Covid-19: Self-isolation Payment Scheme

Lord Bethell Excerpts

Wednesday 2nd September 2020 Lords Chamber

[Baroness Sherlock]

To ask Her Majesty’s Government what are the eligibility criteria for the new payment scheme for people self-isolating and unable to work from home in areas with a high incidence of COVID-19.

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

My Lords, to be eligible for this payment, individuals must live in Blackburn with Darwen, Oldham or Pendle and have been asked to self-isolate by Test and Trace, be employed or self-employed, stand to lose income because they are unable to work from home while self-isolating, and receive at least one of the following benefits: universal credit, working tax credit, income-related employment and support allowance, income-based jobseeker’s allowance, income support or pension credit or housing benefit.

[Baroness Sherlock (Lab) [V]]

My Lords, I am grateful. People are told to quarantine as soon as they have symptoms and wherever they live. Can I ask the Minister two questions? First, why is the payment only for those who have had a positive test or been told to isolate by NHS test and trace? Secondly, the Government’s description of the scheme says that it is intended only for those in high-infection areas, but if there is an outbreak elsewhere, in a care home or a factory, do those workers not need support? If they cannot afford to stay at home, does that not risk creating a new high-infection area?

[Lord Bethell (Con)]

My Lords, the reality of the epidemic is that it targets some communities in specific areas with laser-like focus. The feedback from some of those communities, local authorities and community leaders is that support is needed in some areas where there has been a local lockdown. We have responded to those suggestions and put this financial support in place for specific communities in specific areas. In that, we are responding to local suggestions.

[Baroness Lister of Burtersett (Lab) [V]]

My Lords, can the Minister explain the evidence base for the decision that £13 a day would be sufficient to persuade low-paid workers to forgo their earnings and self-isolate?

[Lord Bethell (Con)]

My Lords, I am not sure that I heard all the question. Can I just explain that those who are isolated for 10 days will receive £130? Other eligible members of their household who have been self-isolating will also be entitled to a payment. Eligible non-household contacts instructed to stay at home and to self-isolate will also be entitled to a payment of up to £182.

[Lord Scriven (LD)]

My Lords, what is the difference in the Government agreeing to pay only certain low-paid people £13 a day to do their civic duty to stop the spread of a deadly virus, but up to £70 a day for anyone to serve on a jury?

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[Lord Bethell (Con)]

My Lords, I do not see that there is a parallel between the two.

[Baroness Warsi (Con) [V]]

My Lords, what current criteria are the Government using to determine local lockdowns? In the light of reports from Manchester today, what improvements, if any, have been made in the area of local consultation and the imposition of a local lockdown since the decisions of 30 June in Leicester?

[Lord Bethell (Con)]

My Lords, a huge amount of data, both national and local, gets put into the local lockdown process during the gold meetings of the JBC. The liaison between gold and local authorities and local MPs has been improved and upgraded massively in the last few weeks. I cannot share any update from the JBC meetings today.

[Lord Loomba (CB) [V]]

My Lords, there are many situations where citizens are being mandated to self-isolate or quarantine, such as specific workplaces or specific countries or, as we have seen at the weekend, with the flight from Zante. However, those people may not live in areas with high incidence of Covid-19. In these circumstances, how will such people be covered by any benefits so that the choice is not between feeding themselves or health protection for anyone affected?

[Lord Bethell (Con)]

My Lords, under the current scheme, benefits are provided to those who live in Blackburn with Darwen, Oldham or Pendle. It does not extend to other areas. We will assess the impact of this scheme and review whether it should or could be extended in any way.

[Lord McKenzie of Luton (Lab) [V]]

My Lords, support for the most vulnerable in undertaking self-isolation should not just, as suggested, be a matter of financial support, important though that is. It should include emotional and mental health support to the household. Does the Minister agree? What provision is being made for this sort of support? In so far as it is provided by local authorities, will adequate funding be made available to them?

[Lord Bethell (Con)]

The noble Lord is entirely right. The decision to isolate is extremely tough for a great many people, both economically and psychologically. The importance of isolation is absolutely critical in our battle against Covid. We have to think of ways of supporting people in every way we can. That is the responsibility of local authorities, and we have provided them with £300 million of funding to support their isolation, test and trace programme. I would like to pay tribute to local authorities that are doing a fantastic job of putting support in place for those who are isolating in expectation of the winter.

[Lord Greaves (LD) [V]]

My Lords, I speak from Pendle, and declare my interests, where council staff and the council leadership are working heroically in the front line of the Covid battle. This is a welcome although very small step. Is the Minister aware, though, that our determination to test, test, test and find positive cases is greatly hindered by the inefficient and failing national tracking, contact and isolate system and by the complex, obscure and bureaucratic way in which decisions on local restrictions and support are being made? Will the Government give much more authority and resources to local people with the skills and local knowledge that are needed, particularly in tracking down local contacts and persuading them to co-operate? Give us the tools and we will get on with the job.

[Lord Bethell (Con)]

The noble Lord gives fascinating testimony, and I pay tribute to the council in Pendle, which is well known for its energetic approach in dealing with the epidemic. I honestly say a massive thank you to all those in Pendle who are working so hard. Despite what the noble Lord has just said, they are being successful. The strategy is working and they are fighting the disease and breaking the chains of transmission, and we are all hopeful that Pendle will be restored to normal life as soon as possible. Our approach is to give those on the ground the tools they need, exactly as the noble Lord asks. I am hopeful that that is happening. I hear reports that it is, and that is very much the emphasis of our approach.

[Lord Wigley (PC) [V]]

My Lords, will the Minister confirm that if local spikes appear around the United Kingdom, this scheme will be available to them? Will it be available in Glasgow, for example? Can he confirm that enough flexibility will be allowed to those administrating the scheme to ensure that those who need the scheme, whose circumstances will vary greatly, will be able to get it quickly and expeditiously?

[Lord Bethell (Con)]

The noble Lord asks a wide-ranging set of questions. We are looking at the effectiveness of the scheme. We are working with DAs to see whether the scheme could or should be extended in Scotland, Wales and Northern Ireland. Once that review is done and we have assessed its impact, we will be able to make decisions of the kind he describes.

[Lord Polak (Con)]

The headline figure of £13 can be, and has been, taken out of context. Can my noble friend the Minister reconfirm that the payment will not impact existing benefit entitlements?

[Lord Bethell (Con)]

My Lords, the payment itself will not affect existing benefits in any way. Payments through the scheme will, though, be subject to income tax and some form of national insurance contribution, in line with other support payments such as through the Coronavirus Job Retention Scheme.

[Baroness Primarolo (Lab) [V]]

My Lords, I return to the question asked by my noble friend Lady Lister. What was the evidence base for the decision that £13 a day would be sufficient to persuade low-paid workers to forgo their earnings and therefore self-isolate? The Minister did not answer the question the first time round; perhaps he could answer it now. What were the criteria?

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[Lord Bethell (Con)]

The evidence base and criteria were our discussions with local authorities and community leaders on what an effective amount would be that would tip the balance in a personal decision to isolate. As I said earlier, those personal decisions are extremely tough. It was agreed with local infection teams and authorities that this was the kind of sum that would make a difference.

[The Lord Speaker (Lord Fowler)]

My Lords, the time allowed for this Question has elapsed, and that concludes Question Time.

Medicines and Medical Devices Bill

Lord Bethell Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Wednesday 2nd September 2020 Lords Chamber

Moved by

[Lord Bethell]

Relevant documents: 19th Report from the Delegated Powers Committee. 10th Report from the Constitution Committee.

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

My Lords, the Medicines and Medical Devices Bill is crucial to the development of a modern, safe, medical regulation regime. Its focus is the development of important innovations that will improve and save lives for the next generation, and the protection of patients in an area which has, historically, been slow to move and which, in a few months, passes from European to domestic legal oversight. When we look at our plans for the health of the nation, having the agility to revise our key regulatory regimes is not a “nice to have”; it is absolutely essential to protect the lives of patients and empower the innovations that will extend their length and quality.

I begin with safety. The first and most critical consideration of any Bill on medicines and medical devices must be the safety of patients. We also consider the safety of providers, the environment and, in Part 2 of the Bill, animals, but the safety of patients is paramount. We have all reflected on the detailed and thorough report of my noble friend Lady Cumberlege. I have listened to the testimony of some of the patients and families who have campaigned on patient safety, and shared, in a small way, their pain and suffering. They brought to life how critical this Bill is. We owe them a huge debt of thanks, as we would not be here today without their determination.

There is no disagreement among us on the importance of the safety of patients. The Bill puts safety at the heart of regulatory decision-making, facilitating the sharing of information to support public health concerns and creating mechanisms to track the use of medical devices or medicines against a patient record. The thoughtful, thorough, modern use of data is how we know that something is going wrong and how to put it right. That is the view of the Government, which my noble friend Lady Cumberlege and her team brought vividly to life in the Bill’s passage in another place. That is why I am delighted with Clause 16, introduced as an amendment, which ensures that data provisions in the Bill are central to its effectiveness. By introducing a medical devices information system—or database—we have radically improved that effectiveness.

We once faced a situation where patients could not be traced, and a conversation could not be had between a patient and their clinician because we did not know which specific device had been implanted into a person or by whom. When I found this out, I was dumbstruck. This must not happen in the future. The Bill will support the tracking and tracing of medical devices and will enable a future system of clinical registries, such as the National Joint Registry, to ensure that UK patients are better supported.

When there is a problem, it is important not only that we know that something has happened, but that we take forceful action. Part 3 of the Bill therefore sets out a consolidated suite of powers available to the regulator, including the ability to step in and recall a device if the manufacturer fails to do so where necessary. Chapter 4 of Part 3 of the Bill clarifies the powers of disclosure around devices, allowing the Secretary of State to warn members of the public about safety concerns. We must ensure that avoidable harm is avoided by acting expeditiously to protect patients. Let me be clear: the regulator can and does work in close partnership with industry to deliver on behalf of patients, but it has, and will continue to have, teeth when industry fails to protect patients.

We live in a world where big data, artificial intelligence and genetics have become enormously powerful engines of innovation, and where engineering and computer science have combined with medicine to create an unexpected synthesis. These drivers of development are generating exciting new medical innovations that are aiding patients who were previously beyond help, bringing down the costs of treatment and driving growth in Britain’s thriving life sciences industry. I have seen the power of innovation at first hand in the last few months, during the Covid-19 crisis. Our National Health Service is the first around the world to have determined the importance of an effective therapeutic drug, dexamethasone, through the recovery clinical trials programme. Our medical manufacturing industry worked closely with the regulator to move swiftly and safely and put 14,000 ventilators into the health system. In the area of diagnostics—my specialist subject—innovation is driving the accuracy, cost, speed and scale of devices beyond our initial hopes.

We need this pace of innovation in day-to-day, back-to-business delivery too. That is why we are investing in the partnership between the NHS, with its unique pool of patients, and the life sciences sector, which can make treatments happen. I pay tribute to the noble Lord, Lord Darzi, who is chair of the excellent Accelerated Access Collaborative, which gets the best new treatments and technologies into the hands of patients and clinicians faster than ever before. We face a new horizon of tailored treatments and diagnostics that we never could have envisaged five or even three years ago: biotechnology, artificial intelligence, robotics. We are at an inflection point where innovation can make a huge difference. I am pleased and proud to be a Minister championing the role of innovation in the healthcare system at this incredible time. Supporting innovation through this Bill ensures that UK patients benefit from the thriving life sciences sector by bringing investment, jobs and prioritisation to Britain’s medical needs, balanced by the need to manage risk.

Availability and attractiveness are the twin pillars of the Government’s strategy on medicines and medical devices, and the key themes of this Bill. Availability means the reliability of medicines and medical devices and their availability to UK patients. Attractiveness means doing everything reasonable to be the first place where new treatments are rolled out and adopted, where investment in life science takes place and where the enrolment of patients in clinical trials is supported.

Recent months have proved how the availability of medicine relies on fast, accurate, responsive regulation. It is the work of the regulator, hand in hand with the industry, that has ensured that therapeutics, including those used in intensive care, have been in safe supply and that devices, including the important vaccines, get into the right hands to bring this crisis to an end. Clauses 2, 6, 8, 12 and 15 all deal with how we ensure the essential and safe flow of medicines and medical devices. Clauses 2, 8 and 12 allow for regulations to be made that could, for example, affect how medicines or devices are distributed. Clauses 6 and 15 allow us to make pre-emptive regulations to reflect the realities of an emergency, such as a pandemic, and to prepare early.

It is right that we do more to get regulated medicines into patients’ hands and do not keep people waiting long for innovative treatments. I pay tribute to a number of noble Lords who I know tirelessly make the case for certain therapeutics or treatments to be accelerated through the health system. The attractiveness of the UK is fundamental to getting new breakthroughs to patients here quickly.

Let me say a word about regulating for the future, and the work of the Delegated Powers and Regulatory Reform Committee and the Constitution Committee. I pay tribute to learned colleagues on these committees: I know they approach their work diligently and seriously, with significant legal expertise, and I anticipate discussion of their conclusions. I know a number of noble and noble and learned Lords will wish to speak to those reports today, and I will pay serious attention to the points raised.

This is, as it must be, a framework Bill. I recognise that concerns have been expressed about the breadth of the powers and a number of suggestions have been made as to how the Bill might be improved. I am listening, but it is important to note the challenges of taking a different approach to that outlined here.

These delegated powers are necessarily broad, given the hundreds of pages of the Human Medicines Regulations alone. These regulations can span many different matters and it is vital that the ability to make a change for the benefit of patients, where even a really minor point can be important, is not lost. We live in a world where it was only 12 years ago that the iPhone was released, yet today we are trying to figure out how to regulate an AI-supported cancer-screening gadget from KardiaMobile that plugs in to your smartphone and delivers a medical-quality ECG in about 30 seconds. We live in a world where 3D bionic arms, such as the Hero Arm from Open Bionics, have multigrip functionality, and where the national lung matrix trial at the University of Birmingham is exploring how patients with non-small cell cancers respond to tailored treatments.

Primary legislation cannot be relied on to be passed quickly when there are matters of concern for the safety of medicines and medical devices. For example, when concerns were raised across the EU about the scrutiny of notified bodies, and safety concerns arose from certain implants, it took years to update legislation. My noble friend Lady Cumberlege has made clear what happens when change is slow: it has an impact on patients. I know this from another area and I will give an example. When the Communications Act 2003 was passed, the internet was hardly mentioned. Some will say we could not have predicted the immense role that video sharing and social media platforms would now play in our lives, but I remember at the time that legislators were urged to take internet innovations seriously and put in place frameworks to anticipate technical change. Now we have widespread fake news, cyberbullying, the intimidation of public figures and a pornography boom, but without the legislative powers that perhaps we would like to stop or regulate them, because there was no framework to make new regulations to cover these innovations. I am here to listen, so I would like to listen to the advice of the Chamber on how to handle this complex challenge.

In conclusion, I remind noble Lords that because of its importance for patients, we need to get the Bill done and to secure the ability to protect patients quickly if the need arises. We need powers to deliver and to trace and track medical devices as soon as possible. I know it is important that we discuss these issues properly, but the Bill is not just exciting, ambitious and direction-setting; it is essential that it makes it to the statute book by the end of the year. I look forward to listening to the contributions ahead; we are receptive to how we might make the Bill better, as we did in the other place. My door is open, and in that spirit of co-operation and consensus building, I beg to move.

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[Lord Bethell (Con)]

My Lords, what a debate. This is without doubt the House of Lords at its best, with thoughtful and powerful points covering medical regulation, legal propriety, patient safety, the European transition, animal welfare, foreign relations and much more. We have listened to powerful points made by 50 speakers. There was a great deal to take in. Our time together in Committee and on Report promises to be rich with important material. I fear I will therefore be unable to address every single point from every noble Lord who has spoken today, but I will give it my best shot.

Noble Lords addressed five broad themes in their contributions: my noble friend Lady Cumberlege’s review, improving regulation for medicines and medical devices, the Delegated Powers and Regulatory Reform Committee report, organs and tissues, and the UK’s future relations with the EU. I will take them in turn.

I am exceptionally grateful to my noble friend Lady Cumberlege for her report and her contribution today. Noble Lords have sent a clear message to the Government and the public that patient safety must be paramount in how we regulate medicines and medical devices. My noble friend is right that patients should be believed. She is also right that it is counterproductive to create an environment in which health professionals clam up or go into hiding. I note her intention to table an amendment on a patient safety commissioner and the large number of noble Lords who expressed their support.

The noble Lord, Lord Alton, gave poignant testimony from his own long-standing campaign on these important causes, including on Primodos. The noble Baroness, Lady Hollins, spoke of the epistemic injustices towards the disfranchised, and the noble Baroness, Lady Burt, spoke movingly about mesh, giving testimony of what she called “medical misogyny” that was hugely uncomfortable. There is a limit to how much I, as a man, can really understand all these cases, but as a husband and a father of two daughters I understand the claim that our healthcare system has not treated women fairly. This Government and this Minister are committed to doing what we can to address this.

I have heard the clear commitment from many Peers, including the noble Lords, Lord Brooke and Lord Patel, the noble Baronesses, Lady Ritchie, Lady Uddin and Lady Watkins, and my noble friend Lord Sheikh to see the report of my noble friend Lady Cumberlege implemented. I said that I would listen, and I have heard very clearly the support for a patient safety commissioner. The nine strategic recommendations in the review need to be considered carefully and we will respond in due course.

I reassure the noble Baroness, Lady Barker, who asked that registries of devices as well as databases should be our expressed direction of travel: we have set this out in the government guidance published alongside the amendment. I would be happy to write to set this out clearly. Many have spoken of the importance of Clause 16 and the underpinning of data. I assure Members that we are able to capture all devices where it is considered necessary to track their use. My noble friend Lord Mancroft is quite right that it is unacceptable in the 21st century, and makes no sense, that our National Health Service cannot keep track of who puts what in whom, and we are determined to change that.

The noble Baronesses, Lady Barker, Lady Walmsley and Lady Andrews, and the noble Lords, Lord Patel and Lord Brennan, raised patient safety. That must be a first consideration. I concur completely with the Minister in the other place that patient safety is paramount—under no circumstances will we seek to make changes that increase risk to patients in the UK. It is absolutely right that we ensure the delicate balance between supporting innovation and maintaining the UK’s position as an attractive place to develop new medicines and devices, but patient safety remains paramount. Innovation and patient safety are not mutually exclusive, and we want to continue to ensure that our regulatory framework facilitates the furtherance of both.

Several noble Lords mentioned the importance of consultation with patient safety groups on regulation that directly affects patients. I reassure all noble Lords that the consultation clause is worded such that where matters affect a particular group or groups, it will be entirely appropriate for them to be consulted.

I turn to the improved regulation of medicines and medical devices. The noble Lord, Lord Patel, expertly described the need to ensure the safety of medical devices. This is something I have indicated that we are wholeheartedly committed to, as indicated by the inclusion of Clause 16. The Government are determined to deliver regulatory change to the current UK system for medical devices to increase patient safety and drive pre-market scrutiny, and we will continue to assess opportunities to improve the wider regulatory system at the end of the transition period. The Bill is vital as it provides the necessary powers that will allow us to make regulatory changes in the interests of patient safety and confidence. The Government are committed to ensuring that patients continue to have rapid access to new medicines, and we have increased access through the early access to medicines scheme. We recognise the importance of innovation and clinical trials for patients and are absolutely committed to building on the UK as a centre of excellence for trials after the end of the transition period. We will ensure that no patients are disadvantaged.

I reassure my noble friend Lord Balfe that the UK already has substantial capacity and expertise to regulate and evaluate the safety of our medicines and medical devices. The Bill ensures that the legal frameworks around medical devices, human medicines, veterinary medicines and clinical trials can be updated to protect patient safety and reflect innovative practices. This is vital as negotiations on the UK’s future global relations continue, as several noble Lords alluded to.

I agree with the noble Baronesses, Lady Redfern and Lady Whitaker, and the noble Lords, Lord Ramsbotham, Lord Bhatia, Lord Willis and Lord Bradley, that it is right that patients are treated by the healthcare professional best qualified to care for them, including prescribing for them where that is safe and appropriate. However, putting individual professions on the face of primary legislation is not the right platform for any potential amendments to medicine supply or prescribing responsibilities. Over time the roles of staff within the health service will evolve and, using this proposed power, professional groups can be given new or additional powers to supply or prescribe medicine, subject to consultation, by amending human medicines regulations. NHS England and NHS Improvement are considering across all non-medical groups, influenced by learning from the Covid-19 pandemic, where there is a need to consider undertaking formal consultation on potential amendments to prescribing responsibilities for several professional groups.

The noble Lord, Lord Hunt, spoke of his frustration that the NHS is slow to adopt new technologies. He is right. Uptake of new medicines is still too slow, and we are working to address that. We recognise the importance of aligning regulatory and health technology assessment processes to ensure timely access to effective medicines.

My noble friend Lord Lansley is right that 10% of global medical innovations in the UK is good—but it is not good enough. I welcome his persuasive points on a new innovation fund and confirm that the Government have made a commitment to support innovative medicines by extending the successful Cancer Drugs Fund into an innovative medicines fund. The Cancer Drugs Fund shows the impact that this approach can have for patients, with 81 drugs treating 167 cancer indications funded by the CDF since July 2016.

I reassure the noble Baroness, Lady Bennett, that there is no contradiction between an intention to change very little in the immediate future and a commitment to evolving our domestic regime to protect patients, to meet the opportunities of technical revolution and to make Britain a destination for life sciences investment, clinical trials and better health services for patients.

My noble friend Lord O’Shaughnessy spoke wisely about the regulatory arms race, the impact of the FDA’s competitiveness and the opportunity of leaving the EMA. I welcome my noble friend Lady Blackwood’s point about the fact that the Bill is incredibly timely, irrespective of EU exit. I am proud of the energy and flexibility that the MHRA has shown during the response to Covid. I agree wholeheartedly with my noble friend Lord O’Shaughnessy that this is an opportunity that must be taken.

The noble Lord, Lord Clement-Jones, speaks knowledgeably about falsified medicines and the importance of commercial data. I reassure him that our objective is to fully consult with industry, patient groups, pharmacists and all interested parties on any regulatory changes before they are implemented.

To the noble Baroness, Lady Sheehan, I say respectfully that I reject the idea that we need to move away from the intellectual property rights regime that has provided incentives to create new inventions and accelerate the development of health technologies, such as Covid vaccines, over more than a generation.

By way of conclusion of this point, I echo my noble friend Lady Blackwood, who set out the opportunity well: there are key areas of regulation where we must choose to develop new regulatory regimes, including gene therapies, genetics, AI and big data. The Bill will help us to produce future-proof, proportionate regulations and standards in full consultation and largely with affirmative regulations that will have full parliamentary scrutiny.

On the question of parliamentary scrutiny, I turn to the DPRRC report. I reassure noble Lords that the majority of the delegated powers in the Bill are not new. They are absolutely necessary if we are to have the appropriate powers to make changes to the critical regulatory frameworks after the end of the transition period. We can currently make changes to those frameworks under Section 2(2) of the European Communities Act 1972, but that power will not be available once we have left the EU and we cannot allow those regulations to stagnate. While oversight of the delegated powers in the Bill will be different from that which currently occurs, we have taken deliberate steps to ensure that the oversight will involve greater parliamentary scrutiny and secure greater involvement by patients, industry and other experts. We will carefully consider the specific and detailed recommendations of the DPRRC as to how we might go further.

As reiterated by my noble friend Lady Blackwood, the majority of regulations are subject to the draft affirmative procedure—a high level of scrutiny that has usually been applied when we have used Section 2(2) of the European Communities Act 1972. As noble Lords know, by its nature this procedure requires parliamentary approval before those regulations may be made and come into force.

I am grateful to my noble friend Lord Blencathra for early sight of his speech, which was a model of courtesy and delicacy. I have heard his message loud and clear. I would welcome his counsel on the central challenge of how to legislate for a fast-moving industry in which there is so much opportunity and so much danger, but also so much uncertainty.

The noble Lord, Lord Hunt, and the noble and learned Lord, Lord Woolf, called for sunset clauses. Here I must express some scepticism. Sunset clauses would emasculate a Bill that is meant to give regulators the powers to be effective and to future-proof medical regulations in a fast-changing industry for many years to come. We must understand the impact on an industry that needs regulatory certainty or else, as many noble Lords have noted, will move elsewhere.

I firmly agree with my noble friend Lord O’Shaughnessy that the Bill gives us the ability to respond flexibly in future to regulate, for example to support the transformation of community pharmacy, to respond to innovations in the market and to improve standards of scrutiny of medical devices. Without the powers in the Bill to update the existing comprehensive regimes, we will be in danger of having static rules that could jeopardise patient safety. We must not allow ourselves to end up in this position.

The noble Baroness, Lady Barker, suggested that there is no scrutiny of the regulations generated under this Bill, but in fact the regulations come back to Parliament and cannot be enacted without scrutiny. I assure the noble Baronesses, Lady Andrews and Lady Walmsley, that we are certainly listening carefully. We are open to ideas for improving the Bill.

I welcome the constructive remarks by my noble friend Lord Lansley, my noble and learned friend Lord Mackay and the noble and learned Lord, Lord Woolf, on the building of a clear framework for the Bill. I have sought to outline such a framework in my remarks on patient safety, availability and attractiveness. I anticipate that these thoughts will be developed ahead of Committee and I look forward to further discussions on these points.

On China and organs, I have heard clearly the points of the noble Lords, Lord Hunt, Lord Collins, Lord Sheikh and Lord Alton, the noble and learned Baroness, Lady Butler-Sloss, the noble Baronesses, Lady O’Loan and Lady Northover, and my noble friends Lord McColl and Lord Ribeiro on imported human tissue, the suggested role of British firms in enabling this trade, the plight of the Falun Gong and the Uighurs, and potential forced organ donors. As the noble Lord, Lord Alton, put very clearly, the idea that British companies are profiting from these trades is abhorrent.

The noble Lord, Lord Collins, is right that we have one of the most ethical regimes for human tissue use in the world, and I share his concerns that we should in no way enable a horrible trade. I recognise that noble Lords are concerned about reliance on overseas reassurances, as outlined in the Human Tissue Act, and I hear these arguments clearly. I note that the noble Lord, Lord Alton, and the noble Baroness, Lady Finlay, will bring an amendment with the support of other noble Lords, including the noble Lord, Lord Balfe, and my noble friend Lord McColl. I reiterate my offer to the noble Lords, Lord Alton and Lord Hunt, and the noble Baroness, Lady Finlay: I would be happy to meet them to discuss this in further detail and will take this up with my noble friend Lord Ahmad, Minister for South Asia and the Commonwealth.

On EU exit, I am committed to ensuring that the UK has one of the best regulatory regimes that ensures patient safety and that patients benefit from innovative products. My noble friend Lord Lansley and the noble Lords, Lord Turnberg, Lord Kakkar and Lord Sharkey, raised the EU clinical trial regulations, which are currently expected to take effect during 2022. I am committed to ensuring that the UK’s regulatory framework for clinical trials is geared towards providing the best possible environment that takes into account the needs of patients, industry, non-commercial researchers and hospitals. That is why this Bill is so critical. The powers will ensure that we have the flexibility to adapt our regulatory framework and that the UK retains a thriving clinical trials environment, so that those engaged in clinical trials can continue to develop innovative and cost-effective treatments that both benefit patients and boost growth.

To the noble Baroness, Lady Morgan, I say that I am totally committed to improving the clinical trials regime. I assure the noble Baroness, Lady Masham, who touched us all with her account of the life-saving efficacy of modern medicines, that we are looking to give the MHRA the resources it needs to provide the best regulations and to give horizon-scanning intelligence and industry insight to help innovation.

The noble Lords, Lord Clement-Jones and Lord Freyberg, highlighted the importance of data. We are considering how to improve the regulation of software-driven devices, including AI and algorithms, and will consult on this. The Bill provides a power to make regulations about the use of data collected for the purpose of preventing the supply of falsified medicines.

Currently, the EU scheme information held on the system can also be used for the purpose of reimbursement, pharmacovigilance and pharmacoepidemiology. Determining the best model for the UK will be subject to consultation and parliamentary scrutiny of the proposed regulations. I will be happy to follow up with further detail in writing.

To my noble friend Lord Balfe, whose knowledge of European democratic structures is extensive, I say that we should embrace the opportunity we have now to discuss our own future and regulatory system here in this place. However, we should continue to work with our international partners.

A number of noble Lords referred to the importance of co-operation with the EU and EMA. As outlined in our approach to negotiations with the EU, we want to agree with the EU an annexe on medicinal products to facilitate trade and support high levels of patient safety.

The noble Lords, Lord Hunt and Lord Rennard, referred to the guidance published yesterday on standstill arrangements. We recognise the importance of continued access to medicine and medical devices. Therefore, to ensure continuity of supply of medicines and medical devices from 1 January 2021, the UK will unilaterally recognise certain EU regulatory processes for a time-limited period. By communicating this well in advance of the end of the transition period, we are providing industry with clarity on the preparations that need to be taken for the 1 January and beyond to ensure the supply of vital goods to UK patients. I would be happy to meet the noble Earl, Lord Devon, to discuss his concerns.

The noble Baroness, Lady Ritchie, referred to arrangements in Northern Ireland and I want to underscore that the implementation of the Northern Ireland Protocol is a top priority for the Government.

There is much more that could be said about the debate tonight. It is a testament to the interest in these issues and the importance of getting this right. I welcome the scrutiny of noble Lords in seeking to make the Bill better, as we so diligently try to do when it reaches us.

Bill read a second time and committed to a Grand Committee.

Health Protection (Coronavirus, Restrictions) (Leicester) Regulations 2020

Lord Bethell Excerpts

Wednesday 29th July 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 3 July be approved.

Relevant document: 22nd Report from the Secondary Legislation Scrutiny Committee

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

My Lords, these regulations were made on 3 July and came into effect the following day. On 16 July, my right honourable friend the Secretary of State for Health and Social Care made a Statement in the House of Commons saying that the latest epidemiological data allowed for a relaxation of some of the measures in the protected area of Leicester. As of Saturday 18 July, local restrictions were lifted in other parts of the county that were initially in the protected area, namely Charnwood and Blaby. As of 24 July, a further amendment to the regulations meant that non-essential retail, out-of-school childcare and education establishments were allowed to reopen in Leicester. Bars, restaurants and hairdressers remain closed until at least the next review, which will be on 30 July.

The concern about the outbreak in Leicester has been significant, which is why we took it so seriously. Engagement has been extensive, repeated and productive, and is, I am pleased to say, yielding results. I would like to say a profound thank you to the local authorities and the local resilience forum, to national organisations including Public Health England and the Joint Biosecurity Centre, and to the local directors of public health, Ivan Browne of Leicester City and Mike Sandys of Leicestershire County Council.

The decision to act was not driven by any one number. It was a judgment about the overall situation. But when we imposed the local lockdown, one number did stand out: the seven-day infection rate. In Leicester, it was 135 cases per 100,000 people, which was at the time three times higher than the next highest area. On the clinical front, admissions to hospital were between six and 10 per day in Leicester, rather than one or two, as in other trusts. Action had already taken place to protect people in Leicester, including increases in testing and public health capacity. We hoped that these interventions and the work of local public health teams would get the infection rate down. However, by the end of June it was clear that the high rate of infection was continuing.

The cross-government Covid-19 operations committee, chaired by the Prime Minister, decided on 29 June to take further measures. The Secretary of State set out these measures in his Statement. Most of the measures taken did not require legislation. We increased testing capacity further, with eight mobile testing units deployed across the city and three local test sites. We also gave additional funding to the upper tier local authorities: Leicester City Council received about £2.5 million and Leicestershire County Council received approximately £2.3 million. This enabled them to enhance communications, including using locally relevant languages and channels such as community leaders and volunteers. We recommended against all but essential travel to and from Leicester. Shielding measures could not be relaxed, as they were in the rest of the country the following week. Schools in Leicester were closed, except to vulnerable children and children of critical workers.

Data is critical to the response, and gigabytes of data have been provided to directors of public health and local authorities to inform their local action plans. From 11 June, NHS Digital made available to directors of public health an operational data dashboard, including counts of local tests, local total positives and local total voids per local authority. Leicester had access to the dashboard from 19 June. The PHE field team provided support and analysis for the directors of public health prior to them gaining access to the dashboard. Local-level test-positive data, including postcodes, was provided to Leicester on 25 June, once it had signed a data-sharing agreement. As of 20 July, PHE has provided to directors of public health access to fully identifiable data via a secure platform to enable them more flexible access to positive-test case and contact-tracing data to support their outbreak management responsibilities. Data is currently updated daily.

Every day there are dozens of conversations between directors of public health, local authorities, the JBC and PHE. Data and analysis are shared on secure platforms and according to privacy laws. However, I remind noble Lords that data on its own does not beat the virus; local action beats the virus, and I commend the unsung local heroes—the infection-control professionals—who deal with many outbreaks and break the chain of transmission by implementing effective Covid action plans every day of the week.

Given the urgency of the situation in Leicester, we used the emergency procedure to make the present set of regulations as soon as we could. They require the closure of non-essential retail, limited overnight stays and restricted gatherings, and they enable households containing only one adult or one adult and one or more people under the age of 18 to link with one other household.

Regulation 2 requires the Secretary of State to continue to review the need for the restrictions. The first review was on 16 July; the next one will be on 30 July. Regulations 8 to 11 set out how the provisions will be enforced. We also published guidance in the relevant languages for people living in Leicester.

Since these measures were introduced, it is clear that our co-ordinated local and national effort, particularly by the people of Leicester, is working. The number of positive cases is down by 54%, with the seven-day total per 100,000 of population reducing from 140 to 64.

We always knew that the path out of the lockdown would be a marathon, not a sprint. The Leicester lockdown has demonstrated our willingness and ability to take action where we need to. We will learn from the experience of the lockdown in Leicester to develop our responses to further outbreaks. As I said earlier, one review of the regulations has been completed and another is due by 30 July.

I am grateful to all Members for their continued engagement in this challenging process. I profoundly thank the people of Leicestershire, who have responded so well to the measures in place. It is thanks to their continued efforts that we were able to reopen non-essential retail and childcare and education centres. I commend the regulations to the House.

--- Later in debate ---

[Lord Bethell]

My Lords, I shall try to answer as many questions as I can. There are more than 30 of them, however, and I therefore hope that noble Lords will forgive me if I am brief.

In answer to the noble Lord, Lord Hunt, we have shared data when we have had data, but I cannot hide from this Chamber that when we started this process, we did not have data. Now that we do, we are sharing it.

I commend the noble Lord, Lord Scriven, for his well-remembered comments on the emergency powers for councils. We have done exactly that when it was needed and when they were asked for.

In answer to my noble friend Lord Ribeiro, we have put in place a system of co-ordination with local authorities that is proving effective. It is largely endorsed by those local authorities.

In answer to the noble Baroness, Lady Young, workplace and ethnic data is shared when we have it. Many do not wish to share their ethnic and workplace data, and we would prefer people to step forward to have a test. But I completely agree that local authorities do not have large contact-tracing outfits; that is why we have a centralised system.

I completely share in the comments of the noble Baroness, Lady Jolly, on the responsibility of employers. I pay tribute to the great many employers who have followed guidelines. I condemn those who break them and call on all employers to consider enhancing measures to break the chain of transmission.

I bow to the greater expertise of my noble and learned friend Lord Garnier in the area of Leicester.

May I please confirm to the noble Lord, Lord Harris, that, as I have said before, we are not phasing out self-testing? It is accurate—as accurate as laboratory testing—and very popular, particularly among those who prefer to avoid hospital, such as those who are still shielding.

I confirm to the noble Baroness, Lady Walmsley, that the boundaries are drawn up by directors of public health, mayors, county councils and the boroughs.

I confirm to the noble Baroness, Lady Verma, that local intelligence collection is essential. I commend the work of Ivan Browne, whose local intelligence is profound and invaluable. I agree that it has a huge amount of value to add to centralised data.

In reply to the noble Baroness, Lady Jones, the decision on Spanish travel shows how quickly things have changed and why we need to approach regulations as we do.

I say to the noble Lord, Lord Campbell-Savours, that I recognise the progress made in Leicester. I completely reject the suggestion that party politics has taken a role in these decisions. The decision on the future of the Leicester lockdown will take place on 30 July.

I reassure the noble Baroness, Lady Barker, that we maintain a rolling watchlist of areas and that support is offered to those areas. That has been done in the past, it is happening today and it will continue in the future.

I reassure my noble friend Lord Holmes that local and accessible materials have been made available. I completely understand the importance of getting this right.

My noble friend Lord Robathan is correct that Covid shines a spotlight on uncomfortable places in our society. The use of exploited labour in sweatshops has contributed to this disease. It is not good enough and it needs to stop.

In answer to the noble Lord, Lord Addington, one major lesson from Leicester is that we have to redouble our efforts to communicate our messages to hard-to-reach communities, which have not always heard our messages on social distancing, hygiene and isolation. We are focused on that mission.

On the second wave, I say to the noble Lord, Lord Truscott, that we are hopeful but cautious. That is why we are investing in diagnostics, therapeutics and vaccines.

I reassure the noble Lord, Lord Willis, that data is shared as he describes and that we are investing heavily in serology testing.

I thank the noble Baroness, Lady Uddin, who has championed the use of all languages in local situations. It is a lesson that we have taken to heart and we are redoubling our efforts in this area.

The noble Lord, Lord Liddle, is right that trust between local and central government is key. Dozens of bilaterals happen every day, but life is not simple and complex collaboration is essential to fighting this disease.

I remind the noble Baroness, Lady Benjamin, and all those who have clear 20/20 rear vision that we have done a huge amount to prepare areas on our watchlist. However, outbreaks happen extremely quickly and are extremely difficult to predict.

In reply to the noble Lord, Lord Clark, the travel patterns of the population are complex, exactly as he describes. It is a challenge that defies simple solutions and analysis of travel patterns is an important part of our response.

The noble Lord, Lord Rennard, is quite right to emphasise the links between obesity, diabetes and the worst effects of Covid. I share his hopes for our obesity strategy and can confirm that corporate influence will not be brought to bear.

Regarding care home discharge, may I reassure the noble Baroness, Lady Barker, that all patients are required to be tested prior to discharge? No care home should be forced to admit an existing or new resident if they are unable to cope with the impact of that person having Covid-19.

To the noble Lord, Lord Bhatia, and the noble Baroness, Lady Uddin, who asked about the impact on business: we have introduced a generous and wide-ranging package of support to help as many people as possible whose incomes are affected. The Coronavirus Job Retention Scheme remains open, and over 9 million jobs have been supported nationally.

To the noble Baroness, Lady Massey: Blackburn with Darwen has taken a number of proactive measures; we are working the authority and will look at further measures if necessary. Case rates in Blackburn with Darwen have decreased slightly, but we are monitoring them very closely.

To the noble Lord, Lord Roberts of Llandudno: the economic and clinical effects of the disease are both horrible, as he described. To reassure him, however, we are working hard to get the balance right, and addressing those who are underprivileged is an important part of that.

The noble Baroness, Lady Gardner, is right to remind us of the challenge of the second wave by example of Melbourne, and she is right to remind us of the importance of having a really good holiday.

I say to the noble Baroness, Lady Brinton, that I completely recognise and sympathise with the concerns of the vulnerable and the clinically extremely vulnerable. I remind her that the clinically extremely vulnerable are able to access, where they are eligible, statutory sick pay, self-employment income and income support packages, and they are benefiting from the injection of a further £8 billion into the welfare system.

On communications, the information given to those shielding has been clear and consistent. Decisions have been guided by the latest scientific advice, which has evolved as we have learned more about the virus, and we have worked closely with patient groups and charities throughout the process to ensure that our communications are correct.

Turning to the metrics for Leicester, I can tell the noble Baroness, Lady Thornton, that our lodestar is to break the chain of transmission, and we will do whatever it takes to fulfil that commitment. As for guidance or legality, we lean in all matters towards guidance and try to avoid mandating wherever possible.

In Oldham, we are working hard to reach those communities termed “hard to reach”. Resources have been allocated generously to Oldham, and more will be made available when they are needed.

Motion agreed.

Covid-19: Response

Lord Bethell Excerpts

Monday 27th July 2020 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, from these Liberal Democrat Benches, I thank and congratulate all the millions of people, whether paid staff or volunteers, who have worked tirelessly over the last five months to combat this pandemic, serving people and providing support during what is the most extraordinary health crisis in 100 years. As the noble Baroness, Lady Thornton, outlined, it is very disappointing that the Government Whips’ Office has resisted giving your Lordships’ House the opportunity to have a timely discussion on each of the three Covid Statements, on 14, 16 and 20 July. Each covered different, urgent and serious matters for our country that should be scrutinised by your Lordships’ House, so I too will use all three Statements as the basis for my questions to the Minister today.

First, given that the report of 20 July has a strategic and end-of-term report feel, we have an overarching concern about the Government’s repeated mantra in Statements about protecting the NHS at all costs, including the preparations for a second wave. Unfortunately, it appears that lessons have not been learned from the consequences of that single priority, not least those from throwing our care sector to the wolves without adequate testing, PPE or financial support for its massively increased costs. So I ask the Minister again: do all parts of the care sector now have repeat and regular testing, the PPE they need to practise new standards of infection control and continuing financial support for the consequences of both?

As I mentioned on Friday in the debate on the coronavirus regulations, a further group feel they have been left high and dry: people who shield, whether they are disabled, elderly or have serious underlying conditions. So I again ask: will the Minister explain why the letter to shielders dated 22 June insists that shielders lose all the support for shielding from 1 August? The letter instructs recipients to follow strict social distancing at all times and to stay at home where possible but, in complete contradiction to that, also instructs people to return to work if it is Covid-safe and removes access to furlough pay and sick pay, so if it is not safe to return to work and shielders cannot work from home, they are now at high risk of losing their jobs. Blood Cancer UK is extremely concerned about this risk for people who have been shielding as from August they will face an impossible choice between returning to work and risking their health or staying at home and risking unemployment. It asked the Government to extend the furlough scheme for the small number of people involved for up to three months or to provide alternative financial support to protect them from life-threatening ill health, and we agree. Will the Minister undertake to raise this with the Chancellor of the Exchequer as a matter of urgency and write to me?

Lifting the lockdown also brings into sharp relief how much real progress has been made by the Government on testing, tracing and isolating as a key tool to manage outbreaks. To that we must again add quarantine arrangements. On the news today, following the Spain quarantine regulations, we heard the Government say that they will not be monitoring any quarantine arrangements. They are still experimenting with temperature screening at airports and are not routinely testing people as they arrive in the country. If we are serious about having a proper system for people arriving in this country and quarantining safely, when will that be put in place?

We also hear that testing capacity will shortly reach 500,000 a day, which is welcome, but there seems to be no routine to test that capacity to the full. It is still not universal, despite repeated requests, regularly to test NHS and care staff to keep them safe. We hear that many local testing centres are closing down and that the test at home system is to stop. Can the Minister reassure your Lordships’ House that a full test, trace, isolate and quarantine policy is in operation, not least to test the larger-scale, effective system that we will need in the event of a second wave? How many people were tested on Friday?

Finally—the Minister can probably recite my next question as I have asked it so often, but I will be grateful if he could answer my actual question, not repeat the usual mantra because just saying that local authorities are being given more data at postcode level is not enough—when will all local authorities and directors of public health get the full data that they have requested and signed data protection releases for on a daily basis and at a more granular level than postcode, without which they cannot effectively tackle spikes in cases swiftly? The Minister saying that he is giving them more data is not enough. It must be the data that they need and for which they have already signed data protection releases.

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

My Lords, I thank the noble Baronesses, Lady Thornton and Lady Brinton, for their detailed questions, which I will go through as speedily and thoroughly as I can.

On accountability during the Recess, there are long-standing precedents on this and we will obey them, as is normal.

On the arrangements for Spain, I reassure the noble Baroness, Lady Thornton, that there is a very thorough system of regular meetings to assess the exemptions on travel. This is done at several levels of government and detailed intelligence from the front line is provided to those meetings. However, the situation in many countries is fast changing, and the Spanish situation is a good example. The information we had at the beginning of last week was quite different from the information we had by the end of the week. Fast turnaround decisions are not a sign of panic or weakness; they are a sign that the system works and is working well. We are trying to be as flexible as we can and we respect the country’s desire to travel, but when the infection rate in overseas countries moves, we have to move quickly as well. Within individual countries, there is no way for us to control intra-country transport. It is therefore very difficult and challenging to have a regional exemption list. That is why we have not been able to give exemptions to the Balearics, and I say that with a personal interest in the matter.

Our guidance on face masks is based on trust. There is no compulsion and they are not mandatory. In some countries they are mandatory, but not in this country. That is why the science is so important to us, and it is one reasons that we may have moved behind some other countries. The guidance we now have on face masks is extremely clear. I pay tribute to the large and growing number of people wearing them. I believe this country is moving in the right direction.

We are concerned about shopworkers. USDAW makes a good case for the need to protect shopworkers who may be put in an awkward situation. That is why we work closely with the police to ensure that the right protections are in place.

I say a profound thank you to the people of Leicester, who have done an incredible amount in a difficult situation. The signs are that the prevalence of the disease has come down a long way in Leicester thanks to their commitment. The lessons we have learned include some of the most obvious lessons you could learn, but there is no replacement for local contacts and the involvement of local communities. However, there are hard-to-reach communities where our message has not got through and we need to do more to reach them. In particular, I am grateful to faith leaders in Leicester who are working with us on preparing for Eid and ensuring that the message on social distancing gets through in time for that important celebration.

Full details of the budget for NHS Test and Trace will be published when the time is right, and when that time arrives I will be glad to place a copy in the Library as requested.

I completely agree with the noble Baroness. Having an equitable distribution of the vaccine in this country and overseas is key to the Government’s policy. That is why we are working hard with the World Health Organization, GAVI and others to ensure that vaccines are shared as a global resource. We hope that a vaccine can be found, and the indications from Oxford are encouraging, but we recognise that vaccines for coronaviruses, particularly those affecting the respiratory system, are difficult. That is why we are making a massive investment in the test-and-trace programme and in therapeutics and why we remain vigilant over local lockdowns—to rid this country of this horrible disease.

Both noble Baronesses spoke about social care. I do not recognise the phrase used by the noble Baroness, Lady Brinton, that the care sector has been “thrown to the wolves”. I find that an unhelpful characterisation. I say yes to regular testing, yes to PPE and yes to financial support—we have given £3.7 billion to local authorities to help them pay for the cost of Covid-19, and on 2 July we gave a further £500 million to the social care sector. We remain vigilant with regard to the financial resilience of the social care system and we are working very closely with social care providers on the ongoing costs of both testing and PPE, as well as the financial resilience of the entire sector.

On shielders, the noble Baroness, Lady Brinton, makes a very good case. The handling of those who need shielding is one of the most delicate challenges that we face. Those who through no fault of their own are particularly vulnerable to the effects of the disease are put in an invidious situation, and we are extremely grateful to all those who have gone through the hardship of extreme shielding during this long and difficult time. I take on board all her comments and extend my profound thanks to all those concerned. I will look into the question of the parcels that she raised in the debate last week. My inquiries are ongoing on that, and I will respond to her, as I promised to last week.

On the arrangements for travel, it is true that the current medical advice is that we are currently sceptical whether temperature testing is effective and therefore we have not imposed it.

On testing, it is a frustrating but unavoidable truth that a test today does not necessarily mean that you do not have Covid and that you may not display both the symptoms and contagiousness of Covid in the days ahead. That is why snap testing at airports cannot be a sure-fire and safe route for protecting the country, which is why we have to look at isolation as a way of protecting the country.

On the mandation of isolation, as in other matters to do with Covid, we apply a voluntary principle because we believe that trust is the best way to keep the public on side, and we have neither the legal nor the other resources necessary to impose mandation.

On the questions from the noble Baroness, Lady Brinton, about the state of the testing programme, I reassure her that testing at home is not stopping and that NHS staff are regularly tested. There is a very clear plan, that plan is heavily resourced and we are continuing to invest in it with innovation, manpower and legal support where necessary.

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

We now come to the 40 minutes allocated for Back-Bench questions. I ask that both questions and answers be brief so that I can call the maximum number of speakers.

[Baroness Morris of Bolton (Con) [V]]

My Lords, as the management of Covid-19 moves to localised decision-making, good will is going to be more important than ever to ensure that people observe the restrictions placed on them. I use my own circumstances as an example. I am currently living under, and fully complying with, extra restrictions because of the outbreak in the centre of Blackburn, yet I have a Bolton address, a Bolton telephone number and I live in Bolton. For me, as for hundreds of others, a random line drawn on a map places us on the far boundaries of Blackburn with Darwen. This geographical disconnect, which will be replicated across the country, risks undermining co-operation. I would be most grateful if the Minister could assure the House that, should local authorities have to take the difficult decision to impose extra restrictions or lockdown, they will be charged to do everything in their power to make them as narrowly focused as possible to ensure that the necessary element of good will remains.

[Lord Bethell [V]]

The noble Baroness is entirely right that these local outbreaks create invidious choices for local authorities, and the fine tuning of the boundaries is an important part of the lockdown process. We saw that in Leicester, where the boundaries of the lockdown were changed for the very reasons that she outlines, both to preserve trust and in order to be effective. However, I remind the noble Baroness that the movements of people within areas mean that the disease can spread. Therefore, the lockdowns do not necessarily apply only to those areas with high prevalence in any one period, and sometimes buffers need to be put around the infection area, which is why these areas can seem to be either unfair or overextended.

[Lord Patel (CB) [V]]

My Lords, Amnesty has reported that the UK has had 540 deaths among health and care workers, second only to Russia. Compare that to Spain, which has had 63 deaths. Have the Government carried out a root-cause analysis to find out the causes of these deaths, and will they publish the results? If the Government have not carried out such an analysis, will the Minister agree that one should be carried out with some urgency in case there is a second wave of infection?

[Lord Bethell [V]]

My Lords, local trusts have been urged for many months now to undertake a profound risk assessment of workers, particularly BAME workers, in order to understand where infection may have come from. Infection control teams in individual trusts are charged with the responsibility for delivering infection control plans. It is at that level that we can understand the detailed causes of infection because in each trust those causes can be quite different.

[Lord Snape (Lab) [V]]

My Lords, may I, for the second time in three days, press the Minister on what information is given or not given to local authorities during this pandemic? Is he aware that in the borough of Sandwell last week there were nearly 100 new cases of Covid-19, of which no fewer than 28 were confirmed at a single workplace in West Bromwich? Is he further aware that these 28 cases were discovered not by notification through the Government’s track and trace system but by a telephone call from the relative of one of those infected to Sandwell council’s public health department? Does the Minister agree that workplace addresses must be included in the information given to local authorities nationwide so that councils can act immediately to tackle the problem? Will he ensure that that is done in future?

[Lord Bethell [V]]

My Lords, local authorities have had daily Covid-19 containment dashboards, which include 111, 119, online triage information and positive case information at UTLA and LSOA levels, for more than two weeks. Data for directors of public health who have signed the data-sharing agreement requires data-sharing agreements as personally identifiable information, and is mostly for their teams. That data includes much more granular data, including sex, age, postcode, ethnicity, occupation, test date, pillar and test location type. This question of data is one that concerns us enormously. We have moved a phenomenal amount in recent weeks, and it is my genuine belief that those in local authorities, directors of public of health and local infection teams have all the data that they need to do the job.

[Baroness Jolly (LD) [V]]

My Lords, social care has barely been mentioned in the last three Statements. Could the Minister clarify, in the event of a second wave of coronavirus, who in the Department of Health and Social Care is now leading on preparations with the care sector, and who from the care sector is leading in those discussions? How frequently do they meet?

[Lord Bethell [V]]

My Lords, I pay tribute to my colleague Helen Whately, the Minister for Social Care. She has worked incredibly hard and tirelessly on this area, which is her ultimate responsibility. There is a social care team which handles those negotiations, and I thank all those in the social care industry who are engaged. The social care industry is highly fragmented so engaging with the entire industry is a massive challenge. That is why we have put in place new structures, new dialogues, new guidelines and new ways of working to ensure that we are match-fit for the winter.

[Lord Lansley (Con) [V]]

My Lords, a number of countries, including Hong Kong and Austria, undertake testing at ports of entry. Under certain circumstances, that can limit the time that people have to spend in quarantine. Will the Government offer such testing at UK ports and airports?

[Lord Bethell [V]]

My Lords, that is not in the current guidelines. The noble Lord is entirely right that it is incredibly time-consuming and not currently practicable. For the reasons I outlined in answer to an earlier question, a test today does not guarantee that someone will not be infectious either tomorrow or the next day. That is why we have not focused on testing at ports, but we remain open to suggestions. We assess a large number of options and, as evidence and trials emerge that may demonstrate the efficacy of different policies, we will of course consider them and remain open-minded.

[Baroness Watkins of Tavistock (CB)]

My Lords, the Statement is clear that the intention is to mass-vaccinate the population once we have a vaccine that is safe and effective. Can the Minister inform us of Her Majesty’s Government’s plans to achieve this, in the light of concerns among general practitioners that they will be overwhelmed, and given that as many as one in six people in a recent survey said that they would not take up the vaccine if it was available? Do the Government intend, for example, to deploy the many nurses and doctors who volunteered to assist earlier this year to deliver vaccinations for both flu and Covid-19? Will they engage faith leaders in encouraging the uptake of vaccinations through proper explanation of the benefits to individuals and to society as a whole of so doing?

[Lord Bethell [V]]

The noble Baroness raises an incredibly important issue and I pay tribute to Kate Bingham, who is running the Vaccine Taskforce. She is tackling exactly the issue that the noble Baroness raised. GPs are right to be concerned about capacity, which is why we are looking at ways of massively increasing the capacity to deliver such a vaccine. We will definitely look at resources such as returnees, pharmacists and other sources of people power to deliver the vaccine into the arms of the nation. On the anti-vaxxer groups, the fake news and wrong stories around vaccines are an area of deep concern. We are working with faith groups and other civic leaders to put right the arguments for a vaccine because, at the end of the day, any vaccine requires the participation of a large proportion of the country in order for it to be truly effective. It will cause huge disruption and personal suffering if trust is not maintained in the efficacy of such a vaccine.

[Baroness Andrews (Lab) [V]]

Where does the Minister think the greatest risks of a second wave of Covid-19 now lie? What specifically needs to be achieved by early autumn to prevent that, and what extra support will be provided specifically for care homes?

[Lord Bethell [V]]

The noble Baroness invites speculation; I wish that I knew the precise answer to that key question. We are extremely vigilant in a large number of areas, including the measures to release a degree of social distancing and on foreign travel, as she knows. We know that if the country remains committed to the basic principles—hand washing and hygiene; social distance; and isolation when necessary—those three principal pillars will be the ones that defend us from the spread of the disease. We are doing everything we can to shore up those pillars, and that is particularly true in social care, where we have massively boosted testing for both staff and patients and brought in hygiene control, particularly around PPE. We will continue to support the sector financially to ensure that agency workers can be used as little as possible.

[Baroness Walmsley (LD) [V]]

My Lords, there are still issues about the length of time it takes for test results to be returned and contacts traced. Is the Minister aware that a four-week pilot scheme for the OptiGene saliva test in Southampton was completed a week ago? This test takes only 20 minutes to process. Since it does not rely on throat and nose swabs, there are less likely to be false negatives because of faulty swabbing. Can the Minister give the House the results of the pilot, which was referred to by a witness to the Science and Technology Committee as a potential game-changer? Are there plans to make the new test more widely available? In light of the latest news about travellers from Spain, will the test be given at the airport to all passengers returning from non-exempt countries so that they can be followed up quickly at the address they have given on the passenger locator form, and should they not have another test a few days later?

[Lord Bethell [V]]

My Lords, I pay tribute to colleagues at Southampton, who have been managing this exciting trial of saliva-based LAMP testing. The LAMP process is extremely exciting, as it removes the time-consuming RNA extraction process from the testing; turnaround times are therefore dramatically reduced. Saliva is a much more accessible vector for the virus than swabbing and therefore has potential for mass appeal. We are extremely interested in the pilot of the OptiGene technology. It is, though, at an early stage. I would not want to raise expectations too quickly on this, but it remains one of a great many similar exciting technologies that our innovations and partnership team is looking at. I am extremely optimistic about the speed and scale of innovation in our test and trace programme, and I believe that we can move more quickly, at bigger scale and with more accuracy than we ever have before in the very near term.

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

My Lords, does the Minister accept that confusion arises in the UK and overseas because England and the devolved Administrations’ Covid announcements often differ in content and timing, and may lack distinction between guidance and statute? Such announcements will continue for months, so can a structured and less confusing scheme be adopted for all regions—for example, including agreed regular days and time across the UK—for making or updating announcements?

[Lord Bethell [V]]

It may appear from the outside that there are differences between the devolved nations and England, but my experience is that the four-nations approach to combating Covid has been extremely united and effective, and that we have worked extremely well together. It is true that we move at a different pace on some subjects, but we are generally moving to the same destination and in the same direction, and for that I pay tribute to my colleagues in the devolved nations.

[Baroness Falkner of Margravine (Non-Afl) [V]]

My Lords, the United Kingdom has spent 30% more than any other EU country on PPE. Of the UK’s PPE contracts, 73% went through without any competition at all, compared with 61% in Europe. The Department of Health had 137 contracts totalling more than £1.9 billion, none of which was subject to competition, according to Spend Network. The Department of Health has told today’s Financial Times:

“We have a robust process in place to ensure that orders are of a high standard and meet commercial due diligence.”


Which of those two statements is correct—that from Spend Network, or that from the Department of Health?

[Lord Bethell [V]]

Anyone who has stood at the Dispatch Box to answer questions on PPE, as I have done, will feel extremely proud of the fact that we have managed to purchase a very large amount of it under very difficult circumstances. We have also responded well to the challenge of a global collapse in the PPE supply chain. Despite appearances, we have substantial stockpiles of both near-term seven-day and further-term 90-day PPE resources; by that, I am very pleased. Competition does not necessarily guarantee either quality or delivery. I pay tribute to colleagues in the NHS, in the Cabinet Office and at DH who have, under extremely difficult circumstances, thoroughly checked out the delivery and bona fides of the contracts we have signed while working closely with the NSA to avoid fraud. We continue to work closely with both domestic and overseas suppliers, which I would argue has delivered a valuable result for the country.

[Baroness Fookes (Con) [V]]

I will follow on from the question posed by the noble Baroness, Lady Watkins of Tavistock. Have the Government worked out an order of priority in which people might receive a vaccine? Would it be front-line workers, the elderly or even—perhaps—government Ministers?

[Lord Bethell [V]]

My Lords, the Cabinet Office is charged with the role of deciding the order of priority. There are precedents for this; it is a well-established list that is decided at a level outside the DH. I do not know if Cabinet Ministers are given priority, but I slightly suspect that junior Ministers are not.

[Lord Reid of Cardowan (Lab) [V]]

My Lords, I will ask about the poorest of our fellow citizens. According to the ONS report last Friday, in the four months March to June this year, the mortality rate for Covid-19 in the most deprived areas of England was 140 deaths per 100,000 people. This was more than double the mortality rate—63 deaths per 100,000 of population—in the best-off areas. In fact, it was 120% above. Even worse, in June the mortality rate in the most deprived areas was 137.5% higher. In short, it is getting worse. Why was there no mention of any of these in the Statements that have been laid before us? What measures are the Government taking to address this particular problem?

[Lord Bethell [V]]

The noble Lord touches on a subject that is extremely sensitive—it makes me feel emotional to think about it—but he is entirely right that those who are least advantaged in society are hardest hit by this disease and lots of other diseases. There are behavioural reasons for this: the decisions that people make about social distancing and their own health. There are also environmental reasons: the living conditions and the places in which they live. Neither of these detract from the fact that this is a very sad and upsetting truth. However, we are extremely conscious of the challenge, as we are of all health inequalities. The particular lever that we are focused on is trying to get our message out to hard-to-reach communities, who may not have heard the important messages on hygiene, social distancing and isolation. We have in place a programme of marketing in order to reach these communities to communicate these important messages.

[Baroness Smith of Newnham (LD) [V]]

My Lords, the noble Baroness, Lady Falkner of Margravine, raised the issue of the procurement of PPE. Can I press the Minister on the procurement of vaccines? According to the Statement, the Government appear to have secured 190 million doses of vaccine—if they succeed. Could he tell us what procedures have been undertaken to procure the vaccines and reassure the House that the country will not lose money if the vaccines do not, in fact, succeed?

[Lord Bethell [V]]

I am not quite sure of the 190 million number. I think that is possibly an aggregate number of different vaccines. However, the practicalities of vaccine research are extremely expensive, and there are eight, nine or 10 potential runners and riders in the global vaccine market. It is the practice for countries to contribute to those research costs up front in order to have access to the vaccine should it be successful. That is the practice for medical research of many kinds, and these are the practical costs of trying to break the difficult mystery of the disease and providing security for ourselves and for our children.

[Baroness Meacher (CB) [V]]

My Lords, I pay tribute to the Minister for the way he answers all our endless questions. I want to raise two issues of huge importance. I understand that the system of track and trace, in the absence of an app, will not be sufficient to prevent a second national wave of Covid-19. Can the Minister tell the House when we will introduce the Google/Apple app? Secondly, have the Government assessed the cost of full regular community testing, which would involve the entire population being tested weekly? This would certainly be costly, but surely it will be infinitely less costly than a second national wave of Covid-19—in terms of the demolition of the economy—particularly if we can use the Southampton saliva test.

[Lord Bethell [V]]

The noble Baroness is entirely right that track and trace on its own, with or without an app, is not enough to prevent a second wave. The only thing that can do that is the behaviours of the British people themselves. Commitment to hygiene, distancing and isolation is the best bulwark we have against this horrible disease. In terms of community testing, given the current level of technology, mass testing of the entire nation on a weekly basis is beyond the resources of our technology, testing capabilities and, frankly, the tolerance of the British people. However, as I said in answer to an earlier question, the technology is moving incredibly quickly. It has already moved a long way in the last few months, and I am hopeful that technologies such as—but not only—the OptiGene technology may offer new opportunities. However, they have to be validated, invested in and developed: they are not on the near-term horizon.

[Viscount Eccles (Con)]

My Lords, I am sure my noble friend is well aware of the importance of the use of language in Statements and careful use of language. Given the importance of the working relationships between national and local authorities, will my noble friend expand on the assertion that the new powers delivered last Saturday will enable local authorities to “act with more vigour”? It seems a strange phrase to me, and I would welcome some expansion on how those relationships are going.

[Lord Bethell [V]]

My Lords, the relationship with local authorities is extremely good, and I recommend that noble Lords do not believe everything they read on this subject. I completely commend those who work closely with PHE, the test and trace programme, the joint biosecurity team and all the sectoral parts of government that reach out to local authorities, DPHs and local infection teams. A very strong bond is forming, and we have a very large number of outbreaks up and down the country that you never read or hear about, and which are not celebrated either for being good or bad because that partnership works well. The intelligence and data are put into the hands of the people who need them, and the teams move quickly and effectively to deal with the outbreak. I am extremely grateful for this; a huge amount of progress has already been made, and we continue to invest in those relationships.

[Lord Hunt of Kings Heath (Lab) V]

My Lords, it is clearly good to hear that the relationship with local government is on a good level, as the Minister has said. However, why is it that directors of public health have been complaining for weeks about the lack of information? The Minister says that they are getting all the information they need, but this has occurred only in the last few weeks. If it is a question of data protection legislation, why was emergency legislation not put through in the spring to enable local authorities to have all the information they clearly need?

[Lord Bethell [V]]

My Lords, it is put to me week in, week out that our relationship with directors of public health is in some way troubled. I reassure noble Lords that, every single day of the week, we are in contact with dozens of directors of public health in amicable, constructive dialogues that lead to concrete action, local interventions and sharing of data. These conversations happen in a cordial and friendly fashion. The message may have got through to some noble Lords that there is some huge acrimony and difficulty between us, but that is not the perspective that I have. The data has got through. It is a hell of a thing to have put up a huge track and trace system in a few months. That we can get such detailed data to a large number of people within the envelope of reasonable data security legislation is nothing short of a miracle. I am extremely proud and pay tribute to those involved.

[Baroness Bull (CB) [V]]

My Lords, I want to follow the noble Lord, Lord Reid of Cardowan, in pointing to ONS data, this time data showing that 60% of all deaths from Covid-19 have been among those living with disabilities. A recent report from Oxford University and the Bonavero Institute of Human Rights found a failure of government to embed social and human rights models of disability in its response to the pandemic, and a failure to support people with disabilities to make the adjustments required to comply with fast-changing regulations and to continue to live flourishing lives. Will the Government commit to an immediate review of the impact on disabled people of legislation passed during the coronavirus crisis, and will they put in place a disability-inclusive Covid-19 response and recovery action plan which involves people with lived experience of disabilities in decisions on economic and social recovery as well as ongoing healthcare guidance?

[Lord Bethell [V]]

My Lords, it is a horrible truth that this disease hits hardest those with vulnerabilities. We have put in place a massive national programme to seek to protect the most vulnerable, and those with disabilities have been very much the focus of our attention. I cannot make the commitments that I know the noble Baroness wants me to make, but I reassure her that those with disabilities are the focus of what we are trying to do.

[Lord Ribeiro (Con) [V]]

My Lords, the London Nightingale hospital was mothballed in mid-May and remains at standby for a second wave of Covid-19, having treated just 54 patients since it opened on 3 April. In a recent report of 19 July, Harrogate Borough Council questioned how the 500-bed field hospital based in Harrogate Convention Centre would be deployed. Given that £3 billion has been allocated to maintain the seven Nightingale hospitals until the end of March 2021, and noting that the Harrogate centre has not treated a single patient since it opened, can my noble friend the Minister say what the strategy is for those hospitals? Should they not be designated Covid centres to which all local hospitals can refer their patients, thereby allowing the NHS to resume its routine work and centres such as the London Nightingale hospital, which could reopen in six days with 250 beds, to provide assisted ventilation, hemofiltration and dialysis to support seriously ill Covid patients?

[Lord Bethell [V]]

My Lords, the Nightingale hospitals have been a huge success in helping us to protect the NHS at a time when our needs were greatest. Since then, when prevalence rates were lower, we reallocated resource into restarting the NHS to gain ground during the summer months on our backlog of business-as-usual work. Those resources are needed in the hospitals where people usually work. The mothballing of the Nightingale hospitals allows us to use that capacity for what is most needed right now.

[Baroness Jones of Moulsecoomb (GP) [V]]

My Lords, evidence suggests that obesity doubles a patient’s chance of being hospitalised with the virus, hence the Government have put forward a strategy for reducing obesity, which I welcome. However, they could have introduced a sugar tax 10 years ago, which might have resulted in fewer obese Britons now. Is that policy under consideration?

[Lord Bethell [V]]

My Lords, the obesity package that the Prime Minister announced today is one of the most ambitious, impactful and thoughtful of any Government in recent history. We will see how it plays out and consider new measures when the time is right.

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

Covid-19 and obesity are so often a fatal combination, and it explains the high mortality in the UK, with its dense population and the fact that two-thirds of people are either overweight or obese. Is it not therefore time for those strangers to the truth in the media and in politics to stop demoralising the public with their repeated false news, including blaming the Government for the high death rate? Should we not expect the media and politicians to use their power to support the country and the Prime Minister’s campaign to reduce obesity and its complications, in order to minimise the number of deaths from the next pandemic?

[Lord Bethell [V]]

My Lords, it is not the feeling in the Government that we should duck hard questions about performance, and we embrace those who ask difficult questions about how things have gone. None the less, the noble Lord is entirely right that the country has a difficult challenge that it needs to face up to: that of obesity. It has had a profound effect on the health of the nation for a generation and we have been caught out by Covid, as obesity has undoubtedly had an impact on our total death rate. It is a point that the Prime Minister made powerfully in his video earlier today. That is why we have put together the package that we have, and we look to all civic leaders and the media to support us.

[Lord Loomba (CB) [V]]

My Lords, we are all aware that more than 45,000 people have died as a result of Covid-19, and the number is still rising. Is any statistical analysis by gender available, and how will the Government support the Covid widows who have may lost the breadwinner in their family?

[Lord Bethell [V]]

My Lords, PHE publishes detailed statistics which give a gender breakdown. I recommend that the noble Lord has a look at the data. We express our sadness and regret for all those who have passed away and our support for all those mourning them.

[Lord Bradshaw (LD) [V]]

The rail industry is keen to introduce a flexible form of season ticket to support a return to rail travel for those who have been working from home so that they may in future work flexibly. Will the Minister seek on my behalf assurances from his colleagues in the Department for Transport that they are treating this matter with urgency and not obstructing it? If he could write to me about that, I would be grateful. Will he also acknowledge the health benefits of getting people out walking, cycling and using public transport again, instead of relying solely on their cars, which lead to more congestion, more pollution and little or no exercise on the part of drivers? Further government encouragement would be welcome in bringing that about.

[Lord Bethell [V]]

The noble Lord is entirely right that Covid will lead to changes both subtle and profound in the way we do many things in our life, including patterns of commuting, and a renewed commitment to modes of transport that support our health, particularly cycling and walking. Local authorities such as TfL already have strong bicycling and walking plans. Those will undoubtedly be enhanced, and the Government entirely support them.

[Baroness Neville-Rolfe (Con) [V]]

My Lords, with an eye to its impact on any autumn resurgence, I hark back to questions asked on 11 March by the noble Lord, Lord Kennedy of Southwark, and my noble friend Lord Forsyth, about deep cleansing. My experience of countries in Asia, such as Singapore and Korea, which also pioneered mask use, is that they appear to be much better than us at cleansing medical facilities and other risky premises. They use mists and sprays, applied aggressively in the hands of cleaning professionals, rather than relying on the random impact of risk assessments, NHS and care home cleaners and controllers, and personal hygiene routines, which the Minister emphasised. What does the latest guidance say about cleaning and cleansing? Can we do better?

[Lord Bethell [V]]

My Lords, we can undoubtedly do better in the area of hygiene. The guidance is very clear on what types of detergents work and how they should best be administered. I pay tribute to the cleaning staff in the NHS, who have worked incredibly hard during the epidemic, putting themselves at risk; they have done a very good job. None the less, our view is that the greatest challenge is to change the behaviours of the British public. Work still needs to be done to persuade all of us to wash our hands more and to maintain cleaner personal hygiene. Transmission of the disease happens most often through manual contact—touching the face and shaking hands. That can only be challenged by washing hands.

[Lord Dobbs (Con) [V]]

My Lords, Public Health England has been including in its death totals those who once had Covid, recovered, but have since died from other causes. So, if you once had the virus but no longer have it, and get hit by a bus, you still get listed as a Covid casualty. How can Ministers and others reach sensible policy decisions when the basic statistics provided to them seem so flawed? Has this bizarre practice now stopped? Have Public Health England offered any justification for it?

[Lord Bethell [V]]

The Secretary of State has asked Public Health England to review the logging of death statistics; we await the review’s results.

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

Lord Rogan? We will move quickly on to the noble Lord, Lord Balfe.

[Lord Balfe (Con) [V]]

My Lords, on three occasions today the Minister has said that, if you have a Covid test today, you are not guaranteed to not have the disease tomorrow. In that case, what on earth is the purpose of having the test system at all? Secondly, the NHS is not functioning properly. Bearing in mind the precedents of my noble friends Lord Deighton and Lady Harding, would it be a good idea for the Minister’s department to appoint a specific person to get the NHS up and running again, as foreseen by my noble friend Lord Ribeiro in his perceptive question?

[Lord Bethell [V]]

My Lords, we use the tests we have got because they are the tests we have got. The way in which the disease manifests itself is not, I am afraid, something that I can negotiate with. We do what we can, but I emphasise that an unfortunate feature of this disease—and many others—is that it harbours itself silently in our bodies and manifests itself both to infect and be diagnosed only when it is ready. That is a simple fact of life. However, the testing regime has a profound impact on the spread of the disease by identifying those who have some form of symptom, even if it is a quiet one. I pay tribute to Sir Simon Stevens, who is working hard to get the NHS back to business as usual and is having a profound impact on the issue.

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

My Lords, the time allowed for this business has now elapsed. I apologise to the four speakers who did not have time to put their questions.

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

Lord Bethell Excerpts

Friday 24th July 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 3 July be approved.

Relevant document: 22nd Report from the Secondary Legislation Scrutiny Committee

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

My Lords, I beg to move that these regulations on the Order Paper, in the name of my right honourable friend the Secretary of State for Health and Social Care, be approved. I will start with a short summary of the social distance regulations, because there are numerous regulations, some amendments and some overlapping timelines, which it is helpful to clarify.

The Health Protection (Coronavirus, Restrictions) (England) Regulations 2020—the major lockdown regulations—were introduced, as noble Lords will remember, on 26 March. These regulations outlined restrictions on gatherings and required a number of businesses to close. The regulations have been amended four times to facilitate easements as we opened up the economy and to allow for technical clarifications.

The regulations made by the Secretary of State on 3 July, which came into force on the 4 July and which we are debating today, were a significant set of updates. Rather than amending the 26 March regulations again, we have revoked them, replacing them with the Health Protection (Coronavirus, Restrictions) (No. 2) (England) Regulations 2020. Today we are debating the amendments to those 4 July regulations as well. These amendments were made on 9 July and came into effect on 11 and 13 July. These amendments allowed for businesses such as nail bars, spas, tattoo parlours and outdoor swimming pools to reopen. I will give more detail later on additional changes taking place today.

Since then, there have been further changes. The regulations being debated today do not cover the recent announcements of making face coverings in shops, supermarkets, cafes and enclosed shopping centres mandatory from today, 24 July. On this matter, I pay tribute to the campaigning on this issue by the House and in particular by the noble Lord, Lord Campbell-Savours, who I know will speaking late today.

The Government have scheduled this debate as quickly as possible following committee scrutiny to allow for timely parliamentary scrutiny. I know that noble Lords have voiced concerns in relation to parliamentary scrutiny, and we are listening and working to ensure that debates take place as soon as possible after legislation has been laid. We have needed to use the emergency power to amend these regulations, as they place great restrictions on individuals, society and business. For these same reasons, we have looked to ease restrictions as soon as it is safe to do so. I also acknowledge that noble Lords may have concerns in relation to the possibility of many debates having to take place on return from the Summer Recess. As I have mentioned, we are working to have debates as soon as reasonably possible and, if we need to have further debates on returning, that is what we shall do.

Thanks to an immense national effort to slow the spread of the virus, we have been able to restore some of the freedoms cherished by us all. Sectors to reopen include hospitality and leisure, and more contact between families and friends has been allowed. As my right honourable friend the Health Secretary set out in a Statement in the other place on 16 July, we are moving from blanket, national measures to targeted, local measures, supported by our NHS Test and Trace system. Often this is on a very small scale, such as in an individual farm or a factory. To allow this shift from national to local action, we have provided local authorities with new powers to enable them to put in place local restrictions on individual premises, organised events and access to public outdoor spaces through the regulations that came into effect on Saturday. This includes the ability to require premises, events or public spaces to close if necessary.

However, when needed, we also act on a broader basis, as we have in Leicester. Draft regulations have been published which set out a non-exhaustive set of options, illustrating the ways government might legislate under the Public Health (Control of Disease) Act 1984 as part of a targeted approach that responds to the particular circumstances of a local outbreak in England. These powers include: closing businesses and venues in whole sector, such as food production or non-essential retail, or within a defined geographical area, such as towns or counties; imposing general restrictions on the movement of people; imposing restrictions on gatherings; restricting local or national transport systems— closing them entirely, or introducing capacity limits or geographical restrictions; and mandating the use of face coverings in a wider range of public places.

As our response to Covid-19 and circumstances in local areas evolves, we may develop new categories of intervention and would develop draft regulations accordingly. The measures in the draft regulations will allow for effective, targeted interventions, while seeking to avoid a return to a national lockdown. In the event that the Government need to make a significant intervention, they would do so in a way that targets the transmission of the virus while minimising the disruption to individuals, society and the economy.

In Leicester, we have moved towards a position where we can relax some, but not all of the restrictions that were in place. We are removing them in order to enable the reopening of non-essential retail, childcare and education establishments from today, 24 July. It is vital that this is done in a way that makes local businesses Covid-secure. We will continue to review the measures regularly, with the next review taking place on 30 July.

I turn now to the regulations that we are debating today. From 4 July, many businesses across different sectors have been allowed to reopen, including hospitality, leisure, tourism, recreation and sport. We have also relaxed the legal restrictions on overnight stays and on gatherings. The regulations still require some businesses which were considered too high-risk at the time to remain closed. They also provide new powers to close public open spaces where it is considered necessary to do so to prevent, protect against, control or provide for a public health response to any incidence or spread of the coronavirus. The amendments to the regulations will allow outdoor facilities at water parks and outdoor swimming pools to reopen. Guidance has been published for these sectors, outlining how they can reopen safely.

Along with the changes to the regulations, guidance has also been issued on how organised, outdoor, grass-roots team sports and participation events can begin again and how outdoor performances with audiences can take place. This is an important milestone for our performing artists, who have been waiting patiently in the wings since March. The regulations and subsequent amendments do not apply to the city of Leicester and the borough of Oadby and Wigston.

Noble Lords will be aware that we have announced plans for future changes to the restrictions, and the legislation for these changes was laid on 23 July. These are important and valuable changes. As a nation, we have made huge strides in getting the virus under control. I am grateful to parliamentarians for their valuable scrutiny and I commend the regulations to the House.

--- Later in debate ---

[Lord Bethell]

My Lords, I want to say a profound thank you to those who have contributed to this debate. I know that it has been a frustrating experience but, for me, it is a meaningful event. The contributions made are heard. Influence has been made and it has had an effect. On the subject of letters that have not been replied to, I assure the House that we are working extremely hard to address them. A system has been put in place to try to address all out-of-date letters before the end of the recess. I am working hard to do that.

I will try to address as many of the specific questions as I possibly can, which will mean that some of the answers are very short. I apologise in advance if any of them seem to skate over serious subjects briefly. I will attempt to address each noble Lord in turn.

I start with the very serious subject of disability, which is a massive and important area that I cannot possibly do justice to from the Dispatch Box in the time given. However, I reassure the noble Baronesses, Lady Bull and Lady Uddin, and the noble Lord, Lord Holmes, that we take very seriously the effect of Covid on those with physical and mental health issues. I emphasise the £750 million of funding for charities providing key support for those groups.

I thank my noble friend Lord Blencathra, who is concerned about the enforcement of the law. I reassure him that we absolutely are enforcing the law. I pay tribute to the public, who have gone along with these regulations with great compliance. To the noble Baroness, Lady Jolly, I confirm that Regulation 6 of the No. 2 regulations gives the Secretary of State the power to close public outdoor spaces, and the No. 3 regulations give the same power to local authorities.

I reassure the noble Baroness, Lady Randerson, that the National Police Chiefs’ Council is working hard to assess whether there is any evidence of disproportionality in the fines being given to minority groups.

On the important point about data raised by the noble Baroness, Lady Barker, I reassure her that local authorities receive all the information they need on Covid cases, and data sharing agreements have been signed with upper tier local authorities. They receive details of the number of cases and tests, data from 999 and 111 calls, postcode data and a large amount of specific data.

To the noble Lord, Lord Hain, I say that we are working hard to open schools, but we need to work with parents and teachers to get them both over the line.

I assure the noble Baroness, Lady Walmsley, that the location of walk-in centres is being chosen very thoughtfully and directly targeted at those who need them most.

The noble Lord, Lord Holmes, is absolutely right that obesity has been a key driver of illness. As noble Lords will have read, we are launching a major national campaign next week, which I am personally participating in. This will be a long-term campaign to change the health outcomes of the nation.

On the important point about debates, I reassure my noble friends Lady Anelay and Lady Hooper, and the noble Lords, Lord Tyler and Lord Purvis, that arrangements for recess will follow long-standing precedents, and any debates that need to happen will be prioritised when the House returns.

To the noble Baroness, Lady Andrews, I say that we are guided by the science. The CMO and the Government Chief Scientific Adviser are key advisers who intermediate between SAGE, the scientific community and policy- makers in government. I have already answered the question of the noble Baronesses, Lady Randerson.

My noble friend Lord Moynihan outlined a small discrepancy in the regulations. If he will write to me, please, I would be glad to clarify that. However, I make it clear that Scotland and England are heading to the same place but simply moving at different speeds on different items.

To the noble Lord, Lord Hunt, and the noble Baroness, Lady Tyler, I say that we have been asked to move quickly. That is why we are seeking as much parliamentary scrutiny as possible.

To the noble Lord, Lord Willis, I say that we publish as much data and scientific advice as we possibly can. I emphasise that the SAGE minutes, which were once kept secret, are now published promptly.

I completely share the views of the noble Lord, Lord Singh, on the important influence of faith communities. We have worked hard with them on a number of key issues, including cremations. I am reminded of the work we are doing with faith communities on the forthcoming celebration of Eid, which is a delicate matter.

To my noble friends Lord Robathan and Lady Altmann, I say that there is much that is still mysterious about this disease, but one thing I do know is that the British public has thoroughly supported the lockdown.

To the noble Lord, Lord Clark, I say that masks are recommended in taxis. The regulations on this are very clear, and I pay tribute to the important work taxi drivers have done in the face of extreme difficulty.

I thank my noble friend Lady McIntosh very much indeed for reminding us of the profound and positive impact of these regulations, which is something that is sometimes overlooked. To date, gloves are not in the guidance, but they remain an area that we are looking at.

The noble Lord, Lord Oates, made important points on face masks that I cannot fully cover. As suggested by other Peers, the delay helped the public prepare for changes in regulations. Although it creates a hiatus, these preparations are important.

To the noble Lord, Lord Harris, I say that self-testing is accurate—our assessments have proved that—and is also extremely popular, particularly for those who cannot leave home.

To the noble Lords, Lord Loomba and Lord Clancarty, I say that I completely recognise the challenge facing the performing arts, which is recognised by DCMS. It has made a generous and profound contribution in this area and continues that work.

I do not share the gloomy assessment of the situation made by the noble Baroness, Lady Sheehan. I pay tribute to colleagues working on the test and trace programme, who have made an enormous amount of progress.

My noble friend Lord Wei makes important points on innovation in the workplace. The Government desperately need innovation from industry. I commend business leadership in this area and ask for more.

The noble Baroness, Lady Ritchie, talked about vaccines. My understanding is that the Cabinet Office has published a distribution hierarchy. I reassure her that it will be a four-nations approach and that there is no question of any nation being favoured over another.

Turning to the noble Lord, Lord Truscott, I pay tribute to colleagues at PHE, which has been at the eye of the storm and has taken a lot of flak. Having been on the front line with them, I reassure the House that they give thoughtful, scientific and sometimes challenging advice—we would not be in the shape we are in if it was not for their interventions.

Turning to my noble friend Lady Gardner, I personally pay tribute to the dental industry—I was at the dentist this morning and I used to live in the very house in west London where her late husband practiced his dentistry work. I will continue to pay tribute to the work of dentists, who face an important challenge, and likewise to pharmacists.

I reassure the noble Lord, Lord Foulkes, that the resources going into the NHS and the testing programme are massive. Our preparations for the winter are dogged, and we fully share both the efforts and resources with all four nations. I share the views of the noble Baroness, Lady Northover: we are at an inflection point in the National Health Service and we are working our hardest to make that impactful.

The noble Baroness, Lady Benjamin, completely and utterly nailed it: we are deeply concerned about hard-to-reach groups. That is why we are hugely focused on them and working hard.

The noble Lord, Lord Liddle, makes an assessment that I cannot possibly agree with—one that is a long way from where the public is. However, I pay tribute to those who have kept Parliament open under difficult circumstances.

To my noble friend Lord Cormack, I say that I am 100% in favour of baby-on-board-style badges, and we are assessing ideas of the kind he recommends.

To my noble friend Lord Balfe, I say that we are cognisant of the concerns of USDAW and we are engaging with its representatives on this important issue.

To the noble Lord, Lord Snape, I say that data protection is there to protect us all, but we are finding ways to get data to the DPHs, as I have previously discussed.

To the noble Lord, Lord Addington, I say that we welcome next week’s obesity launch.

The noble Baroness, Lady Brinton, raised serious concerns about shielders. I will address those in correspondence as I do not have the details to hand.

Regarding the questions on DPIAs, the test and trace programme has had DPIAs in place. The overarching programme has not had one, but it is ironic that half the questions are on privacy and half are on the lack of data. I cannot help feeling that we might have landed in about the right place.

Finally, I very much hope that in that medley I have somehow answered all the questions of the noble Baroness, Lady Thornton.

Motion agreed.

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

Lord Bethell Excerpts

Friday 24th July 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 10 July be approved.

Motion agreed.

Pharmacies

Lord Bethell Excerpts

Monday 20th July 2020 Lords Chamber

[Lord Grade of Yarmouth]

To ask Her Majesty’s Government what steps they are taking to ensure that independent pharmacies are able to continue to support the communities in which they are based.

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

My Lords, I pay tribute to the immense contribution being made by community pharmacies in the epidemic. We are hugely grateful for the unequivocal commitment that the sector has shown and we want to make sure that the sector is treated correctly. We have made available £370 million in advance payments to aid cash flow, providing funding for the medicine delivery service for shielded patients and increased drug reimbursement prices. We are talking to the sector about additional funding for Covid-19 costs.

[Lord Grade of Yarmouth (Con) [V]]

I am grateful to my noble friend the Minister for that response but, as I am sure the whole House will agree, independent pharmacies in so many small towns such as Yarmouth and places such as the Isle of Wight are now the heroic first line of defence for GPs and the NHS. The most vulnerable in these communities depend on them for medical advice and deliveries of vital prescriptions, which they offer for free. In my view, it is totally unrealistic for the department to point to some recent funding help as if that has solved the problem. It is nowhere near enough to keep the pharmacies in business, let alone to allow the pharmacists to have a day off or even earn a living. It just demonstrates that the department fails to understand why independent pharmacists are still in such grave peril. May I please urge my noble friend to meet a delegation of these front-line heroes, to hear directly why their businesses continue to hang by a thread? When they fold, they will not be replaced.

[Lord Bethell [V]]

My Lords, I agree with every word of the tribute of the noble Lord, Lord Grade, to the role of community pharmacies, particularly during the epidemic. They have played an absolutely pivotal role in communities, with advice, medicines and support, and I pay tribute to their hard work and commitment. I would be very pleased to meet a delegation to discuss the challenges that they face.

[Baroness Pidding (Con) [V]]

My Lords, as the noble Lord, Lord Grade, says, throughout recent months during the coronavirus crisis many independent pharmacists have served an important role in supporting their local communities. Does my noble friend agree that their role would be enhanced—indeed, it would be vital—if they offered flu vaccines as the autumn and winter months approach? What can the Government do to ensure that they are able to offer this potentially life-saving facility?

[Lord Bethell [V]]

My Lords, the role of pharmacies in the administration of vaccines is critical. Not only will the standard flu vaccine be coming up shortly, but, if today’s news is to be taken on the level, the possibility of a Covid vaccine is at some point on the horizon. That is why we are talking to the sector about the role that community pharmacies can play in the greater administration of vaccines, both of flu and of Covid.

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

My Lords, will the Minister indicate what further discussions will take place with the National Pharmacy Association to ensure that community pharmacies become the front line for giving out services that would normally have been dealt with by GPs and emergency departments, to ensure that they take the flak and slack off the National Health Service and continue to provide an essential service to the wider community?

[Lord Bethell [V]]

As the noble Baroness is probably aware, the Secretary of State for Health and Social Care spoke at the annual conference of the National Pharmacy Association, at which he reiterated his commitment to the sector. The noble Baroness puts it well: pharmacies have something very special and valuable because of their trusted role. We very much want to see an enhanced role for pharmacies in the delivery of healthcare.

[Baroness Pitkeathley (Lab) [V]]

Does the Minister agree that independent pharmacies are of particular importance in rural areas, where they are often the only source of advice and information, as well as prescriptions and equipment, for people with disabilities and their families? Will the Minister confirm both his support for these rural pharmacies in particular and the Government’s commitment to ensuring that they can continue to provide all these vital services?

--- Later in debate ---

[Lord Bethell [V]]

The noble Baroness is entirely right. Although the vast majority of people live within a 20-minute walk of a pharmacy, many people face issues with location. That is why we will continue to maintain the good level of access that we have through the pharmacy access scheme, which provides additional financial support to pharmacies in areas where there are fewer pharmacies. Our commitment remains fully in place.

[Baroness Jolly (LD) [V]]

My Lords, clinical commissioning groups can commission local pharmacies to carry out tests on their patients, such as for blood pressure or atrial fibrillation. This would relieve local GP practices. How widespread is the adoption of this way of using pharmacies and what is being done to increase its uptake by clinical commissioning groups?

[Lord Bethell [V]]

The noble Baroness is right that pharmacies can play an enhanced role, particularly in providing the kinds of services that mean that people do not have to visit their GP. If we have learned one thing from Covid-19, it is that GP surgeries can be a source of infection and that GPs can sometimes be much more impactful working away from home. That is why we support exactly the kind of initiative that the noble Baroness outlines.

[Baroness Wheeler (Lab)]

My Lords, we know that the health service faces the herculean challenge of dealing with pent-up demands caused by the coronavirus pandemic, including for postponed elective surgery and delayed preventive interventions. Community pharmacists have proved themselves a key element of assistance during the crisis and should have an important role to play in future in helping to clear the backlog by bringing more care into the community. What plan do the Government have to expand the clinical role of pharmacies and what steps are they taking to ensure that pharmacies are far better integrated into the primary care system?

[Lord Bethell [V]]

The noble Baroness is entirely right. We have introduced a new framework—the community pharmacy contractual framework—which has down- played some services that were not offering value for money but has enhanced some services that have made a huge impact, many of which are of a clinical nature. The settlement also includes a transitional payment, which will help to secure the financial resilience of the pharmacy sector. We could not be more committed to the community pharmacy sector. I believe that the future of healthcare in this country will depend much more on the role of pharmacies delivering the kinds of services that the noble Baroness outlines.

[Baroness Gardner of Parkes (Con) [V]]

My Lords, the essential difference between community pharmacies and dentists and doctors and so on is availability, which is much greater in community pharmacies. Availability, continuity and reliability are things that all patients benefit from. I am therefore very supportive of this. I remember so often as a dentist hearing from patients that they had had dental pain at some incredible time and the pharmacy was the only place where they could get any immediate help. I would like the Minister’s assurance that this will continue.

[Lord Bethell [V]]

As the father of four small children, I completely endorse the noble Baroness’s point. Many a night have I been outside a hard-working pharmacist’s shop looking for advice, support and essential medicines. I pay tribute to the hard-working community pharmacy sector, whose pharmacists are often up until midnight helping their local communities and hard-hit fathers like me.

[Baroness Barker (LD) [V]]

What advice has the department had from local directors of public health about the resources that are necessary to ensure continuity for community pharmacies during local lockdowns?

[Lord Bethell [V]]

We are fully engaged with the sector. The National Pharmacy Association and the other stakeholder groups are in close communication with the department to ensure that they have the PPE, medicines and finances to keep going during the epidemic. The voice of the DPHs is involved in that stakeholder engagement.

[The Lord Speaker (Lord Fowler)]

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

Smoking

Lord Bethell Excerpts

Monday 20th July 2020 Lords Chamber

[Lord Faulkner of Worcester]

To ask Her Majesty’s Government how they plan to achieve their objective of making England smoke-free by 2030.

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

The Government are moving fast on several fronts to address the issue of smoking. That is why we have brought forward the prevention Green Paper and the tobacco control plan. Covid has offered an opportunity for more people to give up smoking, which is why we have instituted the Quit for Covid plan.

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

When will the Government publish their response to the prevention Green Paper consultation? Will today’s proposed guidance for smoke-free areas outside pubs and restaurants be agreed with his department, the DHSC? Will it be published before the House rises and will it be subject to parliamentary scrutiny?

[Lord Bethell [V]]

My Lords, the government Green Paper published on 19 July is an extremely complex proposal. That is why we are considering it in great detail. It addresses the urgent need to tackle the disproportionate amount of smoking in deprived areas and among marginal communities. We are engaged with those communities to figure out what will work best. When we have those answers, we will publish our reply.

[Baroness Gale (Lab) [V]]

Does the Minister agree that reducing smoking in pregnancy is essential to achieving a smoke-free generation, yet rates of smoking in pregnancy have not declined significantly since 2015? Financial incentive schemes are being effectively used to support pregnant women in Greater Manchester to give up smoking, including younger and more disadvantaged women. What further steps do the Government intend to take to reduce rates of smoking in pregnancy and will this include the national rollout of an incentive scheme?

[Lord Bethell [V]]

The noble Baroness points to the knottiest and most difficult of the challenges of giving up smoking. It is extremely sad that anyone should contemplate smoking during pregnancy, but this is one of the most durable and knottiest problems. I commend the use of creative and innovative schemes such as the one in Manchester to which the noble Baroness alludes, but more needs to be done, because prevention is better than cure.

[Lord Rennard (LD) [V]]

My Lords, 1 million people have given up smoking to protect their health during lockdown and now 86% of people in the UK do not smoke. Will the Minister therefore support the amendment this afternoon, which would mean that if additional tables and chairs are put outside pubs and restaurants through pavement licences, all the new seating areas created will be smoke free and more attractive to potential customers?

[Lord Bethell [V]]

The noble Lord is right to commend those who have given up smoking during Covid. I pay tribute to anyone who has given up smoking. I struggled and found it immensely difficult, but I am glad that I did it. There is a government amendment to the Bill, which the Department for Health and Social Care supports, and we wish it every success.

[The Earl of Shrewsbury (Con) [V]]

Is my noble friend aware that I quit smoking many years ago and the credit for that is entirely down to the NHS and my GP? Can he tell me what is the estimate of the current annual cost to the NHS of treating smoking-related medical issues?

[Lord Bethell [V]]

My Lords, I believe that the annual cost is £2.3 billion. It is far too much and we must do more to get it down. Huge progress has been made but we are still committed to a smoke-free 2030.

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

Do the Government recognise the particularly high addictive potential of tobacco among the young and that two-thirds of 100,000 youngsters who took up smoking last year went on to become long-term smokers? Without banning passive smoking in open areas, all the public health gains to date will be lost. There is strong evidence that smoking bans have been most effective in improving health.

[Lord Bethell [V]]

My Lords, I completely recognise the power of the smoking bans, as well as the threat of young people taking up smoking and sticking with the habit for a long time. We are on track to meet our national ambition of reducing under-15 smoking from 5.3% in 2018 to 3% or less by 2022. However, even that seems too high and we will continue to work on our efforts.

[Baroness Thornton (Lab)]

My Lords, it would be nice if, on his birthday, we could get to my noble friend Lord Simon, so my question is very short—fewer than 75 words. Inequalities in smoking remain the largest cause of life expectancy gap between the rich and the poor and are the main reason for the lives of people with serious mental illness being shortened by up to 20 years. Does the Minister agree that the smoke-free ambition may be achieved only by the most advantaged and will the Government’s further proposals address this inequality?

[Lord Bethell [V]]

Health inequalities are one of the most pernicious and difficult aspects of modern life and the Government are focused on them. Smoking is a graphic example of the worst of our inequalities. That is why the prevention Green Paper focuses on these kinds of inequalities and why our response will be muscular and determined.

[Baroness Walmsley (LD) [V]]

My Lords, the Government propose that pubs should aim at two metres between smokers and non-smokers when outside. However, the Minister should know that social distancing is already being flouted when alcohol is involved. Is he concerned that this so-called compromise is supported by FOREST, which is funded by the tobacco industry, and will he answer the question of the noble Lord, Lord Faulkner, and ensure that the guidance will be issued by the Department of Health and Social Care rather than by MHCLG?

[Lord Bethell [V]]

I take a different view from the noble Baroness on the success of pubs’ efforts to introduce social distancing. I spent the weekend in a number of pubs and I was extremely impressed by the measures that publicans have put in place. That is why we support the role of local authorities in judging the right measures for the right pubs and why we will support the government amendment.

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

My Lords, I am sure that the Minister is aware that the rate of smoking among adults in Blackpool is almost double that of Westminster. Given the Government’s levelling-up agenda, plus the fact that we know that smoking is related to illnesses that amplify the impact of Covid-19, and indeed threaten greater rates of death, why have we not seen emergency legislation to bring in a smoke-free 2030 fund, which has already been well explored and set out?

[Lord Bethell [V]]

I completely agree with the noble Baroness that there is a massive health dimension to the levelling-up agenda. Health inequalities affect families the hardest and the Government are highly focused on them. However, it is not our style to introduce emergency legislation, because we believe that prevention is better than cure and that people have rights and choices to make for themselves.

[Baroness Blackwood of North Oxford (Con) [V]]

My Lords, I welcome the publication of the draft guidance on pavement licences in time for the debate this afternoon. However, I note that, while local authorities are to consider public health when setting local conditions, Section 5.2 fails to reference the smoking reduction targets set out in the tobacco control plan or the ambition for a smoke-free England by 2030. These would be a helpful addition, so will the Minister consider including them as the guidance is finalised?

[Lord Bethell [V]]

It is not my role to comment on the drafting of legislation in the manner that my noble friend describes. However, I resolutely repeat the Government’s commitment to a smoke-free 2030 and the tobacco control plan, both of which are absolutely essential to our tobacco policies.

[Viscount Simon (Lab)]

My Lords, no licences are required to sell deadly tobacco products and, while retailers can be prosecuted for underage sales or selling illicit tobacco, penalties are low. Over 70% of small tobacco retailers strongly support introducing a licence that could be removed if retailers break the law. Will the Government commit to consulting on the introduction of such a licence to help progress towards a smoke-free 2030?

[Lord Bethell [V]]

My Lords, I completely hear the views of retailers. No one wants to put a retailer in an awkward position and I completely understand why they would support the introduction of licensing. However, that is not currently our plan and we believe that we can get to a smoke-free 2030 without introducing onerous and expensive new regulations of the kind that the noble Viscount describes.

[The Lord Speaker (Lord Fowler)]

My Lords, the time allowed for this Question has elapsed. We now come to the fourth Question.

Covid-19: Personal Protective Equipment

Lord Bethell Excerpts

Thursday 16th July 2020 Lords Chamber

[Baroness Andrews]

To ask Her Majesty’s Government what steps they are taking to ensure that there is a sufficient supply of personal protective equipment for (1) hospitals, and (2) care homes, in the event of a second wave of cases of COVID-19.

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

My Lords, we have made our supply chains more resilient by massively expanding both our supply from overseas and our domestic manufacturing capability. We are now confident in our supply of PPE to meet the needs of health and social care over the next seven-day and 90-day horizons and are looking further ahead. We continue to model future demand from health and care services to cover the approach of winter and bring resilience to the supply chain.

[Baroness Andrews (Lab) [V]]

My Lords, the Government are being warned, urgently, on all sides to prepare for a second wave of Covid this winter. I hear what the Minister has said but last week, the Public Accounts Committee found that the Government are still not treating the supply of PPE with similar urgency. Will the Minister now commit to publishing a detailed plan by September, as the committee has asked for, explaining what exactly will be different, so that mistakes are not repeated and health and care workers are better protected?

--- Later in debate ---

[Lord Bethell [V]]

My Lords, I completely share the concerns of the noble Baroness, Lady Andrews, about a second peak and we are working to prepare for that. I respect the views of the PAC and emphasise that our approach to PPE is incredibly serious. A huge amount of work has gone into it and a huge amount of progress has been made.

[Baroness Browning (Con) [V]]

Can my noble friend identify what lessons have been learnt so far from both the quantity and quality of the PPE that has been used in homes and hospitals? What action will be taken to minimise cross-infection for those who have to go into people’s domestic homes and who often work in more than one location?

[Lord Bethell [V]]

My Lords, the big lesson from Covid is that the quantity of PPE needed for a disease like this is massively more that could ever have been expected, particularly compared with our past experience. It has hit every country in the world and has hit the global supply chains incredibly hard. A benign lesson is that British manufacturers are capable of stepping up the challenge, and I salute their work. Contamination from itinerant workers was always one of the greatest challenges of the care sector, and we have put in a huge amount of work and financial resources to avoid the need for workers who move from home to home.

[Baroness Coussins (CB) [V]]

My Lords, when I asked the Minister on 24 June to ensure that interpreters in the NHS would not be forgotten when stockpiling PPE in case of a second wave, he very helpfully told the House that he would continue to press the department on this. So, I am mystified that I still have not had a reply to my simple question of 12 May, asking who is responsible for providing PPE for freelance NHS interpreters. Can the Minister enlighten me today?

[Lord Bethell [V]]

The noble Baroness is entirely right to champion the role of interpreters. Their role in the recent Leicester lockdown has been incredibly important: there could not have been an incident that better highlights the importance of language skills in the healthcare setting, and I pay tribute to the noble Baroness for championing those. The care of interpreters is an incredibly complex question and entirely depends on where they are sited. It is the responsibility of individual trusts to look after interpreters in hospital settings but, in other settings, it may be that of other organisations.

[Lord Rooker (Lab) [V]]

Do the Government now accept that there is no further excuse for secret, non-competitive contracts for PPE channelled through the friends of Ministers and special advisers? There are thousands of UK companies ready and willing to bid for contracts to produce PPE—why not use them? China may not be reliable in the future.

[Lord Bethell [V]]

I completely reject the implications of the noble Lord’s question. While British companies have stepped forward and we are pleased to have made many contracts, there are not, I am afraid to say, thousands of domestic producers capable of providing the billions of items we need in the British health service. I pay respect to all the companies that moved quickly and contracted under difficult circumstances for major contracts. I also salute the companies overseas with which we have good relationships, and which remain our trusted partners.

[Baroness Brinton (LD) [V]]

My Lords, alongside PPE we must have a comprehensive test and trace system to prevent a second wave. Today, the Health Service Journal reports that virtually all the top team of test and trace are leaving, and that McKinsey is contracted to review the governance and entire form of test and trace. Why would the Government bring in a multimillion-pound consultancy firm to review a so-called world-beating test and trace system?

[Lord Bethell [V]]

My Lords, turnover of the test and trace team is an inevitable consequence of an organisation that was set up using temporary staff, many of whom are on short contracts and need to return to their previous roles. It is regrettable, but I owe them a huge debt of thanks for the work they have done. The work of McKinsey is focused on governance, not on HR. It was commissioned some time ago and it is an entirely proper and regular appointment.

[Baroness Thornton (Lab)]

My Lords, I refer back to what the noble Lord said about the amount of PPE that is needed. It is actually the case that in the 2016 report it was signalled that we would need a gigantic quantity. I am sure we would all agree that we need better organised and effective preparation if there is to be a second wave, and the centralised purchasing of PPE, managed by local public health agencies, will ensure effective distribution. I want to ask about the care sector. Does the noble Lord believe it is acceptable or wise for care homes to have to pay over the top prices and compete for PPE? Does this not put the wider public health interests at risk? What steps is the Minister taking to end discrimination against the care sector in the supply of PPE and ensure essential protection for care workers, residents and visitors?

[Lord Bethell [V]]

My Lords, it is a reality that the cost of PPE has gone through the roof. There is nothing that I or the Government can do about that. It is something we are going to have to live with and budget for: it is part of the new reality. As to the procurement of PPE, as the noble Baroness knows, within the care sector it was previously the arrangement that local providers would source their own PPE. The Government have stepped in to bring resilience and confidence to that supply chain and to offer alternative sources of supply to local care homes. We have moved emphatically and sought to bring both affordability and resilience to the supply chain.

[Lord Dobbs (Con) [V]]

My Lords, I was going to ask my noble friend about private sector provision of PPE, but I shall move on to something which may be even more significant—the hopeful news of developments in Oxford scientists identifying a vaccine against Covid. Is my noble friend able to offer any update on that news? Can he set out what role the private sector has in the development and, we hope, eventual manufacture of any such vaccine?

--- Later in debate ---

[Lord Bethell [V]]

My noble friend is entirely right: the news from Oxford appears to be incredibly encouraging. Coronaviruses are typically very difficult to provide vaccines for, but the Oxford team is clearly confident that it is making serious progress. It has a contract with AstraZeneca, which is its private sector partner in the UK and globally. The administration of that vaccine, should it be successful, or of any other successful vaccine, is a matter of huge national importance. Thanks to Kate Bingham and the Vaccine Taskforce, we are putting a huge amount of work in to ensure that the administration of that vaccine into the arms of the country will be done in a speedy and efficient fashion.

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

My Lords, the noble Lord, Lord Deighton, was appointed last April, with much fanfare, to resolve a national PPE crisis. Is he now responsible for ensuring adequate PPE, both clinical and other types—particularly for care homes, to deal with any second wave and the expected higher numbers infected through the winter months—for the whole of the UK, or just for England?

[Lord Bethell [V]]

My noble friend Lord Deighton is still in place: I spoke to him recently. His impact has been immense, and I owe him a huge debt of thanks for that. He is particularly focused on the “make” leg of the PPE project, and within that he has recruited firms such as Medicom, Redwood, Photocentric, Ramfoam, Elite and Macdonald & Taylor Healthcare—British manufacturers that are, between them, providing hundreds of millions of items of PPE.

[The Deputy Speaker (Lord Faulkner of Worcester) (Lab)]

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

Independent Medicines and Medical Devices Safety Review

Lord Bethell Excerpts

Wednesday 15th July 2020 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, on behalf of the Liberal Democrat Benches, I too thank the noble Baroness, Lady Cumberlege, and her team for such an outstanding report. It is not only comprehensive but blunt in its language, so that no one can misunderstand the failings of all levels of the healthcare system, whether in our NHS or other health and research settings, over many years. We too pay tribute to those women, and their children and families, for continuing against all the odds for years when too many ears, including the Government’s, were deaf. I also pay tribute to the many parliamentarians, including Norman Lamb, who over the years supported them. They pushed for this review in Parliament and raised it in any way they could.

Ministers have apologised for these failings, including for the system not listening and for not acting soon enough, over the decades since patients first started to raise the problems with these three medical interventions. Last week, when I asked the Minister about the timetable for implementing the recommendations, he said that

“it will take some time for the Government to study these recommendations … and to come back on the timetable”.—[Official Report, 9/7/20; col. 1224.]

The noble Baroness, Lady Cumberlege, says in her letter introducing the report:

“Over the past two years we have found ourselves in the position of recommending, encouraging and urging the system to take action that should have been taken long ago.”


She also said:

“Implementation needs to be approached with a new urgency and determination, founded on the guiding principle that our healthcare system must first do no harm.”


When the interim report was published, leaving this House in no doubt about the direction in which the review group was proceeding, many people expected action at that point.

I am grateful to Epilepsy Action for its briefing, which demonstrates exactly why urgent action must be taken now. Epilepsy Action, the Epilepsy Society and Young Epilepsy jointly surveyed over 500 women and girls who had taken sodium valproate since the pregnancy protection plan was introduced two years ago. One in 10 were unaware of the possible risks of birth defects. Almost half said that they had not discussed the risks of taking medicine with their health professional in the last 12 months, and only four in 10 said they had signed the annual risk acknowledgement form. For patients and families who have suffered as a result of these interventions, urgent action needs to be taken on government departments such as the DWP regarding the way it assessed the damage caused, and on how government as a whole compensates them for this gross injustice.

So I ask the Minister again: when will the Government return to those affected and to Parliament with clear recommendations and a timetable to do honour to the report and to all those affected? And when will the various bodies in our healthcare sector be set a deadline to publish the list of recommended actions that they will take that will not need parliamentary action? Last week, the Minister told your Lordships’ House that the Government had moved ahead on one of the recommendations—the creation of a patient safety commissioner—but their version is not independent, as asked for in the report.

So much of this report is about changing cultures: we still have not learned from Mid Staffordshire, East Kent and Shrewsbury maternity care, all of which Ministers have rightly been appalled by. For all the excellence and commitment of the individuals who, singly and collectively, provide our unique healthcare in the United Kingdom, there remains an unhealthy culture in some parts that does not listen to patients, does not understand conflicts of interest and resists change. That must change, it must change soon and it must be led from the top by the Government.

The report quotes Professor Ted Baker, chief inspector of hospitals for the CQC:

“I have to say 20 years later it is very frustrating how little progress we have made. It’s clear to me we still have not got the leadership and culture around patient safety right. As long as you have that culture of people trying to hide things, then we are not going to win this.”


Armed with this blunt and excellent report, I hope that the Minister can demonstrate the Government’s support with firm actions and dates, and not just with warm words that will drift away. The hopes of patients and their families and the future safety of our healthcare system depend upon it. When, Minister, when?

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

My Lords, I start by reiterating the tributes from both noble Baronesses, Lady Thornton and Lady Brinton, to my noble friend Lady Cumberlege and her team, who have worked indefatigably on a high-quality report that does justice to this important cause. Most of all, I pay tribute to the patient groups, the specialist groups and those who campaigned on these important issues and who have brought attention and a huge amount of official focus to causes that had been overlooked for years and decades. I pay tribute to their patience, their expertise and their stamina in bringing these important causes to attention. It is entirely right that the Minister, my colleague Nadine Dorries, made an apology to those groups, and I reiterate that apology on behalf of the healthcare system to all the families affected by the report, for the time it has taken to listen and to respond to their concerns.

Both noble Baronesses referred to the culture that led to these issues being overlooked. I think that that is one of the most important learnings from this report. As Nadine Dorries said, I thought very movingly, in her speech in the House of Commons, the system has to learn to listen much more clearly. Listening must happen not just from the top but also at the level at which patients engage with the system itself. I think that trying to change that culture is one of the most important challenges facing us today. It is not just a question of bringing in punishment and retribution for those in the professional world who have failed; it is trying to create a culture where mistakes are recognised and accepted and where people address and take on board the concerns of patients themselves—and on that important cause we are hugely focused.

The noble Baroness, Lady Brinton, asked what we are doing. Already, much has been done. There has been progress in lots of areas. We already have 12 different types of patient safety function in place within the NHS: the Patient Advice and Liaison Service; commissioners of NHS services; the Parliamentary and Health Service Ombudsman; Healthwatch; the NHS Complaints Advocacy service; the CQC; the NHS Friends and Family Test; the professional regulators; the Healthcare Safety Investigation Branch; the Professional Standards Authority; the National Director of Patient Safety; and the complaint systems within individual trusts.

That patchwork quilt of patient safety and patient advocacy is an enormous function within the NHS. The report teaches us that it has not been enough to identify the major themes of failures—in this case, involving medical devices—and there has not been the patient advocacy necessary to see complaints through when they have really mattered. It is that question which we are turning to: how do we make these considerable and important efforts to put patient safety at the heart of the NHS more effective?

The noble Baroness, Lady Thornton, asked about the regulatory implementation of that response. The most important legal implementation is the registry of medical devices, which was in an amendment to the Bill on Report in the House of Commons, and it has enormous support from the Government. That registry, which is an incredibly important source of accountability and of clinical information, is the key to preventing such terrible events concerning medical devices in the future.

The report was published only last week, and it will take some time to focus on all its other recommendations. I can update the House on the specialist centres that the report quite reasonably recommended should be set up: NHS England is assessing bids from NHS providers to be specialist centres for mesh inserted for urinary incontinence and vaginal prolapse.

The noble Baroness, Lady Thornton, also asked about the MHRA regulatory review. The MHRA has begun a comprehensive and far-reaching programme of change, which will include enhancing its systems for adverse event reporting and medical device regulation. The MHRA has taken important steps to put patient advocacy at the centre of the work that it does.

There is nothing we can do today to make good the harm done in the past. However, as both noble Baronesses have rightly pointed out, there is much we can do to put patient safety at the heart of the NHS and to ensure that we have the technology, the systems and the culture to make sure that these mistakes never happen again.

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

We come now to the 20 minutes allocated for Back-Bench questions. I ask again that both questions and answers be kept brief, so that I may call the maximum number of speakers.

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

My Lords, I first thank the noble Baroness, Lady Cumberlege, for such a wonderful and constructive report, and all the members of the committee, especially Professor Sir Cyril Chantler, whom I have known for many years.

I have just two questions. Will the report encourage clinicians to consult the appropriate royal college before designing a new treatment? Secondly, after introducing a new treatment or a new operation, should the clinician be encouraged to wait for an appropriate interval to ensure that no complications occur?

[Lord Bethell]

I thank the noble Lord for his searching questions. The role of the MHRA on both medical devices and medicines has been massively upgraded, and the review process for new medical devices has been improved. However, medical devices have different criteria from medicines.

One of the most important things that we have sought to do is to include a registry of the medical devices themselves and a registry of the medical devices inserted into individuals. Compliance with both procedures are the most important steps for clinicians embarking on new products.

[Lord Kakkar (CB) [V]]

My Lords, I thank the Minister for answering questions on this Statement and in so doing remind noble Lords of my registered interests. In her excellent report, the noble Baroness, Lady Cumberlege, identifies concerns about the lack of evidence that is required prior to the granting of marketing authorisation for many medical devices, where all that is often required is demonstration of equivalence to an already marketed product. The noble Baroness highlights the striking difference that exists with regard to the situation for medicinal products, where robust evidence of efficacy and safety is required before a medicinal product can be marketed. Are Her Majesty’s Government content with this situation—this difference between the level of evidence required before a product and a device can be marketed as regards patient safety? If there are concerns, what approach do Her Majesty’s Government propose to take with regard to ensuring that there is proper evidence of both the safety and efficacy of a device prior to its broad marketing and use in large populations of patients?

[Lord Bethell]

The noble Lord alludes to an extremely difficult balance that we have to seek to make. He is entirely right that medical devices and medicines operate on different criteria. The most important thing is that the MHRA resources for focusing on the approval of medical devices have been improved and the procedures enhanced. However, medical devices remain an important area of potential innovation, and we are concerned not to suffocate this area of potential improvement as it has been suffocated in other areas. At present, the Government believe that we have struck the right balance, but we remain keenly focused on it and it is under constant review.

[Baroness Kennedy of The Shaws (Lab) [V]]

I add my voice to the tributes that have been paid to those who produced this report, and especially to the women who persisted in having their voices heard. What came through to me very clearly was that the women themselves had not been listened to. It reminded me—I hope it will remind the House—that the complaints of women who were failed by the legal system were very much the same, about not being considered credible and about somehow exaggerating what they were describing and not being heard. It is about changing professional cultures. We have had this in the law and in policing, and we are now having to consider it in the medical professions and probably all our professions. How will the Government deal with embedded attitudes, and how will we change the training of our young medical professionals and change the attitudes inside our teaching hospitals? I want to hear about how you change cultures.

[Lord Bethell]

The noble Baroness is right: we do not listen to our women clearly enough. The medical health of women is more complicated than the medical health of men, and that point has been overlooked for too long. We are working hard to bring this into the education of young medics and to update the attitudes, procedures and knowledge of those who are already in the profession.

[Baroness Jolly (LD) [V]]

The noble Baroness, Lady Cumberlege, recognised the importance of regulation in her excellent report. Our regulation system is in a transitional stage. Regarding the European Medicines Agency and the Medicines and Healthcare products Regulatory Agency, the text of the political declaration accompanying the withdrawal agreement stated only that the UK and EU will “explore” the possibility of co-operation. Can the Minister confirm what exploratory talks have been made to ensure that the EMA and MHRA remain strong and convergent post Brexit, and that the MHRA is adequately staffed?

[Lord Bethell]

The noble Baroness is right that regulation is important, but so is culture. I emphasise the importance placed by the Cumberlege report on a change in attitude in the healthcare service as much as on a change in regulation. I cannot guarantee that the EMA and the MHRA will be aligned on regulation in all matters, but I can guarantee that the MHRA will be given the resources it needs to do the job properly.

[Lord Lansley (Con) [V]]

My Lords, as a former Secretary of State for Health, perhaps I may say that I and all my colleagues who have taken responsibility for the NHS over decades should join in expressing our deep regret at the systemic failures laid bare in the report of the noble Baroness, Lady Cumberlege. Will my noble friend reiterate the point about cultural change? It is not just about implementing the recommendations, important as that is, but about achieving cultural change. I direct that point in particular to patient involvement. By that I mean not just consultation, not just a patient voice, not just decision aids but patient-reported outcomes being a central part of the measurement of the performance of our health service and its accountability.

[Lord Bethell]

I completely endorse the comments of my noble friend. To embellish his point, it has been very interesting to see through Covid how patients have had to track their own symptoms, take advice on 111 for themselves and, in millions of cases, look after themselves at home, possibly with telemedicine to support them. This may an inflection point in the attitude of many people to their health. I certainly welcome a revolution of patient power and putting patients first in our healthcare system.

[Lord Alton of Liverpool (CB) [V]]

My Lords, families and dedicated campaigners such as Marie Lyon have told the All-Party Parliamentary Group on Hormone Pregnancy Tests, of which I am vice-chairman, that they have unequivocal admiration for the noble Baroness, Lady Cumberlege, for compassionately understanding their pain and suffering and allowing them, for the first time in more than 50 years, to have hope. Does the Minister agree with the report’s conclusion that, when the first comprehensive study, in 1967, identified a link between congenital abnormalities and HPTs, Primodos should have been removed from the market and that this regulatory failure has seen justice delayed and denied? Will there now be an independent re-examination of the contested conclusions of the report of the expert working group? In implementing the Cumberlege recommendations without delay, what practical help and redress will be provided for families whose lives were irreparably blighted by Primodos?

[Lord Bethell]

My Lords, I completely share the view of the noble Lord and of the patient groups who have unequivocal admiration for the noble Baroness, Lady Cumberlege, who has done the nation a great service with this report. As he knows, the Primodos case is subject to legal dispute, so I cannot comment on it from the Dispatch Box, but no one can read the report without feeling great disappointment that those hardships were suffered by those women. It is of enormous regret to us all.

[Baroness Gardner of Parkes (Con) [V]]

My Lords, I am pleased to speak today very briefly. I have known the noble Baroness, Lady Cumberlege, for years since I worked in the health scene myself. She is widely experienced, and no one could have done a better report. It is very impressive and certainly not to be ignored. The various points that she has made, including the nine major recommendations, are all sound and people are very aware of them. We must realise that, though the health service is much loved by everyone in the country, there are failings which we have to accept and work on. I congratulate the noble Baroness on this marvellous report and hope that, as she urged in her press conference:

“This report must not be left on a shelf to gather dust.”


I am pleased to commend the report and the remarks passed.

[Lord Bethell]

The noble Baroness is entirely right. The report must not be left on the shelf. We have already done much, and in the Medicines and Medical Devices Bill we will do more. The other recommendations will be taken extremely seriously.

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

My Lords, this wonderful but deeply disturbing report has so many points to make, but one point that has not been brought out in coverage as much as it might have been is the noble Baroness’s recommendation that the responsibility for ensuring transparency of interests should fall not only on the medical profession but also on manufacturers, who must take responsibility for ensuring that, where they are creating potential conflicts of interests with medical professionals and researchers, they show that. Can the Minister tell me what plans the Government have to make sure that manufacturers are being open, honest and transparent in all their dealings and that, should they not act in that matter, action is taken?

[Lord Bethell]

The noble Baroness is entirely right that transparency is essential in order to have a fair and equitable healthcare system. The GMC has already considered these areas and has moved a long way. The world has changed considerably since many of these horrific events took place, but I am sure there is more to be done and this recommendation, like others, will be considered seriously by the Government.

[Baroness Bryan of Partick (Lab) [V]]

My Lords, there is so much to be said about this excellent report, but I shall quote one devastating sentence on mesh implants, where it raises the question

“whether the modification of a device so that it required less skill to insert should have been the preferred option rather than improving the surgical skill base.”

Does the Minister agree that there is an urgent need for a robust surgical training programme for inserting mesh devices and, just as importantly, for their removal? Will resources be put in place for such a programme?

[Lord Bethell]

The noble Baroness is right to emphasise the dangers of the insertion of mesh. It is a procedure that is still taking place within the NHS. We are looking at bids for specialist units in relevant trusts to build up the kind of specialist skills necessary to deal with the problems that have emerged from mesh procedures that have gone wrong.

[Lord Greaves (LD)]

My Lords, this is yet another outstanding report from the noble Baroness, Lady Cumberlege. The beginning of the “Implementation” section reads:

“Our recommendations are designed to pave the way for a future healthcare system that looks and feels very different.”


This is not only an outstanding report; it is a revolutionary report. Do the Government accept that this is not just another committee of inquiry but an investigation that found the facts and came back with recommendations? Are they going to set up the task force?

[Lord Bethell]

I completely agree with the noble Lord, Lord Greaves, that this is an important report. I pay tribute to my predecessor my noble friend Lord O’Shaughnessy, who commissioned it. We take it extremely seriously. No one could possibly read about the hardships suffered by the women described in this report without wanting to move swiftly on it. It has only been a few days so I cannot announce a strict timetable for every measure, but I assure the noble Lord that it is taken seriously and we will be moving on it in the very near future.

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

My Lords, this important report must become core in every curriculum, because patients must be listened to. It is correct to say that there must be a culture change, but I would like to focus on the third recommendation about establishing a redress agency. How quickly will the Government progress that? Without that, and without changing the whole culture of compensation and complaints, we will not get the openness and listening whereby if somebody comes forward with something they should expect the answer, “Thank you for telling us,” not “Oh well, we’ll look into it.” Until that changes and every comment is welcomed and patient- reported and family-reported outcomes are used to move services forward, we will not get the culture change that is needed.

[Lord Bethell]

The noble Baroness is right about culture change, but we are aware that having a big, clunking fist of financial threat hanging over individuals who are considering the admission of mistakes is not the right combination to create a culture of self-awareness and acknowledgement. We have to move extremely delicately to encourage people and make them feel safe enough to acknowledge the mistakes that might have happened and to embrace the kind of dialogue with patients that is necessary to deal with these results. That delicate balance is one of the most important things to get right in our reaction to this report.

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

We have heard some of this before. Thirty-four years ago, I submitted to the then Secretary of State—now our Lord Speaker—a patients’ charter prepared by the association of CHCs, which talked about listening to patients, putting them at the centre of every decision, and having a proper system of redress. Since then, every White Paper published by every successive Secretary of State has paid lip service to those principles, as the Minister has today. But the noble Baroness, Lady Cumberlege, has shown how shallow the commitment has been. The Minister talked about a patchwork quilt of safety mechanisms; can he convince us that this time it will be different? When will the Government say not only that they accept her recommendations in full, but what robust arrangements there will be to make sure that action and culture change actually follow?

[Lord Bethell]

Let me reassure the noble Lord that this report is taken seriously. But I acknowledge the fact that some of these issues are extremely complex, and when dealing with issues such as sexism, bullying, racism and a failure to engage with patients, there are not single-shot solutions like patients’ charters that will somehow transform the ecosphere. We have to look at it in the round, and that is why there will be major interventions like the HSIB, the people plan and the focus on fairness in the workplace that will ultimately make a big difference.

[Lord Hussain (LD) [V]]

The excellent report from the noble Baroness, Lady Cumberlege, puts patient safety at the heart of everything. I welcome the proposal in theme 3 on patient-informed consent to ensure that patients really understand and are able to co-sign their patient aid decision with the clinicians. Will the NHS ensure that professional translators able to assist patients who have English as a second language will be there at meetings and to discuss consent with them?

[Lord Bethell]

The noble Lord is right to focus on this. We have put in place enormous measures to address the issue of translation. Technology is being used in a much more thoughtful way to make sure that translation services can be put into a great many environments. One-to-one translation is also important, and that is why we have emphasised it.