Cannabis Oil
Lord Bethell Excerpts(3 years, 6 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, we are on the case. I completely recognise the problems faced by Alfie Dingley and all the individuals reliant on the previous arrangements with the Dutch Government for the supply of Bedrocan oils. The department is working urgently with Dutch Minister Tamara van Ark to find a solution that will enable these patients adequately to access the medications they need, and we are committed to setting up clinical trials to inform future NHS commissioning of cannabis-related medicines.
Baroness Walmsley (LD) [V]
My Lords, I thank the Minister for that very encouraging response. He will know that time is of the essence because these medicines prevent children having severe fits, some of which are life-threatening. Can he go back to his department and educate some of his officials? Unfortunately, a lot of the families are very upset at being told that they can safely be switched to an alternative formulation. That is both ignorant and dangerous. All the expert clinicians who know about these issues say that that cannot be done safely. Even if it could, eventually putting these children back on to the original formulation sometimes does not work. Will he make sure that his officials listen to the clinicians who are expert in prescribing and in following the progress of people on these formulations?
Lord Bethell (Con)
My Lords, I am grateful for the noble Baroness’s kind words, and I will indeed take that patient feedback back to the department. I reassure her that this is an area where patients have undoubtedly led the way, and clinicians have to catch up. In doing so, there will need to be a meeting of minds and regulation in areas that are open to patient interpretation. In that period, there will undoubtedly need to be compromises on all sides.
Baroness Warwick of Undercliffe (Lab) [V]
My Lords, the law changed over two years ago. The then Home Secretary said:
“We have now delivered on our promises … we will work with the NHS to help support specialists in making the right prescribing decisions.”
But they have not; it has been a hollow promise for terminal brain cancer sufferers such as my nephew. NHS doctors will not prescribe medical cannabis, and the BMA advises medics not to prescribe it, yet I understand that the UK is the largest producer of medical cannabis in the world. Just how many prescriptions have been issued for unlicensed cannabis medicines, other than those subject to randomised control trials, in the last 12 months?
Lord Bethell (Con)
My Lords, the noble Baroness is being a little unfair; Health Education England published a medicinal cannabis education package on 8 August 2019. But we cannot force clinicians to make prescriptions. That is not how the health service works. We need to work on clinical trials to put in place the correct authorisations and to give marketing authorisations for these important and promising drugs. That will require collaboration between government, the regulator and industry, and I call on industry to step up to that challenge.
Baroness Barker (LD)
My Lords, some people in England and Wales are reliant on hormone therapies produced in the EU 27. Who precisely in the NHS is responsible for ensuring continuity of supply of those therapies to patients?
Lord Bethell (Con)
My Lords, procurement decisions in the NHS are done by the NHS. I do not think that a specific or unique group is focused precisely on hormone therapies, but I would be glad to go back to the department and write to the noble Baroness to confirm that.
Lord Mancroft (Con) [V]
My Lords, I draw your Lordships’ attention to my interests as set out in the register. If we can vaccinate 1.5 million people in a few weeks with a drug that did not even exist a couple of months ago, how come we cannot prescribe properly a drug that has been legal to prescribe for over two years? Cannabis contains over 120 different cannabinoids and eight terpenes, and the way in which these are configured makes a world of difference to their effectiveness. What training is being given to ensure that the right combination of cannabis oil required to treat different medical conditions is correctly prescribed? I think it is time that the Government stepped up to the plate on the training.
Lord Bethell (Con)
My Lords, I would turn around my noble friend’s proposition and ask this question. If many vaccine manufacturers can turn around clinical trials in eight months for an extremely complicated vaccine, how come the cannabis-producing companies cannot turn around clinical trials over years?
Lord Field of Birkenhead (CB)
I thank the Minister for his reply. I declare that I am a cannabis user to counter pain, and no doubt later today we will be able to come back to that issue. I hope that his officials are watching to witness the support there is in this place for the role that he is trying to secure so that young sufferers who shake their brains to pieces might get relief today rather than tomorrow, when it is too late.
Lord Bethell (Con)
I thank the noble Lord for sharing that personal testimony, which is extremely touching and relevant. I share with him that there is a large amount of ministerial support for the principle of this exciting and interesting area. If there is any frustration on my behalf, it is only that somehow the industry has not matured to the point that it can sponsor the kinds of clinical trials that can take these important medicines through the necessary authorisation process that can put them on the NICE list so that they are available for more patients.
Baroness Thornton (Lab)
It is not surprising that people are astonished that important cannabis products, which can transform the lives of those suffering from debilitating, painful conditions, are approved yet still not available—and in some cases supply has been disrupted as a by-product of Brexit. Would the Minister care to speculate as to why this has not happened? It is not just that the companies have not stepped up—why have they not done so? Would the political will that has been brought to bear on various other issues faced by this Government, such as Brexit, not be usefully brought to bear on this one?
Lord Bethell (Con)
The noble Baroness puts a very reasonable challenge to the life sciences arrangements in the UK. We are blessed with major pharmaceutical companies, and a lively and exciting biotech industry, all of which are well plugged into the regulatory authorisation process. This is a novel, exciting, patient-led and innovative area. For those reasons, it has not had the financial backing of either business or the financial institutions to put in place the very simple, straightforward requirements of clinical trials, which are there for patient safety in the first place, not for government box-ticking. We are working extremely hard to try to resolve this Catch-22 situation and I hope very much indeed that we will be able to announce news on that shortly.
Lord Addington (LD)
My Lords, it is nice to hear that the Government are taking this problem seriously. If these drugs are effective, would it not be a good idea to encourage the demand side of this equation, where doctors prescribe them, by pointing out what the drugs allow a child with epilepsy, for example, to do—that is, lead a normal life, get educated, get qualified and be able to have a job—and the cost to the state if they do not?
Lord Bethell (Con)
The noble Lord alludes to an important, although frustrating, point. If I may gently push back, the truth is that there is a large amount of very persuasive anecdotal evidence, some of which we have heard today. It is completely compelling—it is just not scientific. Patient safety relies on extremely rigorous clinical trial regimes; that is why we have safe medicines in the UK. It is simply not possible to persuade front-line clinicians to make prescriptions on the basis of anecdote rather than clinical study.
Baroness Stuart of Edgbaston (Non-Afl) [V]
My Lords, I am delighted that the Minister is on the case and that we can make sure that this issue is resolved for this set of parents. On a wider note, however, would the Minister consider revisiting the NICE guidelines, last published in November 2019, which had a list of recommended research, to ensure that we potentially widen the base of research and bring more speed into the process?
Lord Bethell (Con)
The noble Baroness is right that research is the key. I reassure her that we are looking at ways to try to bring research forward. The issue is not with the NICE guidelines themselves; it is with getting the scientifically backed data to be able to justify the authorisations from the MHRA. We are working extremely closely with the NIHR. We are looking at the NHS, which, as the noble Baroness likely knows, does have manufacturing capability within itself for these kinds of drugs. As some noble Lords here will know, we are engaged in thoughts about how the NHS manufacturing capability can be used to mobilise clinical trials in this important area.
The Deputy Speaker (The Earl of Kinnoull) (Non-Afl)
My Lords, the time allowed for this Question has now elapsed.
Covid-19: Restrictions
Lord Bethell Excerpts(3 years, 6 months ago)
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Lord Robathan
To ask Her Majesty’s Government what assessment they have made of the success of the restrictions introduced to address the Covid-19 pandemic in reducing the transmission of Covid-19 between 1 July and 31 December 2020.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, the science of virus transmission is very simple: tiny bugs spread by contact and by breath. Lockdowns work because they put space between people, but there are costs—horrible costs. That is why each day we publish gigabytes of data on infection rates, we analyse the patterns and we design lockdowns to have the maximum impact for the lowest economic and social cost.
Lord Robathan (Con)
My Lords, yes, but: in the last few months we have seen ever more stringent restrictions—tiers 3 and 4, the failed circuit breaker in Wales, a second lockdown which ended only just over a month ago, and now a third lockdown—yet cases keep rising. The Prime Minister said on “The Andrew Marr Show” on Sunday that the evidence is not clear. We all want to see policy based on empirical evidence, so please, can the Minister go back to the department and instigate a detailed examination of why these hugely damaging restrictions have not seen a reduction in infections, hospitalisations and deaths?
Lord Bethell (Con)
My Lords, I am extremely grateful to my noble friend for that sage advice. I can reassure him that lockdowns do work—in Leicester, Bolton, Luton, Liverpool—and I can give him very clear case studies of how specific measures have affected national, regional and local outbreak infection rates. The truth is that tier 3 was enough for the original variant, but it is not enough for the new variant, which is 70% more transmittable. That has hit our country hard, which is why we have to have this new, horrible lockdown.
Baroness Mallalieu (Lab) [V]
My Lords, the figures surely show that this pandemic is now endemic in our population. Clearly, lockdowns cannot permanently suppress the virus but might just temporarily prevent medical facilities being overwhelmed. What are the Government doing to ensure that vaccination is rolled out 24/7, including by Public Health England, and skilled medical staff on Covid duties are relieved from all non-specialist aspects of their work by the many skilled and suitable volunteers who are offering to help?
Lord Bethell (Con)
My Lords, the noble Baroness analyses the situation extremely well and has laid out exactly the Government’s plan for rolling out the vaccine. She is entirely right that we are using lockdowns to bridge the gap until herd immunity is achieved through the vaccine. We have mobilised an enormous amount of the NHS, and are very grateful to the volunteers who have stepped up and are making an enormous difference. We are trying to get as much of the vaccine as possible out of the factories and warehouses, with batch control, and into the country’s surgeries and hospitals to vaccinate millions of people before the spring.
Baroness Walmsley (LD) [V]
My Lords, a weak link in the measures to suppress the virus has been the small percentage of people not self-isolating when they should. This is often because they cannot afford to do so. Dozens of times my Lib Dem colleagues and I have asked the Government to provide adequate financial support for self-isolators. So I ask the Minister again: in order to suppress the virus, will the Government pay the wages of poor people who need to self-isolate?
Lord Bethell (Con)
My Lords, I pay tribute to the advocacy of the noble Baroness and her colleagues on this important point. I acknowledge the financial pressures on those of limited means who are required to isolate. We have put in provisions for statutory sick pay and the £500 Covid bonus to help to support those people, and there are local authority funds and provisions to provide additional support. The point that she makes is made well and we completely acknowledge the challenge.
Lord Herbert of South Downs (Con)
My Lords, does my noble friend share my incredulity that those who are opposed to lockdowns continue to make their arguments, in spite of the fact that cases are obviously rising very fast, in spite of the advent of the new variant, which is more infectious, and in spite of the current very serious pressure that our hospitals are seeing? Is it not the case that, in the end, their arguments boil down to the callous suggestion that somehow elderly people who have pre-existing conditions but might nevertheless expect to live for many more years are expendable, when they are clearly not?
Lord Bethell (Con)
My noble friend puts it well. I always welcome the challenge of noble Lords on any subject whatever, but I agree that underlying many of the objections to lockdown appears to be an assumption that some lives matter less than others. Whether you are asthmatic, diabetic, infirm or just old, I think that your life is worth just as much as everybody else’s. That is why I am extremely proud of the national effort to work together to protect those who are less advantaged and to protect our health service.
Baroness Campbell of Surbiton (CB) [V]
My Lords, thousands of people who are currently extremely vulnerable are now in greater danger from a lack of protection against the virus. Our care workers are more likely to come into contact with coronavirus, and requests for testing have escalated. Therefore, can the Minister please tell me when I and countless others who employ personal assistants can expect them to be vaccinated? Our workforce is not currently prioritised in the same way as care home workers and registered agency carers.
Lord Bethell (Con)
My Lords, I do not know the precise nature or status of the care that the noble Baroness has, but it is true that care workers are massively prioritised, and those with pre-existing conditions are also prioritised. We cannot prioritise everyone at once. Those over 80 are at the top of the queue, but those who work with the vulnerable, those shielding and those with pre-existing conditions are also towards the top of the list. We are working as hard as we can to get vaccines to those people as soon as possible.
Baroness Thornton (Lab)
My Lords, on this second day of national lockdown, it is important to look to the future and make every effort to keep our families and fellow citizens safe. Given how close London’s hospitals are to being overwhelmed—within days—what are the short-term plans to alleviate this very urgent and serious challenge? I gather that the ExCel Nightingale hospital will be used either for in-patients or as a mass vaccination centre, or both. How soon will that happen?
Lord Bethell (Con)
The noble Baroness quite rightly pays tribute to the work of the NHS. An enormous amount has been done on the marginal expansion of ICUs. My local hospital, University College Hospital, has increased the number of beds from 19 to 52 by expanding the scope of the wards and the oxygen supply. We have put a huge amount of work into A&E units, often building out the front of the units to create more space. Those marginal differences are being extremely effective, and that is our first line of defence. The Nightingale hospitals are there as back-up and, if they are needed, we will bring them into play.
Lord Lilley (Con)
My Lords, perhaps I may break with convention and the advice I was given when I first entered Parliament and ask a question to which I do not already know the answer. Every week, the Government submit figures to EuroMOMO for deaths from all causes. During the spring, the figures showed a huge level of excess deaths over the normal, but currently, and in recent weeks right up to the end of last year, they show almost no excess over the normal level of deaths in this country. That conflicts with all the evidence we are seeing from hospitals and elsewhere. Can my noble friend reconcile the figures and the facts?
Lord Bethell (Con)
The CMO has given some guidance on this matter. He has made the observation that deaths from other flus are down, partly because of the social-distancing that is part of the lockdown. He has also pointed out the very sad, but I am afraid inevitable, possibility that the large amount of infection that has grown up in the last few weeks will in time lead to further deaths. This is an uncomfortable piece of speculation but, as sure as night follows day, I am afraid that infections and hospitalisations will lead to further deaths. We are running at nearly 1,000 a day at the moment and that number is set to increase.
Baroness Falkner of Margravine (CB)
My Lords, I refer to my interests as set out in the register and point out that my remarks are personal. Compliance and transmission are interlinked, and transmission rates are hugely dependent on public compliance. So I echo the point made by the noble Lord, Lord Herbert, that, although senior libertarian individuals and leaders point to the fact that individuals can make their own assessments of risk, that is not the case. Does the Minister agree that complying with the rules is a public duty that we owe one another and not a matter of choice?
Lord Bethell (Con)
The noble Baroness makes the point well. My observation is that the British public are extremely supportive of both the lockdown and the measures involved. Of course, we all see highly visible exceptions in our travels and when we work, but by and large the British public have massively complied with the measures without any severe form of compulsion, and for that I pay an enormous amount of tribute. In the first lockdown, we had to behave as though the person we saw near us might have the disease; the suggestion now is that we should behave as though we have the disease. It is that discipline that we all need to apply.
The Deputy Speaker (Baroness McIntosh of Hudnall) (Lab)
My Lords, the time allowed for this Question has now elapsed.
Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020
Lord Bethell Excerpts(3 years, 6 months ago)
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Lord Bethell
That the Regulations laid before the House on 11 December 2020 be approved.
Relevant document: 40th Report from the Secondary Legislation Scrutiny Committee. Instrument not yet reported by the Joint Committee on Statutory Instruments.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, today we have more than a million people in Britain infected with Covid. A third are asymptomatic, and most are highly infectious. That is just too many. That is why on Monday the Prime Minister announced a new national lockdown. The measures are tough but necessarily so. They reflect not only the current case rate but the extent of the pressures faced by our health and care system.
We have over 30,000 people with Covid in hospital beds, with over 2,500 people on mechanical ventilation, and based on the infection rates of the last month and the inevitable clinical chain reaction those numbers are set to rise. Yesterday, sadly, the UK reported a further 1,041 people who had died after testing positive in the 28 days previous and, with yesterday recording our highest daily increase since mass testing began, unfortunately it is inevitable that more deaths are on their way. That is why the Government took swift and decisive action this week, introducing a national lockdown and closing schools. We take this action with deep regret—for society and for the economy—but it is necessary to respond to the grave situation that we face.
The SIs we are debating today cover the tiering system introduced following the November national lockdown. Those regulations have been amended five times to extend the geographical reach and to fine-tune the terms, and we are also debating this week’s national lockdown. Overall, these SIs tell the story of our containment of the original strain of the virus, with a tiering system that eventually proved to work. They also cover the subsequent identification of and reaction to a more transmissible strain of the virus that was far more aggressive than anything that had been seen anywhere in the world before.
The New and Emerging Respiratory Virus Threats Advisory Group spelled it out clearly: the new variant demonstrates a 70% increase in transmissibility. This means that successful measures that were previously in place such as tier 3 are no longer enough to reduce the transmission of cases. The new variant makes up around 60% of cases in some parts of England, and that is rising. Since the beginning of December, cases reported per day in the UK have steadily increased, with on average 15,000 reported in the week of the 6 December, 34,000 in the week of 20 December, and a shocking 57,000 in the week to 3 January. This will inevitably lead to more hospital admissions and increased pressure on secondary care over the coming weeks. This is why a national intervention, introduced swiftly, is so necessary, and why the tier 4 measures have been strengthened by the closure of schools.
We are also taking on additional measures to support industry given the further national restrictions. We have announced additional support to the most affected businesses worth £4.6 billion across the UK. This support will help businesses get through this difficult period until spring. We will take further decisions about our economic response to coronavirus and how best to support the economy, businesses and jobs at the Budget on 3 March.
We have aimed to balance the economic impact of greater restrictions on business with measures to protect public health. Implementing a national lockdown with the vaccine rollout will allow the nation to return to some sense of normality and for the economy to bounce back. We have mitigated the short-term impact through financial support schemes to reflect these changes, and will carry on supporting the British public through these tough times.
However, we are not back to the bleak days in March: hope is on the horizon. The rollout of the Pfizer and AstraZeneca vaccines is making excellent progress. We have now vaccinated over 1.1 million people in England and over 1.3 million across the UK. The rollout in care homes started on 16 December, meaning that our most vulnerable as well as vital care staff can be protected.
While the vaccines project is an international collaboration, we should take a moment to recognise the contribution of the British life sciences sector and to reflect that an easy-to-administer, affordable and mass-produced vaccine offers Britain a way out of this disease and will make a huge impact on the global response.
The end is in sight but, until that time, we must all take responsibility for reducing the transmission of the virus, protecting the NHS and saving lives by complying with these restrictions. I know that these measures require a huge sacrifice. They are designed to minimise our social contact, coming at the cost of seeing our friends and family, participating in the hobbies we love and preventing us taking those holidays we desperately look forward to, and the economic cost is high. But this is a price worth paying to help our key workers, who have dedicated themselves for the benefit of others. We owe it to them and to protect the economy from a collapse in confidence and from rolling lockdowns.
The other SI that we are debating today relates to the self-isolation periods for households and is another example of how we have applied what we have learned. We are doing everything we can to identify and isolate the infectious. Between 25 December and 31 December, 346,901 people across the UK tested positive and were told to isolate, and a further 493,573 people were identified as recent close contacts, of which 92.3% were reached and told to self-isolate. This is a massive national effort.
On 14 December, we amended these regulations to make changes to the self-isolation period for households, non-household contacts and international arrivals, reducing it from 14 days to 10. This is based on evidence showing that the likelihood of being infectious as a contact after 10 days is low. To bring our policy in line with other nations in the UK, the 10-day self-isolation countdown begins on the day after exposure, onset of symptoms, or a positive test result.
Before I finish, I will address the question of parliamentary scrutiny. I want to be clear that no one in the Government makes use of these emergency procedures lightly, nor do they do so without the conviction that they are absolutely essential. Unfortunately, as I have set out and as we have seen across recent weeks, urgent action has been required. I know that some of your Lordships may be disappointed that the amendments were made before there was a debate. However, I emphatically reassure them that we remain committed to parliamentary scrutiny. I commend these regulations to the House.
Lord Bethell (Con)
My Lords, we are debating today the 59th regulation in a restriction round—quite a colossal number. They are unfortunate and regrettable, but they are necessary. This Government are committed to making them the best they can be, and I am extremely grateful to noble Lords for their recommendations and suggestions on the restrictions. Let me trot at pace through a few of the recommendations from noble Lords.
Noble Lords are entirely right that money to isolate is an incredibly important element of the effectiveness of isolation. I reassure noble Lords that we are in active dialogue with 314 local authorities to figure out how to make the isolation payments more effective and mobilise charities’ and local authorities’ support for those who need it.
A number of noble Lords brought up travel restrictions. I completely agree with the noble Lords, Lord Winston and Lord Reid, that international travel has been a source of infection for this country in the first and second waves, and continues to be. The prospect of a South African variant that is even more transmissible than the Kent variant puts a spotlight on that threat of infection. That is why we are working on processing new measures, which will be introduced shortly, for pre-flight testing for travellers to Britain, and we look forward to those being announced shortly.
In the meantime, I have to break it to the noble Baroness, Lady Jolly, that test-to-release, which she mentioned, was introduced on 15 December. I get a weekly update on it, and I can reassure her that the evidence to date suggests that the isolation of travellers on test-to-release is much more effective using the testing mechanism than it was on the isolation mechanism. We will probe those figures very carefully, but I am optimistic that that scheme has worked well.
My noble friend Lord Lancaster mentioned the tiering system. It is a grim prospect, but I warn noble Lords that we are unlikely to spring out of this national lockdown straight into the sunny uplands, and a new tiering system will likely be necessary. The right honourable Secretary of State for the Home Office spoke this morning on the radio about the kinds of penalties that she has instructed the police to apply. I reassure the noble Lord, Lord Berkeley, that our approach to the lockdown is effective and implementing all the regulations necessary.
To my noble friend Lady Altmann and to the noble Lord, Lord Foulkes, and others who asked about test and trace, may I just be crystal clear? I sometimes find I am repeating myself on this matter. In the last week of the year, test and trace identified 450,000 people who had Covid and isolated another 350,000 of their contacts. That is an absolutely incredible achievement. No other country has a scheme like it, and it has become repetitive and inaccurate to suggest that it is not making any impact.
The noble Baroness, Lady Thornton, and others asked where community testing might be going. Of course, during a lockdown, the community testing component is not necessary, but I reassure the noble Lord, Lord McNally, and others that we are very committed to it. We are in dialogue with councils at all levels about how they might use community testing, and with schools about once the lockdown is lifted.
A number of noble Lords looked beyond this lockdown to the future. The noble Baronesses, Lady Finlay and Lady Bennett, asked about ventilation and workspaces. That is exactly where our heads are at the moment; we are trying to understand and think through the implications of this pandemic. The reality is that there will be no quick transition. We shall have to think about workplace hygiene. My noble friend Lady Wheatcroft asked how workspaces will have to be reimagined. I very much welcome the suggestions, evidence and recommendations of noble Lords in this area; it is something that both BEIS and DHSC are looking at very closely, and I look forward to updating the House on that.
A number of noble Lords’ questions and comments were about the vaccines, not the regulations. Since that is the hot subject, let me address it directly. I reassure noble Lords that, whatever they may read in the papers about problems and blockages, the rollout of the vaccines is being done at pace. It includes the Army; volunteers are being mobilised, GPs and pharmacies are being recruited and we will hit the numbers that the Prime Minister has committed to. The noble Baroness, Lady Masham, rightly thanked factory workers and others involved in the process of manufacturing and logistical support in supplying these vaccines. It is an incredible process to put together 30 million or 40 million vaccines before the spring at pace in highly delicate, secure and hygienic environments, and to get them to the front line in a way that is temperature-controlled and fulfils the commitment to the MHRA.
Patient safety must be our priority. That is why it is done in a thoughtful fashion. While we are very grateful to BrewDog and others for innovative ideas for how to roll out the vaccine—through the middle of the night and what have you—we must get it right. You cannot jab someone’s arm and inject them with a potent vaccine without being absolutely sure that it is the right person in the right place, the right vaccine and in the right conditions. Getting all those stars aligned requires an enormous logistical process, and we are absolutely determined to get it right. We also must have availability of vaccine. I thank Pfizer and AstraZeneca for the enormous lengths that they have gone to to provide millions of doses of vaccines, but it takes time to deliver. At the moment, it is not the NHS that is the limiting factor but the provision of the vaccines.
To achieve that provision, we will deliver through hospitals, GPs, pharmacies and mass centres. Today, we have 107 hospital sites online, and there will be a further 100 by the end of the week; there are 595 GP-led sites, and there will be a further 180 by the end of the week. The mass centres will be open shortly, and they will have a huge impact on the rollout.
Obviously, the big vaccination centres have hugely more impact than small pharmacies and rural doctors, but that is not to say that those are not being prioritised as well. However, I ask for noble Lords’ consideration: the practical matter of getting a vaccine that has to be temperature controlled and comes in large packs of sometimes up to 1,000 doses to small rural pharmacies, community pharmacies and GP practices in the far-flung parts of Britain is an enormous logistical exercise—we have to balance scale and volume with breadth and the niche interest. I think we are getting it right; we have not forgotten anyone, but there will need to be a little bit of time before we can reach everyone.
A number of noble Lords have talked about cancelled trips to the GPs; I completely recognise and acknowledge those stories. It is true that, sometimes, we have to line people up for appointments, and the delivery of the vaccines, which is an extremely delicate task, has not always proved to be as reliable as we might have hoped. We are seeking to iron that out, and I ask for the forgiveness and forbearance of any pensioners or patients who have had to wait for their vaccine. I reassure noble Lords that, if there are cancelled appointments, it is only because we are trying to make maximum use of the stock of vaccines that we have at the moment.
On the volunteer scheme, I completely and utterly agree with all noble Lords who are frustrated and irritated by the large amount of bureaucracy that this has involved. As the noble Baroness, Lady Watkins, rightly pointed out, we have stamped on some of it, but there is more to do, and I think that there is a lesson to be learned about how the NHS and British Government treat volunteers, and we are making a lot of progress on that already.
To my noble friend Lady Neville-Rolfe and others who asked whether we are using the Army, I say yes we are using the Army.
On dentists, I reassure my noble friend Lord Balfe that all those with direct patient care are prioritised for the vaccine, whether they are dentists or dentists’ assistants.
I do not recognise so well the stories of the noble Baroness, Lady Brinton, about logistical problems, with car parks and freezing GP surgeries. I am on a vibrant WhatsApp group with MPs, and I am deluged with hundreds and hundreds of positive stories of quick, polite and accessible service. I would be very grateful if the noble Baroness would write to me with her anecdote; I would be glad to follow it up.
On therapeutics, I am grateful to my noble friend Lord Moynihan for his quite accurate remarks on the importance not of vaccines but of the therapeutics that can assist in recovery. We are grateful to RECOVERY and REMAP, the two big clinical trial schemes that have proved to be a massive global success—and, without giving the game away, I am hopeful for more good news from that direction shortly.
I remind my noble friend Lord Cormack that, although he may get his vaccine soon, immunity does not necessarily mean sterility. While he himself may take the vaccine and, therefore, be protected from the impact of Covid, he may be the carrier of the virus. To those, like myself and my noble friend Lady Penn, who are not candidates for the priority list for the vaccine, we would be extremely wary of anyone who has had the vaccine but is still a carrier of the virus. That is a really important policy point that we will have to wrestle with in months ahead.
I reassure the noble Lord, Lord Truscott, that the Oxford vaccine is extremely good, and just as good as all the others.
Lastly, on the NHS, I completely agree with all those noble Lords who pointed out that the second, or potentially the third, time round is tougher for the NHS: there are mental health issues and capacity issues, and there is the sheer miserableness of being back on the front line again. I live opposite University College London Hospital; the sound of the ambulances arriving through the night wakes me all the time. It used to be once or twice a night, but it has been a dozen times a night for the last month, which is a sombre reminder for me, personally, of the front-line experience of those who work in the NHS. I profoundly thank all those who are spending a tough winter looking after those with Covid and other conditions. We are working hard to get volunteers to support the front line, but I acknowledge that that has been slower than perhaps expected. Some £15 million has been allocated for mental health support for those in the NHS, but more can and should be done, and we are consistently working on it.
By way of winding up, I say that these restrictions are extremely regrettable. The noble Baroness, Lady Fox, demonstrates her anger and frustration; I do not really agree with much of what she says, but the emotional frustration she shares is well expressed, I think. However, I cannot hide from the Chamber that the new variants that have developed in Kent, South Africa and elsewhere present a tough challenge for all of us. We have learned an enormous amount about how to contain the virus and we have a huge amount of hope from the vaccine, but we have a long way to go.
Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) Regulations 2020
Lord Bethell Excerpts(3 years, 6 months ago)
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Lord Bethell
That the Regulations laid before the House on 14 December 2020 be approved.
Relevant document:40th Report from the Secondary Legislation Scrutiny Committee
Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 4) Regulations 2020
Lord Bethell Excerpts(3 years, 6 months ago)
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Lord Bethell
That the Regulations laid before the House on 30 December 2020 be approved.
Relevant document: 40th Report from the Secondary Legislation Scrutiny Committee. Instrument not yet reported by the Joint Committee on Statutory Instruments.
Health Protection (Coronavirus, Restrictions) (No. 3) and (All Tiers) (England) (Amendment) Regulations 2021
Lord Bethell Excerpts(3 years, 6 months ago)
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Lord Bethell
That the Regulations laid before the House on 5 January be approved.
Instrument not yet reported by the Joint Committee on Statutory Instruments.
Obesity
Lord Bethell Excerpts(3 years, 6 months ago)
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Baroness Walmsley
To ask Her Majesty’s Government what assessment they made of the report by the All-Party Parliamentary Group on Obesity The Future of Obesity Services, published on 25 November 2020.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, we welcome the ongoing work and support of the All-Party Parliamentary Group on Obesity and its report The Future of Obesity Services, which continues to make a valuable contribution to the debate. We published Tackling Obesity: Empowering Adults and Children to Live Healthier Lives last July, which demonstrates an overarching campaign to reduce obesity, takes forward actions from previous chapters of the childhood obesity plan and sets out measures to get the nation fit and healthy.
Baroness Walmsley (LD) [V]
I thank the Minister for his reply, but he will know that we have had several obesity strategies before. What steps are the Government taking to ensure that this latest strategy is implemented in full without delay? Can he provide an update on the timelines for implementation? One of the main concerns of our witnesses was that the full range of services should be provided everywhere in the country, with easier access at any stage of the pathway. Will the Government take this on board?
Lord Bethell (Con)
I thank the noble Baroness very much for the recommendations of her report. Implementation is key. We have 13 workstreams, which is too much for me to go through in detail, but yesterday evening I tweeted a full list of each of them for her interest. Her point about implementation on the front line is extremely well made. I reassure her that the NHS plan makes it very clear that front-line services should provide obesity support in all the right cases.
Baroness Stuart of Edgbaston (Non-Afl)
My Lords, the report quite rightly encourages the Government to continue their promotion of better health and to develop an obesity prevention strategy. Twenty years ago, food was moved largely out of the Ministry of Agriculture into the Department of Health. Obesity is a question of our relationship to food. Could I encourage the Minister, in the light of changes to the way we do agriculture, to focus also on health and how, locally, the relationship between health, agriculture and the provision of food can actually be deepened?
Lord Bethell (Con)
The noble Baroness puts her point extremely well indeed. Undoubtedly, there is a movement in the country as a whole to relate more closely the production of food in this country and the way in which healthy eating relies on good, locally produced food, and I take on board her points entirely. We very much take obesity more seriously as a result of Covid. That has given our plans a huge amount of energy, and the sponsorship of the Prime Minister has been very vocal.
Lord Holmes of Richmond (Con)
My Lords, would my noble friend agree that serious mental illness—SMI—must be a significant factor in the commissioning of and referrals within obesity services if those currently experiencing obesity and mental illness are to get the service, support and help they need?
Lord Bethell (Con)
My Lords, not everyone who is obese has mental illness, but some people who are obese do have mental illness. That is why we announced measures on weight management in Tackling Obesity: Empowering Adults and Children to Live Healthier Lives, which makes clear proposals for how those who have obesity as part of their mental illness challenge can be supported and provided for.
Baroness Boycott (CB) [V]
My Lords, I obviously welcome the report from the APPG, but I feel that we have heard it before and that its problem is in its implementation. I would like to make the point that a lot of our emphasis on the prevention of obesity is about stopping the promotion of unhealthy foods, whereas we do very little to promote healthy foods and to make a healthy diet affordable. Children from the poorest households are, at the moment, the most likely to suffer from obesity, but they are also suffering from food poverty. Healthy food is currently twice as expensive per calorie as unhealthy food, so just having a policy of restricting access to unhealthy foods can actually risk pushing people more into hunger and making them end up eating cheaper food. So, in order to address the inequalities in obesity levels, it is vital that restrictions in promotions of unhealthy food must be balanced by an increase of healthy foods, plus a really good public health campaign that encourages people to eat more healthily and tells them how.
Lord Bethell (Con)
The noble Baroness makes her point very fulsomely. We are doing a huge amount on advertising, promotions, front-of-pack nutritional labelling, out-of-home calorie labelling, alcohol calorie labelling and a whole range of stuff. The noble Baroness may well shake her head, but the truth is that this Government are doing more than any previous Government in this matter.
The Lord Speaker (Lord Fowler)
Could we have short supplementaries, please? I call the noble Lord, Lord Brooke of Alverthorpe.
Lord Brooke of Alverthorpe (Lab) [V]
My Lords, I declare an interest as a member of the all-party parliamentary group involved with the report. We recommended that the Government should build on their Better Health campaign with a public information campaign. Picking up on the last point of the noble Baroness, Lady Boycott, and on the Minister’s remark that he had tweeted about the 13 streams, is not the basic problem that the public are not aware that we are trying to run a campaign and that we need a clear relaunch? This is the opportune moment to do it, when we have such problems with Covid.
Lord Bethell (Con)
The noble Lord rightly alluded to the Better Health campaign, and I remind him that we did relaunch it yesterday. That went extremely well and got a lot of coverage. But there is only so much that government advertising can do; I do not think that we can advertise our way out of this problem. It is up to individuals to make their own decisions, it is up to GPs to give the support that people need and it is up to us as a society to accept that the health of the nation is important to its resilience and to its long-term health. Until those decisions are made, we struggle to make progress in this area.
Baroness Jolly (LD) [V]
My Lords, what works in rural Cornwall may not work in metropolitan Camden. Could the Minister tell the House whether there is a plan to require local integrated care systems to develop a local obesity prevention and treatment strategy for their population, strengthening existing services and sharing good practice across the national network?
Lord Bethell (Con)
Yes, I am glad to be able to reassure the noble Baroness that ICSs will be instructed to take obesity as part of one of their primary framework objectives. In fact, that is a very good example of how ICSs will make a big impact on complex issues such as obesity and how that impact will be felt in far-flung communities such as those in Cornwall.
Lord Vaizey of Didcot (Con)
My Lords, there is much to commend in the Government’s obesity strategy, but the restrictions on broadcast advertising are completely wrong-headed and based on no evidence whatever. In fact, I think that the Government’s own impact assessment says that it would reduce calorific intake by 1.7 calories—the calorie value of a Tic Tac. If the Government are determined to pursue this wrong-headed strategy, could the Minister assure me that they will not impose further restrictions on broadcast advertising until they level up and impose the same restrictions on online advertising?
Lord Bethell (Con)
My Lords, I can give my noble friend no such assurance. The decrease in sugar in soft drinks, as he knows full well, between 2015 and 2019, was 43.7%, and the increase in soft drink sales during that time was 14.9%. With six out of 10 adults and more than one in three children between the ages of 10 and 11 technically obese, clearly more needs to be done.
Baroness Thornton (Lab) [V]
My Lords, I think that the noble Baroness, Lady Boycott, is quite correct, and I did appreciate the Minister’s last answer to his noble colleague. But perhaps the Government need to consider healthy food where they can actually influence this, such as in hospitals, schools and care homes, and reinstate standards for healthy foods in those places.
Lord Bethell (Con)
Yes, I entirely agree with the noble Baroness. There are parts of the Government’s estate where more could and should be done in order to promote healthy foods. I pay tribute to the work of Prue Leith, who has done a lot to champion healthy food in hospitals. Progress has been made; I visited Southampton hospital with her earlier last year and saw her bringing healthy food direct to the patients, and the use of trolleys in order to ensure that warm food is delivered and that food does not have to come out of a plastic bag. More can be done, but I reassure the noble Baroness that we are working hard at it.
Lord Singh of Wimbledon (CB) [V]
The Sikh community has for some years run lectures and health checks in gurdwaras to reduce the calorie-rich diet of those from rural communities to one more suitable for the more sedentary occupations in the UK. Would the Minister agree that, with a little support from the Government, our places of worship can be of real help in reducing an above-average incidence of obesity and associated health risks in those from the subcontinent?
Lord Bethell (Con)
The noble Lord makes an incredibly important point, and he makes it very delicately. I am extremely grateful to him for bringing this to the Chamber. It is true that many people from rural communities in the subcontinent bring with them eating habits that are simply not appropriate for modern life. We have seen that in Covid, where some of the most challenging incidences of Covid ITU have been in communities with a high level of people from the subcontinent, whose eating habits have, frankly, left them in no good state to fight this horrible disease. Tackling that issue is extremely complex, and I am extremely grateful to the Sikh community for setting this good example.
The Lord Speaker (Lord Fowler)
My Lords, the time allowed for this Question has elapsed. We now come to the third Oral Question.
Health Protection (Coronavirus, Restrictions) (All Tiers and Obligations of Undertakings) (England) (Amendment) Regulations 2020
Lord Bethell Excerpts(3 years, 6 months ago)
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Lord Bethell
That the Regulations laid before the House on 21 December be approved.
Instrument not yet reported by the Joint Committee on Statutory Instruments.
Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 2) Regulations 2020
Lord Bethell Excerpts(3 years, 6 months ago)
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Lord Bethell
That the Regulations laid before the House on 17 December be approved.
Instrument not yet reported by the Joint Committee on Statutory Instruments.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, despite all the pressure we are under, I would like to take a moment to celebrate some good news. The Government have today accepted the recommendation from the Medicines and Healthcare products Regulatory Agency to authorise Oxford University/AstraZeneca’s Covid-19 vaccine for use. This follows rigorous clinical trials and a thorough analysis of the data by experts at the MHRA, which has concluded that the vaccine has met its strict standards of safety, quality and effectiveness. We have hundreds of thousands of doses ready to go and 100 million on order—enough for everyone.
On 4 January, the NHS will start administering doses to a revised list that reflects many of the interventions by noble Lords in this Chamber in recent debates. While the vaccine project is an international collaboration, we should take a moment to recognise the contribution of the British life sciences sector and reflect that this easy-to-administer, affordable and mass-produced vaccine offers Britain a way out of this disease, and will make a huge impact on the global response.
But, in the meantime, news from the front line remains grim. While the November national restrictions drove cases down in most areas, it is now clear that cases are rising again at a worrying rate. Across the whole country, cases have risen 57% in the last week, driven by the highly transmissible new variant. The number of people testing positive for Covid-19 has increased rapidly and a growing proportion have the new variant. Data from 29 December showed that there were an enormous 53,135 new Covid cases across the UK—half with the new variant—an increase of 272,551 over seven days. NERVTAG has concluded that the new variant demonstrates a substantial increase in transmissibility, of around 70%, and the R value appears significantly higher, with initial estimates at 0.39 and 0.93 higher—a massive margin in epidemiological terms.
In September, we introduced the tiering framework, which we built upon and refined in December. This is designed to provide a flexible and responsive system, which allows areas to move up and down the tiers as case rates change. It proved effective, with many areas containing transmission. Despite our efforts, the new variant has changed things. It forced us to establish the new tier 4 and to move regions, such as London and the majority of the south-east, into this higher tier.
The good news is that there is no evidence, at this stage, to suggest that the new variant of the virus is likely to cause more serious disease, that our current testing regimes will not detect it or that a vaccine will not respond effectively to it. For this, we give thanks. But the bad news is that there is no data showing that it causes less disease. The new variant accounts for 60% of cases in London and is growing around the country. As always, we see that increased infections lead to increased hospital admissions and loss of life. I need hardly remind noble Lords that this is a time when the NHS faces enormous challenges from winter pressures, its commitment to elective procedures and now the new variant. That is why we introduced the tier 4 stay-at-home measures we are debating today.
As in the November lockdown, people in tier 4 areas must stay at home and not travel out of tier 4. They may leave only for a limited number of reasons, such as work, education or caring purposes. People elsewhere are advised to avoid travelling into tier 4 areas. In tier 4, support and childcare bubbles are the same as in all other tiers. However, all non-essential retail and indoor entertainment will close. International travel is restricted to business trips. The clinically extremely vulnerable in tier 4 areas should do as they did in November and stay at home as much as possible, except to go outdoors for exercise or to attend health appointments.
However, we have listened to noble Lords in this Chamber and the public about what is important for the way people go about their daily lives. Unlike under the November restrictions, communal worship and a wide range of outdoor recreation are permitted. The restrictions imposed in tier 4 areas are hard, but necessarily so. They are designed to reduce transmission of this new variant, so that the NHS is not overwhelmed and we can return to normal as quickly as possible. These stricter rules are in line with other major European countries.
In addition to Greater London, other areas have now moved into tier 4, including Cambridgeshire, the rest of Essex, Norfolk, Suffolk, West Sussex, Hampshire, Southampton, Oxfordshire and Waverley. These changes took place on Boxing Day. We have balanced the economic impact of greater restrictions on business with measures to protect public health. These restrictions impact business in the short term, which is hugely regretful, but we should be clear that they will be economically beneficial in the long term, because we will get back to normal quicker. We are also mitigating the short-term impact through financial support schemes.
On 19 December, we had to take the horribly difficult decision to reduce the Christmas bubble exemption. I know that this meant that the majority of us could not celebrate in the way we would choose. However, given the increase in transmission rates, it would have been irresponsible and reckless to provide too great a window for increased social mixing and the inevitable increase in transmission that that brings.
Therefore, the Government had to ask people across the country to make further restrictions to their Christmas plans. Although this period has been difficult, we now have clear hope. With the rollout of the vaccine under way, we can start to plot our path out of the pandemic with greater certainty, but it is precisely because of this hope that we cannot give up now. That is why my right honourable friend the Secretary of State for Health and Social Care will make a Statement in the House of Commons later this afternoon, addressing future tiering arrangements in response to the new variant. My right honourable friend the Secretary of State for Education will make a Statement in the other place on the return of schools and universities. The sacrifices we make now are crucial to getting back to normal and ensuring that, next year, Christmas will be much more normal for every family in the country.
I commend the hard work of the NHS teams on the front line, including our Chief Medical Officer, scientists developing vaccines and other therapeutics, and those in the life sciences industry seeking to mitigate the impact of this epidemic. I also express the sympathy of us all to those feeling under pressure of any kind—financial hardship, domestic strife, health concerns, educational worries, mental health pressure or just the worry for loved ones and an uncertain future. To all those, I say that there is light at the end of the tunnel. With new scientific advances being made every day, we are taking concrete steps but, in the meantime, we must dig deep. The end is in sight and, until science can make us safe, it is our duty to put in place these new rules, which will help us to keep this virus under control. I commend these regulations to the House.
Lord Bethell (Con)
My Lords, I am enormously grateful to noble Lords for an informed, thoughtful and passionate debate. These regulations are incredibly important, but they are clearly not enough to battle the growth of Covid in recent weeks, and the noble Lord, Lord Harris, was entirely right to spotlight the situation in London, which is particularly acute. In Havering, there is a prevalence of 1,500 per 100,000. I remember being surprised when somewhere hit 200, and we used to be happy with 400—1,500 is an astonishing number. I fear that that is what we are looking at, at the moment, and that is the seriousness of the situation we have to face up to.
Some noble Lords have suggested that we are not doing enough, and I will answer a few questions in that area. As noble Lords who have frequently attended these debates will know, we could not have been more committed to our testing regime. In the last reported week, from 10 to 16 December, 92.6% of contacts were reached, 93.9% of pillar 1 tests were within 24 hours and 91.1% of care home tests were within three days. Some 2,293,012 tests were done in that week. That is a colossal number, which reflects an enormous commitment.
The noble Lord, Lord Berkeley, is quite wrong when he describes the project in the Channel Tunnel as chaotic. It was a remarkable achievement, and I do not think that any other country could have pulled it off: 30,000 tests were brought together incredibly quickly on the roadside, with a multinational team of hauliers, under the most difficult circumstances. This helped to get trade moving, and I personally pay tribute to colleagues from the DfT, the military, local police, the test and trace programme and all those who made that possible. I also pay tribute to those who are pulling together tracing partnerships and the community testing regimes over the Christmas period; they have made enormous progress.
A number of noble Lords have quite rightly asked about volunteers and whether we could or should be using them more. I reassure noble Lords in the Chamber that we are absolutely working our hardest to make use of volunteers where we can. A number of noble Lords have asked about administrative problems, and I reassure noble Lords that NHS Resolution has put in place clinical negligence schemes for coronavirus under the terms of the Coronavirus Act, which we debated here at the beginning of the year, and Covid-19 has been added to the Vaccine Damage Payments Act.
NHS volunteer responders have delivered 1 million tasks to 123,455 unique clients; that is the work of 360,000 NHS responders. The St John Ambulance, which has had an absolutely massive impact, has delivered 200,000 hours of support and has very helpfully been involved in training 30,000 people for the administration of the vaccine. It is very much our intention to make use of that valuable resource. Of the 45,000 on the Bringing Back Staff team at the NHS, 2,700 have already been used, and many more will be deployed right now.
In relation to the vaccination, I reassure noble Lords that the authorisation today is a complete game-changer in relation to the scale and speed of the deployment. Not only is the vaccine massively easier to take to care homes, in particular, and GP surgeries, but the change in the dosage pattern means that we can not only deliver every single dose as it arrives in the warehouse but we do not necessarily have to book someone in for an immediate second dose. That gives our deployment programme an enormous amount of flexibility, and will lead to a great increase in our turnover: we will literally be delivering them as quickly as they can be manufactured.
Others are concerned that we are doing too much, and I will address that very quickly. In relation to projections, I have stood at this Dispatch Box and had the projections of the Government, SAGE and PHE derided by noble Lords as fearmongering. Who could possibly have believed that we would have 53,000 new infections? It is a little bit rich of noble Lords to question the work of scientists and our modelling teams in relation to their projections on today of all days. We accept advice from a very wide range of scientists; no voice is excluded. It is the role of government to synthesise advice into policy, and we do not need to smear or deride the scientists who supply that advice.
I have been through the statistics on public support on numerous occasions; I do not think I need to go through that again. There is massive public support for the measures that we have implemented. As for ignoring the Government, adherence rates are remarkably high, and I pay tribute to the public, which, although there are exceptions, by and large are incredibly committed to the regulations that are in place.
Lastly, as I have said before, it is not the Government’s policy to use two-week lockdowns as an emergency brake. These were used in Wales but not nationally, and that will not be our policy.
I agree with the sentiments of the noble Baroness, Lady Watkins—at heart, I also celebrate British liberties, but it is the virus that is not respecting liberty, not government, and we have no option but to bring in these kinds of measures to battle the virus, save lives and protect future generations.
A number of noble Lords mentioned schools, which are, without doubt, the most difficult subject at the moment. Of course it is right that we should do absolutely everything we can to keep schools open. Noble Lords who made that point enjoy my complete and utter support, but the epidemiology is very challenging. Schools have undoubtedly been the source of an enormous amount of transmission. Some of that is asymptomatic, but it is deadly nevertheless. The opening of schools has contributed to the high rate of transmission, particularly in London. It will be up to the Secretary of State for Education in the other place to make the announcement on schools, but the Government are entirely committed to trying to keep schools open for exactly the reasons cited in this Chamber, not least because it is those who come from the poorest backgrounds who undoubtedly suffer most from their closure. However, in order to make an effective regime to battle this virus we may need to make some tough decisions.
The noble Baroness, Lady Thornton, asked whether this is going to be enough. That is not for me to answer; my right honourable friend the Secretary of State for Health will be making a Statement in the other place shortly and he will address the question of any future restrictions or regulations. However, the noble Baroness is entirely right; the challenge we face this week is completely different to the one we had when we went into recess before Christmas. This new variant is of a different order; we may as well be battling a different disease. We will have to step up to that challenge in order to see ourselves through to the spring, when the vaccine will have been delivered to sufficient numbers to make a real difference. I regret that that may strike a chilling note at the end of this debate, but we have to face up to it.
Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 3) Regulations 2020
Lord Bethell Excerpts(3 years, 6 months ago)
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Lord Bethell
That the Regulations laid before the House on 29 December be approved.
Instrument not yet reported by the Joint Committee on Statutory Instruments.