Health and Care Bill

Lord Desai Excerpts

Lords Hansard - Part 1 & Committee stage
Wednesday 9th February 2022 Lords Chamber

[Lord Winston (Lab)]

My Lords, I am very reluctant to intervene in this long debate, but I have travelled down from Manchester specifically for this group of amendments. I have not been involved with this Bill previously, partly because of my own ill health, and also because of my teaching outside London, but I will make a short intervention here.

My noble friend Lord Hunt has raised the very important issue of the nature of interaction between human beings, which is absolutely essential in considering some of the issues raised by the noble Baroness, Lady Greengross, and others. I am not going to advocate music therapy, dance therapy, exercise therapy or art therapy here, because, speaking as an academic, one of the problems here is that we simply do not understand the truth of the interaction that makes these things work. One of the big problems is that really good randomised controlled trials are still very much lacking.

I am reminded, for example, of a very good randomised controlled trial, by Dr Nair in Australia, of quite a large number of demented people in a care home to whom he played music. From his results, there was no question but that the music, which was extremely tranquil baroque music from sixteen different composers, actually made them more disturbed, more sleepless, more angry, less able to eat their food and more likely to come into conflict with the nursing staff.

So it is very unclear what is actually happening in the brain. During the debate today we have heard claims made about changes in brain structure, but the truth is that we have not done sufficient research to really be clear about this. The research is very expensive, and one of the problems is that it involves very complex things such as time on scanning machines, for example—functional MRI. There is simply not enough research going on into the dementias—whatever they are—to fully understand the nature of what we are talking about.

I am not suggesting that we do not do music therapy but, speaking with my interest as an ex-chairman of the Royal College of Music, I say that we have seen that some of the things we do simply do not work or, if they do, it is not understood how. One of the things with music therapy, for example, is that you see individual patients interacting with somebody else, and it may be that the interaction is more important than the actual music. For example, watching musicians play in person may be better than watching them on a screen or just listening to music. There is a lot of work that needs to be done here before we can make big claims.

These are important amendments that are well made and well put, but we need to be really clear in debating this legislation that, until we understand the mechanisms—the phenotype—of what we are discussing, we have to recognise also that much more money is required for research into the dementias. That is really critical and there is a risk here of making legislation that will not fundamentally change the real problem that we are facing.

[Lord Desai (Non-Afl)]

My Lords, I rise to say that Amendment 297A is obviously very desirable. But, as an economist, I have to say: if we implement this, who will be deprived? GPs’ time is limited and GPs’ numbers are limited, as we all know. Through much of my life in the NHS, all that the GP did for me was prescribe what I needed. It took about five minutes, and the GP did not even have to talk to me; they could look at the computer to find out who I was and what I was doing. It is, quite rightly, only people over 65 who need a caring GP, so we have to devise a system for those who do not need extensive consultation and familiarity with the GP but can be dealt with in a summary fashion. Perhaps we could have junior and senior GPs, so that we could release the senior GPs for this sort of work and have other people for prescriptions and simple tasks.

[Baroness Walmsley (LD)]

My Lords, I was going to speak for two minutes but now I am going to speak for only half a minute. I have one question for the Minister. I know that his department has a small team developing the National Dementia Strategy. Can he can tell us whether any additional capacity is being planned to add to that small team doing this important work? Frankly, without a national strategy, the new ICSs will not be able to measure their performance in their dementia care plans against a national standard. The matter is urgent, because the position of people living with dementia has worsened during the Covid-19 pandemic and, while we are trying to tackle the backlog of treatments for patients with physical health needs, we must not forget those with dementia.

Health and Care Bill

Lord Desai Excerpts

Lords Hansard - Part 1 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, my name is attached to six amendments in this extremely important group. I should like first to turn to Amendment 14 in the name of the noble Baroness, Lady Thornton, to which my name is attached. Other noble Lords have expressed support for amending the triple aim to explicitly include health inequalities, and I add my voice to that call. The examples given by the noble Lord, Lord Patel, and others about the real-life causes and impacts of health inequalities show just how important it is that we strengthen the Bill.

I would like briefly to highlight the specific impact of mental health inequalities, which are pervasive and deeply embedded. As the noble Lord, Lord Crisp, said in our debate on Tuesday, mental illness itself causes inequality. People with severe mental illness live, on average, between 15 and 20 years less than the general population. Black people are more than four times as likely as white people to be detained under the Mental Health Act. There are higher rates of suicide in the LGBT community, yet many in that community do not, or feel that they cannot, seek healthcare because of fear of discrimination. People with a learning disability often suffer with significantly worse physical and mental health than the general population.

The Centre for Mental Health Research has shown that it is often groups of people with the poorest mental health who have the greatest difficulty accessing healthcare that meets their needs and produces good outcomes for them. Unless an ICB is focused on which groups of people have the poorest health in the first place and understands why that is the case, it will, frankly, struggle to reduce the inequalities flowing from that.

Amendment 14 would amend the triple aim duties specifically for NHS England. Amendments 94, 185 and 186 in the name of the noble Lord, Lord Patel, to which I have attached my name, would replicate that explicit inclusion in the triple aim for integrated care boards, NHS trusts and NHS foundation trusts.

As the noble Lord, Lord Young, has said on health inequalities, regarding them as implied in the first element of the triple aim—to consider the impact of decisions on the health and well-being of the population—does not, in my view, get us any further than where we are today. Given the statistics that I have outlined and the fact, as we have heard, that the pandemic has made things a lot worse, we clearly need to go further.

I turn now to Amendment 65, regarding the role of local health systems. It seeks to strengthen the health inequality duty placed on integrated care boards by giving them a requirement to

“implement systems to identify and monitor inequalities in physical and mental health between different groups of people within the population”

of their area. As things stand, the provisions in the Bill will ensure that NHS organisations are required to address inequalities in a similar way to how CCGs currently do it. But we need to see more ambition. The provisions would be strengthened and not merely transferred. The current requirement to “have regard to” is not enough. Local health systems have a central role to play in addressing health inequalities. They are ideally positioned to understand the challenges in their areas and, to use the jargon—for which I apologise —co-produce local solutions with communities. The development of integrated care systems gives us a new opportunity for local areas to take population health and place-based approaches, so that the vulnerable groups who have been referred to do not fall through gaps.

There is a lot about health inequalities that we do not know; we suspect, but we just do not have the data. Amendment 65 proposes that the Bill includes clearer and more direct requirements for integrated care boards to focus efforts on identifying and monitoring those inequalities. Currently, the quantity and quality of data collected is inadequate for it to be fully disaggregated against the different protected characteristics and provide a real insight into the inequalities that exist. That is why I have attached my name to Amendment 61 in the name of my noble friend Lady Walmsley, which I strongly support.

Robust information and data are prerequisites for any action. Improved data collection—both on health services and on wider inequalities in the area—will lead to a far better assessment of what needs to be done, particularly in areas such as public mental health and the local NHS workforce. I will quote one statistic about GPs. A GP working in a practice serving the most deprived patients will, on average, be responsible for the care of almost 10% more patients than a GP serving a more affluent area. This simply cannot be right.

I will end by quoting from work we have already heard about—the work of Professor Sir Michael Marmot. It needs no introduction. He has demonstrated that efforts to address health inequalities will benefit society as a whole. The NHS Long Term Plan states:

“While we cannot treat our way out of inequalities, the NHS can ensure that action to drive down health inequalities is central to everything we do.”


I urge the Government to ensure that the Bill does just that.

[Lord Desai (Non-Afl)]

My Lords, as an NHS patient but not an expert, I will say one small thing about inequalities. Given the way in which the NHS is structured, with no money paid up front and with excess demand and inadequate supplies because of budget shortages, it is forced to allocate treatment by queuing—and queuing, obviously, means that people have to wait.

There is a fallacy that somehow the poor have more time than the rich. In my experience it would improve matters immensely if, when appointments are given, there was less delay in the patient seeing the person whom they are supposed to see. I know that, right now, there are standard regulations that cover these matters, so that people end up waiting three hours. I have done that. But my time is not as valuable as that of someone poorer. You do not measure the value of your time by your income. So it would improve matters if the allocation of services were made using communication devices. This would waste less of patients’ time and help them better access services.

[The Lord Bishop of Carlisle]

My Lords, I will speak on behalf of my noble friend the right reverend Prelate the Bishop of London. She has added her name to Amendment 65, and we on these Benches support the other amendments in this group that seek to reduce health inequalities. As we have heard, these amendments would help to ensure that the Bill does not forget the underserved and disadvantaged in our society, many of whom have been mentioned already.

In the Christian and Jewish faiths, there is a Biblical concept—shalom—which embodies a sense of flourishing, generosity and abundance. Shalom can be summarised as experiencing wholeness, or a state of being without gaps. This is reflected in the World Health Organization’s definition of health, which is about not only the absence of disease but mental, physical and social well-being. It is a vision for individuals and for the whole of society. Our efforts to design a more holistic health service are, in effect, aimed at achieving that sort of shalom. We see this clearly in the decision made to place 42 integrated care systems across the country. What is not yet apparent is the relationship of these systems and boards to the wider community.

This Bill must seek to involve local communities—and not just professionals—in the reduction of health inequalities. These amendments highlight the monitoring of both physical and mental inequalities, take account of the experiences of young people and children and place more emphasis on the strength of local interventions to help reduce and prevent health inequalities. I commend them wholeheartedly to your Lordships’ House and to the Minister.

Health and Care Bill

Lord Desai Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Desai (Non-Afl)]

My Lords, I add my congratulations to everybody else’s on the brilliant maiden speech made by the noble Lord, Lord Stevens. The noble Lord, Lord Patel, described many of his achievements, but he failed to mention that he was a member of the Holloway ward Labour Party many years ago, of which I had the honour to be chairman. I am sure he gained lots of knowledge at that time.

There are some great constants in British political life. One is that we always say that our NHS staff are marvellous, and they are, but we do not meet their wage demands; they have to be underpaid to be marvellous. The NHS is always in crisis, and we all love it. This is the great contradiction of British political life: everybody praises the NHS, Governments never pay NHS staff adequate wages, but we all love it.

I worry that this Government’s ambition, as set by the Chancellor, whom I respect very much, is to be a tax-cutting Government. A tax-cutting Government will never adequately fund the NHS. I also worry that when there is a funding crisis, all Governments reorganise the service, because somebody says, “There’s a lot of waste in the NHS, and we must cut the loss and get more managers”, or, “We want more integration”, and so on. So I somewhat welcome this Bill, but I do not think it will solve anything very much.

The biggest failure of the NHS, if I may say so, has been that health inequalities have not been corrected as much as we hoped when it was established. When the pandemic happened, you did not need a computer to predict who was going to be last in the queue. The postcode lottery always works. Women, the elderly and racial minorities will always be the last in the queue and will suffer. This should not happen in a universal healthcare system. Unless we make that the primary concern of any reform of the health service, we will still be waiting for the next reorganisation, and the next.

This is, I am sure, a very good Bill. Lots of professionals and others who have engaged themselves with the National Health Service will find good things to say or good things to change in it. However, I would like to have seen a 15-year funding plan for the NHS, guaranteed by the Government, which would say: “We cannot do it now but within five or 10 years we assure you that, given the increasing needs of the population for health services due to age and other problems, we will meet those needs adequately and remove inequalities and problems at least by date X.” That is not happening, and I do not think it will happen any time soon.

Let me say one more thing. I am an economist and have to say something about economics. One thing I said many years ago when I was on the shadow Front Bench as spokesperson for health is that, while the NHS is free at the point of service, we have to make people aware that it is not costless. We have to make patients aware that everything they do costs money somewhere in the system. At that time, I wanted to propose a smart card. Each time anybody uses the National Health Service, it tells them how much it costs, not how much money they have to pay. They just tap it and it shows the cost so that people are aware that not going to an appointment costs money and calling an ambulance costs money. If people become aware of how much it costs, we may get a little help from the patients as well as from the service.

Adult Social Care

Lord Desai Excerpts

Thursday 2nd December 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for his question and pay tribute to him as one of the authors of a paper on funding social care, which had a number of interesting ideas. I am also very grateful to noble Lords across the House who have approached me with different ideas, including from the Labour Benches, these Benches and the Cross Benches. The Government have looked at a number of plans and have decided on this, but we are in conversation with the private insurance industry, including the ABI and others, to discuss what financial products it can offer in response to the changes. Some people are quite happy to take out insurance policies, but it depends on individual wealth levels and circumstances, and a number of different matters. We hope that there will be a development of the private market, and we are in conversations with the insurance industry. It has told this and successive Governments that, at the moment, there is no private sector solution for social care insurance. I regret that and wish that there was. My noble friend’s idea of the state underwriting it is interesting, but many reports have been written. I know that the noble Baroness, Lady Walmsley, will writhe in pain at this, but we have drafted that letter. Whatever we do, we will be criticised for it, but we will do this. We have set the vision for the first three years and have set the challenge for all of us to come together to provide the best possible social care for the future.

[Lord Desai (Non-Afl)]

My Lords, I want to reinforce something that the noble Lord, Lord Dubs, said: the distinction between unpaid and paid care workers is very unfair because people who have to care do not have a choice whether to do so—they just do not get paid. The noble Lord mentioned his mother looking after her sister—there is no choice in that matter. Something ought to be done to redefine the category of unpaid social worker, perhaps by making such people part of universal credit so that they will get a statutory payment as of right—because they are relieving the state of some expenditure on care and, of course, performing a very useful social function.

[Lord Kamall (Con)]

The noble Lord makes the very important point that unpaid carers save the state billions of pounds a year with all the work that they do and the love and attention that they give. Sometimes, they do have a choice, but they choose to be carers because they are worried about putting their relative into a home and are not quite sure about that—I understand that. But the fact is that, if they are unpaid, we are looking at how we can support them better. Unpaid carers are very different, and you cannot lump them all into one group: they have different needs and are at different stages of their lives. I emphasise the importance of making sure that we understand how we can personalise that journey for everyone—the cared- for person and the carer. But, if you have given up work, a range of other benefits may be available, and we want to make sure that unpaid carers are equally valued and not penalised for looking after a loved one.

Social Care

Lord Desai Excerpts

Thursday 28th October 2021 Grand Committee

[Lord Desai (Non-Afl)]

My Lords, this is a very simple problem but the solution is very difficult. For a long time, economists have talked about what is called the life-cycle hypothesis—how families or individuals rearrange their consumption pattern over a lifetime by transferring some of the future income to the present, as we do in the student loan system and when we buy a house through a mortgage. Mortgages are interesting; all Chancellors stand up and say, “The debt-to-GDP ratio is really very high. Every family that starts with one of at least 300% will have a mortgage.” Everybody knows how to do that.

Our problem is that people do not know how to do the backward transfer. People do not know how to transfer the present value to the future. That is a matter of incentives. Ultimately, there have to be incentives. Building societies evaluate you and give you the money and you pay it off. I spoke on this when we were discussing the extra tax for social care. By and large, the better-off middle classes have a house. The house is congealed capital gains. The question is how you melt that capital gain to make it available without melting it so much that it flows away. I was at that time proposing some form of council tax, which I will not repeat now.

Interestingly, families have assets which they do not want to sell and realise because they want to pass them on. That is one incentive. We have to give them some sort of scheme whereby they would say, “I want to pass on the money that I have to my children, but I don’t want to pass all of it on. I will split it.” How can we give families an incentive to split? Whenever I get up, I propose a new tax, so I will do that. We treat asset transfers to children very lightly; we do not tax them. If we were to say that passing your house to your children would be fine but we would tax it at 40%, which is the higher rate of income tax, or even 20%, the family would ask itself whether it would be better not to preserve the house but to sell it beforehand and split the equity between the family.

I am always autobiographical, so I will say that I am about move to downsize. I have a house in Camberwell that I am about to sell and I shall move to County Hall, which will be easy for inviting all my friends to come to have a drink at my place. That will release cash for me to keep, which is not taxed under current regulations. That is all right; I can do whatever I like. But if, for example, I were to stay in my house and then transfer it, it would not release cash in my lifetime but it would release cash to my children. If the Government said, “That’s fine, but if your children get it you will pay 20% tax”, I would be more encouraged to downsize while living than to wait until I die for my children to get it. This is a very simple thing. We have to give some kind of incentive or disincentive for people to unfreeze their frozen capital gains. If you look at the wealth distribution, that is the largest amount of wealth people have. It is a matter of ingenuity by people who think about taxation.

My noble friend Lord Lipsey, whom I thank for obtaining this debate, spoke about equity release. If you watch television on Saturday and Sunday afternoons, there are adverts for equity release, funeral insurance and that sort of stuff, so there is a market, but I do not think it is a very efficient market. We have to see why that is. What incentives can we give for the market to be more lively? Is there anything we can give to the sellers so that they come up with interesting products? Right now, all they are talking about is how you can be healthy and enjoy the money while you exist and run around in gardens.

A house is a frozen sum of money. How can you melt it, share it with your children and pay for your care? Everybody should be told about this: you are going to need care and you had therefore better provide for it. This is a harsh thing to say, but the existence of the NHS has discouraged saving. We have begun to believe that we do not need to do anything about our health, because it is taken care of. We do not realise that social care is not included in what the NHS does. We can either merge the two and provide them with more money or clearly separate them and tell people that it is not possible to have social care in hospital. It is a different kind of problem.

This is not strictly to do with assets, but about the running costs of social care. It is a slightly tricky business, but many people are cared for by their own family. This is done on a voluntary basis, usually by women. Women end up looking after their husbands, often because they live beyond them anyway, and they do it unpaid. It is extremely hard work, although they may be able to hire people in. Is there any way in which we can create a social dividend income, so that people taking care of an elderly person, even if they are a relative, would get something? It could be like a universal credit or pension payment, but it would be some sort of sustainable payment. We know that carers for the disabled and so on have problems taking holidays and things like that. We know that this happens so, if somebody, whether a man or a woman, can show that they are taking care of their relative, they would get some compensation for doing it and saving the state money. It is basically giving them the money the state saves.

Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)

Lord Desai Excerpts

Wednesday 20th October 2021 Grand Committee

[Lord Desai (Non-Afl)]

My Lords, this is a very good report, as many noble Lords have said. There is not much I can say in any kind of expert way, so I will follow the model of the noble Lords, Lord Davies and Lord Winston. The noble Lord, Lord Davies, talked about the report from his own professional side, while the noble Lord, Lord Winston, told a lovely personal story. I will do those two things because it will be more helpful.

First, as an economist, I was involved in measuring human welfare. Twenty years ago, I was involved in inventing the concept of human development. At that time, life expectancy was popular among economists. However, I discovered that it is not a good measure of what we really want to measure because, once a country has taken care of infant mortality and under-five mortality, life expectancy rises. After that, it slows down and does not actually indicate anything much except that the death rate in older people also slows down slightly.

I always say that if I move from a country with a lower life expectancy to one with a higher life expectancy my health does not improve. How is my health condition to be measured? I think the report has an angle on that which is: how many years do I have left to live? I thought I had invented a new concept about potential lifetime. What is the potential lifetime of any person? Your age-dependent life expectancy minus your age is how many years you have left to live. One of the things we ought to look at is whether that measure should be more easily available as an indicator.

On a personal level, what is my condition? I may be 50, but my multimorbidities make my potential lifetime shorter. The idea of healthy years of life left has less utility as a group measure than if you could measure it individually, as I am sure we can. We need better measures of what we are trying to measure—not so much ageing, but healthy living as you get older and how many years of that you have to deal with.

About six months ago all my underlying conditions, as they are called, flared up and I became an ageing person, as it were. At least two hospitals are currently looking after me. One is King’s College Hospital near where I live and another is the Tessa Jowell. I am very well looked after.

What is very interesting about my experience—and I think it was partly inactivity during the pandemic that finally got me—is that, until then, my overworked GPs were not able to tell me what was happening with me. When I went to the GP, which I did not do very often as I knew how burdened they were, my GP had no time. It is a group practice and no GP had, until now, ever introduced themselves to me or asked my name—but they know my name. They have five minutes, if that. They stare at the computer and look at what medicines I get and give me some medicine. No GP ever told me what the medicine does for me. It is just “take this”. It is one of those things that happens. They know what they are doing and I presume that, as they know, I do not need to ask. It would only waste their time.

The report says something about how care is episodic. As a patient, I would like to have an assurance that somewhere is a portfolio of all my conditions from the first time I saw a GP until now, which the GP can access. If that was the case, then at some stage somebody would tell me why I have got to where I have, what I have done wrong and what I could do further. It is not that they cannot do it; they just do not have the time. We are living with an extremely underfunded National Health Service and, while it is doing marvellous work without a doubt, there are limits to what a human being can do in a day.

It is an unfair contrast but, when I grew in India—no doubt we were paying for the GP and were slightly better off—my mother would go to the GP and say: “Now listen, this boy has got such and such. Last time you gave such and such medicine. Can you give something else?” The GP would then have a nice, long chat. Obviously, I was lucky. I was richer, but my family was not very rich, believe me.

When my multimorbidities caught up with me again, I was in India, and I had an amazingly detailed explanation of what was happening to me and why, and which morbidities were interacting with each other. It is not possible to get that sort of thing. Can we somehow make lives easier and give GPs the technical apparatus so that they can quickly see how to improve the care of an individual patient, especially elderly patients who have more complications?

We also know that these conditions are exacerbated by income inequalities, where you live and so on. This happens all the time. Whenever there is a crisis, I could tell you who would suffer most—the elderly, women, ethnic minorities and others in a postcode lottery. In the 2008 financial crisis, the same people suffered, because of the economic conditions. All I can hope is that we improve the support that clinical people have to take care of us as well as possible.

We should also do something about inequalities. Last week, in your Lordships’ Chamber, we had a lot of discussions about the cut in universal credit, pension problems and so on. As the Government are levelling up, they should try to reduce inequality as much as possible.

Covid-19: One Year Report

Lord Desai Excerpts

Thursday 25th March 2021 Lords Chamber

[Lord Desai (Non-Afl)]

My Lords, it is a pleasure to follow the noble Baroness. I think the Prime Minister is quite right: greed is good, and capitalism works. I disagree with most people who say that the Government have made mistakes and that things have gone wrong. This is precisely how it is meant to work. This is how 18 years of Thatcher government worked. The noble Lord, Lord Oates, had a marvellous time in the coalition, but I remind him that, in the coalition, when we were all supposed to be in it together, the way to cut budgets was to cut corporation tax, because that was important. Of course, you also had to cut welfare spending, but that is not unusual.

In this system, which works, the few gain and the many suffer. That is what we have been living under for a long time and it is not going away. People say that the pandemic changed everything and brought us all together. It did not. Ultimately, NHS nurses ended up working overtime and now are being told that they will not be paid any more. That is the way the world works. Why are we surprised?

Basically, the sequence of a late lockdown and an early end to the first lockdown is simply explained: some people in the Government, especially the Back-Benchers, were impatient to go to the pub, which is every Englishman’s right. The Chancellor wanted the economy to resume, so there he was carrying a tray of beer or whatever it was, with his mask on. He just could not wait. The lockdown had to be ended early, because there were profits to be made by people. How could we stop it? Very reluctantly, the Prime Minister reimposed the lockdown. We know how eager he is to lift it, because he cares for liberty. It is basically so that a few are free to go to restaurants or their foreign homes. Who is going to tell Stanley not to go?

We should not have been surprised at all. In every crisis, the poor suffer. There may be no restaurants open, but the food banks have to open, because people cannot go anywhere else except food banks. Black and ethnic minorities invariably suffer. The postcode lottery always works against us. Women suffer, especially elderly women. Children suffer. We know all this. It takes Marcus Rashford to tell the Prime Minister that, if you do not have free lunches available in the holidays, children will starve—in the fourth-richest country in the world. We know all this; none of it is rocket science, but it is precisely how the system works. It is not too much to say that there is not much hope.

When identity cards were going to be introduced, as my noble friend Lord Brooke said, the objection of the coalition Government was about privacy. I remember that the Deputy Prime Minister was a champion of privacy. I am very glad that he needed a huge bribe to give up his principles and join Facebook. I admire that; it is how capitalism works. It is quite impressive.

We economists, naive as we are, believe in learning by doing. Here, we know that there is no learning by doing. We are going to make the same mistakes again and again because we sort of half trust science but we trust the profit motive more. Lives and livelihoods may be important but not everybody’s livelihood is that important.

I want to add one more thing. Everybody wants an inquiry—fantastic. I want a long inquiry. They are all long; who remembers Chilcot? It will take ages. Can I please be a member of that inquiry? I too want five years in the QEII Centre, then I will produce a fantastic, 22-volume report, guaranteed to answer all the questions —by which time, I hope, there will be another Government.

Covid-19: Transparency and Accuracy of Statistics

Lord Desai Excerpts

Monday 9th November 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, we are grateful to the Office for Statistics Regulation for its challenge; its points were perfectly reasonable and we take them on board completely. However, I reject the characterisation made by my noble friend and his suggestion that the modelling is either political or erroneous in some way. I remind him that, in January, the modelling showed that the epidemic in China was considerably larger than anything reported at the time. In February and March, we used data from the “Diamond Princess” and elsewhere to show how the threat of Covid was much larger than had previously been understood. In March, we showed that the epidemic in the UK was doubling every three to four days, allowing us to make the difficult decision to lock down. Throughout the spring, the modelling demonstrated that half the UK had not been infected, as previously thought.

In mid-September, the modelling showed that we were at the start of a second wave, despite those who said that there was no evidence of it. It also showed that the uptick in cases involving younger people would spread to older adults and, as a result, into healthcare. Most recently, the six-week projections of SPI-M that were produced throughout October, based on contemporary trends, have been remarkably accurate at assessing the trajectory of hospital admissions and deaths.

[Lord Desai (Lab) [V]]

My Lords, the fact is that the public have lost trust in scientists and science. They lost trust in government long ago. Is it not time for the Government to ask the Royal Society to carry out a thorough check and review of every statistic released by SAGE or any other government adviser so that we can be sure that the statistics are presented properly, are sound and are not exaggerated so as to mislead the public?

Health Protection (Coronavirus) (Restrictions) (England) (No. 4) Regulations 2020

Lord Desai Excerpts

Wednesday 4th November 2020 Lords Chamber

[Lord Desai (Lab)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Altmann, who is an economist and a friend from the LSE. In the 30 years I have been in your Lordships’ House, I have never had the luxury of six regret amendments from the Government Benches themselves—so we can have the luxury of supporting the Government for a while. Let them quarrel among themselves.

As an economist, I used to be very humble in the face of natural scientists. I used to think that their models were solidly based on theory, experiment and science, and that we economists were just doing things and quarrelling with each other. I have to admit that I was in the econometric modelling business—my God—60 years ago and did the first computer simulation of an econometric model for my PhD. But let us leave all that behind.

I am embarrassed that what we call science has made a complete fool of itself in front of all of us. Epidemiologists, virologists and people who claim to have done several computer simulation models have not come to a single agreement. They have not got a model of what causes the infection or how it spreads. They have not given us any solid clue as to the rate at which the infection spreads—the R number. Is that number valid for a whole nation or only for a locality? What is the technical basis of the R number? How can we have a national lockdown with the goal of reducing the R number to below 1 across the nation, with no errors? Is this serious science? Do the Government have any critical ability they can borrow from somewhere else to judge what they are hitching us to do for the next month, if nothing better turns up?

I will make two points I have raised before. Is our aim to reduce the rate of infection or the rate of mortality? There is a difference. Look at America, where everybody says that Trump made a mess and there are a lot of infections. The rate of mortality as a proportion of infection is the same in America as here. The economic outcome in America for the third quarter of this year is a plus 33% growth in GDP: a real bounce-back from the recession—a genuinely V-shaped recession—while we are floundering around. As the noble Lord, Lord Forsyth, who is very knowledgeable on this matter, pointed out—

[Baroness Penn (Con)]

My Lords, there are many more speakers.

[Lord Desai (Lab)]

I will now sit down, under protest.

Covid-19: Test Results

Lord Desai Excerpts

Tuesday 27th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am distressed to hear the anecdote that the noble Lord has just shared with us. We embrace the support and help of anyone who steps forward, particularly someone such as Mr Wilson, who clearly has an enormous amount of expertise. I would be delighted if he would write to me personally and I would be very prepared to meet him. I would also like give massive thanks to all those from all the relevant logistical, pathology, military and medical sciences who have formed an organisation practically the size of Tesco, which is what the national diagnostic system now looks like. It is only with the support of British industry, universities and business that we have been able to build this up and we are enormously grateful for that support.

[Lord Desai (Lab) [V]]

My Lords, we have had continuous failure of test and trace since March. Again and again, we are missing the targets. Why? Is it the equipment, the personnel or the management structure that is causing this failure of our efforts?

[Lord Bethell (Con)]

I am not sure that I can answer the false premise. Actually, test and trace has enormous achievements—the isolation of 1 million people who would potentially have spread the disease is the most glaringly obvious—but we are here to talk about turnaround times and there, I completely accept that the current performance is not where it should be. I have sought to explain the reasons for that, and the enormous increase in capacity in the last 60 days. I have also sought to explain the measures we are putting in place to mitigate that. I am confident that those measures will be successful, and I am happy to report back to the House on them