ONS: UK Life Expectancy

Lord Bethell Excerpts

Thursday 17th December 2020 Lords Chamber

[Lord Rooker]

To ask Her Majesty’s Government what assessment they have made of the publication by the Office for National Statistics National life tables—life expectancy in the UK: 2017 to 2019, published on 24 September.

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

My Lords, life expectancy is at its highest level ever, but we have seen improvements stall and we expect to see adverse impacts from Covid on life expectancy data in the future. Covid has shone a light on the differences in health outcomes between communities; that is why the Government remain committed to levelling up health outcomes so that everyone can enjoy a long and healthy life.

[Lord Rooker (Lab) [V]]

My Lords, my Question has nothing to do with Covid. What are the reasons life expectancy improvements have slowed in comparison to the previous decade? The flatlining in the ONS statistics, at figure 1, is a worry because it is a trend of 10 years, and the Marmot review in February said that this had not happened since the year 1900. For women in the most deprived areas, life expectancy actually fell between 2010 and 2018, so why has there been no national health inequality strategy since 2010? Why has that disappeared off the face of our policy-making? When does the Minister expect the flatline to go back up again?

[Lord Bethell (Con)]

My Lords, the noble Lord is entirely right that this stalling of the life expectancy curve is extremely worrying, and he is right to emphasise the disappointing results in deprived communities, where, as he says, we are going backwards instead of forwards. Covid has shown how that has a huge impact on the resilience of the nation’s public health. The Government are committed to this agenda—we published a prevention Green Paper and we are committed to building a strategy out of that Green Paper, and since then we have done work on better health, on obesity and on other areas of life expectancy—but I agree with him that more can and should be done.

[Lord Davies of Brixton (Lab)]

My Lords, it is clear that there has been a downturn in the rate of mortality improvement since 2010, and the evidence is that the impact of these negative trends has been greater among more deprived groups, with some suffering an actual decline in their expected lifespan. Does the Minister accept that a significant reason for this has been the imposition of austerity policies since 2010 under successive Conservative Governments?

[Lord Bethell (Con)]

No, I do not.

[The Lord Bishop of Durham [V]]

Given the ONS recent findings that the lowest regional life expectancy for both male and female children at birth in 2017-19 was observed in my area of the north-east of England, when will Her Majesty’s Government commit to a full- blown strategy to eliminate the obstacles disproportionately facing children in poverty here in the north-east?

[Lord Bethell (Con)]

The right reverend Prelate is right to emphasise some of the disappointing figures around children, and the north-east is one area where the challenge is greatest. But I remind him that we have strategies for healthy behaviours in school, we are committing a huge amount of funding for more physical activity in schools, and we think that this will have a major impact on both the fitness and healthy outcomes of children. That kind of project will make a big impact.

[Lord Kirkhope of Harrogate (Con) [V]]

My Lords, can my noble friend give any real explanation as to why the UK is so low down on the OECD figures for average annual increases in life expectancy at birth? On the ONS tables, England is 18th out of 21 countries, with Scotland and Wales faring even worse. Is there a particular reason he can think of—could it be methodology or social habits? Has he any further explanation of the comparative situation here?

[Lord Bethell (Con)]

My Lords, I cannot give an answer in the round and explain every element, but we have to face up as a nation to the fact that some of our habits are unhealthy. In some communities smoking rates are extremely high, and the difference between different communities is profound—1.6% in west London, compared to 25.7% in Blackpool. Our obesity, BMI and consumption of high-calorie food is just too high. This is not the sole explanation, but as a nation we have to face up to some of our behaviours.

[Lord Rennard (LD)]

My Lords, half the considerable difference in life expectancy between the richest and poorest in our country is entirely accounted for by smoking. At present, the Government are spending considerable amounts of money on advertising campaigns which tell people how to keep safe during the Covid pandemic. In the future, will the Government reinstate advertising aimed at promoting smoking cessation, to meet their own target of making Britain a smoke-free country and helping to improve the health and life expectancy of the poorest in our society?

[Lord Bethell (Con)]

The noble Lord makes his point extremely well: smoking rates in this country are far too high. The huge amount of Covid advertising at the moment has squeezed out a lot of our public health messages, and I reassure him that we will return to them—including the smoking campaign—when normal business resumes.

[Baroness Redfern (Con) [V]]

My Lords, there have been life expectancy improvements in the UK, which I welcome. My concern regards paediatric obesity, which brings associated increased risks of morbidity, disability and premature mortality in adulthood. The Government have set a national ambition to halve childhood obesity rates by 2030. As they have taken a strong lead with the soft drinks industry levy, what proposals are being looked at to extend its mandatory approach beyond soft drinks to wider product ranges?

[Lord Bethell (Con)]

The noble Baroness is entirely right: 15% of children aged two to 15 are obese. That is a shocking figure, and extremely disappointing. We have already done a lot to bring in the taxes on sugary drinks, and we are ploughing the money from them into sport in schools. But she is right that the taxes on sugary drinks provide an interesting template, which could be used in other areas where industry fails to step up to its responsibility and to reduce the harm of fatty or other destructive foods.

[Lord Patel (CB) [V]]

My Lords, the Science and Technology Committee, which I have the privilege to chair, will publish a report in January on ageing, science, technology and healthy living, which noble Lords will find an interesting read. The Government have set themselves a grand challenge, with a target of increasing healthy life by five years by 2035. In light of the ONS report and the effects of the pandemic, what increased barriers do the Government think that they face to achieving that—or can it be achieved at all? If the Minister wishes to give a Written Answer, with a copy in the Library, I would be content with that.

[Lord Bethell (Con)]

The noble Lord makes his point extremely delicately and politely, but he is entirely right. We have a commitment for five extra healthy years by 2035, and the combination of the Marmot review, the ONS figures and Covid make that seem an extremely daunting challenge indeed. I am not sure if I have the complete answer standing at the Dispatch Box right now. I would be glad to write to him and explain how we will undertake the Green Paper on prevention, the response to which will be published next year, as an opportunity to outline the kind of strategy he calls for.

[Baroness Thornton (Lab)]

The Minister’s response to my noble friend Lord Davies of Brixton was an abrupt one, which kind of suggested that it was an accident that we are where we are with life expectancy and that the Government’s policies have no impact on that. My question actually follows very neatly from that of the noble Lord, Lord Patel. Do the Government intend to establish life expectancy and well-being as a strategic marker and measure for the whole nation’s well-being and welfare in all Acts? How will that feed into reforms for the NHS?

[Lord Bethell (Con)]

My Lords, I think that healthy living and life expectancy is a strategic marker. We are naturally focused on it and, in particular, the disparities between communities, which have been alluded to by a number of noble Lords. The huge gap between life expectancy in Blackpool and west London is extremely disturbing, and something that the Government are highly focused on. These are complex issues. They involve government policy—as the noble Baroness quite rightly points out—but also personal behaviours, and it will very much form part of the NHS plan going forward and the rebooting of the NHS in a post-Covid world.

[The Senior Deputy Speaker (Lord McFall of Alcluith)]

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

Covid-19: Vaccinations

Lord Bethell Excerpts

Thursday 17th December 2020 Lords Chamber

[Lord Harris of Haringey (Lab)]

I draw attention to my interests in the register and beg leave to ask the Question standing in my name.

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

My Lords, more than 137,000 people in the UK have received the first dose of the Pfizer/BioNTech Covid-19 vaccine in the first week of the largest vaccination programme in British history, and I thank all those involved. It will take at least until spring for all high-risk groups—an estimated 25 million people in England—to be offered a Covid vaccine. We remain committed to the principle of offering everyone in Britain a vaccine.

[Lord Harris of Haringey (Lab)]

The Government have form on overpromising and underdelivering, so I am interested in the figure that the noble Lord has given. Assuming that he is going to achieve 25 million vaccinations, that means in excess of 1 million people a week being vaccinated between now and then. With 200 vaccination centres, that means something like 7,500 vaccinations per week and, if centres work 14 hours a day for seven days, that will be something like 75 per day. Does the noble Lord not think that he is in danger —again—of overpromising and—again—of fuelling the widespread belief that the crisis is over, which is leading to the behaviour that we all know is likely to fuel the number of cases in the next few weeks?

[Lord Bethell (Con)]

My Lords, the mathematics done by the noble Lord are interesting but not quite a reflection of the strategy. It is undoubtedly true that the NHS is, wisely, taking the start of the deployment with great care. This is an extremely complex vaccine to deliver, but hospital hubs, local vaccination services and vaccination centres will be rolled out around the country. The kind of ambition that the noble Lord describes—quite rightly—is exactly what we seek to deliver; we will update the House as that deployment plan rolls out.

[Baroness Warwick of Undercliffe (Lab)]

My Lords, I want to urge early access to the vaccine for the terminally ill. On Tuesday, in response to my noble friend Lady Thornton, the Minister said that there was a powerful case but any further refinements to the priority list will “create profound operational challenges”. That is not a good enough answer for my nephew, Matthew Walton, who has stage 4 brain cancer. Surely his two young children should be able to spend their remaining time together without the additional threat of an early death, which could so easily be averted by a vaccine—unlike his cancer. Will the Minister please press this powerful case?

[Lord Bethell (Con)]

The noble Baroness makes the case extremely well; I pay tribute to her personal testimony. I looked into this matter after giving my answer to the question last week. I assure the noble Baroness that those who are terminally ill are, of course, clinically vulnerable by nature. We will ensure that those who are clinically vulnerable will get the vaccine when it is clinically appropriate to do so, which I hope brings her some reassurance.

[Baroness Brinton (LD) [V]]

What provisions and logistics are in place for those not registered with GPs to receive the vaccine?

[Lord Bethell (Con)]

Those who are not registered with GPs and would like to take the vaccine need to register with GPs. We have put in place provisions to allow easier registration processes, we have updated our data arrangements and we are expecting a large number of people to seek out registration. That will be one of the benefits of the vaccination programme: clearer, better records of those in this country who are part of the NHS family.

[Lord Moynihan (Con)]

My Lords, last month, my noble friend the Minister was hoping to receive advice from the World Anti-Doping Agency for our Olympic and Paralympic sports stars preparing for the 2021 Tokyo Games on the specific point of whether MRNA vaccines were prohibited under the WADA code. I understand that the vaccines have been deemed safe and acceptable for use within the guidelines, protocols and rules of the WADA prohibited list. If this is the case, will my noble friend ask his department: to publish WADA’s detailed advice; what testing capability our national anti-doping agency—UKAD—has for synthetic messenger RNAs; and for information on when all elite sportspeople can expect to be vaccinated so that they can train and compete safely?

[Lord Bethell (Con)]

I am grateful to my noble friend for his championship of this important point. It is not necessarily the role of the department to rule on this matter, but I note that UK Anti-Doping welcomed the World Anti-Doping Agency’s publication of its view on the vaccine. We welcome that moment and I very much hope that it provides the reassurance that athletes are looking for.

[Lord Pannick (CB)]

My Lords, my mother-in-law is 84 years old. That sounds like the beginning of a bad joke but it is not funny because she has serious health concerns and is very high risk. Over the past couple of weeks, my wife has repeatedly telephoned her NHS GP practice in north-west London—I will not name it, although I am happy to tell the Minister which it is. Staff there say that they have no vaccine, no information about when they can expect to receive the vaccine, no guidance from the Department of Health and no protocols. Does this not support the concern expressed by the noble Lord, Lord Harris, that there is a real danger of the Government underperforming yet again in this context?

[Lord Bethell (Con)]

I hear the concerns of both the noble Lord and his mother very clearly but I assure him that, to date, the rollout has very much focused on the 70 hospital hubs where we are getting the protocols and practices about getting this extremely difficult vaccine into people’s arms correct before we roll out distribution to all GP services. It is not at all my expectation that every GP service in the country will have the vaccine, nor that they will necessarily be ready to deliver it this week, but that guidance has been distributed. If the noble Lord would like to send me the details, I will ensure that that GP practice is up to speed on this important matter.

[Baroness Thornton (Lab)]

My Lords, my concern is about NHS staff. They may need to deal with a third wave in the new year, they will be required to work through the Christmas period dealing with the current spike and they will be co-ordinating the vaccine—so they might be completely overstretched in January and February. Would it be a good idea to ensure that at least front-line, high-risk clinical area staff are vaccinated immediately? Does he agree that this would make sense from an operational point of view? I know from my work as a non-executive director of a London hospital that it would be a huge morale booster for the staff to whom we owe so much.

[Lord Bethell (Con)]

I take on board the noble Baroness’s points on the NHS. Its staff have been under huge pressure, which is likely to be sustained into the new year. I pay tribute to their hard work. The JCVI has looked extremely carefully at the prioritisation. The most important thing is to avoid pressure on ICUs and the threat of mortality. That has been done by prioritising age over role. I also pay tribute to the St John Ambulance service, which has done an amazing amount of work in gathering 40,000 inquiries for training on delivering the vaccine. By undergoing training, those people will relieve NHS staff of an enormous amount of the pressure that the noble Baroness rightly describes.

[Lord Scriven (LD)]

My Lords, following on from my noble friend Lady Brinton’s question, it is estimated that between hundreds of thousands and millions of people are not registered with a GP. Some have the most chaotic lifestyles, do not speak English and are not plugged into the most basic services. How will the Government make arrangements for people who are outside normal registration processes to be vaccinated?

[Lord Bethell (Con)]

The noble Lord makes the point well. He is right that there are undoubtedly communities that conventional NHS outreach has not got to; we have learned that fact during Covid. Our immediate priority is to reach the over-80s and ensure that the deployment programme works for those groups that are most at risk. We will be turning our attention to the groups that he describes, but I cannot avoid the fact that, if you are going to get a medical service, you need to be registered with a GP. That is something that some people are going to have to make part of their life.

[Lord Mann (Non-Afl)]

The registered GP services where I live are banging on the door for this vaccine at the moment. What is the latest date for a universal rollout to every primary care area in the country, making the vaccine available to those who are vulnerable?

[Lord Bethell (Con)]

I completely understand the noble Lord’s impatience to know that. I am afraid that I cannot provide him with a precise date. One reason why is because we do not know the availability of the other vaccines. As he knows, the AstraZeneca vaccine, the Moderna vaccine and three others are all in the pipeline at the moment. If they get authorisation from the MHRA, that will completely change our deployment programme. At the moment, we are putting in place contingency measures for an uplift in our deployment should any of those be authorised; that will lead to a major growth in our deployment plans.

[The Senior Deputy Speaker (Lord McFall of Alcluith)]

My Lords, the time allowed for this Question has elapsed. Oral Questions have now finished.

Covid-19 Update

Lord Bethell Excerpts

Tuesday 15th December 2020 Lords Chamber

[Baroness Jolly (LD) [V]]

I support the points made by the noble Baroness, Lady Thornton, on lockdown; she and I have repeated them regularly in these debates, and yet there is no change. My points will be around vaccines, acute hospitals and their staffing, and Christmas. I thank the Minister for repeating the Statement and join him in welcoming the news about vaccines. Anyone in need of a real feelgood story should watch last night’s “Panorama” programme about the development of the Oxford team’s AstraZeneca vaccine.

How confident is the Minister of 100% vaccine coverage, for those that are entitled, by Easter 2021? This is a lot of people, and we are not certain of all vaccines being available by that time. Could he explain to the House what determines who receives the AstraZeneca vaccine and who the Pfizer—or indeed any other vaccine that may come along? Is he confident that the new vaccines will be effective against the new variant that is emerging?

Can the Minister give us a statement about acute hospitals in tier 3 areas? At the moment, it looks as though the rise in cases in the London area and the south-east is almost matched by the rise in hospital admissions—they are just a percentage point apart. Are the Government confident in London’s hospital capacity? We know that, in some areas, there are Nightingale hospitals; is the NHS intending to bring them into use if necessary? Are there the clinical and other staff to run them?

For many of us, an in-person Christmas may not be possible. We need to look at the impacts that Thanksgiving had on the US Covid-19 figures and assess our risk. Many of my contemporaries have decided not to travel to celebrate with friends and family, and our children have told us that this is what we are going to do as well, so it looks as if many will be resorting to whatever is their favourite conferencing software to catch up with family.

Finally, will the Minister outline the Government’s communication strategy for Christmas? Clear messaging is imperative but many of the public who have been interviewed are unclear. Will ads be used in newspapers, broadcasts and online social media? Christmas is 10 days away, and people would appreciate a clear steer from the Government. This needs urgent and professional communications attention.

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

My Lords, I am extremely grateful for the clear and thoughtful questioning from the noble Baronesses, Lady Thornton and Lady Jolly. Both of them are right: we are seeing a sharp rise in south Wales, London and parts of the east and south-east of England, which is making us rethink some of our approach to Christmas. We have seen a sharp rise in the virus across London, Kent, parts of Essex and Hertfordshire, and reports of a new variant. We saw the evidence of this starting in the 15 to 19 year-old age group and we have taken swift and decisive action but, unfortunately, more may be necessary. We know that this rise will be mirrored in hospital admissions, and it takes only a few doubling times to put pressure on the NHS. The noble Baroness, Lady Jolly, is absolutely right to question whether we have the resources in place to see such doubling take place over time. This is a trend we are seeing all over Europe, in countries such as Sweden, where nearly all the intensive care in Stockholm is currently in use, and even in Germany, where tougher new restrictions were announced over the weekend.

It is entirely natural that we look very closely at the Christmas relaxation, but I am not in a position to share any update on that this evening. The noble Baroness, Lady Thornton, asked: what is the Secretary of State’s plan to keep us safe? We have plans, and I will be glad to share them with noble Lords. However, may I just say a word about personal responsibility? The noble Baroness, Lady Thornton, put it well: it is up to each and every one of us to decide whether we will take a minimalist or maximalist interpretation of the rules. At the end of the day, it is a personal decision on what kind of risk approach one will take to Christmas. The SAGE advice has been published and it is clear. It does not make very comfortable reading for those of us with elderly relations who have been looking forward to seeing us, but it clearly states that we should be looking to spend time at Christmas with as few people as possible for as short a time as possible and, wherever possible, outside instead of inside. I am afraid to say that that will be what a responsible Christmas looks like for everyone. It is not something that the Secretary of State can ordain; it is, unfortunately, what the spread of the virus requires.

I acknowledge—the noble Baroness, Lady Thornton alluded to this—that the tier 3 regimes, particularly in the north of England, have had a profound impact. The behaviours of people in the tier 3 areas have been considerably amended, and that has seen a sharp reduction in the infection rates in those areas. It demonstrates that restraint works, and I take a moment to applaud all those who have played a role in that achievement.

On the vaccine, I will be very happy to provide an update on the special cases that the noble Baronesses alluded to. Both the case for unpaid carers and the case for the terminally ill are powerful, and we are listening carefully to them as they are made. However, the JCVI has put in its priority decision and that is what we are working to at the moment. Any further complications or refinements to that create profound operational challenges, but we are listening very sensitively to the case being made for the special cases.

I share the tribute of the noble Baroness, Lady Jolly, to the AstraZeneca team. The “Panorama” programme last night was a tonic for the soul during these difficult times, and I would recommend it to everyone.

As to the new variant to which the noble Baroness, Lady Jolly, alluded, the preliminary scientific judgment is that it does not at the moment show any evidence that it will escape either the vaccine or any other therapeutics that are targeted at Covid. That is always the natural concern in these circumstances; we are studying it very carefully indeed and will, of course, update the House if any changes do emerge. However, the new variant, which has been correlated with higher levels of transmissibility in Kent, does remind us that the threat of Covid is undiminished and we must remain committed to the restrictions in place to contain this horrible virus.

[The Deputy Speaker (Baroness Morris of Bolton) (Con)]

My Lords, we now come to the 30 minutes allocated for Back-Bench questions.

[Lord Patel (CB) [V]]

My Lords, we know that all viruses evolve and, while we do not yet know whether the genomic variant identified is more infectious, we do know that the transmission rate of the virus is rising exponentially. By the way, the Minister just said that the new variant correlates with increases in infection; the word “correlates” suggests cause and effect that has not yet been proven. Can the Minister tell us what scientific matrix the Government will use over the next week to make the political decision on whether to ease or otherwise the current restrictions, going forward to Christmas and beyond?

[Lord Bethell (Con) [V]]

My Lords, I am extremely grateful to the noble Lord, Lord Patel, for his description of affairs, which, as ever, is as thoughtful as we would hope. However, I clarify and disagree with him in that correlation and causation are not the same things. I chose my words extremely carefully: there is a correlation with higher transmissibility, but there is no evidence that this is caused by the variant; I want to be crystal clear about that. I pay tribute to colleagues at the Sanger and at COG, the genomics collective that is doing the work on tracking down the science of the new variant. Their insight is profound and they will be playing into the decisions about whether any judgment on the variant should play a role in the decisions about any future restrictions.

[Lord Hayward (Con)]

My Lords, does my noble friend the Minister accept what I deem to be the position in relation to the younger generation: that they are suffering from lockdown fatigue and are not responding to government messages? I suggest that, rather than having government Ministers and some scientists conveying the message of the importance of acting responsibly, they consider along with Jonathan Van-Tam somebody like Marcus Rashford, Rio Ferdinand or Harry Kane to convey the message that we are failing to get across? In association with that and the comments that have been made elsewhere, can the Minister tell us whether he has any information, in light of the FDA’s announcement, as to whether the Moderna vaccine will be recognised in this country in the near future?

[Lord Bethell (Con) [V]]

My Lords, I feel the point that my noble friend makes extremely personally. I am currently isolating with a 14 year-old; like many 14 year-olds, he and his friends never demonstrate any symptoms of Covid whatever and yet it would seem that they are carriers and vectors of the infection. The recent explosion in transmission in London and the south-east was led and probably caused by the 14 to 18-year-old age group, even though almost all of them are completely asymptomatic. We have worked with celebrities and opinion leaders in the youth groups to try to get this message across, but I point my noble friend to the announcement today of a very large increase in the use of asymptomatic testing in schools in the new year, as an indication of our commitment to ensuring that transmission among asymptomatic young people is contained.

[Lord Winston (Lab) [V]]

I thank the noble Lord for repeating the Statement. I concur with what the noble Baroness, Lady Thornton, said from the Front Bench. We know from the history of plagues that they occur through travel. This happened in the 1340s and again in the 1660s with the plague of London. Now we are seeing people travelling to London, which is a massive hub of travel; they come to the airport, they do not leave a phone number or address—they are not required to do so—and tests at the airport are voluntary. Many people go missing and are not followed up by a proper track. When they get tested, they pay for it, so it is entirely voluntary. Does the noble Lord feel that these arrangements are sufficient, given that so many people travel to London and that there is a risk of this plague continuing just as they have done historically?

[Lord Bethell (Con) [V]]

I am grateful for the noble Lord’s insight. He is right that travel is the friend of the virus. Many of the growths in transmission have been associated with it; one thinks of the ski resort holidays at the beginning, the spring break migrations in America and other examples. I reassure him that, while he is right to question the arrangements around our airports and transport hubs, we have brought in a much more strenuous test to release programme which is much more realistic than the previous isolation programme. The procedures around the passenger location ports have been tightened up and the enforcement and tracking arrangements for passengers have been supplemented. There is now a very strong body of evidence to suggest that passengers are abiding by the testing programme. As he may know, private tests were launched yesterday, and their uptake has been incredibly impressive.

[Baroness Hollins (CB) [V]]

My Lords, 200,000 people are on their GP’s learning disability register and get the flu jab on the same terms as over-65s, but only one in 10 of this group has been prioritised for vaccination. My research 25 years ago found that these people were 58 times more likely to die before the age of 50 in ordinary times, and PHE research found a death rate 30 times higher for 18 to 34 year-olds with learning disabilities than for others of the same age during the first wave. To require them to wait until their chronological age group is eligible seems discriminatory. Will the Minister commit to look at this again?

[Lord Bethell (Con) [V]]

I completely acknowledge the correlation between mortality and learning difficulties that the noble Baroness alludes to. PHE has looked at this in respect of Covid very closely. That evidence played into the JCVI prioritisation process; it landed on age as the main determinant for that process but continues to review this based on evidence. The noble Baroness makes a good case, but I reassure her that the JCVI has looked at all this evidence very closely.

[Lord Robathan (Con)]

My Lords, during all these restrictions and over the lockdown we had for one month, which ended on 2 December, we have been told that the Government are following the science—the “unstoppable force of science”, to quote the Secretary of State in yesterday’s Statement. However, in late September SAGE recommended circuit breakers of two to three weeks, which Wales imposed for 17 days until 9 November; it now has coronavirus rates that are nearly three times those of England. What confidence does the Minister have in the scientific advice he is given?

[Lord Bethell (Con) [V]]

My Lords, the restrictions in England have never been based on a two-week circuit breaker. It was not a policy that the DHSC supported.

[The Deputy Speaker (Baroness Watkins of Tavistock) (CB)]

The noble Baroness, Lady Blower, has withdrawn, so I call the noble and gallant Lord, Lord Craig of Radley.

[Lord Craig of Radley (CB) [V]]

My Lords, the Statement refers to a new variant of the virus. Is this the only variant, or are others being found overseas? Porton Down is working to discover whether the current vaccines will remain effective. When does it hope to report? I declare an interest: I was vaccinated in the Fakenham medical centre in Norfolk this morning—a very efficient and reassuring experience—which had 365 planned for today.

[Lord Bethell (Con) [V]]

I massively congratulate the noble and gallant Lord on his vaccination this morning. I am extremely proud of that moment and glad that he has taken a step towards safety. It is a fantastic piece of news, which we should all celebrate.

On the noble and gallant Lord’s question on the variant, there are dozens—possibly hundreds—of variants, some of which are minimal and insignificant. The one that has been thrown up in Kent is being singled out only because it correlates with an increase in transmissions in Kent. It is not certain whether this is because of the variant or because of behaviours in Kent, but naturally we are worried about it. I am not a biologist, but I am assured by the biologists that the new variant does not seem to show any attributes that would mean that it could escape the vaccine. Naturally, we are looking at it very closely and hope to have an answer to his question shortly.

[Lord Randall of Uxbridge (Con) [V]]

My Lords, the Government are between a rock and a hard place with regard to the Christmas arrangements. If it is decided that circumstances now dictate a change, does my noble friend agree that it is imperative that the public are given as much notice as possible of any changes?

--- Later in debate ---

[Lord Bethell (Con) [V]]

My Lords, we always seek to give the public as much notice as possible. But I accept that one of the most frustrating aspects of this pandemic has been that the virus does not behave as predicted, and that the response to restrictions and policies by the public has not always turned out exactly as we planned. It is therefore sometimes true that our policies need to change at short notice. This is incredibly challenging for the public—I do not duck that point in any way—and I am extremely grateful to the public for their forbearance under the circumstances.

[Lord Mackenzie of Framwellgate (Non-Afl) [V]]

My Lords, I can fully understand the necessity for additional measures announced by the Health Secretary in another place yesterday in light of the statistics. It is not just Covid deaths likely to increase but, of course, the deaths from diagnostics not being carried out on potential cancer and stroke patients—not to mention the pain and misery being inflicted on patients who have to postpone elective life-altering surgery. Is there not now a powerful case for the Government to consider reversing the superspreader travel festivities bonanza during the five days of Christmas which, as night follows day, will inevitably lead to more infections, hospital admissions and deaths, as has happened in America following Thanksgiving?

Finally, having heard the Minister’s considered responses this evening, am I right to feel a little more optimistic?

[Lord Bethell (Con) [V]]

My Lords, the noble Lord, Lord Mackenzie, makes a powerful case. There is undoubtedly a dilemma about what we should do in the approach to Christmas. The country does deserve a break, because it has done so much this year to contain the virus, and yet the consequences of too much social mingling are harsh, as he rightly describes. I reassure him that we have done a huge amount to restart elective surgery and other diagnostics and to get the NHS working as hard as we possibly can. It is our objective to ensure that the non-Covid death rate is not affected by the Covid response.

[Lord Campbell-Savours (Lab) [V]]

My Lords, can I return to the issue of masks, which I have been pushing since February? With London in lockdown, a new variant and the prospect of an explosion in transmission in the new year, why not, in this rapidly developing crisis, adopt a vigorous belt-and-braces approach, follow worldwide mandatory practice and require mask wearing in all public places outside the home? Why not ban the use of valved masks, apart from in clinical settings? They protect only the wearer. Now is the time for really tough decisions; there is a big crisis that confronts us.

[Lord Bethell (Con) [V]]

My Lords, I pay tribute to the campaign and advocacy by the noble Lord, Lord Campbell-Savours, on masks. He has moved the needle on this subject. I would argue, perhaps, that there is a huge amount of mask-wearing, particularly in public places; certainly in shops, on transport and even in the House of Lords, mask-wearing has become mandatory. So, he has already come a long way. We continue to review additional options in this area. His point on valve masks is extremely well made and is one that I have made to the relevant officials.

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

My Lords, I declare that I chair the National Mental Capacity Forum. I ask the Minister to express thanks to staff in his department as they continue to work with us and the Ministry of Justice to run a rapid-response webinar on Friday, requested from primary care leads yesterday, following their pilot, to support primary care as vaccination is rolled out to care homes, where many residents have seriously impaired capacity. We aim to disseminate the latest guidance and ensure appropriate information to support understanding for consent to vaccination, including easy-read and pictorial versions of information.

[Lord Bethell (Con) [V]]

I am enormously grateful for the work that the noble Baroness, Lady Finlay, and the National Mental Capacity Forum have done during the pandemic. The issue of mental capacity and consent has been addressed in official guidance that the NHS and others have issued to medical professionals who will administer the Covid vaccine in care homes. I understand that officials at the DHSE and the MoJ are supporting the forum with the webinar planned for this Friday, and I am absolutely delighted to reaffirm the Government’s support for the forum’s work on these important areas.

[Baroness Verma (Con)]

Will my noble friend do a communications strategy or campaign to debunk the idea that the vaccines have animal content? There are messages going around on social media that would stop people from minority communities, in particular, from having the vaccine if it did have animal content.

[Lord Bethell (Con) [V]]

I thank my noble friend for providing this opportunity to scotch that unhelpful rumour. I confirm that there are absolutely no animal components in the vaccine. That point has been endorsed by the British Islamic Medical Association, members of which issued a fatwa earlier this year confirming that the vaccine was halal. My noble friend is right that there are stories on social media that are extremely distracting. We engage with sympathy with those who are concerned about the vaccine, but these stories are completely wrong, and I would like to put them to bed.

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

May I continue on the theme of vaccines? Has the Minister seen the very recent survey by King’s College and Ipsos MORI, which found that 46% of all 16 to 34 year-olds say that they have seen or heard messages discouraging the public from getting the vaccine? Alarmingly, 27% of them believe that the real purpose of a mass vaccine programme against coronavirus is to track and control the population. Social media is playing such an important role in vaccine disinformation. Is the Minister really satisfied that all is being done to combat it?

[Lord Bethell (Con) [V]]

My Lords, the noble Lord, Lord Hunt, is right to be concerned. Some of the data we have on public attitudes is of extreme concern and the statistics he has referred to show exactly why we have focused on this area as much as we have. We have worked extremely closely with social media platforms to try to minimise the availability of this material, and we have a large communications programme to engage with those concerned about taking the vaccine. I reassure him that our experience to date has been that when those who are considering taking the vaccine reach the moment of decision, their confidence increases, and I am hopeful that that will continue.

[Baroness Stuart of Edgbaston (Non-Afl)]

My Lords, in the Statement made in the other place, reference was made to notification to the World Health Organization about the new variant. The Statement went on to say:

“Public Health England is working hard to continue its expert analysis at Porton Down.”—[Official Report, Commons, 14/12/20; col. 23.]


I invite the Minister to make it absolutely clear that the work done at Porton Down is on behalf of the whole United Kingdom, not only Public Health England, and that any of the vaccinations which have been procured are procured on behalf of the whole United Kingdom. He may also want to say how the vaccines are to be distributed.

[Lord Bethell (Con) [V]]

The noble Baroness is entirely right. The vaccine is a great success story for the union and for the United Kingdom. We have had a four-nation approach and the distribution of the vaccine shows the union at its best. She is right to say that the work done at Porton Down is on behalf of all the nations of the United Kingdom and that the communication to the WHO was on behalf of the whole country. That communication demonstrates that our approach to the vaccine is to put transparency first and that we have moved extremely quickly to share this insight with our colleagues overseas.

[Viscount Waverley (CB) [V]]

My Lords, I am reliably informed that only two of the 14 passengers in a carriage on the 5.48 am Southeastern train from Gravesend to the London terminus this morning were wearing masks, so clearly the message is not getting through. Adding to the words that the Minister offered to the remarks of the noble Lord, Lord Winston, on the challenges that have appeared this morning of the long- awaited test release scheme, I ask: why not resolve this in part by passengers obtaining a test evidencing a negative result within 72 hours of travel into the UK? Further, if they have received a vaccination abroad or a negative test result abroad, will official confirmation from an appropriate authority from abroad be acceptable to the United Kingdom?

[Lord Bethell (Con) [V]]

If I have heard the question correctly, that is exactly how the test release scheme works. Travellers are invited to sign the appropriate forms and after some days they can be released from isolation early by taking tests. That scheme has been signed off by the Chief Medical Officer and data from the test is transmitted to Public Health England. We currently have a UK-only testing regime and we do not take tests from overseas, but we are keeping the scheme under review.

[Lord Balfe (Con)]

My Lords, it appears that it is among younger people where the spread is now concentrated. What is the severity of the infection? It has been put to me that it is not that severe and that, indeed, many younger people are saying that they have to learn to live with it. I do not think that things are helped by the harsh rhetoric of “4,000 deaths a day” and so on. It just goes over people’s heads. They are saying, “This is not believable. They are going on about it, but it doesn’t matter.” Instead of using punitive terms, could the Minister go for more of a nudge theory, as put forward by David Cameron, and try to persuade people that it is in the interests of everyone to do certain things, rather than terrify them all the time—because that is not working?

[Lord Bethell (Con) [V]]

My noble friend Lord Balfe is entirely right to say that the symptoms in young people are zero in many cases. There are issues of both saliency and believability among many young people who think that this is a disease that simply does not touch their lives. It is understandable that they may think it implausible that they could be carrying the disease. However, the statistics are crystal clear. When looking at the heat maps, you can see easily how infections grow among the young and then graduate through the demographics until they hit older people, and then hospital admissions rise. I am extremely sympathetic to young people and why they find this idea a challenge to believe in, but we have to hit home with this message—otherwise, we will not be able to contain the disease.

[Baroness Bennett of Manor Castle (GP)]

My Lords, my question follows that asked earlier by the noble Lord, Lord Young of Cookham, to the noble Baroness, Lady Stedman-Scott. It referred to how some local authorities have run out of funds to give the £500 payment for people to self-isolate, when they would not otherwise be able to financially. In response, the noble Baroness said that there is only a fixed envelope of money, suggesting that no more would be provided to those local authorities. As Health Minister, would the noble Lord agree with me that, whatever tier people are living in, they have to be able to self-isolate and feed themselves, pay their rent, et cetera? Do people not need that £500 in every part of the country, without there being a postcode lottery?

[Lord Bethell (Con) [V]]

My Lords, the noble Baroness is entirely right: the whole purpose of the isolation payments and the idea behind them is the recognition that people who are being asked to self-isolate, particularly if they come from a low-income household, to which the isolation payment is targeted, need financial support to fulfil their civic obligations. That is why we put the scheme in place. It is true that it has been tremendously successful in some areas. We continue to review whether that fund needs to be topped up.

[The Deputy Speaker (Baroness Watkins of Tavistock) (CB)]

The noble Lord, Lord Rooker, and the noble Baroness, Lady Fox of Buckley, have withdrawn, so I call the noble Lord, Lord Singh of Wimbledon.

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

My Lords, the Statement rightly emphasises the need for swift and decisive action to control the deadly virus, which is increasingly affecting schoolchildren. Yet, when a few schools in London planned to close a few days before the end of term but to continue with internet classes, they were threatened with legal action. Does the Minister agree that, while children’s education is important, their health and that of their parents and grandparents should also be considered before rushing to legal threats?

[Lord Bethell (Con) [V]]

The noble Lord makes his point well, but I respectfully disagree. One of the great challenges from closing schools is that young people then socialise and spread the disease much further and wider than they would if they stayed at school. This has been demonstrated time and again around the world. Also, to keep our hospitals open and our businesses and education systems going, and to stop deprivation from accelerating, it is desperately important to keep schools open. That is why, today, we announced the rollout of a much greater and enhanced asymptomatic testing regime for schools, in the new year, which will see bubble and teacher testing, so that schools can remain open.

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

My Lords, in the light of the British Medical Journal’s formal joint letter with the Health Service Journal, I hope that the Minister will reconsider the Christmas relaxation of the rules. The point I wish to make really echoes those of my noble friends Lady Verma and Lord Hunt. It is about the scepticism around medicine within some sections of the communities—in particular within Bangladeshi communities, where disproportionate numbers of deaths and infections have occurred. In the light of many noble Lords raising questions about communication issues, will the Minister urgently meet me and some of the local specialist media to consider reviewing the messaging that targets some of these communities?

[Lord Bethell (Con) [V]]

I completely accept the point made by the noble Baroness. It is incredibly frustrating that the exact communities which have often seen some of the highest mortality rates are also those which are sceptical about the vaccine. This is one of our biggest challenges; it has been for months and will continue to be so. I pay tribute to colleagues at the Department of Health and the Cabinet Office who have done a huge amount in working with specialist media—radio, magazines and online forums—to target exactly these communities. They have used advertising and direct engagement with the presenters to put the message across, often in local languages, and this has proved increasingly effective.

[The Deputy Speaker (Baroness Watkins of Tavistock) (CB)]

My Lords, all speakers have been called.

Care Quality Commission Report

Lord Bethell Excerpts

Tuesday 15th December 2020 Lords Chamber

[Baroness Bull]

To ask Her Majesty’s Government what steps they are taking in response to the report by the Care Quality Commission Out of Sight—Who Cares?, published on 22 October.

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

My Lords, the Government are clear that in-patient care should be high quality, therapeutic and for the shortest time possible, and that any kind of restraint should be used only as a last resort and in line with strict protocols. That is why the evidence in the CQC report of poor care and excessive use of restrictive practices is so unacceptable. Our response to the report from the Joint Committee on Human Rights in October outlines many of the measures that we are already taking. We will respond formally to the specific recommendations in the CQC’s report at the earliest opportunity.

[Baroness Bull (CB)]

My Lords, this report details an horrific culture of restraint, seclusion and segregation in the care of people with learning disabilities and autism. NHS data seems to show around 3,400 in in-patient care, some in isolation for 13 years, with no meaningful activity, outdoor space, natural light, furniture or belongings—their food served through hatches and their only human contact via intercoms and screens. Does the Minister agree that, while that number is unacceptably high, it is low enough that the development of pathways individualised to support community living should be possible? The costs might be high, but the cost of hospitalisation is higher. When will government deliver those long-promised solutions and end these abuses of human rights and human dignity?

[Lord Bethell (Con) [V]]

I am not sure that I completely recognise the numbers given by the noble Baroness. In August, there were 365 instances of seclusion and 10 instances of segregation of those with autism and learning difficulties, but I would be glad to correspond with the noble Baroness to clarify those things.

I reassure the noble Baroness that the progress that we are making to create the pathways to which she rightly alludes is very much the focus of the department. Earlier this morning, the Minister for Social Care chaired the first Building the Right Support delivery board, in which she brought together representatives of the NHS, LGA, ADS, DfE and MHCLG to make progress on exactly what the noble Baroness is talking about. I reassure her that funds of £74 million have been put in place to help those with autism and learning difficulties who are being discharged into the community.

[Baroness Wheeler (Lab)]

My Lords, the 66 case studies across hospitals and community settings in this very shocking report were of extremely vulnerable people who have all been badly let down by the health and social care system. Most depressing of all is that the actions promised after Winterbourne View and similar appalling situations in the past, which we hoped would lead to major changes in treatment and understanding in the care and support of autistic people and those with learning difficulties, have just not happened. Once again, there is a litany from the patients themselves, and from their families and carers, saying that, if they had received help and support earlier, or when in crisis, they may not have needed hospital care. What are the Government doing to ensure that the right community support is in place for people with autism or learning difficulties in every local area?

[Lord Bethell (Con) [V]]

I completely endorse the noble Baroness’s observations. She is entirely right that the 66 case studies in the report make very harrowing reading. That is why the report was commissioned in the first place, as an acknowledgment that the current state of affairs is not acceptable and needs to improve. Overall, £4.5 billion is going to primary care and community health services, and that is additional money to be committed by 2023-24. It is part of the Government’s overall commitment in this area, and we look forward to publishing a White Paper on mental health shortly.

[Baroness Fox of Buckley (Non-Afl)]

I thank the noble Baroness, Lady Bull, for tabling this Question. The Care Quality Commission report is deeply shocking reading—the utter cruelty of using seclusion and segregation in care settings for people who cannot advocate for themselves. I note that the report recommends that families and advocates are involved in the development of care plans, and I fully agree with that.

Would the Minister comment on the unintentional consequences of Covid regulations in care homes, which means that there has been a huge expansion of the numbers of those who are secluded and segregated who cannot advocate for themselves? For example, there are those with dementia who have been locked away, deprived of contact with their advocates and loved ones and, equally, treated with undignified and inhumane measures. Will he look at the harrowing examples detailed by the Rights for Residents campaign, which will show him that it is not just a small number now but many more, sadly, as an unintentional consequence of government policy?

[Lord Bethell (Con) [V]]

My Lords, I would be grateful to hear from the Rights for Residents campaign, which sounds like an important and valuable contribution. I reassure the noble Baroness that the numbers of those who have undergone restrictive practices who have autism or learning difficulties do not appear to have risen during the pandemic. That is not to say that the current numbers are acceptable.

[Baroness Browning (Con) [V]]

My Lords, I refer to my interests in the register. My noble friend has not mentioned—and I would like to remind him of it—that in 2009 Parliament passed the Autism Act. It is the only medically diagnosed condition, apart from mental health, considered important enough to have its own Act of Parliament. Many of the issues raised in the CQC report to do with diagnosis and failure to intervene at an early stage with appropriate and timely interventions are covered in the Autism Act. Will he ask his department to look again at that Act, which is subject to ministerial guidance, and make sure that not only is it implemented but there is sufficient funding for that Act to be put into practice?

[Lord Bethell (Con) [V]]

I am very grateful for the reminder from the noble Baroness, and I would be glad to take her recommendation back to the department and write to her on whether there are any measures that we need to put in place to ensure that we are fulfilling our commitments under the Autism Act. It was an important Act, and I suspect that we are well within the measures that it has enacted.

[The Lord Speaker (Lord Fowler)]

Can we speed up a little, please? I call the noble Baroness, Lady Jolly.

[Baroness Jolly (LD) [V]]

My Lords, the noble Baroness, Lady Wheeler, is right to flag that this is not the first time that we have heard this catalogue of appalling treatment. The shame is that in some places local authorities and the NHS use a one-size-fits-all approach to commissioning services. We have to put the individual in care at the centre and treat them and their needs. When did a Minister last issue commissioning guidance to local authorities and the NHS in this matter, as the partners that have to commission the process? What family involvement is recommended in those conversations?

[Lord Bethell (Con) [V]]

I cannot go into details of commissioning guidance in this short Question, but I reassure the noble Baroness that, when it comes to family involvement, new guidance has been issued in response to the Joint Committee on Human Rights, which puts family involvement in any seclusion or restraint decision. That is an immediate development since the report in October.

--- Later in debate ---

[The Lord Speaker (Lord Fowler)]

Did the Minister hear that in his babysitting duties?

[Lord Bethell (Con) [V]]

My Lords, my noble friend makes an extremely important point. The role of families and communities in the social care provided to those with autism and learning difficulties is extremely important and will be at the centre of every recommendation that we make in response to this report.

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

I declare my role as chair of the National Mental Capacity Forum. Are the Government considering the separation of learning disabilities from within the Mental Health Act to drive training in early crisis recognition and de-escalation in the community, learn from good practice and pilot alternative ways of providing places of safety in a crisis? The underlying social problems need social care solutions and are not always appropriate for, or amenable to, medical intervention.

[Lord Bethell (Con) [V]]

The noble Baroness makes her point extremely well. These are exactly the kinds of questions that have been considered by Sir Simon Wessely’s review of the Act. As I said earlier, we are looking forward to publishing a White Paper on the Mental Health Act 1983 shortly, and those are exactly the kinds of issues that it will seek to address.

[Lord Touhig (Lab) [V]]

My Lords, I refer the House to my interests in the register. As vice-chairman of the All-Party Parliamentary Group on Autism, I know all too well the devastating impact this undignified and inhumane so-called care has had on many autistic people. A new autism strategy is crucial, setting out how the Government will ensure that autistic people receive the right support and social services care in the first place, so that they do not end up in these hospitals. Can the Minister assure the House that the autism strategy will address this and the services supporting it receive the funding they need so that autistic people can have the quality of life we all enjoy and take for granted?

[Lord Bethell (Con) [V]]

I completely acknowledge the noble Lord’s championship in this area. He is right that autism is a distinct condition that should not necessarily be treated in a clinical surrounding, and I pay tribute to those in social care and community care who provide more thoughtful, considerate and sympathetic care environments for those with autism. I share his aspiration that those with autism should be cared for in a productive way that gives them fulfilled lives. He is entirely right that we need to continually refine our strategies to ensure this ambition.

Ockenden Review

Lord Bethell Excerpts

Monday 14th December 2020 Lords Chamber

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

My Lords, I start by echoing the very thoughtful words of the noble Baroness, Lady Thornton, and the noble Lord, Lord Scriven, in their reflections on this harrowing report. It does make desperately awful reading. Any noble Lord who took the time to read the report would surely be enormously moved, not just by the story of the cultural and practical problems at the Shrewsbury and Telford Hospital NHS Trust, but also by the personal testimony of Rhiannon Davies—who fought an 11-year campaign after the death of her daughter, Kate—and of Kayleigh Griffiths. They both campaigned stubbornly and with great determination after the deaths of their daughters. They have done a phenomenal thing in bringing this situation to light, and we owe them our compassion and our thanks for their hard work and determination.

We also owe great thanks to Donna Ockenden, who has done a memorable job in terms of this report. It is a massive enterprise that is the result of a huge human investment of time and emotional commitment by Donna and her staff. The report itself is not only huge in scale but great in the humanity with which it deals with this difficult subject. We give great thanks for that.

I reassure both the noble Lord, Lord Scriven, and the noble Baroness, Lady Thornton, that we absolutely take this report seriously. It does outline major issues in the culture of many maternity wards. That is a cultural challenge that is both recognised by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists, and something that they are working on very well indeed. But I accept that more can be done. In its application, the Government commit not only to implementing the recommendations at trust level but to ensuring that the message made very clearly in the Ockenden report is heard throughout the NHS system.

We are committed to a major investment in the education around midwifery, which includes the rewriting of curriculums, and the Better Births programme, which has already delivered enormous value. There will be a maternity programme review that will update the Better Births programme. There has also been a £9.4 million investment in maternity safety pilots, some of which will be focused on training and some of which will be on safety measures—exactly the kinds of measures that are alluded to in the report.

But the most challenging and, I think, moving element of the report is the stories of the parents themselves and how they were not listened to. This echoes the findings of the report by the noble Baroness, Lady Cumberlege, which, I think, has moved everyone in the House. Time and again we hear the same story, of how those who have witnessed wrong practices and poor culture in the NHS have had to fight the establishment so hard in order to have their voices heard. If any noble Lords heard Rhiannon Davies speak about her own experiences campaigning on this, who would not be moved by that?

We take on board very seriously the recommendations of the noble Baroness, Lady Cumberlege, for a patient safety commissioner. We acknowledge her amendment to the Medicines and Medical Devices Bill, and we look forward to the Report stage of that Bill in the new year.

I would also like to remind noble Lords that all maternity major incidents—certainly neonatal deaths, stillbirths and brain injuries—are now routinely referred to the Healthcare Safety Investigation Branch, which does an independent investigation. This is an important development since many of the incidents reported by the Shrewsbury and Telford Hospital NHS Trust report. HSIB is doing extremely important work, and I believe that this will be a very large improvement.

Both the noble Lord, Lord Scriven, and the noble Baroness, Lady Thornton, raised leadership. I reassure them both that we have put in place much stronger surveillance, both by the regulators—the CQC and others—and by NHS England to keep track of these sorts of incidents, so that we can much more quickly identify weak spots in the area.

On the question of staffing levels brought up by both noble Lords, I reassure them that the recruitment of midwives—3,000 were committed to in 2018—is going apace. We have committed to a major investment in marketing in order to ensure that we hit our targets on that.

The noble Lord, Lord Scriven, asked whether we were committed to change, or whether this report will sit on the shelf and gather dust. I reassure the noble Lord, and all noble Lords, that we are still very much committed to the maternity ambition to halve stillbirths, deaths and injuries between 2010 and 2025. We are already nearly half way there on that ambition, and we will work relentlessly to ensure that it is achieved.

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

We now come to the 20 minutes allocated for Back-Bench questions.

[Lord Patel (CB) [V]]

I declare an interest, because I was privileged to work for over 35 years in a maternity unit, with brilliant midwives and doctors—I was a lead obstetrician—to which the events described in this report were totally alien. So we have another report on the failings of maternity services. The root cause of this, as found in previous reports, is the unquestioning practice of regarding all pregnancies as low risk and striving for a natural birth. Does the Minister agree that, for better outcomes for the mother and her unborn baby, society should expect a better working relationship between midwives and obstetricians, while recognising their individual professionalism? This report should be the starting point to making that happen. The Minister mentioned that both Royal Colleges were working together to bring this about. They might be the solution but, if they are not, they will be the ones who are blamed next.

[Lord Bethell (Con) [V]]

My Lords, I pay tribute to the insight of the noble Lord, Lord Patel, who brings with him not only expertise as an obstetrician, but deep involvement in the patient safety agenda. I completely agree that collaboration and close working relationships between midwives and obstetricians absolutely benefit the collective care of mothers and babies. When that does not happen, and when agendas other than patient safety come into play—around natural births or what type of person should be present at a birth—it is absolutely to the detriment of the safety of both mother and child. I am absolutely determined that the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists step up to their leadership role in resolving this cultural stand-off. As the noble Lord rightly put it, in almost every maternity centre in the country a fantastic service is provided by clinicians and nurses—but, when that chemistry goes wrong, patients suffer, and we cannot let that happen.

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

I do not see the noble Baroness, Lady Altmann, in her place, so I call the noble Baroness, Lady Blackstone.

[Baroness Blackstone (Ind Lab)]

My Lords, I declare an interest, as set out in the register, as the chair of the trustees of the Royal College of Obstetricians and Gynaecologists. As the Minister has admitted, this report makes shocking reading, so what steps will the Government take to monitor the improvements they are pledging for maternity services right across the country to avoid the tragedies that are revealed by this review? Will the Government commit to publishing the findings of any future evaluation and, in particular, data on the avoidable deaths and long-term disabilities that result from failures in the care of women during childbirth?

[Lord Bethell (Con) [V]]

My Lords, policy officials at the DHSC are working with both the CQC and NHS England on improving our surveillance and the publication of data, as the noble Baroness rightly points out. A key development in this area is the work by HSIB to investigate each and every death and major incident in maternity suites. That provides an absolutely invaluable resource to understand where and when things go wrong. We will continue to publish those reports as they happen and will learn lessons from their insights.

[Baroness Bennett of Manor Castle (GP)]

My Lords, much of this debate has already focused on the issue of staffing shortages in our NHS, particularly among midwives. I am sure that the Minister is aware of the survey last month from the Royal College of Midwives, which showed that 83% of midwives did not believe that their trust or board had enough staff to provide a safe service and 42% said that half or more of their shifts were understaffed. The Minister referred to recruitment campaigns and investment in future training, but the Ockenden review calls for an immediate focus on relationship building, training and things that will take a great deal of time and resources to deliver, where there are problems. I cannot see any alternative if we are to fill some of those gaps immediately. Training will take many years, but an overseas recruitment of midwives will bring in the staff we need to create the space to allow people to have that training—that time and reflection.

[Lord Bethell (Con) [V]]

My Lords, I respectfully disagree with the noble Baroness’s insight—the Ockenden review does not point the finger at staffing levels in relation to the problems; it points the finger at a number of items, particularly the cultural problems that emerge when differences of opinion between clinicians and midwives arise and where a culture of respect breaks down. Those cultural differences can be improved by what we would politely call education; it is essential that we invest in the right kind of education in order to bring midwives, obstetricians and gynaecologists closer together and to break down the hierarchical differences and the ideological differences about the best way to have a baby.

[Lord Lansley (Con)]

My Lords, as a Secretary of State responsible for the health service for some of this period—two years out of two decades—I share in the responsibility for what happened here and for the fact that it was not known about and that action was not taken sooner. I am sure that others who have been Ministers in the department over these two decades will feel likewise.

What is shocking is not only the individual trauma that parents have suffered but the scale of what the Ockenden review discloses—we are grateful to Donna Ockenden and her colleagues for persisting in trying to understand and disclose the scale of what has happened. I ask my noble friend about our responsibility, which was, of course, that there should be external oversight and action taken when these things go wrong. From my point of view, one of my objectives was that there should be more clinically led commissioning so that local clinicians would understand what was happening and have the power to step in.

The Ockenden report shows that, in May 2013, the clinical commissioning groups set up a review that, in October 2013, reported:

“The overall findings of the review demonstrate that this is a safe and a good quality service”.


I encourage Donna Ockenden and the department to look very carefully at how they could ensure that local clinicians responsible for commissioning take that responsibility seriously and act upon it.

[Lord Bethell (Con) [V]]

On behalf of the Chamber, I thank my noble friend for his touching testimony. He is entirely right; there are two CCGs in the local area: the Telford and Wrekin CCG and the Shropshire CCG. They did exactly what they should have done in 2013, launching an investigation into the levels of service at the Shrewsbury and Telford Hospital NHS Trust. It is not clear why the findings of that report turned out as they did; nor is it clear why other interventions, or potential interventions, by the CQC and other regulators did not get to the bottom of the problem. Those questions will be addressed in the second of Donna Ockenden’s reports, in 2021; there has not been time for them all to be addressed in the interim report, but there is much more to go into, and this is undoubtedly one of the important points she will need to address.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I declare an interest as a member of the GMC board. Nothing can excuse the repeated failures and the lack of compassion and kindness exposed by the review. What is so striking is the paragraph in the report that refers to the eight chief executives working in the trust over a period of 10 years and 10 chairs over 20 years —no wonder there is a leadership and governance issue in the trust. I ask the Minister: what on earth have NHS England, NHS Improvement and the CQC been doing? It seems that their interventions, which I suspect have been punitive in nature, have not provided the kind of support that is needed.

Does the Minister agree that we need a wholly new approach to this trust, which gives it high-level attention and provides stability in leadership—not a constant turnover because of an intervention by one or other of the many regulators that can do this—and above all, support from neighbouring services that can provide help? I suspect that this trust needs an awful lot of help to get out of this terrible situation.

[Lord Bethell (Con) [V]]

My Lords, I completely take on board the noble Lord’s observations. It is true that Donna Ockenden’s report alludes to the failure by senior leadership to monitor and intervene where clearly there were problems. However, let us not confuse correlation with causation. This was not caused by a failure of senior leadership, but by a breakdown in the basic management systems and culture of the maternity services within the trust. That should have been addressed by the senior leadership, but it was not necessarily caused by them. I completely endorse the observation of the noble Lord that neighbouring trusts have an important role to play in checking in and benchmarking behaviours. That is a point made very clearly in the Ockenden report, and one that I hope they will step up to.

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

I salute the courage of the parents of Kate Stanton Davies, Pippa Griffiths and so many others in their tenacious personal search for truth and justice. Donna Ockenden’s report was harrowing reading. The pain, trauma and inhuman disregard for the safety of baby and mother was palpable, profoundly damaging confidence and trust in maternity services. It made me relive my own decade-long failed attempt to seek information on whether my lengthy abandonment on a bed overnight after 48 hours of labour pain has anything to do with my now 42 year-old son’s brain damage and lifelong disabilities. I was dismissed constantly, admonished for “being an Asian mother too ashamed to have given birth to a disabled child”, which is far from the truth about a much-loved son.

Sadly, I was not alone, as the Ockenden report details. It has been repeatedly confirmed by so many others and by the first maternity advocacy scheme, which was set up in the 1980s to address the high postnatal mortality rate of mothers and babies among Bangladeshi, Pakistani, Somalian, Vietnamese and African women, whose maternity experiences, even today, remain inconsistent and patchy. Therefore, can I ask the Minister what consideration can and will be given to historic grievances in any future review of maternity services, given what the right honourable Jeremy Hunt in the other place, and Donna Ockenden, have said about the experience of mothers and babies highlighted being only the beginning of unearthing potential malpractice across England?

[Lord Bethell (Con) [V]]

I join others in paying tribute to the personal testimony of the noble Baroness. The story that she tells is extremely moving. One cannot think about the challenges and difficulties that she must have had since that awful night, which she so movingly describes. The report makes it clear that those with a BAME background have disproportionately high rates of difficulty at birth and in maternity services, something which undoubtedly we need to look at more carefully. However, the Ockenden report is not a historic grievances report, and that will not be the focus of our response.

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

Lord Mann? No? We will move on to the noble Baroness, Lady Stuart of Edgbaston.

[Baroness Stuart of Edgbaston (Non-Afl)]

My Lords, this is the second time in six months that this House has been exposed to quite harrowing tales of patients’ experiences in the NHS. I am glad that the Minister mentioned the report by the noble Baroness, Lady Cumberlege, and her call for a patient safety commissioner. Both the Ockenden and the Cumberlege report identified a problem with the culture in the NHS. We cannot go on having review after review. While it is important to listen to the patients’ experiences as part of putting things right, we must learn comprehensive lessons. Will the Minister therefore say just a little more as to how he intends to take the idea of the patient safety commissioner forward, and in particular how that patient safety commissioner will be independent of and not part of the NHS?

[Lord Bethell (Con) [V]]

My Lords, it would be premature of me to describe in too much detail how any patient commissioner may work, since we are half way through the Bill’s progress. But I would like to reflect on the very good arguments made by my noble friend Lady Cumberlege and her supporters during the Bill’s passage at Second Reading, in Committee and in the amendment-moving process. She has made very convincing arguments for how a patient safety commissioner can be an ultimate destination for those who have not found due process and a sympathetic ear elsewhere in the consideration of their grievances. It is entirely right that any commissioner, whether a victims’ commissioner or any other kind, should feel a strong sense of independence; that is a total benefit that we endorse in the provision of any commissioner. But commissioners are not enough; what we need is a change in culture. That is why Aidan Fowler, the DCMO looking at this, works so hard and why we have a patient safety agenda that works to address this at every level of hospital trusts.

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

All speakers have now been called, so we move to the next business without a break.

Puberty-blocker Drugs

Lord Bethell Excerpts

Thursday 10th December 2020 Lords Chamber

[Lord Young of Norwood Green]

To ask Her Majesty’s Government what assessment they have made of the administration of puberty-blocker drugs to children under the age of 16.

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

My Lords, the Government are committed to providing the best possible care for children and young people accessing gender identity services. Earlier this year, the National Institute for Health and Care Excellence was asked by NHS England to undertake a thorough review of the latest clinical evidence on the use of puberty suppressants and cross-sex hormones. An independent group, under the chairmanship of Dr Hilary Cass, will make recommendations about the existing clinical policies based on this evidence.

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

My Lords, I wish to make my position clear: I am opposed to all forms of transphobia and transgender discrimination, but this should not override the rights of women as defined in law. I welcome the Minister’s statement on the guidance and the research, and I am sure he agrees with me on the importance of the NHS guidance. Does he also recognise that this needs to be ported? What actions will the Government take to ensure that local services, such as CAMHS, are sufficiently resourced to provide psychological support to all children and young people with gender-related distress?

[Lord Bethell (Con) [V]]

My Lords, the noble Lord puts his point extremely well. I share his concern for those with trans or gender concerns of any kind. I reassure him that provision of gender identity services at all levels is an absolute priority for the NHS. In the recent court case, we have seen a clarification of the guidelines attributed to some of those services, but it in no way mitigates against or suggests a lack of commitment on the part of the NHS to such services.

[Baroness Nicholson of Winterbourne (Con)]

Will the Minister confirm that since no baby can be born in the wrong body and human sex cannot be changed post- birth, the extensive plastic surgery, castration, double mastectomies and concomitant lifetime of heavy unnatural drug use that follow the introduction of puberty blockers are not the right way to assist a troubled child to gain mental stability and a contented and healthy future?

--- Later in debate ---

[Lord Bethell (Con) [V]]

I reassure my noble friend that people with gender dysphoria cannot access gender reassignment surgery under the age of 18, so young people are not eligible for the type of procedure that she describes. Gender identity services are clinically led and focus on enabling the young person to choose the path which suits their needs. They support children to explore their feelings, recognising that there is not a one-size-fits-all approach. This seems an appropriate approach in the circumstances.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I warmly welcome the court ruling that children cannot consent to treatment to suspend puberty. Will the Minister join me in saluting the bravery of Keira Bell for taking this action and echo her message that being a tomboy or not liking stereotypically girly things does not make girls or young women any less female? Crucially, will he clarify that this ruling does not undermine the 1985 Gillick judgment giving young women the legal right to reproductive healthcare without parental consent and that the false and scaremongering misinformation circulated by certain organisations, including Amnesty International and Mermaids, is driven by a particular agenda rather than a concern for trans- gender people’s rights?

[Lord Bethell (Con) [V]]

My Lords, I salute the court’s thoughtful and lengthy judgment, which brought enormous clarity to an area which is very important but which has also caused concern and ambiguity. The court has made it clear that children under a certain age are not ordinarily able to make the kind of decisions that have previously been asked of them, but there are openings. No one under the age of 16 can now be referred on to puberty blockers unless a court rules that it is in the child’s best interest. These are helpful clarifications and we look forward to further work to clarify this area.

[Baroness Wheeler (Lab)]

My Lords, the mental health and well-being of young children and teenagers who present with gender dysphoria are paramount. Given the NHS England announcement on puberty blockers, what support are the Government giving to children and teenagers affected by the revised guidelines and their families and schools? On medical matters, will a young person under 16 concerned about gender dysphoria who approaches a GP continue to be covered by the duty of doctor-patient confidentiality?

[Lord Bethell (Con) [V]]

I reassure the noble Baroness that patient-doctor confidentiality remains paramount and is respected. To update her, the Tavistock has immediately suspended new referrals for puberty blockers and cross-sex hormones for under-16s. In future, they will be permitted only where a court specifically authorises it. I reassure the noble Baroness that those already on the programme will continue their medication until the review has been finalised.

[Baroness Barker (LD)]

The legal team that brought the recent case has, over recent years, brought several cases designed to oppose LGBT rights and to restrict the reproductive rights of women and girls. All those actions are consistent with campaigns run by organisations including the Heritage Foundation and the Alliance Defending Freedom—extreme evangelical right-wing American organisations. Will the Minister tell the House which NHS England boards and committees approved the amendment of the gender identity service specification on 1 December, prior to the court requiring them to do so, and in the light of the fact that this judgment can and will be appealed? If he does not have that information now, will he write to me?

[Lord Bethell (Con) [V]]

Well, my Lords, it is not appropriate for me to comment on those who have brought these cases, and outstanding judicial proceedings exist and are in place at the moment, so it is not possible for me to comment from the Dispatch Box in response to the noble Baroness’s remarks. All I can say is that the NHS, NICE and the Tavistock all have the interests of patients at their heart; we are not ideological about that. We are absolutely committed to the best interests of patients, and I would be glad to write to the noble Baroness to answer in any way that I can the questions she asked.

[Baroness Gale (Lab) [V]]

Is the Minister aware that the ruling and the NHS England response to it have caused significant uncertainty and distress among young people and families currently supported by the Tavistock clinic and those on its waiting list? Can the Minister say what steps the Government are taking to ensure continuation of care for young people currently in the care of the Tavistock who are affected by the NHS England response to the court ruling?

[Lord Bethell (Con) [V]]

I am sure that the noble Baroness’s testimony is entirely right, and it concerns me that anyone has any concerns in this matter. I reassure her that the Tavistock is doing absolutely all it can to reassure current patients and those who are on the referral list; its communications have been excellent throughout. The provision of puberty-blocker services to existing patients has continued, and it will remain in close contact with those patients as the review plays out.

[Lord Dobbs (Con) [V]]

My Lords, I hope this is an appropriate moment to reflect on the life of Jan Morris, that glorious writer who died just over two weeks ago. She was born a man, served in the British Army, fathered four children with her beloved wife Elizabeth and then transitioned from male to female in the 1970s—a challenge she bore with extraordinary humour and patience. So perhaps I may recommend that my noble friend reads all her books in his spare time. Would he agree that Jan Morris’s example of seeing the world in glorious colours, rather than narrowly in black and white, and of always showing kindness and tolerance even to those who disagreed with, and perhaps disapproved of, her, is an example that should inspire all sides of this debate and give comfort to those, in particular children and their parents, who find themselves struggling with the same difficult situation she did?

[Lord Bethell (Con) [V]]

[Inaudible]—to be more affected by their warmth and kindness. Jan was an absolute model of warmth and kindness. Having worked in the nightclub industry, I have met, worked with and enjoyed the company of many trans people, which has always proved to be an extremely uplifting experience. I am a massive supporter of the trans movement in the round.

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

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

Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2020

Lord Bethell Excerpts

Thursday 10th December 2020 Grand Committee

Moved by

[Lord Bethell]

That the Grand Committee do consider the Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2020.

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

My Lords, these regulations will provide an agile and robust regulatory environment for Covid-19 test providers. This is essential to ensuring that everyone has access to simple, effective and high-quality testing services that they can count on.

The Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2020 will remove all CQC regulatory requirements for Covid-19 test services. Existing exemptions leave inconsistencies, resulting in some Covid-19 testing providers being within the scope of CQC regulation while other providers are exempt. We want to tidy this up. We will simplify the regulatory system for Covid-19 test providers, making it easier to understand for both suppliers and consumers.

The second SI is the Health Protection (Coronavirus, Testing Requirements and Standards) (England) Regulations 2020, which will impose requirements on private test providers to become accredited by the United Kingdom Accreditation Service and to attain specific stages of a process towards this accreditation within a given timeframe, starting on 1 January 2021.

I will say a word on context. Last week, the Medicines and Healthcare products Regulatory Agency recommended authorising Pfizer/BioNTech’s Covid-19 vaccine. While we wait for the vaccine deployment, testing and contact tracing remains one of the most effective ways of controlling the virus. During this important period, the more rapidly we can identify people at risk of infection, the quicker we can get life back to normal. In the last nine months we have built the largest diagnostic network in British history, which is helping us to tackle the spread of the disease and create the long-term capability to ensure that we are prepared to tackle future pandemics. However, we will only defeat the virus if the public and private sectors work together. The private sector has a critical role to play and has shown this time and again throughout this pandemic. I thank those in the diagnostics, logistics, data and associated industries for their contribution to our pandemic response.

In addition, it is not right to look to the NHS to provide every test for every circumstance. Private sector testing can support NHS Test and Trace by offering tests to those who have a reasonable need for testing but are outside the conventional clinical or epidemiological use cases. It can also help to drive innovation. The Government are therefore supporting the development of a private testing market. We want to ensure that everyone has access to simple, effective, high-quality and affordable testing services that they can count on, whether from the Government or a private provider.

As the demand for testing continues to grow and the number of providers increases, we need to reassure the public that quality control is as important as ever. That is why we want to support private providers to ensure that they can enter the market in a timely manner and meet the demand now without compromising the quality of their testing service.

There is currently a requirement in England to register with the CQC if you are involved in the removal of bodily cells, tissues or fluid samples or the analysing and reporting of these samples for Covid-19 testing. This requirement is subject to a number of exemptions, depending on the type of Covid-19 test sampling and analysis and on the entity undertaking the sample collection. This has resulted in inconsistent requirements for test providers, which have been a source of confusion. Test providers have emphasised the complexities surrounding entering the Covid-19 testing market and we have listened to them.

The first statutory instrument that I have laid before your Lordships will remove the requirement for Covid-19 testing providers to register with the CQC by exempting Covid-19 testing as a regulated activity under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As the CQC is an English regulatory body, this does not apply in the other nations of the UK. These requirements will be removed, preventing confusion over the scope of regulations from causing restrictions in total testing capacity. It is imperative that a quality service is provided and testing capacity is not restricted; the change from CQC to UKAS will create an agile and robust regulatory environment.

The United Kingdom Accreditation Service, known as UKAS, is the sole national accreditation body in the UK, independent of, but appointed by, the Government. Accreditation by UKAS is the recognised gold standard for organisations offering test services. Since the beginning of the pandemic, we have been working with UKAS to ensure that Covid-19 test providers can access advice on quality assurance and become accredited. It has taken time to ensure that we get this right. Recognising this, and the urgent need for high-quality private testing, on 27 November my department and UKAS launched an adapted three-stage UKAS accreditation process for private test providers, to ensure that new and innovative providers can be accredited faster, without compromising on rigorous safety standards.

The second instrument that I have laid before your Lordships will require all providers offering test services on the English market to complete stage 1 of the UKAS accreditation scheme and attain UKAS applicant status from 31 December. After 31 December, new entrants to the market will be required to achieve UKAS applicant status before offering test services on the English market. The instrument also requires providers to achieve stage 2 UKAS appraisal and stage 3 UKAS accreditation statuses. Providers will need to complete stage 2 UKAS appraisal by 31 January 2021 or, if entering the testing market after 31 December, by whichever is later of 31 January 2021 or four weeks after gaining applicant status. Providers will then need to complete stage 3 UKAS accreditation by 30 June 2021 or, if entering the testing market after 31 December, by whichever is later of 30 June 2021 or four months after gaining appraisal status. Providers will be prevented from offering test services if they fail to meet these requirements. We have engaged closely with providers to ensure that these timelines are achievable.

Stage 1 UKAS applicant status requires applicants to self-declare that they meet 10 minimum standards, set by clinicians. Having gained applicant status, stage 2 UKAS appraisal requires test providers to demonstrate that they are progressing towards accreditation. The last stage, stage 3 UKAS accredited status, requires applicants to achieve full accreditation. As a result of the legislation that I have laid before your Lordships, test providers that provide tests commercially will be required to undergo this staged accreditation process. Employers that provide test services only to their own staff and organisations that supply tests at no cost will not be required to gain UKAS accreditation, although I would advise that they do so to ensure that their test services meet the highest possible standards. From 15 December, international arrivals will be able to opt in to “test to release” and all test services used for this purpose will be required to be working towards full accreditation.

Before I set out my final justification for these SIs, I must thank the JCSI, which scrutinised them so quickly. I will explain how the tests for the presence of antibodies are covered by these regulations. Current forms of tests for antibodies are not covered by existing CQC legislation and will not be covered by the UKAS legislation. As such, these regulations do not leave any regulatory gap for testing for antibodies that did not already exist. However, providers of tests for the presence of antibodies to Covid-19 can choose to apply for accreditation if they wish to do so.

Fundamentally, the new UKAS scheme will simplify the process of looking for a commercial test. Consumers will be able to identify providers capable of delivering a quality end-to-end test service, giving individuals and businesses the assurance they need. We strongly advise that consumers and organisations procure test services only from the gold standard providers which are on their journey to UKAS accreditation. They will be clearly listed on GOV.UK.

The legislation that I have introduced will simplify the testing landscape for test providers and regulate the market consistently, protecting consumers and helping test providers. I am enormously supportive of employers who have already chosen to begin testing their staff, but it must be done properly, using the right tests for the right purposes. These regulations will help employers and individuals to identify the right test services for their purposes and will help test providers to enter the market.

Finally, I apologise for not being with your Lordships in the Grand Committee this afternoon. I have been asked to isolate because a member of my household has tested positive. I am extremely grateful for noble Lords’ forbearance in this matter. I beg to move.

--- Later in debate ---

[Lord Bethell (Con) [V]]

I thank noble Lords enormously for an incredibly thoughtful discussion and I will seek to answer as many of their piercing and thoughtful questions as I can. If I miss any I will be pleased to write to noble Lords to clear up any loose ends. I will forgo the normal warm words at the beginning of such a speech and move directly to addressing the questions raised by noble Lords.

It is absolutely vital, as we open up our economy, that NHS supplies are saved for the situations where they are most needed. That is the principle behind what we are doing here today. To be clear: we are continuing to massively upgrade our commitment to testing. The PCR testing capacity for clinical and symptomatic testing is now reaching towards 800,000 a day—a colossal number—and the turnaround times have come down dramatically. In my household’s case, the test was taken at lunchtime yesterday and the result came at 7 am today—a phenomenal logistical achievement. We are also committed to the kind of community testing that the noble Baroness referred to, with the testing of asymptomatic individuals using technology such as the lateral flow devices that noble Lords will be aware of. This is exemplified by, but not limited to, the kind of testing in universities and schools that we have been piloting this autumn and will be rolling out in a very big way over Christmas.

As I have said before, we are investing massively in NHS testing, free at the point of use and available free of charge to all those who meet the use cases defined by the CMO. To ensure that this is possible, we need to enable the provision of new and innovative testing programmes that are as reliable and effective as possible. However, the NHS cannot possibly have pressure put on it to provide every test that every person in every part of this country wants at every time of the day. That has never been the case in this country and cannot be the case in the future. If tests are needed that are outside the use case or if someone is seeking to enable activities that fall outside the responsibility of our public health regime, it is right that those tests are sought from outside the NHS. It is therefore right that we seek to regulate the provision of those tests by the private sector.

The legislation that I have set out will ensure this, providing public confidence in testing and supporting private providers to enter the market. As I have set out, we need to create an agile regulatory environment for test providers, and we can do this by removing all CQC regulatory requirements for test providers, replacing them with the gold standard UKAS accreditation for commercial test providers. It is not our intention to cap the price, but it is our expectation that, given the billions of Covid tests now being manufactured around the world, the price will fall dramatically, and it is our intention to ensure that the quality meets clinical standards.

These measures will simplify the complex regulatory system for Covid-19 test providers; simplify the process around looking for a commercial test; and give individuals and employers essential assurances over the tests they procure. In response to the noble Lord, Lord Hunt, and my noble friend Lord Bourne, accreditation by the UKAS is the recognised gold standard for organisations that offer test services. My officials have worked really closely with colleagues at the UKAS to ensure that the accreditation scheme for Covid-19 test providers is as agile as necessary to deal with this growing market. The adapted three-stage approach is a direct result of this, ensuring that new and innovative providers can be accredited in a timely fashion, while preserving the UKAS gold standard. My officials will continue to work with the UKAS to ensure that this process is as seamless as possible, that test providers are given the support that they require to move through the scheme, and that correct enforcement procedures are in place.

Regarding contracting private industry to supply testing services, I hope that I will not shock either the noble Lord, Lord Hunt, or the noble Baroness, Lady Bennett, if I tell them that we are already engaged with the private sector in the purchasing of healthcare services for the NHS in the UK—not least in the provision of primary healthcare, which is conducted by the private sector in the form of GP practices, and through social care. That is also true in testing services. Time and again, throughout this pandemic, the private sector has shown that it has a critical role to play. While I note the comments of my noble friend Lady Wheatcroft, my experience of private-industry contractors has been largely positive; where there have been problems, we have to look at the whole partnership of government, universities, NHS and private industry for responsibility, not seek to scapegoat any particular party in this national collaboration. It is vital, as we look to open up our economy, that NHS Test and Trace supplies are focused where they are needed most. To ensure that this is possible, while utilising new testing innovations, the Government are supporting the development of the private testing market. To do this, we are bringing forward the regulations that I have laid before noble Lords today.

In response to the noble Lord, Lord Hunt, and to my noble friend Lady Altmann, I make it clear that the existing lengthy and costly on-boarding process is one reason for introducing this more agile system. The existing system is suited for major complex laboratories, many of which have been around for many years, and new entrants to the market are rare. We hope to have a more agile regime that will encourage innovation, but I will be glad to write to noble Lords with details of the intended costs.

My noble friend Lady Altmann is absolutely right to be concerned about fraud. She is right that there is a self-assessment at the beginning of the process, which is quicker and cheaper, to encourage new entrants and to avoid bottlenecks as this industry scales up. However, this is quickly augmented by a mandatory requirement to follow a rigorous on-boarding process with full administration. I am convinced that this will provide the necessary supervision of this industry, although I take her comments seriously and we will keep a careful eye on this threat. To answer my noble friend Lord Bourne, the test providers will be prevented from offering services if they do not have the right authorisations. If they break the rules, there are substantial—unlimited, I think —fines set by magistrates and applied to the company to ensure enforcement.

The legislation that I have introduced will simplify the regulatory landscape for test providers and regulate the market consistently. I thank Covid-19 test providers for their pivotal work at this time. We encourage the development of these sorts of test services in order to reduce pressure on the NHS and ensure that the test and trace programme can focus on situations where it is needed most; but it must be done properly, using the right tests, for the right price and the right purposes, and with the right enforcement regime. I beg to move.

Motion agreed.

Health Protection (Coronavirus, Testing Requirements and Standards) (England) Regulations 2020

Lord Bethell Excerpts

Thursday 10th December 2020 Grand Committee

Moved by

[Lord Bethell]

That the Grand Committee do consider the Health Protection (Coronavirus, Testing Requirements and Standards) (England) Regulations 2020.

Relevant documents: 37th Report from the Secondary Legislation Scrutiny Committee and 34th Report from the Joint Committee on Statutory Instruments (special attention drawn to the instrument)

Motion agreed.

Covid-19 Vaccine Rollout

Lord Bethell Excerpts

Wednesday 9th December 2020 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, I thank the Minister for the update today, and for the all-Peer Zoom this morning. Yesterday was indeed a happy day. Like many—including, it has to be said, the Secretary of State—I was very moved watching 90 year-old Margaret Keenan get her jab. However, the challenges of the next period are as acute as, if different from, those of the period we have been through. What is the timeline for the vaccine for people who are housebound or shielded and cannot attend a surgery, whether in a hospital or anywhere else? It seems that the easy distribution of the vaccine will depend on the new vaccines coming down the track: communications will be vital. So what communications will people receive, from whom? Will that be centrally controlled or will it be done locally—through primary care networks, for example?

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

My Lords, the JCVI has laid out a clear prioritisation, putting great emphasis on those who are older—the over-80s—and those in social care. The vaccine will come to those who are shielded and living alone in due time. There are some practical issues with getting the current Pfizer vaccine: as the noble Baroness undoubtedly knows, it has to be kept in cold storage and comes in substantial batches, which are difficult to break up. The initial cohort consists of 6 million people—those over 80, and the health and social care workers who support them. As for future vaccines, those looking forward to being vaccinated should wait for a letter. Those letters are being organised through their doctors, who have access to a central database to ensure that the right prioritisation takes place.

[Baroness Jolly (LD) [V]]

I thank the Minister for the update, and join others in celebrating the good news about the first vaccines, administered yesterday. There are several different vaccines in the pipeline. Can the Minister update us on where they all are in terms of MHRA approval, and therefore of uptake? How many doses will be available, and by when?

[Lord Bethell (Con)]

My Lords, the precise status of each vaccine in the pipeline is a subject for dialogue between the vaccine manufacturers and the MHRA. I can tell the noble Baroness that we are extremely encouraged by the substantial number of vaccines in the pipeline. The safety data for all those for which we know the response is also extremely encouraging. AstraZeneca—the one that most eyes are on—is making good progress, but I am afraid that I cannot give a clear or confirmed time for when, or if, it will be authorised. As for doses, as the noble Baroness probably knows, we have committed to more than 320 million doses overall. The precise details of those are published on the Vaccine Taskforce website, and I would be glad to send her a link to that, so that she can get all the details.

[Lord Bates (Con)]

I thank my noble friend for this very good news, and for his tireless work in keeping us informed. Throughout this crisis, we have been given an object lesson in who are truly the key workers in our society, such as those working on farms and in supermarkets, and those servicing utilities, cleaning streets, organising deliveries and keeping us safe. Will he ensure that this lesson is remembered when ordering the front of the queue for the rollout of the vaccine?

[Lord Bethell (Con)]

I am grateful to my noble friend for his kind comments, and endorse his tribute to all those who have worked hard on the front line of healthcare during this pandemic, at times putting themselves at risk, and all of them under great stress. We owe them enormous gratitude. The JCVI has made a clear priority list and advised that the first priorities for any vaccination programme should be the prevention of mortality and protection of healthcare staff and systems. Therefore the vaccine is being rolled out to the priority groups, including care home residents and staff, people over 80, and healthcare workers. They are the ones who will be at the top of the list, and that seems to me proportionate, fair and right. As we work through the later prioritisations, others in the population will have access to the vaccine.

[Lord Bilimoria (CB) [V]]

My Lords, many congratulations to the Minister, the Government, Kate Bingham and the Vaccine Taskforce on V-day, yesterday. Does the Minister agree that this has been possible only because of the collaboration, in just six months, between the private sector, the Government, the NHS, universities, including Oxford, and the pharmaceutical sector, including AstraZeneca? In due course, could business help to roll out the vaccines, through inoculations taking place in offices, factories and business premises, thus causing less disruption? The CBI, of which I am president, stands by, ready to help.

[Lord Bethell (Con)]

I am enormously grateful to the noble Lord for his clear and heartfelt offer of help, and I completely endorse his comments. The collaboration between the NHS, the Government and business has been at the heart of our entire response to the pandemic. This collaboration has been termed the “triple helix”—a phrase that I like very much indeed. It is going to be at the heart of our building back of the healthcare system in the years ahead. On the noble Lord’s kind offer, I remind him that when someone takes any medical treatment, including a vaccine, they have to have the space to take stock and recover from the excitement of the vaccine, and they have to be supervised in that space by someone with some kind of clinical experience. So, while his offer is kind, it is likely that vaccine distribution will be in locations where we can put clinical supervision.

[Baroness Blackstone (Ind Lab)]

My Lords, do the Government intend to create some kind of vaccination passport, which will allow people to attend events across the UK and to travel to and from the UK without quarantine, if they have been vaccinated?

[Lord Bethell (Con)]

My Lords, the noble Baroness raises an extremely intriguing prospect. If it is indeed the case that those who have been vaccinated are not themselves contagious and cannot transmit the disease, there is the possibility that the vaccination will enable them to do things that might not be open to other members of the public. However, it is too early to call that one. We do not have the scientific evidence to demonstrate that the vaccine stops any infectiousness. We are working hard to try to understand that better. If it can be proved, we will look at an enable strategy.

[Lord McLoughlin (Con)]

My Lords, there have been many bleak days since the early part of this year, but yesterday was a day in which we can take great pride in the MHRA and all the people who were involved in bringing this vaccine quickly to the public in this country—the first in the world. In the past, a lot of criticism has been made of Kate Bingham. She has done a remarkable job in the way she has helped secure these vaccines from across the world. Will the Government be sure to learn the lessons of involving both private and public sectors in this remarkable venture?

[Lord Bethell (Con)]

My Lords, I join my noble friend in paying tribute to the MHRA. We have all seen Dr June Raine in her flawless presentation and authoritative explanation of the authorisation of the vaccine. I am sure that, if she were here today, she would want to pay tribute to her incredibly impressive team at the MHRA. I also pay tribute to Kate Bingham and the very many people from the private sector who have stepped forward during the pandemic to take on onerous, sometimes high-profile and sometimes quite controversial roles in the battle with the pandemic. We owe them a huge tribute. They have often given up their time and put themselves in the firing line in order to do this work. Kate Bingham has massively delivered for this country and I am grateful to all those, either at the top of the task force or in local community work, who have stepped forward and made a contribution to our battle against Covid.

[Lord Foulkes of Cumnock (Lab Co-op)]

My Lords, does the Minister agree that there is a danger that this whole programme could be undermined by crazy anti-vaxxers, particularly on social media? What are the Government going to do to counteract this?

[Lord Bethell (Con)]

The noble Lord speaks truth, as always, in this matter. We are naturally concerned by those who deliberately seek to undermine the integrity of the vaccine. However, we are also considerate of those who might have quite reasonable questions about it or might even have what we think are completely unreasonable ones but who have concerns about, or an emotional response to, vaccines. Our approach is to handle those doubts and questions in a dialogue and a spirit of partnership, trying to answer them as considerately as we possibly can. Yes, we should battle those who seek to profit commercially or are acting in their own narrow, national interest to undermine the vaccine in this country. But we want to answer those in our community who have questions about the vaccine with transparency, reassurance and science.

[The Deputy Speaker (Lord Russell of Liverpool) (CB)]

My Lords, the time allowed for this question has now elapsed. We will pause for a minute before the next item of business.

Coronavirus Vaccine

Lord Bethell Excerpts

Thursday 3rd December 2020 Lords Chamber

[Baroness Jolly (LD) [V]]

No one can deny that the news about the Pfizer-BioNTech vaccine is just what we need as the days get shorter and Christmas still seems some way off. The technical achievement is enormous, and I am happy to congratulate all those involved in the creation of the vaccine, in the lightning regulation process and in its manufacture. The logistical challenge is next, and I feel sure that, again, the armed services will figure highly here.

Some time ago, I asked the Minister who might carry out the vaccinations. There are not enough NHS staff free to do it. Is there a plan to train others? The training is very short and needs no clinical background whatever. I seem to remember that student friends, when training to be doctors, would practise their technique by injecting oranges. I understand that it will be at least Easter before all the population has received the first round of the Pfizer vaccine and midsummer before we have all had the two jabs.

Can the Minister clarify what sort of immunity someone would have if they failed to get the second jab? What is the timescale of the availability of the other vaccines that we know are in the pipeline? When do we expect all the population of the UK who are willing to be vaccinated to have received their vaccine, and does he have an indication of how many will refuse it?

Vaccine is not a magic bullet—yet. Those of us who will not get it for some time will have to be careful and adhere to the rules outlined by the Government. We might be surprised that not everyone is aware of the symptoms of the virus—the cough and the loss of taste and smell, along with flu-like symptoms. They have not been part of the messaging but, on prevention, we all know “hands, face, space”. Was there a reason that the messaging did not include symptoms? I appreciate that if you are an avid follower of the PM’s No. 10 virus briefings, all that information is at your fingertips, but for many these are not required viewing. How much is the department using Instagram, Facebook and Twitter to get these messages out? If it is not using them, why not? For months to come, people will be testing positive, and anyone who does will still be required to quarantine.

I would like to spend the rest of my time addressing some issues relating to self-isolation that have come from research by King’s College London, based on surveys carried out by the Department of Health and Social Care. Many of us who have been in this situation isolate, as that is doing our bit to prevent the spread of the virus. King’s found that intentions to isolate were high but, when it came to sticking to it, the numbers were low. It found that there were both practical and psychological barriers to an effective isolation system. Practically, there is the issue of finance. The evidence suggests that those of a lower socioeconomic status with dependent children or older relatives struggle financially or lose their pay if they self-isolate, and they choose to ignore the advice.

The £500 grant has not been available since the onset of the lockdowns, and £250 does not cover all the costs for a family for a week if you lose your wage. If a child has to go into quarantine, there is no eligibility for support, yet in all probability a parent will have to take time off work to care for the child. Not all employers continue paying a salary to those isolating or caring for someone who is isolating.

The data that I referred to came from a series of surveys carried out by the department. Is that data in the public domain? It would be really interesting to see the breakdown by geography and demography.

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

My Lords, I am enormously grateful for that large number of thoughtful and nuanced questions, and I will try to cover as much ground as I possibly can.

I start by supporting the noble Baronesses’ tribute to the MHRA. It has played a complete blinder. It has quietly worked since January for this very moment. It has thrown an enormous amount of expertise, diligence and professionalism at the extremely challenging task of managing this vaccine authorisation, and it is to its massive credit that it has landed with an enormous amount of confidence and has been greeted so well.

The noble Baroness, Lady Wheeler, asked about EU law and exactly where we stand in terms of Brexit. She is exactly right that this authorisation was done under the terms of European law, and the carve-out that we took was indeed completely within the realms of European law. I pay tribute to the international collaboration that lay behind this vaccine—among the inventors, with their Turkish-German background, with the contributions of the German company that founded the vaccine and of the Americans, who have marketed and distributed it. In fact, the collaboration behind it has been global.

However, there is something British about it as well. In Britain, we have a long-standing commitment to research into infectious diseases, and that has created an enormously strong framework and foundation for the work that we have done. At universities such as Oxford, where the Jenner Institute is based, and Imperial, we have established a terrific international reputation for our work on infectious diseases.

The regulator, the MHRA, has gone about its work with an enormous amount of confidence and expertise. That has meant that it has been able to handle, in parallel, the clinical trials for efficacy and the reviews for safety. It analysed huge amounts of data in parallel in real time, so that it could turn around the authorisation promptly and confidently when presented with the final data.

The commercial effectiveness of the Vaccine Taskforce has been phenomenal. It has secured contracts for a large number of vaccines, which has meant that manufacturing has been able to take place in advance, and delivery of the vaccine, which is happening as we speak, is able to take place promptly. On the enormous amount of collaboration on the deployment of the vaccine, about which the noble Baroness asked, I pay tribute to colleagues in the NHS, NHSD, the military, and those in social care and logistics. There has been enormous collaboration across the piece.

The noble Baroness asked exactly what figures there are for delivery and when it is scheduled to take place. I am afraid that I cannot give the precise schedule, but I reassure her that, as soon as we know the precise timetable, we will publish it to give the confidence and reassurance to the public that, quite reasonably, they would like.

The noble Baroness is entirely right that social care is our number one priority. The prioritisation list from the JCVI is crystal clear. It also presents a big challenge because, as she knows, the Pfizer vaccine requires cold storage. It comes in units of more than 100 vials. We do not want to waste this extremely valuable vaccine, so we are having to work closely with social care colleagues and the NHS to ensure that workers and those in social care can receive it. That will be difficult, and I do not doubt that there will be problems, particularly, as the noble Baroness pointed out, with getting the vaccine to small units of social care. However, I reassure her that colleagues are working on that night and day and are very focused on delivering a solution.

The noble Baroness asked whether those who take the vaccine will need to isolate. Yes, they will, and that will have to continue for a while. The truth is that we do not know whether taking the vaccine will reduce transmissibility. Our suspicion is that it will, but until we have the clinical evidence that that is the case, we have to be pragmatic and ensure the safety of the public. However, we are working extremely hard on trying to resolve that issue, and I reassure the noble Baroness, care home managers and those who live and work in social care that they are at the top of the priority list.

The noble Baroness also asked me about delivery of the vaccine from Belgium. I reassure her that there are numerous fallback plans for all kinds of scenarios and that the transport arrangements for this valuable cargo have been thought through incredibly carefully.

The intention is not to roll out mass testing or community testing in every single local authority before Christmas. We are working with those local authorities that have stepped forward and that either are the most keen or have the highest infection rates, to ensure that the partnerships that we have in place develop really good best practice and that those directors of public health who are the most energetic have the resources they need to develop new models. That work is happening at pace and we get updates on it every day. It promises to be an extremely effective model for cutting the chain of transmission.

I pay particular tribute to universities, which have worked extremely closely with both the Department for Education and the department of health to ensure that there is community testing on campus, so that the migration home before Christmas is done safely and effectively.

The noble Baroness, Lady Jolly, is entirely right that apparently it is not very difficult to learn how to give an injection. I have been offered a training course, but I am not sure that anyone would actually want an injection from me. However, I reassure her that we have mobilised an enormous army of people to administer the vaccine. That includes those existing in the NHS and social care as well as pharmacists, who have stepped up massively and to whom we are very grateful, and it will include the return to service of many retired healthcare professionals, to whom we are enormously grateful.

As the noble Baroness pointed out, there is a pipeline of vaccines coming through, not least the British one developed at Oxford University in collaboration with AstraZeneca. I cannot give her a schedule on precisely when all of those will be delivered, but it is extremely promising that there are between half a dozen and a dozen vaccines on their way. It serves as an indication of how science has ridden to the rescue to help us out of this awful pandemic.

Regarding those who are either sceptical or refusing a vaccine, we are reassured that concerns about the vaccine are at present relatively low. We are engaging with anyone who has a concern about the vaccine with respect and in a spirit of dialogue to try to present the evidence in a transparent and reassuring way. That approach seems to have paid dividends, and I am encouraged that the British public will be stepping forward for the vaccine in very large numbers.

I reassure the noble Baroness that we have a massive social media campaign to engage the public. I pay tribute to the media teams in the department and the Cabinet Office, who have worked incredibly hard throughout the entire pandemic and have handled literally dozens of campaigns, often at pace, with enormous creativity and diligence—and have got sign-off from Ministers, which is no mean feat at times—under difficult circumstances. They deserve all our thanks and praise.

Lastly, on the noble Baroness’s quite important questions about isolation, she is absolutely right: isolation is key. There is no point in testing and tracing if you do not isolate. However, the surveys that she refers to are fragmented. I am not sure if some of the simple surveys actually tell the whole truth. In honesty, people’s response to isolation is probably more subtle than simple binary questions would suggest. We are beginning to understand that many who are isolating, although they may not have completely obeyed every strict command in the isolation protocols, have massively changed their behaviours, and we are looking at ways of supporting those people through civic and financial support and through our messaging to ensure that the isolation protocols are as effective as possible.

--- Later in debate ---

[Lord Patel (CB) [V]]

My Lords, as we embark on a mass vaccination programme, it is important that we follow up all those who are vaccinated, or at least a cohort of them, with whatever vaccines are used, in a scientific way. It is important that structured scientific data collection is implemented. Do the Government plan to do that, and who will be doing it? I hope that it will be UK academic institutions, because there is much more science to learn post vaccination about the effectiveness of different vaccines and the science of the new way of developing these vaccines.

[Lord Bethell (Con)]

As ever, the noble Lord is extremely wise in his observation. He is entirely right to hold us to account. There is no point in enjoying this fine moment too much when you have the noble Lord, Lord Patel, on your case reminding you about the next big challenge around the corner. He is right that pharmacovigilance is essential. We need to make sure that this and other vaccines work and that we learn from the behaviours of all of them. That is precisely why we put the deployment of this vaccine through the NHS. There was a temptation to set up an alternative agency and focus on the actual injection of the vaccine over all other matters. Instead we have run it through the NHS digital process, which means that all the information around the vaccine is put very firmly into the GP record. That means that we can do population-wide analysis of the results of the vaccine. We have a very large research community in the UK both in the companies such as Pfizer, which, as he knows, are responsible for pharmacovigilance, and in the university sector. We will have all those records available for them to do the follow-up work that he rightly emphasises.

[Lord Dobbs (Con) [V]]

My noble friend will know that I have reservations about some aspects of government policy, but the news about the vaccine is wholly good news. It is a triumph for all concerned and I join in with his praise for them, although my noble friend himself should not be shy about taking his own share of the credit. He mentioned that other vaccines are coming down the road—in the pipeline, I think he said—including the Oxford vaccine. These vaccines have different characteristics and require different handling. How do the Government plan to distribute and discriminate between the different vaccines? Will one get priority over another? While I understand that he cannot be precise, can he offer any further guidance about how soon we can hope that everyone who wants one will have a vaccination available?

[Lord Bethell (Con)]

I thank my noble friend for his kind words. I reassure him that everyone in Britain who wants a vaccine will get one. In fact, we are going to do everything that we can to encourage everyone in Britain to have a vaccine. We believe that prevention is better than cure, and that vaccines such as the ones coming down the pipeline offer the best possible fightback against this horrible disease. With regard to the different properties of the vaccine, his observation is entirely right: it is likely that the different vaccines have different properties, not least that some are much easier to transport than others, but some might work better, for example, with children or with those susceptible to other conditions. We do not have full data on the other vaccines so it is impossible to make those comparisons at this stage, but I assure him that when we have the data we will make sensible decisions along those lines.

[Lord Clark of Windermere (Lab) [V]]

I thank the Minister for being so frank and admitting that the initial rollout will not be uniform throughout the country this year. I want to ask him about those individuals prioritised for the vaccine on the grounds of age or having weaker immune systems—specifically, who will identify those individuals? Initially the role of GP surgeries was highlighted for that task. Is that still the case? What will happen in those GP surgeries—there are quite a number of them—that have no GPs? Will the nurse practitioners be able to perform the role of identifying those individuals? I would like a specific answer to that because it is important in the longer term for a great many people.

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

I remind noble Lords of the request for brevity.

[Lord Bethell (Con)]

I remind the noble Lord that the criteria sent out by the JCVI is extremely simple and mainly driven by age, so the selection procedure is very straightforward. He is right that the distribution of the vaccine is limited by both the size of the vials and the need for cold storage. That is why there will be an emphasis on hospitals over GP surgeries. That represents a challenge in places such as rural areas that may be distant from hospitals, but I reassure him that the deployment team is doing all that it can to ensure that no one is left behind.

[Baroness Brinton (LD) [V]]

Does the Minister agree with the JCVI’s decision not to prioritise unpaid carers—most of whom are caring for clinically, or extremely clinically, vulnerable people—when unpaid carers are not just prioritised but encouraged and chased by the NHS to have the flu vaccine in order to help protect the person they are caring for?

[Lord Bethell (Con)]

My Lords, difficult decisions have to be made by everyone in this. The JCVI has looked very carefully indeed at the challenge of how to prioritise this vaccine, taking representations from a large number of groups. Ultimately, its priority is to protect life and the NHS, and its clear decision has been to have a prioritisation based on age because this is the greatest driver of mortality.

[Baroness McIntosh of Pickering (Con) [V]]

My Lords, I add my congratulations to my noble friend, the MHRA and everyone associated with producing this vaccine in such record time; it is a great tribute to our health service. I will focus on the fact that the flu jabs for the over-50s are still being distributed, and there is a reluctance among some—perhaps as many as two-thirds of the over-50s—to take up the flu vaccine, as they would like to wait for the Covid vaccine, which, of course, defeats the purpose of offering them the flu vaccine. Is this something that my noble friend is aware of, and is it something that he could address? I echo the remarks of the noble Lord, Lord Clark, and ask that specific regard be had to the challenges of administering the vaccine in rural areas. Will my noble friend use, as far as possible, the dispensing doctors in this regard? I pay tribute to them and the work I do with them.

[Lord Bethell (Con)]

My Lords, as few will be surprised to know, the rollout of the flu vaccine has been hugely successful this year; the take-up has been massive. I am not aware, from the stats that I have seen, of any slowdown in the take-up of the flu vaccine, but the point my noble friend Lady McIntosh makes is understandable—I am happy to check it out. I also encourage anyone who is thinking about deferring the flu vaccine until they get the Covid vaccine to think again because it is a massive priority to get vaccinated for both.

The noble Baroness and I have talked before about dispensing doctors, whose role is very important. There is a challenge with the distribution of the Pfizer vaccine because of cold storage and the large number of shots in each vial. I am not sure whether that means that rural dispensing doctors can play the important role that they might do at this stage of the distribution, but I reassure the noble Baroness that they will play a role in the national distribution as it pans out over the next few months.

[Viscount Waverley (CB) [V]]

My Lords, I note that many unknowns exist in differing vaccine effectiveness cycles. Are the Government planning to combine the careful management of linking certified testing to identity data, particularly given that the technologies and solutions are available? As regards the urgent rollout of vaccines globally, I propose that a commandeering exercise of wide-bodied aircraft, laid-up due to Covid, be considered to lessen the global logistical nightmare.

[Lord Bethell (Con)]

My Lords, in relation to the logistical nightmare, one of the nice things about vaccines is that they do not take up much space: they are relatively compact, so I am not sure that wide-bodied aircraft will be needed, but I thank the noble Viscount for the wise suggestion. In relation to certification, he raises an interesting prospect that we have not fully bottomed out yet. As I said in response to earlier questions, we do not know whether vaccination will reduce transmissibility. Our hope and expectation are that it will, but until that is proven, any thoughts of certification will be premature.

[Lord Liddle (Lab) [V]]

I congratulate the Minister on his generous attribution of credit for this remarkable achievement, which was in very sharp contrast to the two Cabinet Ministers who sought to make cheap and inaccurate nationalist points about it yesterday—that is to his credit. Speaking as a Cumbria county councillor, I say again that his honesty about the constraints on the rollout is commendable, and I ask whether he agrees that, in rural areas, it is still very important that we concentrate on remedying the defects in our tracking and tracing system that our Cumbria public health director has identified? There is still a lack of proper liaison between the national and local systems, and this deficiency has to be addressed in this period, as people may become more relaxed as a result of the wider availability of a vaccine.

[Lord Bethell (Con)]

I welcome the noble Lord’s challenge and completely endorse his point that tracing will remain important. Not everyone will take the vaccine initially; it will not be available to everyone for months, as the Deputy Chief Medical Officer made plain in his briefing earlier today. Tracing remains a really important feature of our fight against this disease. However, I respectfully suggest that his information is a little out of date: the amount of collaboration on tracing between the national and local efforts, particularly with DPHs such as the one in Cumbria, has come on in leaps and bounds, even in the last few weeks. From my briefings and meetings with DPHs, I know that they have been provided with an enormous amount of data, support and access to tracing resources in order both to bring their local intelligence and insight to bear and to support the national tracing effort. I applaud all those DPHs who have stepped forward in this way, and I am very hopeful that the local-national combination on tracing will pay massive dividends.

[Lord Scriven (LD) [V]]

My Lords, in the first priority group, there are over 3.2 million people aged 80 or over. As the UK will get doses for 400,000 people initially, what access framework is in place to ensure an ethical approach to the vaccine rollout for these first 400,000 people that is not based on having the sharpest elbows or the chance of having a hospital appointment?

[Lord Bethell (Con)]

My Lords, the noble Lord raises an important challenge there; fairness and equity are important in this important time. However, I will try to assess the situation: we have 800,000 doses of a vaccine that is incredibly difficult to transport, requires cold storage and is in vials containing more than 100 doses each. Therefore, practical considerations are pre-eminent at the moment, rather than sharp elbows.

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

My Lords, I thank the Minister for the gracious way he has introduced this discussion, and I welcome his assurance of dialogue. I hope he will agree, as he has assured us, that the vaccine will not be the only effective means of preventing infections and further deaths and that the Government will continue their heartening improvement of the test and trace programmes and ensure that those in tiers 2 and 3 have the required financial measures. Can he assure me and the House that his department will urgently scale up communication with particularly vulnerable and poorer communities, where concerns around vaccination are significant? Can he assure me that any proposed government use of the police and army will be done with consent and after consultation with local authority leadership?

--- Later in debate ---

[Lord Bethell (Con)]

The noble Baroness will probably have noticed earlier today the recent publication of test and trace figures, which showed a dramatic improvement in both the tracing numbers and the testing turnaround numbers. We still have far to go, and improvements are needed, but this is an extremely encouraging set of figures, which demonstrate that our focus on getting this important service right is undiminished.

In relation to getting the vaccine to poorer communities, the noble Baroness is entirely right: there are communities where the Government are not trusted as much as they are elsewhere and where there is suspicion of the vaccine. We are working extremely hard at the department, in the NHS and with Cabinet Office colleagues to reach out to community leaders and think of thoughtful and creative ways of ensuring that the vaccine penetration among these communities is strong and that we have built the confidence and belief necessary for people to step up and take the vaccine as they should.

[Lord Rooker (Lab) [V]]

My Lords, I echo my noble friend Lord Liddle in applauding the Minister on his approach and attitude. Is it not worth celebrating the involvement and success of Turkey, Germany and Belgium in getting this vaccine to the UK? We did not order all the vaccines so early. During the next few weeks, the Health Secretary has to be the most trusted voice of Government as he rightly seeks to persuade people to take the vaccine. How can he perform this role when he has uttered a string of untruths? The latest is that the medicines regulator could only work fast because of Brexit. This is untrue and everybody knows it. I hope this problem of trust can be restored because the advice given by the Secretary of State will be crucial to the take-up of the vaccine.

[Lord Bethell (Con)]

I am slightly surprised by the tone of the noble Lord’s question. If there were ever a moment when my right honourable friend the Secretary of State for Health deserved a bit of praise and a thank you, today would be that day. That ad hominem attack was beside the point. On his serious point about trust in the vaccine, it would not be helpful for politicians to lead the charge. Our approach is to put science and the NHS at the forefront of our communications. They are truly engaged with both the expertise and the communities that need to take the vaccine.

[Baroness Walmsley (LD) [V]]

My Lords, the rollout will require many people, in addition to those giving the injection. Are there any plans to use the thousands of NHS volunteers who signed up during the first lockdown to act as marshals, drivers, identity checkers, or whatever else is required? In planning the appropriate use of the military, have the Government recognised the concerns of certain community leaders that their presence at testing sites would not reassure members of their communities who are hesitant about taking the vaccine because they do not trust authority?

[Lord Bethell (Con)]

The noble Baroness is right about the NHS volunteers. We would very much like to work with those who stepped forward. Their move was extremely welcome and kindly meant. However, the deployment of the vaccine is a precise affair. We are relying on people having to put in long hours—often not at their own discretion or convenience. Volunteers may well play a role, but the backbone and functional aspect of the deployment will rely on professional staff.

I appreciate her conundrum about the military. It is a delicate dilemma. I do not want to live in the kind of country where we turn our back on the military because some people might feel uncomfortable at the sight of uniforms on the streets. We need to build trust with communities. I want to use this moment of the vaccine to build a bridge of trust between those whom the noble Baroness reasonably described and the military. We must not make the mistake of disrespecting the military by turning them away from this important task.

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

My Lords, as the Minister who established the MHRA, I strongly endorse the Minister’s congratulations. I pay particular tribute to the outstanding leadership of Dr June Raine. I note what the Minister said about unpaid carers and the justification for not giving them priority but would the Government be prepared at least to discuss this with Carers UK? On care homes and visitor testing, which are mentioned in the Statement, is the Minister aware of calculations by Care England that the infection control fund will not cover the cost of implementing the new testing regime, let alone all the other areas for which the fund is intended? Will the Government consider increasing the fund?

[Lord Bethell (Con)]

My Lords, the support we are giving to social care throughout this period is incredibly important. I should be happy to meet with Care UK to discuss this. I cannot duck the issue. The JCVI has made its prioritisation clear. It is based on thoughtful science, infection rates and the calculation of how best to save life. While I feel compassion for carers, including some in this Chamber, we have to live with this tough decision. I cannot pretend I am going to try to change it. The inspection control fund is generous; we have put a large amount of money into it. If it proves not to be enough, we will be happy to revisit it. Protecting social care through these final few months is a big priority. I should be happy to discuss how we can do this better with the noble Lord at his convenience.

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

My Lords, all supplementary questions have been asked and answered. I congratulate noble Lords.