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NHS: Hospital Visiting

Debate between Lord Bethell and Baroness Brinton
Wednesday 15th September 2021

(8 months, 1 week ago)

Lords Chamber
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Lord Bethell Portrait Lord Bethell (Con)
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What a touching piece of testimony from my noble friend. The feelings he had as a child are felt by a great number of people, not only those in hospital and social care but their loved ones. We are mindful of the impact of visiting on the mental health and the good feeling of those in hospital. Visiting was suspended on 4 April last year, but that suspension was lifted on 5 June. Since then, we have sought wherever possible to put careful visiting policies in place. In October last year, the number of visitors was limited to one family contact or somebody important to the patient; since then, we have made huge strides in trying to lift those restrictions wherever we can. It is left to trusts to implement exactly those restrictions that are suitable to maintain infection control in their area.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, in his Answer to the noble Lord, Lord Farmer, the Minister said it was vital to keep hospitals safe from Covid infections. There are now over 8,400 Covid patients in hospital with around 1,000 daily admissions and rising. SAGE is concerned that, in a month, there could be 8,000 patients a day. Paragraph 36 of yesterday’s autumn and winter plan says that the UK HSA is reviewing easing specific infection prevention and control and social distancing to better manage activity. Can the Minister give assurances that this will not happen while cases in hospital continue to increase at this rate?

Lord Bethell Portrait Lord Bethell (Con)
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We are trying to have visiting policies that are proportionate to the situation. To reassure the noble Baroness, as she probably knows, the number of visitors at the bedside is currently limited to one close family contact and somebody important to the patient. Those are the guidelines we have in place. As I said, we leave it to trusts to run their own infection control measures. She is entirely right that the potential for nosocomial infections within hospitals, which was such a serious feature of the pandemic last year, is one that we are extremely wary of and careful about.

Covid-19

Debate between Lord Bethell and Baroness Brinton
Wednesday 15th September 2021

(8 months, 1 week ago)

Lords Chamber
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Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, the publication of the 33-page Covid Autumn and Winter Plan, including plans A and B, rightly talks about the need to resume life as normally as is possible while Covid is still around, but to move into restrictions faster if cases surge and the NHS is pressured. The World Health Organization’s special envoy on Covid, Dr David Nabarro, has said that the UK is right to find a way to live with the virus. However, he added:

“Speed is of the essence. We’ve been through this before and we know, as a result of past experience, that acting quickly and acting quite robustly is the way you get on top of this virus, then life can go on. Whereas if you’re a bit slower, then it can build up and become very heavy and hospitals fill up, and then you have to take all sorts of emergency action.”


Why does the Statement talk about the vital importance of mitigations, such as meeting outdoors where possible, ensuring ventilation if inside and wearing face coverings? Why are there no clearer, repeated messages for the general public about all these vital interventions, especially what we can all do now to slow down the increase in cases and hospital admissions?

At the No. 10 press conference on Monday, Professor Chris Whitty said:

“Anybody who believes that the big risk of Covid is all in the past and it’s too late to make a difference has not understood where we are going to head as we go into autumn and winter.”


He is right to be concerned. The seven-day rolling figure for daily hospital admissions is now around 1,000, with an average of 8,400 Covid patients in hospital beds. These numbers are considerably greater than they were this time last year. SAGE is very concerned that, as rules are further relaxed and people start coming back into work, the number of Covid patients going into hospital is set to increase substantially. This would put the NHS under real pressure, with perhaps as many as 7,000 admissions a day in six or so weeks, so it says.

The Statement announces the final decision on the booster scheme for those aged over 50, healthcare staff and the clinically extremely vulnerable, following the third dose for the half a million people who are severely clinically vulnerable. We welcome this. However, the World Health Organization reminded us that we should also be providing doses for low-income countries, but I see that the Government are planning only 100 million doses over the next few months. That is a drop in the ocean given that only 2% of the populations of low-income countries have been vaccinated. Will the Government agree to review and increase this number?

We on these Benches welcome the news on 12 to 15 year-olds getting vaccines. We accept that this was a difficult and complex decision, but we are pleased that there finally is one. There was an excellent slot on the “Today” programme this morning, with a group of 12 year-olds asking a paediatrician some questions; he had to look one answer up on Google. I hope that all parents and children will be able to access this sort of information because we know that it makes all the difference in coming to a decision.

However, as the noble Baroness, Lady Thornton, said, anti-vaxxers are causing serious problems. Good on Chris Whitty for what he said about one celebrity who attacked the idea of 12 to 15 year-olds having vaccines. However, today, yet another celebrity attacked him on social media, saying that he should be hanged. That is disgraceful. What are the Government doing about public servants like Professor Whitty being threatened in this way? As importantly, what will the Government do about the disinformation that people are now spreading at school gates, including leaflets with the NHS logo on them?

Ten days ago, Dr Jenny Harries announced that all clinically extremely vulnerable children in England—even those still on chemotherapy—would be removed from the CEV list and expected to return to school as term was starting, regardless of their underlying condition or the fact that there are no masks, bubbles or even, in many schools, proper ventilation. Although it is really important to have all children back in school, this cohort of children is at particular risk. Their consultants and GPs are as bemused as their parents, so why is Jenny Harries’s letter to the parents of these children, explaining why they are being removed from the CEV list, not on either the NHS or UKHSA website? Will the Minister write to me to explain this decision? We are hearing confusion from parents and medics alike.

Finally, last week, I commented on the continuing farce of Ministers U-turning daily on the use of vaccine passports for clubs. It is confusing to keep up with the U-turns on U-turns; I note that the Statement is trying to have it both ways. I suspect that Ministers could do with some new flip-flops.

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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I thank the noble Baronesses, Lady Thornton and Lady Brinton, for such thoughtful questions. I am very pleased to be here to answer questions on both these Statements, and I thank the noble Baroness, Lady Thornton, for her kind remarks earlier.

I too welcome the decision to bring forward the vaccination of children. I reassure the noble Baroness, Lady Thornton, that it will be done in the same way that a large number of other vaccinations are run through the school process. As I am sure she knows, vaccinations for things such as HPV and flu have been done at primary school for some time and there are extremely well-established and thoughtful protocols for handling them. They are handled not by school nurses but by nurses employed by the local authority or on contract by the local CCG to deliver the vaccinations, and the consent forms are handled directly with the parents. There is an extremely well-established process for the very rare occasions where there is a difference of opinion between the child and the parents. It is important that we get that right. I reassure the Chamber that this process for vaccinations has been handled for years. The professionals who deal with such disagreements are extremely well trained and the Gillick principles, which are extremely well known, will be applied to the Covid vaccination. I think all noble Lords agree that that is entirely right. Children aged between 12 and 15 will be provided with information, usually in the form of a leaflet, for their use. The school- age immunisation provider will, prior to vaccination, seek consent for all the vaccination programmes.

The noble Baroness, Lady Thornton, quite rightly raised the question of children being pressured into taking or not taking the vaccine. I reassure her that the school-age vaccination programme and the clinicians involved are very well equipped and are well versed in dealing with vaccines in schools; this will not be a new thing for the schools or professionals involved. Their ability to gain consent and to communicate exactly why the Chief Medical Officer has gone ahead is an important element of the decision to accept the recommendation from the CMO on the back of the JCVI recommendation. The four CMOs have said that it is essential that children and young people aged 12 to 15 and their parents are supported in their decisions, whatever decisions they take, and are not stigmatised for accepting or not accepting the vaccination offer. Individual choice will be respected.

The rollout is starting immediately, at the beginning of next week, and we expect that it will end in schools by the end of November. The advice from Dr June Raine of the MHRA is that the flu and Covid vaccinations can happen contemporaneously—studies have supported that—but that will not necessarily happen in every case. The practicalities of the supply of Covid and flu vaccines are, as noble Lords know, extremely complex, and we do not want to make a complicated situation any worse by trying to force a combination if it is not possible.

The noble Baroness, Lady Thornton, asked about our arrangements for the current winter period and particularly about mandatory masks. I completely understand the concern of noble Lords in the Chamber about making masks mandatory. The noble Baroness, Lady Thornton, referred to it as “light touch”, but our feeling is that it is not light touch to mandate the wearing of masks; in fact, it is an intrusion into people’s life in the most intimate way. That is not to say that it should not happen at all, but we are at a stage of the pandemic where we are trying to move the responsibility for individual choices, such as wearing masks, on to people to take it for themselves. Of course, if the worst happens and we have to move into plan B, we have the legal and influential role to be able to mandate masks, but at this stage it feels proportionate to try to use persuasion rather than mandation.

I remind noble Lords that the messaging around the pandemic is not the only thing we are trying to do right now. In response to the remarks of the noble Baroness, Lady Brinton, about public messaging, I reassure her that I am the Minister who signs off the marketing around Covid and other health messaging. We are currently spending a substantial sum communicating our messages on Covid. The fact that she thinks they do not exist is an example of the public exhaustion that is an inevitable result of 18 months of relentless campaigning on Covid. We have to recognise that the public can hear us only so many times before they start tuning out the message.

There are other very important messages that we have to get through to the public, the most important of which is for those who show symptoms of other diseases to step forward to get their tests, so that we can catch people who are ill with non-Covid diseases. We have a massive backlog of diagnostics; the NHS figure on the expected numbers of people who have diseases such as cancer, and need to be seen by GPs and specialists, is huge. We need to get those messages across to people as well and, while it is not a zero-sum game, to be aware that these messages compete with each other. We are using this moment where there is a pause in the Covid epidemic to try to get people back into the GP surgeries and the diagnostic hubs—back into hospital—to try to catch diseases and reduce the lists. That fightback is extremely important and is one of the reasons why we are focused on the “Help us to help you” messaging.

The noble Baroness, Lady Thornton, asked about testing in schools. I reassure her that we have not only put a huge effort into the double supervised testing which, as she knows, kicked off the school term but are sustaining the support for school testing. There will be a review at the end of September but there are no current plans to end regular testing in schools. We have to ensure that there is value for money and that the testing is effective, but it is extremely well supported by schools. I believe it has made a serious impact on the spread of disease within schools and pay tribute to teachers, headmasters, parents and pupils for the high rates of uptake in schools. Around one-third of all positive cases are tracked down through asymptomatic testing, which is a really good indication of how effective it is at breaking the chains of transmission.

There is a review of our border arrangements in play, and I believe the Secretary of State for Transport will be making a Statement tomorrow. However, I reassure the noble Baroness that we take border control extremely seriously. We are very conscious of the threat from variants of concern. At the same time, however, we have to recognise that vaccination makes a big difference and be proportionate in our border arrangements. We are conscious that although travel is regarded as a voluntary matter, people may have strong family roots or good business reasons. Being able to travel is one of the great joys and loves of people’s lives, so we are seeking to be proportionate and reasonable in our travel arrangements. The Secretary of State will make further announcements on that tomorrow.

On the point made by the noble Baroness, Lady Brinton, on public servants, I could not agree more. The rhetoric that has been directed at public servants such as Chris Whitty and JVT sometimes leaves one feeling quite cold and disappointed at the British public. As she probably knows, we have made arrangements to put a big arm around those people who have been threatened and improve the security arrangements for them. I call on everyone to express support for our public servants, who have a very tough job. They are often communicating unpalatable, difficult truths to the public and challenging some of the assumptions and preconceptions of those who would like life to be slightly different from what it really is.

In particular, I noted the physical attack on the MHRA headquarters in Canary Wharf 10 days ago. Videos of that attack really disturbed me; it was brutal, nasty and ferocious. I pay tribute to the Metropolitan Police, who responded extremely quickly and emphatically, and to professionals at the MHRA who had steady nerves on that Friday afternoon. We cannot operate in a society where differences of opinion about public health policy lead to physical violence on the streets of London. I absolutely condemn those who participate in physical attacks of that nature, along with the kind of violent extremism that calls for people to be hanged. This is no time for that kind of extremism. Those who participate in it are trying to divide society. They really need to move on and find something else to do.

I am extremely pleased to hear what I think was the implicit support of the noble Baroness, Lady Brinton, for the principle of vaccine passports. It is right that we hold such an intimate and strong measure in reserve in case we need it for plan B. The technical and regulatory arrangements for the measures have been put in place but we have held off the implementation because it is not felt that it is needed right now. However, should it be needed either to break the chains of infection and restrain the spread of the virus or to encourage vaccine uptake, which is one of the benefits of such a measure, we will turn to it as part of our plan B measures. That is a proportionate treatment of that potent but very heavy state intervention.

Commonwealth Fund Report: NHS Ranking

Debate between Lord Bethell and Baroness Brinton
Tuesday 14th September 2021

(8 months, 1 week ago)

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Lord McFall of Alcluith Portrait The Lord Speaker (Lord McFall of Alcluith)
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My Lords, we will now have a virtual contribution from the noble Baroness, Lady Brinton.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, the report points out that, although the UK is fourth overall in the rankings, we are ninth out of 11 on health outcomes. As the noble Baroness, Lady Thornton, outlined, the top three countries are particularly good at investment in preventive services and primary care, but the report also talks about wider social care, including housing, nutrition, transportation and early years services. All these investments tackle inequity and deprivation, as covered in both the Leadsom report and the Marmot report. Given the Chancellor of the Exchequer’s statement that there is no money for anything other than the NHS and social care, what are the Government proposing to do to address investment in these vital areas?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, we are investing a tremendous amount in preventive care, and I agree with the noble Baroness that this is key to the future—to better and longer lives and, on my noble friend’s point, to increasing the productivity of our healthcare system. I have already mentioned the key components of our preventive agenda and I add to that list the £325 million that we have allocated to the diagnostic fund precisely to catch disease earlier, to give people the treatments they need earlier, and to bring down the cost of our healthcare service.

Social Care: Family Carers

Debate between Lord Bethell and Baroness Brinton
Monday 13th September 2021

(8 months, 1 week ago)

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Lord Haskel Portrait The Deputy Speaker (Lord Haskel) (Lab)
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My Lords, we will now have a virtual contribution from the noble Baroness, Lady Brinton.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, the Disabled Children’s Partnership reports that parents of disabled children say that two-thirds were not able to access care at home during the pandemic. In the two years prior to the pandemic, large numbers of respite care beds for disabled children had already been shut down. Given that none of the new social care levy is targeted towards disabled children and young people, can the Minister say whether urgent funding will be provided for this vulnerable and too-often forgotten group, where unpaid carers are often on duty 24/7?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I do recognise the problem: 23% of carers—1.3 million—provide care for 50 hours or more a week. That is an absolutely astonishing figure, and I pay tribute to the contribution they make. The overall contribution by carers is around £56 billion a year. We cannot undervalue that contribution in either emotional, care or financial terms. The precise allocation of funding for this new financial package is not yet confirmed. When it is, I will make sure that the reasonable points the noble Baroness made are heard clearly in the department.

NHS: Nursing Workforce

Debate between Lord Bethell and Baroness Brinton
Wednesday 8th September 2021

(8 months, 2 weeks ago)

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Lord Bethell Portrait Lord Bethell (Con)
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I pay tribute to the noble Lord’s great experience and expertise in this matter. He will be aware that we have a social partnership forum, where we work extremely closely with the professions on how to improve retention. But I think that the motivation of those in public service and, in particular, in healthcare is much more complex than he describes. We have come to a 3% pay agreement with the nurses, and they have demonstrated huge support for the healthcare service during the pandemic, which suggests that it is more complex than he describes.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, current NHS nursing vacancies in England are now thought to be over 40,000. Nurses have recently reported concerns that a number of nursing posts at a standard that require a registered nurse or midwife are now being advertised to those not registered with the Nursing and Midwifery Council, presumably because of the shortage of nurses. What steps will the Government take to ensure that only properly qualified nurses and midwives are recruited to these posts that require registration?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, there are vacancies in nursing, as there always are. The vacancies at present are not hugely higher than they are normally and, in fact, we have more nurses today than we did two years ago. What I can report to the noble Baroness is that UCAS data shows 27,720 acceptances to nursing and midwifery courses in England as of 7 September. That is extremely good news; it shows the commitment of our graduates to the nursing profession and our commitment to making sure that more nurses are trained.

Residential Social Care: Staff

Debate between Lord Bethell and Baroness Brinton
Monday 6th September 2021

(8 months, 2 weeks ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I am enormously grateful for the insight of the noble Lord in this matter, in which I know that he is a great expert. However, he should of course remember that social care is provided through independent providers and local authorities. Social care workers are free to organise themselves as they wish, but that is not the arrangement that we have in this country.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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Last week, three-quarters of providers in the United Kingdom Homecare Association said that recruiting social care workers is the hardest that it has ever been. In July, they warned that they faced a perfect storm of losing staff through Brexit and increased pay in retail and agriculture making their wages uncompetitive. They are at breaking point. One-third said that they are handing back some or all of their care contracts to local authorities because they cannot fulfil their contracts now—this is before they lose any unvaccinated staff—so what steps are the Government taking to urgently help the elderly in our care homes, the care homes and their staff going through this crisis?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I am aware of the anecdotes that the noble Baroness alludes to, but they have not been seen through the figures that we have in the department. However, we are providing support to providers: we have a national recruitment campaign that is running in the autumn; we have put in free and fast-track DBS checks for staff recruited in response to the pandemic; and we have the promotion of adult social care careers in our jobcentres.

NHS Update

Debate between Lord Bethell and Baroness Brinton
Thursday 22nd July 2021

(10 months ago)

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Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, I echo the thanks to all the staff who have made a hybrid Parliament work over the last year especially, from these Benches, to the health team, because of the high workload of health and Covid business. I also repeat the good wishes to the noble Baroness, Lady Penn, as she starts her maternity leave.

Along with colleagues in the Commons, I am unconvinced that the first half of this Statement was planned to be delivered by the Minister yesterday. In the bizarre events of this week, of Covid restrictions being lifted, a rush of announcements—Monday’s, and today’s on vaccine passports—U-turns, and No. 10 contradicting Ministers, this Statement is definitely filed under “Y” for “You couldn’t make it up”.

Yesterday morning, the press were briefed and opposition politicians heard on the parliamentary grapevine that the NHS staff pay rise would be announced in the Statement. Even Sky News and the BBC news channel were saying that there would be an announcement on NHS pay in the Commons yesterday afternoon. Yet, when the Minister stood up, there was not one word about the pay award, just an end-of-term report and a much-deserved paeon of praise about how wonderful our NHS staff are—they are, and they deserve that praise. However, an extraordinary line in the Statement says:

“But I can assure those hardworking nurses: you should feel it soon”.


Well, they did. Four hours after that Statement, a Written Ministerial Statement and a press release were slipped out, bypassing parliamentary scrutiny, presumably in the hope that it would not be spotted. NHS staff, especially junior doctors and nurses, are appalled. I am not sure this is what the Minister meant by

“you should feel it soon”.

However, it gets worse. This morning’s Times says that the 3% NHS staff pay rise will be funded by robbing the expected increase in national insurance contributions reserved for the social care proposals leaked earlier this week by the Government. That is an absolute disgrace, especially given the appalling way that No. 10 has handled the social care reform proposals. After the Queen’s Speech, Ministers told us that it would be this autumn. Last week, they suddenly said that there would be an announcement this week but, this week, they have thrown the proposals back into the long grass, with a promise—again—of later this autumn, two years after the PM promised us, on the steps on No. 10, that this was his absolute priority. His actions are showing otherwise.

I know that the Minister understands that social care needs urgent reform and that it has borne the brunt of the first year of the pandemic. Can he confirm the Times story about the funding of the NHS pay rise and whether this decision was made by the Secretary of State for Health and Social Care or by the Chancellor of the Exchequer? Can he also say when the full proposals for social care will now be published, including the funding arrangements?

Moving to the only substance of this Statement, the autism strategy, we on these Benches also pay our respects to the late Dame Cheryl Gillan MP, who was such an advocate for those with autism. Peter Wharmby, the autistic writer, speaker and tutor, says that the autism strategy sets its targets very low in saying:

“Moreover, we have been able to transform society’s awareness of autism, as … 99.5% of the public have heard of autism … which is so important in autistic people being able to feel included as part of their community.”


Peter Wharmby is right. Much of the strategy talks about continuing as usual, but if you talk to autistic people or parents of autistic children, they all say that much needs to be done in supporting those with autism, especially in education and at work. Knowing that autism exists is not the same as providing the best environment for those with autism to overcome the barriers they face in society and giving them the support that they need to succeed. The Disabled Children’s Partnership points out that the pandemic has exacerbated existing problems around support for those with autism, creating further social isolation and poor health outcomes. It is depressing that the autism strategy is so unambitious.

One particular problem that parents face when trying to get support for their autistic children is an automatic assumption that parent carers are treated as a resource—worse, their parenting capacity is often questioned. There is no mention here of support for their needs. As John Bangs, a special needs expert, points out, this deliberately ignores carers’ legal rights. It is noticeable that this autism strategy makes no real reference to ensuring that parental and familial carers are supported. When will these wider issues relating to positive support for those with autism and their familial carers be addressed?

Finally, briefly on the Covid Statement in the Commons today, page 4 says that

“two doses of a covid vaccine offers protection of around 96% against hospitalisation.”

But the key bit of information we need in the “pingdemic” at the moment is the rate of double-jabbers getting Covid. I understand that it is part of the same study that is quoted, but what is the answer and where can we find it? If the pingdemic is due to the virus spreading —we hear of police and control rooms unable to operate and empty shelves at supermarkets—perhaps it is time we actually understood how many double-jabbers are getting Covid and having to go into self-isolation, and thereby creating a problem. The Minister needs to consider whether lifting all restrictions on Monday was the right thing to do.

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
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My Lords, I join the noble Baronesses, Lady Thornton and Lady Brinton, in thanking my noble friend Lady Penn for her hard work over the last 18 months and wishing her well in her pregnancy. She looked absolutely fantastic as she left, and our hopes and good wishes are with her.

I also thank the usual channels, the House of Lords staff and the Speaker’s office for all their contributions to the virtual House and for keeping the business of the House going during this awful pandemic. There has been an enormous amount of traffic from the Department of Health—more than 50 Statements, 2 Acts and hundreds of regulations. I thank all noble Lords for their challenge, their scrutiny and their patience during this difficult time.

The pay review body has given us its recommendations, and we have accepted them. I thank it for its work and insight. I reassure the noble Baroness, Lady Thornton, that the Office of Manpower Economics will publish its analysis online shortly. We are extremely pleased that we can follow the guidance of the pay review body. Junior doctors have their own separate framework, worth 8.2% over four years. They are working from that framework today.

On the funding of the pay review, as noble Lords know, we gave the NHS a historic £33.9 billion settlement in 2018 and have provided £92 billion to support front-line health services throughout the pandemic. The pay uplift will be funded from within that budget, but we are very clear that this will not impact funding already earmarked for the NHS front line. We will continue to make sure that the NHS has everything it needs to continue to support its staff and provide excellent care, throughout the pandemic and beyond. That is why we accepted the PRB’s recommendations in full and provided NHS workers in scope with the pay rise.

On the question from the noble Baroness, Lady Brinton, on safeguards in September, I cannot make any guarantees but I definitely hope not. We very much hope that we are in the final stages of this pandemic, as the impact of the vaccine is being felt, bringing down the R number and saving those who are infected from hospitalisation, severe disease and worse.

The noble Baroness, Lady Thornton, talked about filtration for schools, and I noted her question on this yesterday. I said that we had been looking at it. I am not aware that the results of that analysis have come through yet. To be honest, I am wary of investing too much in unproven technologies. The two things that have been proven to work are isolation and vaccination; we are backing those two measures most of all. However, I accept her point about the importance of ventilation and will continue to look at it.

Likewise, the JCVI is looking very carefully at vaccination for children. We are working with international partners to get to the bottom of it. At the moment, we have a clear read-out—we will move—but our priority is providing either third shots or variant booster shots in the autumn to the most vulnerable. That is where our priorities are at the moment.

The noble Baroness, Lady Brinton, asked about social care. I note the Government’s statement on that; we will bring reform recommendations in the autumn. On her point about the autism strategy, I also pay tribute to the contribution of Cheryl Gillan, who worked so hard in this area and whose impact is still being felt.

I think the noble Baroness, Lady Brinton, overlooks some of the really good work in this strategy. There is £74 million of funding for a number of high-priority projects, which have been designed in collaboration with stakeholders from the community. I guide her to the implementation plan that accompanies the strategy, which has detailed recommendations on a six-point implementation matrix that has grit and traction. I would be very grateful for her feedback on that.

I pay tribute to parent supporters; the noble Baroness, Lady Brinton, is entirely right that they often bear the brunt of care and are often best placed to care for and support those with autism. I remind her that we have provided £31 million through the mental health and well-being recovery action plan specifically for the parents of those with autism, recognising how the pandemic was hitting that group in particular.

Animal Diseases: Future Pandemics

Debate between Lord Bethell and Baroness Brinton
Wednesday 21st July 2021

(10 months ago)

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Lord Bethell Portrait Lord Bethell (Con) [V]
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My Lords, the noble Baroness is right that we need to massively increase international capacity for vaccine production. The Government are working on a vaccine strategy that will include ideas for doing that. A TRIPS waiver is something we have looked carefully at. It is our strong view that this Government support intellectual property, because it is only through our commitment to intellectual property that we can encourage the kind of massive investment by the private sector necessary to develop vaccines in the first place. For that reason, we remain hesitant about supporting a TRIPS waiver policy.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, Professor Sir Jeremy Farrar says in his new book that viruses do not change how they transmit between humans and animals, but humanity has become much more mobile. He deplores the pandemic nationalism evident over the last year, saying:

“Only the virus benefits from a pivot towards myopic nationalism because that will keep it circulating for longer. A divided world is a diseased world.”


I thank the Minister for saying what the Government plan to do through their chairmanship of the G7, but can he please confirm the timetable for the delivery of the “one health” approach, including its funding?

Lord Bethell Portrait Lord Bethell (Con) [V]
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My Lords, the “one health” approach is moving through the G7 process at the moment. I am not sure whether a precise timetable exists. I am happy to check to see whether dates are available, and I will write to the noble Baroness accordingly.

Covid-19

Debate between Lord Bethell and Baroness Brinton
Wednesday 21st July 2021

(10 months ago)

Lords Chamber
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Baroness Brinton Portrait Baroness Brinton (LD) [V]
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I thank the noble Lord, Lord Bethell, and the noble Baroness, Lady Penn, their officials and all staff in the Lords, the Whips’ Office and the health team, as well as Members, for their extraordinary work this year on Covid-related business—mostly emergency Statements and statutory instruments. From these Benches, we particularly wish the noble Baroness, Lady Penn, a safe delivery and a happy maternity leave.

The Statement talks about enjoying “new experiences” following the lifting of lockdown and safely slowing the spread of this deadly virus, but 48 hours is a long time in politics, as evidenced by the difficulties of taking this Statement two days after it was delivered. So much has happened, much of it demonstrating that this Government are still struggling to get a grip on keeping people safe from this deadly virus.

The phrase in the Statement:

“We are cautiously easing restrictions”


is the most extraordinary thing to say, given all the rhetoric about freedom day—and it is wrong. All restrictions have been lifted—no mandatory face masks—and young people have understandably taken their lead from Ministers. There are videos of young people deservedly enjoying themselves in nightclubs in the knowledge that the Prime Minister has declared it safe to do so, yet hidden in this Statement is the bizarre announcement that in two months’ time only those who are double-jabbed will be able to go to such crowded venues, thus delivering Covid ID cards by the back door. Once again our young people, who have had to bear much of the brunt of lockdown life, are the ones targeted by this Government.

That little phrase caused chaos on Tuesday morning. Paul Scully was not clear about which other large venues might be included—for example, pubs with performance dance venues, large or small. He thought so. Two hours later, No. 10 contradicted that: no pubs. Can the Minister tell me what is the difference between a pub with a large dance venue of, say, 500, and a nightclub that can have up to 400 people and why one will require everyone to be double-jabbed but the other will not? I am really struggling to understand the difference. Perhaps the Minister can point your Lordships’ House at a safety document that sets out what the risks are for these different venues and why it is appropriate to ignore lateral flow tests and only go on double vaccination when we know that people can still get Covid after they have been double-jabbed.

The Statement is right to praise the progress of the vaccination scheme, although there is some considerable way to go, including awaiting the data on whether the booster jab can be given at the same time as the flu jab in the autumn. What plans are in place to provide support for GPs if the jabs cannot be given at the same time? We all know that the annual flu vaccine date requires a very large amount of administration by medical and admin staff alike.

The Statement says that JCVI has decided not to vaccinate all 12 to 17 year-olds yet but is keeping it under review. I too refer to today’s ONS data that was referred to by the noble Baroness, Lady Thornton, demonstrating underlying illnesses and a greater prevalence of long Covid among the young than among older people. I thank the Minister for the helpful briefing on Monday, but I remain concerned that with up to 1 million children out of school now it has been clear that the alternative to vaccinating secondary-age pupils appears to be allowing Covid to rip through our schools. We all want our children back in school in the autumn, so what are the Government going to do about that? It is good that the Government are finally allowing the children most vulnerable to Covid to receive the vaccine because they deserve protection and that those children with an immunocompromised or immunosuppressed adult in their home will also finally be able to be vaccinated. That is good.

This Statement also refers to the regulations debated in your Lordships’ House last night, and I hope the Minister has taken away the many concerns expressed by all sides of the House. The Statement refers to tradespeople, such as plumbers and hairdressers, who will also have to be doubled-jabbed to gain entry into a care home. I have two questions about these non-staff members. I am happy to receive a reply by correspondence if the Minister does not have immediate answers. First, if the registered person is not on the premises when an outside worker comes in, can another member of staff admit them and make the decision about their vaccination status? What does that do to the registered person’s responsibilities? If a plumber comes out of office hours to, say, mend a burst pipe and the registered person is not there, must they be turned away? Secondly, care homes are already reporting that some contractors are heavily ramping up the rates for care homes for their staff who have been double-jabbed. Did the hurried and inadequate impact statement published on Monday include the cost to homes of this outrageous practice, and will the Government issue guidance that it should be stopped immediately? Can the Minister say when the detail of how this is all going to work in practice will be published?

The Statement refers to the fact that we must be pragmatic about how we manage the risks we face, yet the past two days have been full of contradictions from the Prime Minister and other Ministers about the need to self-isolate when people are pinged. It has taken journalists to reveal that the only legal responsibility to self-isolate is when called by track and trace, but after the embarrassing U-turns on Sunday morning of the Prime Minister and the Chancellor about not self-isolating, the PM is confidently saying “You must self-isolate once pinged”. Apart from the irony of that statement, given his behaviour, once again we have Ministers not seeming to understand the difference between advice to people—moral guidance, perhaps— versus the reality of a chaotic series of SIs that confuse not just the police, the public and Parliament but the very Ministers responsible for them.

With a further 44,000 new cases today, making us world-beating in one league table no one wants to head, a further 73 deaths and millions of people being pinged and everything in chaos, I fear we are in for a long and difficult summer.

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
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My Lords, I am enormously grateful for the thoughtful and challenging questions from the noble Baronesses, Lady Thornton and Lady Brinton. I will start by using a couple of their specific questions to illustrate, as clearly as I can, the strategy behind our approach and the challenges and limitations in what government can and cannot do.

When it comes to the app, this situation illustrates the difficulties of leaving an epidemic. I remember well the CMO talking about what happens to a country when it enters an epidemic; at the beginning of last year, he gave us an introduction and said how difficult it was when you are trying to make that transition. The challenge is of having a partially vaccinated population that has huge pressures to get on with life, while at the same this infection leaves many largely untouched by the virus—in fact, the largest proportion of people. That is exactly the kind of dilemma we are wrestling with.

With the app and the Government’s position on whether you have to isolate when you get pinged, isolation remains the most important action that people can take to stop the spread of the virus. It breaks the chain of transmission. There is no single better measure for breaking the spread of the virus than isolation, so it is argued that it is crucial for people to isolate when told to do so, either by test and trace or by the app. I can confirm that the Government’s advice is to isolate if you are pinged by the app although, as I have said previously, this is not captured in law.

Both noble Baronesses asked about policy on schools and why we emphasise Covid vaccination over LFDs for entry into venues. Those questions give me an opportunity, I hope, to be really clear about the strategy. It is to vaccinate a sufficient proportion of the country that the virus cannot spread so easily, and that R is brought below 1. When we have that moment, we can be more confident that the impact of the virus on hospitalisations, severe illness and worse will be brought under control. At the rates at which we are vaccinating, we are hopeful that we can reach that stage relatively soon.

There is no other plan; there is no way of beating the virus other than ensuring that the vaccination deployment is as effective as possible. That is why we are looking at ways to bring young people and those who are reluctant onside, by engaging them in dialogue, answering their questions and emphasising through our measures the critical importance of vaccination, particularly when sharing space with others in your community.

On vaccinating children, healthy children are at a very low risk from Covid-19, with their risk of death being around one in 2.5 million. No previously healthy child in the UK under the age of 15 has died from the pandemic in the UK, and admissions to hospitals or intensive care are very rare. That is why we are taking a cautious approach in this area. The JCVI will keep this advice under review as more safety and effectiveness information becomes available on the use of vaccines in children; for example, regarding reports of myocarditis as an adverse event following vaccination with Pfizer. However, we will be extremely energetic in looking at all avenues in this area.

We are also looking at booster shots. Following the publication of interim advice by the JCVI, the Government are preparing for a potential booster vaccination programme from September. The noble Baroness, Lady Brinton, asked what the state of the country will be in the autumn. That will in large part depend on the flu vaccine and on the Covid vaccine, which can be taken at the same time. We are working closely with GPs to ensure that that rollout is as effective as possible, because the resilience of the NHS depends enormously on the success of our dual vaccine rollout.

Lastly, the noble Baroness, Lady Thornton, spoke about the importance of keeping life moving. I do not know that phrase but I know that there is a huge backlog in the NHS. There are other profound impacts of our social restrictions and our lockdown measures on the health of the nation, the economy and our society. We cannot continue in this way for ever. There is value in trying to open up our economy and giving individuals the information to be able to make decisions for themselves. That is the inflection point we are at now. I have enormous sympathy for those looking for information on the best approach but I hope the direction of travel is crystal clear.

Covid-19

Debate between Lord Bethell and Baroness Brinton
Thursday 15th July 2021

(10 months, 1 week ago)

Lords Chamber
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Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, the Prime Minister told us 10 days ago that we were heading for “freedom day” and that all the data was going in the right direction; all restrictions would be lifted, and now was the time to take personal responsibility for our behaviour and for the Government essentially to step back. The Secretary of State’s Statement on Monday confirmed that, although with a marginally more cautious note about taking care. I echo particularly the comments made just now by the noble Baroness, Lady Thornton, about the mixed messaging in the new guidance for business and on returning to work, which conflicts with what was said both in the Statement and by the Prime Minister.

However, since the Prime Minister’s and Mr Javid’s confident assertions on Monday, there has been an outpouring of disbelief from senior scientists and doctors. Cases are currently doubling every nine days, and yesterday there were 42,000 new daily cases—a level last seen at the beginning of the January total lockdown. If there is no slowing of that doubling rate, we will have hit 100,000 new daily cases by the beginning of August. And that is before the Government’s expected extra cases as a result of “freedom day” on Monday.

Ministers constantly say that there are fewer people in hospital, that fewer people need ventilation and there are fewer deaths, but what they do not mention is that those numbers are a matter of ratios, and that with the current level of cases our hospitals are already reporting A&Es with the equivalent of a winter surge and more wards being turned into Covid wards for patients. A letter published a few days ago in the BMJ, initially signed by 1,000 doctors, is at over 7,000 signatures and still rising. The data is already clear that the surge in new cases from three weeks ago is increasing hospital admissions right now. So what are the Government doing to support and protect our NHS from this sharp increase and pressure on doctors, nurses and hospitals right now?

While many people are being responsible, still following the guidance and using their face masks, sadly there are many who are not. I was talking to a young security guard who told me that, this week, she is finding it impossible to persuade people to put masks on in their local shopping mall, despite the fact that the rules are still in place. Yesterday, my local community pharmacist told me in despair that two people arrived separately asking him for PCR tests as they each had Covid symptoms and thought all the previous rules had just finished. Not for the first time, much of this is about the Prime Minister’s muddled communication style. In the light of the fact that Scotland, Wales and Northern Ireland are going to retain the face mask mandate, and that the metro mayors, including Sadiq Khan and Andy Street, would like to do so, will the Government please reverse the lifting of the face mask mandate immediately, so that it remains in place, especially on public transport?

I turn to the new guidance for the clinically extremely vulnerable. I have to say that I have never read such an inconsistent and contradictory formal guidance note from the Government—and I have read a few. You should stay at home to be safe but if you cannot work from home, go in; you must remain socially distanced from everyone outside your bubble, even if they do not have to; you must not mix with unvaccinated people, outside or inside. I ask the Minister to tell me how on earth you know who is unvaccinated. As one of the CEV, do I stand in the doorway at opening time at my local greengrocer’s—a quiet time—and shout out to any customers and staff, “Anyone not vaccinated in here”? Of course not. The inevitable logic of this is the restart of shielding but without any of the previous support.

Worst of all, on Friday evening Public Health England put out a press release in which it mixed up advice to the clinically vulnerable and the clinically extremely vulnerable by citing vaccine efficiency research relating to the former in advice to the latter. That paragraph has been repeated in the formal guidance published on Monday. It is plain wrong. In a total administrative muddle, no one has gone through the nine pages of this guidance and updated it, so it is littered with references to the need to follow other rules and guidance for the general public in place at 17 May and 21 June, all of which goes next Monday. Please will the Minister ensure that the guidance is reviewed immediately to remove these anomalies?

All this, and the lack of answers to my questions last week about who the clinical lead is on the clinically extremely vulnerable, tells us 3.8 million former shielders that we have been not just forgotten but thrown to the wolves. Please will the Government actually review the guidance to keep the CEV group safe and provide the support that they need?

I also gave the Minister notice of the following two questions, as they both concern urgent and slightly unusual elements of lifting restrictions. First, for a couple of weeks now, Malta has said that it will not accept UK citizens who have received particular batches of the AZ vaccine manufactured in India, about 5 million doses of which have been given in the UK. Earlier this month, the Prime Minister reassured the press, saying:

“I am very confident that it will not prove to be a problem.”


However, holidaymakers are being turned away from Malta right now. When will the Government resolve this problem?

Secondly, those thousands of wonderful people who came forward to take part in the AstraZeneca clinical trials have been told that their vaccine status cannot be put on the NHS app, which means that they cannot go abroad, either to work or on holiday, or do certain jobs in the NHS that require this evidence. In early June, there was a blog on the BMJ website that set out these problems, but three months on from this issue being initially raised, there is still no resolution. It is utterly wrong that these publicly-minded people have now been left in limbo. Can the Minister say when this problem will be resolved and their vaccine details uploaded?

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, I am enormously grateful to the noble Baronesses, Lady Thornton and Lady Brinton, for their thoughtful questions. The noble Baroness, Lady Thornton, put it extremely well: we are at a delicate inflection point. It is a moment when the whole country needs to be cautious about rushing into change, but it is also a moment when the vaccine is having an enormous impact and change is therefore appropriate.

Infection rates are rising dramatically, but we cannot avoid the fact that hospitalisations and deaths are holding relatively steady. Today, there are 2,970 Covid patients in beds and 470 on ventilators. This is a massively smaller proportion than in the pre-vaccination spikes, when the connection between infection, hospitalisation and death was much firmer and more profound. At the same time, as the noble Baroness, Lady Thornton, rightly pointed out, waiting lists are huge and the gap for diagnostics for severe diseases, such as cancer, is extremely concerning. It is our responsibility to step up to that deficit and not be wholly distracted by Covid. This is therefore a moment when we have to balance competing demands on our healthcare; we are trying to hit the right balance.

On masks, I pay tribute to the Lord Speaker for his leadership in this area and on asymptomatic testing. I saw his Twitter post where he was being swabbed for his LFD test—a commendable sign of leadership. He and the noble Baroness, Lady Brinton, are entirely right: we should wear masks out of consideration for others, including others who may not have had the vaccine or may not be able to have the vaccine. However, it is also entirely right that central government cannot mandate every aspect of human behaviour for months and years to come. I take great pleasure in the sight of local leaders using their influence to inspire the public in this matter. I remind the noble Baroness, Lady Brinton, that DPHs are able to bring in mandatory measures where there are areas of outbreak. People need to know that the wearing of masks has an impact, and we are hopeful that they will go along with that. Although legal restrictions are being removed, the guidance will recommend that masks continue to be worn in certain situations, and businesses will be encouraged to support staff and customers who continue to wear masks.

In line with businesses, public services have always been free to set their own entry policies as long as they meet their existing obligations, including under the Equality Act. Public services must continue to protect workers and others from risks to their health and safety, including from Covid. That is only right and fair.

On the very important question of the immuno- suppressed and the immunocompromised, both noble Baronesses made extremely powerful points. I want to express in very clear terms my personal sympathy for all those who have concerns about the impact of the vaccine and for whom the rise in infections presents a very real threat to their health. However, I flag the Public Health England report on the clinically extremely vulnerable group as a whole. It makes it clear that there is little reduction in vaccine effectiveness for them compared to those who are not in high-risk groups, with between 76% and 93% effectiveness after a second dose. The PHE data also suggests reduced effectiveness for the immunocompromised and the immunosuppressed, particularly after one dose, but effectiveness after two doses is much higher. These general figures mask substantial variations, which we have discussed before—we would expect this between one set of compromised systems and another—but future studies will provide much more granularity on that. It is not right, however, to suggest that all those with compromised immunities are left unprotected by the vaccine.

The guidance for those who are clinically extremely vulnerable was updated and published on 12 July, as the noble Baroness, Lady Brinton, pointed out. This confirms that changes to social distancing rules in step 4 will also apply to the CEV, who are advised to continue considering additional precautions that they may wish to take on board. I hear very clearly the noble Baroness’s points about anomalies in the guidance; I will take those back to the department and try to tidy up the documentation as she advises.

I can inform the House that we are writing to NHS clinicians to update them on them on the latest position regarding vaccine effectiveness for these groups and provide information on potential treatment options currently under development, such as monoclonal antibody therapies and novel antivirals, as well as access to antibody testing. This guidance will support clinicians in their conversations with patients. This is such a variegated group that that kind of personalised advice is critical.

The interim JCVI advice is that all clinically extremely vulnerable people, including immunosuppressed individuals and their household contacts, should be prioritised for a booster vaccine in the autumn. We are continuing to invest in the OCTAVE study, which will provide further data on patients with suppressed immune response. Interim results for the immediate response to the vaccine will be available from the middle of July.

We are absolutely focused on ensuring that the population is given clear guidance. The NHS app is undoubtedly an area that needs to evolve. Its effectiveness as a technological tool in giving people counsel and advice when they have been in close proximity to someone with the infection is extremely valuable. We are looking at ways in which that value can be enhanced.

On the specific question of the noble Baroness, Lady Brinton, about Malta, it is for member states to determine what they accept at their borders regarding vaccines. Foreign travel advice recently published for Malta misleadingly reported that it would not accept the specific batches received from the Serum Institute of India in the UK. This has now been resolved with agreement from the Maltese Government, and Malta is now accepting proof of vaccination from any Covid vaccine administered in the UK.

Turning to those who, as the noble Baroness, Lady Brinton, rightly pointed out, stepped forward for the critical AstraZeneca vaccine clinical trials, being on a vaccine trial absolutely should not disadvantage them. The Government intend to take any action available to ensure that that is the case. We are working with clinical research sites to add participant information of vaccine clinical trials to the national immunisation management service—NIMS—to allow participants to access their NHS Covid pass for both domestic and international travel purposes.

Covid-19 Update

Debate between Lord Bethell and Baroness Brinton
Thursday 8th July 2021

(10 months, 2 weeks ago)

Lords Chamber
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Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, one year ago when lockdown was lifted, we had around 1,000 new cases a day. Yesterday it was 32,000 new cases. Equally concerning, cases are doubling every nine days; hospitalisations are going up; ventilation bed occupation is going up; NHS Providers, as the noble Baroness, Lady Thornton, has said, is talking about hospitals moving back into created-Covid wards and managing safe areas. GPs and hospitals are all reporting a worrying large increase in young people with long Covid, putting further pressure on their services, let alone the worries of an epidemic of long-term illness in the working population. Anecdotal evidence suggests that some hospitals are now considering cancelling some staff summer leave. Wonderful as yesterday’s England victory was, the sight of 60,000 fans walking down Wembley Way in very close proximity with hardly a mask in sight was concerning. As with the England-Scotland match, we must expect a surge in cases. Yesterday, the BBC asked Dr Mike Ryan of the World Health Organization about the UK proposals to lift all restrictions on 19 July. He replied:

“The logic of more people being infected is better is, I think, logic that has proven its moral emptiness and epidemiological stupidity”.


The letter in today’s Lancet from 100 senior medics and scientists echoes the WHO view. What are the Government doing to explain to the experts why their strategy is safe?

I will return to the substance of the Statement later, but I start by thanking the Minister for the meeting yesterday with other Peers, Blood Cancer UK and the Anthony Nolan trust to discuss the immunocompromised and the clinically extremely vulnerable. There are over 2 million CEV who had to shield—that is 3% of the population. So, arising from questions I have asked the Minister many times before in your Lordships’ House, I will ask the following. The CEV, of whom I am one, are worried at the total silence to them over recent weeks since shielding ended formally but, with stay-at-home advice still in place, with cases rocketing daily and all restrictions easing, can the Minister explain how advice to them is being co-ordinated publicly by government? One blood cancer patient said today to an APPG of parliamentarians that the dissonance of their safety versus everyone else’s freedom was hard to bear, especially with no advice. In particular, who has clinical responsibility for drawing together the different issues of therapies, responses to vaccines and continuing care for underlying diseases, and which Minister has overall responsibility?

Overnight, there have been some suggestions from journalists that shielding might even return. If so, that needs to be communicated very urgently to those at high risk, who have not been told about their low vaccine antibody rate. They may be planning to mix with people, or perhaps even go on holiday. Will benefit support for the CEV who have to stay at home but cannot work from home be reintroduced? If the Government are serious about the irreversibility of the lifting of all restrictions, some of the CEV will not be able to return to work for weeks, or even months.

I turn to testing. There are reports today that the Government plan to charge for the lateral flow tests from the end of this month. As LFTs are supposed to be the great self-regulators that the Government are relying on, how much are people going to be charged? You do not pay the Government for a blood test to see whether you have picked up any other infection. The level of charging for PCR tests for people returning from abroad also remains a big issue. Last week in your Lordships’ House the noble Baroness, Lady Vere, told my noble friend Lady Ludford that PCR tests could be obtained at a price of £85 for two. My noble friend’s local pharmacy is charging £398 for a test on the same day, or £240 for the next day for two tests. I know other members of the public have reported similar problems. Can the Minister say how the pricing of PCR tests is being managed and, perhaps more importantly, where one can find the “£85 for two” tests?

On Tuesday, I set out what we from these Benches seek in a return to normal life. We want people to return to work as soon as possible, to be able to mix with family and friends and for our children to be able to have consistent access to education without interruption. We also agree that now is the time to start to do some of that but—and it is a big “but”—we cannot get rid of all the safeguards that protect people mixing together while the virus is still live. An effective test, trace and isolate system is essential. This Statement makes it clear that that is being dismantled. Can the Minister explain why that makes any sense?

Last night, Sebastian Payne of the Financial Times reported the re-election of Sir Graham Brady MP as chairman of the 1922 committee, and tweeted:

“Brady’s re-election is … a reminder of why Johnson is dropping masks and nearly all other … restrictions on July 19: ministers privately say the government no longer had the … votes to keep the measures in place. Relying on Labour would have been … difficult for the PM.”


Are the Prime Minister and the so-called Covid Recovery Group now putting health and lives at risk for their own principles?

Finally, with the threat of 100,000 cases by the end of the month, with hospitals saying they are already worried about the increase in patients and with the threat of the new lambda variant and new north-east variant under investigation, please will the Minister confirm that these changes are not irreversible and that the protection of the NHS, and the safety of all the people in this country, remain the Government’s priority?

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, I am enormously thankful to the noble Baronesses, Lady Thornton and Lady Brinton, for such thoughtful questions. I will certainly try to address as many of them as I can.

In reply to the noble Baroness, Lady Thornton, on the advice we get, I am afraid, as I said last time, that we of course draw on lots of advice from lots of people. I completely acknowledge, as she rightly pointed out, that no decision in this pandemic is risk-free. She set out the list of possible risks very well. There is always the possibility that there will be new variants. We are extremely concerned about the existing 1 million people who have self-diagnosed with long-Covid symptoms; the possibility that that number may rise is very much on our minds, and we are putting in place NHS provision to assist in diagnosis and treatment of that.

We are extremely concerned that test and trace resources will be stretched. We are therefore looking extremely closely at the policy around testing and isolation, while providing test and trace with the resources it needs to get through any increase in the infection rate. I also completely acknowledge the concerns of the NHS Confederation on hospital beds and hospitalisations —although the statistics on those today are extremely encouraging.

Those are all acknowledged concerns that we keep close track of, while putting in place measures to mitigate and minimise their impact. However, the noble Baroness, Lady Thornton, half-answered her own question, because she is entirely right: we need to focus on getting the NHS back to speed in order to address the very long waiting lists and to get elective surgery back on track. It is very difficult to find an answer to the question, “If not now, when?” That has been tackled by the CMO and a great number of people. It must surely be right that we take the inevitable risks of restarting the economy and getting people back to their normal lives at the moment of minimum risk from the virus, which has to be in the middle of summer. Assessing those risks precisely is incredibly complex. Impact assessments of the kind that we would normally associate with legislation are the product of months of analysis. They often identify one relatively straightforward and simple policy measure. We are talking here about a machine of a great many moving parts.

I cannot guarantee that any model anywhere could give us accurate projections of the exact impact of what is going to happen this summer. We are, to a certain extent, walking into the unknown: the Prime Minister made that extremely clear in his Statement. As such, we are ready to change and tweak our policy wherever necessary in reaction to events. However, what we know very well now on the basis of our assessment of the data, and because of the pause we put in place to give ourselves breathing time to assess and additional time to roll out the vaccinations, is that that direct correlation between the infection rate and severe disease, hospitalisation and death has massively diminished. There is a relationship, but it is a fraction of what it used to be.

We can therefore look at a period where those who are at extremely low risk of any severe disease may see an increase in the infection rate, because we know that those in the highest-risk groups have been protected by two doses of the vaccine, and two weeks, and because we are working incredibly hard to get as many in the high-risk groups vaccinated as possible—half a million a day—and to roll out the vaccine to younger cohorts. That is the balance. I cannot deal in certainty here, because certainty does not exist. Balance is key, and I believe the balance we have here is the right one.

The noble Baroness asked specifically about the NHS Covid app. It is in some ways emblematic of the kind of decisions we are making at the moment. She is entirely right: the anecdotes are loud and clear. The app is pinging loudly around the country as the infection rate moves up. To clarify the legal point, as noble Lords probably know, the app protects privacy. We do not know the identity of the person who has the app. In fact, we have no information about people who have the app at all because it has such rigorous privacy protection. As such, the ping from the app is advisory but a telephone call from test and trace is mandatory. That has a legal status and a breach of that advice could lead to an FPN or a knock on the door. It has a different status in that respect.

Given the large number of infections and the large number of pings, we clearly need to review the way in which the app works. The Prime Minister talked about this earlier today. He talked about moving from a quarantine-and-isolation approach to more of a test-and-release approach. We are not quite there yet but we are clearly well on the way. Therefore, I would be glad to clarify how we have made those decisions once they have been announced.

The noble Baroness, Lady Brinton, talked about the plight of the immunosuppressed. I am grateful to her and to Anthony Nolan, Cancer UK and others who were on the call yesterday. I express complete sympathy with the point made by the noble Baroness. If you are at home and your immune system does not work as well as other people’s, and you see the rest of the country opening up, you will feel extremely uncomfortable, as though the world has moved on and that you have perhaps been left behind. Those were the feelings described to me by the experts I met yesterday. On an emotional level, I completely sympathise with that. There are some people in this country whose immune systems do not protect them from flu and contagious diseases that would have no impact on those with a fully functioning immune system. We have complete sympathy for those people.

I acknowledge the noble Baroness’s point that there is a need for clear advice because the immunosuppressed are a highly diverse group. There may be people recovering in hospital with a completely flatlined antibody system, compared to someone who has rheumatoid arthritis but is otherwise living at home and is mobile. It must be right that that communication is done on a tailored basis through the healthcare system. We will look at ways in which we can ensure that GPs are informed and have the right information in order to give that bespoke advice.

The dissonance is hard to bear. I recognise the noble Baroness’s point but I do not necessarily have a suite of answers for absolutely everyone in this condition. We have large investments in antivirals and in therapeutic drugs, including some of the monoclonal antibodies that may offer some protection to some people in this situation, but it is not going to be a blanket measure. As a result, we are putting a huge amount of investment in the OCTAVE study, which looks specifically at ways in which vaccines, boosters or therapeutics can be used to protect those whose immune systems are not right. Ultimately, it is going to be down to the vaccine. The vaccination of a large proportion of the population, including the carers who look after the immunosuppressed, is how we will offer protection to these people.

On the noble Baroness’ question about the LFT system being dismantled, I do not recognise those press reports. On the provision of PCRs by the private sector, she asked how prices are determined. The answer to that is through the market. The marketplace introduces competition and innovation. I am pleased to say that the price for tests is coming down and will come down further. The one provided by Chronomics for TUI is now £30; that is a very encouraging sign that there is more to go.

Covid-19 Update

Debate between Lord Bethell and Baroness Brinton
Tuesday 6th July 2021

(10 months, 3 weeks ago)

Lords Chamber
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Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, on the 73rd birthday of the NHS yesterday we supported and echoed the thanks to everyone in the NHS and the care sector for their extraordinary and humbling response to the pandemic, which continues to this day. We are far from being an NHS back to normal, whether through increased Covid cases, the backlog of hospital appointments and life-threatening delayed diagnosis, all the way through to the more routine but also vital services. So, our best present to the NHS will be to lift restrictions and return to normal in the safest way possible for them, for patients and the wider health of our country.

For months, the Prime Minister has talked of “data, not dates”. The data shows cases running at over 25,000 per day and predicted to rise to 50,000 per day by the end of the month. Hospitalisations are up and even ventilator bed use is up, which, while not as bad as in the previous two waves, is putting pressure on the hospitals dealing with them.

There is a large surge of cases in the north-east, and there are concerns that a new variant may exist there. Cases in the UK of the lambda variant from Peru are now being investigated as it appears more transmissible and possibly more resistant to vaccines. If the UK is following the route out of the pandemic used by Israel and the USA, we should note that both those countries are now finding that that system is not working for them: Israel’s proportions are picking up again and Florida is struggling to cope with a very large surge in cases.

Yesterday’s Statement was a case of ideology over science. It says that the vaccine is a “wall of defence”, but it is a wall with holes in it. First, one-third of adults have not yet had their second jab; nor have any children. That is a reservoir of millions—not just thousands, as the noble Baroness, Lady Thornton said—who are at risk of catching Covid, whether seriously or not, and passing it on to others. Secondly, double-jabbers are not conferred with magical total immunity and protection, and we know that they can transmit it too.

We on these Benches want to start with a return to normal and to lift restrictions. We desperately need to kick-start the economy, to start to socialise again and, as my noble friend Lord Scriven said last month, to live with Covid as it is now endemic and will be with us for some years to come. However, that means providing the safety net needed to ensure that people are as safe as possible. Asian countries that managed their pandemic well learned from SARS. The use of face masks became routine and a matter of personal and wider social responsibility, allowing life to continue in the flu season and in the pandemic. They also maintain strong and effective test, trace and isolate systems all the time. We will be discussing test, trace and isolate in detail following the Statement that is due to come to your Lordships’ House on Thursday, but the proposed reductions in test, trace and isolate will remove the UK’s ability to manage outbreaks swiftly, during which time others will catch and pass on Covid.

When we drive into our towns and cities, we rely on local authorities to set up traffic systems, including traffic lights, to help to guide us on safe journeys, regulate movement and reduce harm and damage. But it is as if “freedom day” is getting rid of all our traffic lights.

Proportionate responses are needed, and these include face masks. Early last year, even the WHO was equivocal on the use of face masks but, as the world became aware that this is a respiratory disease passed on through droplets, most countries moved to face mask mandates. On 19 July we switch to rules that make it only the responsibility of individuals. Thankfully, most people have taken that responsibility seriously, but not everyone has. That is important because, despite what the Minister said in response to my question yesterday about the clinically extremely vulnerable, there is no direct reference to the CEV in this Statement—unless he meant the passing reference to them being part of the priority group that will get the third jab. They need to know where they stand. There is no new advice, just the burning of the remaining rules that keep them safe.

Last night the Government published the Health Protection (Coronavirus, International Travel and Operator Liability) (England) (Amendment) (No. 5) Regulations 2021 and brought them into force at 6 am this morning. This amendment allows supporters of foreign teams with tickets for the final stages of the Euros to travel. Tens of thousands of foreign fans will be waved in, despite the high number of daily cases and despite 1,300 cases among Scottish fans after they travelled to Wembley to play England last month. I am not surprised: it is a crowd-pleaser. But as a legislator I find it extraordinary and unacceptable that the Explanatory Memorandum states this amendment is needed “to protect public health”. Frankly, that is in complete contradiction to the regulations themselves. Such inconsistent behaviour from the Government typifies a desire to please people, rather than think ahead and manage scenarios.

What we need is careful planning when lifting restrictions that keeps people safe by having effective measures in place: face masks in risky environments; test, track, trace and self-isolate rules that protect people; and funding for those who have to self-isolate. That is the way we can move to a new normal, to an economy that can work again, with health traffic lights around us to manage and minimise Covid.

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, I am enormously grateful for the thoughtful questions from the noble Baronesses, Lady Thornton and Lady Brinton. I will address the first question from the noble Baroness, Lady Thornton, on where we get our advice from and will try to explain a little bit about how these decisions are made.

We get advice from a wide variety of inputs. They include the NHS, and we look very carefully at NHS capacity and projections for trying to catch up with the very large waiting lists that we have for electives. We get advice from schools about the prevalence of infection and attendance at schools. We look to Parliament for guidance, scrutiny and challenge. We have talked to GPs about the front-line picture that they see. We look to the JVCI for epidemiological advice. SAGE provides an important challenge and interesting support, particularly in terms of modelling, but it is not the sole repository of all the evidence for our decision-making. We are extremely grateful for its input but we have to take on board a very large set of perspectives when we make these decisions. We cannot rely on just one data set from one group. It is a holistic situation, and we have to balance a lot of different and competing needs at the same time.

That is why the decisions made in the Statement yesterday and in the Statement made by the Secretary of State an hour ago are proportionate and have, I hope, the caution, care and clarity that the noble Baroness quite rightly referred to. She is right that some infections will, very sadly, lead to severe disease, hospitalisation and, in some cases, death. But the proportion of those infections is much smaller than it was before the vaccine arrived. We have successfully vaccinated a huge proportion of those who are the most vulnerable to this disease. As a result, although infections are rising, the impact on hospitalisation and death is a very small fraction of what it once was.

We need to proceed with caution, keeping a very close eye on those relative relationships, but the picture that we see at the moment is relatively straightforward: the vaccine works. The statistics for both the BioNTech and the AstraZeneca vaccines are incredibly impressive in terms of both hospitalisation and transmission.

The noble Baroness challenged me to explain what I thought might be an acceptable level of deaths. I do not wish to split words with her, but the honest truth is that I do not accept any deaths as acceptable. I am not just trying to be smart with the language. It is our mission, particularly in the Department of Health but in the Government as a whole, to try to tackle all deaths as well as we possibly can.

All health decisions are always based on a balance of risk, whether it is a GP taking your blood pressure in his or her surgery or whether it is for big demographic interventions of the kind that we are debating today. Balance is the essence of public health decisions, and we are trying to make the best possible decisions around this. They have to take into account the huge challenge that the NHS faces in tackling business-as-usual disease. Millions of people have not turned up for the diagnostics that they should have taken or to have examinations of the lumps and bumps that they are worried about. There is a huge catch-up in terms of the waiting lists, and those have an impact on illness, long life and death. We have to balance the priorities of the pandemic and those of our existing healthcare system, and also the usual life of our communities. That is why we are taking the route that we are.

The noble Baroness, Lady Thornton, raised public transport. That is not only a practical and very important context for this discussion; it is iconic of the decision to move from mandation to a voluntary principle on behalf of a large amount of the public for a large number of the measures that we did, at one point, put into law. We are trying to seek a new covenant with the country based on consideration for each other. The noble Baroness put it extremely well, and I entirely share her scruples. I have four children—who are vectors of infection, to put it politely—and I attend a large number of business meetings, including here in the House, and I regard myself as a high-risk candidate for carrying the disease. I have never caught it myself and I have been vaccinated but when I sit on a Tube train I wear my mask, not to protect myself but to protect the person next to me. That is my personal assessment and my personal decision. That is the spirit in which we are inviting people to step forward and make their own decisions and to be considerate to each other.

We cannot have laws on all these matters for the rest of time. At some point we have to ask the country to step up and take responsibility and to have personal agency in these decisions. If we do not put that challenge to the country in the summer months, when our hospitals are relatively safe and the virus has the right conditions, when will we be able to make those decisions?

I agree with the noble Baroness about the position that many workers find themselves in. She is right that PHE data is very daunting when you look at the low-paid, front-line workers who drive taxis and buses or are in all sorts of other front-line positions. They have been hard hit by the pandemic, partly because of their living conditions, partly because of their environment and partly because of the prevalence of comorbidities, but also because of the risk that they personally put themselves at. I call on everyone to be considerate on that point. We need to think about the kind of risk that people are putting themselves at when they go about their normal day-to-day work. I ask people to be thoughtful about infectious respiratory diseases and, in fact, all diseases. That is why the Prime Minister has talked in the terms that he has.

In the meantime, we are making changes to the way we are doing things. The noble Baroness, Lady Thornton, asked me about children. To be clear: the Secretary of State said in his Statement that anyone under 18 who is a close contact of a positive case will no longer need to self-isolate after 16 August. Instead, children will be given advice about whether they should get tested, dependent on their age, and will need to self-isolate if they test positive. These measures will come into force on 16 August, ahead of the autumn school term. That is a proportionate response to the changed situation we find ourselves in, with the massive rollout of the vaccine and the evidence that we can see in front of our eyes of the impact of the disease on those who are under 18.

In reply to the noble Baroness, Lady Brinton, I spoke about the Secretary of State’s speech yesterday, in which he said very clearly, on the clinically extremely vulnerable, that guidelines will be published, and that remains the case. We are extremely sympathetic to those whose immune system does not allow the vaccine to have an impact. What use is a vaccine that supports your immune system if your immune system does not work very well? That is a challenge that more than a million people in the country face, and we are working extremely hard to address that issue. That work includes a huge amount of research through the OCTAVE study and a massive investment in the antivirals task force and the therapeutics task force. Those who are clinically extremely vulnerable, particularly those who are immunosuppressed, have not been forgotten and are very much the focus of our efforts, but it is an extremely difficult challenge to meet.

Health: Dementia

Debate between Lord Bethell and Baroness Brinton
Monday 5th July 2021

(10 months, 3 weeks ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, guidance to help enhance best practice in dementia assessment and diagnosis was recently updated and published to support a personalised approach and choice in the delivery of remote consultation or face-to-face diagnosis. The guidance was developed in collaboration with stakeholders, including those with lived experience, and through the Dementia Change Action Network. I completely acknowledge the point that the noble Baroness makes. We are working as hard as we can to get the kind of face-to-face assessments she describes. They play an essential role in what we do.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, the 2019 national memory service audit carried out by NHS London reported that a quarter of English dementia services were unable to provide or refer on for carer psychoeducation. Knowing the struggles that my stepmother had over a decade ago getting recognition, let alone support, as my father’s dementia worsened, these figures remained stubbornly low. Can the Minister say when early support will automatically be available for all carers of those diagnosed with dementia?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I pay tribute to the role of carers in the kinds of situations the noble Baroness describes. We are doing an enormous amount to supply training for carers in all facets of their delivery, including support in caring for those with dementia. I am not sure that I can make the guarantee that she seeks right now, but I reassure her that this is one area of our investment in carers that we take extremely seriously.

Hospital Waiting Lists

Debate between Lord Bethell and Baroness Brinton
Tuesday 29th June 2021

(10 months, 4 weeks ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, there has been an enormous pandemic, which has, of course, had a huge impact on the healthcare system. During the pandemic, the financial support for the NHS—as well as the system support—has been huge and had a huge impact. We are looking at a backlog and working hard to get through it, but noble Lords should be in no doubt that we are thoroughly committed to getting back to full operational capacity.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, around 10 million people across the UK are affected by arthritis, and the widespread impact of rheumatology conditions costs the NHS over £10 billion a year. The recent British Society of Rheumatology report, Rheumatology Workforce: A Crisis in Numbers, lays bare the shortage of all multidisciplinary staff, including the consultants, nurse specialists and physiotherapists who are needed to deliver the NICE treatment guidelines. This shortage of staff and funding is already impacting severely on rheumatology waiting lists. Can the Minister say how this funding and workforce gap can be addressed with immediate effect? If he does not have the figures and answer to hand, please can he write to me?

Lord Bethell Portrait Lord Bethell (Con)
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The noble Baroness points very well to exactly the kind of challenge that we face at the moment. She is entirely right that conditions such as arthritis and rheumatology require complex combinations and collaboration between many different staff, as well as the application of new and effective treatments and therapies. That is exactly where we are working hard to catch up. I will go back to the apartment, dig out any statistics I can and write to her accordingly.

Social Care Reform

Debate between Lord Bethell and Baroness Brinton
Tuesday 29th June 2021

(10 months, 4 weeks ago)

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Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell)
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My Lords, the commitment to publishing a review of social care is absolutely heartfelt. We have delivered on Brexit and the vaccines, and we will deliver on social care. The Prime Minister has made it crystal clear that that will be done by the end of the year; that commitment remains in place. It will require enormous financial commitment by the whole nation at a time when our finances as a nation are extremely stretched. Therefore, it is entirely right that very careful consideration is given to it. It will also involve a very large amount of engagement with other parties and the relevant stakeholders. Again, this is not something that has been rushed. We have just been through the most awful pandemic; it is not possible to do a review of this generational nature at the same time as fighting this awful disease, but we will be true to our commitments and deliver the plan as promised.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, in last Thursday’s debate on social care and carers, the Minister said

“a plan for reform absolutely is under way. We have before us the building of foundations, which will be laid in the social care measures in the health and care Bill, which will support us in working together”.—[Official Report, 24/6/2021; col. 447.]

Arising from that, is it planned to publish a White Paper or any other consultation document or, as the Minister’s speech implied, will the reforms be published as part of the health and social care Bill without any wider consultation? Given his answer just now to the noble Baroness, Lady Wheeler, will parliamentarians be ask to make decisions on the health and social care Bill without seeing the details of the future social care reforms?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, new legislation will increase integration between health and social care by removing barriers to data-sharing, enabling joint decision-making and putting more power and autonomy into local systems. The noble Baroness is entirely right on that. The Bill has been published and the noble Baroness is very welcome to engage in some of the engagement sessions that I have had on it already. I should be glad to run more, if that would be helpful to her. A White Paper and a public consultation are not planned.

Covid-19 Update

Debate between Lord Bethell and Baroness Brinton
Tuesday 29th June 2021

(10 months, 4 weeks ago)

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Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, I echo on behalf of these Benches the concerns about the treatment of Professor Chris Whitty. It is totally unacceptable, and it is good news that the police are now investigating this.

Just now, in reply to my question on the Urgent Question, the Minister said that the health and social care Bill has been published. Over the last few minutes I have been searching the web, but I cannot find it— can he help me any further?

Yesterday’s Statement from the new Secretary of State struck an interesting new note. The department is clearly no longer going to be led by data but by dates. Yesterday, 22,868 new cases of Covid were reported. This time last year, when lockdown was finally lifted, daily cases were under 1,000. Even with the high level of vaccinations, this is causing illness and pressures on the NHS—even if it is a different kind of pressure to that of a year ago. On Sunday, Andrew Marr reported on his programme that his own experience of catching Covid had been difficult. He said that, while he had not needed to go to hospital, he was more ill than he had ever imagined possible, and it was not an asymptomatic experience. In the light of this and the reports of growing numbers of people living with long Covid, can the Minister say why data will now clearly not factor into the decisions about 19 July?

On these Benches, we believe that we need to learn to live with this disease, but unlike the Statement from the new Secretary of State, we do not believe that this is just about vaccination, important though that is. This week, Israel has found that, despite early and comprehensive levels of vaccination, the delta variant is ripping through its communities. We have argued since February 2020 that controlling outbreaks is vital. Can I ask the Minister about the provision of test, trace and isolate arrangements moving forward? Specifically, have local directors of public health been given access to emergency funding for the provision of surge testing and tracing and vaccination in their communities? When will the pilots for increased support for those needing to self-isolate be published? We still believe that people should be paid their wages if asked to self-isolate. As that number is considerably fewer than six months ago, it would be not only cheaper for the Treasury but a much more effective way of ensuring that the spread of the virus is reduced.

Usually the Minister agrees with me on the importance of test, trace and isolate, even if we perhaps disagree on how that should be funded and supported. Can he respond to the concerns of the doctors and scientists who are appalled with today’s proposals that company directors will be able to temporarily leave quarantine for business meetings? People are still furious that the Prime Minister delayed adding India to the red list, with the resultant rapid spread of the more transmissible and more serious delta variant. As Professor Christina Pagel says:

“luckily elites don’t get or transmit covid.”


Stephen Reicher, the eminent behavioural scientist, said he was horrified by the

“scandalous misuse of science as a cover for political decisions … which is putting us all at risk.”

When commenting on the DCMS report published on Friday, he said:

“The headlines and the political response isn’t just an exaggeration, they directly contradict what the report says. It warns that the research wasn’t designed to draw any conclusions about the effects of events on transmission and mustn’t be used to do so”.


Yet Ministers and the press are all reporting that these events in the trial had no effect on infections and were safe to reopen.

Yesterday, a No. 10 spokesperson explicitly denied that government Ministers have used private email addresses. They said:

“Both the former health secretary and Lord Bethell understand the rules around personal email usage and only ever conducted government business through their departmental email addresses”.


This is directly contradicted by the Second Permanent Secretary in meeting minutes published by the Sunday Times. Those minutes clearly state that former Health Secretary Matt Hancock

“corresponds only with private office via a gmail account”.

As the Good Law Project has reported, on 19 April 2020, the noble Lord, Lord Feldman, emailed the noble Lord, Lord Bethell, at his private address, about the availability of Covid-19 test kits via a Canadian company, saying:

“Certainly worth contacting … to see if they can help … and the pricing seems competitive.”


Self-evidently, this is government business, and specifically within the portfolio of the noble Lord, Lord Bethell. The noble Lord, Lord Feldman, once co-chair of the Conservative Party, was writing to the Minister at his private email address on government business. In addition, I note that the Minister’s meeting with Abingdon Health on 1 April 2020 was not disclosed on the ministerial meeting schedule.

We note that, unlike the response from the noble Lord, Lord True, on the earlier UQ, it is not possible for the public to access private emails; the Freedom of Information Act specifically excludes it. Not going through the formal government-approved routes, whether for emails or declarations of meetings, gives the impression that perhaps the Minister has something to hide from his dealings with a former chairman of the Conservative Party and the company he was acting for. I note that the company was awarded an £85 million contract after the meeting and the emails.

There has been considerable speculation about the role of Ms Gina Coladangelo as a lobbyist, unpaid adviser to Matt Hancock and then a non-executive director for the Department of Health and Social Care. The press and media have also reported that the Minister gave Ms Coladangelo a parliamentary pass last year. Can he tell the House what personal parliamentary service she provided for him during that period? Does the Minister feel that his position is tenable, given this evidence?

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, I am enormously grateful for those extremely thoughtful questions. As ever, I welcome the challenge and scrutiny that the House of Lords always provides on these matters.

I completely endorse what the noble Baronesses, Lady Brinton and Lady Thornton, very thoughtfully said about Chris Whitty. Chris Whitty and JVT are both complete legends, and both have been accosted in public. This is completely unacceptable. We must look at the security of those who serve us so well, and we must somehow address the disrespect that often happens when public figures walk in public. It is a great regret that this has happened.

The noble Baroness, Lady Thornton, asked about nurses’ pay. I repeat to her what my right honourable friend the Secretary of State for Health said yesterday: this absolutely remains a priority. We must have a fair pay settlement. That pay settlement is going through the pay review process at the moment, and we look forward to receiving the output on that.

Both the noble Baronesses, Lady Brinton and Lady Thornton, asked about the basis for the optimism that we have at the moment. I have stood at this Dispatch Box for 18 months as the purveyor of difficult news to the House, and have lived through some very difficult moments in that time. I am acutely aware of the concerns that noble Lords have. I think the questions put were very reasonable and deserve a clear answer, so let me explain why we are a bit more optimistic than I think we ever could have been in the recent past. The case rates are slowing down, for both over and under-60s. Hospital admissions among the over-60s have started to fall, and while there are signs in both measures that the rate of growth is slowing, there is just not enough to fundamentally change our assessment of the risk of delta. In the last two weeks, we have seen case rates fall in both Bolton and Blackburn. That is an incredibly important observation, and one that bears testimony to the effectiveness of the local authorities, test and trace, and all of those who have contributed. It is mainly driven by the under-60 group, but not wholly. Rates among older people are plateauing right across the country at a lower level, and hospitalisations and severe illness are being prevented by people being doubled vaccinated against Covid-19. There are very clear signs that the vaccine is working in lots of ways.

By 19 July, two significant things will have changed that may give us stronger confidence. First, we will have offered a first dose to all adults in the United Kingdom. The NHS states that it can do this by 19 July. We will have also given a second dose to a higher proportion of over-40s, giving them more protection against hospitalisation. Secondly, we will be very close to the school holidays, which start on 26 July, and school-aged children being out of school. This will significantly reduce transmission among the population which is unvaccinated and has driven case growth. Universities should also be out.

We are monitoring the data every day. So far, we have not seen indicators that substantially change our assessment of the four tests. I hear loud and clear what the noble Baroness, Lady Brinton, says about Andrew Marr and his experience. Vaccination is not a panacea. It does not save everyone from any illness at all, but it has a significantly strong effect for us to move on to the next stage.

In terms of the backlog, I assure the noble Baroness, Lady Thornton, that we are putting funds in place to do whatever it takes to get us back to where we began. I cannot give the specific reassurances she asked for on whether specific funds will be extended, but it is our aspiration to work as hard as we can. On GP data, I assure her that the clinical trial progress that we have made on things such as Regeneron in the last few days gives us such a clear inspiration and motivation for ensuring that we get this project right. On trusted research environments, we have demonstrated that we listen and that we will change how we implement the GP data transfer, but our objective remains resolute. We are committed to continuing with this programme of work.

I will give a very clear response to the very important question regarding emails, asked by the noble Baronesses, Lady Brinton and Lady Thornton. I am absolutely rigorous in ensuring that government business is conducted through the correct formal channels. Contracts are negotiated by officials, not by Ministers. Submissions from officials are handled through departmental digital boxes, and that is right. Official decisions are communicated through secure governmental infrastructure.

I have read the Ministerial Code; I have signed it and I will seek to uphold it in everything that I do. The guidelines are clear that it is not wrong for Ministers to have personal email addresses. I have corresponded with a very large number of noble Lords in this Chamber from both my parliamentary address and my personal address. That is right and I will continue to do so. In their enthusiasm, third parties often seek to engage Ministers through whatever means that they can find, including their personal email. That is not the same as using a personal email for formal departmental decision-making. Those who have seen material on the internet should judge it extremely sceptically, because distorted fragments of evidence do not provide sufficient grounds to rush to judgment on how Ministers do their business.

I do not recognise the substance of the comments of the Second Permanent Secretary, as referred to by the noble Baroness, Lady Brinton, and he has indicated to me that he does not recognise the substance of those comments. I completely recognise the comments that were made regarding the meetings with Abingdon Health. The meetings schedule from that week was overlooked because of an administrative oversight. It has now been uploaded to the internet. I will be glad to share a link to that register. On the complaint made by Anneliese Dodds, I have written to the Parliamentary Commissioner for Standards and would be very glad to share that letter with the noble Baronesses, Lady Thornton and Lady Brinton.

I take this post extremely seriously. During the work of the pandemic, many people—officials, Ministers and those in industry—worked extremely hard to address the severe epidemic that we face, and I am extremely proud of how that business was conducted.

Covid-19 Update

Debate between Lord Bethell and Baroness Brinton
Tuesday 15th June 2021

(11 months, 1 week ago)

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Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, we on these Benches echo the support of the noble Baroness, Lady Thornton, for the Commons Speaker’s statement yesterday on the Government’s continued abuse of Parliament.

We repeatedly warned the Government that sending out mixed messages about lifting restrictions on 21 June would cause problems. Even in March, the Prime Minister made it evident that he wanted us out of restrictions “irreversibly”—his word—by next Monday. What is worse is that we are now in a fourth Covid wave because of his desire to visit President Modi in India in mid-April. The resultant dangerous dithering about putting India on the red list contrasted sharply with the TV news. Every evening, we saw that the then delta variant was scything through India. Even then, Indian epidemiologists were talking about a much faster transmission. We on these Benches have repeatedly asked why India was not added to the red list on 2 April.

At yesterday’s press conference we were warned that the current delta variant wave will likely peak in mid-July, as cases, hospital admissions and patients needing ICU increase steadily. Even if vaccines mean that hospitals are not being overwhelmed, there is an increase. The UK now faces continuing restrictions entirely because of the Prime Minister’s delay.

The academic paper Estimating the Failure Risk of Hotel-based Quarantine for Preventing COVID-19 Outbreaks in Australia and New Zealand, published in February this year, calculated the risks and likely seeding of variants in the light of infection control and surveillance used locally. It now provides an essential baseline to assess seeding of cases coming from abroad. Devan Sinha of Oxford University and other UK scientists have used this to look at the seeding of the delta variant in the UK. He noted that 96% of the seeding of the delta variant occurred after 2 April—that is, after Pakistan and Bangladesh were added to the red list but India was not. He estimates that putting India on the red list on 2 April would have delayed the current wave by a further four to seven weeks. That four to seven weeks would have meant that all over-40s had had access to a second dose and, at seven weeks, most over-30s. He said that the wave would have been

“much smaller and mostly neutered”.

What have the Government learned from this delay? Why did it take so long for the delta variant to be moved from a variant of interest to a variant of concern? Despite MPs, Peers and scientists all asking in early April, Matt Hancock told the Commons that it would be listed as a variant of concern on 20 April. In fact, it was not listed until 7 May. Even worse, surge testing did not start until May either. If it was serious enough for India to be added to the red list by 23 May, why was it made a variant of concern only on 7 May? Was the delay with PHE or with Ministers?

The necessary continuation of restrictions at the current level means that a number of support schemes are now out of kilter with the restriction levels. These include lifting the embargo on evictions, the reduction in furlough support while people are still being asked to work from home if possible, and other business support mechanisms. Please can the Minister say whether they will be extended until we know that we are lifting restrictions completely? When, oh when, will any of these Statements or communications make it clear to the clinically extremely vulnerable and their families and friends what they are expected to do?

The Statement lists the areas where restrictions are to be lifted, many of which will be welcome, especially the 30-person limit on attending weddings, receptions and commemorative events, and out-of-school residential visits in bubbles of up to 30. But I ask again about mask wearing in schools, given the continuing increase in delta variant cases among children. Will there be specific guidance for these events, including lateral flow testing before and after, so that any outbreaks at a wedding could be tracked and managed? What level of new Covid cases per day would change the pilots on large events with higher capacities, especially the ones planned at full capacity?

It is good to see the removal of enforced quarantine for care home residents after trips out of homes. I never did understand that one, given that staff and visitors did not have to self-isolate.

It was good to hear the emphasis in the statement from Professor Whitty and Sir Patrick Valance on the importance of the second dose. I repeat my regular plea that all Ministers use this as a reference point. Far too many only ever use the number of people having had the first dose. With the delta variant, it is even clearer now that two doses are essential.

Why on earth did the Prime Minister say yesterday that 19 July is definitely the terminal day for restrictions? We all hope that he is right, but if he and Ministers are led by data, how can he say that?

Finally, the Statement refers to surge testing in areas where the variant is also surging, but maps show such a steady rise in cases across the country. Can the Minister confirm that there are enough test, trace and isolate staff to manage effectively this fourth wave of Covid?

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, I am enormously grateful to the noble Baronesses, Lady Brinton and Lady Thornton, for such thoughtful and searching questions.

Covid-19: Vaccines and Pregnancy

Debate between Lord Bethell and Baroness Brinton
Monday 14th June 2021

(11 months, 1 week ago)

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Lord Bethell Portrait Lord Bethell (Con)
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I am extremely grateful for those constructive suggestions from the noble Baroness. We have a very large amount of materials specifically for pregnant women, including guidance for pregnant women and a guide for women who are of childbearing age, pregnant or breastfeeding; those are widely distributed by GPs. However, as I said, a lot of pregnant women do not know that they are pregnant, so it is not possible to reach all of them all the time. At the moment, our priority is to ensure that those aged over 50 take their second jab. We will sweep up other demographics, and we will make that a priority when we reach it.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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A close family member rang her surgery to ask for advice about being called for vaccination while breastfeeding. They said that it was nothing to do with them and told her to ring the main vaccine booking line. That person said, “Just ask the person who vaccinates you”, who said, “Oh, I don’t know. I’ll have to check”. Last week, Channel 4 reported that this is a widespread problem for pregnant and breastfeeding mums. It is evident that there is no clear guidance for front-line staff on what to tell mums. Can this be remedied as a matter of urgency?

Lord Bethell Portrait Lord Bethell (Con)
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The noble Baroness alluded to a problem that is, I am afraid, commonplace in the healthcare system: an acute sensitivity about giving advice to those who are pregnant because people are very concerned about giving the wrong advice, which sometimes leads to no advice being given. We are aware of this problem but I assure the noble Baroness that material is given to those on the front line—I have mentioned some of the materials that we have published—and GPs have all that material at their disposal. We have recognised this problem, we have moved on it and we are making as much material as possible available to the right people.

Carers: Support

Debate between Lord Bethell and Baroness Brinton
Thursday 10th June 2021

(11 months, 2 weeks ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I can reassure the noble Baroness that economic considerations absolutely will be borne in mind. It is a huge challenge to take on the massive economic benefits of unpaid carers, and I will be glad to meet Carers UK—I have in fact already begun scheduling a follow-up meeting to this morning’s call.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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Too often, the family carers of children with the most serious and complex health needs are at the back of the queue for care breaks, and many had no breaks during the pandemic at all. Research by Together for Short Lives has found that cash-strapped English local authorities fund just 1% of the care costs of children’s hospices which provide these short breaks. Does the Minister agree that the Government need to fill the £400 million funding gap in social care for disabled children as a matter of urgency, to ensure that these carers get the breaks they desperately need?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, as the noble Baroness knows, we have worked very closely with hospices to fill the funding gap that hit them hard during the pandemic, and I pay tribute to those who worked so hard looking after younger vulnerable people. The pressure on care breaks has been intense during the pandemic.

NHS Digital: Primary Care Medical Records

Debate between Lord Bethell and Baroness Brinton
Tuesday 8th June 2021

(11 months, 2 weeks ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I am grateful to the noble Baroness for her kind remarks. As she knows, there is an incredibly rigorous system for ensuring the safe curation of this data, and I pay tribute to the Caldicott Guardians, the ICO and the IGARD board, which has put in place a very tough and rigorous surveillance system to ensure that all the data sharing that goes on within the NHS complies with the legal requirements and the guidelines laid down by law and by the NHS. These are tough conditions and they are applied very rigorously.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, it is a relief to hear that there will be a delay, but I am astonished that the Government have left it this late. When will the data protection impact assessment for this be published, and will the Minister place a copy of the DPIA in the House Library, so that Members can read NHS Digital’s own statements about the privacy risks and the impact of the programme? It might help the ICO in its deliberations about whether the system proposed is safe.

Lord Bethell Portrait Lord Bethell (Con)
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I am grateful for the question. I will look into that date and share whatever materials are available.

Covid-19: Government Handling and Preparedness

Debate between Lord Bethell and Baroness Brinton
Tuesday 8th June 2021

(11 months, 2 weeks ago)

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Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, I absolutely join the noble Baroness in paying tribute to all carers, particularly unpaid carers, who have shouldered a huge burden in the past 18 months. The role that they have played has been a real example of the sense of service and commitment that characterises the social care community in this country. We have put in place a large amount of resources through local authorities and payments to local authorities to support carers. That has helped in infection control and to reduce the itinerant nature of some social care in order to prevent the spread of the disease. But it is undoubtedly true that the burden on unpaid carers remains immense, and we continue to support, both through local authorities and through charities, the work that they do.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, in the national Carers Week, it is worth remembering that the 2017 report on Exercise Cygnus said:

“Local responders also realised concerns about the expectation that the social care system would be able to provide the level of support needed if the NHS implemented its proposed reverse triage plans.”


It also recommended that local support should be developed and planned for social care and health. Was that recommendation put into practice? Were the concerns expressed by local responders borne out last year? Will the Government now publish their internal review of pandemic preparedness to ensure that the lessons have been truly learned?

Covid-19 Update

Debate between Lord Bethell and Baroness Brinton
Tuesday 8th June 2021

(11 months, 2 weeks ago)

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Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, I declare my interest as a vice-president of the Local Government Association. I also want to thank the Minister for his long stint at the Dispatch Box, yet again.

I want to start with the issue about consultation on NHS Digital patient data, which the noble Baroness, Lady Thornton, just alluded to. In 2013, the Government wrote to every household to explain the care.data project. This new scheme has had no such communication with the public. As people hear about it, they are increasingly concerned about the breadth of data that will be captured. Will the Minister agree to use the delay to ensure that every adult in England is written to as a matter of urgency, including an opt-out form they can use if they so choose?

I also want to pay tribute to our health workers and carers—paid carers and especially the unpaid carers—who have gone not just the extra mile over the last 14 months but a whole marathon. Can the Minister say what steps the Government are taking to help the exhausted staff and carers who know that there are many miles still to go before we are through this? Help is needed right now for them in an emergency plan that does not just focus on getting back to work as normal.

The Minister is right to say in the Statement that there is no room yet for complacency. The delta variant will not be the last variant trying to wriggle between those who are protected and those who are not. We are concerned that there is not a focus on communicating to the public about how we need to find a way to live with Covid circulating, as my noble friend Lord Scriven said yesterday. We have moved into Covid being endemic, and the public will want and need to know what they should do over the next few months.

Communication about the vaccine figures is cheering to hear, but still too many Ministers talk about the one-dose level, not the two. The Minister in the Lords, to his credit, usually make that point, but the Prime Minister and many other Cabinet Ministers do not make it clear that we need 90%-plus of adults to have had two doses before we are anywhere near safe, and that social distancing, mask wearing and hand washing will still need to happen.

I thank the Minister for giving more information yesterday on the isolation support pilots. He said:

“In Blackburn and Bolton, this will include trialling broadening eligibility during surge testing, so that all those who are required to self-isolate, who cannot work from home and earn under £26,000, receive a £500 payment.”—[Official Report, 7/6/21; col. GC 202.]


That is still only £50 a day if you are expected to self-isolate. If you are told to isolate on a Monday, and usually work nine to five, this works out at £7.81 per working hour—less than the minimum wage. If the minimum wage is the very minimum that the Government believe an individual can live on, why are they paying less than this to people for doing the great public good of self-isolating? What about people who work in risky occupations and have been told to isolate multiple times over the last year? For them, it is not just one period of 10 days.

From these Benches, we believe that the Government need to pay people’s wages. Now that fewer people should be required to self-isolate, as community cases are lower, we should be diverting resources to really get right what the Government have been getting wrong all along. We must stop Covid in its tracks. Examples from other countries show that paying wages has a strong and demonstrable effect.

On international travel, the red terminal at Heathrow is an improvement, but there are still issues with those arriving from amber countries, who are asked to jump on public transport to get home and need to travel in various ways before they are tested, once in this country.

Given the increase in cases of the delta variant among primary-age pupils, would the Minister outline what measures are being taken to prevent transmission in schools? When will the JCVI report on vaccines for 12 to 17 year-olds? Are any plans beginning to consider whether vaccination should happen for the under 12s? We strongly echo the comments of the noble Baroness, Lady Thornton, about mask wearing in schools. Is this really the right time to stop that happening?

Finally, I note that the consultation on vaccine and testing certificates has closed. Will the Minister say when the Government will publish their plans following that consultation? What type of legislation will be brought in on this, and will Parliament be able to see and comment on any regulation prior to it being enacted?

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, I am thankful, as ever, to both noble Baronesses, Lady Thornton and Lady Brinton, for thoughtful and challenging questions. I will try to deal with as many as I can.

The noble Baroness, Lady Thornton, asked about the narrowing of doses. May I remind her that for those classed as vulnerable and those aged over 50, the dose period has been narrowed from 12 weeks to eight weeks. We are giving some latitude in the areas of special enforcement for the narrowing of the doses. I completely endorse her points on that and reassure her that plans are afoot. As for moving the age group to those aged over 18, our instincts are that the JCVI prioritisation process has worked extremely well. It is clear, it is fair and it has been effective. In conversation with those at the G7, I received a huge amount of admiration from other countries for how well that prioritisation process has gone. Therefore, we are reluctant, at this very late stage, to jump the gun on that, but I take her point that particularly those in areas where the infection rate is ticking up may benefit from early vaccination. Therefore, we constantly look at and review that point.

As for vaccination of children in schools, raised by the noble Baronesses, Lady Brinton and Lady Thornton, as they know, the MHRA has given its approval. The ball is now in the JCVI court. We are going to wait for it to pronounce. The state of our vaccine supplies means that we do not have a supply for children at hand right now, so there is scope for a really thoughtful conversation on that. When the JCVI has pronounced, the Government will engage on its recommendations, but I do hear, loud and clear, the obvious support that it has in this House.

As for the Nepal variant, I cannot say exactly how much of it came from Portugal, but it is true that it was present in the UK before Portugal was green-listed, so I think it is fair to say that not all of it came from there.

Moving on to NHS staff, I completely pay tribute to the contribution of NHS staff and those who work to support the NHS, social care and public health. I recognise completely the picture painted by the noble Baroness: many feel exhausted and burned out. Our focus is therefore on recruitment and the recruitment of more GPs and nurses is going extremely well. I would be happy to share updated statistics on that if it would be helpful. The work plan—the NHS People Plan—has within it a clear outline of the kind of workforce planning that we have in place. That is something that the recruitment programme has fully embraced.

I agree that the pressures on A&E, and on acute late-stage interventions from the NHS, have been rising for years—for decades. This is an unsustainable model in the long run, which is why this Government are fully committed to the prevention agenda. We have put in place plans for the Office for Health Promotion. That will be the device for using data to support our prevention agenda, and we will be working particularly with local authorities, and increasingly through the NHS, to ensure that we are putting in place measures that improve the nation’s health and that we do not just focus on those who are already extremely ill.

Moving on to data, I thank the noble Baroness for her kind comments. I completely agree that transparency is absolutely right. We want to be as transparent as possible, with both the professions and the public. These are complex issues. I accept that we could do better to improve our communications. We will be using this two-month hiatus as energetically as we can to engage the public and the professions in the changes that we are bringing about. They are changes that are absolutely essential for any modern use of data to promote resource allocation—when it comes to the workforce, as the noble Baroness rightly pointed out—and for research. I really would encourage all noble Lords who are interested in this to look at the minutes of IGARD. Noble Lords will see exactly which data uses are being sanctioned, and will be amazed by the extremely high-level, science-led research programmes that the GP data is contributing to. It will reassure noble Lords that this is an extremely well guarded and thoughtful process, and a massive asset to the nation. I agree with the noble Baroness that our data is a huge national asset; it is there to benefit patients and is mainly used for clinical trials and for planning within the NHS. That is right and I can reassure her that that is the way we intend to continue.

The noble Baroness, Lady Brinton, asked about mental health support for care workers and NHS staff. I reassure her that we have put in a huge amount of support for NHS staff: 10,300 calls have been made to the helpline, there have been 4,600 conversations on the national line and 200,000 downloads of the app, and 500,000 have engaged through the web page. The provision of mental health support for NHS staff has been extremely helpful for those stressed by the last few months, but we continue to invest in that area.

I remind the noble Baroness, Lady Brinton, that those receiving isolation payments are still eligible for their benefits. They will get support from housing benefit and other benefits if they qualify.

The noble Baroness asked about schools. The use of testing to protect schools has been one of the phenomenal success stories of this pandemic. There have been 65 million tests deployed since January, and a million tests were deployed on Sunday alone. That is both to break any chains of transmission within schools and to protect the opening of schools, which every parent in the country knows is an essential objective of our pandemic response.

On certification, we are making an enormous amount of progress. That is a Cabinet Office lead. When the plans have been crystallised, they will be published, and I am extremely hopeful that we will be able to make progress.

Lastly, the noble Baroness, Lady Thornton, mentioned the memorial wall. I am aware of it and have seen very moving pictures. I have not yet visited the wall, but I will take this prompt to go. While I am not across the future plans for the wall, I am grateful for the suggestion and will take it up.

Covid-19: Variant B.1.617.2

Debate between Lord Bethell and Baroness Brinton
Wednesday 26th May 2021

(12 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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I share the noble Baroness’s concern, but I can reassure her on a couple of things. It is, I think, a real tribute to the hard work of parents, teachers and the pupils themselves that the infection rates in schools have been relatively contained, and certainly have not shown the same kinds of behaviours that they did in September of last year. But we remain extremely vigilant, for exactly the reasons the noble Baroness explained. On the question of face coverings, it is a very difficult balance to strike—they are intrusive and disruptive but, on the other hand, they are an effective way of minimising infection. It is an area that we keep a very close watch on.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, the delayed publication of official Public Health England Covid variant data, which was slipped out during the Eurovision Song Contest results, is bad enough, but can the Minister say whether the Secretary of State for Education has the power to remove official PHE data on cases in schools? If so, what were his grounds for that removal?

Lord Bethell Portrait Lord Bethell (Con)
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I really bridle at the suggestion that we run our data publication programme on the basis of the Eurovision Song Contest schedule. That really is not a credible suggestion. There is an issue with positivity rates for some of this data because not every test is registered, and, as a result, it is difficult to draw conclusions about exactly what proportion of tests have become positive. It is for that reason that we are careful about how we present some of the data, and that is behind some of the decisions that have been made about which tables to publish.

COVID-19 Variant: Travel Guidance for Local Authorities

Debate between Lord Bethell and Baroness Brinton
Wednesday 26th May 2021

(12 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the characterisation presented by the noble Baroness is unfair. We are trusting people to be responsible and to act with caution and common sense, as they have done throughout this pandemic, and to make decisions on how best to protect themselves and their loved ones. We are seeking to avoid bringing these measures into law and instead are using guidance. The communication of that guidance could have been done better but we are working extremely hard with regional partnership teams, Public Health England, local authorities, JBC colleagues and the incident management teams to ensure that these communications are done in the most effective way possible.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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I declare my interest as a vice-president of the Local Government Association. Earlier, on the “Today” programme, Grant Shapps said that it was down to local authorities to disseminate the new travel guidance to their citizens, but local authorities reported that they had not been told about it. Do the Government expect them to develop telepathic skills? What does that say for the way government truly operates as a partner with our councils, directors of public health and local resilience forums, which are dealing brilliantly with this new, rapidly transmissible Covid variant? Are they getting extra resources to cope with the extra burdens on them?

Lord Bethell Portrait Lord Bethell (Con)
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No, the noble Baroness will be relieved to know that we are not relying on telepathy. Instead we have regional partnership teams, which include Public Health England regional directors, and Contain and JBC colleagues, working together with local authorities, and these meet on a three-times-a-week basis at the regional team updates. Attendees can include government departments, including the MHCLG, the DfE, particularly REACT, and the No. 10 Cabinet Office task force. It is through this kind of extremely regular and intense collaboration between all the different parties working on this extremely complex pandemic response that we share data, provide guidance and ensure that the communications are done to the best of our ability.

Covid-19

Debate between Lord Bethell and Baroness Brinton
Wednesday 26th May 2021

(12 months ago)

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Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, the noble Baroness asks two very pertinent questions which slightly answer themselves, in a way—but let me try to update the House on our plans in that area. She is right that we have powers on local lockdowns, but that is not the focus of our thinking at the moment. Local lockdowns are an important tool, but not one that we think is a priority right at this moment. We are focused on the vaccines. It is beyond doubt that this Indian 2 variant particularly hits those who are not properly vaccinated—and by “properly” I mean “have had two doses and two weeks”. Those who have forgone either their first or second dose are particularly vulnerable, and you have only to look at the infection data and, particularly, the hospitalisation data to understand that.

That is why we have rolled out surge vaccination in those areas. What that means is a huge amount of communication, a huge amount of engagement with the communities and the presence of various mobile vaccination units sent directly into the heart of the communities to provide different channels and mediums by which people can step up for their vaccine. The response has been extremely strong and I am touched, as I have said, by the videos of people in some of those communities, particularly in Bolton, where people have queued up for their vaccines. I pay tribute to the DPHs and local authorities that have facilitated that programme.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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I echo the gratitude of the noble Baroness, Lady Thornton, to the Minister for his stamina this morning. Can he say whether each of the 121 local authority areas reporting cases of Covid variant B16172 are being given specific extra resources for mass surge test, trace and isolate and arrangements for surge vaccination on top of their planned allocation for this financial year? Can he say when the pilots for extra help with self-isolation will conclude? When would any likely rollout of a proper approach to supporting those who have to self-isolate, including paying their wages, start?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the noble Baroness alludes to a dilemma that we face. It is not possible to organise surge testing and have pinpoint outbreak management in 120 different areas. That is just too many and our resources do not stretch to that. Many of the outbreaks are substantial clusters. Sorry—let me phrase that better. There is a small number of very substantial clusters in the towns and cities of which noble Lords will be aware. That is where we are focusing the surge testing and surge vaccination. In the other areas, we are working with DPHs to ensure that they know the best way to target the particular behaviours of the India 2. That means that it has very high transmissibility, which requires an extremely quick reaction to school and workplace outbreaks, and within specific communities. That kind of briefing and guidance has been channelled through the Chief Medical Officer’s department and the kinds of infrastructure that I described in my answers to previous questions. The response has been extremely strong and I hope we are making some impact on the spread of the India virus, but we remain extremely vigilant.

Heathrow Airport: Border Control Passenger Safety

Debate between Lord Bethell and Baroness Brinton
Tuesday 25th May 2021

(12 months ago)

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Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, how many of the passengers who flew in from India between 2 April and 23 April have now tested positive for Covid? If the Minister does not have the data to hand, please could he write to me with it? Given the guidance—slipped out by Ministers last week—for Hounslow residents to stay at home because of the Indian variant, what advice are the Government giving to all workers at Heathrow, whether they are from Hounslow or not, to keep them safe from Covid?

Lord Bethell Portrait Lord Bethell (Con)
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I do not have the statistic that the noble Baroness asked for, but I would be glad to write to her with it. The surge testing and vaccination in areas of VOC outbreak are now in many communities up and down the country that are not correlated with the presence of airports. They are distinct and specific to each of those communities: we work with the local DPH to ensure that the local outbreak plan is tailored to the needs of that community.

Northern Ireland: Flight Passengers and Covid-19

Debate between Lord Bethell and Baroness Brinton
Wednesday 28th April 2021

(1 year ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I am enormously grateful to the Irish Government for the very large amount of informal clinical data-sharing that goes on. CMOs of both countries exchange data on such matters as VOCs the whole time, and that kind of day-to-day clinical exchange of on-the-ground information works extremely well. The specific question of travel information is a lacuna that needs to be closed, I recognise that it needs to be shut, a lot of work is going on to shut it and I am grateful to those involved.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, I think noble Lords understand that there have to be special arrangements, and the common travel area seems to work well for most things. The Minister knows that I have asked him repeatedly about the joining up of data of international travellers between whichever border they arrive at, the NHS and the testing system, especially the private testing system, otherwise any self-isolation system will fail. Can the Minister say whether this gap that there was before has now been remedied, so that every part of the NHS can pick up data information from borders, and how it works across all four UK countries? Will he explain a bit more about the CTA arrangements between Westminster, Stormont and the Republic?

Lord Bethell Portrait Lord Bethell (Con)
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I reassure the noble Baroness that the data flows between borders, Test and Trace, NHS and JBC work extremely well. I was in the Covid Gold meeting earlier today and we had presentations that captured all the data flows from all those places, and we have extremely good see-through on VOCs, infection rates and bed occupancy. The progress we have made on that area is astounding. Where we have a lacuna is on the transfer of data from Irish travellers to Northern Ireland, and that is something we are working to close.

Covid-19: Update

Debate between Lord Bethell and Baroness Brinton
Tuesday 20th April 2021

(1 year, 1 month ago)

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Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, I add my tributes from these Benches to all those who continue to work well above and beyond the call of duty in all areas to do with managing the Covid pandemic. This includes the vaccination teams, the invisible workers—the scientists working in labs and all those who we do not see on a daily basis—as well as our overtired doctors, nurses and other clinical healthcare workers, and those in social care who are still taking remarkable precautions.

It is worth noting despite the reduction in cases, hospital cases and deaths that daily cases are still double the level that they were at the lifting of lockdown 1, so it is good that the Government are not speeding things up. We need to continue to move carefully and steadily, as later parts of the Statement talking about the India and South African variants give cause for some concern. It is also reassuring to see that uptake of the vaccine is excellent. However, the Statement is silent on when all adults will have been offered the second vaccine. That is important because, as scientists constantly remind us, two doses are needed. Focusing only on the first vaccine is giving the vast majority of the public overconfidence about protection. If people want to go on holiday, one dose of the vaccine will not be enough, whether that holiday is in the UK or abroad.

That leads also to those who are immune-suppressed and to those under 18, because until all are safe, none are safe. Can the Minister say if there is any news on the OCTAVE clinical trials on the ability of those who are immune-suppressed to make and retain antibodies? Those formerly shielding—including me—still need to avoid mixing with people. They are still waiting for news to see if they can relax, even after two doses of the vaccine.

What is the news for children? I understood that the trials on over-12s had been halted following the blood clot issue with the AstraZeneca vaccine. Is that still the case? What are the long-term plans to ensure that our under-12s and, indeed, our under-18s are safe? The Statement says that:

“The vaccine is our way out of this pandemic”.


Not on its own, it is not. We must continue to test, trace and isolate to keep people safe. The Government are to be applauded for the large number of lateral flow tests because they are useful, but they are not as effective as PCR tests for really tracking the virus.

Had I not been unable to do so, I would have loved to have been at Wembley on Sunday supporting my team, which, sadly, lost to Leicester. I would have been delighted to have been part of a testing arrangement to see what happens, but other fans have said that they were only asked to be tested in advance and that there is no testing afterwards. Is that correct? In other words, how detailed is this testing for moving back into normal life going to be?

I am a member of the All-Party Group on Coronavirus, and this morning we heard from scientists who are bemused that immediate contacts of those who test positive are still not routinely PCR tested, which all the countries with a truly effective test and trace system operate. That is vital with the high percentage of people with Covid still having no symptoms, so they would believe that there is no reason for them to be tested, and it is particularly important with the information about the spread of the variants from South Africa and India.

I have family who live in Wandsworth. This time last week, as the announcement about mass testing across Lambeth and Wandsworth was made, we were told that everyone in those areas would be publicly informed. Three days later, not only had my son heard nothing, but he walked past a newly set up testing site a few hundred metres from his house, went in, and discovered that he did need to be tested. So, he and my daughter-in-law had their tests. It transpires that the only notification from Wandsworth Council before the weekend was a tweet, with none of the mechanisms used elsewhere such as texts via GPs, posters up in the street, word of mouth, or even leaflets. How on earth can that be real surge testing if only a small percentage of the population see a handful of tweets?

On the India variant, scientists also told the APPG this morning that the estimated figure of 103 cases was considerably lower than the likely number of cases circulating because only 10% to 15% of positive lateral-flow swabs are sent on to laboratories where they are scanned for variants. This might mean that the actual number is 10 to 20 times the official estimate. This brings us full circle, back to test, trace and isolate. Even with vaccines, it is vital to have an effective test, trace and isolate system to keep people safe. As the noble Baroness, Lady Thornton, outlined, adding India to the red list but giving people three-and-a-half days’ notice before implementing it, means that a large number of cases are likely to slip into the country. Even if they are caught through positive testing, we are unlikely to have a real sense of the actual number of cases.

This follows on from the concern that we from these Benches have had about successful self-isolation and quarantining for a year. The APPG heard evidence this morning that demonstrated that arrangements at our borders, particularly in airports, are not Covid safe, either for travellers or staff, and they risk becoming breeding grounds. This now needs to include effectively separately passengers who arrive from red-list countries from those who arrive from others, and ensuring that all quarantine rules are observed. We heard evidence that people were leaving their quarantine hotels early, and that others, quarantining at home because they did not come from red-list countries, were being forced to use public transport to get to testing centres for their day eight tests. Worse, border staff are discovering around 100 fake Covid test certificates daily, and there are probably many more. If that does not signify a real worrying standard for the possibility of vaccine passports, I do not know what does. When will a proper test, trace and isolate system be put in place that includes immediate contacts and more lateral-flow tests being tested for variants, along with vital, proper, paid arrangements for self-isolation, including quarantining and proper separation in the transport arrangements for those coming from abroad?

Finally, I will spend just one minute on Greensill. It is not just Greensill: we need desperately to see full publication of all meetings and correspondence—informal and formal—that Ministers have had regarding all contracts, whether it is payday loans, PPE or testing arrangements. This also includes the new quarantining partners; the Health Secretary said on Monday that two have already been sacked, having been in place only for a short time. It is vital that the smell-test on all these contracts is evident and sure.

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, I am enormously grateful to both the noble Baronesses, Lady Brinton and Lady Thornton, for such thoughtful questions. I totally and utterly endorse both with regard to their massive thanks to NHS staff, to the vaccinators and, in particular, I echo the words of the noble Baroness, Lady Brinton, who thanked the invisible workers. I am acutely and particularly aware of the lab technicians, many of whom have worked unbelievably hard in difficult circumstances, often located far from their homes, supporting our laboratories up and down the country. There are many other categories of invisible workers in our healthcare system and they deserve our huge thanks.

I am as concerned as the noble Baronesses about the threat of variants of concern. It is an absolutely frustrating and anxiety-making fact, that we simply do not know a huge amount about what the impact of these variants will be on transmissibility, severity and escapology. We are throwing absolutely everything we have got at this to try to understand the features of this disease. However, it is true that while we can study them in a mathematical or computer-generated model, we get only so far with that. We can study them on the workbench and get a little bit further, we can stick them in a tube with some serum from someone who has had a vaccine, and maybe figure out a bit more, but it is only when we have the real-world data of how the vaccines have worked in real life when put up against the virus that we can accurately conclude what the impact will be. Therefore, only the passage of time will give us the critical data we need to go forward.

In the meantime, we are standing up a huge international effort to try to understand the variants that are emerging around the world. The noble Baroness, Lady Thornton, asked me about global co-ordination. Britain is absolutely playing its role; it is using its chairmanship of the G7 to full effect. As noble Lords are, I am sure, fully aware, we have a world-leading facility in genomic sequencing. We have made a massive, open-hearted offer to the world to sequence the genomes of any variants of concern, from any country in the world, through the newly launched New Variant Assessment Platform. We are working to set up hubs to develop expertise in that capacity around the world. We are working extremely closely with multi-laterals such as the WHO, with the relevant major trusts such as the Gates and Rockefeller foundations and the Wellcome Trust, and with individual countries, to provide the insight, the fast-turnaround analysis and the assessment of new variants as they turn up.

Within our own country, it is concerning that variants have made landfall, but I reassure noble Lords that we have put in place remarkably diligent efforts to close down any spread of variants of concern when they have occurred, whether they are from India, Brazil or South Africa. It is a fact that the Operation Eagle process, which is supported by local authorities, DPHs, test and trace and by the JBC, has so far—touch wood—proved to be extremely effective at closing down community spread. We have numbers of the variants in the UK but a very large proportion of them are known to be related to travel and they have not yet created clusters of infection of the kind that might cause concern. The MQS—Managed Quarantine Service—has played an absolutely critical role. I pay tribute to the MQS team, who are at this very moment putting in place arrangements for managed quarantine for flights with travellers from India. They have put in place the necessary pre-testing, the hotels and the assessment.

While I hear, loud and clear, the concerns raised by the noble Baroness, Lady Brinton, about that process, I reassure her that her list of concerns is quite different from the operational notes that I am given every day. The truth is that it has kept a lid on any spread of VOCs in the UK to date. On Wandsworth, I pay tribute to the enormous civic response to our concerns around the cluster there. I recognise the concerns of the relative of the noble Baroness, Lady Brinton, in that area, but there has been an absolutely massive news and community-marketing promotion of the home testing, pharmacy testing, MTUs and ATSs in Wandsworth. Very few people indeed cannot have heard of the arrangements that are in place.

With regard to the OCTAVE clinical trials, that is of grave concern to all those who have immunosuppressed circumstances. We are working extremely hard with Birmingham University, with Professor Paul Moss, to understand more about the response of those with immunity issues. It is a frustrating fact that those with pre-existing immunity issues are likely to be the ones who have the lowest and least response to the vaccine. We are trying to understand as best we can how that can be supplemented. As noble Lords may know, we have already invested considerably in new arrangements for therapeutics and antivirals that we believe will support those with immunosuppressed conditions. I would be glad to write to the noble Baroness about our arrangement for vaccines for the under-12s.

If there are any other questions that I have not had time to answer, I would be glad to write to the noble Baronesses with full answers.

Crohn’s Disease and Ulcerative Colitis

Debate between Lord Bethell and Baroness Brinton
Thursday 15th April 2021

(1 year, 1 month ago)

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Lord Bethell Portrait Lord Bethell (Con)
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I would like to reassure the noble Lord that the scenario I described typically includes two gastroenterology consultants, a clinical intermediate fellow, a GP partner and a patient representative. It is exactly this kind of team approach that delivers the best patient outcomes, as the noble Lord rightly outlined.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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In 2012, NICE published a treatment pathway for Crohn’s and colitis. It was a groundbreaking change to ensure consistent and comprehensive services, including the team approach referred to by the noble Lord, Lord Turnberg, and outcomes for all patients of this autoimmune disease across England. NICE further updated this in 2019, so there has been a pathway for nine years. Why is it not being adhered to by NHS England? What will the Minister do to ensure that all Crohn’s and colitis patients get the treatment they are promised by NICE?

Lord Bethell Portrait Lord Bethell (Con)
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I am not sure it is correct that it is not being adhered to widely, but there is some variation in all parts of the NHS. That is why we are developing a right-care scenario for IBD with key stakeholders. This will create a very clear template for all patients and all those involved in their care. It will, I hope, help create more consistent standards across the healthcare system.

Health and Social Care Update

Debate between Lord Bethell and Baroness Brinton
Monday 22nd March 2021

(1 year, 2 months ago)

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

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

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

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

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

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

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


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

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

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


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

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

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

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, I am enormously grateful for the questions from both noble Baronesses. I will try to address them and if I omit any, I will be happy to write to them with more details.

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

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

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

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

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

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

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

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

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

Covid-19: Government’s Publication of Contracts

Debate between Lord Bethell and Baroness Brinton
Thursday 11th March 2021

(1 year, 2 months ago)

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

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, the inevitable public inquiry will eventually set out the truth of what has happened with contracts during the Covid pandemic. In the meantime, given that the Urgent Question Statement says that the Government

“have always been clear that transparency is vital”,

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

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

World Health Organization: Pandemics

Debate between Lord Bethell and Baroness Brinton
Tuesday 9th March 2021

(1 year, 2 months ago)

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

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

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

NHS: Pay

Debate between Lord Bethell and Baroness Brinton
Tuesday 9th March 2021

(1 year, 2 months ago)

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

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

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

Women’s Health Strategy

Debate between Lord Bethell and Baroness Brinton
Tuesday 9th March 2021

(1 year, 2 months ago)

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

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

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

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

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

The Statement notes that

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Covid-19 Update

Debate between Lord Bethell and Baroness Brinton
Thursday 4th March 2021

(1 year, 2 months ago)

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Covid Contracts: Judicial Review

Debate between Lord Bethell and Baroness Brinton
Monday 1st March 2021

(1 year, 2 months ago)

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Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, I am grateful for the question from the noble Baroness, Lady Thornton. During those hectic days, more than 15,000 suppliers approached us. Many of them were credible, but many sadly were not. It was entirely right and the best practice to have a high-priority lane to triage and prioritise those who were the most credible. A sample of 232 suppliers in that lane reveals that 144 came from Ministers, 21 from officials, 33 from MPs and 31 Members of the House of Lords not in the Government—including many who chose to write to me personally with the names of recommendations. I am enormously grateful to those who got in touch.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, the Prime Minister said last Monday in the House of Commons that

“the contracts are there on the record for everybody to see.”—[Official Report, Commons, 22/2/21; col 638.]

However, the evidence questions that statement. Can the Minister say how many PPE contracts entered into in the first wave of the pandemic, up to the end of June, remain unpublished? If the number is not to hand, please will he undertake to write to me with it?

Lord Bethell Portrait Lord Bethell (Con)
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From memory, it is my understanding that 99% of the contracts are published and 1% are outstanding. I am happy to check that and confirm it to the noble Baroness.

Covid-19 Vaccines Deployment

Debate between Lord Bethell and Baroness Brinton
Thursday 11th February 2021

(1 year, 3 months ago)

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Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, I start by congratulating everyone working in the vaccine sector: the scientists, still working behind the scenes to ensure that there are vaccines that will be effective against the South African and Manaus variants; those involved in the manufacture and supply chain; and all those on the front line, making sure that the vaccines are delivered into arms safely and swiftly by clinicians, with administrators, staff, the military and volunteers helping. A notable reason why the UK has been able to manage this so well has been the expertise of Professor Chris Whitty and our vaccine research community, which has so many years’ experience in epidemics, including the Ebola outbreak in west Africa.

The Joint Committee on Vaccination and Immunisation has also kept our focus on who should be protected first, and the government delivery group, led by Kate Bingham, has also done well. The numbers vaccinated in the top four priority group continues to grow and I, for one, hope that the target for next week will be achieved.

The Statement says:

“We … visited every eligible care home possible with older residents in England and offered vaccinations to all their residents and staff. That means we are currently on track to meet our target of offering a vaccine to the four most vulnerable groups by mid-February.”


However, I still cannot find the actual number and percentage of social care staff vaccinated, whether those working in care homes or domiciliary care staff providing essential support to keep people living in their own homes, so please can the Minister provide the number and percentage of social care staff who have now had their first dose of vaccine? Once again I ask: why are care staff not disaggregated from NHS staff in the published data?

The target of “offering” a vaccine to those in or working in homes is, frankly, no target at all. We know that, after Christmas, an alarming number of cases were diagnosed in care homes, which has resulted in residents and staff being refused vaccine until all cases are over in those homes. With very limited visits by families, the only way that Covid could have come in is, unfortunately, via staff, who probably picked it up from others over the Christmas break. Today, the ONS has said that one-third of all Covid cases in hospital during this pandemic have been over the past month. That is truly shocking.

Was the Prime Minister’s bold statement last year that Christmas should not be cancelled and his encouragement to allow people to mix, against all the expert advice from SAGE and alternative SAGE, worth it? How many deaths will have resulted from those cases, which could have been avoided if that expert advice had been followed earlier?

There are reports of some surgery teams arriving at care homes with enough vaccine only for residents and staff being redirected to large hubs, many miles away. This is unhelpful when staff work shifts and are on low wages, with no access to the transport needed to get to a hub. What is planned to ensure that all care home staff can be vaccinated at their place of work by their local vaccination teams?

Another bit of ONS data this week has shown that there were more than 30,000 Covid-related deaths of disabled people between mid-January and mid-November last year, representing 60% of all Covid-related deaths in that period. I remain concerned that many of those under 70 who are disabled or learning disabled and live in homes are still not on a priority list. We know that those requiring close personal care are at very high risk. The ONS data proves that. When will the Government add them to the top four priority lists?

The opening of large hubs is welcome, but they must not replace very local access to vaccines, whether through GP surgeries or local pharmacies. Worrying reports are emerging of GPs running out of supplies and being told that the large vaccine hubs are being prioritised over them. I thank the Minister for the excellent briefing that MPs and Peers had earlier this week on vaccines and possible treatments for Covid-19. The Statement says:

“This trial will look at whether different vaccines can be safely used for a two-dose regime in the future to support a more flexible programme of immunisation.”


It goes on:

“I want to reinforce that this is a year-long study, and there are no current plans to change our existing vaccination programme, which will continue to use the same doses.”


However, the green book on the vaccination programmes states:

“For individuals who started the schedule and who attend for a vaccination at a site where the same vaccine is not available … it is reasonable … to offer a single dose of the locally available product”


to complete the schedule. If safety has not yet been established, why does the green book say that potentially unsafe dosing regimes can go ahead?

The Minister is correct to say that no one is safe until the whole world is safe, and it is good that the UK has made a commitment of £548 million to COVAX with match funding to provide 1 billion doses of vaccine this year to developing countries. I hope that the Prime Minister will use his chairing of the G7 to encourage other countries to donate their share to make this happen. The examples of the South African and Manaus variants are a wake-up call to all of us that we must work as a global community to protect all people and the world’s economies from Covid-19.

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I am enormously grateful for the thoughtful questions from the noble Baronesses. They are entirely right to applaud the progress of the vaccine. I start by sharing some pretty formidable statistics on that. An absolutely remarkable 95.6% of those aged 75 to 79 have received their first dose. I have never seen a government statistic quite like that. It is an astonishing figure. Such a very large proportion of a target population have come forward, have been efficiently vaccinated and are now protected from the worse effects of this awful disease. It is an enormous success story. Of those over 80 years old, 91.3% have received their first dose and 74% of 70 to 74 year-olds have received their first dose. Up to 9 February, an astonishing 13,580,298 people received their vaccine. These are extraordinary figures. It will have a huge impact not just on the personal lives of those who have been vaccinated and their families but on the workings of the entire NHS. It is a massive game-changer and will dramatically reduce the amount of hospitalisation for and deaths from Covid. We are determined to take full advantage as a country of this enormous success story.

We are enormously pleased with the WHO readout on the AstraZeneca vaccine. It is exactly what we hoped for and what we understood from the clinical trials of the vaccine, and it is pleasing to see worldwide recognition that a 12-week gap between the two doses is the right approach and that the AstraZeneca vaccine is good for over 65 year-olds. I greatly thank those at the WHO who have done that. We are completely committed to the vaccine rollout and we will not take our foot off the pedal in any way.

I completely understand the point of those who are concerned about the impact of the lockdown. The noble Baroness alluded to the words of Charles Walker, who is entirely right that the lockdown has a huge impact on the economy, the public mood and particularly on those who cannot make it to school. However, the approach we are taking—a slow and steady approach of not rushing into anything—is exactly the one that will pay the greatest dividends for the economy. It is hugely supported by the general public and it will mean that, when we release the lockdown and return children to school, we can do it with the confidence that we will not have to go back again.

We are concerned about the lag in take up, particularly in black African communities. There are clearly, among the really good stories of take up, one or two areas where we are concerned. The work of the communications team on anti-vaxxers’ stories and the support we have got from social media firms has been really good across the board, but this is one area where we are enormously focused. The data is not always crystal clear, and we have not published it all yet, but this is one area where the noble Baroness is entirely right and we are very concerned.

The noble Baroness asked for reassurance on the second dose: will everyone get a second dose, and are there enough supplies in the warehouses for everyone? I reassure her and all noble Lords who may be concerned on that point that we are absolutely committed to the second dose. Everyone will get it, and they will get it on time. The supplies are in place.

The noble Baroness, Lady Brinton, asked about whether it was our policy to give a difference second dose to the first. I will be crystal clear: this is not our policy. If you are given a dose of “A” then your first dose will be “A” and your second dose will be “A” as well, and not “B.” We are looking into clinical trials that seek to understand whether an “AB” combination might be safe and may even be better. There are examples in other spheres where mixing two different vaccines can have a benign effect on the body and can stimulate a greater antibody response. We are looking at this very carefully. The COM COV clinical trial has been given £7 million to look into this. It is a long-term clinical trial and we are not expecting a readout any time soon but, if there are benefits, we will chase those down.

I completely agree with the noble Baronesses, Lady Thornton and Lady Brinton, on variants of concern. We have all been alerted to the grave danger that a mutation might have enhanced transmissibility, increased severity and escapology. Should such a variant emerge that could somehow jeopardise the Ming vase of our massive vaccination success story, we would be extremely concerned to address it. We are shortly having a debate on borders, and I shall save my comments for that debate, but I completely endorse the concerns of both noble Baronesses.

The noble Baroness, Lady Brinton, mentioned Professor Chris Whitty. To all those who missed it, I mention the presentation he gave yesterday on the investment in therapeutic drugs and antivirals, which was unbelievably impressive. We are enormously lucky to have someone like Chris as our Chief Medical Officer. Indeed, the Deputy Chief Medical Officers, Jonathan Van-Tam and the others, have all served us extremely well. I also praise others who have stepped up to public life in our time of need, including Kate Bingham and the noble Baroness, Lady Harding. They have both done an enormous public service and deserve enormous praise.

The noble Baroness, Lady Brinton, asked about disabled people. She is entirely right: there are those who are disabled or who have learning difficulties, and we are concerned about the impact of Covid on them. Many who are clinically extremely vulnerable are already in the priority level 4 and will already be in the prioritisation list. Others will be in prioritisation level 6. We are looking at whether we should change the prioritisation system in any way, and the JCVI keeps a running watch on this. I reassure the noble Baroness that all those in a high-risk group will be prioritised in a reasonable fashion. We will be reaching prioritisation level 6 very soon indeed.

The noble Baroness, Lady Brinton, talked about the importance of sharing vaccine with other countries. Tedros is absolutely right: we are not safe until everyone is safe. Britain has taken leadership role in CEPI, Gavi and ACT; we continue to support the global distribution of vaccines through our contribution of IP, our massive financial contribution and our diplomatic leadership. We remain committed to that, and we will continue to use our chairmanship of the G7 to influence other nations to step up to their responsibilities.

Covid-19

Debate between Lord Bethell and Baroness Brinton
Thursday 11th February 2021

(1 year, 3 months ago)

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Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, the Minister is right to say that it looks as if the corner has been turned on cases, and even on hospitalisations, in this most recent surge. I too, like the noble Baroness, Lady Thornton, look forward to actually seeing the quarantine regulations being laid in Parliament. We keep asking for sight of them as early as possible. We have known that this quarantine arrangement was coming in—leaks started in December.

The BMA and other medical groups are concerned that those without GPs must have access to the vaccine. Last week, the Government announced that undocumented migrants can register with GPs for a Covid vaccine without fear of being prosecuted by the Home Office. This is good news, as we need everyone possible in the country to be vaccinated, to keep us all safe. However, the law currently requires the NHS to report those without a defined migration status. This amnesty announcement, based on the suspension of so-called immigration data sharing between the health service and the Government, is temporary, only during the pandemic. What safeguards are there that this data will not be shared after the pandemic is over? A temporary amnesty will not encourage people to come forward if their data can later be shared.

According to Ministry of Justice data, 2,400 Covid-positive cases were recorded in prisons in December—a rise of 70% in a single month. Given that the Government have a legal duty to provide equivalent healthcare to those in prison, can the Minister explain why prisoners in priority groups 1 to 4 started to be vaccinated only from 29 January?

Will the Minister answer a question I asked earlier this week without a response? There have been number of reports of Sitel and other call centre contractors having their contracts reduced by government and immediately sacking track and trace staff because, as a Sitel manager said,

“At this point in time as a business we need to reduce the number of agents because we have done our jobs.”


Can the Minister please confirm or deny that the Government have asked for track and trace staff numbers to be reduced? Do the Government still believe that test, trace and isolate remains a vital part of coming out of this pandemic, or are they totally relying on the vaccine? Everything that the scientists and doctors are telling us is that we will have to continue to take all precautions, such as “hands, face, space”, and will also need all the protection tools, such as test, trace and isolate, for some time to come, otherwise we will be hurtling towards yet more cases, hospitalisations and deaths.

That brings me to borders. On 22 January last year, alongside the noble Baroness, Lady Thornton, I asked the Minister’s predecessor what steps were being taken to monitor flights from places where Covid-19 had been confirmed or was suspected. I have repeatedly raised worries that the UK was not following either the World Health Organization advice or the actions of the CDC in America, which has resulted in many cases coming into the UK from China and the Far East and, during February, through those returning from skiing holidays in Italy, France and Austria. Every step of the way, the Government have been too slow in making arrangements to monitor passengers, whether placing them in quarantine at home or, as is now proposed, in quarantine hotels.

Some countries have learned through experience that early action at borders is vital. South Korea, Australia and New Zealand are notable examples. Taiwan should be a role model for us all. It began monitoring passengers arriving as early as 31 December 2019, and shortly afterwards created formal quarantining, both at home and in hotels, with electronic monitoring by health teams. Its Government’s clear communication with its people, providing the carrot of a support package for anyone quarantining, as well as the stick of substantial fines, has meant that a country of 23 million people had, in 2020, fewer than 800 cases, with only seven deaths. One city alone has 3,000 hotel rooms reserved for quarantining; the Government here are proposing 4,000 for the whole of the UK. And the fines in Taiwan are not small, at up to 300,000 New Taiwanese dollars—about £7,500—with one businessman who breached quarantine seven times in three days fined more than £26,000.

Taiwan’s approach is as much about self-isolation as it is about quarantine for those coming from abroad, and the view of the Taiwanese public is that everyone should do their civic duty, helped by the clarity of messaging from the Government and their medical experts. So it is a shame that our Government’s key message is all about the maximum prison sentence. We need as much of the carrot in our approach, rewarding people for self-isolation, preferably by paying their wages and by supporting them with care calls and delivering shopping and medicines, most of which has been notable by its absence to date.

Two things are clear from the worries over the new variants. The UK public want to do their duty. The vast majority of people are complying with lockdown. They also understand that the nature of Covid-19 is changing, and that new variants mean we must change the way we live too. So will the Government please make the changes that we on these Benches have asked for, for over a year, regarding borders? Otherwise, we risk losing all the progress made with vaccinations, we risk children not returning to school, and we risk further and substantial damage to our economy.

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, I am enormously grateful for the questions from the two noble Baronesses. By way of introduction, both the noble Baronesses are entirely right that the variants of concern have been a massive game-changer and the reason for this profound inflection point in our approach to border control. Having invested so much in vaccine deployment, having got it right so emphatically, having been ahead of the world in the identification, development, purchase and now deployment of vaccines, and having got so many people who were at threat of sickness and death into a position of safety, it seems entirely right that we now protect the country from mutations that might escape the vaccine by taking tough measures on the border.

That is different from the situation of a year ago: we had comparable infection rates and were all facing the same virus, which did not seem to mutate for months on end. At that point, the priority was to keep our borders open in order to keep the flow of goods, medicines and essential supplies in the planes, trains and boats that are necessary to support Great Britain. But the variants of concern have completely changed that view. That is why we brought in this new, robust and emphatic regime. It depends, in very large part, on existing legislation, but I reassure noble Lords that our plans are to bring in new regulations, where necessary, at the earliest moment. I hope that that will be very soon.

The noble Baroness, Lady Thornton, asked about international surveillance. That is an important part of our overall plan. In Britain, as noble Lords know, we have the most advanced investment in genomic sequencing anywhere in the world, by far. We are hugely investing in a great dash on capacity, turnaround times, accuracy and the geographic distribution of that surveillance in the UK. But we are also investing in international systems. We have made an open-hearted, big and generous offer to the countries of the world to do genomic sequencing for them, wherever necessary. If anyone wants to send their specimens to the UK, to the Sanger at Cambridge, we will do that for them. We are sending machines, often from Oxford Nanopore, the British diagnostic company, to diagnostic centres in countries that have some genomic capability, to enhance their testing and speed up their turnaround times.

The noble Baroness, Lady Thornton, asked about the enhanced measures we are putting in place to check when people arrive in the UK. I can reassure her massively, because the system for the passenger landing form has been digitised and hugely enhanced. We have dramatically increased the amount of validation of the data put into the PLF. The pretesting certificates are linked directly to the PLF, and we are working on linking it to the hotel booking and testing forms. We are also putting in enhanced surveillance of those isolating at home, which includes phone calls, SMSs and an increased investment in police time to follow up where there may be suspicion of a breach. We are also making a crystal-clear communication to those who have access to private jet travel that we will not tolerate those who have the resources to pay the fines but feel that they can, or want to, get around these measures.

The application of the hotel quarantine measures to all countries—both red list and amber—is something that we keep under review. There is a rolling review of the red list, and we are putting in place the necessary infrastructure, should it be required, for a blanket hotel quarantine protocol on all travellers to the UK.

The noble Baroness, Lady Brinton, kind of answered the question on the number of hotels, for which I am enormously grateful. We have currently booked 16 hotels with 4,600 rooms. However, I reassure her that this is an on-call framework, and we will have access to a massively increased number of hotel rooms if that should prove necessary.

But I have to be clear: the signal from the British Government and the instruction from the Home Office and the Department of Health and Social Care is that there should be no need to travel other than under the most exceptional circumstances. We are not trying to encourage anyone to travel, and we expect the number of people travelling to and from the UK to remain at a low level for the foreseeable future. For those who are currently overseas and seek to return but are experiencing some hardship because they were not expecting, did not plan for and cannot afford the considerable cost of the hotel quarantine, we will publish schemes to spread the payment of that to help people out.

Regarding the legislation, the noble Baroness, Lady Thornton, made a big point of saying that a sentence of 10 years was too long for a breach of contract. I remind her that Section 1 of the Fraud Act 2006 creates a general offence of fraud and introduces a number of ways of committing it, including fraud by false representation and fraud by failure to disclose information. Committing fraud is a very serious offence. Not everyone who commits their first fraud will get a custodial sentence, but if people repeatedly breach these restrictions or put the lives of others at risk, it will be up to either the magistrates’ court or, ultimately, the Crown Court to decide on the sentence. The maximum sentence is 10 years and it is quite right that it should be. The noble Baroness, Lady Brinton, made a very good point when she referred to Taiwan, which I shall mention in a moment.

The noble Baroness, Lady Brinton, asked about the data flows on undocumented migrants and the temporary amnesty. I reassure her that it is absolutely our intention to get everyone in the UK vaccinated, whatever their status. We are completely status blind when it comes to distribution of the vaccine, but we need to know who you are before we inject you with drugs—that is a basic clinical need and one that we cannot avoid.

She asked specific questions about the flow of data and whether this would be a temporary amnesty or would last longer. I do not have access to the precise answer to that question but am happy to commit to write to her on that important point.

The noble Baroness asked about prisons. She is entirely right to be concerned. We have had a terrific track record on protecting prisoners from this disease over the year, but she is right that in recent weeks epidemics have emerged in prisons. We are working incredibly hard to deploy a very large amount of testing and, where necessary, implementing isolation, and the vaccine has been rolled out to those who are qualified.

Turning to Sitel managers, I assure the noble Baroness, Lady Brinton, that we are enormously thankful to all those who have contributed to the tracing operation. We balance the workload between a variety of providers, and Sitel is just one of several that we have. There is no question of our backing off from our tracing operations—quite the opposite. Test, trace and isolate remains an important part of our armoury and it only increases. In recent times, we have doubled up on our commitment to the Lighthouse labs, which have proved cost-effective, accurate and fast. The genomics turnaround in tracking variants of concern has been remarkably efficient. On tracing and VOCs, Project Eagle is working extremely well and I saw incredibly impressive numbers on that this morning. Pharmacovigilance around the vaccine is being supported by test and trace, and the creation of the NIHP is apace.

Finally, the noble Baroness, Lady Brinton, mentioned Taiwan. Given that I am married to a Taiwanese wife, I can absolutely bear testimony to the remarkable achievement of that island nation. Taiwan was hard hit in 2003 by SARS, a time I remember well, since my Christmas was cancelled. It learned the lesson and applied important measures. The island has the advantage of social cohesion, but both the stick and the carrot were thoughtfully used, as the noble Baroness rightly pointed out. It created a green list country with a remarkably low level of infection and death, and that is a lesson we can all learn from.

The public are doing their duty and absolutely understand the threat of variants of concern. It is incredibly impressive and I am optimistic for the future.

Covid-19 Update

Debate between Lord Bethell and Baroness Brinton
Thursday 4th February 2021

(1 year, 3 months ago)

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Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, we also express our condolences to the family of Captain Sir Tom Moore. He was an inspiration and an example to so many.

The health Statement reminds us that this is HIV testing week. HIV Prevention England rightly says that the message about early HIV testing must be well publicised. I pay tribute to our Lord Speaker for his key role as Health Secretary in the 1980s in managing urgent and uncompromising messages to the public about HIV and AIDS. This Government could learn much from those campaigns about communicating clear messages.

From these Benches, we also echo the excellent news that 10 million people in the first four priority groups have been vaccinated so far. Last week, I asked the Minister whether the vaccine dashboard could break down vaccine take-up below national level. I note that this Statement says that this is happening at local health and local authority level. However, there is still no breakdown between health and social care staff. On Tuesday, the United Kingdom Homecare Association reported that only 32% of its staff had been vaccinated so far. It said that invitation to vaccinate care staff was a local lottery, with some areas having excellent arrangements, but others not. Live-in carers face even harder access to vaccines, as they are often completely left off local vaccination lists.

Further, we know that some care staff have concerns about taking the vaccine, so dialogue is vital. Recently, there was an excellent radio interview with a GP from the north-east who explained how they had talked to staff who were worried about vaccinations at the care home where they worked. Those staff were reassured and were vaccinated. Too many social care staff are just referred to large vaccination hubs with no opportunity to discuss it with a known and trusted GP. Will the Minister ensure that GP surgeries can still have vaccine doses for everyone in groups 1-4, including social care staff, so that the barriers to vaccination are tackled and removed? Please can we see the NHS and care staff separated out on the vaccine dashboard?

This Statement also raises the emerging problems with the South African variant, with further restrictions in some postcodes. These, as well as the new changes to the UK variant discovered in Bristol and Liverpool, remind us that Covid-19 is still challenging us at every turn. I say well done to the local directors of public health and leaders of councils, working with their local NHS, on their excellent speed of response and the clarity of their local messages to people in the relevant postcodes.

I have a couple of questions for the Minister. First, Ministers have said that the new South African variant problems were discussed and planned for last Thursday. So why was there not an announcement before the weekend, ensuring that affected residents could protect themselves and their neighbours as soon as the risk was apparent? Secondly, the Statement says that everyone in these areas must have a PCR test—good. However, a letter sent from the NHS to hospital staff said that no staff were to go to work until they had had the results of a PCR test. Given that hospitals already have a large number of staff off sick or self-isolating, what help are they getting to deal with further staff absences?

The Minister will remember that I have urged the Government to include unpaid carers in the priority list in order to protect those they care for. The announcement of their inclusion in priority group 6 is welcome. However, they are not in the summary lists in the vaccines delivery plan. Will the Minister commit to clear up any confusion by explicitly including unpaid carers in government communications and by publishing specific guidance on making sure that they are vaccinated as part of group 6?

Finally, we look forward to hearing the Prime Minister speak on 22 February about the route map out of this third lockdown. Progress on vaccination is vital, but test, trace and isolate is also essential if we are to avoid a fourth national lockdown. We on these Benches believe that people who are self-isolating should be paid their wages and have access to a proper care package, as in Germany and Taiwan. We have been asking for this for 11 months. The failure of people to comply with self-isolation rules demonstrates that the current system is not working. Will the Government urgently review the arrangements for isolation and encouragement to comply?

Yesterday, Chris Whitty and the Prime Minister were clear that this third lockdown cannot be lifted until it is safe to do so. Yet already MPs and some Peers are pressuring the PM to open schools immediately. Strong, clear messaging is needed every day—as strong as on the AIDS campaign by the noble Lord, Lord Fowler, 30 years ago. We know from polling data that the vast majority of people want to do the right thing. The Government’s role is to tell us what and why and to provide support for those who need help to do it.

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, I am enormously grateful to both the noble Baronesses for their thoughtful and provocative questions. I join the noble Baroness, Lady Thornton, in paying tribute to Captain Sir Tom Moore. His story touched on something we have talked about in this Chamber this year: the way in which someone, in their 99th year, can make a tremendous impact on the whole country, bringing us together and raising money for NHS staff. It was an amazing achievement so late in life. It demonstrates that every year of every life, however late in that life it is, is valuable. That is why this Government are extremely proud of the measures that we have put in place to protect the lives of, and avoid severe harm to, the elderly and infirm.

I also share in the noble Baroness’s tribute to NHS staff and the vaccination rollout. She is entirely right; there is huge mental and social attrition across the NHS at the moment. The hard work that goes on, particularly in intensive care, is having a tough impact on those who work there. We hear of the need for some form of respite for NHS staff, loud and clear, but I have to be candid: when we are done dealing with the hospitalisations for Covid, there will be a massive wall of work to manage the huge backlog and restart business as usual. We are looking at the human investment needed. I pay tribute to my colleague Helen Whately, the Minister who covers the NHS workforce. She speaks to the NHS and social care workforce daily. We are looking extremely carefully at the investment that will be needed to support healthcare staff in the difficult year ahead.

The noble Baroness, Lady Thornton, asked about those who refuse the vaccine. I am afraid that those statistics do not exist, because people do not identify themselves as vaccine refusers. However, the overall picture is extremely positive at the moment. Those in categories 1 to 4 are stepping forward for the vaccine in tremendous numbers, and we are extremely encouraged by that. I take on board the insight of Tim Spector and others who have spoken thoughtfully about the barriers. I pay tribute to civic and particularly religious groups, which have often put vaccination sites in their temples, synagogues, churches and other religious settings. That is exactly the kind of trusted civic engagement that has led to vaccine deployment reaching deeply into communities that might otherwise have been worried or suspicious.

The challenge that we will face will be when we turn our attention to the younger. To answer the other question from the noble Baroness, Lady Thornton, we will be rolling out the vaccine to all age groups. The very good news from AstraZeneca about the vaccine being an extremely effective agent against transmissibility is exactly what we need to know, because it gives a green light to using the vaccine to avoid not just severe illness, hospitalisation and death, but transmissibility. We have to get the message across to those whose lives are not necessarily saved by the vaccine—it saves someone else’s life—that taking it is important and something they should feel trusting about and obligated to do. That will be the second phase of the vaccine rollout, and we are thinking carefully about how to do it as effectively as possible.

The noble Baroness, Lady Thornton, alluded to staff vaccination. She is entirely right about the very high number of Covid deaths in homes at the moment, and I reassure her that vaccines have been offered to every person in every home. There is an email address, which I would be happy to share with all noble Lords, for anyone who thinks that they have not been offered the vaccine. There is an absolute backstop for anyone who thinks that they have been overlooked or have missed out. We are doing our level best with an effective deployment and rollout programme to ensure that all social care homes, whatever their status, and all staff in them are protected by the vaccine.

I will say a word about schools and teachers. I completely support the views of the noble Baroness, Lady Thornton, and many other Peers who have spoken thoughtfully and emotionally about the importance of getting schools back. The Government and I agree that this is our priority. I spoke to the Schools Minister, Nick Gibb, about this yesterday. I pay tribute to the work of the Department for Education in rolling out testing in schools. Either today or very soon, we will have had the millionth test in schools, which is a great tribute to the work that schools, teachers and the DfE have done on asymptomatic testing in schools. It is an important way to cut the chain of transmission and to protect all those in schools, from both the disease and being agents of transmission to those who are more vulnerable. I support all the measures on social distancing, PPE and testing that we can put in place to keep schools open.

When it comes to vaccinating teachers, I emphasise that saving lives and avoiding severe harm is the priority for the vaccination programme. While we are sympathetic to teachers and will definitely have them on the prioritisation list, the protection from harm and death is our current priority.

We take the news on mutations from South Africa, Brazil, California, Kent and Bristol, and all the other manifestations of mutations, extremely seriously. The noble Baroness, Lady Harding, spoke about not expecting a mutation, but of course it was not the virus mutating that was not expected—that is commonplace. The CMO spoke about that impactfully and early, in February and March; he utterly predicted that mutations would lead to a second wave. But the virus had not mutated much last year. In fact, it was a phenomenally rigid and consistent virus for a long time. What was not easy to predict was that a highly transmissible disease would emerge that completely outperforms its previous classic manifestation. We saw that only when the infection rates started to climb extremely quickly. We changed our tack accordingly, and we continue to change our tack.

As I have said from the Dispatch Box previously, we are in a different game now. Previously, the focus was on keeping a lid on infection rates and getting the prevalence levels low. That remains an important feature of our battle against Covid. On the other hand, we have to protect the vaccine. We are aware of the potential for a mutation to emerge that escapes the vaccine. That has been seen in other diseases and could be seen in this disease. That is why we have mobilised Operation Eagle to track down the South African variants that have landed in the UK, where we do not have a clear chain of transmission. That is why we are going door to door, offering PCR testing to all those—around 10,000 people—in each of the relevant postcodes, to put a lid on any community transmission. That is why we have deployed a special team, tracing variants of concern, which is tracking down the origins of each infection to stamp out and suppress variants of concern, where they emerge.

This is exactly the kind of capability that we need to put in place should a highly transmissible vaccine-escaping variant manifest itself. I pay tribute to those in test and trace who have put together this capability extremely quickly and are implementing it so thoroughly.

Both the noble Baronesses, Lady Thornton and Lady Brinton, alluded to the important issue of isolating. I hear those points loud and clear. We support those who are isolating, and make a £500 payment to those on benefits, who need it. Charities and local authorities support those who isolate. But I hear the point made about additional measures, and we are looking at further ways to support those who are required to isolate, either because they are infected themselves or because they are the contact of someone who is infected.

The noble Baroness, Lady Brinton, spoke thoughtfully and movingly about the role of the Lord Speaker in fighting HIV and AIDS, and I join her in paying tribute to the Lord Speaker, whose 83rd birthday was earlier this week. The messaging in that campaign was poignant, it cut through and we all remember it very well.

I also pay tribute to those in the communications team who have, during the last year, put through some incredibly impactful campaigning around the Covid messages. There has been massive societal behavioural change because of the clarity and the impact of the campaigns that we have done. Those campaigns have got better and better, and the most recent “look into my eyes” campaign, as it is now called, is one of the most impactful. When we look back on this campaign, we will think very highly of the marketing and communication skills of those in the Department of Health, the Cabinet Office and other departments, who have worked so hard in this area.

The noble Baroness, Lady Brinton, alluded to the vaccination of social care staff. She is absolutely right to allude to lists. One of the current difficulties is that we do not have proper lists of all those who work in various roles in social care, either as domiciliary staff or in unpaid roles. My colleagues are looking at this, and we are moving quickly to address it. I know that the noble Baroness feels very strongly about the vaccine dashboard; I have taken it back to the department and spoken to the vaccine team about it and I will raise the matter with them again. Regarding the unpaid carers and the delivery plan, I will take that to the department again. I will be happy to write to the noble Baroness.

International Year of Health and Care Workers

Debate between Lord Bethell and Baroness Brinton
Monday 1st February 2021

(1 year, 3 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the noble Baroness makes a completely fair point. Her observation is entirely right and her recommendation is one that the Prime Minister has made clear is part of his thinking. Social care workers have done a phenomenal job during this pandemic. Their role in supporting the elderly and infirm is extremely valuable to the whole country. It is only right that they should be treated fairly; a review of their pay and circumstances will be part of the social care package when that is announced.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, the WHO notes with concern the increase in international health worker migration; there are also concerns about their workplace treatment in their host countries. The 14% of brilliant non-British NHS staff are essential in holding up our healthcare systems, as has been especially evident during this pandemic. Last week, there were worrying press reports that hospital trusts were telling non-UK NHS staff without NHS numbers that they were not eligible for the Covid vaccine. Please, can the Minister say whether all NHS staff are eligible for the vaccine—and if he cannot, will he explain why not?

Lord Bethell Portrait Lord Bethell (Con)
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I take this opportunity to confirm to the noble Baroness that all NHS staff qualify for the vaccine. I would be very grateful if she could communicate to me any incidents where an NHS trust has said otherwise. We are enormously grateful in this country to all those who migrate to support our social care services. We are profoundly grateful for those efforts, and I want to ensure that everyone is treated well in their workplace. Generally, those in the social care workplace are treated well; there are exceptions, and we crack down on those exceptions extremely hard.

Covid-19: Vaccinations

Debate between Lord Bethell and Baroness Brinton
Wednesday 13th January 2021

(1 year, 4 months ago)

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Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, I welcome this Statement on the on the vaccine strategy and rollout, which we have been asking for from these Benches, in both Houses, since before the first lockdown. The Government have rightly set themselves stretching targets and we agree with them, especially in the light of the new variant’s high levels of transmission. The news this week of the severe problems that our NHS is facing across the country shows how out of control the virus is at the moment. Individuals must comply with the spirit and the rules of lockdown to help to reduce cases as soon as possible.

The Prime Minister has talked repeatedly about a vaccine signalling the end of the pandemic. I fear that lax messaging about the hope that vaccines bring is hampering the message about lockdown. It is a relief to hear in this Statement a more measured tone about this being a staging post in a long journey. Please can somebody tell the Prime Minister? The Minister will know that epidemiologists repeatedly make the point that we are a long way from life returning to normal. I note, for example, that in the debate about the vaccination priority list, the advice to clinically vulnerable people from government is that, even after their vaccine, they must remain shielding until told that it is safe for them not to shield.

On supply, we remain concerned that the Government will struggle to reach 2 million a week by next week—mid-January—given the numbers of vaccines being delivered this week. We are also receiving reports from GP surgeries of fewer doses arriving than ordered or, worse, short-notice cancellation of orders causing administrative chaos for already hard-pressed administrative surgery staff. While the opening of super vaccine hubs is welcome, can the Minister say why the hubs are vaccinating only during the day? If it is truly a priority to vaccinate as many people as possible, arrangements should be made for close to 24/7 delivery. I hear that, in the last hour, the Prime Minister has announced that the Government will try to start a pilot of some 24/7 hubs as soon as supplies permit—but how soon is soon? What are the vaccine supply pinch points? It is clear that targets are already slipping. This week, the target of 2 million a week has moved from mid-January to the end of January, and it is now the end of March instead of the end of February for the top five priority groups. Is this for the supply of all three approved vaccines, or just the AZ vaccine, where there is a much larger order to be rolled out with more substantial delays if there are supply pinch points? Also, it is because of a shortage of glass vials, or vaccine manufacture and regulation checks?

What are the Government doing to ensure that vaccine hubs are not superspreader locations? There have been worrying reports about people being asked to change masks and sit and wait less than two metres away from other people in the vaccine hubs. Given that the first five priority groups are all high-risk people, the last thing the NHS should be doing is encouraging them to go to areas that do not follow the government guidance on “hands, face, space”. Inevitably, there are glitches with any new process. We are still hearing of problems with the Pinnacle IT system that is being used for vaccinations. Some hubs were resorting to pen and paper in despair, and there are further problems reported with patients being asked to give the same detailed answers to a group of questions about Covid symptoms and allergies as they arrived, as they were registered and then as they were being given their jab. Any effective IT system should enter that information once. IT delays are reported as causing major delays, queues outside centres and daily targets missed at hubs. Can the Minister say what is being done to remedy these problems?

Can the Minister also say whether the vaccine dashboard will separate out the number of care home residents vaccinated? I see that care home cases are increasing again, which we deplore. As earlier this year, we strongly object to Covid patients being sent from hospitals into care homes, unless they are specialist Covid-designated units separated from other non-Covid residents. Even better would be to follow the example of Southampton hospital, which is using local hotels as step-down facilities. Will the Government endorse this and ensure that care home patients are kept safe through this surge until they are vaccinated?

The Government have announced that fewer than 1,300 surgeries and pharmacies are approved to deliver vaccines. The large hubs are all in urban areas. What will the Government do in rural areas, where elderly people do not have access to transport and may have to travel considerably further than the 90-minute journey for vaccinations announced this week? Are there plans as yet unannounced to increase substantially truly local-level provision, at a high-street level, in every rural village and small town—whether at a local surgery, pharmacy or visiting mobile vaccination unit—to ensure that vulnerable people who cannot travel or take the risk of infection will get access to the vaccine? It is not good enough for the Government to say that vaccines have been offered if the patients concerned cannot get to the vaccination delivery point.

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, I am enormously grateful for the detailed questions from the noble Baronesses. In particular, I endorse the words of the noble Baroness, Lady Thornton: it is indeed a remarkable achievement to have invested in such a broad array of candidates and to have purchased such an enormous quantity of doses—367 million. This is indeed a profoundly important step by the Government and one that we should celebrate and take pride in.

However, I acknowledge the searching questions from the noble Baronesses, so let me try to cover as much ground as I possibly can. The noble Baroness, Lady Thornton, asked about the digital backbone. This is absolutely critical to vaccine delivery. In many ways, injecting it into arms is the simple bit. Capturing the records, getting the invitations out right and the process of establishing identity are absolutely critical; in any project of this scale and complexity, that is where the problems are most likely to happen. That is why I pay tribute to colleagues at NHSX, NHS D, Test and Trace, PHE and elsewhere in the NHS who have done an amazing job of bringing together patient records around the nation to ensure that the invitations are sent out promptly and accurately and that the records are captured correctly. That information will be absolutely essential to both pharmacovigilance and the policy assessment of key issues such as transmissibility and efficacy. It employs the yellow card system to spot adverse incidents, and all data will go straight into the GP record, which is profoundly important when it comes to the research and analysis of the rollout of the vaccine. These may seem like prosaic details, but it is the most enormous digital achievement and one that will have an amazing impact on the health of the nation. I enormously encourage everyone in the country to ensure that they know their GP number, that they are properly registered with their GP and that they respond to any correspondence about the vaccine.

The noble Baroness, Lady Thornton, characterised the vaccine rollout as “traditional”. Can I just push back gently on that suggestion? There is nothing traditional about the sheer scale of this rollout, or about its speed and complexity. Our approach has been to work through the NHS, and from that point of view it might seem traditional, but I reassure noble Lords that not only is the latest technology being used but there is also the complexity of the collaboration between all the different parts of government—the Army, the NHS and PHE. Every single relevant part of government is being employed in this huge task, and it is something we should be enormously proud of.

The noble Baroness, Lady Thornton, asked about the supply figures. I am pleased to tell her that AstraZeneca has confirmed that it will be supplying 2 million vaccines a week. That is an enormous sum and it will mean that we can hit some really ambitious targets. Some 14.5 million people will be vaccinated by mid-February. Those are in categories 1 to 4, which includes care home residents and residential care workers, and they represent 88% of the mortalities in hospital. That will be transformational to the resilience of our healthcare system and to our approach to the pandemic. Some 17 million further people from categories 5 to 9 will be vaccinated by the end of spring, and all adults over 18—52 million of them—will be offered the vaccine by the autumn. That is a massive achievement.

The noble Baroness, Lady Brinton, quite rightly emphasised that this does not change absolutely everything overnight. She asked, quite reasonably, about schools and workplaces. I can confirm that there is still a huge amount to do by the entire nation to ensure that we do not have high infection rates, that we still deploy testing in order to break the chains of transmission and that we understand how to keep infection down—because the tragic thing about this awful virus is that it hits the old and infirm, who can be protected by the vaccine, but it also hits the young. It has become very clear from recent hospital admissions and from our growing understanding of long Covid that this disease hits all parts of society, and although we will have the most afflicted vaccinated by the spring, this is still going to be a societal challenge for months to come.

The noble Baroness, Lady Brinton, mentioned the letters to those shielding, which suggest that people should still remain shielded. That is a really important point and one we have to resolve, because those who are shielded who may go out into the community can themselves still be vectors of transmission. Those very people who we have done so much to protect may themselves be transmissible. Therefore, people are going from being protected to being potentially dangerous to others, and this is going to be a mind shift that we will all have to go through.

The noble Baroness, Lady Brinton, asked about GP surgeries. I acknowledge her point. There have undoubtedly been stories of GP surgeries which have set up queues of people to be vaccinated and then there has not been a delivery of the vaccine. However, I reassure the Chamber that it has been a very small minority. More than 95% of vaccination deliveries have happened on time, and in the grand scheme of things I take the view that if some GP surgeries have stood people up and asked them to come back another time, that is a small price to pay to ensure that the greatest number of people can be vaccinated as fast as possible.

The noble Baroness, Lady Thornton, asked about London. It is true that if we look at the infection rate, London has a relatively small distribution of the vaccine, but we are a young city here in London, so it makes sense that we have a lower proportion of vaccination. There are 2.8 million people who are more than 80 years old in the country. Not many of them are found in London, which is why the London figures look as they do.

On pharmacies, I reassure all noble Lords who have asked me about this that my colleague in the other place, Nadhim Zahawi, is incredibly energetic in engaging pharmacy chains and community pharmacies. It is true that we have a pilot with hundreds of pharmacies already running in it, but it is very much our intention to work closely with pharmacies to deploy the vaccine. As noble Lords know, vaccines come in plates of 1,000. It is much easier to deploy those plates in large centres than in small ones. We are working extremely hard to break those packages down into smaller groups and to get those groups into smaller locations but, quite reasonably, in order to get the vaccine into the most arms possible, we are starting with the big centres.

The noble Baroness, Lady Brinton, asked me about hygiene management in the distribution of the vaccine. She is entirely right: if you have a small room, such as a GP surgery, and you have a large queue of people, it is going to be extremely difficult to keep them all separated. That is why the development of these seven massive distribution centres in such places as the ExCel and Millennium Point in Birmingham is such an important development, because there is the space to be able to move very large numbers of people safely through the process. They will have a huge impact when they are opened next week.

On 24/7 vaccination, I am pleased to say that the Prime Minister has made an announcement on that. I must share with noble Lords that there has not been an overwhelming consumer demand for vaccinations at 4 am, but we are going to try this out as a process, and if there is indeed a big demand for late-night vaccination, then we will step up to the opportunity.

I was asked about rural distribution. Yes, it is incredibly important to get through to rural communities, particularly as many of the elderly and infirm can be found outside the city centres. I reassure noble Lords that, before very long, we will have vaccination centres within 10 miles of all communities. The noble Baroness, Lady Brinton, is entirely right to say that there will be some people for whom we have to take the vaccination to them; we cannot expect them all to drive to a vaccine centre. Provisions are being made through local health authorities in order to ensure that that is delivered.

Covid-19: Vaccine

Debate between Lord Bethell and Baroness Brinton
Tuesday 12th January 2021

(1 year, 4 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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The noble Lord is entirely right: the second dose is important. However, it is important not for efficacy but for durability. We have put in substantial data provisions to record every single dose into every single arm, and to put a follow-up dose into exactly those arms. We are using the NIMS system and every single vaccination is put into the GP record. They will be tracked down extremely diligently for exactly the reasons that the noble Lord describes.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, a number of scientists have expressed concerns about delaying the second dose of the Pfizer/BioNTech Covid vaccine. On the excellent Radio 4 programme “How to Vaccinate the World”, Professor Sir David Spiegelhalter said that, as the RNA technology used is new, there is less data to give confidence on spacing. But he suggested that, given a number of people have received their first dose, now is the perfect time to do a small randomised research trial on comparing those receiving their second dose at 21 days and others receiving it at 12 weeks, which would then perhaps give more confidence. Is that happening?

Lord Bethell Portrait Lord Bethell (Con)
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Who can hold a torch to Professor Spiegelhalter and his analysis of the data? Although I did not hear him, I completely welcome his comments. I reassure the noble Baroness that enormous efforts are being put into the pharmacovigilance around this vaccine. Some of this is of a clinical and scientific nature, and it takes a while to read out. We have therefore put in parallel systems to get an early read-out on exactly the kinds of questions that she has asked.

Covid-19: Vaccinations

Debate between Lord Bethell and Baroness Brinton
Thursday 17th December 2020

(1 year, 5 months ago)

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

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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What provisions and logistics are in place for those not registered with GPs to receive the vaccine?

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

Coronavirus Vaccine

Debate between Lord Bethell and Baroness Brinton
Thursday 3rd December 2020

(1 year, 5 months ago)

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

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

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

Covid-19: Vaccination Prioritisation

Debate between Lord Bethell and Baroness Brinton
Wednesday 25th November 2020

(1 year, 5 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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I hear loud and clear the conundrum expressed by the noble Lord. These prioritisation questions are very difficult. I hear his plea loud and clear and I undertake that these kinds of considerations will be considered in the prioritisation process.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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What provision is being made for another group who feel totally forgotten by this Government—namely, extremely vulnerable children, whether they have medical conditions or physical or learning disabilities, many of whom have been unable to access carers or schools since March? When is the review that the Minister just spoke about likely to publish its results?

Lord Bethell Portrait Lord Bethell (Con)
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It will not be possible to publish any results until we have the clear data on the vaccines. Individual vaccines may behave quite differently with different groups of people. There may be some vaccines that work well with the elderly, some that work well with those with clinical conditions and some that work well with children. It is only when we know that data that the final prioritisation can be published.

Covid-19: Response

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

(1 year, 10 months ago)

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

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

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

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

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

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

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
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My Lords, I thank the noble Baronesses, Lady Thornton and Lady Brinton, for their detailed questions, which I will go through as speedily and thoroughly as I can.

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

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

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

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

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

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

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

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

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

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

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

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

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

Covid-19: Personal Protective Equipment

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

(1 year, 10 months ago)

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Lord Bethell Portrait Lord Bethell [V]
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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]
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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]
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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

(1 year, 10 months ago)

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

(1 year, 10 months ago)

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Baroness Brinton Portrait Baroness Brinton (LD) [V]
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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
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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.

Social Care

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

(1 year, 10 months ago)

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Lord Bethell Portrait Lord Bethell
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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]
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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
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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.

Covid-19

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

(1 year, 10 months ago)

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

Independent Residential Care

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

(1 year, 10 months ago)

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Lord Bethell Portrait Lord Bethell [V]
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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]
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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]
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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

(1 year, 10 months ago)

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Lord Bethell Portrait Lord Bethell
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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]
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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
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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

(1 year, 10 months ago)

Lords Chamber
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Baroness Brinton Portrait Baroness Brinton (LD) [V]
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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)
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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

(1 year, 11 months ago)

Lords Chamber
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