Debates between Lord Bethell and Baroness Brinton

There have been 37 exchanges between Lord Bethell and Baroness Brinton

1 Thu 16th July 2020 Covid-19: Personal Protective Equipment
Department of Health and Social Care
3 interactions (240 words)
2 Wed 15th July 2020 Independent Medicines and Medical Devices Safety Review
Department of Health and Social Care
2 interactions (1,472 words)
3 Thu 9th July 2020 Independent Medicines and Medical Devices Safety Review
Department of Health and Social Care
2 interactions (206 words)
4 Wed 8th July 2020 Covid-19
Department of Health and Social Care
3 interactions (335 words)
5 Wed 8th July 2020 Social Care
Department of Health and Social Care
3 interactions (232 words)
6 Tue 7th July 2020 Independent Residential Care
Department of Health and Social Care
3 interactions (315 words)
7 Mon 6th July 2020 Medicinal Cannabis
Department of Health and Social Care
3 interactions (277 words)
8 Wed 1st July 2020 Covid-19 Update
Department of Health and Social Care
2 interactions (1,492 words)
9 Wed 24th June 2020 Personal Protective Equipment
Department of Health and Social Care
3 interactions (213 words)
10 Mon 22nd June 2020 Coronavirus
Department of Health and Social Care
3 interactions (322 words)
11 Tue 16th June 2020 Covid-19: Mental Health
Department of Health and Social Care
3 interactions (265 words)
12 Tue 9th June 2020 Covid-19: R Rate and Lockdown Measures
Department of Health and Social Care
3 interactions (284 words)
13 Tue 9th June 2020 Exercise Cygnus
Department of Health and Social Care
3 interactions (234 words)
14 Thu 4th June 2020 Covid-19: Obese and Overweight People
Department of Health and Social Care
3 interactions (199 words)
15 Wed 3rd June 2020 Covid-19: Response
Department of Health and Social Care
2 interactions (1,107 words)
16 Wed 20th May 2020 Covid-19: Care Homes
Department of Health and Social Care
3 interactions (321 words)
17 Tue 19th May 2020 Covid-19: Response
Department of Health and Social Care
2 interactions (2,394 words)
18 Thu 14th May 2020 Care Homes: Covid-19 Testing
Department of Health and Social Care
3 interactions (282 words)
19 Wed 6th May 2020 Covid-19: Government Response
Department of Health and Social Care
3 interactions (410 words)
20 Thu 23rd April 2020 Covid-19
Department of Health and Social Care
2 interactions (1,986 words)
21 Thu 23rd April 2020 Covid-19: Personal Protective Equipment
Department of Health and Social Care
3 interactions (292 words)
22 Wed 22nd April 2020 Covid-19: Medically Vulnerable People
Department of Health and Social Care
3 interactions (329 words)
23 Tue 21st April 2020 Covid-19: Removal of Restrictions
Department of Health and Social Care
3 interactions (303 words)
24 Mon 16th March 2020 Covid-19 Update
Department of Health and Social Care
2 interactions (2,073 words)
25 Thu 12th March 2020 Coronavirus
Department of Health and Social Care
2 interactions (1,829 words)
26 Wed 11th March 2020 Covid-19: Deep Cleaning
Department of Health and Social Care
3 interactions (290 words)
27 Wed 11th March 2020 Dementia: Accident and Emergency
Department of Health and Social Care
3 interactions (263 words)
28 Mon 9th March 2020 Health Protection (Coronavirus) Regulations 2020
Department of Health and Social Care
4 interactions (851 words)
29 Mon 9th March 2020 Coronavirus
Department of Health and Social Care
3 interactions (447 words)
30 Thu 5th March 2020 Health: Lesbian, Bisexual and Trans Women 3 interactions (222 words)
31 Wed 4th March 2020 NHS: Doctor Retention 3 interactions (186 words)
32 Tue 3rd March 2020 Coronavirus (COVID-19) 2 interactions (2,064 words)
33 Tue 3rd March 2020 Clinical Negligence 3 interactions (240 words)
34 Wed 26th February 2020 Wuhan Coronavirus 2 interactions (1,782 words)
35 Mon 27th January 2020 NHS: Children’s Emergency Beds 3 interactions (300 words)
36 Thu 23rd January 2020 Hymen Surgery 3 interactions (205 words)
37 Tue 5th February 2019 Healthcare (International Arrangements) Bill
Department of Health and Social Care
2 interactions (2,559 words)

Covid-19: Personal Protective Equipment

Debate between Lord Bethell and Baroness Brinton
Thursday 16th July 2020

(2 months ago)

Lords Chamber
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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell [V] - Hansard

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 Portrait Baroness Brinton (LD) [V] - Hansard

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 Portrait Lord Bethell [V] - Hansard

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.

Independent Medicines and Medical Devices Safety Review

Debate between Lord Bethell and Baroness Brinton
Wednesday 15th July 2020

(2 months ago)

Lords Chamber
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Department of Health and Social Care
Baroness Brinton Portrait Baroness Brinton (LD) [V] - Hansard

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?

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

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.

Independent Medicines and Medical Devices Safety Review

Debate between Lord Bethell and Baroness Brinton
Thursday 9th July 2020

(2 months, 1 week ago)

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Department of Health and Social Care
Baroness Brinton Portrait Baroness Brinton (LD) [V] - Hansard

My Lords, the country owes an enormous debt of gratitude to the many campaigners who have fought tirelessly over decades to get their issues raised and to ensure that this never happens again. It is good that the Government have apologised on behalf of many Governments, and it is reassuring to hear that there will be some amendments to the Medicines and Medical Devices Bill, but the people who are affected need redress urgently. Can the Minister give us an indication of when this will happen?

Lord Bethell Portrait Lord Bethell - Hansard

I share with the noble Baroness, Lady Brinton, my personal respect and admiration for the campaigners, who are described in the report as having lived through the most awful experiences and who, through personal commitment and determination, have brought attention to these huge failures and have pursued their cause with enormous patience. We owe them a huge debt of gratitude. In terms of commitments on the individual recommendations, I have mentioned what we have done so far and what we have on the near horizon. However, it will take some time for the Government to study these recommendations—to understand from my noble friend Lady Cumberlege herself her detailed recommendations—and to come back on the timetable that the noble Baroness requested.

Covid-19

Debate between Lord Bethell and Baroness Brinton
Wednesday 8th July 2020

(2 months, 1 week ago)

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

My understanding regarding the 1984 Act is that the regulations are published under the appropriate section. They have been published as is appropriate, but they are not brought to the House for debate. If I am wrong, I will be happy to write to the noble Baroness.

Baroness Brinton Portrait Baroness Brinton (LD) [V] - Hansard

Today, the Public Accounts Committee has reported real concerns that the Government have no realistic plan for supplying PPE in the event of a second wave. Can the Minister comment on that? I know I ask this regularly, but can the Minister tell the House when all NHS and social care staff, including those working in people’s homes, can get regular, repeated testing that is not dependent on symptoms? Yesterday, Matt Hancock said that, finally, some day centres, sheltered living and non-care home settings will be able to access tests. Which ones and when? I noticed that, on Monday, the Covid data dashboard was changed, removing posted-out but not returned tests. Does that mean that, in future, posted-out tests will not be counted unless they are returned?

Lord Bethell Portrait Lord Bethell - Hansard

On PPE, I pay tribute to my noble friend Lord Deighton, who has performed an amazing task in providing an enormous supply of PPE. There is sufficient PPE in the NHS, social care and other parts of the healthcare system for all those who need it. There is a PPE hotline for those who would like to order it directly and, at this stage, stockpiles are being created to get us through the winter months. On tests, a testing portal is available to all of social care. It can be accessed either by social care employers or, if employees or residents want a test, they can order one themselves through the public testing portal. It is my understanding that posted tests are no longer counted in the same way: they are counted not on dispatch but when they are processed. The “test and trace” programme initiated this change in the recent change of data, which I think was 10 days ago.

Social Care

Debate between Lord Bethell and Baroness Brinton
Wednesday 8th July 2020

(2 months, 1 week ago)

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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell - Hansard

My Lords, the role of carers during the epidemic is one of the great stories of commitment and sacrifice. I pay tribute to all those who have given up their time and taken the risks necessary to perform this important community role. On encouraging people to stay home, there are clear guidelines on who is recommended to stay at home. It depends on clinical need and people’s precise circumstances, according to their GP’s recommendations. I urge all people to follow those guidelines.

Baroness Brinton Portrait Baroness Brinton (LD) [V] - Hansard

My Lords, I remember that there was cross-party support 10 years ago for the Dilnot review’s proposals. I support warmly the comments of the noble Baroness, Lady Pitkeathley, about the need for a national care service. Will this review and White Paper also look at matters that are often forgotten in a care setting: housing standards for life, and sheltered and community settings, to make sure that we do not yet again end up looking at just adult social care and care homes?

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness is quite right to shine the spotlight on those who are in social care but not necessarily aged over 65. Half of all social care costs are now dedicated to those under 65. Housing standards is an important question. The stock of housing for social care will be considered in any forthcoming review. It is imperative that we have a modern and up-to-date industry.

Independent Residential Care

Debate between Lord Bethell and Baroness Brinton
Tuesday 7th July 2020

(2 months, 1 week ago)

Lords Chamber
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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell [V] - Hansard

My Lords, we are enormously grateful to all those working in the care home sector, who have protected residents through this awful epidemic, and we continue to support them. We have increased recruitment in the area, and are in the midst of an enormous recruitment marketing campaign to bring new, qualified people into the care home sector. The Secretary of State wrote to relevant stakeholders on 14 May, inviting them to cross-party talks on the care home sector. We are continuing those conversations and hope to bring them to a head at the earliest opportunity.

Baroness Brinton Portrait Baroness Brinton (LD) [V] - Hansard

Yesterday, our Prime Minister said that

“too many care homes didn’t really follow the procedures”.

In March, the care sector asked for testing for patients discharged from hospital. The Government’s reply—not necessary. The sector could not get the promised PPE as government supplies failed to appear. All our amazing 1.6 million care home workers needed testing from March—it took the Government three months. Complex government guidance changed frequently, sometimes even daily. Our care homes have had to cope with 30,000 excess deaths in three months and massively increased costs. Does the Minister agree with our Prime Minister, or with the National Care Forum, which said that Boris Johnson’s remarks were, “frankly, hugely insulting”?

Lord Bethell Portrait Lord Bethell [V] - Hansard

I thank all those who work in the care home sector for the enormous amount of sacrifice and commitment that they have shown to protecting residents. The noble Baroness, I think, portrays the situation unfairly. Guidelines have changed quickly because the situation changed quickly. PPE demand could never have been expected at the levels it reached; the Government responded incredibly quickly to move PPE into both NHS and social care. On testing, we started from a very low base; testing has now been introduced in care homes for both patients and staff. The Government will continue to be committed to protecting both staff and residents in the care sector.

Medicinal Cannabis

Debate between Lord Bethell and Baroness Brinton
Monday 6th July 2020

(2 months, 2 weeks ago)

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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness shines a spotlight on an uncomfortable but realistic fact of life in our medical service: those with money are able to pay for treatments beyond the reach of those who rely on the NHS for absolutely everything. Another area that concerns me is that those who have relied on fundraising have found that Covid has restricted the amount of money coming from donors. That is why we have put money into medical research charities and support charities that can help support those fundraising for their medicine.

Baroness Brinton Portrait Baroness Brinton (LD) [V] - Hansard

Since the law changed in 2018, only two children with severe epilepsy have accessed whole-plant cannabis medicine via the NHS. Recently, a child ended up in intensive care in the middle of the Covid pandemic and almost died because her parents could not fundraise the money to buy her medicine privately. Does the Minister accept that this is a complete failure of the policy and that a new regime for the regulation and control of access to medical cannabis is now required?

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness’s point on fundraising is well made, and I think I answered it in my previous answer. We are looking at it closely. On policy-making in this area, it is extremely tough to regulate innovative drugs that simply do not have clinical trials and evidence bases behind them. We have put a huge amount of effort into this area. We are working closely with industry; I call on industry to do everything it can to help this process. We are trying our hardest to provide the right regulatory environment. As the noble Baroness pointed out, we have already made important changes to the law.

Covid-19 Update

Debate between Lord Bethell and Baroness Brinton
Wednesday 1st July 2020

(2 months, 2 weeks ago)

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Department of Health and Social Care
Baroness Brinton Portrait Baroness Brinton (LD) [V] - Hansard

My Lords, first, on behalf of the Lib Dem Benches, I once again pay tribute to all of those who are helping to curb the coronavirus pandemic, whether in the front line or behind the scenes, and especially in Leicester. We know that there are many unsung heroes who continue to work long hours in stressful and ever-changing environments. Secondly, on behalf of these Benches, and in memory of the outstanding report by William Beveridge, I extend our congratulations to the NHS on its birthday, and note that of the five evil giants, many are still present in those most affected by Covid.

If the Minister is unable to answer all the questions asked, will he write to noble Lords with an answer? I hope that I can speak for other Members of your Lordships’ House when I say that we understand that the nature of a pandemic means that there are many questions to raise, but to repeatedly not have answers from Ministers is disappointing.

On that note, I ask the Minister for the fifth time in just over two weeks what the problem is with ensuring that every local council and director of public health has full test and tracing data as it becomes available. Over the past three weeks, it has become clear that full data has not been provided, and directors of public health, council leaders and mayors have all had to beg for data so that they can intervene early to prevent further cases, hospital admissions and deaths. Information is being dribbled out and it appears that pillar 2 testing lies at the root of the problem.

Stella Creasy MP asked a Written Question in the Commons, which was replied to by Minister Nadine Dorries on 11 June. It states:

“The contract with Deloitte does not require the company to report positive cases to Public Health England and local authorities.”

Does that remain the case, or has the contract now been varied to ensure that that information is made available immediately to key partners? The issue of why any such contract should not require positive cases to be reported is quite extraordinary but for another day; however, with low transmission, tracing pillar 2 cases is absolutely critical. Are all local authorities and directors of public health now getting full data, including pillar 2 data immediately so that they can prepare for small or larger local outbreaks? That is important because there are reports from across England of areas with increasing cases—indeed, as the noble Baroness, Lady Thornton, said, Sky News reported this morning that 35 other local authority areas may face locking down if their cases do not reduce quickly.

That raises an issue about the powers of local lockdown. It was rather strange to hear Matt Hancock saying on Monday evening that he would bring forward legislation for local lockdown, but this morning on Sky News he said that he would rather not do that by legislation but by consent. So I put what I hope is a hypothetical case to the Minister. If this Saturday a number of Leicester residents get in their cars, what powers to the police have to prevent them from going to Loughborough, Derby or Sheffield to be able to go into a pub? Clearly, at the moment, local authorities do not currently have the powers to stop them: their powers relate only to single buildings. But if the Secretary of State believed on Monday that there needed to be legislation, why not today?

This feels very much like policy by press release, and local legislation enforcers, whether they are police or local authorities, need to know what powers they have as a matter of extreme urgency. I also ask again, why will Ministers not give the powers of local lockdown to local authorities and directors of public health, obviously working with Public Health England, the NHS and Ministers? For any final decision to rest with the Secretary of State inevitably slows down processes, as we have seen in the Leicester case over the past three weeks. Above all, we must keep people safe.

Finally, will the Minister inform the House whether there is sufficient supply of PPE in Leicester and other areas where cases are increasing for hospitals, primary care, care homes and care in the community? The Health Service Journal reports today that there is still much panic buying of PPE, with some orders costing 10 times the amount that would have been paid before March.

This Saturday marks the lifting of lockdown for most of England except for those of us shielding and the people of Leicester. Will the Minister ensure that the wider public will remain safe with the increases in cases in at least 35 other local authority areas? Will the Government move much more quickly to ensure that public safety is guaranteed?

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

My Lords, I thank the noble Baronesses, Lady Thornton and Lady Brinton, for their thoughtful questions. To answer directly, it is extremely important that we are currently here debating the outbreak in Leicester, because in a way it is a tribute to the success of the hygiene, isolation and social distancing strategy that has borne so heavily down on this disease that we are now in the position of focusing on those rock pools of the epidemic that have been left behind by the tide of this disease going out. But I completely accept the importance of this outbreak management. That is where the Government’s focus is centred.

I reassure both noble Baronesses that the data that local authorities and local directors of public health require is being given to them and access is being provided. All local authorities were issued with data-sharing agreements to access personally identifiable local testing data on 22 June. After signing those data-sharing agreements, the first local authorities accessed the data on 24 June. Leicester accessed it with its log-in details on 25 June. An enormous amount of progress is being made in an area that is now very much our focus. Local authorities, public health directors and infection control teams have worked hard in the past few weeks knuckling down on those lockdowns that did not get away, on the local outbursts that were well managed and that have not hit the headlines and that are now falling lines on the epidemiological graph.

The noble Baroness, Lady Brinton, asked about the legal aspect. I reassure her that the lockdown in Leicester is being carried out under the Public Health (Control of Disease) Act 1984 at the request of the local authority as the provisions of that Act require. Therefore, regulations will not be brought to this House. The Secretary of State and the Government have sought to manage the epidemic through the consent of the people, not through making things mandatory. That has been our consistent approach because trust and collaboration are at the heart of this country’s response and we do not believe that making things mandatory through regulation will be as effective. However, if regulations are necessary, we will bring them to bear in order to protect lives and save the NHS.

I pay tribute to the British people for their enormous collaboration and the huge sacrifice that many have made in order to put in social distancing and other necessary measures. I pay tribute to the shops, pubs, churches and other venues that are working so hard in order to apply the necessary regulations for reopening on 4 July, which will be an incredibly important but worrying experiment in opening up our society.

On further lockdowns around the country, none is currently planned. Our profound hope is that none will be necessary. Our severe fear is that they will be, because epidemiological experience suggests that a virus that has a doubling rate of two or three days very quickly spirals out of control in geographical focal points. But we remain incredibly vigilant, and the focus of our effort is to use the necessary data to identify outbreaks when they happen and to move epidemiological resources into place in order to deal with those outbreaks.

On further data, we hope to make announcements shortly in order to get the most local data open to the dashboards available to local authorities and public health officials in the very near future.

The noble Baroness, Lady Thornton, asked about the involvement of the Mayor of Leicester in decision-making in Leicester. I reassure the noble Baroness that he was very much at the heart of all the analysis, the meetings with PHE, the gold meetings of the JBC and the process of agreeing the lockdown arrangements. That is entirely right and proper for such a situation.

The noble Baroness, Lady Brinton, asked about PPE in social care. I reassure both noble Baronesses that the measures in place to manage imports and the manufacture of the necessary domestic PPE have proved to have a huge yield and at the moment our RAG rating is extremely positive on PPE for all aspects of the healthcare system.

Personal Protective Equipment

Debate between Lord Bethell and Baroness Brinton
Wednesday 24th June 2020

(2 months, 3 weeks ago)

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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell [V] - Hansard

My noble friend is entirely right that having adequate stocks on hand is important, but having line of sight is also important. Individual trusts are able to make their own decisions on whether they wish to have stockpiles on the premises or a flow of supplies from their suppliers. At present we are working on supporting the trusts in their decisions on this matter.

Baroness Brinton Portrait Baroness Brinton (LD) [V] - Hansard

At yesterday’s Home Affairs Select Committee, Dr Jane Townson of the United Kingdom Homecare Association said that domiciliary and personal care workers are still struggling to get access to testing and PPE because the system is not designed for care at home, which means that infection control is almost impossible. Will the Minister undertake as a matter of urgency to review home care workers’ access to testing and PPE to protect them and their clients?

Lord Bethell Portrait Lord Bethell [V] - Hansard

The noble Baroness is entirely right to emphasise the importance of getting home care workers adequate supplies. The expectation is that the majority of social care providers, including home care providers, would continue to access PPE via their normal wholesale suppliers, but we are rapidly overhauling the way in which PPE is delivered to care homes and domestic care supplies, including through emergency dispatches via the pilot e-portal and the national supply disruption response.

Coronavirus

Debate between Lord Bethell and Baroness Brinton
Monday 22nd June 2020

(2 months, 4 weeks ago)

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

My Lords, I pay tribute again to those at KCL who developed the symptom-tracking app. The information from it has been enormously helpful over the last few months. In many ways we have benefited from the app’s independence as a source of important front-line intelligence. I am aware of the letter written to the Prime Minister, and I hope very much that we will be able to work more closely together. The information on asymptomatic references is very important. However, I stress that the ONS study suggests that, unfortunately, many people who declare the symptoms of coronavirus are mis-self-diagnosing, and we have to bear that factor in mind.

Baroness Brinton Portrait Baroness Brinton (LD) [V] - Hansard

Following last week’s Urgent Question, the Secretary of State responded to questions about new outbreaks in local areas and local authorities not being given access to all the necessary data. He said:

“We have provided more data to them, and we will continue to do more.”—[Official Report, Commons, 17/6/20; col. 810.]

I am still hearing from local authorities that the data sent to local areas is still incomplete, which means that vital urgent local tracing teams are trying to do their job with one hand tied behind their back. This includes the outbreak at the meat-processing factory in Kirklees. When will local authorities and directors of public health get the data they need?

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness, Lady Brinton, is right that the creation of a seamless network between the centre and local authorities is challenging. A huge amount of work has gone into refining the accuracy and speed of the exchange of data, and the joint biosecurity centre is investing a huge amount of effort in getting this right. The responses to Kirklees, Leicester and Cardiff show the progress that has been made, but also some of the shortcomings. We are fully aware of the challenge and difficulty of getting this right; we are very much focused on it and it is our top priority.

Covid-19: Mental Health

Debate between Lord Bethell and Baroness Brinton
Tuesday 16th June 2020

(3 months ago)

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Lord Bethell Portrait Lord Bethell [V] - Hansard

My Lords, the noble Baroness, Lady Thornton, raises an important point on the mental health of young people. A primary concern is the effect that the epidemic has on young people, at a delicate stage of their development. However, the return to schools is a very delicate matter. It requires the confidence of both parents and young people. We do not want to create further distress or concern. Therefore, we are taking steps in a thoughtful and measured fashion, to ensure that both pupils and parents are confident about the journey back to school.

Baroness Brinton Portrait Baroness Brinton (LD) [V] - Hansard

My Lords, research led by Louisa Codjoe at King’s College London on tackling mental health inequalities found that BAME people are less likely to contact their GP about their mental health, to be prescribed anti-depressants or to be referred to a specialist mental health service. Any failures by the professional health services lead to fear and mistrust among the community, perpetuating a cycle of poor access. How do the Government plan to prioritise access for BAME communities and training for GPs to overcome these barriers?

Lord Bethell Portrait Lord Bethell [V] - Hansard

The noble Baroness, Lady Brinton, is entirely right to raise the issue of attendance. One of the greatest concerns during the epidemic is the declining attendance at mental health services, at primary care level and in hospitals. We are working hard on that. Last week, we launched the first aid kit for psychological first-aiders. Public Health England has launched this important resource, and it is indicative of the kinds of measures we are putting in place to address the inequalities of which the noble Baroness speaks.

Covid-19: R Rate and Lockdown Measures

Debate between Lord Bethell and Baroness Brinton
Tuesday 9th June 2020

(3 months, 1 week ago)

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

The London School of Hygiene & Tropical Medicine’s report is one model of more than a dozen that contribute to the SPI-M committee, which looks at modelling. We value it, but it is not the only model. Regarding the statistical analysis of R, I pay tribute to the Office for National Statistics, which has put in place a massive testing programme to look at prevalence across the country. Hundreds of thousands of tests are done. This is by far the gold standard in terms of understanding prevalence and it feeds in accurate, up-to-date information for the accurate assessment—not modelling—of R0. It is on that work that we depend.

Baroness Brinton Portrait Baroness Brinton (LD) [V] - Hansard

On 3 June, my noble friend Lord Scriven asked the Minister which body had legal powers to implement a local lockdown. The Minister replied:

“The arrangements for local lockdowns are not fully in place. In fact, the policy around them is in development and a full decision has not been made”.—[Official Report, 3/6/20; col. 1428.]

Five days on, local authorities and directors of public health are reporting publicly that their hands are tied without the postcode data they need or the specific powers for lockdown. When will this vital decision be made so that flare-ups of Covid can be stopped?

Lord Bethell Portrait Lord Bethell [V] - Hansard

The work is being undertaken at the moment. Rather than focusing on local lockdowns, we are focusing on local action plans with a wide variety of measures, perhaps including behavioural changes as well as clinical and diagnostic interventions. It is only by working across the piece that local actors, such as local authorities, directors of public health and local infection directors, can implement the right array of measures. That holistic approach is the one we are pursuing.

Exercise Cygnus

Debate between Lord Bethell and Baroness Brinton
Tuesday 9th June 2020

(3 months, 1 week ago)

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Lord Bethell Portrait Lord Bethell [V] - Hansard

My Lords, I admit that my briefing is not entirely specific, but it is my impression that operation Cygnus did not address the question of ventilators. One of the distinctive characteristics of Covid was the pneumonia response, which required an unanticipated and dramatic increase in our need for ventilators. That is one of the reasons why there was a global shortage of this key equipment. I have addressed this with the notes I have before me and will be happy to correct it if I have misunderstood.

Baroness Brinton Portrait Baroness Brinton (LD) [V] - Hansard

The Minister has asserted that my noble friend Lady Jolly misrepresented Cygnus, but she and other noble Lords have quoted from it. The Minister said earlier that “nothing could have prepared us” for something of this severity. Surely the point of pandemic preparation is also to watch what is happening elsewhere, such as in China and Italy in January and February. Why was the government response so slow to adapt to the needs of Covid as it emerged?

Lord Bethell Portrait Lord Bethell [V] - Hansard

The noble Baroness conflates two separate matters. The National Risk Register of Civil Emergencies is updated regularly and assesses civil emergency risks with a five-year horizon. The ongoing monitoring of risks in overseas countries is done in a different manner. I was trying to convey to the House that operation Cygnus was a rehearsal for a flu pandemic, not for the kind of virus that Covid proved to be.

Covid-19: Obese and Overweight People

Debate between Lord Bethell and Baroness Brinton
Thursday 4th June 2020

(3 months, 2 weeks ago)

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Lord Bethell Portrait Lord Bethell - Hansard

The noble Lord makes a good case. Chapter 2 of the obesity recommendations makes it very plain that clear labelling and data play a critical and pivotal role in helping people to make choices, but so do interventions on the actual content on the food. We will look at both of those for future options.

Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

Section 8.3 of yesterday’s PHE review on disparities and Covid demonstrated very clearly that Covid, obesity, hypertension and diabetes type 2 were all severely raised for the BME community. Given that the Minister said in the House yesterday that this review was just the first step in understanding Covid in our BME communities, what urgent guidance is going to our primary care sector to advise our BME communities on what they need to do?

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness, Lady Brinton, is entirely right. The review has done an excellent job of laying a path for greater understanding of the disease and is informing the PHE response. GPs already have a very clear work plan for advising BME communities on the threat of diabetes, in particular, and on obesity and healthy living for all circumstances. This will be redoubled during the epidemic that we are experiencing.

Covid-19: Response

Debate between Lord Bethell and Baroness Brinton
Wednesday 3rd June 2020

(3 months, 2 weeks ago)

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Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

My Lords, I too thank the Minister for the Statement. From these Benches, we send our condolences to the family of Lord Rea; he will be missed. I also repeat the support from the Liberal Democrat Benches for everyone working hard to help contain and reduce Covid-19, from the magnificent front-line staff in the NHS and the care sector to all key workers, whether visible to us or not: we know that you have given your all. We also send our condolences to all those who have seen the death of families and friends over the last four months.

The World Health Organization has insisted repeatedly that no country should start to lift lockdown until Covid-19 is no longer in the community. With the noble Baroness, Lady Harding, confirming that there are still over 8,000 new cases per day, clearly it is still in the community, and WHO also says that lockdown should not be lifted until a full test, trace and isolate process is in competent operation across the country, which it is not.

Can the Minister explain why Ministers took the decision to start the process of lifting lockdown even though the Chief Medical Officer refused to allow the threat level to reduce from four to three? Unlike other European countries, which started lifting lockdown only when the daily death rates were below 10, today the department reports a total of 359 people died in the UK in the last 24 hours. Why was the shielding advice changed over the weekend, and why was no guidance sent out to GPs, care homes and clinical groups? I can confirm, as someone who is shielding, that I still have had no advice, by text, by letter or by telephone, on what I should be doing now that the advice appears to have changed. What can the Minister do to reassure people who are shielding that this is safe advice?

What steps are the Government taking to prepare for flare-ups of cases in our communities, and, worse, an early second wave? Will the care sector be involved in that preparation, given that they appear to have been left to hang out to dry in order to protect the NHS? I understand that unlike hospitals, the care sector has not been approached at all yet.

In the Statement, the Secretary of State refers to the publication of the Public Health England report on disparities and the risks and outcomes of Covid-19. The Runnymede Trust summarised the problems with the report, saying that there were not

“any recommendations on how to save BAME lives.”

What specific guidance is being provided to the NHS and care sectors to protect BAME staff in high-risk Covid-19 areas? Can the Minister comment on the report from the Western General Hospital that BAME locums were disproportionately placed on rotas in coronavirus-intense wards, and that the hospital has experienced a recent and very large spate of cases?

Yesterday, the Office for National Statistics wrote its second letter in four weeks to the Secretary of State, challenging him in the bluntest terms and accusing him of obfuscation and confusion on the number of daily tests carried out. Can the Minister give the House a date when we will be able to see real and consistent data on testing, approved by the ONS, back- dated and adjusted, so that there is no room for any misunderstanding?

I return to the issue I have raised repeatedly with the Minister: the care sector. At the weekly APPG on Adult Social Care update today, we heard again from across the sector that it still faces a number of problems, some of which the noble Baroness, Lady Thornton, outlined. To be clear—before the Minister responds again, saying that this is just anecdotal evidence—we were told that this is happening in a large number of care homes and settings in wide areas right across England. This is not a one-off.

First, a number of CCGs are still pushing care homes to take block-bookings of patients coming out of hospital without having had Covid tests. The Prime Minister and Secretary of State have repeatedly said that this has never happened. It has happened and is still happening. When will it stop?

Secondly, on PPE, the care sector says that the Clipper system is finally starting to be rolled out across the country—a mere eight weeks after your Lordships’ House was told that it was only a handful of days away. However, care homes report that deliveries are still only a portion of their original orders, meaning homes still have to make decisions about rationing. Can the Minister provide a date by which the care sector will receive all the PPE it orders and needs?

Thirdly, the Minister told us that all care homes would be offered tests by 6 June. I repeat my question from two weeks ago as to why some homes are excluded from the portal so that they cannot access tests. These are homes for learning-disabled adults and disabled people under 65. Given the worrying comments on the inequalities data in the PHE report, when will this change?

Fourthly and finally, I echo the points made by the noble Baroness, Lady Thornton, about it being essential for all health sector staff to be able to access repeat testing to keep people safe. While it is true that it is happening for NHS staff, it is not true that our care homes or staff working in the community are able to access regular testing. Can the Minister please provide a date by which staff in care settings will have regular testing? This is vital because there are so many asymptomatic cases. They need parity with the NHS.

I recognise that I have asked a large number of specific questions and hope that, even if the Minister cannot answer them now, he will be able to write to me and others taking part in the Statement. Perhaps he could also answer any of the questions from the noble Baroness, Lady Thornton, if he cannot answer them now.

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

My Lords, I start by echoing the words of both noble Baronesses and give thanks for the contribution of Lord Rea to the House. I did not know him well but have read the many testaments to his work. He clearly lived a full life and made a massive contribution to the House, for which we should all be thankful.

I echo the noble Baronesses and give a moment of thought to all those who have had deaths in their family and among their friends. I have lost both an aunt and a godfather to Covid in the last few weeks; my family has not been untouched, and I think—

Covid-19: Care Homes

Debate between Lord Bethell and Baroness Brinton
Wednesday 20th May 2020

(4 months ago)

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

My Lords, the issue the noble Baroness raises was recognised in the very early stages. The problem of itinerant staff who move from one resident or patient to another was always going to be one of the most difficult to tackle. They perform an absolutely vital role in the care of non-domiciliary patients. That is why we put more money in to pay for more staff, provided PPE for the staff who were working and continue to upgrade the testing arrangements for both staff and patients, to ensure that they are protected.

Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

Yesterday, Professor Dame Angela McLean said testing had been prioritised in the NHS over care homes. Today, Justice Secretary Robert Buckland said the Government had prioritised the NHS over care homes as well. Yesterday’s Health and Social Care Select Committee also heard members of the care sector report continuing and widespread problems with PPE—chaotic, unreliable and extremely expensive, with the Clipper system promised two months ago still not rolled out. When will the Government ensure that our care sector gets the urgent priority support outlined in the Government’s social care action plan on 15 April, needed to keep residents and staff safe?

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness is quite right to focus on the importance of social care, but I think she unfairly characterises the effort made to ensure that social care is protected. The social care action plan announced on 15 April has been enormously important and extremely effective. Also on 15 April, we rolled out outbreak testing for all symptomatic care home staff and residents. We brought in extra funding on 16 April, with £850 million in existing social care grants. There has been new guidance and more money for local authorities, and we have launched a workforce recruitment campaign for care home staff. An enormous amount has been done. Care homes were always vulnerable, and we have sought to put every possible measure in place to protect them.

Covid-19: Response

Debate between Lord Bethell and Baroness Brinton
Tuesday 19th May 2020

(4 months ago)

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Department of Health and Social Care
Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

My Lords, I thank the Minister for the Statement. The ONS statistics this morning showed that over 44,000 people have lost their lives, with the Financial Times estimating that the total figure is now well over 60,000 when a percentage of excess deaths is taken into account. From these Benches, we send our sympathies to all bereaved families and friends, and our thanks and support to the amazing front-line staff in the NHS, social care and community sector, and to others in key roles working to save lives and keep people safe.

The Secretary of State began his Statement by talking about flattening the curve, but yesterday an article in the British Medical Journal said:

“What is clear is that the UK’s response so far has neither been well prepared nor remotely adequate … Above all, the response to covid-19 is not about flattening epidemic curves, modelling, or epidemiology. It is about protecting lives and communities most obviously at risk in our unequal society.”

We agree.

I echo the points made by the noble Baroness, Lady Thornton, about the acceptance, at last, by the Government of a third symptom, anosmia, but many other countries have more symptoms. France says that you should self-isolate if you have any symptom on a list of 10. Why do our Government still refuse to increase that list?

The Secretary of State has repeated his claim that he has prioritised testing in care homes, yet he still repeats that testing for everyone in care homes, whether staff or residents, will be only “offered” by 6 June. The Adult Social Care APPG is still hearing of care homes waiting for that “offer” of tests, and of others that have had tests but results still going astray or taking 10 to 14 days to be returned. On that basis, if Ministers are really prioritising care homes, why does the Statement announce testing for members of the public over the age of five now while people at the heart of the firestorm of Covid in care homes still have to wait up to two weeks before being offered a test?

Still on testing, can the Minister tell us the percentage breakdown of PCR testing results versus antibody testing results? If not, can he tell the House when this information will be publicly available? We need as many PCR tests as possible as part of an effective test, trace and isolate programme. How many of those carrying out testing are paid roles versus volunteers? A couple of weeks ago, the Minister told your Lordships’ House that testing would be extended through, among other things, a deal with Boots. Five days ago, Boots had an advertisement seeking volunteer testers taken down after public outrage that a company that had been given a commercial contract with the Government was relying on volunteers to carry out the work. Was using volunteers part of its tender to government? If so, does the Minister approve of companies using volunteers while pocketing public money in a contract?

On tracing, it is encouraging to hear that more than 21,000 tracers have been recruited, but today there are reports of people recruited receiving multiple emails congratulating them on being successful or attending online training that has completely fallen over and failed technically. Can the Minister say what percentage of those 21,000 have received full training and are now working as tracers? Last week, the Secretary of State said that local tracers would be used, whether local health or environmental health tracers, as well as central ones. Can the Minister say how many local tracers—that is, not Serco call-centre tracers or central NHS tracers—there will be from the 21,000?

The Statement asserts that the Government now have all the elements to roll out their scheme of test, track and trace, but I repeat that there is no focus on isolation for those who have to quarantine. Test, trace and isolate is used not just by the WHO but by many countries. What plans are in place to support people isolating, whether at home or in a quarantine unit, once lockdown is lifted? They will feel much more vulnerable at that point, when everyone else is moving back into their normal lives. Experience from Taiwan, Germany and South Korea shows that community health support for those in quarantine is more likely to make it successful. Again, countries that have been successful in containing the virus all had fully operational test, trace and isolate programmes up and running from day one. Given that each new venture the Government have undertaken during this crisis, as outlined in the BMJ article—from expanding PCR tests from a low base to manufacturing ventilators, supplying PPE and now the tracer app—has had a very problematic start, to put it kindly, are the Government starting to run full contact tracing now, using new staff in an area that has sufficient cases of coronavirus, before lockdown starts to be lifted but particularly by 1 June? It would be inappropriate for schools to return and people further to return to work without such a system in place.

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

My Lords, I thank the noble Baronesses for their penetrating and searching questions. I will go through them systematically.

First, I want to say a few words, partly in response to the appeal for transparency from the noble Baroness, Lady Thornton, and partly in response to some of the suggestions about the performance of the Government in their response to Covid. I assure the House that the Government approach this epidemic in a spirit of openness and transparency, and we would like to work in partnership with other parties. I simply reject the suggestion, consistent in some of the questions, that the projects undertaken by the Government have in any way been characterised by failure or disappointment.

I bear testimony to the huge achievements of those who have worked extremely hard to throw up remarkable schemes which have been enormously successful and massively mitigated the effect of this disease. The testing network, the ventilators, the lighthouse labs and the nightingale hospitals were all hugely ambitious ventures, greeted with scepticism when launched and accompanied by complaints while being thrown up. But their achievements have been enormous: they have had a huge impact.

I would therefore like to turn around the tone of this debate, to be a little more positive, and celebrate the huge achievements of those who have thrown their heart and soul into the response to coronavirus. I pay tribute to their achievements and to the personal sacrifices many of them have made by giving up their time, and even putting their lives at risk, to conduct these important roles.

Quite reasonably, both noble Baronesses asked whether the Government regard isolation as part of the programme. I can reassure them that isolation is absolutely the key point. The way to stop transmission is for those who have symptoms, and especially those who have tested positive, to shield themselves from the rest of society in order to prevent the spread of the disease. Everything that we do in the test and trace programme is ultimately to promote good behaviours by the British public, so that people who have symptoms will distance themselves from the rest of society, putting a brake on the disease. It is absolutely imperative, and at the heart of all our communications.

I pay tribute to the British public, who have made huge personal sacrifices during this lockdown. The culture of isolation will be an essential part of keeping a lid on the disease. The Government are committed to providing mental health support, and practical and cultural support, for those who are in a state of isolation. I thank both noble Baronesses for throwing a spotlight on that.

I want to convey to the House the enormous complexity of identifying the key symptoms of this disease. By any common sense, it would seem incredibly obvious how to spot Covid, but I have sat in numerous meetings running through the data and know how difficult it is to have a consistent set of symptoms that can be understood clearly and communicated simply to the public. The data on this disease is extremely complex. As I have said to the House before, this disease is a very difficult adversary, as characterised by the way in which symptom checking is so difficult. We have moved to a new and upgraded set of symptoms, and we may well have to move again. However, we are seeking to encourage absolutely anyone who has any symptoms to declare them and seek a test.

Perhaps I may move quickly through the questions put by the noble Baroness, Lady Thornton. I reassure her that the NHSX app is very much part of our plans. The Isle of Wight programme has been enormously successful and take-up rates have been huge. But it did teach us one important lesson: that people wanted to engage with human contact tracing first, and quite reasonably regarded the app as a supplementary and additional automated means of contact tracing. We have therefore changed the emphasis of our communications and plans to put human contact tracing at the beginning of our plans and to regard the app as something that will come later in support.

I reassure the noble Baroness that the testing of NHS and care staff is an absolute priority. Testing by the NHS of both groups is well under way. As announced by the Secretary of State, we are looking carefully at bringing in antibody testing to answer the question from staff who may query whether they have had the disease in the past, and to understand better what the role of immunity might be. The science is not firm; the lessons are not clear; but we need to understand the role of antibody testing and find out how it can help us combat this disease.

I advise the noble Baroness, Lady Thornton, to be very wary of private tests. They vary enormously in quality, as I know through my own experience. The time after having the disease when you take the test impacts enormously on the test and the assumptions one can make about a positive test are not proven. You cannot currently share with an employer any impression that you might have immunity, on the basis of a test.

I reassure both the noble Baronesses that our involvement with local groups in the tracing operation is being energetically promoted. We have appointed Tom Riordan, the chief executive of Leeds City Council, to lead this part of the programme. He is running an excellent programme to work with local authorities, directors of public health, environmental health officers and local resilience forums to ensure that our tracing system is as local as it possibly can be. It cannot all be done locally: some of it is better done digitally, and the highly automated routines of the app are very good. Some of it must be done at scale on a national basis by the massive call centres that we are throwing up, but some of it is best done by local groups. Those processes are being put in place energetically and I thank GPs, local directors of public health and all those who are engaged in them. We will be putting together local Covid plans that will be implemented by the relevant local authorities. These will form an important part of keeping a lid on this contagion.

I also pay tribute to those who are helping to organise the major test centres, including Serco, and those who have stepped up to take roles as contact tracers. They are going through complex training at the moment; it is a challenging task. No one wants to hit the phone and tell someone that they have to isolate; it is a tough message to have to deliver. I have no doubt that there will be problems with this complex and difficult task, but I pay tribute to those involved and express my gratitude to those running the programme.

On care homes, as the noble Baroness, Lady Thornton, rightly described, every death is a source of great sadness. However, I pay tribute to all those who have put their safety on the line by delivering tests in care homes. I reassure the noble Baroness, Lady Brinton, that there is a website where any care home that wants a test can register their interest and get a response promptly. Any care home worker who wants an individual test can access a site where, as a key worker, their test will be prioritised. There should be no reason why any care home or care home worker should wait two weeks, as suggested in the question.

I put my hand up and explained that mistakes were made 10 days ago when, due to problems with our Northern Irish test laboratory, some care home tests were either delayed or voided. That was an enormously regretful situation, but, when you put together an operation of this scale at such pace, some mistakes will be made. We have done an enormous amount to rectify those mistakes. Bringing in the noble Baroness, Lady Harding, to run the operational side of our testing regime is a great step forward.

I will also say a word in defence of the volunteers who are working at our drive-in test centres. These are often furloughed workers who do not need paid employment, but they are spending their time usefully and are often committed and have a sense of public service. I bridle at the thought that they would be sneered at or in any way insulted. The role of Boots in recruiting them is entirely honourable, legal and appropriate for the times we are in, and I very much thank those volunteers who have dedicated their time and risked their personal safety to do this difficult and possibly risky job. It is not appropriate to suggest that there has been public outrage at this arrangement—quite the opposite. The British public support this kind of individual public service.

The recruitment of tracers is going extremely well indeed: 21,000 have been put in place, which is way beyond our initial expectations, and the training is going well.

This programme is developing very quickly. We will seek to make announcements about it later this week and there will be a further rollout next week. I am extremely proud of the achievements that we have made, and I thank everyone who is involved very much indeed.

Care Homes: Covid-19 Testing

Debate between Lord Bethell and Baroness Brinton
Thursday 14th May 2020

(4 months, 1 week ago)

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Lord Bethell Portrait Lord Bethell - Hansard

My Lords, it is not true that the list of priorities did not include care homes. In every epidemic, care homes are always a priority. History has taught us that and we knew it from the beginning. We have focused on them enormously; that is why care homes are a number one priority at the moment. We are determined to reduce the rate of infection so that infection does not leak into the community.

Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

In a reply during Oral Questions earlier today to my noble friend Lady Barker, the Minister said that test results for the care sector are turned around within 48 hours. Yesterday, care home organisations told the APPG for Adult Social Care that many are not getting any results back—a big black hole—that those which do say that 10 days is not unusual, and that local resilience forums are not being allowed to get the results either. They cannot plan support. While 6 June is three weeks away, the crisis in our homes is now. Given his previous Answer, can the Minister give a date by which all care sector results will be returned within two to three days?

Lord Bethell Portrait Lord Bethell - Hansard

I think the noble Baroness casts the situation unfairly. There are undoubtedly cases where test results have taken longer. Last weekend, a laboratory let us down and we had some delays, but I pay tribute to the team who turned around a very difficult situation. By far the vast majority of tests are turned around within our target time, and we are currently trying to reduce that time by using mobile and satellite units to take the tests to residents. That work is showing great and encouraging signs of improvement.

Covid-19: Government Response

Debate between Lord Bethell and Baroness Brinton
Wednesday 6th May 2020

(4 months, 2 weeks ago)

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Lord Bethell Portrait Lord Bethell - Hansard

I welcome the noble Baroness’s questions on accountability. However, I remind her that not all Covid-related matters are covered by the department of health; Ministers have been in front of the House every day it has been open, answering questions on Covid, and they have given fulsome and thoughtful answers to questions and scrutiny. I welcome also her question on the eight-week review, which, as she says, is coming up in a fortnight. I will find out how the usual channels wish to mark that occasion in the House, and I would welcome the chance to submit the Government to scrutiny on the matter.

Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

From these Liberal Democrat Benches we echo the points made by the noble Baroness, Lady Thornton. We believe that lockdown should be lifted only using the WHO advice for “test, trace and isolate” to keep people safe. On 23 April, I asked the noble Lord, Lord Bethell, why “isolate” had been dropped from the Government’s slogan. He told your Lordships’ House:

“Turning to track and trace, I confirm that isolation is an absolutely intrinsic part of the track and trace regime: it just does not rhyme so well, so you never put it at the end, but ‘track, trace and isolate’ is the programme.”—[Official Report, 23/4/20; col. 166.]

Today, the Department of Health and Social Care’s Dear Colleague newsletter does not mention “isolate” in the context of lifting lockdown. Can the Minister say what evidence there is of a government plan for isolation, and how will we know that people are isolating, which is absolutely vital if we are to succeed in stopping transmission and keeping people safe? Although testing has increased it has not yet reached a consistent number of 100,000 per day, so what evidence is there for the Prime Minister’s new target of 200,000 per day by the end of May being delivered?

Lord Bethell Portrait Lord Bethell - Hansard

The Government’s commitment to isolation is spelled out clearly in guidelines published by Public Health England, and it is promoted every day with the Government’s “stay at home” slogan. On the 200,000-test aspiration, we have put in place a remarkable platform for testing. We have strong partnerships with important companies, we have sourced new supply chains of critical reagent swabs and other supplies that are in short measure, and we are making the logistical arrangements necessary for a massive expansion of testing. I believe that those will take us to whatever is necessary to meet the testing needs of the country.

Covid-19

Debate between Lord Bethell and Baroness Brinton
Thursday 23rd April 2020

(4 months, 4 weeks ago)

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Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

I thank the Minister for repeating the Statement and for his work on testing. We may have some difficult questions for him, but I hope I have the support of the whole House in saying thank you to him and his team for the work they are doing on this difficult area.

I too thank all the staff and volunteers in the NHS and the wider social care sector and other key areas who have been working during this crisis, whether directly on the front line or in supporting families and our children in schools. We send our condolences to the families of the bereaved, and are pleased that many people are recovering, even though we know that, if they have had it badly, it takes time. From these Benches, we echo the concerns about the high percentage of BME deaths, among workers and non-workers alike.

The Statement says that there are 3,000 spare critical care beds, but ITV reports that care home residents now account for up to half of Covid deaths. However, last week the Daily Mail reported that care home residents were still being asked to sign letters to say that they would not go to hospital in the event that they had Covid-19. Will the Minister confirm that these critical care beds in hospital are not spare? There are plenty of people in care homes who could use those beds but they have been put under pressure, no matter how gently, to sign the letters.

It is good to see the Nightingale hospitals coming on board—even if they are empty, for the right reasons. One of the concerns expressed has been about the staffing and the initial request that any patient had to have staff accompanying them from their previous hospital. Can the Minister say that this has now definitely stopped and that staff with appropriate critical care experience are able to be recruited? I gather that this has also been a problem for increasing the number of beds.

There was a good message in the Statement for people to go to their GPs and to use 999 for emergencies, but today there was a report of somebody who had a severe heart attack not being picked up urgently, as heart attacks are still second-level priorities to Covid. As a result of that 20-minute target rate, sadly the patient died. Is there any rebalancing of priorities for ambulances now that we seem to be over the peak of cases?

On equipment and medicines, it is good to hear that there are now just over 10,000 ventilators. Are they full ventilators, or does that include CPAP and BiPAP machines? How many more are to come? There have been some worrying shortages of medicines for those who need to be sedated, and recently we have heard news that there is a problem with kidney dialysis and kidney medicine for people who have come out of intensive care and require long-term support. Is there a shortage of such medicines, what other medicines are at risk and what proposals are there to remedy that problem?

We have spent many hours today talking about PPE. We are still waiting for supplies for everything outside hospitals. On 6 April, Clipper was heralded as being about to solve this problem, but it is still woeful. Until the social care and community sectors get the support they need, they will continue to be worried about the spread of Covid.

The Turkish ambassador has written to various people in the APPG on Turkey, setting out the actual arrangements—as opposed to those reported by the Government—concerning the delay in the package that appeared to get stuck. Turkey actually donated 250,000 pieces of medical protection equipment to us; the rest came through privately. Can the Minister say when the remainder of the consignment due from a Turkish supplier will arrive?

It is good to hear that formal arrangements for testing, tracking and tracing are now under way, but the WHO always puts in a third word alongside “test” and “trace”: “isolate”. Any mention of isolation in the Statement is notable by its absence. Taiwan, South Korea and Hong Kong have all managed to suppress further bursts of Covid because of the arrangements for not just testing and tracing but isolating. It is good to hear that an app will be available, but the Minister will know that there are people with technical experience concerned about whether it is appropriate to use Bluetooth for it, because of security issues. Can the Minister assure the House that this is not the case and that people’s data will be used only for NHS purposes and will absolutely not be able to be used by any providers of the app or beyond? The 18,000 tracers announced by the Secretary of State just before this Statement are a good start, but we will need more for good national coverage. Worryingly, Mr Hancock said a few days ago that all this will be operated centrally. Is that still the case, or will he use the existing trained tracers that there are in local communities, whether environmental health tracers in councils or in local health teams? It seems rather bizarre to try to cover the country on that level.

On shielding, it is good that there is a request to create more volunteers and to celebrate the volunteers, but notable by their absence in the Statement are the many people who have not yet had their letters on shielding and whether any further groupings may have to consider shielding—which I understand is the case.

I congratulate the Government on their progress on test and trace, but confirm that we are extremely concerned about supplies of equipment and medicine and hope that things will be remedied speedily.

Lord Bethell Portrait Lord Bethell - Hansard

My Lords, I greatly thank the noble Baronesses, Lady Thornton and Lady Brinton, for their extremely perceptive and thoughtful questions. I will answer them, in the words of the moment, at pace.

The noble Baroness, Lady Thornton, asked about BAME. The precise figures for BAME deaths are not to hand. PHE will have a very thorough investigation into this. It will come up with a scope and a delivery date shortly.

On isolation, one of the frustrating and awkward things about the virus is how unpredictable it is and how many unknowns there are. It confounds expectations. The question of isolation remains one for which we are reviewing our advice. We are in constant contact with other countries to learn more about best practice.

On the European project, I make it absolutely 100% clear that there was a cock-up, not a conspiracy. There were emails from Europe to us that were missed; there were meetings that our side missed. It was a great shame that that opportunity was missed, but we have put in place the processes and arrangements to work with our European partners on future procurement if they are helpful to the NHS and our care system.

The noble Lady, Baroness Thornton, is quite right to ask about capacity and testing. The blunt truth is that infection rates have gone down dramatically. The lockdown has had a profound impact. The KCL infection rate graph has gone from 2 million to half a million. That has a profound effect on demand for tests. Access is no longer a problem. At 5 pm, on the No. 10 presser, the Secretary of State explained how key workers can access a test for themselves. A major advertising campaign will begin tomorrow. They can either attend the drive-ins or Amazon will deliver a test to their home. Therefore, for those without a car, travel is not necessary. That capacity will be essential when we build the kind of track and trace capability that we will need to take us out of lockdown.

The noble Baroness, Lady Thornton, asked about postponed treatments. I echo her sentiments entirely. It is of grave concern that the numbers of non-Covid deaths can be worse than of those who die of Covid themselves, as in any epidemic. The message in the Statement is crystal clear: if you need treatment, contact your GP or your hospital. We will do everything we can to give you the treatment that you need. We are trying to use this hiatus to clear some of the backlog. The noble Baroness mentioned cancer. That is a particularly tricky problem because those cancer patients in treatment who have challenging immune systems will not wish to attend hospitals where there is Covid. We are doing all that we can to try to make arrangements and provide hygienic arrangements for them.

The noble Baroness, Lady Brinton, asked about care beds. Let me slay one myth: the ONS is very clear about the proportion of deaths at care homes. It is 10%. It is an offence to misrepresent the cause of a death. Causes of death are reported to PHE. The CQC carries that information to the ONS. These are reliable figures and I would be glad to send those who suggest that it is more than that the details on the ONS website. There is no pressure on anyone to be in a bed that is not recommended by strong clinical advice. It is true that we have spare hospital bed capacity, but it is not true that we are pressurising anyone to stay in a care home who should be in a hospital bed.

The noble Baroness, Lady Brinton, raised the question of medicines. That is an area where our supply chains have been put under extreme stress. Suppliers in China, India and America have all been under pressure and we have been in conversation at government and corporate level to ensure we have supplies. The noble Baroness is right that some of the first-choice medicines for sedation have been in short supply, but there are ample and various back-ups for those medicines. She is right that a feature of the Covid disease, is, it seems, that it attacks the kidneys and there has been a big increase in the need for kidney dialysis and the drugs associated with it. We are putting in place the supply chains necessary to fill that need.

As for the Turkish ambassador, I am not going to give a blow-by-blow account of every plane and truckload of kit that comes to Britain; all I can say is that we are extremely grateful to both the Turkish ambassador and to our Turkish corporate providers and we find the scrutiny they have been put under unfortunate and regrettable.

Turning to track and trace, I confirm that isolation is an absolutely intrinsic part of the track and trace regime: it just does not rhyme so well, so you never put it at the end, but “track, trace and isolate” is the programme. I have been given a thorough briefing by the Taiwanese CMO on their use of track and trace and, having a Taiwanese wife, I can tell noble Lords that I am up to speed on their achievements in that area.

On app security, I assure the House that the Bluetooth we are using is the latent, not the overt, Bluetooth: data is not carried in the same way as in overt Bluetooth, and one of the reasons we have chosen that method is the strong security offered. I also reassure the House that we have strong data arrangements. It is one of the reasons we have gone for a latent Bluetooth technology, and no data will be shared with our technology providers.

Lastly, the noble Baroness, Lady Brinton, is entirely right to raise the tracing part of track and tracing. I reassure her that we will be using a variety of different methods. There will be a central bank of callers. We will also be using local resources where they are necessary, and we will also be using friends networks. We have learned from the best case studies from abroad that often the influence of friends in persuading people to isolate has the most profound effect.

Covid-19: Personal Protective Equipment

Debate between Lord Bethell and Baroness Brinton
Thursday 23rd April 2020

(4 months, 4 weeks ago)

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Lord Bethell Portrait Lord Bethell - Hansard

My Lords, it is not correct that Turkey was asked to intervene only at the last minute. We have been in constant, daily and regular contact with the Turkish Government. We are grateful to the Turkish Government for their help and involvement and we continue to work with Turkish companies on this order. On the NHS’s requirement, this virus undoubtedly requires much more protection than any other disease that we have encountered. The demand for PPE will continue to rise. We will meet that need through our Make programme and continued strong relationships with foreign providers.

Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

My Lords, Methodist Homes has reported the deaths of 250 residents and two staff from Covid-19 since the beginning of the outbreak. Last week, it was forced to buy 200,000 face masks for £200,000—five times the going rate. The current government allocation is 300 masks per home per week, when the reality is that they need over 1,000. The system for providing support for our care homes, which are really struggling—they are actually now the focus of the outbreak—is just going from bad to worse. Can the Minister please tell us exactly when homes will receive the PPE that they need?

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness is entirely right to commend the sacrifice of hard-working care workers who put their safety on the line and put themselves in harm’s way. She is also correct to allude to the challenge for care homes—15,000 of them—that have previously largely looked after their own procurement arrangements. This Covid disease presents an enormous procurement challenge. The Government have stepped up and are helping care homes in many ways. Nearly a billion items of PPE have been distributed in the last six weeks and we will continue our commitment to support care homes.

Covid-19: Medically Vulnerable People

Debate between Lord Bethell and Baroness Brinton
Wednesday 22nd April 2020

(4 months, 4 weeks ago)

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Lord Bethell Portrait Lord Bethell - Hansard

My noble friend is entirely right that the political context in Britain is based on rule by consent. We are not an authoritarian state. However, I cannot hide from my noble friend the point that I made to the noble Lord, Lord Truscott: it is the virus that is a discriminator, not the Government. The clinical assessment of risk for many older people, particularly those with medical conditions, is very high. The Government will be guided by clinical advice in their advice and recommendations to all groups, although the effect of safeguarding and lockdown on the elderly is fully understood. We will put in as many mitigation measures as we can to prevent any long-term harm.

Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

My Lords, on 16 March the noble Lord, Lord Bethell, told the House that anyone with an underlying health condition will be contacted by their local GP to clarify what kind of risks they face. A very large number of people still have not had their letter or text from the Government saying that they should be shielding, let alone conversations with GPs. I am in the shielding group and my consultant has told me that I should prepare to be shielding for 18 months. Can the Minister confirm that everyone who should be shielding has now been notified by the Government and their GP that this is the case?

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness is entirely right. Letters should have been sent to all those who should be shielding. I am aware, as she rightly points out, that this process happened extremely quickly and there was a very fast turnaround. I have accounts of people who were sent a letter who should not have had one and I have accounts of people who should have had a letter who did not get one. We are working hard to fill the gap, but 1.3 million letters were sent out and, on the whole, I believe that this exercise has delivered clear recommendations to those involved.

Covid-19: Removal of Restrictions

Debate between Lord Bethell and Baroness Brinton
Tuesday 21st April 2020

(5 months ago)

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Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness is entirely right. I have spoken to Paul Nurse and commend the Crick Institute on the work it has done to build up the remarkable capacity of 2,000 tests a day. However, there are practical issues with the “Dunkirk spirit”. There are enormous logistical challenges in getting swabs and serology to laboratories. There are logistical problems with them registering the correct patient details and then getting the responses back. We have made substantial advances—the Crick Institute has been a pioneer in this—in bringing industrial levels of organisation both to the very large number of tests done each day and to the logistical backbone necessary to process those results.

Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

Yesterday, the World Health Organization said that Covid is not going to go away, there is not yet a treatment or vaccine and we have to be a Covid-ready society. It still says that any release from lockdown must involve testing, tracing and isolation. Can the Minister say whether there will be enough local sources for testing, comprehensive tracing and arrangements for isolation ready prior to any release from lockdown in the United Kingdom?

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness is entirely right. Tracking and tracing will be absolutely essential for keeping down R0, the transmission rate, when it comes to the implementation of our medium-term strategy. We are working extremely hard to dramatically increase our testing capacity. I assure the House that that capacity is growing enormously, at scale and exponentially. It is our expectation that it will easily meet the requirements of tracking and tracing. That tracking and tracing will be implemented by several work streams. The app already unveiled will be an important part of that, as will the PHE manual contact-tracing resources and the use of any other technological advances and innovations developed as part of this response to the epidemic.

Covid-19 Update

Debate between Lord Bethell and Baroness Brinton
Monday 16th March 2020

(6 months ago)

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Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

I too thank the Secretary of State and the Minister for the Statement. I also thank the Prime Minister, the Chief Medical Officer and the Chief Scientific Adviser for the press conference earlier, which laid out the new advice that we will have to take into account. I will come to this at the end of my comments, but I note in particular the advice to people over 70 and with underlying health conditions; I have been asking in your Lordships’ House for specific advice for about six weeks now—at last, it is here. A couple of points of clarification would be useful but it is extremely helpful.

I also thank all NHS and social care staff, public health officials in our local communities and other public servants who are all now working above and beyond even the emergency duty. We on these Benches recognise them across the country in everything they do. Our thoughts are with those who are currently ill and the families of those who have died.

I will not repeat much of what the noble Baroness, Lady Thornton, said, but I want to make the point that the past week has seen a big sea change in attitude among not just the public but many experts who may not be epidemiologists but certainly have an understanding of modelling. It is important to keep them onside by making sure that the modelling is published; I echo the concerns that that has not happened yet, although I note that Chris Whitty said that it would become available in due course.

I share the horror at the Daily Telegraph article being behind a paywall. Notably, some of the largest American newspapers are making every single article on coronavirus free so that the public can access it; I wonder whether we could encourage our newspapers to do the same.

On testing, which seems to be the big issue of the day, I had an email from a friend who has been in a hospital in London with a severe case of coronavirus. That person is recovering now, but it was noticeable that there was an astonishing lack of knowledge on the part of paramedics, NHS 111 and others that breathing difficulties were a symptom. It was assumed that she was having a panic attack, although she had never had one in her life before. It was clear that A&E was completely overwhelmed. There was not enough protective equipment, and the doctor who saw her said that when doctors themselves became sick at their hospitals they were told to self-isolate for seven days but were not being tested, so they did not know whether they were immune or infectious.

The doctor concerned was desperate, and said that testing seemed to be happening only in care homes and in hospital outbreaks. The whole system had been overwhelmed. According to the Health Service Journal, the Department of Health and Social Care has said that the regime is set up to provide testing, but at the moment it is unclear how it will be applied. More and more of the people we are asking to go on to the front line are feeling very exposed.

Moving on to some workforce issues, various airline companies have announced that they are in real trouble; I think everybody understands why. And they are not alone. From these Benches, I express real concern about the Prime Minister’s announcement today, in which he encouraged people not to go to clubs, cinemas, restaurants and theatres. That is likely to mean that many of those businesses will not be able to claim on their insurance, as they could if this was an instruction, as opposed to a guide. Can the Minister tell us why the Prime Minister used that framing? It will cause serious problems for many small businesses.

As for other money issues, it is reported that there is a very large drop in donations to food banks. What will the Government do to ensure that the many thousands of people who rely on food banks will continue to get the support they need, when most people are no longer dropping two or three items into the boxes as they leave the supermarket?

There was some debate recently, involving the House of Commons Library, about sanctions for those attending jobcentres. According to the Library report, Will Quince MP had said that there would be discretion, and that people would not be sanctioned as long as they let the jobcentre know before the appointment. There are two problems there. First, if someone is sick they may not be able to call in and spend the hours it takes on the phone to do that. Secondly, if staff at the DWP are ill, there may not be enough people available to take those messages. Surely during this crisis—the Prime Minister has made it plain how severe it is—sanctions should be stopped for everybody.

Finally, on the advice to the over-70s, I am grateful that Chris Whitty said this afternoon that anybody, adult or child, with an underlying condition, including anybody who had had to have a flu jab, should consider taking action, especially if they have respiratory problems. Can the Minister confirm that and make it clear? I understand that the message about flu jabs has just come down from the website, so I am concerned that there will be confusion. There is no doubt about people who are immunosuppressed, but will he please reassure people who use inhalers—that is certainly one of the categories on the Department of Health and Social Care website—that they will be included?

Lord Bethell Portrait Lord Bethell - Hansard

My Lords, I thank the noble Baronesses, Lady Thornton and Lady Brinton, for their testing but important questions. Let me go through them systematically. As there were quite a few, I will do it at pace.

I can reassure the Chamber that the CMO has committed to publishing advice. It is extremely complicated, because the models used by SAGE are the result of many different collaborators submitting papers to a central committee, so publishing something simple and robust that can be used by third parties is not as easy as it might initially seem. But that commitment has been made, and we support the commitment to transparency.

In answer to the question from the noble Baroness, Lady Thornton, about other countries’ data, I reassure the Chamber that there is an extremely strong spirit of collaboration between the countries of the world in fighting this virus. The Prime Minister had a G7 call over the weekend, in which there was a very strong commitment by those countries. That will begin a cascade of inclusion to other countries around the world in order to launch a real commitment to combating the virus. That spirit of collaboration is a powerful and encouraging dimension of an otherwise very difficult situation.

Both the noble Baronesses asked about tests: this is a really important question. The tests that we have are, rightly, being concentrated—as the noble Baroness, Lady Brinton, alluded to—on ICU units and care homes. The reason is that it is likely that those who show the most symptoms are also the most infectious. Therefore, the people who are most likely to catch the virus are those who are nearest those who have the strongest symptoms. Those include our healthcare workers, who not only deserve to be protected but need to be, in order to keep our health and social care system working. That is, therefore, where the tests are being focused.

It is also worth saying that, until the end of this week or next week, we are at the very tail end of the winter flu cycle when, if you have a cough or a cold, it could be any number of viruses. However, that is likely to change and, as we go forward, if you do have a cough and a temperature, it will be most likely that you have coronavirus and so the relevance of testing diminishes. None the less, we are working extremely hard to increase the number of tests available and the way in which we test will move to bedside instead of central testing. We hope to be able to develop an at-home test. I believe that there is news of that on the horizon.

The noble Baronesses, Lady Thornton and Lady Brinton, both asked about the media. I reassure the House that the article in the Telegraph was not behind a paywall; it was freely available from 11.20 pm last night. I can confirm that, if any noble Lord has any concerns about it. The Prime Minister has made a commitment to daily updates, in the company of his medical advisers. The public have clearly found that approach reassuring, and it will continue during this important phase of the virus.

The noble Baroness, Lady Thornton, asked about those with underlying health conditions and whether the definitions were clear. The noble Baroness, Lady Brinton, asked about flu jabs and whether those on the flu jab list would be contacted. I reassure both noble Baronesses that those on the flu jab list will be contacted by their GPs within the next few days. Advice will be given and, where necessary, health and care packages put in place for them. Those with underlying health conditions will be contacted by local GPs in order to clarify exactly what kind of risks individuals face.

Both noble Baronesses rightly brought up the question of the economy. This is an area of massive concern, not only to the Government but to everyone whose job and livelihood are threatened by a slowdown in the economy. Without doubt, the recommendation to close clubs, pubs, theatres and all manner of social gatherings will have a profound effect on the economy. The Chancellor has already committed billions of pounds to an economic fund to try to support those industries. Further work is being put into place to ensure that businesses can see this epidemic through.

Those who are homeless or in the gig economy will be the particular focus of measures. We are working extremely hard to change the system of statutory sick pay to include those who would not necessarily be captured by the usual arrangements. That work is still in progress, but we look forward to providing an update when the coronavirus emergency Bill is brought to Parliament on Thursday.

The noble Baronesses, Lady Thornton and Lady Brinton, asked about ventilators. These are clearly the key pieces of equipment that we need to combat the most profound effects of the virus. We have 5,000 in our stock and are working extremely hard to increase that number dramatically. Industry has responded extremely positively. We have been overwhelmed by the response from all parts of industry, from big, established companies to innovators, academics and those with good ideas for how to increase the number of ventilators. We were already in the market many weeks ago and have done a lot to shore up our supplies.

It is entirely right that any number of ventilators will not be any good if you do not have the staff to man them, so we are going about retraining existing clinical staff in how to use them. To give an example, on Saturday I sat next to a surgeon who has found that his operating theatre has been turned into a respiratory support unit. He and his anaesthetist are learning how to work the respirator.

The NHS undoubtedly faces a period of enormous pressure. There is no amount of special pleading that I can do from this Dispatch Box to hide the fact that front-line clinicians and support staff will be under huge pressure. They will take profound personal risks and they are being asked to deliver an important national duty. As I am sure that everyone in the Chamber does, I pay tribute to the work that they have already done and to the work in prospect on the horizon.

Lastly, the noble Baroness, Lady Brinton, asked about food banks. I reassure her that we have a full understanding of the challenge faced by charities—the collapse of not only food donations but financial donations. That is why special provision has been given to DCMS to provide funds for charities, which will play an incredibly important part in many aspects of this national effort, particularly in providing the kind of support to social care needed for those who face an extremely difficult time of loneliness and exclusion as they take the correct decision to socially distance themselves from this virus.

Coronavirus

Debate between Lord Bethell and Baroness Brinton
Thursday 12th March 2020

(6 months, 1 week ago)

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Baroness Brinton Portrait Baroness Brinton - Hansard

I apologise for using an inappropriate term. None the less, even yesterday the Secretary of State said that we were not in delay. I recognise that things are moving very fast, but it is worrying that the Government keep saying that they are following the clinical advice yet there seem to be some differences in this. That matters in the light of what is happening elsewhere in Europe. Whether we close schools is obviously down to the advice of Chris Whitty, who is an epi- demiologist. He has been clear that there are disadvantages as well as advantages. What we are concerned about is that it is beginning to feel as though the professional advice is differing slightly from the political advice.

I am very pleased that the Government have responded to the WHO news about moving to a pandemic, and this morning’s letter from Chris Whitty to all doctors is extremely helpful in setting out their roles in being flexible and having to do things differently. But we know that the Italians have struggled with the number of hospital beds in ITU, and of ECMO beds, ventilators and other specialist equipment. By the way, it is really good that China is now helping Italy out. Learning as a global community from one outbreak area onwards is excellent.

However, the data paints a worrying picture. Japan and Korea top the OECD table for hospital beds per thousand at 13 and 12; Italy has 3.2 and the UK 2.5. What is happening to ensure that we have the ITU beds and ventilators that will be needed for the more severe cases which, as the news from Italy has shown, has been very problematic? Last night, a former public health director, Professor John Ashton, said on “Newsnight”:

“We’ve got a complacent attitude … We’ve wasted a month. If this now spreads the way it looks as though it’s likely to spread, there will not be enough hospital beds and people will have to be nursed at home.”

I am afraid that there are still holes in the advice and action, especially in social care. I shall repeat the concern that yesterday no extra money was provided in the baseline Budget for social care. Also, while the Secretary of State made it clear that social care is being included in the emergency coronavirus grant, that is for adult social care only. I repeat the question that I and my colleagues in another place keep on asking: what about the most vulnerable children who are often on ventilators or, if not, they end up on ventilators if they get even a cold? If there is no extra resource for them, that is a real problem. Many parents are hearing that everything is about care for the elderly. Children may be asymptomatic, but these children will not be, so it is vital that they are given support. If the Minister cannot answer that now, I would be really grateful for a reply outside.

The Secretary of State talked in the Statement about everyone working together. As we move into the delay section, we already know that directors of public health, councils and other key stakeholders such as CCGs are doing fantastic work, but—as many of us know that communication between Public Health England and the directors of public health has been a problem—can the Minister reassure the House that those lines of communication are working effectively and being monitored by senior people in both the NHS and government?

I echo the points about the announcement of the public health grant. That is the Secretary of State for Health and Social Care’s responsibility. We are only a fortnight away from the new financial year. It is ridiculous that we do not have the details.

Will the Government relax appraisal and re-registration requirements during Covid so that we are fighting the virus and the specialists are not having to fill in paper the whole time?

Finally, where is the personal protective equipment for social care? It will undoubtedly be needed, not just in care homes but for those being nursed at home.

Lord Bethell Portrait Lord Bethell - Hansard

My Lords, I thank the noble Baronesses for those excellent questions. I will take them at some pace, because there were a lot of extremely worthwhile questions and I will try to answer them as best I can.

The noble Baroness, Lady Thornton, asked about advice. I would like to explain to the Chamber the effectiveness of the contact tracing that Public Health England has put in place. Nadine Dorries shared her diary with Public Health England officials. They have gone through an extremely thorough contact-tracing process and have identified those individuals most at risk. It is a feature of our strategy for dealing with this virus that we have put contact tracing very much at the heart of what we do. It has proved an extremely effective measure. I understand from the Chief Medical Officer that more than half of those positively identified as carrying the virus in the UK have been identified through contact tracing, which is an indication of how thorough that process is and how effective it has been.

For those who remain concerned, the guidance from 111 is that it is those who show symptoms who should present themselves for a test. Those who have been in proximity but are not currently showing symptoms should use common sense and isolate if they feel like it, but that is not the positive guidance from 111.

The noble Baronesses, Lady Thornton and Lady Brinton, both asked about containment and delay. The truth is that we are in a transition period. The CMO’s advice is that the virus will almost inevitably spread through the British population, but the testing statistics speak for themselves. On 11 March 2020, 27,476 tests had taken place and only 456 had tested positive. The simple arithmetic of that is that if you are ill and feeling poorly at the moment, you probably do not have coronavirus. We are still at the tail end of the winter flu cycle; many germs are still in circulation. As yet, although coronavirus has been identified in many places in the country, it is not turning up in a very high incidence or proportion of those tested.

We are not complacent about this; we take it very seriously indeed. We can see the storm on the horizon, but the question of timing is incredibly delicate. I understand the frustration and concern in this Chamber, the media and the general public that not enough is being done, but the science, modelling and guidance from those who study epidemics are clear that we have to get the timing right. When we do, we will move emphatically, clearly and in a focused way, but we have to get that choice right.

The noble Baroness, Lady Thornton, specifically mentioned schools. The evidence suggests that, thankfully, children are not strongly affected by this virus, if at all. It is not currently clear whether those who are infected are infectious. There are strong signs that if they are infectious, they are not very infectious. There needs to be a degree of sense when it comes to the infection. In the balance between the social and economic effects of closing schools and taking mums and dads out of the workplace versus the safety of the children, particularly the effects on clinical and care workers, the opinion of the Chief Medical Officer and those who advise him is that closing schools is not the correct option in the UK today.

The noble Baroness, Lady Thornton, asked about the LGA and social care associations. I will reassure her on two fronts. They are very much engaged in all our preparations. Money is very much on the table and the resources that they need to combat this virus will be there to top up their budgets. The same is true on public health funding: the CMO is actively engaged with directors of public health to ensure that they have the resources they need.

The noble Baroness also asked about inspections for care homes and recent submissions by those who run care homes. I assure the House that we are listening to all those organisations that have concerns about inspection regimes and meeting legal requirements when physical resources and resources of people and time are under huge pressure. We hear their concerns loud and clear and will be making realistic provisions about those inspections and legal requirements.

The noble Baroness asked about the charitable sector. I hear its concerns but hope that this incident will be a massive opportunity for communities to come together and for the charitable sector to play an important role in providing support in care and to clinical staff. Funding for the sector is being looked at by DCMS. I have been updated by the Minister concerned, who assures me that their plans are progressing and that engagement is happening in a very serious way.

The noble Baroness also asked about CCGs and shared her anecdotes about the pressures on CCGs. Let me be absolutely clear: pressure is inevitable. There will be huge pressures on the people and the resources at every level, particularly in front-line and primary care, but we are working extremely hard to ensure that they have the physical manpower and administrative resources that they need to meet the challenge. For example, the noble Baroness, Lady Brinton, asked about PPE suits. They are being delivered, if not this week then next week. We have listened to the concerns of CCGs about the provision of suitable protection resources, and deliveries are happening as we speak. I hope that the recent letter from the CMO provides the kind of clear guidance that CCGs have been looking for.

In terms of registration documentation, the noble Baroness, Lady Brinton, asked about those returning to work. It is a primary concern of ours, because the current arrangements for those seeking to return to work in front-line clinical roles are clunky and administratively onerous. The process takes a long time and is completely unsuitable for the challenge we have ahead. That is one of the important measures that we will be addressing in the week ahead.

Specialist beds are our primary concern. The experiences of China and Italy make it crystal clear that those who have severe respiratory responses to the virus are creating the greatest demand on resources and are at the greatest risk. We are doing everything we can to convert existing resources into relevant, suitable provisions for those who will need respiratory help, and we are working hard with the oxygen manufacturers and providers to ensure that we have the kit and the personnel to answer that need.

Both the noble Baronesses, Lady Brinton and Lady Thornton, asked about social care. I reassure the House that the financial provisions outlined by the Chancellor yesterday will include all aspects of social care, including those relating to children and the most vulnerable in society. Directors of public health will be included in decisions about how those financial resources are allocated.

Covid-19: Deep Cleaning

Debate between Lord Bethell and Baroness Brinton
Wednesday 11th March 2020

(6 months, 1 week ago)

Lords Chamber
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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell - Hansard

The noble Lord is entirely right that cleaning is important, but the kind of deep cleaning protocols he described are not those recommended by the CMO at this stage of the epidemic. The SAGE group of statisticians and epidemiologists is modelling the outbreak of the virus very closely. Its computer models track the behaviours of the virus, the demographics of the country and the behaviours of people in different circumstances. Its focus is to try to ensure that we channel all our efforts into effective measures and do not explore red herrings or distracting policies that might prove counterproductive or distract from effective measures.

Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

Can the Minister assist the House? He said just now that advice was published at the end of February on how to decontaminate non-hospital environments. It is extremely difficult to find; I have not managed to find it yet. It is clearly difficult for cleaning companies to find. One company in the UK which works across a number of our cities published its own advice to its cleaners which was taken from the Singapore standards. If people cannot find this advice, how on earth do they know what the NHS wants people to do in this country?

Lord Bethell Portrait Lord Bethell - Hansard

I completely take on board the noble Baroness’s observation. I have here a copy of the regulations and I am happy to lay it in the Library. It is on GOV.UK in exactly the place you would expect to find such guidance, but I take on board the comments. We are spending millions of pounds on public information and employer advertising. More will be done to ensure that this kind of information reaches the people who need it. I will ensure that the message is heard loud and clear.

Dementia: Accident and Emergency

Debate between Lord Bethell and Baroness Brinton
Wednesday 11th March 2020

(6 months, 1 week ago)

Lords Chamber
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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell - Hansard

The noble Lord is quite right to point out the delay in providing an answer on social care. That is why the Secretary of State for Health and Social Care wrote to Peers earlier this month, initiating a round of cross-party conversations and putting in the diary the beginnings of a process to pull together cross-party agreement. That cross-party agreement is essential to providing a long-term solution to this important problem.

Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

My Lords, I want to pick up on the point of the noble Lord, Lord Forsyth, about the lack of any extra funding for social care in the Budget. There was a reannouncement of just over £1 billion from before Christmas, but the Local Government Association states that social care generally needs about £4 billion to be able to maintain any sort of service to meet demand, which rises to £14 billion by 2030. Just saying that we are getting together to start to talk about social care problems is not enough. Where will extra money come from to remove people from hospital who do not be need to be there and to fund social care properly?

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness is entirely right to say that this is an important issue. Short-term funding has been put in place for the best possible short-term arrangement, but this is a long-term problem that cannot be solved by any Government on their own. It requires cross-generational and cross-party agreement. That is why an important and well-organised set of engagements has been initiated. It is timetabled, and the Government have committed to action in this area.

Health Protection (Coronavirus) Regulations 2020

Debate between Lord Bethell and Baroness Brinton
Monday 9th March 2020

(6 months, 1 week ago)

Grand Committee
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Department of Health and Social Care
Baroness Brinton Portrait Baroness Brinton - Hansard

In the past they have been on that register, and the big concern is the move from one department to another. If I am being told that that is not the case, that is not the feedback I am getting from directors of public health. As the Minister knows, I have other concerns about the relationship between Public Health England and directors of public health, which is why I asked for clarification.

Lord Bethell Portrait Lord Bethell - Hansard

I completely understand the point of clarification. If there is information available on what proportion of directors of public health are also public health consultants, we will share it with the noble Baroness. However, the way that the regulations are drafted at the moment means that the powers in the regulations are held not by directors of public health but by public health consultants.

Baroness Brinton Portrait Baroness Brinton - Hansard

I am sorry to interrupt the Minister again but the point is not about the register kept by Public Health England. My point concerns the definition of public health consultant—I am afraid that Hansard now has the relevant document, otherwise I would quote from it—and most directors of public health have to do that qualification because the job description, which is in the statutory guidance, says that they must be registered. That is my problem, and I know that it is clearly a problem for some of them as well. There is a bigger issue here. Should this become a pandemic and we see a large spike in numbers, we will need everyone qualified in public health to be able to do this, and there seems to be a problem in excluding the people at the heart of managing coronavirus within their wider communities.

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness makes a very reasonable point. My understanding is that this decision was made not on a personnel basis but on an administrative basis. We are seeking to restrict the number of people who are able to execute these potentially quite serious powers. Having a list of available people is a legally clear and responsible way of doing things, but creating a new administrative definition goes beyond the powers of these regulations. However, I have already taken on board the noble Baroness’s points about the role of directors of public health in this epidemic. Those points have been listened to and are being followed up, and I will continue the dialogue that we already have in place on that.

The noble Baroness, Lady Thornton, asked why the 2008 powers are not sufficient. The answer is that it is mainly for practical reasons. The 2008 Section 2A powers give local councils powers but mobilising local councils to do things, sometimes at the weekend, sometimes at ports where they are not necessarily administratively present and sometimes overnight, is administratively a challenge. We found that in practice during the containment at Arrowe Park, it was really Public Health England officials on the ground who dealt with the situation and who needed these powers both in their back pocket and in their administration of the situation. That is why we have sought to do this. It is fair to say that a lessons-learned review is expected in the years to come and this will be the kind of issue that we will look at again.

The noble Baroness, Lady Thornton, asked what the difference is between detention and isolation. Although I do not have the legal definitions in front of me, my understanding is that isolation can be in someone’s house—literally holding them away from the rest of society—whereas detention involves confining someone to a place that they cannot leave, such as a police cell or a jail. Both are covered in these regulations. It is worth saying that you could, for instance, seek to isolate someone in a hotel room near the Arrowe Park facility and that would be covered.

The noble Baroness also asked about magistrates’ courts. I reassure her that MoJ colleagues were fully consulted on this and they did not see a problem. The objective was to try to create a low bar for an appeal to make the appeal process as easy and accessible as possible, recognising that these are very serious powers and we want to make them as sensitive as possible. In terms of police involvement and whether the police would wear suitable suits, they absolutely would. Police officials are highly protective of their workforce. Public Health England is working closely with the police to ensure that they have both the guidelines and the kit necessary to protect the workforce.

On the term of the regulations, I agree with the noble Baroness that two years is longer than we hope or pray this virus will continue. However, the advice from the CMO was that we cannot necessarily plan for that. Viruses sometimes last longer than expected; they can create multiple strains, and it may take time to have the lessons-learned review and to bring in new powers. That said, it is also possible that a coronavirus Bill that overtakes these regulations will be brought to the House later this month and the sunset clauses would necessarily be included in that.

Coronavirus

Debate between Lord Bethell and Baroness Brinton
Monday 9th March 2020

(6 months, 1 week ago)

Lords Chamber
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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell - Hansard

My Lords, the noble Baroness has expressed concerns about those in residential homes and people with learning difficulties. The needs of all the most vulnerable in society are paramount. There is no doubt that intense pressure will be put on social services, social care and clinical care. We are doing all we can to ensure that support is in place, which will include the mobilisation of civil society, charities and volunteers to take up some of the pressure being put on those services.

On training provision, modern call centres have very flexible working arrangements whereby staff are brought on and off contracts. Those who have already received 111 training are being brought back on to the front line. The funds for that are properly in place.

On the timing of the peak, it is impossible to say with certainty when that will be, but the CMO is crystal clear: we will do everything we can to spread it out over the summer and we will keep this House and the public up to date.

Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

My Lords, I also thank the Minister for answering the Urgent Question. Going back to my point about advice for vulnerable people, it is good to hear that advice is finally planned, but vulnerable people need that advice now. I have been saying this in your Lordships’ House for about three weeks. Will the Minister please let us know when we are going to get it?

My second question follows up on the previous one about 111. In addition to the worrying report from the woman on the “Today” programme this morning who kept not getting return calls over a three-day period, despite a high temperature, cough and many other symptoms, we also picked up on people ringing 111 with clear symptoms being told that they cannot be tested because they cannot name an individual who has been diagnosed with coronavirus. I repeat the same question: are the new call handlers being trained effectively?

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness is absolutely right about the importance of guidance and I reassure her that an enormous amount of work is being done to draft clear guidance for employers, volunteer groups and all parts of society, which will include case studies, FAQs and detailed recommendations. That work is being guided by the CMO and senior officials at PHE.

As for 111, we look very closely at the metrics for the return of calls. Overall, the headline figures suggest that the 111 service is bearing up incredibly well under intense pressure, but I do not deny that there must be people who have had bad experiences. These pressures sometimes lead to poor results and we will keep a very careful eye on that.

Health: Lesbian, Bisexual and Trans Women

Debate between Lord Bethell and Baroness Brinton
Thursday 5th March 2020

(6 months, 2 weeks ago)

Lords Chamber
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Lord Bethell Portrait Lord Bethell - Hansard

My noble friend is entirely right to raise the issue of adult gender dysphoria. Delays in finding the right consultations are of concern to the Government. Those delays have an impact on the mental health of those concerned. It is a focus of the LGBT action plan, and I would be glad to update my noble friend as progress is made.

Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

My Lords, last year’s Women and Equalities Committee report, Health and Social Care and LGBT Communities, recommended:

“Training can be the first exposure that students have to LGBT health needs. All registration bodies should ensure that case studies … does not play into stereotypes. Registration bodies should develop these case studies in cooperation with local LGBT organisations.”

Can the Minister tell the House whether organisations are now following this advice?

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness is entirely right to ask about training, which is at the heart of our LGBT action plan. NHS England has funded the Royal College of Physicians to develop the UK’s first accredited training course on gender medicine and has developed online and video content to help to create the type of training we believe will have an impact. The training of the workforce and its awareness of LBGT needs will be at the heart of improvement in this area. That is why we are focusing our efforts on training.

NHS: Doctor Retention

Debate between Lord Bethell and Baroness Brinton
Wednesday 4th March 2020

(6 months, 2 weeks ago)

Lords Chamber
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Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness makes a very important point. It is clear that the lifestyles of clinical professionals in the NHS are changing. Many choose to take time off after their studies before joining practice and many seek to return after taking time out from professional front-line work. It is 100% the responsibility of—and in the interests of—the NHS to make that journey as quick and easy as possible.

Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

My Lords, last year the Health Foundation reported that there had been no progress towards the Government’s target of 5,000 extra GPs by this year, mainly because of issues of pay, lack of investment in learning and development, and the stress of the job. Can the Minister update us on whether that target will be met this year?

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness’s figures are not exactly the same as the ones I have. Last year, 3,250 students were studying to be doctors; this year there are 3,500, and next year there should be 4,000. Those are the numbers provided to me. If there is any difference between the two, I would be glad to discuss them with her elsewhere.

Coronavirus (COVID-19)

Debate between Lord Bethell and Baroness Brinton
Tuesday 3rd March 2020

(6 months, 2 weeks ago)

Lords Chamber
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Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

My Lords, on behalf of the Liberal Democrat Benches, I thank the Minister for repeating the Statement. We repeat our thanks to the staff of the NHS and the Department of Health and Social Care, as well as to all those working cross-department on preparing for the various possible outcomes in the event that this escalates.

We also echo the points made from the Labour Benches about No. 10’s announcement that we will not take part in the EU early warning system. It was clear from the media yesterday that the NHS and medical experts all say that we must be part of it. To have No. 10 say, “No, we won’t”—presumably because it has the dirty letters “EU” in it—is extremely unhelpful. Will the Government please review this position as a matter of urgency and, as they said in their Statement, take scientific and medical advice on whether we should be involved?

We welcome the two amounts of £20 million that the Government have put forward for research into Covid-19—the first for the Coalition for Epidemic Preparedness Innovations, but particularly the £20 million for Covid research here in the UK, including on epidemiology and treatment in hospital. Far too often we focus only on blue-sky research. This needs to be very practical and it is—these Benches welcome that.

I apologise for being a broken record on this. However, I am sorry to say that the advice for those who are either vulnerable or have underlying medical conditions is still not clear. The Minister and I have had an email exchange on this matter. The WHO and the American CDC still offer clearer advice to members of their public about what to do if you are either elderly or have underlying conditions than we do in this country, whether you are travelling abroad or in a community that may have some cases. Can this be beefed up? There is a statement in the action plan report that this will be strengthened in due course, but that will be once we get to mitigation.

There are already concerns in the medical and disabled communities about whether people should be shaking hands. I was somewhat concerned to hear the Secretary of State affirming confidently on television this morning that shaking hands was still fine. I am sorry: if you have an underlying condition, you do not want to be shaking hands with people. You should be washing, not doing that. Wearing hand splints, I have learned over the years to wave at people. It is much easier. Perhaps we could get a trend going with that.

We know that emergency legislation is coming up. That is heralded in the action plan. There are some concerns from our Benches on the extent of the mobilisation of retired and former staff. There has rightly been an emphasis on clinical staff. There will be questions that our Benches will look to have responses to. If people, particularly doctors, have been deregistered, perhaps because of retirement, will there be an expedited system, a reduced appraisal system, or a system to take people on who perhaps have not been reregistered but could work under supervision? It is important that these things are both clear and done at speed. But we are extremely concerned that there is no mention of people in other core parts of the NHS and social care system who are not clinical staff. The cleaning, catering and admin staff also keep the NHS and our social care system going. What arrangements are being put in place to provide extra support for them?

Once we move into mitigation and discussion about the possible closure of schools, surely it more important to keep schools open, even if there is only a reduced number of pupils in those schools, if the pupils’ parents are key workers—essential workers in the NHS, the police and other key areas. There is no sign that that has been thought about at this stage. It seems to us that this is an important point to cover.

Finally, after a nearly a decade in your Lordships’ House, I should not be too surprised when Ministers, particularly the Prime Minister, use very positive frames for things. The idea that the NHS will move out of a winter crisis into a landscape of delight once we get to the summer is extraordinary. We know that our social care system is at breaking point. The social care system was grateful for the £240 million provided by the last Chancellor in the autumn. However, the Local Government Association and almost every health think tank say that our current social care system is short of £2.5 billion now, without any impact from coronavirus. Of course, our social care system will have the patients most at risk of serious illness should coronavirus move into our communities. So, without heralding anything in the Budget, which I understand the Minister cannot speak about, can the Minister reassure the House that there will be serious support: for ensuring that there are no delayed discharges because there will be adequate support for social care in the system?

Lord Bethell Portrait Lord Bethell - Hansard

My Lords, I thank all the other parties for their spirit of collaboration and support during this awesome challenge. That was reflected in the debate last Wednesday and is reflected again today.

I start by reaffirming the commitment of this country and this Government to international co-operation. That co-operation is being led by British scientists, who were the first to crack the genome of this virus and who immediately published their material freely on the internet, which instigated a huge advance in the research being done around the world on Covid-19. Britain remains committed to the WHO initiative and is a very active leader and supporter. Our scientists are flying to some of the hardest-hit countries of the world. Without diminishing our own capability, we are very active contributors of intellectual, practical and personnel support to those in need around the world. I pay tribute to all involved.

On the EWRS, mentioned by the noble Baronesses, Lady Brinton and Lady Thornton, I reassure noble Lords that, in line with the withdrawal agreement, the UK has continued access to the EWRS during the transition period. We continue to share key updates with our European counterparts via this system. As set out in the UK’s negotiating mandate, we are open to exploring further co-operation between the UK and the EU on all matters of health security, including the exchange of information and expertise on infectious diseases such as coronavirus. We are open to exploring mechanisms for the UK and EU member states to continue to share and act on real-time alerts and information on new and emerging health threats, as currently carried out by the EWRS.

Regarding the Bill, as part of the Government’s plans, we are considering what additional powers may be needed to contain and mitigate the spread of the virus and to manage any impact. That Bill will be brought when it is needed; the timing and schedule have not been finalised.

The noble Baronesses, Lady Thornton and Lady Brinton, both brought up school policies. The noble Baroness, Lady Brinton, put her finger on a key and important point of the Government’s policy in this area. It is absolutely essential that services such as schools continue to be open for as long as they reasonably can be, so long as the medical advice supports that decision. Those who provide essential services, including social care and running the infrastructure of this country, depend on schools to be able to go to work. That is why the direction to school heads is, where possible, to keep the schools open. It is possible that, at some point in the future, as part of the delay strategy, the recommendation may change—but it would be done under the guidance of our medical advisers, and with strong epidemiological evidence that such a decision would make a profound difference to the spread of the virus. We are not in that situation yet, so the policy on schools remains, now and for the foreseeable future, that they should remain open where the medical advice confirms that.

On the question of a travel ban, it is true that this Government have not banned travel as some countries have done. That is based on the advice of our medical advisers, who suggest that trying to put in place travel bans to countries such as Italy would be like creating a medical Maginot Line; travellers will seek ways around the ban, tracing contacts will become impossible, and finding evidence of the origins of the virus will be lost in deception. Italy is one country that put in place serious travel bans around the world, and it is facing many of those challenges now with, sadly, a high rate of infection and challenges in tracing the origins of those infections.

Both noble Baronesses asked about sick leave. It is absolutely right that concern should be had for those who make the correct and responsible decision to self-isolate. Government lawyers have looked at sickness pay arrangements and it is very clear that those who self-isolate qualify immediately for statutory sickness pay. They may self-validate for seven days. After the seven days, they may seek an email confirmation of the diagnosis by dialling 111, thereby avoiding an unnecessary and potentially dangerous trip to either their GP or to hospital.

The practicalities of the gig economy, which were quite rightly raised in the debate so far, are challenging. There are provisions in the welfare system, and provisions among employers to behave generously, but this is an area that the Government clearly need to continue to review.

Tributes should be made to health staff, who provide absolutely essential support to keep our hospitals and surgeries open. It is, in fact, at times like this that one realises the profound and important contribution made by non-clinical staff. We owe it to them to provide generous and open-hearted arrangements, so that they can continue their work and, if necessary, self-isolate in financial security and confidence, and the Government are committed to reviewing those arrangements.

The noble Baronesses, Lady Thornton and Lady Brinton, both asked about social care. It is undoubtedly a concern that we all have for those who are older and more fragile—this virus is clearly targeting them. Provisions for social care are absolutely uppermost in the Government’s mind. A huge initiative will be made to recruit both professional and volunteer staff to support the social care industry during this period, when many workers will be self-isolating and support for people—whether they are in homes or living on their own—will be stretched. That recruitment is absolutely key to the Government’s plans.

Arrangements to ensure that that recruitment can include retired professional staff, who may have allowed their qualifications to lapse, may form part of forthcoming legislation, but I reassure the Chamber that the adequate management, supervision and scrutiny of those people will be maintained. This will very much include non-clinical staff as well as clinical staff—which, as I have explained, will be all-the-more important during an epidemic like this.

The noble Baroness, Lady Thornton, asked about funding. I reassure the House that, while the Treasury is carefully controlling the money spent, no clinical decision supported by medical evidence is being held back by financial considerations. The budget has been put in place and the moneys are available to do whatever it takes to manage this epidemic in a responsible and effective fashion.

The noble Baroness, Lady Brinton, is absolutely right to raise the issue of advice to those who are most vulnerable to this virus: those with medical conditions. It was one of the most moving moments of the debate, last Wednesday, when the noble Lord, Lord Davies, also raised it. I have taken these concerns to the CMO, whose office is looking at the modelling and the communications. It is absolutely a number one priority.

New communications are being put together. There is an issue with sequencing: it is the view of the experts that there is little point in seeking to mobilise behaviour change in people before it is required, in case they make those changes to their behaviour, feel that they are unnecessary, lose trust in the system and go back to their old behaviours. So the communication of some messages, the distribution of some advice and the recommendations from the Government need, at times, to obey the logical sequencing of this virus.

Clinical Negligence

Debate between Lord Bethell and Baroness Brinton
Tuesday 3rd March 2020

(6 months, 2 weeks ago)

Lords Chamber
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Lord Bethell Portrait Lord Bethell - Hansard

My noble friend is absolutely correct to emphasise the dangers of no-win no-fee arrangements, and in fact trusts have arranged for lawyers representing personal injury practices to leave the premises of trusts for that reason. However, the Government believe that the fixed recoverable costs consultation that ran in 2017 has powerful recommendations for tackling the issue which he describes, and we look forward to acting on the CJC report, published in October 2019.

Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

My Lords, so far, all the questions have related to costs and lawyers and the NHS side. The trauma to patients and to families of extended delays is significant, and some families, particularly in obstetrics cases, take five to 10 years to get a resolution. What will the Government do to speed up the process, keeping patients and their families in mind?

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness, Lady Brinton, makes exactly the right point. The human cost here is far greater than the financial one. How can it be right that a family that has been through the trauma of some major health disaster then has to stand in court and fight its case against lawyers? This Government are determined to seek to resolve that human cost. This area is extremely complex. Several models have been tried, but we do not have the answers yet. We are working hard to publish a strategy, but I assure the noble Baroness that the human dimension is absolutely uppermost in our considerations.

Wuhan Coronavirus

Debate between Lord Bethell and Baroness Brinton
Wednesday 26th February 2020

(6 months, 3 weeks ago)

Lords Chamber
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Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

From the Liberal Democrat Benches, I start by echoing the Labour Party’s thanks to the NHS, staff at the Department of Health and Social Care and other public bodies, and all the staff, clinical and non-clinical, working around the clock both in the UK and abroad in the FCO in countries where there are cases and UK citizens. I think that we all accept that this is a major continuing crisis. It is one thing for something to happen for two or three weeks, but we are now two months into this, and it is clearly continuing to increase.

I emailed the noble Lord, Lord Bethel, with some questions on the basis that we were all working here for some hours immediately before the Statement, and I hope that advance notice of them was helpful. Dr David Nabarro from the World Health Organization spoke on the “Today” programme this morning about the WHO’s overnight warning that the world must prepare for a potential coronavirus pandemic and that the WHO is beginning to be concerned that the outbreak could be “Disease X”, for which they have been preparing for many years. I also thank the World Health Organization and its staff, who are doing a brilliant job that is invisible to most countries—I shall return to that in one of my questions.

In previous Statements on coronavirus, I have asked other Ministers to explain why UK health advice always seems to be one step behind that of a couple of other countries—I refer specifically to CDC. I will give a personal illustration. I am due to go to Naples at the tail end of next week. I suffer from a long-term condition for which I take medication that suppresses my immune system. As a result, I come into that category of vulnerable people who need to think carefully, yet when I look at the World Health Organization website, the government website and the NHS website, I can find very little of clarity about what I should do as somebody in that condition. However, the CDC website is very clear.

So I ask again, as I have done repeatedly: what advice are the Government and the NHS giving to people regarded as being in a vulnerable position? My previous comment was about people so described who might live in and around Brighton when the cases surfaced there—what should they do and where would they get their advice from? Perhaps I am “asking for a friend”, but what is the position for people going to a country defined by the CDC at alert level 2? I think the UK is at that level, but we do not call it that. The CDC’s advice, in its key points box at the top, is very clear:

“Older adults and those with chronic medical conditions should consider postponing non-essential travel.”

I have seen it, and that is fine. I am sure that other professional travellers will be looking at it, but many people planning holidays will not know where to turn. They would normally go to the FCO website or the NHS website, and it is just not clear on those. In the Statement, the Minister referred to a public communications plan. Are there plans to set out exactly what people need to do? Will part of this communications plan be to make clearer, as the CDC website does, all the different stages and what ordinary people need to do to think about things?

Picking up the point about the Tenerife hotel, have lessons been learned from the cruise ship in Japan about keeping a lot of people in close quarters? Can we be reassured that UK and other citizens who are going to be in this hotel for two weeks will not end up in the same position as the many hundreds on the cruise ship who have now been diagnosed with coronavirus?

Talking of updates, Ireland has just postponed the Ireland v Italy Six Nations rugby match that was due to be played in Dublin, because of the coronavirus virus outbreak. So the Irish Government are already beginning to think that travel plans ought to be reconsidered.

My final question arose from noticing, when using the toilets in this place, that there are now very helpful posters reminding us about the 12 steps of hand washing. Suddenly, in the last two days, hand sanitisers have appeared. That is great; it is wonderful. But what will the Government’s advice be to the general public about personal hygiene such as hand washing and using alcohol hand sanitisers? The World Health Organization’s frequently asked questions and myth-busters pages are very good. I struggle to find anything as accessible in the UK. Most of the BBC report referred to by the noble Baroness, Lady Thornton, was taken from the WHO pages. So let us not reinvent the wheel but talk to people to ensure that they understand where we are.

I want to end on the same note as the noble Baroness. I thank the many hundreds, if not thousands, of people working to keep our country safe.

Lord Bethell Portrait Lord Bethell - Hansard

My Lords, I too express my profound thanks to NHS staff and the ancillary workers who support our clinical efforts: the bus drivers, the hotel staff and the deep-cleaning staff, who all have done so much already to help contain this virus in the UK. I especially thank the Chief Medical Officer, whose excellent advice has guided all our decision-making to date and will continue to be the most important guidance we can have.

There were two questions about the Tenerife hotel. I start by thanking the Spanish authorities. The practicalities are that the Foreign Office is in charge of handling arrangements for British citizens overseas, so questions about managing flights and cancelled services are questions for the Foreign Office. I understand that the Spanish authorities are flying specialist medical staff to Tenerife, because Tenerife has relatively limited health arrangements. A considerable effort is being made to ensure that all nationalities, including British holidaymakers who are in the hotel, have the best possible health provision.

On changing travel advice, we are going to be living through a period over the next few months when travel advice is fluid and changes on a week-by-week basis. The Foreign and Commonwealth Office issues travel advice—it is not for the Department of Health to do that—but my advice is to keep close to the advice. The travel advice of all countries will not always be aligned, but the World Health Organization has, to date, played an important, positive and constructive role in seeking to co-ordinate a response to the pandemic. We in Britain will move from a situation where containment is the priority to one where that is no longer practical, and the advice we give on travel will reflect that transition when it happens.

The noble Baroness, Lady Thornton, asked about the advice given to schools and, with characteristic thoughtfulness, she answered her own question. The current arrangement is that local schools, governors and authorities should make arrangements for themselves. As the epidemic progresses, that decision may need to be reviewed but, at present, it seems reasonable, proportionate and what parents want.

The noble Baroness also asked about capacity within the NHS, and it must be on everyone’s mind that the NHS does not have infinite capacity and it will not be possible to find a hospital bed for everyone affected by the virus. There will be considerable pressure put on the system, but I reassure the House that, over the years, considerable planning has already gone into making arrangements for this pressure and that the safety of the workforce and patients is paramount.

There are considerable measures that individuals can take to support themselves, and Ministers will be emphasising until they are blue in the face the importance of hand washing and self-isolation. These are important behavioural changes that we will seek to communicate to the British people over the next few weeks. In answer to the noble Baroness, Lady Brinton, we are planning and developing a massive communications campaign on how to protect people, particularly vulnerable people, in our population. At present, we are ensuring that people know how to protect themselves, highlighting the importance of staying at home if you feel unwell, and of regular hand hygiene. The needs and special arrangements of those with immune issues, which the noble Baroness rightly pointed out, will also be an important part of that campaign, and plans are well developed for launching it shortly.

A question was asked on the arrangements for travellers to China and, if I understood the question correctly, there is a distinction between those who travel to high-risk areas and those who travel to risk areas. If you travel to a high-risk area such as Wuhan, or one of the sanctioned areas in north Italy, on your return you are asked to immediately self-isolate. However, if you travel to China or Italy more broadly, you are asked to self-isolate if you start to display symptoms of a virus. That is the distinction noble Lords can have in their minds, and which will be communicated to the public more widely.

The noble Baroness, Lady Brinton, asked some detailed questions. I am grateful to her for forwarding them, and I will answer them in detail. She asked about the World Health Organization and its preparation for declaring a potential pandemic. The UK is prepared, and delivering plans for, a potential coronavirus pandemic. The plans are advanced and in place. Any new disease could be considered a “Disease X”. Current information and planning is based on what we call a “reasonable worst-case scenario”.

The noble Baroness asked about advice to travellers and rightly brought up the excellent CDC website. She mentioned CDC category 2 countries, particularly Iran and Italy, whose approaches seem to be different to that of the UK. The Foreign and Commonwealth Office already advises against all but essential travel to Iran. There are 10 small towns in Lombardy and one in Veneto which have been isolated by the Italian authorities. The health page on the Foreign and Commonwealth Office travel advice website has been updated with information on the coronavirus outbreak.

Lastly, the noble Baroness, Lady Brinton, asked about advice to the general population on personal hygiene and noted, quite rightly, the spread of hand-washing advertising and sanitisers in this House. There is very comprehensive advice on this on the NHS website. It can be accessed directly from the NHS homepage by searching for “Covid-19”. There are also answers to common questions, such as: are face masks useful for preventing coronavirus?

We are also aware of the dangers of fake news and a team is working on combating the misleading and wrongful advice that might stem from that.

NHS: Children’s Emergency Beds

Debate between Lord Bethell and Baroness Brinton
Monday 27th January 2020

(7 months, 3 weeks ago)

Lords Chamber
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Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness asked about the statistics. The anecdotes put forward by the Faculty of Intensive Care Medicine and the president of the Paediatric Intensive Care Society are perfectly valid. They are reasonable stories. The question put was about whether NHS statistics are being falsified. These are very serious suggestions and questions. I reassure the House that the statistics put together by the NHS are blue-chip and very much ones that we are proud of.

Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

My Lords, the Nuffield Trust report of December 2017, Admissions of inequality: emergency hospital use for children and young people, noted that children and young people from the most deprived areas are consistently more likely to go to A&E and need emergency hospital treatment. In fact, it specifically said that if unplanned admissions were at the level of the least deprived in the country, 244,000 fewer paediatric emergency hospital admissions would have been needed, saving the NHS £245 million. Given that the Health and Social Care Act 2012 makes reducing health inequalities in access and outcomes an explicit duty for the Secretary of State, can the Minister tell us exactly what the Secretary of State is planning to do to continue to lower this inequality?

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness touches on an incredibly important point. Undoubtedly, accident and emergency services are suffering a big spike in attendance by children and young people. I travelled to 20 accident and emergency wards in December and saw for myself the long queues of children. Clearly, something needs to be done to guide children away from accident and emergency. That is why this Government are doing an enormous amount to improve primary care services by investing in the 111 service and treatment-in-a-day services, for example, which can move people from A&E to create space for those in the most need.

Hymen Surgery

Debate between Lord Bethell and Baroness Brinton
Thursday 23rd January 2020

(7 months, 4 weeks ago)

Lords Chamber
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Lord Bethell Portrait Lord Bethell - Hansard

My noble friend describes an extremely distressing situation. I am very grateful to her for meeting me yesterday to discuss specifically the situation with the Yazidis. The NGOs involved might have been well-intentioned but their offers of either devirginification or hymenoplasty were clearly wrong-headed. Clearly, there is a gap here that needs to be filled and I would be glad to do whatever I can to arrange a suitable meeting.

Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

My Lords, in November the US rapper TI revealed in a blog that he had paid for hymen checks on his 18 year-old daughter and got the doctor to give him the result. In 2018, three United Nations agencies condemned such tests, the WHO saying that

“this medically unnecessary, and often times painful, humiliating and traumatic practice must end.”

Can the Minister confirm that this process will be examined and banned in the UK, along with hymenoplasty?

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness is quite right. It is extremely distressing to hear of these stories. The Government are absolutely determined to catch up and review exactly these kinds of procedures. The full scope of the review is under analysis at the moment, but the suggestion of including such examinations is a good one, and we will look at it carefully.

Healthcare (International Arrangements) Bill

(2nd reading (Hansard): House of Lords)
Debate between Lord Bethell and Baroness Brinton
Tuesday 5th February 2019

(1 year, 7 months ago)

Lords Chamber
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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell (Con) - Hansard

My Lords, I thank the Minister for her excellent introduction and her absolutely excellent maiden speech. I have known her since before she was an MP, followed her progress with absolute awe and grown to respect particularly her expertise in health technology—an area which is a huge opportunity for the country but will also need a lot of scrutiny from the kind of expertise found in this House. I look forward to many engagements on that subject.

On this legislation, I thank the members of the Home Affairs Sub-Committee of the EU Select Committee—the noble Lord, Lord Jay of Ewelme, and his fellows—for their excellent report. What I found striking was the great concern it expressed about the potential loss of existing reciprocal healthcare rights, the dangers of the cost to the NHS and the potential administrative burden, and the large amount of coverage that the report received in the press. It was a brisk reminder of how an overlooked area of policy and machinery of government which is precious to a lot of people needed to be focused on as we approach Brexit.

I was grateful to the noble Lord, Lord Thurlow, for his reminder of the costs of this area of government—it was an important point. I was grateful also to the noble Lord, Lord Lansley, for reminding us that, if we are to take away freedom of movement, we should perhaps get rid of such reciprocal rights—there is a sort of logic to that. I am here to reject both those arguments and to make an appeal in the opposite direction. I want to try just for a moment to extend the debate outside the Chamber, beyond Brexit and Henry VIII powers, to offer a little reminder of how many of the public might regard this as not only a healthcare issue but as one that touches on a subject that is very important to most of them; that is, travel.

Travel has changed dramatically in the public mind. It is not felt to be a luxury any more, as it was when I was a child. It is felt more to be a right and a form of expression; it is a part of one’s education, and it is critical to business. We can all wonder about the sense of entitlement among the modern generation, but I for one celebrate the benefits of travel. It satisfies the yearning to improve oneself personally and, among the business community, enables one to reach exciting new markets. In the context of this debate, we have not really talked much about the benefits of travel both to the country and to individuals. Underpinning that yearning for travel is a desire for frictionless, risk-free and affordable travel. The reciprocal rights that we are talking about are there to provide that kind of cover.

I do not think that there will be a massive change in the country’s mindset in respect of travel just because of Brexit and 29 March; if anything, quite the opposite. There has been a huge boom. Last year, Britons undertook 73 million trips overseas, representing an increase of 4% on the year before—that is a hell of a lot. That growth has gone on at a very steady rate for many years. That growth will go on into the future and we should think in policy terms about its implications. The range of destinations that people are travelling to is only getting wider.

People are also relocating in later life. We have heard a lot about the 190,000 people who have already moved to Tuscany, Provence and the costas, but that number is also edging up. We have to accept that we face the possibility of making provision for an ever larger number of people.

Some 27 million Britons already have an EHIC—the noble Lord, Lord Foulkes, showed us his; I thank him for that. We in my family have six of them; I do not have mine with me. I was staggered when I heard that the figure was 27 million. That is an unbelievable number. For a public policy to be quite so successful and to get through to nearly half the country like that is a huge achievement. There will be public policy professionals who are incredibly envious of that sort of penetration. There were 250,000 claims against those cards last year. Again, that is a daunting number—much higher than I could have imagined.

My appeal today is for us to try to think about this policy not just in terms of the daunting prospect of Brexit, the constitutional implications of the Bill and the cost, but through the lens of the macro changes that we see in society about people’s yearning to go overseas, to take their business and their families with them and to see other lands. We should think about future-proofing this overlooked part of our healthcare provision and accepting that we may need to extend those arrangements in terms not only of their geographical reach but of the sophistication of how we manage them. We should communicate a clear statement to British people and the outside world that nothing that happens around Brexit is about turning our backs on the world or closing the doors. Rather, we should show through our reciprocal healthcare arrangements that we will guarantee fair and reasonable treatment for people who visit Britain and support our own citizens who might run into difficulties when they travel abroad.

Baroness Brinton Portrait Baroness Brinton (LD) - Hansard

My Lords, I join others in welcoming the noble Baroness, Lady Blackwood of North Oxford, and congratulating her on her maiden speech. It is always slightly bizarre for a maiden speech also to be a ministerial introduction to a Bill, but she did it extremely well and set out the case. Along with my colleagues on the Liberal Democrat Benches, I may disagree with some of the things that she said, but she set out the Government’s position eloquently.

In addition to thanking the Library for its very good briefing, I want to thank the BMA for its own. One point that it makes has not been covered so far in our debate today. It says:

“It is essential that any alternative cost-recovery system introduced post-Brexit should not place an undue burden on either the NHS or on doctors or allied health professionals working within the health service”.

In view of the rearrangement of the BBC charter, whereby the BBC is taking on responsibility for the public benefit of TV licences for the over-75s, I worry that a Government in future might take the attitude that it is perfectly acceptable to offset—so I completely support the BMA in saying that it must not affect costs.

Others have spoken eloquently about the number of UK residents who hold EHICs and have received reciprocal treatment. I speak as someone who lost their father-in-law 10 years ago in France. He had the most wonderful treatment over a three and a half-week period after a brain haemorrhage, but sadly died. At no stage of the treatment, moving from a front-line hospital to a big regional hospital of excellence, was there any problem with the card or the E111 form. The only slightly bizarre thing that happened was that, after he died and all treatment was concluded, my mother-in-law received a bill for the ambulance service. It was not that she had to pay it, because if one is covered by E111/EHIC form the cost is met by the state, but every family gets a copy of the ambulance bill because it reminds them how expensive it is—and, guess what, in France there is no abuse of the ambulance paramedic system whatever.

At paragraphs 75 and 76 of the EU Committee report, Brexit: Reciprocal Healthcare, published in March last year—about one year ago—the committee sets out its concerns about making sure that negotiations should start early. It stated:

“We applaud the spirit underlying this ambition”—

of wishing to maintain reciprocal healthcare arrangements—

“but it is difficult to square it with the Government’s stated aim of ending freedom of movement of people from the EU”,

which is of course symptomatic of the principle of reciprocal healthcare. It went on to state:

“More generally, reciprocal healthcare arrangements will only be achieved by agreement between the UK and the EU. The Government has not yet set out its objectives for the future UK-EU relationship. We … urge the Government to confirm how it will seek to protect reciprocal rights to healthcare of all UK and EU citizens post-Brexit, as part of any agreement on future relations”.

It is worth noting that, 52 days away from 29 March, we are still not clear about what the UK wants from the arrangements. We seem to be going back to the negotiating table. I suspect that that explains what the noble Lord, Lord O’Shaughnessy, said about the sparsity of information. It is almost as if Ministers are saying, “Trust the Government, because we don’t quite know yet where we are”.

Some of the points made later in the EU Committee’s very good report give a signpost to where we might be. Chapter 6, on reciprocal arrangements, private healthcare and insurance, talks about contingency planning for the S1 and S2 arrangements and the EHIC. I will not dwell on those, because colleagues have mentioned them, but I remain concerned about arrangements with insurers. The chapter’s final conclusions state:

“Time is now short for the Government to provide much-needed clarity to the insurance industry to help with planning, particularly for multi-trip travel insurance policies that will include the period beyond March 2019”.

It goes on to say:

“There will be consequences not just for the insurance industry, but for tourism and individual travellers. While the industry might derive some benefit should it be required to play an expanded role in providing cover, we recommend that any move for greater reliance on private medical insurance by UK citizens travelling within the EU post-Brexit be subjected to careful scrutiny, particularly in terms of the further regulatory oversight that might be needed to ensure that patients and consumers are treated fairly”.

In November last year, my noble friend Lord Bruce of Bennachie asked the noble Lord, Lord Bates, about the arrangements and advice that would be provided to UK residents planning to book a holiday in an EU member state commencing after the end of March 2019. The noble Lord, Lord Bates, said, in summary, that he did not have details, but went on to say:

“The Government continue to strongly encourage all British nationals travelling abroad, including within the EU, to take out comprehensive travel insurance that covers their personal circumstances and meets their needs. In the unlikely event of no deal, travel insurance policies will remain valid”.—[Official Report, 1/11/18; col. 1424.]

Last week, my honourable friend Tom Brake, who is the Liberal Democrat Brexit spokesman in another place, reported that we had done some mystery shopping for travel insurance in the preceding week, in January 2019. Of the seven travel insurers spoken to, only two firms said that insurance would be paid out as normal in the event of a no-deal Brexit. Three said that they did not know what would happen if a no-deal Brexit came into force. Most worryingly, two of the companies said that holidaymakers would not be covered in this event because they had not yet got any policy on it. That is why I am really worried by the lack of detail in the Bill, which is symptomatic of the lack of detail and discussions going on with the industry itself.

I will briefly touch on Northern Ireland. The noble Lord, Lord Foulkes, has spoken about the importance of arrangements elsewhere in the union. The arrangements that pertain in Northern Ireland at the moment are absolutely not the same as elsewhere in the European Union. Joint health services allow patients to get medicine at any pharmacy, north or south of the border, irrespective of the location of the GP responsible for the prescription. Ambulances on both sides of the border are currently free to travel across it to attend emergencies. People across the island of Ireland are allowed to receive radiotherapy at a new £50 million centre for cancer patients from both sides of the border in Derry. It is important that that specialist provision is available, yet there is no pathway for managing these difficult cross-border issues in Ireland. Will these current arrangements remain in place after 29 March, in the event of a no-deal Brexit? Even in the event of a deal, will it continue if there is no final agreement? Are specific discussions going on between the Republic, Northern Ireland and the UK Government to ensure that there are no cliff edges for residents of Northern Ireland or the Republic? This is not just holidaymakers, or a handful of workers abroad. This is a full, two-way process.

Finally, I move on to the Henry VIII powers. I am grateful to my noble friends Lord Marks and Lady Barker and to the noble Lord, Lord Foulkes, for expressing their concerns in detail. I will not repeat them, but I agree with them about the enormous scope of the Bill and of the underlying arrangements it sets in place. The noble Lord, Lord O’Shaughnessy, responded to the DPRRC saying that there were “too few constraints” on power by saying that there needed to be flexibility because of future trade deals. He will know of my concerns in this area, because I raised questions with him about the protection of the NHS when he was the Minister. One of the lesser-known pillars currently protecting our NHS is the EU directive on public health procurement. It governs the way in which public bodies purchase goods, services and works and seeks to guarantee equal access and fair competition for public contracts in EU markets.

I was concerned by the noble Lord’s mention of future trade deals. We know that the United States of America wanted, through TTIP, to use trade deals to get a foot in the door of larger contracts within the UK. In the past I have said to colleagues on the Labour Benches that we have the protection of the EU directive. I now worry that that will disappear in a puff of smoke if we have a no-deal Brexit on 29 March. I am grateful to the noble Lord, Lord Livingston of Parkhead, who answered my question on this issue in November 2014 by saying:

“Commissioner de Gucht”—

from the EU—

“has been very clear: ‘Public services are always exempted ... The argument is abused in your country’”—

the UK—

“‘for political reasons’”.—[Official Report, 18/11/14; col.274.]

Can we count on the Prime Minister’s statement that all EU law will be enacted fully in the UK and that if changes are to happen they will follow later? Can I take it from that that this EU directive will be enacted and in force on 29 March to protect the NHS from unscrupulous trade deals that we were promised would not happen?

I am particularly concerned. When I asked these questions in the past, Barack Obama was President of the United States. Under President Trump I remain even more concerned about the protection of the NHS. The Minister may say that this should not be affected, because this is about arrangements, but I worry that the scope which sits behind it might actually allow it to happen—so I look forward to hearing from the Minister.