Debates between Lord Bethell and Baroness Thornton

There have been 70 exchanges between Lord Bethell and Baroness Thornton

1 Wed 16th September 2020 Coronavirus
Department of Health and Social Care
2 interactions (400 words)
2 Tue 15th September 2020 Covid-19: NHS Long-term Plan
Department of Health and Social Care
3 interactions (273 words)
3 Mon 14th September 2020 Anti-obesity Strategies
Department of Health and Social Care
3 interactions (273 words)
4 Wed 9th September 2020 Covid-19: Rise of Positive Tests
Department of Health and Social Care
4 interactions (385 words)
5 Tue 8th September 2020 Suicide
Department of Health and Social Care
3 interactions (324 words)
6 Mon 7th September 2020 NHS Counter Fraud Authority (Establishment, Constitution, and Staff and Other Transfer Provisions) (Amendment) Order 2020
Department of Health and Social Care
2 interactions (2,005 words)
7 Thu 3rd September 2020 Health Protection (Coronavirus, Restrictions) (England) (No. 3) Regulations 2020
Department of Health and Social Care
2 interactions (2,193 words)
8 Thu 3rd September 2020 Covid-19: Local Restrictions
Department of Health and Social Care
4 interactions (358 words)
9 Wed 2nd September 2020 Medicines and Medical Devices Bill
Department of Health and Social Care
2 interactions (4,457 words)
10 Wed 2nd September 2020 Childhood Obesity
Department of Health and Social Care
3 interactions (226 words)
11 Wed 29th July 2020 Health Protection (Coronavirus, Restrictions) (Leicester) Regulations 2020
Department of Health and Social Care
2 interactions (2,154 words)
12 Fri 24th July 2020 Health Protection (Coronavirus, Restrictions) (No. 2) (England) Regulations 2020
Department of Health and Social Care
2 interactions (2,457 words)
13 Mon 20th July 2020 Smoking
Department of Health and Social Care
3 interactions (214 words)
14 Thu 16th July 2020 Covid-19: Personal Protective Equipment
Department of Health and Social Care
3 interactions (350 words)
15 Tue 14th July 2020 Medical Teaching and Learning: Ethnic Diversity
Department of Health and Social Care
4 interactions (348 words)
16 Thu 9th July 2020 Independent Medicines and Medical Devices Safety Review
Department of Health and Social Care
3 interactions (127 words)
17 Wed 8th July 2020 Covid-19
Department of Health and Social Care
2 interactions (182 words)
18 Wed 8th July 2020 Social Care
Department of Health and Social Care
3 interactions (263 words)
19 Tue 7th July 2020 Independent Residential Care
Department of Health and Social Care
3 interactions (296 words)
20 Mon 6th July 2020 Medicinal Cannabis
Department of Health and Social Care
3 interactions (297 words)
21 Thu 2nd July 2020 Covid-19: Mental Health Services
Department of Health and Social Care
3 interactions (220 words)
22 Wed 1st July 2020 Covid-19: Mental Health
Department of Health and Social Care
3 interactions (189 words)
23 Thu 25th June 2020 Health Protection (Coronavirus, Restrictions) (England) (Amendment) (No. 3) Regulations 2020
Department of Health and Social Care
4 interactions (2,474 words)
24 Mon 22nd June 2020 Coronavirus
Department of Health and Social Care
2 interactions (283 words)
25 Thu 18th June 2020 Nurses: Recruitment
Department of Health and Social Care
3 interactions (269 words)
26 Tue 16th June 2020 Covid-19: Mental Health
Department of Health and Social Care
3 interactions (307 words)
27 Mon 15th June 2020 Health Protection (Coronavirus, Restrictions) (England) (Amendment) (No. 2) Regulations 2020
Department of Health and Social Care
2 interactions (2,863 words)
28 Wed 10th June 2020 Covid-19: Cancelled Medical Operations
Department of Health and Social Care
3 interactions (244 words)
29 Tue 9th June 2020 Covid-19: R Rate and Lockdown Measures
Department of Health and Social Care
2 interactions (260 words)
30 Mon 8th June 2020 National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2020
Department of Health and Social Care
2 interactions (2,486 words)
31 Thu 4th June 2020 Covid-19: Obese and Overweight People
Department of Health and Social Care
3 interactions (291 words)
32 Thu 21st May 2020 Hospitals: Patient Safety
Department of Health and Social Care
3 interactions (186 words)
33 Wed 20th May 2020 Dental Care
Department of Health and Social Care
3 interactions (216 words)
34 Tue 19th May 2020 Mental Health Services
Department of Health and Social Care
3 interactions (293 words)
35 Mon 18th May 2020 Draft Human Tissue (Permitted Material: Exceptions) (England) Regulations 2020
Department of Health and Social Care
2 interactions (2,413 words)
36 Mon 18th May 2020 Covid-19: NHS Contact Tracing App
Department of Health and Social Care
3 interactions (264 words)
37 Thu 14th May 2020 Covid-19: Testing
Department of Health and Social Care
3 interactions (275 words)
38 Tue 12th May 2020 Health Protection (Coronavirus, Restrictions) (England) Regulations 2020
Department of Health and Social Care
2 interactions (2,459 words)
39 Tue 12th May 2020 Covid-19: Vulnerable Populations
Department of Health and Social Care
3 interactions (315 words)
40 Wed 6th May 2020 Covid-19: Government Response
Department of Health and Social Care
3 interactions (686 words)
41 Wed 6th May 2020 Covid-19: Contact-tracing App
Department of Health and Social Care
3 interactions (302 words)
42 Thu 23rd April 2020 Covid-19
Department of Health and Social Care
2 interactions (2,408 words)
43 Thu 23rd April 2020 Covid-19: Social Care Services
Department of Health and Social Care
2 interactions (4,436 words)
44 Thu 23rd April 2020 Covid-19: Personal Protective Equipment
Department of Health and Social Care
3 interactions (295 words)
45 Wed 22nd April 2020 Covid-19: Medically Vulnerable People
Department of Health and Social Care
3 interactions (261 words)
46 Tue 21st April 2020 Covid-19: Removal of Restrictions
Department of Health and Social Care
3 interactions (347 words)
47 Wed 25th March 2020 Coronavirus Bill
Department of Health and Social Care
2 interactions (333 words)
48 Wed 25th March 2020 Coronavirus Bill
Leader of the House
5 interactions (2,070 words)
49 Tue 24th March 2020 Coronavirus Bill
Department of Health and Social Care
2 interactions (5,682 words)
50 Mon 23rd March 2020 Covid-19: Critical Care Capacity
Department of Health and Social Care
4 interactions (435 words)
51 Thu 19th March 2020 Covid-19: Helplines
Department of Health and Social Care
3 interactions (376 words)
52 Wed 18th March 2020 Contraceptives and Hormone Replacement Therapy Drugs
Department of Health and Social Care
4 interactions (367 words)
53 Mon 16th March 2020 Covid-19 Update
Department of Health and Social Care
2 interactions (2,188 words)
54 Thu 12th March 2020 Coronavirus
Department of Health and Social Care
2 interactions (1,949 words)
55 Mon 9th March 2020 Health Protection (Coronavirus) Regulations 2020
Department of Health and Social Care
2 interactions (237 words)
56 Mon 9th March 2020 Coronavirus
Department of Health and Social Care
3 interactions (921 words)
57 Thu 5th March 2020 Health: Lesbian, Bisexual and Trans Women 3 interactions (243 words)
58 Wed 4th March 2020 NHS: Doctor Retention 3 interactions (239 words)
59 Tue 3rd March 2020 Coronavirus (COVID-19) 2 interactions (1,894 words)
60 Mon 2nd March 2020 Mental Health: Unregulated Treatment 2 interactions (1,584 words)
61 Wed 26th February 2020 Wuhan Coronavirus 2 interactions (1,127 words)
62 Wed 26th February 2020 NHS Funding Bill (Money Bill) 2 interactions (1,592 words)
63 Mon 24th February 2020 Health: Sexually Transmitted Infections 3 interactions (386 words)
64 Mon 27th January 2020 NHS: Children’s Emergency Beds 3 interactions (249 words)
65 Thu 23rd January 2020 Hymen Surgery 4 interactions (321 words)
66 Mon 21st October 2019 NHS: Babylon’s GP at Hand App 4 interactions (431 words)
67 Wed 2nd October 2019 Brexit: Medicines and Medical Devices 4 interactions (432 words)
68 Mon 30th September 2019 Health Infrastructure Plan 2 interactions (1,407 words)
69 Mon 30th September 2019 Human Medicines and Medical Devices (Amendment etc.) (EU Exit) Regulations 2019 2 interactions (1,286 words)
70 Mon 30th September 2019 Brexit: Advertising of Duty-Free Shopping 4 interactions (445 words)

Coronavirus

Debate between Lord Bethell and Baroness Thornton
Wednesday 16th September 2020

(2 days, 14 hours ago)

Lords Chamber
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Department of Health and Social Care
Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

My Lords, the Prime Minister claimed again today that the UK does more Covid tests than anywhere else in Europe. This is not true. Denmark does almost twice as many per 1,000 people, and the UK figure includes antibody tests, which others do not do, and is based on when tests are sent out and not on results. So it is more hyperbole.

I hope today we can look at facts. There is now a backlog of 185,000 swabs and tests are being dispatched abroad. Can the Minister advise the House how many tests have been sent abroad, to which countries, the processing time and the void rates? If the Minister does not have that information at his fingertips today, can he please to write to me and put the answer in the Library?

Secondly, Coronavirus infection rates among middle-aged people have reached the same level now as rates among those in their 20s two weeks ago, and Professor Neil Ferguson has warned us that infections are back where they were in late February. So what discussions have the Government had with the Joint Biosecurity Centre and the CMO about raising the alert level from three to four?

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

I am grateful for the noble Baroness’s questions. In terms of European rates, Britain is way ahead of many of its fellow countries in Europe. On Friday last week, we did 240,312 tests. It is a massive number and, I believe, the highest we have done on any day. This is a huge achievement and I pay testimony to those in the NHS and in test and trace who have contributed to that figure.

In terms of tests being sent abroad, our testing environment and economy are part of an international system. Reagents, swabs, consumables and machines are regularly exchanged between countries and I pay tribute to the enterprise and energy of the NHS and the test and trace scheme for using whatever schemes they can find in order to process the tests accurately, efficiently and promptly. I will be glad to send the noble Baroness details of the rates which she asked for.

In terms of the increase in prevalence among the middle-aged—yes, we are deeply concerned about this. As I have said at the Dispatch Box before, as night follows day, rates progress from the young to the middle-aged and, I fear, to the elderly. We are keeping a close eye on this progress.

Covid-19: NHS Long-term Plan

Debate between Lord Bethell and Baroness Thornton
Tuesday 15th September 2020

(3 days, 14 hours ago)

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

My noble friend is entirely right to raise the importance of social care. Undoubtably, one of the things that we have learned through Covid is that the NHS and social care sectors must work more closely together. That was always envisaged as one of the pillars of the long-term plan. It is now an increased priority. That has been witnessed through much closer collaboration in recent months between trusts and the social care industry. We continue to invest in social care, providing councils with access to £1.5 billion for adult and social care in 2020-21, as extra support during this difficult time.

Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

Following on from the question asked by the noble Baroness, Lady Altmann, I must try to pin the Minister down. Can he commit to publishing a plan for the future funding and provision of social care by the end of this year, as the Prime Minister promised in January? My honourable friend Liz Kendall MP has today written to the Secretary of State about the need for a clear social care winter plan. What steps are the Government taking to ensure that no one with Covid-19 is discharged from a hospital to a care home, to prevent a repeat of the terrible impact that this had in the first months of this crisis?

Lord Bethell Portrait Lord Bethell (Con) - Hansard

My Lords, I cannot commit to a social care plan before the end of the year. It will require a huge amount of political collaboration and I suspect it will take longer than the next few months. I remind the noble Baroness that we have a £600 million infection control fund to help social care through the winter.

Anti-obesity Strategies

Debate between Lord Bethell and Baroness Thornton
Monday 14th September 2020

(4 days, 14 hours ago)

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

My Lords, I entirely agree with the noble Baroness that serious eating disorders are complex, and we need to resource the medical attention required by people with serious mental health issues. However, I do not completely align with her view that all obesity is not a matter of personal responsibility, nor that the education of people about the content of their food through labelling cannot be an important part of our battle against obesity. Covid has spelt it out clearly to all of us. Some 67% of the country is overweight in some way or another. But this is a policy that we are determined to get right, and I would very much welcome the opportunity to meet with the noble Baroness and her team.

Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

My Lords, following on from the noble Baroness’s question, do the Government have eating disorder experts, including those with lived experience, advising them as part of their anti-obesity strategy? It seems to me that is one way of making sure that the messages do not disadvantage those who have eating disorders. There is a reason why advocates for those with eating disorders have been very critical of the language being used. Could the Minister commit to reviewing the campaign in light of this?

Lord Bethell Portrait Lord Bethell (Con) - Hansard

The noble Baroness is entirely right: we do rely on the advice of charities, academics and experts in eating disorders. We do not do anything without full consultation with those who have expertise in eating disorders. We review the campaign regularly, and we will be taking into account the view and feedback of those experts, charities and patient groups as a part of that review.

Covid-19: Rise of Positive Tests

Debate between Lord Bethell and Baroness Thornton
Wednesday 9th September 2020

(1 week, 2 days ago)

Lords Chamber
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Department of Health and Social Care
Baroness Thornton Portrait Baroness Thornton - Hansard

To ask Her Majesty’s Government what assessment they have made of the rise in the number of people testing positive for Covid-19.

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

My Lords, our assessment of the recent rise in positive tests is that we are deeply concerned, particularly about rates among young people, and particularly at a time when children are returning to schools and people are returning to the workplace. We are constantly looking at the latest data on the spread of coronavirus and have worked hard to contain outbreaks early to reduce the spread, protect the NHS and social care sectors, and save lives.

Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

I thank the Minister for that Answer. I was finding it difficult to know in which direction to point myself in framing a question about our testing system, but he has given me the two issues that I want to raise. First, can he tell the House what effect the increase in Covid infections is having on R? What is SAGE advising? The second question is to do with schools. What is a head teacher to do when they have successfully got their pupils back into school and then inevitably have pupils who have symptoms, are at home and need a test—as do their families—but are unable to get one because the nearest centres are either not carrying out tests or have run out of them, the labs cannot process them, or they have been offered testing many miles away and may not even have a car? How are our schools to remain open and safe if the national testing system is not working as it should, and when will this be resolved?

Lord Bethell Portrait Lord Bethell (Con) - Hansard

My Lords, the impact on R is not entirely clear at the moment. ONS and REACT figures will be published shortly, and they will have the statistical analysis that the noble Baroness asks for. However, it is safe to say that R is up. With regard to schools, the Government have made it clear that our support for the return to schools is completely emphatic. However, I remind the noble Baroness that the average distance travelled for tests, even at this stage, remains 6.4 miles. Ninety per cent of people who book a test travel less than 23 miles, and 90% of tests undertaken in our mobile sites are still converted in 24 hours.

Suicide

Debate between Lord Bethell and Baroness Thornton
Tuesday 8th September 2020

(1 week, 3 days ago)

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

I remind the noble Lord that, in July 2018, the standard of proof used by coroners to determine whether a death was caused by suicide was lowered from criminal to civil. That has had a meaningful effect on the number of suicides recorded. I am afraid the numbers for Yorkshire and Humber are not available to me.

Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

My Lords, we need to return to statistics. Last week, the Health Secretary Matt Hancock told the House of Commons that new figures from the ONS showed that the number of suicides in England fell during the peak of the coronavirus pandemic. Could the Minister confirm to the House that this was mistaken? While the figures cited by the Health Secretary are the latest reported by the ONS, the ONS also clearly said that those figures

“cannot be used to show the number of suicides with a date of death in 2020, including those that occurred during the COVID-19 pandemic”.

It is likely, it continues, that it

“reflects delays to inquests … due to the impact of the COVID-19 pandemic”.

As government statistics show, the last time the suicide rate was this high was 1988. I would like to know what government resources are being applied to this and that they will not be cut back.

Lord Bethell Portrait Lord Bethell (Con) - Hansard

The noble Baroness refers to recent statistics, which are, as she rightly points out, subject to change, as coroners’ investigations land on the desk at PHE. I reassure her that the statistics suggest a difference between stress and anxiety, and clinical mental health issues. It seems that one aspect of the coronavirus pandemic is that it has not translated into a massive mental health tsunami, as feared. This is hugely encouraging and a great relief. None the less, we are committed to the mental health support that the Government provide, and continue to support charities such as the Samaritans and CALM, including through the £9.2 million recently given to them for suicide prevention and support.

NHS Counter Fraud Authority (Establishment, Constitution, and Staff and Other Transfer Provisions) (Amendment) Order 2020

Debate between Lord Bethell and Baroness Thornton
Monday 7th September 2020

(1 week, 4 days ago)

Grand Committee
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Department of Health and Social Care
Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

My Lords, first, I need to declare my interests as a former member of a clinical commissioning group and a current non-executive member of a hospital trust—because, of course, we get trained in fraud when we take up these non-exec positions. So I have been diligent in doing my online training with the NHS fraud authority. It is very rigorous and it makes you think very carefully about the whole range of fraud that might occur in the NHS, including in recruitment, procurement and so on. So I will just say that it is very useful that it is so diligent in this. Of course, it is part of the whole audit process that goes on within NHS foundations and NHS bodies all the time.

I thank the Minister for introducing these provisions, which we will of course be supporting. Fraud is by definition a hidden crime and those who commit fraud are of course in a minority. But we are talking about significant sums here. The 2018-19 estimates say that fraud cost the NHS about £1.27 billion. So fraud is not and never has been victimless, and in this case it impacts directly on patient care. I commend the work of the fraud authority in uncovering scams and ghost patients, but there is still quite a long way to go.

Unfortunately, Covid-19 presents a heightened risk of fraud, and it does so across the whole of society. As someone who had to have their bank cards changed three times during lockdown, I say that unscrupulous crooks are seeking to exploit the fact that systems are not working and in particular that our health system is under unprecedented pressure—and they are doing it for their own financial gain. I think all noble Lords will agree that robust response is imperative to safeguard the reputation and resources of our health service, so we welcome these provisions and the extension of their lifespan for a further three years.

The disruption caused by Covid-19 has seen a reported spike in fraud cases across health and social care, ranging from fake PPE to recruitment, as well as cybersecurity attacks. I think noble Lords will agree that this is deeply concerning, so what assessment have the Government made of reports that levels of fraud have been increasing during the Covid-19 crisis, and is the noble Lord able to share any preliminary figures with us today?

Like my noble friend Lord Jones, I say that it is imperative that the fraud authority has the resources it needs to investigate, detect and prevent fraud. So could the Minister assure the Committee that the resources that it does need to investigate, detect and prevent fraud are there, and that there has been increased funding, commensurate with the increased risk?

An urgent concern is the relaxation of recruitment rules and practices to allow NHS bodies to hire staff working across the health and social care sector. I completely accept that this has been necessary at a time of emergency, but I wonder what assessment the Government have made of these exceptional circumstances and the unique pressures that may impact on methods of preventing fraud in recruitment. What advice and support is the fraud authority giving to NHS organisations to help them prevent fraud in these difficult times?

PPE has already been mentioned in this debate, and we have talked a lot about it in the last few months. It is of enormous concern that amounts of public money have been directly awarded outside the usual tendering process, with no competition. What steps is the authority taking to prevent fraud linked to PPE procurement? Given that PPE procurement for Covid-19 is now centrally managed, can the Minister confirm whether this falls outside or inside the remit of the authority? Who will be investigating this as we move forward? Are cases being referred to the Department of Health’s anti-fraud unit, supported by the authority? I hope that the Minister will also take the opportunity to confirm that there will be an inquiry into PPE procurement as we move forward.

The Minister has already mentioned something of vital importance: cross-working. The most recent annual report identifies a number of challenges and potential barriers that affect the ability to tackle fraud against the NHS and highlights the fact that the level of understanding of the nature of fraud in the NHS continues to be uneven across the health system. So if there is underreporting of fraud and suspicious activity, that is of continuing concern. Can the Minister expand on what the authority intends to do to improve cross-NHS working?

In June, as has been mentioned, the Cabinet Office published the Counter Fraud Functional Standard, which is intended to be introduced across the NHS by the end of the financial year. We certainly welcome this move towards a common counter approach across the public sector. But what steps is the NHS Counter Fraud Authority taking to support the NHS organisations to implement this change? Can the Minister confirm that this will be introduced across the NHS by the end of this financial year, as intended, or will it need to be delayed? Perhaps he could explain that.

So we welcome this order and I think that these are all questions that will probably need to be answered in due course.

Lord Bethell Portrait Lord Bethell (Con) - Hansard

My Lords, I thank noble Lords who contributed to this lively debate. I completely endorse the comments of several of them, including my noble friend Lord Naseby, who thanked the CFA for its work. It is tough work; it requires huge diligence. It is not always glamorous, exciting, blue lights and fun; it is about grinding out huge amounts of detective work and auditing and being thorough. I am extremely grateful for the work of the CFA and say a massive thanks for its impact. Some of that is seen directly through the numbers, but a lot of it, as was alluded to by the noble Baroness, Lady Thornton, is seen through soft impacts such as cross-working, “encourager les autres” and a general sense of grip, which it is an important thing for NHS management to have over the system.

With all the taxpayers’ money that is going into investment, recruitment and epidemic response, never before has counterfraud been quite so important—a point made by several noble Lords. The CFA has been instrumental in providing guidance and organisation across the health sector and, very importantly, in sharing intelligence with law enforcement partners.

A number of noble Lords asked about the approach of the CFA. We know that preventing loss is much more cost effective than prosecuting suspects and recovering funds. That is why the CFA does an enormous amount of work on fraud prevention methodologies. It is pushing hard to build and develop capabilities across the NHS and to share national standards and best practice with all parts. That is why it is driving a national, co-ordinated and cross-organisational response focused on prevention—the approach alluded to by the noble Baroness, Lady Thornton.

I say in response to my noble friend Lord Naseby that the CFA was established as a special authority only in 2017, but we have seen from its own strategic intelligence assessment that there has been a year-on-year reduction in fraud loss estimates. For that, we are enormously grateful.

The noble Lord, Lord Jones, asked about the number of prosecutions. The CFA has 45 ongoing investigations, involving 165 suspects. In 37 of those cases, a potential fraud value has been calculated which exceeds £34 million. I hope that that gives the noble Lord an idea of the scale of this work. The estimate for NHS fraud has been reduced, according to the strategic impact authority, from £1.27 billion to £1.21 billion, which shows the recent impact of the CFA. The chair is Tom Taylor and his salary is currently £14,450 for an average of two or three days a month.

The noble Lord asked also about the type of fraud investigated by the CFA. Covid fraud has been focused on—cyber-enabled fraud through malicious emails, apps and SMS texts. It has also investigated fraudulent appeals designed to exploit public sympathy and the spreading of false information. In this, the CFA has worked closely with the Cabinet Office, which has provided incredible support.

On how much fraud is reported to the CFA, it receives around 5,500 reports each year. The figure of 5,500 for 2018-19 was an increase of 700 over the year before. Almost half of those reports relate to fraud committed by NHS staff and a quarter to fraud committed by NHS patients.

My noble friend Lord Bourne asked a number of questions about the budget. The current budget of the CFA, which is an indicative, non-ring-fenced revenue budget allocation, is £11 million. That budget is funded through the DHSC in the same way as other health arm’s-length bodies. In 2019-20, we detected and recovered a total of £126 million which would have otherwise been lost to fraud.

My noble friend asked also about the PPE supply chain. PPE procurement during Covid-19 is currently managed centrally and not by NHS trusts. Therefore, Covid-19 procurement activity falls outside the CFA’s remit. The DHSC anti-fraud unit is working with partners to scrutinise transactions and reduce the risk of fraud against the Government—the noble Baroness, Lady Thornton, asked about that specifically. The CFA is supporting this work, but I will take a moment to give special thanks to my noble friend Lord Agnew, who is very much leading the charge from the Cabinet Office in the anti-fraud campaign. I am a representative member from the health department on what is known as the “fraud board”, which meets regularly to update policies and programmes in this area.

I thank the noble Lord, Lord Bhatia, for his comments. On my noble friend Lord Naseby’s question about the devolved authorities, I want to clarify that the CFA, although focused on England, provides a huge amount of training, technical support, data and other specialist support for DAs. Although they handle this as a devolved area, they benefit greatly from the CFA’s expertise.

My noble friend is entirely right about Covid spending. I would like to have said that everyone behaved immaculately through the Covid campaign, but that is not true. We were subjected to an enormous, co-ordinated and systematic campaign by those who sought to defraud taxpayers. We are conscious of that. We put in place enormous co-ordination with the police authorities in order to spot fraudulent efforts. They were extremely energetic but not always successful, and we have prosecutions in place to chase down fraudsters who sought to take money unreasonably off taxpayers.

Auditing of the CFA is done by the National Audit Office. I reiterate the thanks given by my noble friend Lord Naseby to the CFA.

On the CFA’s three-year cycle, it is an arm’s-length body established as a special health authority under the National Health Service Act 2006, which gives it a maximum tenure of three years. It is therefore out of the electoral cycle. Affirmative secondary legislation is required to extend the tenure for a further three years until 30 October 2023, which is why we are here today.

I think that I have addressed a number of the comments made by the noble Baroness, Lady Thornton, but I reiterate what I said on PPE in particular, which was subject to a concerted, organised effort by the criminal world to defraud the British taxpayer. Our response has been energetic and remains ongoing.

Extending the current model provides an opportunity for the CFA to continue its work. Its budget, which a number of noble Lords asked about, is under review, but we believe that it is ample for the work that it is doing. The department will continue to oversee the function of the CFA in its sponsorship role to ensure that it is fit for purpose. This will also allow the department to consider the best operating model for the CFA in the long term. The order is important secondary legislation that is integral to allowing the CFA independence and a crucial remit to continue. I urge noble Lords to approve it.

Health Protection (Coronavirus, Restrictions) (England) (No. 3) Regulations 2020

Debate between Lord Bethell and Baroness Thornton
Thursday 3rd September 2020

(2 weeks, 1 day ago)

Lords Chamber
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Department of Health and Social Care
Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

I agree with everything that the noble Baroness, Lady Barker, has just said. We shall get to that point by the end of this month. I congratulate the Minister on the marathon session that he has done today. I have just agreed to almost three days this month of statutory instrument conversations like the ones that we are going to have today about things that have already been enacted. They all have to be done by 25 September, so for two Fridays and a Thursday the Minister and I and many noble Lords here will be in the Chamber having similar conversations. The time has come when we actually need to review the whole process. I say that for a number of reasons.

The Minister has said a few things today that I completely agree with; for example, he says that the population are getting a bit exhausted, that we definitely have a second wave coming and that there are things that we therefore need to think seriously about. The Minister has also said that we now know a great deal more about Covid, what happens and how to deal with outbreaks than we did at the beginning of March. When you put all those things together, it should say to us that we do not need the urgent legislation on the statute book that we agreed back in March. It needs to be reviewed. There is now time to plan for the next wave if it is going to happen. There is time to have discussions in Parliament about what needs to be done, what local authorities should be doing, what resources are needed, how the NHS can function and continue cancer and other treatments at the same time as manage a Covid outbreak. We have time to do that. It is about time to ask the Minister to say to the Government that we need to end the emergency legislation. We need to review it and we need to stop it. We now need proper scrutiny of the regulations that we are discussing today.

These regulations should have been debated two months ago. I put on the record again that this process needs to be reviewed as a matter of urgency. If we are to believe the Minister and his colleagues about testing and tracing, the readiness of the NHS, the scientific basis for local lockdowns, the strengthening of local public health efforts, and the greater understanding of the virus, we do not need emergency legislation to facilitate and to avoid a national lockdown. The question that the Minister needs to answer is: when will we see a proper review and revoking of these powers instead of just rolling forward, with Parliament unable to play its part in the legitimate scrutiny of this legislation?

Another legitimate concern which the Minister has heard from several parts of the House is that this piece of legislation can be used to stop legitimate political activity. Can the Minister say whether the legislation has indeed been used to stop legitimate political protest, which this country prides itself on allowing to happen, even in its most bonkers forms?

The noble Baroness, Lady Bull, and others raised important questions about the equality issues raised by this legislation. I would like the Minister to address those questions.

Can the Minister expand on the criteria for serious and imminent threats to public health and the necessary precautions? According to the Local Government Association, local authorities are unsure of the circumstances in which they can use these powers and the threshold for meeting these two tests. For example, many councils have been grappling with the lack of social distancing in venues, including licensed premises, such as pubs, but found that a small minority ignored the requirements to ensure social distancing altogether.

Where areas are on the Government’s watchlist, and there is a clear imminent public health ground to take action, councils feel confident in taking enforcement action under the regulations. However, where there is not a known spike of Covid cases locally, councils have advised that they are less certain about whether they can take enforcement action under the regulations to prevent a local outbreak. Does the Minister believe that a lack of social distancing in itself constitutes a serious and imminent threat to public health?

Hesitancy is not helpful in the fight against Covid-19. The clarity for which we have been calling for months remains a priority. I think that these regulations give a Secretary of State the power to require a local authority to make or revoke a direction after consulting with the CMO or deputy CMO. Can the Minister advise whether the Secretary of State has given any such directions and, if so, where has he done that? Can he confirm whether the CMO or deputy CMO were consulted and whether their responses were shared with the appropriate authority?

I would be grateful if the Minister could explain how this particular set of regulations interacts with the Government’s guidance on other legislative regimes. However, basically, the Government need to take a thorough look at the appropriateness of these regulations and the way in which they are carried out.

Lord Bethell Portrait Lord Bethell (Con) - Hansard

My Lords, I thank everyone involved for this important debate. The restrictions that we have debated today are incredibly necessary and do, in fact, answer many of the points that have been raised in this Chamber about the way in which the Government are going about their fight against Covid, and in particular, about the interaction between central government and local authorities. Empowering local authorities to protect the people in their areas from this terrible virus is the exact reason for these regulations. I would like to pay tribute to those local authorities which are working so closely with government and bringing about important impacts in their areas that close down outbreaks that we never hear about.

I will focus on individual answers to questions, and then wrap up. I reassure the noble Lord, Lord Hunt, that all decisions by local action committees are based on the latest data and advice from experts, including the CMO in consultation with local authorities. That interaction between central government and local authorities has come a huge way since we last spoke in this Chamber and a huge investment has taken place during the summer in building those relationships and getting the data moving between the two. It works nine times out of 10 without any impact on the headlines whatever, and those relationships are being forged extremely closely.

The noble Baroness, Lady Jolly, asked about fixed penalty notices. I reassure her that under Regulation 3 no fixed penalty notices have been issued. I think that is a tribute to the way in which the police have gone about marshalling these restrictions, which, despite the comments of some noble Lords, has been extremely responsible, light-touch and has relied on encouragement wherever possible.

I very much welcome my noble friend Lord Lansley’s comments on the collaborative work between government and local authorities. We are extremely committed to local-led leadership in the fight against Covid. In answer to his question, we are investing massively in systems, data, personnel and the culture of collaboration in that relationship between central and local government.

I completely agree with the noble Lord, Lord McCrea, that the virus hits different people in different ways. When I speak to my counterparts in other countries, what is amazing to me is the reassurance I get that many of the challenges they face are the same, but also how the disease hits different people in different ways.

I remind the noble Lord, Lord Hunt, that some of his comparisons between the regulations before us today and the regulations envisaged in the Medicines and Medical Devices Bill are completely different and an unfair comparison. What we have before us today is emergency regulation in the face of an unexpected, unprecedented and horrible epidemic. It was passed quickly to fight a virus that is killing tens of thousands of people. The regulations anticipated for the Medicines and Medical Devices Bill will be highly considered, highly consultative and under the affirmative action in most cases. It is very important to get that comparison right.

I make a special note on the comments of the noble Lord, Lord Scriven, many of which were echoed by the noble Baroness, Lady Barker. I completely pay tribute to the noble Lord, who is absolutely an advocate for local decision-making and enhanced powers for local authorities. I remember well his interventions during the passage of the Coronavirus Bill and his draft amendment. The processes and resources that we are looking at today, at the beginning of September, for local intervention by local authorities, are completely different from what they were in March. We have made a massive investment of time, money, people, technology and systems to beef up those resources. Today, local authorities, local infection teams and directors of public health are being as effective as they are—and they are being effective—because we have worked so hard to build those resources. If it was not for that work, the impact would not be felt. While I completely pay tribute to the vision and accurate analysis by the noble Lord, Lord Scriven, and others on this point, the truth is that if we had taken that approach in March it would not have worked. But we are building those systems today, and I pay tribute to those involved who have taken it so far.

Also in response to the noble Lord, Lord Scriven, I pay tribute to the hard work that went into these regulations. They are characterised as having arrived here unexpected and unscrutinised. That is not true in this case. These regulations were hammered out in conversations between government, local authorities and DPHs in response to the needs and requirements of those local authorities and directors of public health. They were in response to the political call of those in this Chamber and elsewhere. They were not unexpected or rushed; they were the subject of extensive consultation. On their quality, I remark that no one has particularly questioned the regulations themselves. Their quality is first class; they are completely fit for purpose, and I am extremely grateful to those involved in the drafting of these regulations, which have already proved to be extremely effective and have had a huge impact.

On the comments of my noble friend Lord McColl, I am afraid that I could not hear them all, but I believe that they were a sobering reminder that, as a country, we have not tackled the challenge of obesity, which has correlated the impact of coronavirus in this country. The Government take that extremely seriously. It starts at the top with the Prime Minister and his own personal experience and goes through the announcement in July of our obesity strategy, which we debated in this Chamber yesterday. It is a long-term commitment of the Prime Minister and Secretary of State for Health to address the matter properly.

In response to the question from the noble Earl, Lord Clancarty, yes, you can get a test wherever you live, but typically it costs around £100. That is why we are working on dramatically reducing their cost, so that we can introduce the sort of mass surveillance that he discussed.

In response to my noble friend Lady Wheatcroft, I completely welcome U-turns when the evidence changes. We need to balance between national and local resources and decision-making and analysis.

In response to the noble Baroness, Lady Crawley, I am very sad about the disproportionate effect on BAME. We are studying it extensively to try to understand it properly.

I completely and utterly reject the characterisation by my noble friend Lord Naseby of the Department for Digital, Culture, Media and Sport, which has been extremely active in this space. It is deeply engaged with cricket. The second wave has already hit France and Spain hard and it seems unlikely to avoid Lords cricket ground for any cultural superiority reasons.

In response to the noble Baroness, Lady McIntosh—gosh, I am running out of time here—we are offering the flu jab to 30 million people, and plans are in place to extend it to 50 million to 64 million people.

I have massively misjudged my timing on this, and there are a large number of questions that I would have liked to answer, but I have got it completely wrong. My key points are that a second wave is already reaching across Europe. If you go to Marseille or Barcelona, or, if you are in America, you go to Florida, you will see that the rise in prevalence leads to a rise in hospitalisations as night follows day. We have to be prepared for winter. The days are already shorter, and the schools are back. It is only 113 days to Christmas. We have put into place during this summer important preparations for the winter, and these regulations are an important part of it. They meet the challenge of getting central government to work closely with local authorities. They are very good regulations and answer many of the challenges that I have heard here in this Chamber. For that reason, I commend these regulations to the House.

Covid-19: Local Restrictions

Debate between Lord Bethell and Baroness Thornton
Thursday 3rd September 2020

(2 weeks, 1 day ago)

Lords Chamber
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Department of Health and Social Care
Baroness Thornton Portrait Baroness Thornton - Hansard

To ask Her Majesty’s Government what plans they have to publish the scientific advice which informs decisions to lift restrictions put in place to address Covid-19 in specific local areas.

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

My Lords, data is the key scientific commodity in our fight against Covid. We started with very little; now we have lots, and we are sharing it with our local partners as quickly as the legal, technical and privacy constraints allow. This shared intelligence informs collaborative decisions on local restrictions.

Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

I thank the Minister. On the ministerial Zoom, I witnessed the Conservative MP for Shipley having what looked like a hissy fit when the Bradford lockdown was announced. Despite recommendations to the contrary from the leader of the council and local public health officials, a month later Shipley has been lifted out of lockdown when other parts of Bradford still in lockdown have lower infection rates. On Friday, the Health Secretary announced that restrictions in Bolton and Trafford would be eased on Wednesday, despite leaving Labour constituencies with lower infection rates in lockdown. It seems that the Government were again lobbied by local Conservative MPs to lift restrictions. However, yesterday, the Health Secretary, with what might be called a skidding U-turn, announced that current restrictions would remain following a significant increase in infection. Will the Minister commit to publishing the scientific evidence behind decisions to impose, maintain and lift lockdown restrictions? Would it be better if discussions with local MPs were on the record? Does he agree that political neutrality and transparency are essential to securing public trust and support for measures locally to prevent a national lockdown?

Lord Bethell Portrait Lord Bethell (Con) - Hansard

My Lords, I entirely agree with the noble Baroness that local support, trust and collaboration between actors from all political parties are essential to fighting Covid effectively. I pay tribute to the very large number of dialogues and collaborative interventions we have had across the country with local actors from all political parties. Yes, local lockdown decisions are not always popular. They are tough choices and elected representatives find them difficult, but we have found that politics does not play a part in those decisions and we stick to that.

Medicines and Medical Devices Bill

(2nd reading (Hansard): House of Lords)
Debate between Lord Bethell and Baroness Thornton
Wednesday 2nd September 2020

(2 weeks, 2 days ago)

Lords Chamber
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Department of Health and Social Care
Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

My Lords, I thank the Minister for introducing the Bill, all noble Lords for their contributions and all the organisations, including the Library, that have sent us briefings. I particularly thank the Delegated Powers and Regulatory Reform Committee and the Select Committee on the Constitution for their reports, produced in a timely fashion at the beginning of the recess, thus giving us all time to digest and reflect upon the issues concerning powers contained in the Bill.

We on these Benches recognise that this is an important Bill; indeed, the issues that it addresses are vital. I will concentrate on two or three, or maybe four, issues, most of which have been mentioned in the debate.

As the noble Lord, Lord Blencathra, said in his stirring contribution earlier, it seems that most of the Brexit Bills between now and Christmas will contain the same or similar constitutional challenges, so I think that we can anticipate some serious learned and constitutional debates throughout the autumn.

I am not sure whether I want to describe the Bill as a Trojan horse—something that has a seemingly innocent and benign exterior hiding huge and serious dangers within. Perhaps it is yet another example of the Prime Minister’s cavalier disregard for both timeliness and accountability, combined with our own Health Minister’s self-confessed aptitude for hustling, or perhaps it is all those things combined. However, it is worth recalling the words of one of our most distinguished Cross-Bench colleagues, the noble Lord, Lord Wilson, during the passage of the international healthcare arrangements Bill in February and March last year. On 19 February, he recounted his time as a junior civil servant when he went to discuss a Bill with our very much respected parliamentary counsel. He said:

“My assistant secretary was asked why we needed a particular power, and he rather flippantly replied, ‘Because I thought it might be useful’. Parliamentary counsel gave him a withering look and said, ‘I am not going to draft a clause for you simply because it might be useful. You have to know what you want it for’. He did not know, and we did not get that power.”—[Official Report, 19/2/19; col. 2185.]

It feels as if it is the same with this Bill. Powers have been thrown in just in case they might be useful. The Minister called it “agility”. We agree that agility can be useful, but if it is not linked to policy and what you want to do with it, it is a power that can be abused.

Do the Government know what they want, or are they are putting these powers in simply because they might be useful later? I suggest that they do know what they want: they want the power to do exactly as they decide, whenever they decide it, without scrutiny, accountability or due consideration. For our NHS and care services the important matters are whether medicines are available and how much they cost, the future of scientific research, fake medicines, proper safeguards for medical devices and putting patients at the heart of this. They deserve our full scrutiny and the best constructed Bill possible.

As my noble friend Lord Hunt said—this risk was amply illustrated in the stark narrative of the noble Earl, Lord Devon—leaving the EU’s medicines regulatory regime poses a significant risk to the UK. The Bill is crucial for maintaining the attractiveness of the UK’s life sciences sector and ensuring that patients continue to benefit from the excellent clinical research that takes place in the UK. Therefore, it is vital that we fully understand what constitutes “attractiveness” on the global stage.

Will the Minister reflect on the rumour that leaving the EU is likely to see the UK drop down the list of markets that companies will choose to trial and launch medicines in if mitigating steps are not taken? It is crucial that this legislation carefully defines what the Government mean when they talk about the UK’s attractiveness as a place to conduct clinical trials or supply human medicines. Does “attractiveness” equate to the speed of decision-making at every stage of the medicine pathway? How will patient safety be assured? Will the Minister set out what the Government mean when they talk about attractiveness, how they will apply this to medicines access and what he is doing to ensure that patients in the UK can access new therapies on the NHS as soon as countries such as France can?

The British Medical Association asked about the potential divergence in standards and suggested that this must be kept under constant evaluation to ensure that such changes do not negatively impact the timely supply of safe medicines to UK patients, as my noble friend Lord Turnberg said. The new EU regulation on medical devices is an example of a change coming through from the EU that the UK should seek to capture in the future regulatory framework around medical devices, as facilitated by the Bill. Expected to come into force in 2021, the revised rules were drafted in the aftermath of the metal-on-metal hip and PIP implant scandals. They will introduce stricter requirements on the bodies authorising medical devices and ensure greater post-market surveillance. Will UK patients benefit from changes such as these, which were orchestrated at EU level, when we are no longer part of the EU’s processes? How will that happen?

The impact of moving away from the existing collaborative approach between the UK and the EU could be substantial. The centralised processes that we are currently part of reduce the burden on the regulatory authority in each member state, create a larger European market for the pharmaceutical industry and medical device manufacturers, and thereby facilitate timely access to new therapies and technologies to patients across the EU and EEA. As many noble Lords have said, the EMA accounts for 25% of world sales of medicines, second only to the United States. By comparison, the UK accounts for only 3%.

On medical research, negotiating a formal agreement to maintain access to EU funding programmes, ensure alignment with clinical trials regulations and secure the participation of the MHRA in clinical trials that cross the EU and the UK to maximise collaboration between researchers in both is particularly important if UK researchers are to benefit from the EU’s new clinical trials regulation, which is due to be introduced in 2022 and is expected to significantly improve the current research climate via the introduction of a single clinical trial database and a centralised clinical trial portal. I have been talking to your Lordships’ House about this portal ever since the Brexit vote. It looks like we will not be part of it. I would like the Minister’s comments on that and an explanation of the disadvantage that this will bring to UK patients.

As many noble Lords have said, the Bill presents an opportunity to address the issues raised in the excellent report First Do No Harm, launched and led by the noble Baroness, Lady Cumberlege, whose remarks were very moving indeed in addressing the terrible sufferings of women at the hands of the NHS and the regulatory regimes that failed them so comprehensively. Surely we need to take this opportunity to provide for its recommendations. As other noble Lords have said, we need to consider amendments that will fall within the scope of the Bill and cater for the nine recommendations in the report. At the heart of the Bill lies the issue of patient safety in terms of medicine and medical devices, so it must be an appropriate vehicle with which to implement the report’s recommendations. Will the Minister bring forward amendments to remedy these omissions?

It is rumoured that there are mutterings, possibly among officials, about burying the proposed patient safety commissioner. I would really appreciate it if the Minister could take this opportunity to refute such rumours and commit to working with colleagues across the House—I include these Benches—to make sure that the necessary amendments happen.

I briefly turn to other issues. We are very supportive of extending the prescribing rights to additional healthcare professionals, as the noble Lord, Lord Ramsbotham, and my noble friend Lord Bradley outlined. It is time that this issue was resolved. We intend to support or table amendments in Committee requiring proposals and a timetable for additional prescribing rights.

We will seek clarification about Northern Ireland and regulatory divergence. We will probe the changes to the hub-and-spoke proposals. We will look closely at the work of the proposed patient safety commissioner, the medical devices register and, of course, the impacts of the Bill on animal medicine and veterinary regulation.

Although only 46 clauses, the Bill is a veritable cornucopia of medical and other proposals. We hope to work with the Minister, the Bill team and other noble Lords to improve it and make it worthy of the importance attached to it.

Lord Bethell Portrait Lord Bethell (Con) - Hansard

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Childhood Obesity

Debate between Lord Bethell and Baroness Thornton
Wednesday 2nd September 2020

(2 weeks, 2 days ago)

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Lord Bethell Portrait Lord Bethell (Con) - Hansard

Health checks in the early years of childhood are an incredibly valuable opportunity to intervene in a number of health inputs. Diet and exercise are two of those. Training is in place for health visitors to provide dietary advice but, when back at the department, I will ask whether we are working on any new initiatives at the moment and write back to my noble friend.

Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

I have two questions for the Minister. Could he explain to the House why Professor Dame Sally Davies’ 2019 report on childhood obesity, which made 49 recommendations, seems to have been lost? Given that Public Health England plays a crucial role in addressing obesity, as my noble friend Lord Dubs said, and the obesity team seems to be homeless at present, how will the Government ensure that its expertise, accountability and leadership is retained and relevant bodies are sufficiently funded?

Lord Bethell Portrait Lord Bethell (Con) - Hansard

My Lords, the report from Professor Sally Davies has not been lost; the July obesity strategy leans extremely heavily on the insight and advice of Sally Davies, who continues to have a strong presence in the department and informs all our decisions, as does the public health team at PHE. Professor John Newton had an extremely high profile during the launch of the obesity strategy in July and continues to have an important voice at all levels of the department.

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

Debate between Lord Bethell and Baroness Thornton
Wednesday 29th July 2020

(1 month, 3 weeks ago)

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Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

My Lords, I thank the Minister and other noble Lords for their remarks. Here we are again. I do not intend to rehearse the absurdity of this debate; we need to look on it as an opportunity that has been offered. I think the Minister has picked up, today and before, the dissatisfaction in the House and the statutory instruments committee with the current arrangements for scrutiny and accountability.

Leicester remains in lockdown, a situation that I believe is due to be reviewed tomorrow. Can the Minister explain what metrics will be used to decide what happens next in Leicester? I ask this because the people in Leicester seem to be asking exactly the same question, as my noble friends Lady Massey and Lord Clark said.

New measures to stop the spread of Covid-19 were introduced in Oldham yesterday. Can the Minister confirm whether the new rules in Oldham are guidance or a legal requirement? If the latter, how will it be enforced? How is the new local policy being communicated to residents in Oldham, which has a higher proportion of ethnic minorities among whom English may not be the first language? Oldham Council’s deputy leader, Arooj Shah, said the new measures are essential to prevent a strict local lockdown like in Leicester. Can the Minister confirm that national lockdown relaxations, including the reopening of gyms, cafés and pubs, remain applicable in Oldham? What advice have the Government received regarding the increased risk these relaxations pose in Oldham? Can he advise what the threshold of new cases is for introducing local lockdown regulations in Oldham? Can he confirm whether Oldham has been categorised as an area of intervention alongside Leicester and Blackburn and will receive increased national support, capacity and oversight accordingly?

This debate offers an opportunity for the Minister to update the House on how life in Leicester is and what lessons can be learned from this citywide lockdown. As my noble friends Lord Harris and Lord Liddle said, lessons need to be learned from this. In particular, as my noble friend Lord Harris asked, what happens in a large area such as a London borough? What is the impact of the extended lockdown on children who are missing out on school, local businesses and jobs, universities and voluntary groups and the mental and other long-term health consequences for the people of Leicester?

Have the Government learned the lessons about data? We know from the launch of the NHS Test and Trace system at the beginning of May that Leicester’s director of public health repeatedly asked Public Health England for the results of the data from the pillar 2 tests. Although the Minister has assured the House that all data is now being made available, there is a dissonance between what he and the noble Baroness, Lady Dido Harding, tell us and the anecdotal local-level evidence. For example, Katrina Stephens, director of public health for Oldham Council, said she was being given incomplete data about the occupation and recent location history of people who had tested positive. Can the Minister explain why this information was not available from the start?

As other noble Lords have said, many weeks ago the Leicester director of public health asked week after week for postcode-level details and was assured week after week by Public Health England and regional public health that there was nothing to worry about in Leicester. He was told that on 15 June. Three days later, the Secretary of State announced in a press conference that there was an outbreak in Leicester. In such an urgent situation, with a dangerous virus that spreads so quickly, you would think that data sharing would not be an issue. Is the director of public health in Leicester now receiving all the information he needs to do his job? Are they receiving the contact-tracing data? Is the data made available daily?

Let us look at communications. Over the weekend of 27 and 28 June it was briefed in the Sunday Times by the Home Secretary that Leicester was to be subjected to a lockdown, without warning or the involvement of the city council, local police or the NHS. I hope the lesson has been learned that this is completely unacceptable. We should record gratitude to the local MPs, the mayor, the city council, the Leicester police and local community groups for handling the situation with calm confidence, patience and skill. Does the Minister believe it acceptable that a local lockdown that affects hundreds of thousands of people should be announced in a national newspaper and in the national media? Have the Government learned that lesson? If so, what have they learned?

Finally, I ask about the extra costs that come with the lockdown. Can the Minister tell the House whether the Government will meet all these costs and in other areas where there is a spike? The Leicester MPs are saying that, frankly, the Prime Minister has failed businesses in Leicester and put local livelihoods and jobs at risk. I would be grateful if the Minister clarified what support local businesses are receiving. I am sure the Minister will agree that Covid challenges can be terribly difficult to deal with, but it is vital if the Government want to close down a city that they do it with respect and transparency for the local civic community.

Lord Bethell Portrait Lord Bethell - Hansard

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Debate between Lord Bethell and Baroness Thornton
Friday 24th July 2020

(1 month, 3 weeks ago)

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Baroness Thornton Portrait Baroness Thornton - Hansard

I have asked for extra time for the Back-Benchers but it is not in my gift; it is probably not in the Minister’s gift either. However, I hope that the usual channels will take note of that and agree.

I thank the Minister for introducing these SIs. Let me say at the outset how much I agreed with the noble Baroness, Lady Bull, on the issue of disability, as I did with the noble Baroness, Lady Anelay, and my noble friend Lady Andrews on the points that they made.

Leading the news today, and this week, is the legal obligation to wear face masks in shops, takeaways and so on. This morning, the police, the CBI, retailers and many others expressed their astonishment, scepticism and anger that the regulations and rules were laid only yesterday, even though the announcement was made on 14 July. Even more ridiculously, Parliament will not discuss these regulations until September; in the case of your Lordships’ House, because it will go through normal scrutiny, possibly not until late September. Who knows, they may have changed even before we get to talk about them. Does the Minister recognise that delays in laying regulations have significant implications for enforcement, given that they are often unclear on what precisely is and is not permitted, according to the law, until they are in place? This is a confusing U-turn, particularly in relation to the wearing of face masks.

The regulations we are discussing and the issues of concern today are reflected in this debate. However, this is not a debate because, with one minute per Member, the Minister can choose whether he answers the questions in a meaningful way without any further challenge. He can read his prepared script and there is nothing that we in this House can do. The noble Lord, Lord Cormack, is quite correct: this is a travesty of parliamentary scrutiny. I am not saying that this is the responsibility of the Minister because I know that he works very hard. However, it is really unacceptable. This House is not carrying out its duty of scrutiny at the moment.

I have twice written to the Minister asking for answers to questions I asked that have not been answered. They remain unanswered and I put him on notice that I will continue to do that, because these are the issues that we face. It is very disappointing that we are only just considering these regulations. Yet again, we find ourselves in the absurd situation of having one set of regulations that amend another, and which are about to be amended again, given further policy changes that have been announced—and we are about to go into a month’s Recess. The House cannot be in any doubt that the responsibility for this delay lies with the Government, who may have made a deliberate decision to wait until the last possible moment to lay regulations before Parliament, using the affirmative procedure. It is deeply concerning and unsatisfactory to make regulations in this way, and is indicative of this Government’s cavalier attitude to parliamentary scrutiny. Will the Minister inform us when we will find a better way of ensuring that these regulations are debated in a timely fashion?

The Government’s decision to delay making regulations also has real-world implications. Many businesses are unable to open at the earliest opportunity; this includes outdoor swimming pools. Many of them, along with community groups and charities, have been very critical of the Government’s communication on lockdown relaxation measures. They say that the lack of preparation time has made a short summer season unviable. Other businesses began preparations to open, following headlines on government announcements, only to find subsequently that they are unable to offer certain services. I hope that the Minister will apologise to these operators, their staff and the communities they serve for the Government’s shambolic failure to communicate with industry and provide clarity and guidance in a timely fashion.

On Monday, my honourable friend Justin Madders said:

“As I said last Thursday, parliamentary scrutiny is not something that can be ditched because the timing is inconvenient”.—[Official Report, Commons, Second Delegated Legislation Committee, 20/7/20; col. 5.]

He is absolutely right. The Secondary Legislation Scrutiny Committee has also called on the Government to ensure that the information is provided. We are not being given the scientific information we need to back up these regulations. We need full transparency so that we can have confidence that this Government’s scientific advisers support the measures we are debating. A week or so ago, the Government’s Chief Scientific Adviser said that there was “absolutely no reason” to change the Government’s current guidance on working from home; the very next day, the Prime Minister announced that guidance on working from home would be changed. My noble friend Lord Reid referred to this; it is not acceptable.

The Opposition will again not oppose these regulations —of course we will not, as we welcome the opening up of our society and businesses—but we are concerned that we are entering another critical moment without having available the full information on which decisions are being made, without a clear understanding of the risks and with a test and trace system that is not working. My final question to the Minister is: where is R at the moment? Is it going up or down?

Lord Bethell Portrait Lord Bethell - Hansard

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Smoking

Debate between Lord Bethell and Baroness Thornton
Monday 20th July 2020

(2 months ago)

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Lord Bethell Portrait Lord Bethell [V] - Hansard

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

Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

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

Lord Bethell Portrait Lord Bethell [V] - Hansard

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

Covid-19: Personal Protective Equipment

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

(2 months ago)

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Lord Bethell Portrait Lord Bethell [V] - Hansard

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

Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

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

Lord Bethell Portrait Lord Bethell [V] - Hansard

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

Medical Teaching and Learning: Ethnic Diversity

Debate between Lord Bethell and Baroness Thornton
Tuesday 14th July 2020

(2 months ago)

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Baroness Thornton Portrait Baroness Thornton - Hansard

To ask Her Majesty’s Government what steps they are taking to ensure that ethnic diversity is fully reflected in all aspects of medical teaching and learning.

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

My Lords, the Government understand the importance of racial equality and diversity within the NHS and are committed to ensuring that this is reflected in medical training. We think we could do better, which is why the General Medical Council sets standards to ensure that students and doctors in training have the opportunity to understand the needs of patients from diverse social, cultural and ethnic backgrounds. That is why Health Education England provides a learning module on equality, diversity and human rights for all health and social care staff.

Baroness Thornton Portrait Baroness Thornton (Lab) [V] - Hansard

Thank you, my Lords. I thank the Minister for that Answer. We live in a multiracial society; our NHS serves everyone and is staffed by everyone. However, the training of our doctors, nurses and medical technicians appears not to reflect this fact. We do not know whether current clinical language and learning has exacerbated the dangers to patients from a BME background during the pandemic, for example.

I pay tribute to Malone Mukwende, a student at St George’s, University of London, who published Mind the Gap as guidance for healthcare professionals, showing how skin conditions manifest on darker-skinned patients. This is a question of medical training, not a question of options that people might opt in to. We have to integrate these issues into our medical training to ensure that all healthcare professionals are able to recognise, diagnose and treat all our citizens from all ethnic backgrounds. Are the Government going to act on that?

Lord Bethell Portrait Lord Bethell - Hansard

My Lords, I welcome the noble Baroness’s point. She is entirely right that we live in an extremely diverse community, and this has an impact not only on the way people present their disease but on how they could and should be treated. This is why we build diversity awareness into our training and why we will build extra programmes into the People Plan that will be published shortly, and that is why we remain committed to this agenda.

Independent Medicines and Medical Devices Safety Review

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

(2 months, 1 week ago)

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Lord Bethell Portrait Lord Bethell - Hansard

Health records are absolutely key—that is why we have tabled an amendment on them. That amendment enjoys the support of the Government and of me personally.

Baroness Thornton Portrait Baroness Thornton (Lab) [V] - Hansard

I think we can see that we need a longer discussion on this report. It is quite clear that some of its excellent recommendations will require primary legislation and I hope the Minister may have identified them already. We on these Benches are keen to co-operate with the Government and across the House to bring forward the necessary amendments to the Medicines and Medical Devices Bill.

Lord Bethell Portrait Lord Bethell - Hansard

The HSSI Bill is an incredibly important part of our agenda. It is not currently on our schedule, but we hope to bring it back at some date, or incorporate its contents in another vehicle.

Covid-19

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

(2 months, 1 week ago)

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Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

Last Wednesday, the Minister advised noble Lords that the lockdown in Leicester was being carried out under the Public Health (Control of Disease) Act 1984 and that regulations would not be brought to the House. However, on Friday, Leicester regulations were laid. Can the Minister clarify that and explain why there was some confusion and whether this has any practical consequences for implementation and enforcement in Leicester? Will this apply to other cities such as Bradford, Barnsley or Oldham? At Prime Minister’s Questions just now, the Prime Minister stated that the risks associated with asymptomatic transmission were unknown until recently. This is not the case. I am very happy to provide the Minister with SAGE minutes from 4 February, for example, when precisely that was recorded. Can the Minister clarify that statement for the House?

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

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

Social Care

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

(2 months, 1 week ago)

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Lord Bethell Portrait Lord Bethell - Hansard

My Lords, the precise remit of any review will be the choice of those doing the review when it comes, but I entirely endorse the noble Baroness’s sentiments that the social care workforce is worthy of our respect, particularly for its hard work and commitment during the epidemic. Workforce remuneration has improved since the introduction of the national living wage in 2016. Flexible contracts suit many workers, so a blanket commitment to annual wages is not necessarily suitable, but I endorse a focus on solutions that encompass all aspects of the social care industry, including the workforce.

Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

My Lords, following on from what the noble Baroness, Lady Brinton, said, the Minister’s party has form for not honouring cross-party co-operation on this issue. To mitigate that, given that the Prime Minister has said that he is currently finalising plans, perhaps the Minister could commit the Government to setting a firm date and a timetable that could be published before the House rises for the Summer Recess? Does he accept that we need a plan to be delivered within a year?

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness is kind to think that I am in a position to articulate a timetable from the Dispatch Box—that is beyond my abilities. However, she is entirely right to focus on the urgent need to focus on this area. The Prime Minister and the Secretary of State could not have been plainer that when the time is right and we have dealt with the epidemic, social care reform will be uppermost in our mind and will be the focus of our attention.

Independent Residential Care

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

(2 months, 1 week ago)

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Lord Bethell Portrait Lord Bethell [V] - Hansard

The noble Baroness puts her question extremely well, but I am afraid it is beyond my ability to predict as she asks exactly what the shape of the national care provisions will be. What I can say is that the role of agency staff was always, from the very earliest stage, one of the gravest concerns we had. The CMO flagged it very early, and we moved as quickly as we could to tackle the difficult issue of itinerant staff, and to put in place both the funding and the procedures to anticipate problems of infection around staff who move from one home to the next.

Baroness Thornton Portrait Baroness Thornton (Lab) [V] - Hansard

My Lords, I return to the question raised by my noble friend Lady Armstrong and the noble Baroness, Lady Brinton, because, while it is obviously welcome for the Minister to thank those who work in care homes for the sacrifices that they have made, he needs to acknowledge the hurt that the Prime Minister has caused with his words. Will the Minister clarify which procedures care homes are accused of disregarding? Are they procedures related to the Government’s policy of allowing hospital patients to be discharged without testing, to the failure to provide the required PPE or, perhaps, to setting up the testing programme so late?

Lord Bethell Portrait Lord Bethell [V] - Hansard

My Lords, it is not the role of a junior Minister to speak on behalf of the Prime Minister, but I can say that the Prime Minister, the Secretary of State and I are all enormously grateful for the huge amount of work that social care staff have put into this epidemic. I have seen with own eyes the commitment and expertise that they have provided during these very difficult days. We are, as a nation, enormously grateful for their hard work and skill.

Medicinal Cannabis

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

(2 months, 2 weeks ago)

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Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness will not be surprised to learn that I have just spent three and a half months looking at drugs that might make a difference to Covid, only to find that many of them are not helpful and often quite dangerous, so I do not share the optimism bias that many have towards unlicensed drugs. We remain conservative in our approach to clinical trials. I agree with the noble Baroness and others who have suggested that progress on this should be quicker, and I am leaning into the subject to try to bring that about as soon as we can.

Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

My Lords, it is deeply concerning that no new NHS prescriptions for full extract cannabis oil have been issued since the medicinal use of the drug was legalised more than 18 months ago. This leads to a health inequality: 313 private prescriptions for unlicensed cannabis medicine items, including full extract oil, have been issued. Does the Minister share my concern that only wealthy families and those who can successfully raise funds in the region of £2,000 a month have access to cannabis medicines, while children from poorer families who are unable to afford the prescription are going without? What does he think needs to happen next?

Lord Bethell Portrait Lord Bethell - Hansard

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

Covid-19: Mental Health Services

Debate between Lord Bethell and Baroness Thornton
Thursday 2nd July 2020

(2 months, 2 weeks ago)

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Lord Bethell Portrait Lord Bethell [V] - Hansard

My Lords, I am as concerned about the over-prescription of anti-depressants as the noble Earl and would much prefer people to take cognitive therapies than drugs wherever possible. As I mentioned earlier, we have invested in two major rounds of support for community groups to help those struggling with their mental health, and we are reviewing additional funding for those schemes. We will keep a careful eye on the prescription of anti-depressants, which we are all concerned about.

Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

My Lords, health and social care workers battling through the coronavirus pandemic are paying a heavy mental and emotional toll and will continue to do so. Yet the current mental health support available is not adequate. Will the Government commit to appointing a new independent national well-being guardian to co-ordinate and oversee a proper mental health support package for all NHS and care staff?

Lord Bethell Portrait Lord Bethell [V] - Hansard

My Lords, the work on the NHS people plan continues during the epidemic and we look forward to making the first announcement on that shortly, which will cover many of the concerns of the noble Baroness. I also remind the House that, on 15 June, Public Health England unveiled its psychological first-aid training course, developed by PHE, which has proved extremely helpful, as has the confidential helpline that was unveiled on 8 April, which we continue to support.

Covid-19: Mental Health

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

(2 months, 2 weeks ago)

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Lord Bethell Portrait Lord Bethell - Hansard

My Lords, the confidential helpline for the health and well-being of NHS staff was launched on 8 April. That remains in place and has delivered important mental health support for NHS staff. I will take away the noble Baroness’s recommendation to extend it to a wider community.

Baroness Thornton Portrait Baroness Thornton (Lab) [V] - Hansard

I return to the Question asked by my noble friend Lord Bradley. We know that around a third of schools currently do not provide school-based mental health support and that many young people struggling to cope will not meet the criteria of the NHS mental health services in their area. Will the Minister consider the request of Young Minds for the Government to provide ring-fenced funding to ensure that schools can bring in the extra support needed to help their children?

Lord Bethell Portrait Lord Bethell - Hansard

I should be very glad to look at that request and would be grateful if the noble Baroness would forward it to me. The Young Minds movement is very important. I would say that young people, particularly girls, have been a focus of mental health issues. That has come out in the figures and it is a situation that concerns us.

Health Protection (Coronavirus, Restrictions) (England) (Amendment) (No. 3) Regulations 2020

Debate between Lord Bethell and Baroness Thornton
Thursday 25th June 2020

(2 months, 3 weeks ago)

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Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

My Lords, very conveniently, following on from the noble Baroness’s remarks, I will repeat the question that I did not get to put yesterday in the Chamber because other noble Lords and the Minister spoke at length and only six out of 10 questions were taken. I will take 30 seconds; this question is 75 words long. In April and May, a quarter of those who died of coronavirus had dementia, so access to PPE in care settings is vital. Is the Minister aware that the Alzheimer’s Society has learned that families are being charged up to £100 per week extra to cover the cost of PPE? Can he confirm that the newly announced Covid-19 social care task force will investigate the significant and disproportionate impact the pandemic has had on people with dementia? I am happy if he writes to me with the answer to that question and puts it in the Library.

I have a point about a remark made by the noble Baroness, Lady Wheatcroft, about polling, focus groups and the Government. I will check this, but she mentioned that a great deal of polling was going on. I am not surprised to hear that the Government are polling every single day, but she also said that the Government were polling Conservative voters. The Minister will be aware that this is absolutely against the rules, so I put a marker down. I suspect I am not the only person who may have noticed that. It will have to be followed up.

I thank the Minister for introducing the regulations we are discussing. As everyone has said, they address restrictions on businesses and public gatherings and are the third and fourth amendments to the coronavirus restrictions legislation. I particularly thank the House of Lords Secondary Legislation Scrutiny Committee for its rapid scrutiny of the fourth amendments to the legislation and noble Lords for their mostly disciplined contributions, which seemed to cover most points that the Minister will have to answer.

My noble friend Lord Hunt acknowledged that we are again having a theoretical debate and noted the unsatisfactory nature of this process. Indeed, several MPs from all parties said this in the Commons when discussing the third amendments last week. I think they get to discuss the fourth and possibly fifth amendments next week. We find ourselves in the absurd position of debating one set of regulations that have already been replaced alongside another set that are about to be replaced, given that further policy changes have been announced.

We understand why the affirmative procedure has been used when imposing lockdown measures to protect public health, but the justification is less strong when relaxations are being contemplated. If at all possible, such regulations should not be laid at the last minute, as highlighted by the scrutiny committee in its report published this morning. It notes that

“even a short gap between regulations being laid and their coming into effect would better enable those affected to prepare, having seen the law’s actual detailed requirements (rather than just the headline announcement).”

Given that the latest changes are due to come into effect on 4 July, will the Government commit to laying the fifth regulations within the next few days, to ensure that there is more appropriate lead-in time and to enable the JCSI to report and the House to debate the regulations promptly?

We know this is a fast-moving situation, and public awareness of when new changes come into effect is very important, given that failure to comply with the restriction regulations remains a criminal offence. While we welcome the longer lead-in time for the changes coming into effect on 4 July, as business needs time to prepare, I am concerned that many members of the public seem unaware that other relaxations are yet to take effect. What steps are the Government taking to ensure that the public understand the current guidance, as opposed to forthcoming changes splashed across the news?

Does the Minister share my concern that ending the Government’s daily press conferences may have been premature, given that we are in a period of significant change? It has to be said, people less kind than me have said they are very relieved not to see the Hancock half-hour repeated day after day.

It is true that we face uncertain times and many families face unemployment, jeopardy and hardship. I wonder about the Government’s priorities. Could the Minister explain why opening betting shops, theme parks and suchlike seems more urgent than the future of a child from, say, a hard-pressed family who will have missed six months of school and possibly six months of learning and socialising? Those are millions of our children. Other noble Lords have mentioned this.

Why have the Government not put the same imagination and resources that went into, say, the rapid building of the Nightingale hospitals into how to get our children back to school? Why is the money for tutors not being made available for more teachers? Why are we not bringing back retired teachers, for example, like we did with doctors and nurses? We have a different kind of national emergency for our children, but it is none the less an emergency.

Parliament has a role to play in this, and these are not minor or consequential changes that can be nodded through without debate. They affect millions of people’s lives and debating them weeks after the event, as we said, is a bit demeaning to parliamentary democracy. I believe that such changes should always be accompanied by a Statement to Parliament, not showcased in a Downing Street press conference. We are not merely a rubber-stamping exercise to create the veneer of a democratic process. Can we be clear on the reviews? I appreciate why the Secretary of State will be doing things on an ongoing basis, but we need to see the reviews in some documented form so that we can understand the basis on which restrictions are eased and implemented. A progress to normalcy must include a progress to democratic accountability.

Lord Bethell Portrait Lord Bethell - Hansard

My Lords, I would like to say an enormous thanks for a valuable and important debate. Over the coming weeks and months, we will continue to ease the restrictions put on individuals, society and businesses by these regulations as it becomes safe to do so. The amendments debated today play an important role in that gradual return to normal life, as outlined in the Prime Minister’s Statement on Tuesday. I remind noble Lords that the Leader of the House was here earlier holding a debate on that Statement, as she has done when there have been other announcement of a similar nature. I acknowledge the value of giving people warning of these changes, as referenced by the noble Lord, Lord Hunt, and I acknowledge the frustration of the noble Lord, Lord Purvis, and the noble Baroness, Lady Thornton, about the sequencing of these amendments, which I think I addressed in my earlier comments.

I am pleased that, as of 4 July, we will relax additional restrictions in a safe way. This is an exciting step towards a more normal way of life. Nevertheless, this return to normal life requires constant and careful surveillance of the latest epidemiological evidence, making changes only when the facts suggest it is safe to do so. We understand the burden these restrictions have placed on not only individuals but society as a whole, so the Government will maintain only the restrictions that are necessary and proportionate.

To reassure my noble friend Lady Wheatcroft, and in reply to the thought-provoking challenge made by my noble friend Lord Robathan, I say that, whatever the argument of those who are sceptical of the evidence-based approach to science-led policy-making, the Government are determined to be led by the science. We will sometimes be in conflict with public attitude and the headline writers, but that will remain our commitment. On that point, I cannot hide from the House that we remain ready to reimpose stricter measures if it becomes necessary. As the Prime Minister outlined in his Statement on Tuesday, we will not hesitate to apply the brakes if a national-level response is required.

The debate has provided an opportunity for Peers to raise points relating to the whole spectrum of our activity. I remind the noble Baroness, Lady Jones, that on 23 March the French Government declared a widespread state of emergency that granted the executive branch enormous powers. This has not been our approach. I assure her that trial by jury remains a cardinal tenet of the British constitution.

I will take a moment to address some of the issues highlighted by noble Lords. I start by paying tribute to the noble Lord, Lord Campbell-Savours, for his remarkable and determined perseverance on masks and distancing. In part due to the kind of pressure that he has characterised, our advice will change from 4 July to one metre-plus, which is one metre’s distance plus mitigations when people cannot stay two metres apart. These mitigations will depend on the workplace or setting. For example, people must wear a face covering on public transport since it is not always possible to stay two metres apart. Put another way, this is one metre plus a face covering. In other spaces, mitigations could include installing screens, making people face away from each other, putting in handwashing facilities, minimising the amount of time people are together and so on. Having mitigations in place at one metre can be broadly equivalent in reducing transmission to staying two metres apart. We have set out Covid-secure guidance to help businesses take the measures that are right for them.

On face coverings, in reference to my noble friend Lord Blencathra, the noble Baroness, Lady Meacher, and the noble Lord, Lord Campbell-Savours, who I mentioned, I say that passengers have been told they will be required to have face masks when travelling from 15 June. There are some exemptions for health, age or equality reasons. Transport usage has been slowly increasing as restrictions are lifted. Social distancing remains the most important way to keep safe, but on public transport it is not always possible to follow this guidance.

Baroness Thornton Portrait Baroness Thornton - Hansard

Will the Minister give way? I know that it is a strange thing to ask these days. I am using public transport all the time to get to and from your Lordships’ House. I can report that particularly men and young men are not wearing their masks.

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness is entirely right. It is incredibly tough to persuade people to wear their masks. There is a huge cultural gap. That reason and the insights of our behavioural scientists have led us to move relatively slowly, despite the articulate and passionate exhortations we have had on this subject. We are looking at ways to encourage mask wearing, but it is a struggle and not one that we think that we can necessarily rely on.

On non-essential retail, in response to my noble friend Lady Anelay, I say that I have recently met the Association of Medical Research Charities and I acknowledge the pressures faced by good causes supported by charity shops. The Prime Minister announced a timeline for the reopening of non-essential retail businesses on 25 May. I hope very much that that can bring some relief to that important sector.

We completely understand the impact of the lockdown on the hospitality industry and, as the noble Lord, Lord Scriven, alluded to, garden parties. That is why I am pleased that, following the Prime Minister’s announcement, significant parts of the hospitality and tourism industry will reopen from 4 July. However, to make sure that this is done in as safe a way as possible, all hospitality indoors will be limited to table service. Our guidance will encourage minimal staff and customer contact.

The regulations made on 12 June permitted the use of places of worship for individual prayer. Following the Prime Minister’s announcement on Tuesday, this will be relaxed further and places of worship will be permitted to be open more generally. In response to the noble Baroness, Lady Jolly, I say that this will be a welcome change for those who have been unable to use places of worship for their usual religious practice, and I thank those who have made sacrifices.

In response to my noble friend Lord Naseby, I say that here is no avoiding the fact that singing spreads an aerosol of virus-laden moisture into the air. On cricket, in the words of the Prime Minister, it is plain to everyone that the cricket ball is an infectious vector of disease spreading. I assure the noble Lord, Lord Clark, that we will not hesitate, in the face of a local spike, to bring back whatever lockdown measures are required to save lives and protect the NHS.

The noble Baroness, Lady Ritchie, asked about progress on vaccine development. I am delighted that the UK is taking a leading role in this work. Our best chance of defeating the virus is by working together globally. We have put £84 million into accelerating the work of Oxford University and Imperial College. I pay testament to the work of the scientists there. The noble Baroness also asked about social care; we have set out a comprehensive action plan to support the adult social care sector in England throughout the coronavirus outbreak, including ramping up testing, overhauling the way PPE is delivered to care homes and helping minimise the spread of the virus to keep people safe.

In response to the noble Baronesses, Lady Thornton and Lady Brinton, we cannot avoid the costs of PPE. The global price of PPE has risen dramatically. These costs will have to be borne somehow, somewhere. We are working with Treasury and DH colleagues to figure out ways in which they can be borne.

In response to the noble Baroness, Lady Brinton, on shielding, from 6 July those shielding can spend time outdoors in a group of up to six people, including those outside their household. This can be in a public outdoor space or a private garden. Also from 6 July, those shielding will be able to create a support bubble.

I have answers to questions from a number of noble Lords, including on the devolved Administrations, parliamentary scrutiny and local powers. I will not be able to get through all of them in the time remaining. I thank noble Lords for all their contributions and valuable points during this debate. I reassure the noble Lords, Lord Rennard and Lord Liddle, that a lessons learned process will be undertaken when the time is right, but we are not through this yet.

These regulations have been hugely successful in tackling the spread of the virus. While recognising some local limitations, as mentioned by the noble Lord, Lord Goddard, we are enormously grateful to the public for their sacrifices and to the NHS and social care workers for their hard work on the front line.

Coronavirus

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

(2 months, 4 weeks ago)

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Baroness Thornton Portrait Baroness Thornton (Lab) [V] - Hansard

To follow on from the question asked in the previous debate by the noble Baroness, Lady Rawlings, in the last week the Secretary of State, when explaining the failure of the NHSX app, said that the Government are committed to trying and supporting any innovation that might work in this pandemic. That attitude is to be applauded, as long as it is not linked to exaggerated promises—and of course it means that some things will not work. It is therefore puzzling that the Government refuse to partner and adapt the Covid Symptom Study app, which might close the gap on the two-thirds of infections not currently being identified and fit into the existing human contact tracing effort. Some 3.5 million of us take 30 seconds a day to report our health; with government support, that could easily and quickly be 10,000,000. The founders from King’s College and ZOE have written to the Prime Minister today. In the spirit of trying everything to find a solution, will the Minister encourage a positive response to that initiative?

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

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

Nurses: Recruitment

Debate between Lord Bethell and Baroness Thornton
Thursday 18th June 2020

(3 months ago)

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Lord Bethell Portrait Lord Bethell [V] - Hansard

The noble Lord is entirely right that the role of nurses in the healthcare system has been extremely well exemplified by the response to Covid. The £5,000 bursary was agreed in collaboration with, and with the input of, the Royal College of Nursing. There is of course other support that students can already access through the student loans system and the existing learning support fund, and that goes a long way towards paying for childcare, travel and other costs in cases of exceptional hardship.

Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

My Lords, does the Minister agree with the Chief Nurse, Professor Mark Radford, that student nurses who volunteered to be redeployed on the front line during the pandemic are now feeling cast aside due to the uncertainty about their future, with some finding themselves out of a job but still with debts of up to £30,000 from having done a degree? If he does agree, can he say what the Government intend to do about making them feel less abandoned?

Lord Bethell Portrait Lord Bethell [V] - Hansard

The noble Baroness raises a very concerning point. I take the Chief Nurse’s advice and observations at face level. I express my profound thanks to all those nurses who have been redeployed to the front line and have performed an important task but who are now feeling a sense of either anti-climax or uncertainty. I reassure them that there is an enormous number of job opportunities in the NHS, that there is a role for them in the NHS of the future, and that we will be investing massively in the role of nurses in the years ahead, as exemplified by our commitment to recruit.

Covid-19: Mental Health

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

(3 months ago)

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Lord Bethell Portrait Lord Bethell [V] - Hansard

My Lords, the report is extremely helpful and throws a spotlight on an issue that we are deeply concerned about. Immediate help includes a £4.2 million support fund for mental health charities, and a £5 million fund for Mind, specifically to support charities dealing with Covid-related mental health issues. We will continue to invest in mental health in the long term, to support this important area.

Baroness Thornton Portrait Baroness Thornton (Lab) [V] - Hansard

My Lords, four in 10 pupils are not in regular touch with their teachers, there is a sharp educational divide between the rich and the poor, one in eight children and young people already has diagnosable mental health conditions, and the IFS research now reveals that those groups with the poorest mental health pre-crisis will see the largest deterioration. Does the Minister agree that the Government should put the same amount of resource, energy and imagination that they put into the development of the Nightingale hospitals, for example, into getting our children and young people back to school? Will the Minister commit to the YoungMinds five-point plan, which includes additional support for young people’s mental health as we move out of the pandemic, to meet rising demand, including recommitting to the measures outlined in the NHS Long Term Plan, in full, and funding additional early intervention services?

Lord Bethell Portrait Lord Bethell [V] - Hansard

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

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

Debate between Lord Bethell and Baroness Thornton
Monday 15th June 2020

(3 months ago)

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Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

My Lords, I thank the Minister for introducing these Covid-19 regulations and all the speakers this evening. Tonight’s debate is taking place at the wrong time. We are being asked to approve amendments retrospectively for the second time. We will have a third lot in about a week and possibly a fourth at the beginning of July. These are the second amendments. We will take the third amendments on 25 June. If the JCSI manages to get through the fourth set of amendments we might get to take them on 25 June, but it is more likely that it will be at the beginning of July.

The regulations before us were created and signed into law on 13 May and discussed in the Commons on 10 June. As noble Lords have said, it is far too late to make any difference to these regulations. Indeed, they include the closure of zoos and safari parks—a decision that the Government have now reversed.

While Parliament did not hear a Statement about the changes in May, as several noble Lords have remarked, the media did from the Prime Minister. That might not seem like a big deal in the middle of a crisis, but it means that we have seen neither the supporting scientific advice nor the impact assessment. The Government have not laid a document setting out how their five tests on relaxation have been met, and the joint biosecurity centre has not reduced the threat level. The MoD’s chief scientific adviser, Dame Angela McLean, has stated that changes to lockdown as modelled need a highly effective track, trace and isolate system to be in place. This does not fill me with confidence.

In global terms, the UK has experienced one of the highest death rates for Covid-19. While the official total is just over 40,000, ONS data suggest that there were more like 50,000 excess deaths during the crisis period. The mortality rate has been more than twice as high in the most deprived areas of England compared with the wealthiest. The Government have been criticised during the debate over PPE and ventilator procurement, and the timing and implementation of lockdown. Older citizens appear to have been sacrificed in their care homes, with a slow lockdown and lack of testing. Children’s education and mental health are in jeopardy because of the lack of leadership and resources in education. Today, we learned that 1.5 million children might be hungry over the summer because free school meals will not be available.

Meanwhile, the state of the economy is deeply worrying. Indeed, Covid-19 has laid bare the structural inequalities at the core of our democracy. Hidden under the headline figures are huge differences in the death rates among specific groups, as several noble Lords mentioned. An early report by the Intensive Care National Audit & Research Centre found that BAME people, who comprise only 14% of the population, constitute 35% of the fatalities from Covid.

We are all aware that these regulations come during yet another crucial phase in the fight against coronavirus and, of course, we all wish that they were not necessary, but sadly we know that these restrictions are required due to the ongoing and serious threats to public health. However, as the noble Lord, Lord Naseby, said, the original regulations were not debated for many weeks after they were introduced, despite the fact that Parliament was sitting. Debating them weeks after the event, when they have already been superseded, as we have heard, is frankly a bit of an insult to Parliament, and yet further evidence that the Government are not doing things in a timely fashion. There is no excuse for this. Surely we can have a clear timetable.

May I ask the Minister for sight of the reviews? My honourable friend Justin Madders MP asked in a Written Question whether the Secretary of State would publish the reviews carried out on 16 April, 7 May and 28 May. He received this Answer on 9 June, the day before the debate in the Commons, which said:

“The Department of Health and Social Care has indicated that it will not be possible to answer this question within the usual … period.”

This is not accountability. There is a failure to allow Parliament to do its job of scrutiny. Here we have the most far-reaching impositions on the life of this country in peacetime—necessary actions that are not being properly scrutinised by Parliament. Will the Minister commit to putting the reviews in the Library?

I hope that on this occasion, the Minister will not say again how hard everyone is working. We know that he is working incredibly hard. We know that everybody is working incredibly hard, and we would all commend that. Labour has been pretty clear that we want the Government to succeed in tackling this horrible virus. So, I implore the Minister to take these questions about accountability, effectiveness and leadership as not undermining the national effort but as legitimate scrutiny.

Given all of the above concerns, a crisis of this scale will of course warrant a full public inquiry, but that will be complex and take time. In the short term, and as a precursor to that inquiry, perhaps we need a rapid exercise in learning the lessons to ensure that the Government are better prepared for a potential second wave of infection and to understand better how to hold it at bay. Does the Minister agree?

Lord Bethell Portrait Lord Bethell [V] - Hansard

I want to say a profound thank you to noble Lords because this has been an interesting and wide-ranging debate on these important statutory instruments. Despite the unusual sequencing of regulations and debate, I restate the Government’s commitment to working with Parliament in developing the policies that find expression in the legislation we debate in this House.

The amendments we debated today are a cautious step towards returning to normal life. We are beginning to move along the Government’s road map to easing restrictions. We are listening to the scientific evidence and making changes only when we are confident that it is safe to do so. To reassure the noble Lords, Lord Hunt and Lord Scriven, we remain committed to openness and transparency.

Although they do not form part of the specific measures scheduled for debate today, I will address some of the issues highlighted by noble Lords regarding this gradual relaxation. The noble Baronesses, Lady Jolly and Lady Tyler, touched on the crucial issue of social contact. We know that many people are lonely and isolated as a result of lockdown. That is a particularly significant issue for those who live by themselves. We acknowledge that the introduction of support bubbles for single adult households will not help everyone and it will continue to be difficult for those who are not able to benefit from this change. But we cannot risk throwing away the progress that the British public have made. We are focusing today on taking a cautious step to help those who are isolated and living alone, and lone parents who do not have childcare support.

The Government’s recovery strategy has set out an intention to open non-essential retail from 1 June where it is safe to do so and subject to those retailers following Covid-19 secure guidelines. All non-essential retail is now open. To those noble Lords who voiced concern about the economy, this is a significant milestone in our plans to restart the economy. Our non-essential retail task force is considering how the remaining retail environments, such as hair and beauty salons, can reopen safely in line with the phasing ambitions and public health guidance.

The Government completely understand that the impact of the lockdown on the hospitality industry is profound, and I recognise the commercial logic of my noble friend Lord Naseby. But there is no escaping the fact that restaurants and pubs are naturally crowded and require contact between people, which means that they create an infection-rich environment where it is much more difficult to socially distance. That is why we have established a pubs and restaurants task force to consider how these businesses can reopen safely, in line with the road map and scientific advice.

I am grateful to people of all faiths for the patience they have shown during the lockdown, and I am very pleased that we been able to reopen places of worship for individual prayer this week. In response to my noble friend Lady McIntosh, the virus is communicated by the infected person’s airborne droplets, so it is sensible that activities that generate substantial outward breathing, such as singing, should be restricted. However, I reassure my noble friend and the noble Baroness, Lady Uddin, that we hope to be able to reopen places of worship fully when this is supported by the science. I am grateful to the places of worship task force for its continued engagement.

To reassure my noble friend Lord Blencathra, based on the scientific assessment that people generally develop symptoms and cease to be infectious within 14 days, the NHS Test and Trace programme can identify people at risk of infection and, if necessary, advise them to self-isolate. As a result, we can effectively reduce the spread of the virus and maintain transmission at low levels. We have stood up a brand new, large-scale national system at speed and are continuously improving it. We now need everyone to get behind the system, which has the vital function of keeping us all safe.

The noble Baroness, Lady Tyler, was right to focus on social care. The Government have set out a comprehensive action plan to support the adult social care sector in England throughout the coronavirus outbreak, including ramping up testing, overhauling the way PPE is delivered and minimising the spread of the virus, to keep people safe. The social care sector Covid-19 support task force will ensure the delivery of the social care action plan and the care homes intensive support package. This will ensure that concerted and determined action is taken to reduce the risk of transmission of Covid-19 in the sector, for both those who rely on care and support and the social care workforce.

I thank the noble Lord, Lord Campbell-Savours, for his tireless campaigning on the important issue of masks and for his impactful debate last week. The use of masks is particularly relevant for those on public transport. Social distancing remains central to our strategy and is the best way to keep safe. However, on public transport, where it is not possible to follow the guidance consistently, these changes will ensure passengers benefit from the additional protection of face coverings and help keep front-line staff safe. That is why, from today, passengers must wear face coverings when travelling on public transport in England. There are some exceptions for health, age or equality reasons. As my noble friend Lord Blencathra requested, the regulations already do not exempt all disabled people; they just make appropriate provision for those whose disabilities would impact on their ability to wear a face covering. I understand that those who can put on, wear or remove a face covering, including those with disabilities, are required to do so. I remind noble Lords that our regulations have succeeded largely because they are based on consent, rather than mandation. In response to the noble Baroness, Lady Brinton, the Government would like to continue that principle.

The noble Baroness, Lady Finlay of Llandaff, asked about the resilience of our PPE production system. My noble friend Lord Holmes of Richmond and the noble Baroness, Lady Brinton, echoed these concerns. I am pleased to say that we are building up UK manufacturing, with signed contracts to manufacture over 2 billion items of PPE, including face masks, visors, gowns and aprons, through UK-based manufacturers. The noble Lord, Lord Hunt of Kings Heath, raised an important point on borders and quarantine. On 3 June, the Health Protection (Coronavirus, International Travel) (England) Regulations 2020 were introduced. As set out in the Home Secretary’s announcement on 22 May, the regulations introduced measures to gather contact, travel and address information from travellers arriving in England and require international travellers arriving in England to self-isolate for 14 days. The new measures have been in place across the United Kingdom since 8 June. Public health is a devolved matter. The Government are therefore working closely with the devolved Administrations, which have introduced similar provisions, to create a coherent, four-nation approach, for which we are very thankful.

The noble Baronesses, Lady Thornton and Lady Jolly, and my noble friend Lord Naseby speculated as to the effectiveness of the lockdown. I confirm that, between 27 March and 8 June, 15,715 fixed penalty notices were issued by territorial police in England under the new regulations. These are very low volumes when compared with other enforcement data. Over a similar period in a normal year we would expect, on average, nearly 28 times higher. I also confirm to my noble friend that he is entirely correct: this legislation was amended to increase fines, which was designed to deter those who flout the rules. While we allow some more freedom as part of the recovery, we cannot allow that to be jeopardised by a small minority.

The noble Baroness, Lady Brinton, asked an important question about the disproportionate impact on people from BAME backgrounds. I assure her that we are working closely with policing partners to analyse the data. We are clear that nobody should be subject to police enforcement on the basis of race.

I turn now to social distancing, raised by a number of noble Lords including the noble Lords, Lord Hunt and Lord Anderson of Ipswich, my noble friends Lady McIntosh, Lord Holmes and Lord Balfe, and the noble Baroness, Lady Brinton. The Government always prescribe certain things in law and advise others as best practice in guidance. We may not have the laws to enforce the two-metre rule, but we cannot avoid the fact that the scientific assessment is clear: along with handwashing, maintaining robust social distancing is the best way to mitigate the risk of infection. In response to my noble friend Lord Balfe, I say that public support for these common-sense and effective measures remains enormous.

Timing and scrutiny were raised by a number of noble Lords, including eloquently by the noble Lord, Lord Rennard, echoed by the noble Lord, Lord Purvis of Tweed, and the noble Baroness, Lady Thornton. The regulations state that the Secretary of State should revoke restrictions at the earliest opportunity if they are no longer necessary for public health. Parliamentary scrutiny is essential, but we could not justify to the public keeping the restrictions in place for a few extra weeks while we awaited debate. A Statement has been made to this House at the earliest opportunity for each set of amendments, and I assure noble Lords that we will continue with that. In recognition of the importance of transparency in these unprecedented times, SAGE has published the statements and accompanying evidence it has reviewed to demonstrate how the scientific understanding of Covid-19 has evolved.

My noble friend Lady Stroud raised an extremely important issue on abortion. I assure noble Lords that we take issues around abortion extremely seriously. The amendment to the Coronavirus Act included extensive changes allowing nurses and midwives to certify and perform abortions, which went further than the limited coronavirus measures for home use that were eventually introduced. The coronavirus situation was very fast moving. The balance of risks for home use shifted after the debate in a way that made a reconsideration necessary, but the words of the debate were not forgotten.

As we begin to take steps towards normal life, it is vital that all these measures, including the regulations we have debated today, are kept under constant review. In response to the heartfelt and thoughtful points made by the noble Baroness, Lady Jones, and the noble Lord, Lord Scriven, on prior parliamentary authority, I reassure the House that these restrictions have been placed not only on individuals but on society as a whole, and that the Government are maintaining only the restrictions that are necessary and proportionate at any given time. As and when the science supports it, we will introduce further cautious changes in line with the steps outlined in the recovery strategy. As the noble Baroness, Lady Thornton, remarked, this will of course not be the final debate we have on these important matters. The changes to regulations made on 31 May and 12 June will be brought to the House for debate on 25 June.

This is an unusual situation, but I take some comfort from the tone of this debate. While I acknowledge the many serious challenges made to government action, this amendment has not attracted fundamental rebuttal and I think that the rhythm of these amendments, which are moving quickly in response to fast-changing and unpredictable events, has brought a degree of timely scrutiny under difficult circumstances. Therefore I will finish by recording the Government’s continued gratitude to the NHS and care workers, and to all key workers. I am very proud of and grateful to them for their continued hard work and, on behalf of all those in the House, I thank them for the sacrifice which has been so essential in our response to this crisis.

Covid-19: Cancelled Medical Operations

Debate between Lord Bethell and Baroness Thornton
Wednesday 10th June 2020

(3 months, 1 week ago)

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

I should first like to pay tribute to all those who have been involved in setting up the Nightingale hospitals. People have worked extremely hard to deliver a valuable service to the country. Bed allocation arrangements are made by local trusts and testing within the NHS is now intense. Decisions on the traffic of staff between safe zones and non-safe zones are taken by the local director of infection control.

Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

My Lords, it is important that the Minister informs the House about how beds there are in the private sector, how many were occupied, at what cost and whether there will be a renewal. Does the noble Lord share my concern that if there is a second spike of Covid-19, it will lead to further delays in life-saving operations? What contingency arrangements do the Government have in place for this?

Lord Bethell Portrait Lord Bethell [V] - Hansard

The noble Baroness is right to raise this concern. The bigger focus is less on the operational restraints, because the NHS has in fact done extremely well to keep the flow of operations going during this period. It is actually on demand. What we are most deeply concerned about is that patients return to hospitals and that their confidence in undertaking procedures is restored. That is why we have put a huge amount of emphasis on the marketing side of things. That is not to understate the importance of the operational side, but it is patient confidence that is our focus at the moment.

Covid-19: R Rate and Lockdown Measures

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

(3 months, 1 week ago)

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Department of Health and Social Care
Baroness Thornton Portrait Baroness Thornton (Lab) [V] - Hansard

First, will the Minister say what weight the Government attach to the science presented in the figures that the Centre for the Mathematical Modelling of Infectious Diseases at the London School of Hygiene & Tropical Medicine published, which state that R is above one in the south-west and north-west of England? Secondly, the regularly estimated national R rate appears to be a key driver of policy; accurate measurement of R depends on a world-class testing regime, not yet in place; the likelihood is that some geographical areas may have an R close to or above one; and effective local control measures rely on knowing the local R rate. Given all that, when will the system for more accurate measurements of R agreed with the relevant local authorities be available by localities, so that this information can be used to inform and adapt the emerging local planning led by directors of public health?

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

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

National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2020

Debate between Lord Bethell and Baroness Thornton
Monday 8th June 2020

(3 months, 1 week ago)

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Department of Health and Social Care
Baroness Thornton Portrait Baroness Thornton (Lab) [V] - Hansard

My Lords, I thank all noble Lords who have participated in this debate, and my noble friend Lord Hunt for allowing this small but important statutory instrument to receive full scrutiny. There has been intense scrutiny and there are many questions to be addressed by the Minister. I join other noble Lords in paying tribute to those who work in the care sector for their dedication and courage over recent times. I ask for the indulgence of the House to mark national Carers Week and to pay tribute to and recognise the essential role of family carers, who have received precious little attention so far during this pandemic. Support has been desperately hard to access, and many families feel overwhelmed and pushed to breaking point.

Several noble Lords have said that this sector was in crisis before the pandemic and has been cruelly and badly served by the Government from the outset. As the noble Baroness, Lady Barker, mentioned, some of us were waving warning flags about the need to protect this sector from Covid-19 early in the outbreak. We were told that care homes would not be affected. It took a major campaign and pressure—by the media, by my honourable friend Liz Kendall MP, the shadow Minister for Care and Older People, many organisations such as Age UK, local government, MPs from all parties and your Lordships’ House—for the Government to start recognising the terrible toll and neglect in our care homes.

The notion, repeated by the Secretary of State, that a protective ring was put around our care homes is rather insulting, given the number of deaths and the time and chaos involved in providing PPE and testing. The Minister might advise his right honourable friend the Secretary of State to stop using expressions that are patently wrong and that only serve to deepen the anger and sadness of those families who have lost, and continue to lose, relatives in our care homes.

At some point, there will be an examination of the reasons for the mortality among those in care homes, those with dementia, those with learning disabilities and those in our mental health institutions. What we have to work for is seeing that the transparency and honesty of that examination, and of the price paid, will lead to real reform in our care sector.

The statutory instrument that we are discussing concerns the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 and makes provision for, among other things, NHS-funded nursing care. Several noble Lords have explained what all this means. These regulations amend Regulation 20 of the 2012 regulations and increase the rates for NHS-funded nursing care payment by the NHS Commissioning Board or a clinical commissioning group. Like my noble friend Lord Hunt, I welcome the proposed increase in the FNC rate that the NHS pays to care homes to cover the costs of services that must be carried out by a registered nurse. I repeat his question and echo many of the contributions today in asking: what contribution will this upgrade make to the long-term sustainability of the sector? I commend my noble friend Lady Wilcox on her strong support for reform in the sector.

According to a House of Lords Economic Affairs Committee report, as my noble friend Lady Healy said, 1.4 million older people in England had unmet care needs in 2018. The number of older people and working-age adults requiring care is increasing rapidly, while public funding declined in real terms by 13% between 2009 and 2016. When will the Government respond to that report? When will we see a new proposal for a new model of social care, as mentioned by so many noble Lords tonight? Specifically, given that this SI reached us before the pandemic, what plans do the Government have to put this somewhat battered sector on to a more secure footing in the short and long term? What assessment have they made of the impact that increased care costs resulting from the Covid-19 pandemic has had on the care home fees paid by those who are self-funding or partially self-funding?

Last month, the Health Secretary promised that by 6 June, all residents and care home staff would be tested; today, he said that care homes would only have their tests delivered. This is not good enough. The Government have been too slow to act. Care home residents and staff need to be regularly tested if we are to come to grips with this virus. We need to move swiftly to regular testing of family members, too, so that they can safely visit their loved ones. Ministers should now implement a comprehensive strategy for regularly testing more in care homes, including among the under-65s, and give social care services the priority and resources that they deserve. When will they do so?

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

My Lords, as expected, this has been a moving debate. Who could not be moved by the powerful testimony from the noble Lord, Lord Hunt of Kings Heath, in moving his Motion and by the many noble Lords who have given such clear accounts from the front line of our social care? I have stood at this Dispatch Box—this virtual Dispatch Box—and heard the fears of noble Lords that the social care sector is in some way overlooked. I want to reassure noble Lords that this is not the case.

The country was put on hold three months ago to protect the most vulnerable, at huge cost to future generations. The protection of care homes remains an important consideration in the ongoing lockdown. I welcome the appointment today of David Pearson, who will be known to many noble Lords, as the chair of the Covid-19 social care support task force. Finally, in planning the future of our healthcare, we will be informed by the experience of the last five months—a time when the social care system was the focus of our attention and the whole of government got to know the sector much better. I do not hide from the fact that the last few months have been tough. We may not have had the social care meltdown that other countries did, but there have been difficult times. As such, I am sure that noble Lords will join me in expressing our gratitude to the hard-working staff across the social care sector, local authorities, charities and the NHS.

We all recognise that many of the lowest paid, many of them BAME, put themselves in harm’s way to look after the most vulnerable. The noble Lord, Lord Sheikh, and the noble Baronesses, Lady Pinnock, Lady Uddin, Lady Sheehan and Lady Jolly, made these points very well. For this sacrifice the country is enormously grateful. In particular, since this is Carers Week, I give special thanks and appreciation to our nation’s carers. The noble Baroness, Lady Brinton, rightly referred to the 6.5 million people in the UK who, as the noble Baroness, Lady Thornton, rightly reminded us, are looking after a family member or friend who has a disability or a mental or physical illness, or who needs extra help as they grow older. These are heroes as much as others on the front line, and we give our thanks.

It was instructive to hear from the noble Baronesses, Lady Pinnock and Lady Jolly, about their thoughts on the potential risks around EU exit and its impact on the recruitment of social care staff. The social care sector is vital to the UK, and our future immigration system will ensure that we have access to the skills and talents that we need after the UK leaves the EU. We are continuing to support employers in their promotion of the EU settlement scheme. EU nationals have until 30 June 2021 to make an application to the settlement scheme, and I strongly encourage them to do so.

The noble Lord, Lord Hunt, introduced this debate by bringing to our attention the recently laid National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2020, which I will outline for the benefit of the House. The FNC exists so that individuals or local authorities do not pay for nursing care that is the responsibility of the NHS. My right honourable friend the Secretary of State for Health and Social Care set a national rate in legislation, and he considers it annually.

Following many representations, including in this House by the noble Baronesses, Lady Thornton and Lady Jolly, and a formal review, we increased the FNC flat rate for 2019-20 to £180.31 per person per week, an increase of £14.75. The higher rate has been increased to £248.06 per person per week, an increase of £20.29. This is an overall uplift of 9% on the rate previously set for the financial year. This is a substantial raise that adds an additional £62.4 million of funding into the sector per year, and I am grateful for the welcome from the noble Lord, Lord Hunt, and the noble Baronesses, Lady Watkins and Lady Pinnock, for this development.

The Government have also uplifted the 2020-21 FNC rate by a further 2%. The regulations being discussed today therefore amend the rates set out in the standing rules to £183.92 per person per week for the flat payment. They also increase the higher payment to £253.02 per person per week.

The noble Lord, Lord Hunt, raised the important issue of efficiency challenges. I confirm that an efficiency rate has not been built into the uplifted rate for 2019-20, nor for the 2020-21 rate; the rate was designed to reflect the average cost of nursing care.

However, we are not here today just to discuss that important but relatively small part of social care funding. I shall spell out a few basic points. The long-term financial stability of social care is an imperative for this Government. We have already acted to ensure that the social care sector is properly funded through the epidemic, with major rounds of finance announced earlier this year. Looking ahead, I reassure the noble Lord, Lord Hunt, that we are committed to reform. The manifesto made that clear and the Secretary of State has invited cross-party talks to resolve the complex issues faced, which is the right place to start the process. I reassure the noble Baroness, Lady Wilcox, whose thoughtful and moving maiden speech on this subject is well remembered on all Benches, that these will take place at the earliest opportunity, given the current circumstances. In answer to the noble Lord, Lord Hunt, and the noble Baroness, Lady Healy, that is when the Government will begin to bring forward a plan for social care for the longer term.

The Government have acted to ensure that adult social care is properly funded. At the last spending review, we announced that an extra £1.5 billion would be made available to local government for adult and children’s social care in 2020-21. This came on top of maintaining £2.5 billion of existing social care grants.

The noble Baronesses, Lady Tyler and Lady Bennett, and the noble Lords, Lord Sheikh and Lord Mann, asked about the significant extra funding that the Government had provided. I confirm that the Government expect local authorities to get the funding that they have received to the front line quickly. Local authorities should take steps to protect providers’ cash flows, including making payments on plan in advance and monitoring the ongoing costs of care. I assure my noble friend Lady Altmann and the noble Baronesses, Lady Pinnock, Lady Brinton and Lady Sheehan, that the future of funding in social care will be set out in the next spending review.

My noble friend Lady Altmann raised the financial stability of care homes. We recognise that Covid-19 is imposing significant pressures on the social care sector. We have now made £3.2 billion available to local authorities so that they can address pressures on local services caused by the pandemic, including in adult social care. In addition, in April we brought forward planned social care grants worth £850 million to further support adult and children’s social care.

The Covid epidemic targeted the old and vulnerable; it had the social care sector in its sights. The noble Baronesses, Lady Barker, Lady Watkins, Lady Sheehan and Lady Healy, raised the question of the protective shield announced by the Secretary of State. I reassure noble Lords that the care home support package published on 15 May and the £600 million adult social care infection-control fund represent the next phase of our response for care homes, using the latest domestic and international evidence brought together by Public Health England and drawing on the insights of care providers. This includes making 1 million tests available for residents and workers in care homes, providing a named clinical lead for every care home, infection-control training, the PPE portal as a temporary emergency top-up route and ensuring that every local authority is carrying out a daily review of data on its care homes. Our help to care homes has meant that most of England’s care homes have had no outbreak at all.

The measures we have brought in have created a tsunami of regulations and guidance as we address this horrible disease, and we have responded to requests for clarification from the front line. We have introduced dozens of new ways of doing things. The 16,000 care homes, which range from the big to the small and are supported by half a dozen business models, face their own HR challenges.

We have sought to move quickly and thoughtfully to bring rapid support to a disparate and decentralised care system and have brought in new resources, technologies, supply chains and even the Special Air Service. I have no doubt that, from the point of view of a care home director, it has felt like a confusing set of measures. Under difficult circumstances, there may be things that could have been done better, but I assure the Chamber that we could not have moved faster or with more commitment. The strength of our social care system is the local routes and the tailored offering of thousands of different homes—I acknowledge the persuasive arguments of my noble friend Lady Wheatcroft —but this diversity makes it challenging to implement novel solutions at pace from the centre. I thank those in central and local government who did their best under difficult conditions.

There can be no doubt that the nation’s health and social care is a major priority for this Government. This extends from the fair funding of NHS-funded nursing care and social care more broadly to comprehensive support during the pandemic and, in time, an ambitious plan for reform. We will work with all interested parties—I thank Age UK and the National Care Forum for their briefings before this debate—to make it the most secure and effective service it has ever been. I conclude by thanking once again those working in the social care sector and other front-line services in these challenging times.

Covid-19: Obese and Overweight People

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

(3 months, 2 weeks ago)

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

The noble Baroness is entirely right: there is nothing new to the impact of Covid on those with a high BMI; it is entirely consistent with the impact of other diseases. She is also right that one of the nasty aspects of Covid is its long-term effects, which are not fully understood yet. Evidence suggests that these may be extremely damaging, and it is true that the Prime Minister has spoken about the impact of Covid on him. I have had pneumonia; I know the long-term damage of these kinds of diseases on people. We are looking very hard at offering the kind of support that she describes to those who have been hard hit by Covid.

Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

My Lords, as many noble Lords have said, obesity is a significant risk factor in Covid-19. It is critical that we turn the tide on obesity at the earliest opportunity, and this means starting early in life. What steps are the Government taking to implement the measures outlined in chapter 2 of Childhood Obesity: A Plan for Action? Will the Minister commit urgently to restart existing plans to reduce salt, sugar and calories in our everyday foods, extend the soft drinks levy to other sugary and high-calorie foods, limit the advertising of junk food to children and ensure that people are not inundated with promotions for unhealthy food and drink?

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness is entirely right that chapter 2 outlines an extremely thoughtful roadmap for how to address this issue. It is currently being reconsidered. I cannot make the guarantees she asked for from the Dispatch Box, but I can assure her that we are working hard to see how we can use the example of Covid to make progress on this important agenda.

Hospitals: Patient Safety

Debate between Lord Bethell and Baroness Thornton
Thursday 21st May 2020

(4 months ago)

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

My Lords, the NHS chief executive, Sir Simon Stevens, has written to all NHS organisations signalling a change in the phasing of our response to Covid and inviting them to return operations given over to Covid to their previous use wherever possible. I hope very much that this will lower the impact on patients that the noble Baroness described. If she has a specific example in mind, I would be glad to inquire about it.

Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

Is the Minister aware that some NHS trusts are diverting 999 and GP emergency admission calls to hospitals other than the nearest hospital to avoid transmitting Covid between patients? Can he tell the House when that will stop? Do the new guidelines allow the Government to provide finer-resolution data on hospital admissions, which will assist understanding of optimal admission, treatment and resource allocation strategies?

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness speaks about infection control measures regularly undertaken by trusts. Ambulances frequently take patients not to precisely the nearest hospital but to the one best suited to treating the patient. These infection control measures have been extremely effective and will continue for the foreseeable future.

Dental Care

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

(4 months ago)

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

The arrangements for eye care, similarly, are an extremely delicate matter, because the eye is a potential source of infection, and both workers and patients are at risk through work done by opticians. We are extremely keen to get back to normal, but we put the safety and care of patients and staff first.

Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

My question to the Minister is an amalgam of those already asked, and I want to press him on them. Everyone needs dentists to be able to survive this pandemic and to be open to do their job as soon as possible. What financial support might be given to the sector to make that happen? What steps are the Government taking to ensure that there are treatment guidelines and access to PPE?

Lord Bethell Portrait Lord Bethell - Hansard

My Lords, I completely endorse the point made by the noble Baroness, Lady Thornton. I lost a front tooth a few weeks ago and I cannot wait for the dentists to reopen because it is both uncomfortable and embarrassing. We are providing enormous financial support through NHS contracts, which we have honoured 100% through the epidemic whether or not dentists are seeing patients. However, we recognise that there is a problem with the private sector, and we are working with colleagues in the Treasury to try to find a solution.

Mental Health Services

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

(4 months ago)

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Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness is entirely right. I am living with four children who are greatly distressed at losing their friends and not being able to stay in touch in the way they would like. We will undoubtedly need to provide support to schools to cover a list of mental health issues. The Secretary of State for Education is working on plans for that.

Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

My Lords, as a nation, a vast number of us have seen our mental health deteriorate during the coronavirus crisis, so the challenges facing our mental health services are even greater than they were before. Surely we need a strategy to take us through the Covid-19 pandemic that takes account of the most welcome promises in the NHS long-term plan and addresses and scrutinises the impact of the pandemic on mental health and learning disability settings, including the impact of the temporary measures in the emergency legislation. Such a strategy must address how and when the DoLS legislation will be rolled out, and when and how the Government will bring forward reforms arising out of the review of the Mental Health Act. Does the Minister agree that these are the key ingredients of such a strategy? When will we see progress in this area?

Lord Bethell Portrait Lord Bethell - Hansard

The noble Baroness is right: the Covid epidemic will throw a spotlight on our mental health provision. That provision is already benefiting from an extra £2.3 billion a year by 2023-24. We have already brought forward the 24/7 crisis lines that were due to be delivered in 2023-24, and I think there is a good case for bringing forward other parts of our mental health strategy to address mental health issues during the Covid epidemic. Undoubtedly, we will focus very shortly on ways of doing that.

Draft Human Tissue (Permitted Material: Exceptions) (England) Regulations 2020

Debate between Lord Bethell and Baroness Thornton
Monday 18th May 2020

(4 months ago)

Lords Chamber
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Department of Health and Social Care
Baroness Thornton Portrait Baroness Thornton (Lab) - Hansard

My Lords, I draw attention to the register of interests and my position as an NED of a hospital trust. I agree with the very important last point made by the noble Baroness, Lady Barker, about the European Union rules and regulations. It would be a great shame if we lost our ability to access or give organs across Europe because the Government had crashed out.

It is a great pleasure and honour to speak in this debate. Of course there are some Covid-related questions to be asked, as anticipated by the Minister, but I confess that it is a relief to undertake some positive legislative work, which is the everyday business of this House.

I do not wish to appear ungracious at a time of great agreement and celebration about this Act and these regulations. However, listening to the Minister’s opening remarks, one might be forgiven for thinking that this was a government Bill, when it was in fact a Private Member’s Bill, brought forward by two of my honourable friends in the Commons. As the noble Baroness, Lady Barker, said, it is a great example of parliamentarians doing their job over quite a long period of time and bringing forward progressive legislation that people really want. That the Government backed this is of course vital, and I congratulate them and the Minister on doing so.

I thank the Minister for his excellent introduction, my noble friend Lord Hunt for his inspiring and thorough speech, and all noble Lords who participated in this debate. I commend my noble friend for taking the legislation through your Lordships’ House and gaining support across the House, as illustrated by the contributions today, for this important and life-enhancing change.

The Organ Donation (Deemed Consent) Act 2019 amended the Human Tissue Act 2004 to allow consent for organ donation from deceased donors to be deemed in specified circumstances. These new arrangements have been referred to as “deemed consent”, but “opt-out” has generally been used in public communication, including in the press. During the passage of the Bill, noble Lords scrutinised effectively how the very sensitive issues dealt with in it and these regulations might be handled, so we are now finally able to agree the final regulations.

I do not intend to rehearse the many moving stories about organ transplants here today. We all understand how important this change is and, as many noble Lord have said, that its effect will save lives and change lives for the better. However, I take this opportunity to further press the Minister about the low level of transplants during the period of lockdown. Just 99 organ transplants were carried out in the UK in April, which is the lowest number for 36 years.

While we understand the need to delay operations given the demands on NHS capacity, as well as the risk to patients of proceeding with a transplant and being heavily immunosuppressed in a hospital environment, the fall in the number of operations is deeply concerning. It will inevitably lead to a backlog of patients needing organ donations and increased waiting times and mortality rates. The data has also shown that just 206 patients were added to the waiting list in April, down from 524 in March, suggesting a delay in assessment that could leave patients waiting even longer for a new organ. This is especially important given that the Covid-19 pandemic has resulted in further pressures on the supply of organs too. Patients who test positive for coronavirus cannot be donors, while the lockdown measures have resulted in a decline in the number of road and industrial accidents so there are fewer organs available for transplantation.

Can the Minister give the House a timetable for when this situation will improve? What steps are the Government taking to ensure that those who may require a transplant are assessed and, if necessary, added to the transplant waiting list during the pandemic? How quickly will transplant operations be back to the level of before the crisis? If we are unfortunate enough to experience another spike in Covid-19 and have to bring back the lockdown, and have more Covid-19 patients in our hospitals, will the NHS—with the experience gained from the last few months—seek to have hospitals which can continue to undertake transplant surgery in a Covid-free and protected environment?

I find myself completely in agreement with the noble Lord, Lord Naseby, and my noble friend Lord Hunt that communication and promotion of these regulations and the new law is now vital. I close by paying tribute to Geoffrey Robinson, the former MP for Coventry North West, Dan Jarvis MP and my noble friend Lord Hunt, who sponsored the Organ Donation (Deemed Consent) Bill on which these regulations are based. The ambition is a big one: to achieve an 80% consent rate in England, which will add at least 280 extra donors a year. This could lead to as many as 700 more transplants a year, which seems a very worthwhile aim.

Lord Bethell Portrait Lord Bethell - Hansard

My Lords, this has been an excellent and wide-ranging debate. I welcome the moving and constructive contributions. We are committed to restoring transplant services as soon as possible and reaping the benefits of this excellent legislation. The statistics that I presented earlier are a ray of sunshine at a difficult time.

The noble Lord, Lord Hunt of Kings Heath, put it all very well: there are thousands of people up and down the country who are in desperate need of a transplant. While Covid-19 has completely stopped services in some countries, in Britain we have been able to continue with very urgent transplants, which is a testament to the great work of NHS Blood and Transplant and NHS England.

We now want to go further and take something positive from this horrible pandemic, which has been a stark reminder of how fragile life really is. We must take the chance offered by this excellent law to save lives. I thank the noble Lord, Lord Hunt, for his excellent contribution last year, as the noble Baroness, Lady Thornton, rightly reminded us all, in taking the Bill forward in the first place. He has shown remarkable commitment in following up this important cause and I reassure him that we will make sure that resources are in place to make this policy a success.

On marketing, I reassure the noble Lord, Lord Oates, and the noble Baroness, Lady Thornton, that we will pick up the campaign that was delayed at the beginning of the Covid-19 epidemic. We have every hope that it will cut through. As the noble Baroness, Lady Barker, rightly said, this campaign will target BAME audiences, who are often underrepresented among donors and often cannot find the match that they seek. In 2018, my department launched a campaign to address the myths and barriers, and to create a culture of normality around organ donation. This included funding of £140,000 for the community investment scheme for grass-roots projects. We invested a further £280,000 in 2019 and this work will now pick up again. I reassure the noble Lord, Lord Naseby, that, according to a survey by NHS Blood and Transplant, 58% of people are already aware of this change in the law and, with our marketing, this percentage will keep rising.

Noble Lords also raised the important issue of equality for those waiting for a transplant. Our aim is to help with health inequalities and we are aware that people from black and Asian backgrounds wait for six to 11 months longer for an organ match, compared with the general population. This is clearly unjust and we will put in measures to address it.

I reassure the House that discussions with the family will remain our paramount consideration at all times. On that point, I want to assure the noble Baroness, Lady Deech, by repeating the assurances made by my noble friend Lord O’Shaughnessy that, if the family strongly disagrees, no donation will go ahead as no doctor and no nurse will want to upset the family further. My noble and learned friend Lord Mackay, my noble friend Lord Blencathra and the noble Baroness, Lady Randerson, also raised an important point on deemed consent. However, as linked to the above point, from the outset we have said that the family will be involved. If the family is not around, clinicians cannot establish the medical history and other crucial information about the deceased, and the transplant would be risky.

Of course we take deemed consent very seriously. We have based it on the successful implementation in Wales since 2015. To respond to my noble friend Lord Blencathra, the Human Tissue Authority specifically consulted healthcare professionals and that body will be monitoring implementation in its role as the regulator. In addition, we will keep raising awareness of the importance of organ donation.

I reassure the noble Lord, Lord Hunt, that we will ensure that the additional specialist nurses are well trained, carefully managed and thoughtfully recruited so that they are the right people to have these delicate conversations. I reassure my noble friend Lord Blencathra that they are in fact much better suited than senior clinicians who, if I may put the point delicately, might not have the emotional intelligence or delicacy for such a sensitive moment. I reassure the House that I have spoken to the team about how they will continue their training on deemed consent, taking into account, if necessary, videoconferencing technology to hold the necessary conversations in a Covid environment.

My noble friend Lord Bourne of Aberystwyth asked an important question about deemed consent across borders. To be clear: you can deem the consent to remove, store or use the organ only in England under our new law, but once removed that organ can be transplanted to a patient anywhere in the UK.

The noble Baronesses, Lady Barker and Lady Thornton, made important contributions about continuing to secure organ transplants in the context of EU exit. Each year the UK exchanges a small number of organs with EU member states. In 2018-19, the UK received 14 organs from EU countries and there were 3,951 UK transplants. The focus is on negotiating a future relationship with the EU, but my department is also preparing for a scenario where no further agreement is reached with the EU, which is the legal default position. The current regulatory framework for organs is well established and sets high-quality safety standards for organs imported into the UK.

I thank the noble Lord, Lord Goddard of Stockport, for his positive words around this legislation. I reassure him that we want the conditions of deemed consent to be met, which means that transplants can go ahead when it is safe and training for returning specialist nurses has been completed. The legislation will come into effect on 20 May, but we acknowledge that it may not come into practice straight away due to the limitations of Covid.

I was greatly touched by the testimony of my noble and learned friend Lord Mackay, who spoke movingly of his friend’s experience. I remember that on 15 September 2002 my wife called me with a pain in her eye. She had a corneal puncture which threatened the sight in her right eye. Her left eye is very weak from childhood infections. I cannot disguise from noble Lords that that diagnosis was very grim and she was looking at a life without sight. The surgeon, the wonderful Mr Bruce Allan at Moorfields, helped find a cornea for transplant, which is an organ for which many families are reluctant to give consent. As a result, I am glad to say that my wife retains her eyesight today. To that donor and their loved ones, the Bethell family are enormously grateful.

Through the noble Baroness, Lady Randerson, I thank our friends in Wales, as we are in the privileged position of having modelled deemed consent in England and its implementation on its successful implementation in Wales. As the noble Baroness rightly suggested, our specialist nurses here will benefit greatly from their colleagues’ experience in Wales.

I reassure the noble Lord, Lord Oates, that we will make sure that the NHS has the resources to carry out the additional transplants, including using affordable novel technologies as appropriate. Following funding from the department, NHS Blood and Transplant has recruited 27 new specialist nurses, which is an increase of more than 10% in that important role.

The noble Baroness, Lady Deech, the noble Lord, Lord Mann, and my noble and learned friend Lord Mackay of Clashfern raised the important issue of faith. We are aware that organ donation is in some cases against someone’s culture, faith or belief. That is why we have worked closely with a wide range of faith and belief representatives regarding the change in the law. For example, there are pages on the NHS Blood and Transplant website about organ donation in the context of each of the major UK faiths and beliefs. We are grateful to the all those faith and belief groups which have engaged with us. We and NHS Blood and Transplant will also continue our work with faith communities as the law is implemented.

It is right that this legislation is approved to provide legal certainty that deemed consent will apply only to routine transplants which so many people in this country need. I reassure the noble Baroness, Lady Deech, that, after consultation, we have expanded the list of parts of the reproductive system that are to be excluded from deemed consent. We have clarified that no part of the reproductive organs, for example, vessels, will be removed without express consent, even if they were to be used to support a routine transplant. We have also added renal and lung epithelial cells to the list of advanced therapy medicinal produces as they are possible future technologies.

I thank all noble Lords for sharing their views on these regulations. I thank my predecessors, my noble friends Lord O’Shaughnessy and Lady Blackwood, and many others in this House and in the other place, such as Dan Jarvis and Geoffrey Robinson, who have supported this important measure. I join the noble Lord, Lord Hunt, in thanking the many charities which have campaigned for this, such as Kidney Care, the British Heart Foundation, NBTA and Team Margot. The regulations are an integral part of making the new system of consent work and I urge all my fellow parliamentarians to approve them. We owe it to everyone waiting for a transplant to make sure that this law comes into force and makes a difference to those in need.

Covid-19: NHS Contact Tracing App

Debate between Lord Bethell and Baroness Thorn