Care Quality Commission Report

Debate between Lord Bethell and Lord Touhig

Tuesday 15th December 2020 Lords Chamber

[Lord Bethell (Con) [V]]

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

[Lord Touhig (Lab) [V]]

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

[Lord Bethell (Con) [V]]

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

Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) Regulations 2020

Debate between Lord Bethell and Lord Touhig

Thursday 22nd October 2020 Lords Chamber

[Lord Touhig (Lab) [V]]

My Lords, I thank the Minister for introducing this instrument, although I must put on record my concern that we are only now able to debate these regulations, almost four weeks after they came into effect. Moreover, it is simply unacceptable that this instrument came into force a mere seven hours after it was laid on a Sunday evening. Given that it contains significant requirements and penalties for individuals and employers, a lead time would have been reasonable to communicate these changes to the public and encourage compliance.

The Government say that these regulations are necessary precisely because there have been low levels of compliance. A study commissioned by the Government found that just 18% of people who had symptoms went into isolation. Why was this evidence not included in the Explanatory Memorandum? Is it because the Government are embarrassed by their record? The low levels of compliance must be viewed in the context of the failure of the Government’s test and trace system. The most recent weekly statistics show that only two-thirds of people who tested positive were transferred to the contact tracing system. How can we possibly expect people to self-isolate if they are not contacted?

It beggars belief that what was called Britain’s world-beating app, costing tens of millions of pounds, was finally rolled out months later than promised and is unable to operate on phones more than five years old. This world-beating app cannot accept all coronavirus test codes; it struggles to calculate distances and does not require people to self-isolate. Can the Minister explain why the app, a vital tool in the fight to contain coronavirus, is not part of these regulations?

While I understand the data and privacy concerns, the Government appear to have no qualms about sharing information obtained through the contact-tracing programme with the police—a point made by a number of colleagues. The Secondary Legislation Scrutiny Committee pointed out that those informed by the app could avoid being fined for failing to self-isolate if they do not follow up the notification by applying for a test. Who would know? A number of colleagues today have also made that point. Does the Minister accept that excluding app users is ineffective and discriminatory? It is discriminatory because those who do not have access to the app are more likely to be identified by track and trace, and to be fined.

The Government have said that people on low incomes who cannot work from home and have lost income will be eligible for a new £500 test and trace support payment. With around 4 million people in receipt of benefits in England expected to be eligible for this payment, we welcome this support, however belated its introduction was. However, the Health Minister, Helen Whately, said that only 60 people had received a £500 payment as of last week—60 out of a potential 4 million people. How many people have applied and how many are awaiting a decision for this compensation and support? This is important because these regulations require our fellow citizens to act and do the right thing. The effective delivery of financial support where it is needed is therefore vital to ensure that no one is pushed into poverty for doing the right thing.

[Lord Bethell (Con)]

My Lords, I am enormously grateful for a debate that shed a huge amount of light on an issue which acutely illustrates the delicate task that we and a lot of liberal democracies face in fighting Covid: on the one hand, balancing the preservation of life and the difficult public health measures necessary to protect it with, on the other, our liberty and freedoms, the livelihoods we need and the love of family and friends that we enjoy. I believe that these measures do strike the right balance, but this debate has rightly raised important questions about whether we have hit exactly the right point. I will address a few of those.

I reassure all noble Lords that these measures in no way seek to instigate some kind of mass fining or punishment regime. They are about supporting the principle of isolation, to ensure that there is absolute clarity about its meaning and the requirements expected of people, and to give the authorities the powers to enforce these—if absolutely necessary and only in the most extreme circumstances—when they have been most overtly breached.

We recognise that the people who are breaching isolation have not respected a clear and simple public health message in the first place. It is, therefore, not our policy to believe that they would necessarily be motivated by the threat of a fine. Instead, we seek to support people in a number of important ways and to educate them on the importance of isolation. We remain committed to the principle of consent, wherever possible, and we believe in the good nature and good intentions of the British public. That support has been enhanced by a payment of £500. The noble Lord, Lord Touhig, asked about the number of payments. Those payments are being made by local authorities and we are putting in place the measures necessary to count the number being made.

A number of noble Lords asked about the precise nature of isolation: how long should you isolate for; what is isolation; what are the requirements of those who have been asked to isolate? In the last five months, we have taken a large number of genuinely complex measures through the Chamber. This is not one of them. The protocols around isolation are clearly spelled out. If anyone needs to, they can look at GOV.UK/coronavirus or google “Do I need to isolate?” They will see, spelled out in very clear terms, the timing of the isolation, what is required when you isolate and the support you get when you do. I take with a large pinch of salt the suggestion that this is not clear.

What is definitely true is that isolation is a big challenge. For those in casual work, it may have a massive impact on their income. For those with families to support, it hits their ability to look after them. I do not doubt that it is an onerous obligation, but it is a necessary one, because there is no other way of breaking the chain of transmission. If those with the disease travel in our community and share the virus with those they love or pass by, we will never contain it. If people adhere to isolation, the regime of local lockdowns and of hands, face, space, stands a chance of being effective. We believe that it is effective on the great majority of occasions and we applaud the British public for their adherence.

We have sought not to make these measures draconian. There are exemptions for travelling for food and medical emergencies and for other reasons. As I said, there is support from NHS volunteers, statutory sick pay and discretionary payments from local authorities.

A number of noble Lords raised the impact on the elderly, and I hear their concerns loud and clear. It is without doubt that the Covid regime puts a huge emphasis on digital communication, whether that is getting information from websites or the app itself, which is available on 89% of phones. The elderly undoubtedly have a larger proportion of the older phones or have not updated their technology recently. However, the lack of the app does not necessarily mean that you are somehow excluded from the isolation protocols. The 111 telephone facility is enormously helpful and has proved hugely successful. We have given local authorities special support to reach out to the elderly to ensure that they have both the necessary support under isolation and the information to understand the protocols.

A number of noble Lords mentioned the impact on children. The impact on their mental health is enormous, which is why we are supporting local authorities and charities with funds. The noble Baroness, Lady Meacher, asked about testing in schools. I reassure her that we have, today, started a large set of pilots, first in Stoke and then in a number of schools up and down the country, to try to use testing in a much smarter way in order to keep schools open.

The noble Baroness, Lady Altmann, mentioned the pressure on families and the discipline needed in schools. She made her point very well: it is my personal lived experience and I have no doubts about that pressure. However, I cannot avoid the fact that containing this virus does require us to stop the chain of transmission, in children as well as everyone else.

The noble Lord, Lord Adonis, asked a number of pertinent, thoughtful and detailed questions. I will be happy to write to him with answers to some of them. I reassure him that, although the Welsh may have closed secondary schools, it is very much our intention to keep the schools in England open. On inspecting online learning, on 6 October Ofsted published the first of a new series of briefings looking at how schools are managing pupils’ return, including online learning. The Department for Education has made available an initial 250,000 additional laptops and tablets for children who need them. On wi-fi, the department has delivered over 50,000 4G wireless routers to support disadvantaged children in accessing remote education and vital support services.

There were a number of other detailed questions that I will be glad to write to noble Lords about. The noble Lord, Lord Hain, made a number of points, not all of which I completely agree with, but he is absolutely right that there is a balance to strike between speed and quantity. We have massively increased quantity and will continue to do so, but we have a case to answer on the turnaround time of our tests. The noble Lord is right that turnaround time is very important.

In conclusion, the noble Baroness, Lady Jones, set me a challenge about what we can do to “build back better”. Those were not her words but the Prime Minister’s, but they capture rather well her intention regarding the investment needed to address the levelling-up agenda and the damage done by Covid. I am afraid that I do not run the Treasury, so I cannot necessarily meet with her economists.

However, there are a number of resonant themes in the healthcare sector regarding the way in which Covid will actually lead to improvements in our healthcare system if we take the right measures now to capture that progress. I get reports from the front line about an enormous culture of collaboration between different parts of the healthcare system, which is refreshing and impressive. That is exemplified by the sharing of data. Although we have not changed the guidelines or rules on data sharing, we have hugely encouraged it, which has helped with treatment and therapeutics. The renaissance in the diagnostics and pathology professions, and the investment in a large amount of diagnostic kit, is going to have a huge impact on early interventions in disease. The investment and progress we have made in vaccines and therapeutics demonstrates Britain’s leadership role in and the value of science, and illustrates the huge return on the British taxpayer’s investment in science. It is a sign of how we should take things from here.

Covid-19

Debate between Lord Bethell and Lord Touhig

Thursday 23rd April 2020 Lords Chamber

[Lord Bethell]

My noble friend Lady McIntosh is quite right that we should look at several different workstreams for our track and trace model. As the noble Lord, Lord Scriven, implied, one of the most important things to consider is having surge capacity. Track and trace is very important when you have an outbreak or second epidemic. We need to have in place that additional capacity to track down and isolate those who bring in new infection.

[Lord Touhig (Lab)]

My Lords, refugees and people with irregular status who are medically extremely vulnerable are being deterred from seeking treatment because of concerns around immigration enforcement and charging. What steps are the Government taking to ensure that no one in these circumstances is discouraged or prevented from receiving the treatment that they need?

[Lord Bethell]

The noble Lord raises an issue that I remember was raised during discussions on the emergency Coronavirus Bill. It is my understanding that a generous and open-hearted view is taken on the treatment of those with irregular status in the UK. Now is clearly not the time to try to put in prison those who have irregular status. The precise arrangements escape me, but I would be glad to write to the noble Lord with a precise description.