. There is a whole package of reasons why people do the work that they do. We live in extremely economically challenging times. It is right that the advice given to the pay review body looks at the entire package, not just at the pay increase.

[Baroness Thornton (Lab)]

The Minister is quite right: it is not just about the 1% rise. A newly qualified nurse will earn £21,000 in 12 months; that is their starting salary. The consultants building the track and trace system, at £7,000 an hour, earn more than that amount in under four hours. Perhaps that will help the Minister understand why so many people are outraged at the proposed 1% so-called pay rise. Will he explain to the House what values and priorities he holds that lead him to believe that the Government’s decision is an acceptable one?

[Lord Bethell (Con)]

My Lords, the noble Baroness makes some vivid comparisons on completely incomparable pay differentials. The values that we have are absolutely aligned with public service values. We are determined to create a workplace that is just, fair and equitable. We are committed to giving people a fair reward for the work that they do and to giving people decent job prospects within that role. Those are the values that people go to work for and are motivated by. We need to put together a package that works across the piece and is not narrowly focused on one particular material point, such as pay. I stand by what I said previously: the package of measures that was put in our evidence to the pay review body sees all those values in the round.

[Baroness Jolly (LD) [V]]

My Lords, for the last 10 years NHS pay has lagged behind inflation. Year on year, health professionals have had less to spend than they had the previous year, and the 1% pay rise does not help as inflation removes any increase. Apart from the moral case put by noble Lords, this is not good economics. If people are paid more, they spend more by putting cash back into the economy. Will the Minister ask the Chancellor to look at this again?

[Lord Bethell (Con)]

My Lords, I am at a slight disadvantage because I am not quite sure that I can substantiate the noble Baroness’s view that pay has lagged behind inflation. Her economics lesson is extremely interesting but not one that the Chancellor is necessarily persuaded by. Where she is entirely right is that pay is an important aspect of any recruitment campaign by the NHS, and that is why we have put recruitment at the heart of our commitment to it. That is why we are recruiting 50,000 nurses and making a very large number of GP appointments. We are seeing huge gains in achieving those targets, which reflects the fact that there is not a massive or structural misalignment in our pay arrangements.

[Lord Sikka (Lab) [V]]

My Lords, the Government paid consultants up to £7,000 a day for advice on test and trace but nurses risking their lives are offered less than £1 a day. Does the Minister agree that this contempt for nurses is disgraceful because a higher award can easily be funded? For example, taxing capital gains in the same way as earned income can generate additional tax revenues of £14 billion a year.

[Lord Bethell (Con)]

I am grateful for the economics lesson from the noble Lord. I will take those recommendations and pass them on to colleagues at the Treasury.

[Lord Scriven (LD) [V]]

My Lords, the £37 billion found for the predominantly private sector-led test and trace system equates to spending more than £1 million every day for the next 100 years. How does the Minister reconcile that with the statement that the Government cannot find the money to fund more than a 1% pay increase for front-line NHS staff?

[Lord Bethell (Con)]

My Lords, the test and trace system is part of an essential response to a virus pandemic that has shaken the world, and the costs of that pandemic are enormous. I regret them very much and wish with all my heart that we did not have to spend this money on our pandemic response, but there is no other way of cutting the chains of transmission and responding effectively to this awful disease. The ongoing pay arrangements for nurses and doctors are commitments that we will live with for years to come, and there is a difference between the two.

[Lord Harris of Haringey (Lab) [V]]

My Lords, I should declare that my wife works in the NHS. Does the Minister agree with his ministerial colleague Nadine Dorries that the 1% settlement is generous because it is better than a pay freeze? Nurses get maybe 70p a day while billions are wasted on crony contracts and £200,000 is being spent on titivating a Downing Street living room, replacing decorations that are barely three years old. Does the Minister—or the Chancellor, for that matter—have any idea what living on £25,000 a year is really like?

[Lord Bethell (Con)]

My Lords, I cannot hide from the noble Lord the fact that across the public sector there is a pay freeze. The only area that that does not apply to is the NHS, a point that I think my colleague made very thoughtfully. I remind the noble Lord that many in the private sector have lost their jobs and prospects altogether and that there is a massive economic challenge on the horizon. We fool ourselves if we close our eyes to that and regard the public sector as somehow sacrosanct and immune to the larger economic challenge.

Women’s Health Strategy

Lord Bethell Excerpts

Tuesday 9th March 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, the warm words in this Statement regarding women’s health inequalities are certainly a start, but there is so much to do. Many of us in your Lordships’ House have been working on the Domestic Abuse Bill, where looking at access to health and mental health support for victims—the vast majority of whom are women—has exposed that there is a major problem.

Mental health has been brought into sharp relief, as the noble Baroness, Lady Thornton, has already said. But we know that it has been underfunded, and services pre- pandemic were already at breaking point. The pandemic has really exposed these shortcomings. What are the Government going to do to provide that parity of mental health services they committed to in 2015, which women in particular are finding difficult to access?

The Statement talks about women’s experiences of specific services. For pregnancy and maternity support, the pandemic exposed that, for far too long, pregnant women have been isolated and their partners not permitted to be with them. My own niece had a baby during lockdown and was not particularly well. When she went in for her weekly tests, not knowing whether she would have to stay in until the birth, her husband was not allowed into the hospital with her until she was actually in the delivery suite. That caused tension for far too long.

We have also seen that the vital role of health visitors and community nurses, which has been curtailed somewhat, is absolutely evident when they are not there. Community services for young mothers are really important, and I hope the Government will look at that.

The Statement talks a lot about endometriosis. I was diagnosed with endometriosis well over 40 years ago. I am pleased to say that treatment in hospitals has advanced considerably since those days. But what seems not to have changed is diagnosis and referral. I ask the Minister this: what support is there to train all GPs, primary care nurses and employers to recognise when women have these problems? They should not be dismissed as “a bit of a bother” because all women have a problem at that time of the month. It is not just an information issue for women themselves to recognise it. We need the professionals and the business community to understand that endometriosis is a very serious illness.

The Statement notes that

“77% of the NHS workforce and 82% of the social care workforce are women”.

They are absolutely on the front line but too often have been let down. Despite that enormous ratio of women in the workforce, there are still pay gaps—certainly at a higher level. It would be interesting to see the publication of the percentage of male and female staff at each level and for all trusts and CCGs to publish their pay gaps on an annual basis, as we ask large companies to.

We also know that a higher percentage of BAME women were at risk of serious Covid and death. This was particularly amplified for our front-line NHS and social care staff.

I echo the points raised by the noble Baroness, Lady Thornton, about caring responsibilities. It is not just about care for children who are home from school. The pandemic has brought into sharp relief the unpaid carers of adult family members. I would like to make a call out, and I hope the Minister will support me: when it is time for every one of us to fill in our census form in 10 days’ time, please will unpaid carers tick the box saying that they are carers? We need to know how many people out there are doing this. We know that the majority of them are women.

The Statement talks about issues facing women with disabilities. Yesterday, it was wonderful to see a series of tweets from disabled women about their lived experiences in our society. Some of it, especially on access to health services, was pretty depressing too.

Women with learning difficulties are also often at the end of the queue for health treatments. Ciara Lawrence, who is a Mencap ambassador, is an absolute shining example of how women with learning difficulties can get access to those services. She went for her cervical smear test a year ago. Since then, she has not only been promoting it among other young women with learning difficulties but is teaching the NHS how to work with women with learning difficulties to encourage and support them to have their tests. Women with learning difficulties also say that access to family planning services can often be harder too. Will the Government make sure that these issues for this group of disabled women are addressed?

The paper refers briefly to LBGT women, who also face particular difficulties in accessing services throughout their adult lives. What will the Government do to reach both these groups? I note that, towards its end, the Statement talks formally about working with women’s organisations, but so much will be missed if women who also have other protected characteristics—and their organisations—are not specifically asked.

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

My Lords, the noble Baronesses, Lady Thornton and Lady Brinton, have both made their points incredibly well, and I will not argue the toss about any of them. I completely acknowledge that Covid has hit women harder than men, for all the reasons that the noble Baronesses have given—I could have listed even more. Women who have worked from home have undoubtedly shouldered more of the burden and done more of the teaching, and that has led to adverse mental health outcomes. Those outcomes are a real struggle for a health system to cope with when it is trying to deal with social distancing. We have done our best, using telemedicine to try to bridge the gap, but there is a shortfall and we will have to work extremely hard to catch up. I know from my own experience the challenge that young girls in particular have felt during Covid, and the statistics confirm that.

I agree with the observation made by the noble Baroness, Lady Thornton, about IVF—it has been extremely tough. It has been hard for the HFEA to restart clinics, and there are women for whom the clock is ticking who have no other options. We have worked really hard to try to meet the practicalities of that service but there has been bad news for some people. That is felt very hard indeed.

The noble Baroness, Lady Brinton, spoke very movingly about pregnant women whose partners had not been able to be there for the scan. There are sometimes good reasons for that because the scanning equipment may be in the basement of airless diagnostics rooms where social distancing is not possible and the risk assessment is very tough. That does not detract from the fact that that has massive and distressing mental health consequences.

The noble Baroness, Lady Thornton, mentioned baby loss. There are many aspects to this. Bluntly, deaths during Covid hit all of us hard but women in particular. The noble Baroness spoke movingly of making grief an aspect of health planning; that is a good point, well made.

I completely accept the point made by both noble Baronesses that this plays into a long-term problem—it is not isolated or new. The review by my noble friend Lady Cumberlege paints a very clear picture of a defensive and siloed system that does not always do well for women; the culture is not always right and the practicalities do not always suit women’s lives and women’s bodies. The clinical trials regime has too often suited men. I will not defend every point that the noble Baronesses have made but I pay tribute to those who ran the clinical trials for the vaccines and did an enormously good job of recruiting women and getting a gender balance in those very important trials.

The noble Baroness, Lady Brinton, is, however, also right about data: too often it is skewed towards men. She mentioned in particular data about LGBT and disabled people and the importance of the census, which I completely endorse. But I know from my own work in the data area that too often our data is skewed away from those who belong to gender, disability or ethnicity minorities. The critical example—the one that is quite rightly often cited—is heart attacks, where the male symptoms are cited and the female symptoms are not. That is such a graphic and good example.

The noble Baroness, Lady Brinton, is right to raise pay gaps and representation, as is the noble Baroness, Lady Thornton, to cite the treatments for breast and cervical cancers, which have not always met the need.

I will not defend each and every one of these points. I would like to convey, however, the strong sense that we are trying to get one thing right in particular: listening. Anyone who reads the Cumberlege report, or speaks to my noble friend, will be struck by the really powerful testimony of patient groups who said that what agitated them most—more than almost anything else—was the feeling that they were not listened to. That has many effects, but two in particular. One is that we do not hear the symptoms and diagnostics: we get the health recommendations wrong because we were not listening. The emotional consequences of illness are, therefore, amplified. People feel frustrated and agitated because they can tell that they are not being listened to. We are absolutely determined to get that right.

This is a big exercise—bigger than the mental health exercise, because we have opened it up to the general public. We have had a phenomenal response, even in the day that it has been open, with more than 2,000 responses from the general public—a figure that I expect to grow dramatically.

We want to ensure that this exercise rights the wrongs because we really listen to women: we give them a platform and an opportunity to be heard and our response will be judged by whether we have truly listened to what we have been told.

I urge all noble Peers to put their evidence before the commission. We want a really good response that is truly diverse. There is always an anxiety in these situations that the groups with the loudest voice will predominate, but we are determined to make this evidence-gathering as diverse as possible. So I call on all in the Chamber to submit their evidence and encourage and enable those who have something to say to use this opportunity with vigour.

--- Later in debate ---

[Lord Farmer (Con)]

My Lords, I have constantly argued against the lack of emphasis on prevention in the Domestic Abuse Bill and have been assured that the domestic abuse strategy and guidance will fill that gap. Domestic abuse disproportionately affects women’s mental and physical ill health, so will the new women’s health strategy prioritise its primary prevention, rather than, as usual, simply addressing its terrible harms?

[Lord Bethell (Con)]

I pay tribute to my noble friend for his campaigning on this important cause. It is not the specific focus of the health strategy but it will play a part in it, and I encourage my noble friend to submit the characteristically detailed evidence, for which he is so well known, to this important evidence-gathering process.

[Lord Kakkar (CB) [V]]

My Lords, I draw attention to my declared interests. In taking forward an initiative for clinical research as part of their G7 health agenda, how do Her Majesty’s Government propose to ensure alignment of the clinical research regulatory framework so that the approval of innovative devices and therapies is predicated on clinical trial and registry methodologies with appropriate representation of women, including those from ethnic minorities?

[Lord Bethell (Con)]

The noble Lord makes a really good point. I am not sure whether we have considered the gender aspect of the clinical trials work programme in our G7 agenda. It has been very much about pandemic-preparedness and ensuring that next time we are able to share clinical trial information. Of course, we pat ourselves on the back for our own vaccine clinical trials in the UK, which, I think, have met a new standard for gender representation. He makes a good point, however, about making that case in our G7 work programme, and I will take it back to the department for further consideration.

[Baroness Andrews (Lab) [V]]

My Lords, I welcome the consultation and hearing women speak for themselves. It is very encouraging that there has been such an immediate and very positive reaction. We have known for a very long time that health inequalities affect women specifically and disproportionately, and we can take action without necessarily waiting for the consultation—for example, the 2018 BMA report on women’s health showed that even women’s life expectancy had deteriorated, and it recommended changes in medical training and education. As the Minister says, getting this consultation right is a big challenge, but can he assure me that, however challenging it is, the findings will be heard, followed up, acted on and invested in?

--- Later in debate ---

[Lord Bethell (Con)]

I reassure the noble Baroness that we are committed to getting this right. The Minister of State and Secretary of State are both very committed to this agenda, and the whole healthcare system has tuned in to the importance of getting this right. I pay tribute to some of the fantastic women whom I have worked with during the pandemic at the highest levels of the healthcare system. I will not do a rolling name check now, but I reassure the noble Baroness that there are some phenomenal female leaders at the top of the NHS, social care and science, who will, I am sure, personally drive this agenda forward.

[Baroness Jolly (LD) [V]]

My Lords, the Statement yesterday addressed “taboos and stigmas” around areas of women’s health, and the greatest of these must be FGM, which was not mentioned yesterday. In the year to March 2020, there were over 6,500 women and girls in whom FGM was identified: that is over 15 women a day that we know about. How do these girls and women fit into the national strategy?

[Lord Bethell (Con)]

My Lords, we are of course drafting the national strategy, and we are collecting evidence on what its priorities should be. Undoubtedly, FGM should be in there; it is the most horrific crime, and it still touches far too many girls’ and women’s lives. I would like to see this country rid of it forever as soon as possible, and I encourage the noble Baroness to submit evidence on that point so that we can move clearly on it.

[Lord Bourne of Aberystwyth (Con) [V]]

My Lords, the Statement rightly identifies the concern of mental health. Given the particular challenges experienced by women in the pandemic, from domestic abuse and disproportionate job losses to increased caring responsibilities, I ask my noble friend to give special focus to this area of research. I also applaud addressing the need for proper representation in the research programme of women from ethnic minorities, including from the Gypsy, Roma and Traveller communities .

[Lord Bethell (Con)]

My Lords, my noble friend touches on two very important points. He is entirely right that mental health has previously been underrepresented in the strategies of our healthcare. I hear loud and clear noble Lords who repeatedly make the case for a greater focus on mental health, and I take that message back to the department as much as I can. I reassure him that mental health will be very much a priority in this area. The two facts—that it is often women who are connected with mental health issues and that it is women who are often overlooked—are probably connected. It is extremely challenging for us to get women from ethnic minorities, for instance those from a Gypsy or Roma background—that is such a good example—fully engaged in our healthcare strategy. If the noble Lord has any suggestions or recommendations for how we can better engage with them, I invite him to submit evidence to the consultation.

[Baroness Blackstone (Ind Lab)]

My Lords, I draw attention to my interests as chair of the trustees of the Royal College of Obstetricians and Gynaecologists. I warmly welcome this Statement, but we know that women’s healthcare is too often fragmented and unco-ordinated. So how will the Government ensure that their different strands of work on women’s health—this strategy, the sexual health strategy and the violence against women and girls strategy—are all properly aligned and based on a life course approach to women’s health, avoiding the creation of even more fragmentation for women?

[Lord Bethell (Con)]

My Lords, the question of fragmentation does not affect women alone; it is a problem across the healthcare system. However, the noble Baroness is entirely right: some of the conditions that afflict women in particular are not properly prioritised, and, therefore, the pathways connected with them are not as developed as they should be. That is the kind of challenge that we wish to address. However, the overall macro point is this question of listening: have we really listened to women—their symptoms, needs and health priorities—or are we behind the curve on that? I suspect that, too often, the health priorities that women would like to see emphasised simply have not been heard by the system.

[Lord Wigley (PC) [V]]

My Lords, I draw attention to my registered interest as a vice president of Mencap. In presenting this Statement to the House of Commons yesterday, the Minister stressed that the inquiry that the Government is initiating will specifically include disabled women and those with mental health issues—something that I greatly welcome. Will the Minister confirm that this group will also specifically include, in their own right, women who have learning disabilities, because they are disproportionately vulnerable to illnesses that have no relationship to their disabilities, which places them in potential double jeopardy and needs to be addressed in its own right?

[Lord Bethell (Con)]

Yes, I can reassure the noble Lord that the call for evidence is open to everyone aged 16 and over, which, of course, includes people with disabilities and learning disabilities. The online survey within the call for evidence specifically mentions disabilities throughout, and I reassure the noble Lord that the evidence that we gather with regard to disabilities and learning disabilities will be considered extremely carefully to inform the priorities, content and actions of the strategy.

[Lord Lucas (Con) [V]]

My Lords, should we be looking at leveraging the great success that we have had in developing online medicine during the pandemic to provide women with unmediated, immediate and direct access to specialist services on chronic issues such as menstruation, menopause problems and so on? After all, this is a structure that we have used successfully for many decades for eyes and teeth, and it is one that might also suit the trans community.

[Lord Bethell (Con)]

My Lords, as Minister for Innovation I favour using technology and the latest techniques wherever possible to provide options and choices for all patients, including women, to address their conditions. With women, the delicate question of their bodies, and the different functioning of their bodies to men’s, is one that the health system has to reconcile itself to. I do not regard technology as a panacea to that central challenge; in fact, I think that many of the issues that women face will require face-to-face consultations, and we remain committed to ensuring that that is an option for everyone.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, I will not ask the Minister whether he has read Invisible Women by Caroline Criado Perez—or the medical chapter at least—but, if he has not, I would recommend it. One of the things that it highlights is how many widely and long-used drugs have never been tested for any sex and gender variations in responses. Do the Government have a systematic programme for checking that all drugs have been so appropriately assessed—so that, when the results of this call for evidence are received and acted on, appropriate treatments are available to the newly enlightened medical systems?

[Lord Bethell (Con)]

My Lords, I have previously referred to the challenge of gender-comprehensive clinical trials. There is growing evidence that drug prescriptions should be personalised a great deal more than they are, right across the board—not just on a gender basis but on genomic, ethnic, age and weight bases as well. The noble Baroness makes an extremely good point on this. I cannot guarantee that we will retrospectively conduct gender-specific clinical trials on the full library of medicines in the medicine cabinet, but we are keen to aspire to ensuring a future commitment to gender-specific clinical trials going forwards.

[Baroness Stroud (Con) [V]]

My Lords, in the ministerial foreword to the Women’s Health Strategy, the issue of data gaps has been highlighted. One such data gap I would like the Government to look at is the way in which abortion complication data is gathered. The Minister in the other place confirmed in a recent Written Answer that the only method the department uses to gather this data is via HSA4 forms. Between April and June 2020, from the 23,000 at-home abortions, these forms reported just a single complication, yet FOI requests to just six hospitals during the same period suggested that women were presenting due to complications at a rate five times higher than that reported by the Department of Health and Social Care. Moreover, there were 36 999 calls due to at-home abortion complications every month to the ambulance service. As part of the Women’s Health Strategy, will this gap be addressed, and does the Minister agree that the number of women who present to hospitals due to incomplete abortions requiring surgery or retained products of conception should be collected centrally?

[Lord Bethell (Con)]

My noble friend makes her case extremely powerfully, and the numbers she cites are extremely persuasive. I do not have a full brief on the treatment of abortion complication statistics at my fingertips, but she alludes to exactly the kind of data gaps that we wish to address in this consultation period and in the emerging strategy. If she would like to submit the evidence she has just described, we will definitely take it on board and use it as part of our strategy-drafting exercise.

[Baroness Ritchie of Downpatrick (Non-Afl) [V]]

My Lords, participants in clinical trials for breast and ovarian cancer not only take the medication as part of those clinical trials, whether they are double-blind or whatever, but give information about their genomic background and their ongoing assessments. Would it be possible, subject to their permission, to use that information from women as part of the strategy for updating and improving women’s health?

[Lord Bethell (Con)]

The noble Baroness is way ahead of me on that extremely specific point. I would be very happy to understand it more clearly, and if she could write to me with the details, I would be happy to take it on board.

[Baroness Warsi (Con) [V]]

My Lords, I welcome the Statement and particularly its commitment to ensure that all women’s voices are heard in setting out the health strategy, so can my noble friend confirm what platforms will be used to publicise the call for evidence and what languages it will be promoted in? Particularly in communities where the spoken word is more popular than the writing down of experiences, what efforts will be made to allow women to contribute to this call for evidence via face-to-face interviews, albeit virtually?

[Lord Bethell (Con)]

My Lords, we are largely inviting written submissions from individuals and organisations with expertise in women’s health. It is envisaged that this could largely be done either by individual researchers, royal colleges, think tanks and third sector organisations, as well as the general public. There is an online platform and the online survey accommodates screen reader support, allowing for questions and answers be rendered in other formats, such as spoken language or Braille output. I accept the thrust of my noble friend’s point that we need to do enough to reach ethnic minorities and those from hard-to-reach populations, who should have a voice in this kind of exercise. Let me take that point back to the department and I will write to her accordingly.

[Baroness Stuart of Edgbaston (Non-Afl) [V]]

My Lords, I welcome the Statement and I welcome what the Minister said earlier in response to a question about FGM. I know from the work done in Birmingham hospitals that the problem is probably much wider than any of us appreciate. At the end of this consultation, if the Minister finds that, in some areas where we asked for data, the data was not forthcoming, but we know we ought to seek more data and more information, will he undertake to do so to identify problems where part of the problem is that they are still very much hidden?

[Lord Bethell (Con)]

This debate is, unfortunately, not the place for me to be able to make that sort of commitment, but I completely take on board the point that the noble Baroness makes. There are hidden crimes in our communities and we cannot sit back and wait for them to present themselves; we have to go and find the evidence in order to meet the challenge. I am sorry to repeat this point, but I invite the noble Baroness to make this point in her evidence to the consultation. It is exactly that kind of insight that we are seeking to elicit, and the strategy is exactly the right platform for us to be able to make those kinds of points.

World Health Organization: Pandemics

Lord Bethell Excerpts

Tuesday 9th March 2021 Lords Chamber

[Lord Crisp]

To ask Her Majesty’s Government what plans they have to strengthen the role of the World Health Organization to support the management of future pandemics.

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

My Lords, the UK is a strong supporter of the WHO and an advocate of reform to ensure that it further strengthens its ability to respond effectively to health emergencies. The UK is taking a leading role on reform through our seat at the WHO Executive Board and our G7 presidency. We are working with international partners to push for a stronger early warning system, reduced risk of zoonotic diseases through better surveillance and improved compliance with international health regulations.

[Lord Crisp (CB) [V]]

My Lords, I am delighted that the UK Government are providing support to the World Health Organization, contributing to COVAX and taking this very important role of reform. Further to the Independent Panel for Pandemic Preparedness and Response report, which talked about the World Health Organization being

“underpowered to do the job expected of it”,

will the Government ensure that this is discussed at G7 and that the world will commit to doing whatever it takes to ensure that the WHO is able to respond even more effectively to pandemics in the future?

[Lord Bethell (Con)]

My Lords, the Government are extremely committed to pandemic preparedness. We support the principle of a pandemic preparedness treaty, and we have laid out at UNGA a very clear programme for enhancing global pandemic preparedness. We look forward to the publication of the Independent Panel for Pandemic Preparedness and Response report shortly, and I reassure the noble Lord that this is top of the agenda at our G7.

[Lord McColl of Dulwich (Con) [V]]

Does the Minister agree that the WHO could support the management of future pandemics now by organising a worldwide vaccine passport? People are very keen to travel, and this would help the travel industry and could act as an incentive to those who are reluctant to take the vaccine.

[Lord Bethell (Con)]

My Lords, I share the noble Lord’s passion for international travel. Like him, I cannot wait for global travel to restart. I also see the connection between the promise of a vaccine certificate of some kind and taking up the vaccine itself. Plans for vaccine certificates for global travel are emerging as we speak. We have a Cabinet Office programme which is co-ordinating across government initiatives on vaccine certification, and a review is in progress which will pronounce shortly.

[Baroness Finlay of Llandaff (CB) [V]]

[Inaudible]—excellent record in research, are the Government able to work through the WHO to promote research into recyclable PPE to avoid the environmental hazard of an enormous pile-up of plastics and discarded PPE? Can the Government work on a public education programme of basic hygiene, with clean water and soap available across the world, so that the very basic principles of hygiene can be maintained?

[Lord Bethell (Con)]

My Lords, the environmental consequences of the pandemic are indeed severe, as the noble Baroness rightly points out. We are working with colleagues in Defra to try to figure out answers to this tricky problem of the legacy of all this PPE. With regards to hygiene education around the world, we have a number of programmes in place, through ODA and our various international development plans, and hygiene is very much at the centre of those.

[Lord Judd (Lab) [V]]

My Lords, has the pandemic not brought home almost more powerfully than ever before the total interdependence of the global community? Therefore, are the international institutions such as the WHO and other specialised UN agencies the only way that we can have a sane future for society as a whole? We cannot forge that on our own as an island. We played a distinguished part in the role of developing organisations such as the WHO in the past. Can the noble Lord reassure us that it is not just a matter of saying that we have priorities and commitments but of ensuring that the whole culture of government looks towards strengthening international institutions such as the WHO?

[Lord Bethell (Con)]

I completely agree with the noble Lord. A multilateral approach is at the heart of our response to the pandemic, and I agree that we are not safe here in the UK until the whole world has addressed the question of the pandemic.

[Baroness Brinton (LD) [V]]

My Lords, the World Health Organization recommends regular handwashing as a critical preventive measure against Covid-19, but 3 billion people worldwide lack access to soap and water at home. The UK’s Hygiene and Behaviour Change Coalition responded to the onset of the pandemic with a £100 million commitment to reach a billion people, but this project is now ending. It is wonderful to have the Government’s support for this project, but will they put their money where their mouth is and continue to fund this vital project?

[Lord Bethell (Con)]

My Lords, I am grateful to the noble Baroness for her tribute to the Hygiene and Behaviour Change Coalition. I cannot offer guarantees from the Dispatch Box on its future funding, but I will inquire about the matter. As the noble Baroness suggests, it sounds like a fascinating and important project.

[Viscount Ridley (Con) [V]]

My Lords, after last month’s embarrassing Potemkin investigation of Wuhan, will my noble friend the Minister ask the WHO to insist that the Chinese Government release the genome sequences of eight bat viruses of the so-called 7896 clade held in the Wuhan Institute of Virology database that are known to be very closely related to SARS-CoV-2 and may hold critical clues, but which they refuse to release?

[Lord Bethell (Con)]

My Lords, we are extremely hopeful for the IPPPR process, and we have supported the team in its desire to get to the bottom of its investigations. I do not know the specifics of the bat viruses to which my noble friend refers, but I reassure him that the British Government are leaning on the WHO as hard as we possibly can to make the most of this important investigation.

[Baroness Thornton (Lab)]

Given the cuts to the aid budget which have been announced, and given that experience shows that the world’s reaction to pandemics is to panic and then forget—which Covid-19 has cruelly exposed—can the Minister expand on how HMG are going to support the World Health Organization to address the immediate urgent work to fight the pandemic and to build for the future the firepower and structure to better handle an issue of global magnitude under the Government’s current budget constraints?

[Lord Bethell (Con)]

My Lords, the financial support of the WHO from the Government is generous, and so is our support of COVAX. When it comes to the WHO, we are looking for stronger horizon scanning and early warning, higher-quality technical guidance that is tailored to different countries and resource settings, and greater co-ordination of governance and activity across the animal, human and environmental interface. This is a really clear manifesto. The Prime Minister has laid it out clearly, and we are using the G7 process to ensure that there is support for it across the G7 countries.

[The Earl of Sandwich (CB) [V]]

My Lords, do the Government fully recognise that most of the poorest countries, even states such as Vietnam, are still coping without any vaccinations? Does the Minister agree that much more attention must be paid to the support of local health services in the least developed countries? They are easily bypassed when there are major international health campaigns.

[Lord Bethell (Con)]

The noble Earl refers to the important role that the WHO plays. Of course, we are all frustrated sometimes with our multilateral organisations, but the noble Earl quite rightly alludes to the dependence that many countries have on the advice, counsel and practical support that organisations such as the WHO provide. That is why we want the WHO to step up to its responsibilities, why we have instituted a major reform programme recommendation, and why we are extremely hopeful that the WHO steps up.

[Lord Mann (Non-Afl)]

Will the WHO have a specific input and a direct voice in the G7 deliberations?

[Lord Bethell (Con)]

My Lords, the WHO is not a sitting member of the G7, but we have a representative attending our health track in Oxford, and we have been in dialogue with them directly with our agenda on the G7.

[Baroness Browning (Con) [V]]

The WHO website officially states that, on 30 January, it declared a public health emergency of international concern. It claims that not many countries took much notice and that it was not until it used the word “pandemic”, on 11 March, five weeks later, that people sat up and took notice. This is clearly unsatisfactory. Will my noble friend do all that he can, as I hope he will, to ensure that the system of notification is improved at the earliest opportunity?

[Lord Bethell (Con)]

My Lords, my noble friend is right in her chronology, but we want the WHO to continue to learn lessons on how to improve its response to global health emergencies in the early stage. The delay in that global response is something that the WHO needs to learn from.

Covid-19 Update

Lord Bethell Excerpts

Thursday 4th March 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, from these Benches we, too, congratulate everyone involved in the vaccination process, including our brilliant teams of scientists, both in this country and abroad, who have been working—and continue to work—tirelessly on safe and effective vaccines for the world. We also congratulate the teams who are organising and managing the supply chains and all of those on the front line delivering jabs in arms, or supporting them to make it possible to reach the target of 20 million doses achieved this week. We will also not forget everyone working on Covid at the moment, whether front-line staff in health and social care or back-office staff who may not be visible to us but who are making sure that all these processes are working. We thank them all.

It is reassuring to hear that the second jab supply chain has been factored in, but can the Minister please tell the House if the supply chain and vaccination dose capacity is also protected for the next priority groups due to receive their first dose? This is critical to lifting lockdown.

It is good news that the clinical trials under way since before Christmas are demonstrating that the over-80s are developing good antibodies to resist the coronavirus and that this is now evident in the data. It is fascinating to see the vaccine gap in graphs, showing that there is a much steeper decline in cases in the over- 75s than there is in the under-60s. It is also encouraging to see reports that there have been very few side effects to both the AZ and the Pfizer vaccines. Can the Minister say if this information will be used to encourage those who have so far refused their first dose?

The Octave trial, funded by the Medical Research Council, is now under way, assessing whether those people with compromised immune systems are able to make antibodies. It was reassuring to read the details of this trial from some participating universities and university hospitals and I am grateful that Professor Chris Whitty was able to outline this project in a briefing to parliamentarians recently. I had understood it to be well under way already, although the press release makes it sound as if it is much more recent and still recruiting. Can the Minister say when the Octave trials are likely to publish their results, given that many people currently shielding are anxiously waiting for them?

The Statement refers to the Brazilian P1 variant and to the case of the individual who had not completed their form correctly. There has been silence over the last couple of days, and I wondered whether the Minister could update the House on the search for this individual. As I raised earlier this week, can the Minister help the House to understand why such an issue was able to happen at all? Is it correct that there are no processes in place to ensure that, as people come into the UK, border agency staff check their passports against the online forms completed in advance, so that personal details, such as addresses, are visible? The noble Lord, Lord Balfe, made it plain—as have many others travelling into the UK—that these checks are rarely made, if at all.

Is it correct that local health and resilience forums are not given any details of people quarantining in their areas? This is important to ensure that care support teams would be able to check and provide help for those quarantining if they have any concerns. That might have helped with this particular case: a traveller from Brazil feeling unwell would have had a local contact to talk to about what to do.

Finally, as we wait to see if cases, hospitalisations and deaths have reduced enough to start lifting lockdown carefully in April, can the Minister respond to the report published today showing that test and trace has barely used the check-in app data from visitors to pubs, restaurants and hairdressers, resulting in thousands of people who have been checked in not being warned that they might be at risk of infection? The report states that the Department of Health and Social Care has noted that more than 100 million people have checked into venues since it went live in the autumn, but only 284 alerts have been sent to 274 venues—not 274,000 venues, just 274. Worse, the report says that the lack of guidance for local resilience forum trace teams on how to use the data has left businesses being asked to, or volunteering to, contact customers and visitors, which is technically a breach of GDPR and leaves those businesses and venues open to potential legal challenge.

After spending £40 million on the contact tracing app, encouraging the public to act responsibly, and the department saying today:

“The NHS COVID-19 App is an important tool in our pandemic response”,


can the Minister tell us which of these statements are true? Can he confirm that the guidance given to local authority health departments on how to use the data to notify people from the app is in full compliance with GDPR legislation? Is the figure of only 274 venues receiving alerts correct—yes or no? What steps are the Government taking to remedy this before pubs, restaurants, hairdressers and non-essential retail begin to open again?

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

My Lords, I am enormously grateful for the questions from both the noble Baronesses, Lady Thornton and Lady Brinton. I start by echoing both their tributes to those involved in the rollout of the vaccine. It is a remarkable national achievement and we should all be enormously proud. My own wife was vaccinated last week, and she told me that she cried as she left the GP’s surgery—so moved was she by the experience. That is something I have heard many times before.

The noble Baroness, Lady Thornton, paid tribute to all those involved in science and research, and I absolutely agree. This has been a remarkable moment for British science. We will start celebrating British Science Week tomorrow, and I cannot think of a more apt moment to do that.

The noble Baroness, Lady Thornton, asked about the highest number of deaths. There are a number of reasons. Before I move on, I mention that today is World Obesity Day, and one of the most telling pieces of research that has come out in recent weeks is the work of PHE. We must all reflect on the nation’s health and whether obesity has played a role in Britain’s higher incidence of mortality. I look forward to reflecting on this issue more in the future.

The noble Baroness, Lady Thornton, asked directly about the decisions that the Government have made, test and trace, and the borders. Let me tackle those head on. On the decisions that the Government have made, I share with the Chamber that the road map announced by the Prime Minister has landed extremely well. It is extremely conservative. It puts school openings first, which is undoubtedly the feedback we have had from both parents and the country at large. The easing of measures for the rest of the economy and civic activity is based entirely on the data that emerges from the infection rates and will be done in a way that contains the spread of the virus.

I reassure the noble Baroness that the test and trace operation has developed remarkable capacity, and both the turnaround times for the testing and the effectiveness of the tracing have now emerged as being fantastic. The tracing of the Brazilian variant pays tribute to the effectiveness of the test and trace operation, as does Project Eagle, which has been mainly focused on the South African variant. We believe that the spread of the South African variant has been largely contained by the tracing of the Project Eagle team working closely with local authorities and infection control teams around the world. It shows what we can do with this remarkable resource.

With regard to borders, the “red list” and managed quarantine system has been stood up in an extremely effective way. The families in south Gloucestershire and Aberdeen isolated themselves, as they should have done, and the handling of their variant of concern has been professional. I am led to believe that progress is being made on tracking down our Brazilian friend, the one stray person with the disease.

In answer to the question of how someone could have a test without filling in the form, we believe that there are two ways in which that could happen. Someone could walk up to a testing site, have their test but not fill in the form properly, or they could have had the test sent to them in the post and returned it without filling in the correct form. There are lessons to be learned from both potential models, and we are communicating with those who provide tests to ensure that barcodes are put on all tests.

We have to run a risk-based analysis on cross-infection at airports and infection control within airports. We could close all airports—that could be one way of doing it—but, under the circumstances, I applaud both the airlines and the airports for putting in mitigation and hygiene measures which the CMO’s office believes will be effective.

The noble Baroness, Lady Thornton, asked about sequencing. We have stood up an enormous amount of new sequencing—30,000 samples a week is our current capacity—and we have dramatically reduced the time it takes to do sequencing. The biggest problem with that is transporting the samples around the country, and therefore we are looking at distributing sequencing capacity to the Lighthouse laboratories so that once a sample tests positive, it can be automatically taken to a plate to be sequenced at the same location. We believe that that could make a big impact.

One lesson from Project Eagle I share with the House is that door-to-door tracing is quite effective, but by far the most effective means of tracing has been intelligence-led tracing. The noble Baroness, Lady Brinton, asked about the check-in data, and this has been its power: it has allowed us to trace those who may have bumped into others in, for instance, areas of hospitality. It is not the objective of that check-in data to send out alerts to large numbers of people who may have been present in a location; it is more about empowering the forensic contact tracing necessary to track down potential connections.

The noble Baroness, Lady Thornton, asked about NHS plans. I will focus on one particular area and one of the lessons we have had from recent weeks. We have done an enormous amount to contain the spread of disease and we have seen—partly because of the lockdown, partly because of the wearing of masks, partly because of hygiene—a dramatic reduction in the amount of flu and gastroenteritis across the country. It is not an unrealistic ambition to hope that NHS resources could and should be focused on reducing contagious diseases across the piece and use the lessons from testing, hygiene and diagnostics generally to massively reduce the impact of contagious diseases. That will have huge benefits to the capacity of the NHS to combat sickness and ill health generally.

I thank the noble Baroness, Lady Brinton, for her kind remarks on the contribution of those in the back office of the NHS. I am sometimes admonished by those who say that there is simply too much white-collar, managerial wastage in the NHS. I do not accept that criticism, and the rollout of the vaccine shows the immense management muscularity at the NHS which is able to organise such a huge national programme with such efficiency and courtesy.

The noble Baroness asked about clinical trials. I celebrate the fact that the large amount of really encouraging evidence that we have had has vindicated the decision by the JCVI, the MHRA and the CMO to prioritise the first dose over the distribution of second doses and to bring in the 12-week gap. That was a wise, pragmatic and impactful decision and we thank those involved.

The noble Baroness is entirely right that the large take-up among older people will have a big impact on younger people. The most influential people in anyone’s life are the people whom they love and live with. I cannot think of a better way of marketing it to younger people than the older people whom they love and live with taking the vaccine.

I also pay tribute to Professor Paul Moss and the team at Octave who are working extremely hard on the impact of the vaccine on those with immune deficiency. As the noble Baroness alluded to, the work at the University of Birmingham is at pace. It has been going on for some months, and its impact is already being shared among professionals. I am not sure whether there is an official report planned, but I reassure her that the insight and intelligence from their work is being shared across the system.

Finally, I give enormous praise to all those currently working on our borders. The situation in other countries remains extremely concerning. Variants of concern are rising in many countries, and in Europe infection rates remain extremely high. We have put in place measures on our borders that have the capacity to protect us from these variants of concern and I am enormously grateful to all those concerned who have strengthened those positions.

[The Deputy Speaker (Lord Lexden) (Con)]

My Lords, we now come to the 30 minutes allocated for Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of speakers.

[Lord Lansley (Con)]

My Lords, the speed and scale of the vaccine rollout is indeed a remarkable achievement and reflects great credit to all involved. The House will have noted the publication this morning of the REACH study based on data from February. Among its findings was that there was some regional variation in prevalence, particularly in the later part of February. Will the Government on this basis consider regional variation in the pace at which restrictions are lifted, rather than necessarily assuming that it will be a uniform, national approach?

[Lord Bethell (Con)]

My noble friend is entirely right to raise the issue of regional variation. It had been our profound hope to be able to adjust and to focus lockdown arrangements on geographical locations so that national measures were not the only tool in our toolkit. The evidence from last year suggests that the amount of travel that individuals do makes regional and local lockdowns only partially effective. This has put a massive question mark over the way in which we can use regional and local lockdowns. There is more work to be done to understand exactly how that works but he is right to raise it as a considerable issue.

[Lord Berkeley of Knighton (CB) [V]]

My Lords, it is a great pleasure to congratulate the Minister on behalf of the Government on what has been achieved in lockdown. It is absolutely fantastic. I want to ask two questions. First, bearing in mind that some 20 million people have now been vaccinated, do the Government have any assessment of the number of people who still contract the disease after having had the vaccination? Secondly, do the Government have any idea about the relative impact of side-effects of the different vaccines?

[Lord Bethell (Con)]

My Lords, I have nothing but good news on both those important issues. The number of people who have mild or profound sickness, need hospitalisation or die after having the vaccine is extremely small indeed. There is some differential when we come to the variants of concern. Certainly, mild disease has been observed with the South African variant by sources in South Africa and we are working to understand that. However, severe hospitalisation and death are massively reduced by all the vaccines. The side-effects from all the vaccines on all age groups and on people with almost all comorbidities are extremely small. The yellow list information published by the MHRA is extremely reassuring and so far it has been nothing but good news about the vaccines.

[Lord Winston (Lab) [V]]

My Lords, the House should be very grateful to the noble Lord, Lord Bethell, who is constantly being bombarded with our questions. However, I point out that within six hours of entering a cell this virus will have replicated, leading to millions of copies. Some copies will be imperfect, the so-called variants. Time is of the essence. The risk of dangerous new variants to which we have no defence is eventually likely to be inevitable. Will the Government now answer the question that has been repeatedly asked both in this House and in the other place since Christmas: as the red list of presumed points of embarkation is ludicrous and ineffectual, why do the Government not ensure that all those tens of thousands we have heard about entering the UK daily are effectively separated, screened, tracked, traced and isolated where necessary before they are lost within minutes somewhere in a British city?

[Lord Bethell (Con)]

My Lords, I thank the noble Lord for his grim prognosis and I agree with his analysis. If there is one place in the world where a mutant variation is likely to happen, it will be in an area where you have high infection rates and a large amount of suppression of the virus by either a lockdown or a vaccine programme. If you look around the world, that country is most likely to be Britain. We must be on the balls of our feet to be prepared for unhelpful news on that front.

Can I reassure the noble Lord on the borders? The number of people travelling in and out of the UK has reduced dramatically and the traffic through our airports and seaports is down tremendously. The application of the red list programme is extremely effective and the use of quarantine hotels has been extremely rigorously enforced. The isolation, along with amber routes, has also had enormous resources and is much more effective than it once was. We are prepared to go further. We review the red list constantly and, should the threats mount up to being serious enough, we will extend the red list as far as necessary.

[Baroness Sheehan (LD) [V]]

My Lords, vaccines are key to getting us to a position where we can live with the virus, but we really must listen to scientists telling us that we must control the virus everywhere. While our support for the COVAX initiative is to be applauded, it cannot work effectively without reliable supplies of the vaccine. The Covid-19 Technology Access Pool is designed to do just that. Are we fully engaged in C-TAP?

[Lord Bethell (Con)]

My Lords, we are taking a leadership role in COVAX, CEPI, ACT, Gavi and all the international, multilateral initiatives to roll out vaccine around the world. We are looking at what to do with our own stock of vaccines, and the Foreign Secretary has made it very clear that distribution of the vaccines we have bought is very much on the agenda. The AstraZeneca vaccine is being used as probably the default vaccine of choice around the world, as it is low- cost and easily distributed. Through our G7 chairmanship, we entirely support the agenda of preventing further pandemic by ensuring that vaccines are fairly and widely distributed around the world.

[Lord Forsyth of Drumlean (Con) [V]]

I join others in congratulating my noble friend and his colleagues on the brilliant success of the vaccine programme. However, why is everyone in the United Kingdom, on receiving the vaccine, not being issued with a card to show that they have had it?

[Lord Bethell (Con)]

My Lords, they are issued with a certificate. It is a digital certificate that is put in their patient record. In the modern day, that is by far the most effective way to ensure that people know that they have had the vaccine. A physical card has the potential for fraud. We have looked that extremely carefully, but we think the digital approach is the right one. Most people will receive a small card with their second dose appointment on it, but if my noble friend did not get one, I am sorry about that.

[The Earl of Clancarty (CB)]

My Lords, following on from that question, the need for vaccination passports to travel abroad, discussed earlier, now looks very likely, including, of course, to the EU, which will have its own standard. All the talk is of a phone app, but will the Government ensure that a paper version will be provided which will be acceptable abroad? A significant minority of older people still do not have mobile phones, and why should OAPs have to buy one in order to travel?

[Lord Bethell (Con)]

My Lords, in this matter, we will be led by international standards, and collaboration with our neighbours is essential when it comes to matters of international travel. If a paper certificate is required for international travel, we will put in place arrangements for that. A huge amount of the work that goes on for foreign travel nowadays happens before you ever get anywhere near the airport to depart. Passenger locator forms, pre-testing and vaccination certificates are all necessary in order to book a ticket, and that is where, really, the responsibility of the individual lies.

[The Lord Bishop of Leeds]

My Lords, I add my congratulations to the NHS and the Minister for the rollout of the vaccine, but with continued concern about the mortality rates. Churches, clergy and chaplains have been very involved in pastoral care and in support of the dying and the bereaved, even when buildings have been closed. There is now big concern with Holy Week and Easter coming up. Can the Minister offer a roadmap for when singing by choirs and congregations will once again be allowed, with sufficient time to prepare?

[Lord Bethell (Con)]

I am entirely sympathetic to the question posed by the right reverend Prelate. I cannot think of anything nicer than spending Easter at Salisbury Cathedral listening to the beautiful singing of the choir there. We will be led, however, by the public health practicalities on that. It has been one of the most heartbreaking aspects of this pandemic that those who seek sanctuary through worship have not been able to join the rest of their community, but the practicalities of the spread of the virus are unavoidable, so we will be led by public health advice in this matter. I do not have a date for his roadmap, I fear, but his considerations are very much understood in the department.

[Baroness Donaghy (Lab) [V]]

I thank the Minister for his continuing patience on this subject, and I am sure he did not mean to sidestep the two questions from my noble friend Lady Thornton. One was about the cliff edge for the social care sector, where the special funding is due to come to an end in March, and the apparent delay before we solve our care sector problem until 2022. The second was about there being no mention of NHS funding in the Budget, despite the fact that the roadmap recognises that annual vaccination programmes and continued testing and tracing are likely to be required. Does he have anything to say about those two areas of social care and NHS funding?

[Lord Bethell (Con)]

My Lords, we would not ordinarily expect a big announcement on NHS funding at a Budget such as this, and the truth is that we are not through the woods yet. It is impossible to predict what funds the NHS will need this year or next until we are through this pandemic, and while we are spending time today taking pleasure in celebrating the vaccine, the honest truth is that danger is still around the corner and we do not yet know that we are truly through this. When we are able to say that for sure, it will be possible to take a moment to decide on NHS funding. In the meantime, we remain committed to our manifesto pledges on hospital building and on recruitment, and on both those matters, we have made an enormous amount of progress. The Prime Minister has been crystal clear about his commitment to social care funding reform, and he stands by that commitment.

[Lord Taylor of Goss Moor (LD) [V]]

My Lords, given the undoubted success in the UK of the rollout of the vaccination programme, on which all involved are to be congratulated, our attention must turn, as my noble friend Lady Sheehan said, to consider the global operation because this disease is a global issue, not a United Kingdom one. The United Kingdom cannot live normally without the security of knowing that it is being tackled successfully globally. Will the Government use their chairmanship of the G7 to put in place and publish a global response action plan that goes further than what we have seen already and certainly further than simply donating spare vaccines?

[Lord Bethell (Con)]

The noble Lord puts it extremely well. We have four key themes in the health track of the G7. The first is pandemic preparedness in the round; the second is clinical trial data—that is an essential building block for pandemic preparedness; the third is medical data transfer—one thing we have tripped over repeatedly in our international collaboration on pandemic reform is the difficulty of sharing data; and the fourth is AMR, which is the threat on the horizon. If we have learned one thing from this pandemic, it is not to underestimate the threat from anti-microbial resistance.

[Baroness Pidding (Con) [V]]

My Lords, with the potential need for a rolling programme of booster injections or vaccination against new variants, can my noble friend tell the House what infrastructure is being planned so that we can protect our entire population for as long as is necessary?

[Lord Bethell (Con)]

I am grateful to my noble friend for looking forward. She is entirely right: the experience of this vaccination programme cannot stop when we have finished the initial rollout and we have to look to the future. As I said in my opening remarks, I am extremely hopeful that this can be an inflection point where we double-up on our commitment to rid the country of as much contagious disease as we possibly can. That will include booster shots, to which my noble friend alluded. It will also include a greater commitment to flu shots, and we very much hope that we can increase dramatically the take-up of flu shots at all ages, to stop not only illness itself but transmission.

[Baroness Bull (CB)]

Following on from the noble Baroness’s question and the importance of overall and ongoing vaccination coverage, can the Minister say how many people living in the UK are not registered with an NHS GP and therefore cannot be contacted for vaccination? We know that socially excluded groups, such as rough sleepers, Gypsy, Roma and Traveller communities and vulnerable migrants, are less likely to be registered, and there will be people registered only with a private GP. What assessment have the Government made of the scale of this challenge—how many people are affected—and what efforts are under way to find them and offer them vaccination?

[Lord Bethell (Con)]

My Lords, the noble Baroness makes her point extremely well. It is an area that we have looked at extremely carefully. The proportion of people who are not registered is remarkably small, but the phenomenon does exist. For this particular vaccination round, we have put in procedures so that those who turn up at a GP or vaccination centre who are not registered can be registered on the spot, and I thank colleagues at NHS D, who have put the necessary arrangements into the NIMS programme to make that possible. There are also others who do not know their NHS number—well, an enormous number of them now do know it. That is one of the blessings of this vaccination programme. We are also working extremely hard to reach out to the people the noble Baroness alludes to—the homeless, the Roma community and those who are recent arrivals in the UK—to make sure that the vaccination is offered to absolutely everyone in the UK, whatever their immigration status, whatever their living arrangements and whatever their medical history.

[Lord Sikka (Lab) [V]]

My Lords, last month the High Court concluded that the Secretary of State acted unlawfully by failing to comply with the transparency policy. When did the Prime Minister become aware that the Government were failing to meet their policy, and will the Minister now provide this House with minutes of each Cabinet meeting at which the government failure was discussed?

--- Later in debate ---

[Lord Bethell (Con)]

It was a regrettable administrative oversight; it was one that the Secretary of State has made it clear he would do again if it meant saving lives. I am not aware of it having reached the Cabinet.

[Lord Cormack (Con)]

My Lords, we should all be enormously grateful to those who have made the vaccination programme such a success. In our thanks, we should not forget Kate Bingham and her team. However, there are still inconsistencies. During the last lockdown, pre-vaccine, we could have services properly distanced in Lincoln Cathedral with a choir and a congregation. Post-vaccine, we cannot. Post-vaccine, we are still—I am back to my old hobbyhorse—allowing care home workers to attend to the most intimate needs of their patients having refused a vaccine. Can we have some consistency, please? I am grateful to my noble friend.

[Lord Bethell (Con)]

I am grateful to my noble friend for his question and I echo his comments on Kate Bingham. However, my Lords, we are not post-vaccine; we are, at best, mid-vaccine. Vaccinating 20 million people is an enormous achievement but there is a hell of a long way to go. There is still an enormous amount of infection in this country; nearly half a million people, or thereabouts, have the disease. There are variants of concern being generated in this country, such as the Kent virus, and overseas, such as the Manaus virus. Until we are truly through this, we have to show restraint and make uncomfortable decisions, and we must ensure that the NHS is preserved and we save lives. That, I am afraid, remains our priority.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, British science is indeed to be celebrated, as is government support of it, in vaccine development, genome sequencing and disease-specific registries such as UK Biobank. Will the Government use that experience to establish a national Covid registry to bring together the four main groups of data referred to by the Minister in his reply to the noble Lord, Lord Taylor, to inform long-term planning to reveal links between new variants found on sequencing, different long-term complications, including long Covid, the risk factors behind it and other matters such as body-mass index, vaccine history and any associated other contagious diseases? Such a registry could act as a long-term public health research tool.

[Lord Bethell (Con)]

My Lords, I am grateful to the noble Baroness for her insightful question about the obscure but vital question of data architecture. If there is going to be one powerful legacy of this awful disease, it will be the way in which data helped drive medical research, medical insight and the treatment of individuals. I am not sure if we need a new registry, a national Covid registry; what we need is for our existing data to be able to talk to itself. I can tell the Chamber that we are making enormous progress on that. I pay tribute to the unsung heroes, the CTOs who meet weekly at the NHS data architecture meeting, an obscure but vital forum where an enormous amount of good work is done by NHSX, NHSD, test and trace and others in primary and secondary care who are working incredibly hard, so that if one takes a test today, it goes into one’s patient record tomorrow and can be used the day after by a researcher looking at long Covid, dexamethasone, recovery or whatever. This is how modern healthcare should work. We have not done it well enough to date. We are making great progress on it tomorrow and we must not stop.

[Baroness Andrews (Lab) [V]]

My Lords, like everyone else, I could not agree more that the NHS rollout has been absolutely brilliant. I should also say that the Minister has been resilient, and we all appreciate that. However, I return to what is a more uncomfortable subject, I suspect, and follow up the question on airport testing. The Minister said that far fewer people are travelling and that the pursuit of quarantine conditions is more effective than it was. Given that fewer people are travelling, is it not possible to do what my noble friend Lord Winston suggested and pursue those people through test and trace and airport testing, as many other countries are doing successfully? How can the Minister say that quarantine testing of people in self-isolation is more effective? Can he give us more details on that?

[Lord Bethell (Con)]

My Lords, I thank the noble Baroness, Lady Andrews, for her questions. Perhaps I may tackle the specific question of airport testing, which has been raised a couple of times. The honest truth is that the arrival of families in south Gloucestershire and Aberdeen who had done a pre-flight test and subsequently developed symptoms demonstrates, I am afraid, that pre-flight and airport testing is not as effective as one would hope. If it were, we would not have to impose a 10-day testing regime with tests on the second and eighth days. That is the only rigorous way in which one can do it. It is estimated that airport testing catches perhaps between 10% and 20% of infection, and that is why managed quarantine is so important. The infection rate among those who arrive in the UK is high enough for us to be seriously concerned and to impose the kind of isolation that we have done. Until that infection rate is reduced, I am afraid that we have to look forward to managed quarantine and isolation being a part of the travel experience for some time.

[Lord Dobbs (Con) [V]]

My Lords, I add my congratulations to those offered to all those involved in a remarkable national achievement. It has also been a personal triumph for my noble friend and all his colleagues. However, perhaps I may pursue the question that my noble friend Lord Cormack raised a moment ago. An alarming proportion of Covid infections have been caught by patients in hospital and those inside care homes. Can the Minister elaborate on government plans to require those who work in the NHS and care homes to accept vaccination if they are to continue to work among such vulnerable people? Why are so many of them so reluctant? Does he agree that the trade unions have some nerve in describing any suggestion of that sort as bullying?

[Lord Bethell (Con)]

My Lords, I completely acknowledge the concerns of my noble friends Lord Dobbs and Lord Cormack about nosocomial infection. Undoubtedly, infections caught onsite in Britain last year and this year, and in every epidemic, are not only among the saddest forms of contagion but among the most dangerous. I want to reassure both my noble friends that we are absolutely focused on this point. It is, though, too early to make a call on professional mandatory vaccination. We have got through only the first 20 million people in the highest-risk and, therefore, the oldest age groups, and we have not moved through all the other age groups. The Cabinet Office is looking at this matter and has a review process in place. When that process has coughed up its findings, we will be in a position to debate the matter, and I look forward to that in due course.

[Lord Dubs (Lab) [V]]

My Lords, does the Minister agree that the success of the NHS vaccination programme is a tribute to the efficiency and success of the public sector, in contrast to some of the private organisations involved in other aspects of dealing with the pandemic? I want to put a specific question to the Minister. He used the phrase, “Until we are through this pandemic”. Would it not be more sensible to say that we may never be fully through this pandemic, so our planning must be based on the fact that we will have to continue with the vaccination programme as new mutations develop for many years to come? Would it not be better to look that far ahead?

[Lord Bethell (Con)]

My Lords, I disagree completely with the noble Lord’s first point. The vaccine would not have happened without AstraZeneca and the other private companies that have produced, manufactured and delivered it, so I do not know where the public sector would have got its vaccines from. I completely reject that point.

I agree with his second point. I should not have said, “When we are through this pandemic” because we are going to live with its consequences for many years to come, and if it is not this pandemic, there may be others in the future. We have all, I think, taken on board the fact that in the modern world, there is a new, 21st century cost for the kind of global lifestyle that we have got used to, and that is the international spread of viruses. We can, I think, win the battle, but we will have to adapt. Learning how to do that is the challenge of this year.

[Lord Singh of Wimbledon (CB) [V]]

I too would like to offer my congratulations to the Government on the speed and efficiency of the vaccine rollout. Due credit must be given to all our health professionals for their dedication in risking their own health in care homes and when visiting private houses. The sight of an end to the pandemic should not lead to smugness. We were caught ill-prepared when it began and, with environmental and climate change, along with the increasing movement of people, there will always be new threats. Does the Minister agree, as he has already hinted, that we should plan to use this experience to combat these new threats more effectively?

[Lord Bethell (Con)]

My Lords, I am grateful to the noble Lord for teeing up what I hope can be an insight about the future. We will have to work much more closely with our international allies and colleagues on this matter. We must invest in vaccines, therapeutics and antivirals on a prophylactic basis to be ready for when the worst viruses, including coronaviruses, emerge. We will have to bring international flying standards up to a much higher level so that the spread of viruses when pandemics occur is kept under control. We will also have to put the necessary surgical capacity into our healthcare systems to ensure that they are much more resilient than they were in the past. These are just three examples of the kind of changes that are on the horizon. I am hungry to get on with them and I am sure we will have a fantastic impact in our battle against disease.

[Lord Rooker (Lab) [V]]

My Lords, did the Minister have time to watch the David Harewood documentary shown at prime time on BBC1 on Tuesday about the massive health inequalities in the UK, which of course the Marmot report and reviews have been documenting for a decade? Why have so many Covid deaths been among the poor and the BAME communities?

[Lord Bethell (Con)]

My Lords, I am not an epidemiologist who can totally nail that question, but I recognise and acknowledge completely the assumption. This disease has hit the least advantaged the hardest, but trying to understand the correlation and causation of that is extremely difficult. The evidence so far suggests that some of these causes are to do with the environment: the houses that people live in, the circumstances of their employment and their behaviour within that employment. But some of this is about comorbidities and healthy lifestyles, as well as weight, which I mentioned earlier. These are all matters of grave community concern. We have to take an interest in the public health of the whole nation and we are only as strong as the weakest part. I agree with the noble Lord’s implication: this is a wake-up call for the whole country and we have to address the health of absolutely everyone.

[The Deputy Speaker (Lord Lexden) (Con)]

My Lords, the time allowed for questions on the Statement has now elapsed.

NHS: Staff Numbers after Covid-19

Lord Bethell Excerpts

Thursday 4th March 2021 Grand Committee

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

My Lords, I am hugely grateful to the noble Lord, Lord Clark of Windermere, for securing this very important debate and I pay tribute to his campaign on this subject. I also thank all noble Lords who have spoken so well in such a short amount of time. There is clearly widespread agreement that building a resilient NHS workforce to meet the future needs of this nation is essential, and I completely agree.

I also echo the thanks of the noble Lord, Lord Clark, for the extraordinary contributions of health and care workers across the UK during the pandemic. It is important that we recognise their extraordinary efforts. With the exceptional success in the UK of the rollout of the vaccines programme, we are at last approaching a time when the worst of the pandemic is over and the NHS can return to its business as usual—caring for the nation and providing world-leading healthcare.

I will say a word about the long-term plan. A £3 billion, one-year package has been announced for 2021-22 as part of the spending review to support the NHS in tackling the impact of Covid-19. This will include £1 billion to address backlogs and tackle the long waiting lists raised by noble Lords, by facilitating up to a million extra checks, scans and additional operations.

As the NHS gets to grips with the backlog of care, it is essential that we continue to change the way we deliver healthcare over the next 10 years. All those who spoke about innovation are absolutely right in that regard. We have a road map to do just this in the NHS long-term plan, which clearly sets out a new service model for the 21st century: more care delivered in the community, digitally enabled primary and outpatient care, and a relentless focus on the health of the local population and reducing health inequalities. I reassure the right reverend Prelate the Bishop of Carlisle that the plan absolutely identifies how we can make better use of early diagnosis and technology potentially to improve preventive care, population health and patient care. This will be supported by new and integrated models of care, as laid out in the NHS Bill.

I shall say a few words about staff retention. To do these things, we need more staff, yes, but critically we need to hold on to those that we already have for longer, help them to recover from the herculean efforts of the pandemic, nurture their skills and enable them to provide the care to patients that drives their efforts. The commitment of staff and the wider impacts of the pandemic mean that the NHS continues to see much stronger retention rates.

Despite that, troubling issues need to be addressed to ensure that dedicated NHS staff have the best possible experience of work. The noble Baroness, Lady Tyler, made an absolutely fair point on the need for a holiday. Our black and minority ethnic staff, in particular, report some of the poorest workplace experiences. I remind the noble Baroness, Lady Thornton, that the NHS people plan sets out exactly the kind of programme that she called for to tackle these issues, and we will continue to strive every day to ensure improvement on that front.

I come to NHS workforce growth and planning. The workforce has increased by over 160,000 already since 2010, an increase of 16%. This growth continues to be a key focus to ensure that we meet the rise in demand for health and care services. The 2020 spending review provided £260 million to continue to grow the NHS workforce and support commitments made in the NHS long-term plan. Nursing is absolutely the most critical component in this vision. I am pleased to report to the noble Lord, Lord Clark, that we are on track to deliver 50,000 more nurses by the end of this Parliament and put the NHS on a trajectory to a sustainable long-term supply in future. The 50,000 commitment is underpinned by a robust delivery programme, which will be achieved through increased domestic and international recruitment, and improved retention. The latest NHS workforce statistics show that nurse numbers have increased by almost 10,600 from almost 289,200 to over 299,700 between December 2019 and December 2020.

To reassure the noble Lord, Lord Clark, and echo the noble Baroness, Lady Bennett, the future domestic pipeline is strong, with UCAS end-of-cycle data showing 25,000 student nurses enrolled on courses in 2020-21. This is a 27% increase. I must say to the noble Baroness, Lady Bennett, that we cannot give everyone a place. As I am sure she knows, the job is highly skilled; it is a very difficult vocation, and it is extremely hard work. Not everyone is suited to it. More recent UCAS data shows unique applicants to nursing and midwifery courses in 2021 have increased dramatically to 48,300, or by 34% compared with last year. I hope that that provides some reassurance to my noble friend Lady Wyld.

On primary care, we are equally committed to growing the workforce and expanding the number of appointments available to patients. This will mean improved access to GP services and bigger teams of staff. On the reservations expressed by the noble Lord, Lord Clark, on the GP model, we are completely open to change: we have already looked very carefully at the independent review partnership model, the GP fellowship scheme and other schemes for GPs. But, with record numbers of GPs being recruited at the moment, it is too early to call time on the successful existing model. We have committed at least an additional £1.5 billion in cash terms for general practice over the next four years for additional staff. We will grow the workforce by 6,000 more doctors and 26,000 more primary care professionals. As of December 2020, there were 438 more full-time equivalent doctors compared with a year before.

Education was raised by many noble Lords. The Government have funded an extra 1,500 undergraduate medical school places per year in England—a rise of 25%. I reassure the noble Lords, Lord Willis and Lord Green, that the number of medical school training places will rise to 7,500 each year. We have also delivered five brand-new medical schools: in Sunderland, Lancashire, Chelmsford, Lincoln and Canterbury.

My noble friend Lady Wyld made extremely good points on the importance of perinatal care—a subject in which we share a keen interest.

UCAS data shows that there has been a large increase in the number of applicants to study medicine this year, with almost 5,000 additional applicants compared with 2020.

International recruitment was raised by a number of noble Lords. There is excellent growth in our domestic workforce, but we do still value the workers from all over the world who are playing a leading role in the NHS’s efforts to tackle coronavirus and save lives. We have made £80 million available for the recruitment of overseas nurses and the recruitment of healthcare support workers. Trusts are working hard to fill these nursing positions.

To the noble Lord, Lord Jones, I say that there is nothing ethical about blacklisting healthcare staff from certain countries.

In response to the noble Baroness, Lady Jolly, I say that I do not have the precise number to hand, and I suspect that it is not in the public realm, but I will try to find it and send a note to her. Perhaps I can reassure her that the supply of international nurses wanting to work in the NHS remains strong and, in spite of travel bans in some places, we are seeing more nurses arrive all the time. We have recently published our code of practice for the international recruitment of healthcare professionals, which will ensure that the UK is a world leader in ethical international recruitment and will, I hope, go some way to reassure the noble Lord, Lord Jones.

I reassure my noble friend Lady Altmann that we are also doing more to attract people into social care. We ran a national recruitment campaign across broadcast, digital and social media. The latest phase in the campaign was launched in early February, highlighting the vital role that the social care workforce has played during the pandemic.

On pay, while most pay rises will be paused in the rest of the public sector for 2021-22, the Government recognise, as does the noble Baroness, Lady Thornton, the uniquely challenging impact of Covid-19 on the NHS, so we will continue to provide pay rises for NHS workers, including nurses. For recommendations on pay we are looking to the independent pay review body and will carefully consider its recommendations when we receive them.

A number of noble Lords touched on staff coming back from retirement, which has been raised in previous debates. The noble Lord, Lord Hunt, raised this point. I acknowledge that former healthcare professionals came forward in extraordinary numbers to support the NHS during Covid-19, and we are enormously grateful for their response. Due to the postponement of elective care, the skills and experience of many of these professionals were not deployed at the time—the noble Lord, Lord Hunt, was entirely right to make that point. We need to understand the reasons for that more clearly and to learn lessons for the future—I acknowledge that. In many areas, hospitals preferred to make more use of their existing staff rather than take on unfamiliar staff in a time of pressure, where teams were dependent on trusting relationships to manage the crisis. In future we need to ensure established ongoing relationships at local level, so that when the need comes again—as I am sure it will—this invaluable and public-spirited resource can be quickly deployed to ease pressures.

I am confident that there is the potential to build a permanent legacy through the development of a form of NHS and care reserve, which could help former healthcare professionals remain part of the NHS family, keep their skills up to date and provide additional support in times of pressure. NHS England has been piloting models for an NHS reserve across the regions of England. NHSEI has established seven pilots, one in each region of England. It is drawing on the learning from these pilot sites, the experience of the Bring Back Staff programme and five subject-specific national framework task and finish groups to investigate the best way forward to make additional flexible workforce resources available to the NHS.

I finish by reassuring noble Lords that growing and supporting the NHS workforce is a key priority for this Government. The breadth of our work, which I have only touched on today, should be a testament to the Government’s focus on this essential mission.

Covid-19: Brazilian Variant

Lord Bethell Excerpts

Tuesday 2nd March 2021 Lords Chamber

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

My Lords, the challenge we have is uncertainty. Genomic sequencing data links the Brazilian variant to the South African variant, the so-called E484K mutation. We also acknowledge that there are anecdotes from Manaus on transmissibility, but none of this is clear cut. We are working towards getting the concrete data necessary to make a confident assessment of this mutation. Therefore, we are taking a precautionary approach and we are committed to limiting its spread by all means at our disposal.

[Baroness Thornton (Lab)]

I thank the Minister. According to a report by the World Health Organization, the P1 variant that originated in Brazil has been found in at least 15 countries which are not on the Government’s red list, meaning that arrivals from those countries are currently exempt from the hotel quarantine policy. Virologists have warned that the Government’s red list is at risk of becoming out of date at any time because of the time it takes to sequence coronavirus cases. Indeed, these six cases date back to 11 and 12 February. In the light of these facts, and given concerns that the Brazilian variant may be more transmissible and might be resistant to existing vaccines, will the Government review the red list and take urgent action to introduce a comprehensive hotel quarantine system that applies to all UK arrivals?

[Lord Bethell (Con)]

The noble Baroness is entirely right: this is not the first case of P1 in Europe. As of 11 February, P1 has been identified in 17 countries, with 200 cases reported globally. In the EU, 30 cases have been identified in five countries and areas. We keep the red list under permanent review and have an ongoing process of keeping it up to date. The fact that we have a red list and a managed quarantine programme makes further expansion of the red list possible. It puts our borders and our vaccine under a programme where we can control things, which is to be applauded.

[Baroness Jolly (LD) [V]]

How confident are the Government that our vaccines will cope with the Brazilian variant of the Covid virus and that the passenger from Brazil, who is somewhere in south Gloucestershire, will be traced? What measures are now in place to ensure that an incoming passenger is not lost again?

[Lord Bethell (Con)]

We are uncertain on the vaccine. There is a huge amount of speculation, but I would recommend that noble Lords take it with a pinch of salt because we cannot know for sure how the virus will behave with those who have been vaccinated until we have much better and clearer data. Regarding the current managed quarantine arrangements, I pay tribute to the teams which have stood up the system extremely quickly and well. The south Gloucestershire and Aberdeen arrangements have been incredibly impressive. It is extremely frustrating to all concerned that one person did not fill in the form and slipped through the net. But overall, the programme has shown itself to be extremely robust and we have an enormous amount of confidence in it.

[Lord Balfe (Con)]

My Lords, we seem to be devoting a huge amount of state resources to chasing one person with a mutating virus at a time when the National Health Service is on the point of collapse. Waiting lists are going up and we are in a terrible mess. Will the Government accept that viruses mutate and that we need a strategy to deal with that? Constantly locking people up and extending the list of countries so that you can put more and more people into hotels is a self-defeating policy.

[Lord Bethell (Con)]

The vaccine is absolutely central to our strategy. It is an approach that has proved enormously popular, and I think I speak for a large number of people when I say that defending the vaccine has to be our number one priority. If there were a highly transmissible vaccine-escaping mutation, it would take us back to the beginning of this whole pandemic. That is why we have put in place red list countries and managed quarantine. That is why we are committed to Operation Eagle and the efforts to track down those bringing variants of concern into this country.

[Lord Patel (CB) [V]]

My Lords, the scientists are concerned about the P1 Brazilian variant because of three mutations, one of which is common to other variants, making it more transmissible. One of the others is referred to as the “escape mutation”, which may bypass some vaccine-induced immunity. Does the Minister agree that, apart from the measures the Government are taking of trace, track and isolate and surge testing—which I thoroughly approve of—it is important to continue genomic sequencing, at scale, of Covid cases to detect variants that may arise and to monitor and study post-vaccine immune response? That would enable us to modify the vaccines to boost the immune response and deal with the variants.

[Lord Bethell (Con)]

The noble Lord is entirely right. Our commitment to genomic sequencing, which has lasted for years, has put Britain in great shape to be able to do the sequencing necessary to track these variants. We are doing more sequencing than any other country. But as the noble Lord knows, this is detective work, and it is extremely complex. While the 484K mutation might be the significant change in both the Brazil and South African variants, it might be one of a great many other mutations in its genomic characteristics. This is the detective work we are doing. I am afraid that it will take some time to get to the bottom of it, and it needs to be complemented by field studies into how the mutation reacts in real life, as well as with antibodies. The combination of immunology, virology, biology and real-world clinical study will give us the insight that we need.

[Lord Winston (Lab) [V]]

My Lords, with due respect to the Minister, I wonder if a pinch of salt is quite the right treatment for some of these variants of the Covid virus. It is not just the Brazilian and other different variants. For example, in addition to Siqueira’s paper, which has just been published from Brazil in the last couple of weeks, the paper from Bogota shows numerous variants which are not quite the same. Some of these may be rather more virulent, and it is possible that they may even cause reinfection—it is certainly not very clear. The point is this: surely we need to be very cautious indeed about our airports and whether the list we have is sufficient. At what stage do we decide that we need to take much firmer action with all incoming passengers to the United Kingdom, making certain that they are properly tracked and traced?

[Lord Bethell (Con)]

The noble Lord is entirely right. Things are happening around the world which are causing a great deal of anxiety. Stories of possible reinfection in South Africa are extremely concerning and the huge spike in infections in South America has not been properly explained. It is possible that there are a number of mutations, and mutations of mutations, there. The truth is that we do not have the genomic or immunological data that we need to fully understand what is going on. That is why we have taken a precautionary approach, as the noble Lord recommends. We have instituted both managed quarantine and a red list which we keep under review. If we feel it necessary to extend that list, we will do so.

[Lord Scriven (LD) [V]]

My Lords, tracing new variants will be key in the next phase of this public health challenge. So why does the £22 billion test and trace system not have an individual identifier on each test posted to homes, along with an integrated database? This way, every test could be traced back to an individual, regardless of where the test was sent from, or even if a person incorrectly filled in a form.

[Lord Bethell (Con)]

I endorse the noble Lord’s observation that tracing is important. I pay tribute to the Operation Eagle team. The noble Lord will note that the South African variant, which made landfall in the UK, is currently being contained through the immense work of this team. They are throwing a blanket over communities and doing a huge amount of forensic, detective work in tracing variants. As to his specific point, it is possible for someone to walk up to a testing station, take the test, be handed a form and not fill it in. We are trying to understand if those were the circumstances in this case.

[Lord Flight (Con)]

My Lords, are there risks that the Brazilian variant may not provide adequate protection against reinfection and that vaccinations are less effective against this strain? It carries the same mutation as the Kent variation, which is rated 70% more transmissible than previous strains.

[Lord Bethell (Con)]

My noble friend is stretching my immunological skills to the limit. The Brazilian variant has a number of mutations. It is not clear to us whether those are mutations of transmissibility, vaccine-escape mutations or reinfection mutations, and therefore which we should focus on. All are possible and we are keeping a careful eye on this. An enormous amount of investment and research is going into understanding this more carefully.

[Lord Empey (UUP) [V]]

My Lords, is my noble friend aware that Brazilian companies have a significant footprint in both parts of the island of Ireland? Given that there is a common travel area between the two, what discussions has he had with the Government of Ireland about this? How is it proposed to deal with inflows of people from Brazil who might be able to travel freely throughout these islands?

[Lord Bethell (Con)]

I am grateful to the noble Lord for flagging the Brazilian connection with Ireland, which I did not know about. I reassure him that there is an enormous amount of collaboration between Whitehall and Dublin on this matter. There are strong links on the managed quarantine programme within Ireland in order to close the “Dublin backdoor”, as it is sometimes called. I pay tribute to colleagues in Dublin for their collaborative approach. We do not currently have a five nations unified approach, but it is of interest. We are definitely keen to ensure that there is no backdoor entrance for VOCs through Dublin, or in the other direction.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, given the inevitability of variants and that some will evade antibody responses, what plans do the Government have for unified messaging, across the whole of the UK, that long-term distancing, mask-wearing and other measures are essential, and to tell the public that this is not like flu and we need to live differently?

[Lord Bethell (Con)]

The noble Baroness is entirely right, which is why the Prime Minister struck such a cautious tone when he unveiled the road map. We are not through this yet. A substantial proportion of the country is vaccinated, but we have to protect the vaccine. For those who have not been vaccinated, there are risks, and that is why we still have in force a “do not travel” alert and why we are maintaining marketing and communications at every level on the restrictions that are still in place.

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, to come back to my noble friend Lady Thornton’s Question, the Minister will know that, at the SAGE meeting on 21 January, there were warnings that geographically targeted bans cannot be relied upon to stop the importation of new variants, partly because of indirect travel. He has just said that he does not want a backdoor entrance through Ireland. But what are the Government going to do about indirect travel, which is a clear route into this country to avoid the current quarantine rules?

[Lord Bethell (Con)]

Those who travel to the UK must fill in a passenger locator form. On the PLF they have to state whether they have been in a red list country. We also share an enormous amount of information with the aviation industry to cover people’s previous travel, and therefore it is not as easy as the noble Lord might think to take a hop and a skip into Britain through a third country, as has been proved by those who have travelled from Brazil and been caught by the red list. However, his point is well made, which is I why I reinforce what I said earlier: we keep the red list under review and, if it proves necessary to extend the countries on that list, we shall do so to protect the vaccine.

[Lord Cormack (Con)]

My Lords, at the outset, my noble friend said that the Government wanted to use all means at their disposal to combat the spread of all the variants and mutations. I refer to a point I made last week. One means at the Government’s disposal is to ensure that all those who work in care homes are vaccinated. It is quite wrong that they can refuse it and then attend to the most intimate needs of their patients

[Lord Bethell (Con)]

My Lords, I remind my noble friend that we have some mandatory vaccination already in place in the health service; those who perform operations and other intimate health interventions are required to have hepatitis and other vaccinations, for instance, so there is a precedent for what he talks about. However, it is a huge step, which impacts people’s personal liberty and choices, to make vaccination mandatory for more than a million social care workers. My noble friend makes a persuasive argument, which is why the Cabinet Office is looking at exactly this sort of matter; there is a strong public health argument for mandatory vaccination. Given that we have not rolled out vaccination across the whole population yet, it is premature to make that decision today, but we are considering it carefully.

[The Deputy Speaker (Baroness Fookes) (Con)]

My Lords, the time allowed for this Question has now elapsed. I apologise to those Members whom I was not able to call.

Independent Medicines and Medical Devices Safety Review: Sodium Valproate

Lord Bethell Excerpts

Tuesday 2nd March 2021 Lords Chamber

[Lord O'Shaughnessy]

To ask Her Majesty’s Government, further to the report by the Independent Medicines and Medical Devices Safety Review First Do No Harm, published on 8 July 2020, what plans they have to bring forward a redress scheme for women and families who have been harmed by sodium valproate.

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

My Lords, the Government plan to respond further to the Cumberlege review later this year, as I committed in my recent Written Ministerial Statement. In the meantime, we are carefully considering the recommendation regarding a redress scheme for those harmed by sodium valproate, and measures are in place to limit the prescribing of this drug.

[Lord O'Shaughnessy (Con)]

I am grateful to my noble friend for his Answer. Since my noble friend Lady Cumberlege published her landmark review, another 150 babies have been born suffering harm from in utero exposure to sodium valproate, to add to the 18,000 children—18,000, my Lords—who have been harmed in this way since the 1970s. These children belong to families whose lives have been turned upside down, and who often cannot afford the costs of caring for their damaged children. They need and deserve a redress scheme now. Why can the Government not move faster?

[Lord Bethell (Con)]

My Lords, I pay tribute to those who have put together the valproate registry scheme that became live on 11 February. My noble friend is entirely right. There are 22,095 people on the registry; 462 of them had 490 conceptions, and 180 women were prescribed in a month when they were pregnant. A redress scheme is not necessarily the correct solution to this problem. We are considering it extremely carefully, and when we publish our overall response to the Cumberlege review we will include our considered response to the redress suggestion

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, the noble Baroness, Lady Cumberlege, concluded in her report that the system still did not know how to minimise the risk of future babies being damaged, despite 27,000 women of childbearing age currently taking valproate in the United Kingdom. In view of that, does it not make the case for a redress scheme absolutely persuasive?

[Lord Bethell (Con)]

My Lords, I will leave it to the response to the Cumberlege review to make the decision on the redress scheme. In the meantime, our focus is on a regime ensuring that those who take this important drug have the right advice to prevent them becoming pregnant. I emphasise that specialists review the treatment and ensure that an annual risk acknowledgment form is signed by the prescriber and the patient. This is an important measure ensuring that all those who take this potentially life-changing drug acknowledge and understand the implications of becoming pregnant.

[Baroness Cumberlege (Con) [V]]

My Lords, in our report we suggested that every pregnant woman who is on sodium valproate should be warned by her GP of the potential harm to her unborn child. Can my noble friend please tell me how many of the women exposed to this danger have been notified, and what the plans are to ensure that in future they are told? What incentive is given to GPs through the quality outcomes framework to ensure that they carry out this very important duty?

[Lord Bethell (Con)]

My Lords, as I explained a moment ago, there is an annual risk acknowledgment form signed by the prescriber and the patient, and that is shared with the patient’s GP. GPs should check that the patient has signed an up-to-date annual risk acknowledgment form each time a repeat prescription is issued. We have instituted a valproate safety implementation group that analyses, along with the MHRA, compliance with this plan. We acknowledge the review’s recommendation to introduce an indicator on safe prescribing in pregnancy for future iterations of the quality outcomes framework, and we will respond on that with the rest of the response to the review.

[Baroness Jolly (LD) [V]]

My Lords, redress is important, but so too is patient support. Could the Government confirm that they are considering the recommendation that a network of support centres should be set up to support those women who have been affected by Primodos, sodium valproate or vaginal mesh?

[Lord Bethell (Con)]

My Lords, I completely acknowledge the noble Baroness’s point. Support is incredibly important and our hearts go out to all those who have been hit by any of the three conditions covered by the review. We are absolutely looking at those recommendations to see how they may be implemented to provide the support that the noble Baroness rightly points out.

[Baroness Wyld (Con)]

My Lords, could my noble friend please update the House on the timetable for the appointment of the patient safety commissioner, one of the key recommendations that I am delighted the Government accepted? I understand that that requires new regulations, and the Government have rightly said that we ought to take time to find the best and widest possible field, but surely that just underlines the urgency of the need to get going with this.

[Lord Bethell (Con)]

As my noble friend rightly acknowledges, the everyday workings of the commissioner require some work. That work is being finalised and regulations will be made setting out further details about the appointment and operation of the commissioner—for example, the terms of office, the finances and other support for the commissioner. Officials are now working with legal and appointment colleagues to firm up time- lines and begin both the regulations and the appointment process for the commissioner.

[Baroness Masham of Ilton (CB) [V]]

My Lords, is the Minister aware that, when his noble friend Lord O’Shaughnessy was the Minister, the noble Lord realised the harm that some women had suffered from taking sodium valproate when pregnant? The noble Lord’s support has been inspirational and has given hope to these victims. Will the noble Lord, Lord Bethell, in his position as Minister now, bring forward a much-needed redress scheme for these women and children who have been let down?

[Lord Bethell (Con)]

I am grateful to the noble Baroness for her tribute to my noble friend Lord O’Shaughnessy, who has done an enormous service to us all by championing this cause, both as a Minister, when he moved this review and made a huge impact, and since then with his patient and thoughtful advocacy of this important cause. He speaks very movingly and thoughtfully, and we are greatly influenced by his persuasion on this subject. The noble Baroness should be reassured that we are absolutely looking at the recommendations for a redress agency, and we will come back with considered thoughts on it when we answer the review in the round. Until then, I welcome all thoughts and advocacy on the subject.

[Baroness Thornton (Lab)]

I have two points. First, last summer only 41% of the respondents taking valproate said that they had signed an annual risk acknowledgment form, so I would like the Minister to reflect on the fact that some GPs are not doing the job that they should be in terms of protecting women. Secondly, those affected by thalidomide and contaminated blood have a redress scheme, but it took years for that to happen. We simply cannot wait years for this to happen for those suffering from the effects of sodium valproate.

[Lord Bethell (Con)]

My Lords, I welcome the noble Baroness’s point on the proportion of those who say they have filled in the form. Phase 1 of the registry is a helpful collection of statistics, but we are putting in place phase 2, which will help us to understand exactly how many patients who are taking sodium valproate have actually filled in the form. That will give us the concrete reassurance that we seek on this matter. I recognise that there are redress payments for thalidomide and contaminated blood, but redress payments are not necessarily suitable for every single misfortune that happens in the medical world. However, we will look very carefully at the case for sodium valproate and I take the noble Baroness’s comments on board.

[Lord Jones of Cheltenham (LD) [V]]

Research from Konkuk University in South Korea has suggested that disabilities caused by the compound could cause autism spectrum disorder transgenerationally—in other words, afflict successive generations within families. What is the Government’s view?

[Lord Bethell (Con)]

I am grateful to the noble Lord for raising that study. It is not one that I am aware of, and I am keen to go back to the department to find out whether it has done any analysis of it. I will write to the noble Lord with a response.

[Lord Singh of Wimbledon (CB) [V]]

My Lords, the report First Do No Harm underlines the hurt and devastation that can result from not making patients aware of the possible side-effects of drugs. The harm done by giving sodium valproate during pregnancy cannot be undone, and generous support should be provided. Does the Minister agree that, while the appointment of a patient safety commissioner is a move in the right direction, that in itself underlines the importance of keeping patients fully informed of possible side-effects and listening to their concerns?

[Lord Bethell (Con)]

The noble Lord puts it extremely well and I totally agree with the thrust of his point. For patients to have the right information about the risks of the medicines that they are prescribed is essential. However, if I may stray into a different subject, there is also patient choice. For many patients, sodium valproate provides an incredibly valuable relief from epilepsy and mental illness. It is a drug that continues to be prescribed because some have no choice and there is no valid alternative to the drug. The number of people being newly prescribed the drug—new starters—is down dramatically from previous years, but for some it really is an important part of their therapy. The decisions that they make are personal ones, and we should respect those.

[The Deputy Speaker (Lord Bates) (Con)]

With apologies to the noble Baroness, Lady Browning, the time allowed for this Question has now elapsed.