Long Covid

Lord Framlingham Excerpts

Thursday 17th November 2022 Lords Chamber

[Lord Framlingham (Con)]

Will the noble Lord give way, please? Does he agree there is a growing concern about the serious side-effects that the booster vaccinations can have? Does he agree with me that the Government should look at this very carefully?

[Lord Bethell (Con)]

My Lords, the vaccine programme has been an astonishing success, and the uptake of those vaccines has shown the enormous public confidence in them. I will speak on another date about the profound impact this has had on the health of the nation.

My point here is that, at this moment when we are feeling the effects of Covid heavily on our workforce and economy, the finances at the UKHSA and OHID are under huge pressure. The public health infrastructure built over the pandemic has largely been dismantled. At the same time, we have an NHS straining to look after the sick and a workforce many of whom are too sick to work.

It is time that we work towards a new political settlement that prioritises the health of the nation and not just the treatment of the sick; and that we make the operational decision in health and care to move towards prevention.

Vaccinations

Lord Framlingham Excerpts

Wednesday 15th June 2022 Lords Chamber

[Lord Framlingham (Con)]

My Lords, there is wide- spread and growing concern that vaccinations against Covid-19 may be having a damaging effect on our natural immunity, leading to an increase in diseases such as shingles. Is the Minister aware of this? If he is not, perhaps he ought to make himself so. Could we have a government comment on this?

[Lord Kamall (Con)]

I am afraid I am not aware of the details to which my noble friend refers, but I would be happy if he wrote to me. I will then take that back to my department.

Vaccination: Condition of Deployment

Lord Framlingham Excerpts

Thursday 3rd February 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness raises an important point. I am afraid I do not have detailed answers on patients’ concerns about unvaccinated staff. The main reason for revoking VCOD is that the levels of transmissibility are much lower, with a higher number of people being vaccinated, and cases are less severe. I will have to go back to the department and write to the noble Baroness.

[Lord Framlingham (Con)]

My Lords, given all the scientific information now available, will the Minister accept that there is absolutely no justification whatever for the wholesale vaccination of children?

[Lord Kamall (Con)]

The Government continue to review the data, as other countries do. Clearly, we have vaccinated vulnerable children, and there have been moves, particularly with omicron, to look at vaccinating children. We have reduced the age, but we still need more data. Once we have that data, if it is more appropriate, we will vaccinate children, but we have to make sure we have the data because children respond differently.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2021

Lord Framlingham Excerpts

Tuesday 14th December 2021 Lords Chamber

[Lord Cunningham of Felling (Lab)]

My Lords, I declare an interest as a member of the Secondary Legislation Scrutiny Committee. Your Lordships will no doubt be delighted to know that, in January, I shall be leaving it—not by choice but because I have been cycled off.

At the heart of this dispute with the Department of Health and Social Care is the requirement, not option, that any department submitting secondary legislation—principally to this House, since it is almost never discussed at the other end of the Corridor in the House of Commons —should include an impact assessment. This is not an optional extra. It is not a take it or leave it. It is a requirement at the heart of the process. The committee is meeting at the moment—it may have concluded—and it has a Conservative chairman, who is very good. There is no predetermined disposition among its members to seek a confrontation with any government department. However, in this case, the Secretary of State and his department have point-blank refused to carry out an impact assessment. It is a challenge to Parliament and to the parliamentary process. That is what is taking place.

I agree with almost everything that the right reverend Prelate said about enforcing vaccination and I realise that there are some very serious problems to be resolved there. But that is not what the argument is about. It is about whether Parliament—in this case, your Lordships’ House—has the right to require any government department to produce an impact assessment about its proposals for legislation. It is quite a simple matter. It is not onerous in most cases. It is necessary for the committee to consider the impact assessment—along with other aspects of the legislation, of course—before reporting to your Lordships’ House. I did not hear in the Minister’s opening remarks a coherent explanation—and I have never received or seen one—of why that is not possible in this case.

As I said, your Lordships require their colleagues on the committee to analyse secondary legislation. That is our role and, if we do not have an impact assessment, we cannot fulfil it. That is the issue. I agree with what the right reverend Prelate said, but this is not about enforcing vaccination. It is about trying to learn to understand the impact, through an impact assessment, of this proposed secondary legislation. If committees are not allowed to take a stand on this, there is little purpose to them, because this is one of the fundamental issues of secondary legislation. That is our job and our responsibility and it is what we have been trying to do.

[Lord Framlingham (Con)]

My Lords, I had not intended to contribute to this debate, but I will say a few words. First, I am completely against any compulsory vaccination of any kind. It goes completely against all that we should believe in and I am totally opposed to it. Secondly, I recently put down two Written Questions to the Minister’s department: one about people who had been vaccinated and one about people who had tested positive with antibodies. I wanted to know the difference between the two; I wanted to know about protection from the disease and about transmission of the disease. The Answers that I got said, “We’re looking at it, but as far as we can tell at the moment, there is no difference”—it was 84% versus 85%. There is no difference between the protection that the vaccine offers and the protection given by antibodies in the normal course of events. Surely we are not going to vaccinate people who have the antibodies. It is absolutely pointless, particularly if they are thousands of schoolchildren. Can we not test people who have the antibodies and tell them that they do not need to be vaccinated? That seems to be common sense.

[Lord Hunt of Kings Heath (Lab)]

My Lords, it seems that we have come down to debating two specific issues. The first is, of course, the question of mandatory vaccination for healthcare staff and whether we should support it. The second is the way in which the Government have been treating Parliament over not just this issue but the hundreds of statutory instruments that have been brought in relation to Covid, many of them by the Minister’s department.

We are entitled to a full response as to why the impact assessment was published so late. As I said, I am afraid that this is not the first occasion. I have been following the work of Big Brother Watch over the Covid experience. It has set out clearly the hundreds of SIs that have been brought here retrospectively and the impact on parliamentary democracy. We all know that we are in the middle of a crisis and that, of course, the Government have to act quickly—we all understand that. Even so, the one thing that we are entitled to say is, if they are doing that, they should be able to produce the documentation to justify the action that they are taking.

The mandatory vaccination of healthcare staff was not a decision that was suddenly reached in the last few days; it has been trailed for weeks in the consultation. I declare my interest as a member of the GMC board. I am not speaking on its behalf, but the GMC and many other organisations responded to that consultation, so there is no excuse, in this instance, for there not to be a full impact assessment published alongside the SI so that my noble friend Lord Cunningham and his committee can consider it with ample time and we can then enjoy their recommendations to us.

Covid-19 Update

Lord Framlingham Excerpts

Wednesday 10th November 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness makes a very interesting point and an interesting suggestion. I am not quite sure of the details absolutely on those issues—as I said, further guidance will be published. But I promise to write to her, as she so gallantly intimates or hints.

[Lord Framlingham (Con)]

Does the Minister appreciate that quite a lot of people find the idea of compulsory vaccination absolutely intolerable, for all sorts of reasons, however beneficial it may be? This is a serious move for the whole country. Yesterday, in the House of Commons, I believe that the last Secretary of State said that he would not mind the same conditions being applied to flu. Just where does this end?

[Lord Kamall (Con)]

I thank my noble friend for the question. As noble Lords will know, I see myself as a bit of a civil libertarian. Personally, I have asked a number of questions internally about the whole issue of compulsion. It is a very difficult issue, but I understand the arguments on the other side—that we want patients to feel safe and feel that they are looked after by staff who have been vaccinated. Stakeholder analysis and round-tables came out in favour of compulsion on the Covid vaccine and boosters. When it came to flu, interestingly enough, there was a significant disagreement on the practical timing of the flu vaccine supply and the vast majority of doses being available. We have promised to keep it under review, but that is not mandated at this stage.

Healthcare (International Arrangements) Bill

Lord Framlingham Excerpts

2nd reading (Hansard): House of Lords
Tuesday 5th February 2019 Lords Chamber

[Lord Marks of Henley-on-Thames (LD)]

My Lords, I join the noble Lords, Lord O’Shaughnessy and Lord Foulkes, in welcoming the noble Baroness, Lady Blackwood of North Oxford, to the House and to her post. I congratulate her on making an excellent maiden speech. I hope she will forgive me when I admit to spending a great deal of time in her erstwhile constituency and to having campaigned there in the last two general elections—so I may have played a very small part in her elevation to your Lordships’ House.

Although I thoroughly enjoyed the Minister’s speech, particularly the passages about Oxford, she did not—perforce, I accept, as did she—comply with the tradition that maiden speeches ought to be uncontroversial. I oppose the Bill in its present form. I am conscious of the fact that it has passed through the House of Commons unamended and that the report of the Delegated Powers and Regulatory Reform Committee was, unusually, produced on 15 November, before Committee in the other place. Nevertheless, regrettably, the Committee’s report was taken insufficiently seriously by the House of Commons. Sometimes the lack of scrutiny of departures from our constitutional arrangements is frankly unforgivable.

Of course, noble Lords across this House much want to see arrangements for reciprocal healthcare with member states of the EU, the EEA and EFTA continuing as closely as possible to their present form. Indeed, one of the great risks of the calamitous decision to leave the European Union is 27 million UK EHIC card holders, and 180,000-odd UK state pensioners living in the EU who benefit from the S1 scheme, risking the loss of their current rights to reciprocal healthcare.

The Explanatory Memorandum and the Minister say that the Bill has been introduced as a result of the decision to leave the EU and is intended to respond to all possible outcomes of EU exit with new reciprocal healthcare agreements. However, the Bill confers on the Secretary of State exceptional and untrammelled powers that are utterly objectionable. Furthermore, as I will argue, the breadth of these is entirely unnecessary to achieve what is needed to enable satisfactory reciprocal healthcare arrangements to be made on Brexit.

I shall start by turning to the proposed powers. Clause 1 states:

“The Secretary of State may make payments, and arrange for payments to be made, in respect of the cost of healthcare provided outside the United Kingdom”.


There is no limit on the amount of such payments. There is no limit on the type of healthcare to be provided. Indeed, Clause 3 says that,

“‘healthcare’ means all forms of healthcare provided for individuals, whether relating to mental or physical health, and includes related ancillary care”.

There is no geographical limit on where it is to be provided: the power is worldwide. The additional definition of “healthcare agreement” covers providing to other countries healthcare without limit within the UK, and possibly at UK taxpayers’ expense. Clause 2(1) cures none of these deficiencies.

Worse still, Clause 2(2) is entirely unlimited. The regulations may do any of the things provided in subsections (a) to (i), “for example”. So logically they may also do anything else. The Secretary of State may specify, in regulations, levels of payments and their calculation; classes of beneficiaries; types of healthcare to be provided; set-off arrangements; and reimbursement levels, which may include caps. I interpose that this is particularly important because the Secretary of State may decide who pays back what—whether citizens, international organisations, states or the UK Government. The list goes on with processes, appeals, discretion and an unlimited power to boot to delegate any functions under the clause.

Further, the Secretary of State may, in an exercise of absolute power under Clause 2(3),

“give directions to a person”,

and under Clause 2(4),

“may vary or revoke directions”,

in relation to any function. The Bill does further violence to our constitutional arrangements by providing, at Clause 5(3) and (4), that:

“Regulations under section 2 may amend, repeal or revoke primary legislation—(a) for the purpose of conferring functions on the Secretary of State or on any other person (including conferring a discretion);—


or—

“(b) to give effect to a healthcare agreement … Regulations under this Act may amend, repeal or revoke retained EU law”.

These are Henry VIII powers in terms that would have made even that Tudor monarch blush. But we should remember that Henry VIII powers take their name from the Statute of Proclamations 1539, which enabled the King to govern by decree without regard to Parliament. In the context of a process whereby Parliament is supposed to be taking back control, these powers fly in the face of parliamentary sovereignty.

The House will by now be familiar, from speeches by the noble Lord, Lord Foulkes, and others, with the conclusion of the Delegated Powers and Regulatory Reform Committee:

“Clause 2 has a breath-taking scope. Indeed the scope of the regulations could hardly be wider”.


I had the honour of serving on that committee under the distinguished chairmanship of my noble friend Lady Thomas of Winchester. Our discussions were entirely non-partisan and our reports generally—indeed, I think always—unanimous. They were carefully considered. We were extremely well staffed and our recommendations were almost always accepted and implemented by the Government.

The principles we applied were well known and well understood. First, we considered whether a delegation to a Minister was proper and appropriate. Only if it was would we move to the second stage of considering the proposed level of parliamentary scrutiny. Henry VIII powers were to be severely limited to those cases where the need for them was fully explained and justified.

The passage of legislation around Brexit has seen many arguments about the use of Henry VIII powers, but I regret that the Bill persuades me that the Government have learned nothing. As we are forced into an unholy rush to get Bills through, our constitution takes second place to political expedience and face saving. An important passage in the committee report is at paragraph 11:

“All regulations made under clause 2 are subject only to the negative procedure, save where they amend primary legislation. If, without such amendment, as quoted by the noble Lord Lord Foulkes, the Secretary of State wished to fund wholly or entirely the cost of all mental health provision in the state of Arizona, or the cost of all hip replacements in Australia, the regulations would only be subject to the negative procedure. Of course, these examples will not be priorities for any Secretary of State in this country. But we judge powers by how they are capable of being used not by how governments say they propose to use them. The fact that the powers could be used in this way suggests that they are too widely drawn”.


That last reference to the potential use of powers is an important quote from paragraph 20 of the committee’s guidance to departments, published in 2014:

“If the government has in mind a particular proposed exercise, it is helpful for the Committee to be told of this. But the Committee will judge the power by reference to what could be done under it by the current or any future government and not only what the current government say they intend to use the power for”.


That principle is what makes the Government’s Explanatory Memorandum unhelpful and the caution of the committee essential. I am afraid that the Minister’s speech and that of the noble Lord, Lord O’Shaughnessy, failed to grapple with this issue. The Minister seeks to reassure the House while she urges the House to accept the possibility of what is unacceptable. I accept the committee’s view that its examples of Arizona and Australia are extreme. However, we have a Government who are, in their own words,

“determined to make a success of Brexit”,—[Official Report, Commons, 10/7/18; col. 929.]

and resolutely opposed to our staying in a customs union with the EU, so as to be free to make trade deals across the world. May it not be that, in their zeal to reach such trade deals, given the difficulties of so doing, the Government could offer in exchange for trade deals health agreements to third countries on terms that Parliament might consider unsatisfactory were it allowed to consider them properly?

The EU’s new economic partnership agreement with Japan, mentioned earlier by the noble Lord, Lord Henley, demonstrates how difficult new trade deals may be. Nor should we forget either that the ill-fated TTIP attracted so much opposition in the United Kingdom precisely because it opened up our healthcare market to American competition, to the extent that the Conservative Government in 2016—

[Lord Framlingham (Con)]

The noble Lord is putting a most peculiar slant on some aspects of this legislation. I am following this very carefully. Is there not a good case for being perhaps overgenerous and having a wide scope in this area to ensure that nobody misses out, rather than being too precise and risking the chance that people will suffer as a result?

[Lord Marks of Henley-on-Thames]

No, and I regard that view as profoundly dangerous. The reason is that when we need arrangements that justify legislation, we can specify what legislation we need. As I will seek to go on to show, I believe that the arrangements that could be put in place by the Bill, were it tightly drawn and properly amended, could enable all outcomes from our exit from the European Union to be catered for by reciprocal healthcare arrangements in a way that is constitutionally acceptable—as I do not believe this is. As for giving too much ground and being too generous, that is a slippery slope indeed to allowing the Executive to take undue and unacceptable power from Parliament.

I suggest that it is not unrealistic to foresee a Government seeking to enter into healthcare agreements that would be unfair to the UK and unwelcome to many. The Bill would make that possible by unamendable regulation, possibly passable by the negative procedure.

So what should happen? If we secured a withdrawal agreement, an implementation period to the end of December 2020 and any extension of such a period would ensure that we continued reciprocal healthcare arrangements substantially as at present. That is what the Minister wants; I accept that she wants it, and that many in the Government want it as well. But we cannot guarantee that we are going to get it, and the Government have resolutely set their face against ruling out a no-deal agreement.

There is presently no reason whatever to make fresh statutory provision for any extra healthcare agreements outside the EU, the EEA and Switzerland. Such arrangements can be made if relevant, when necessary and authorised by a proper and detailed statute—nothing to do with Brexit—just as they could have been made at any stage over the past few years.

The need now is for provision in the event of no deal. I suggest that in that ruinous event, the only arrangements that we could practically make for continuing reciprocal healthcare would be the same as, or broadly comparable to, the existing arrangements. The noble Lord, Lord O’Shaughnessy, explained that, from his discussion with other European Health Ministers, he regards it as likely that they would want similar arrangements. Similar arrangements might be possible. Something completely different would, I suggest, be entirely impractical.

It might be necessary to agree such arrangements on a bilateral basis with individual states. It might be possible to make such arrangements on a multilateral basis. For such purposes, I accept that legislation is necessary. An appropriate Bill could be drafted without undue difficulty. Indeed, as the Bill is here and has passed through the House of Commons, I accept that amendment of it, while demanding, might be possible. The powers of the Secretary of State to introduce a new scheme and make equivalent agreement arrangements with other member states, whether on a bilateral or multilateral basis, could be carefully drafted in a fashion that was appropriately limited and would command the confidence and respect of this House.

However, I have no hesitation in saying to the House that the Government must come back in Committee with amendments that limit this Bill to that achievable and justifiable purpose. To press ahead with it in its present form for fear of a no-deal Brexit would be unconstitutional and improper. The Government must think again.

Government Vision on Prevention

Lord Framlingham Excerpts

Tuesday 6th November 2018 Lords Chamber

[Lord O’Shaughnessy]

My noble friend is quite right. The campaigns took quite different approaches. One used tax and regulation and the other used destigmatisation and the provision of services, but they were highly successful and I reassure him that the knowledge and learning from those campaigns influence our current prevention strategy.

[Lord Framlingham (Con)]

Given how unhelpful much of the advertising is nowadays, how brave are the Government prepared to be in curtailing it?

[Lord O’Shaughnessy]

We have said that we will clamp down on junk food advertising. Clearly we have cut down on the advertising of alcohol, smoking and many other things over successive Governments. This country has led the way in dealing with this sort of issue, so I am confident that we will have the necessary approach.

NHS Winter Crisis

Lord Framlingham Excerpts

Monday 8th January 2018 Lords Chamber

[Lord O’Shaughnessy]

First, I join the noble Baroness by reiterating on a personal basis a tribute to the staff who have worked so hard over this period. I think we all know many of those people, and they do an extraordinary job. Social care is clearly a really important part of the picture because it is not just the flows into hospitals but the flows out. A lot of that is to do with delayed transfers of care. That is one reason why additional funding has been going in—I think it is £1 billion this year. It is important to point out that all local authorities have now signed up to plans to reduce what are called DToCs, in the jargon. DToCs have been falling, which means that there is the opportunity to get people out of hospital. That could be into a care home or residential care or it could be to their own home.

[Lord Framlingham (Con)]

My Lords, the disastrous white elephant which is HS2 will cost a minimum of £60 billion. The NHS needs £5 billion to balance the books, and a fraction of HS2’s cost would provide finance for the NHS for years to come. I urge the Minister to please urge the Government to scrap HS2 and spend the money saved on sensible projects, with the NHS at the top of the list.

Francis Report: Update and Response

Lord Framlingham Excerpts

Wednesday 11th February 2015 Lords Chamber

[Earl Howe]

The noble Lord, as ever, makes a series of very important points. The personal qualities of these guardians need to be considered very carefully. At this early stage, we have made no firm proposals along those lines. As I have indicated, we think that every NHS organisation needs to identify one member of staff to whom other members of staff can speak if they have concerns, particularly if they feel that they are not being listened to. Clearly, the qualities of that local guardian need to be of a kind that inspires trust in the body of employees. As regards the national whistleblowing guardian, that will be a full-time post within the CQC. Again, it will require somebody of stature, sensitivity and trustworthiness so that the system can be seen to be robust.

[Lord Framlingham (Con)]

My Lords, when I served in the other place, I tried very hard to persuade the then Government to bring back the traditional role of matron into our hospitals. I know that we have modern matrons, but they are not the same thing. It was a most disastrous day when we took matrons away from our hospitals; heaven knows why we did it. If we reintroduced that role, with all its responsibility—and particularly its authority—and an awareness of what goes on the hospital, many of the things that we are talking about today would be resolved.

[Earl Howe]

I am sure that my noble friend’s comments will strike a chord in many places. I am aware that we have had debates of this kind quite often in the past. Of course, it is open to any NHS organisation or hospital to appoint a matron if it so wishes—and indeed some do that. The key point here is that there should be appropriate leadership in nursing at a senior level in the organisation. The successful organisations of which I am aware have had a senior nurse on the board and someone who has taken direct responsibility for nursing standards throughout that organisation.

NHS: Cottage Hospitals

Lord Framlingham Excerpts

Monday 13th October 2014 Lords Chamber

[Lord Framlingham (Con)]

My Lords, I begin by congratulating the noble Lord, Lord Naseby, on obtaining this debate and on his contribution to it, which I found extremely interesting. I agreed with every word that he said. I completely support the principle of mutualisation in our smaller hospitals, believing, as I do, that in medical matters particularly no one understands the needs of an area better than local people and the medical professionals who support and care for them.

I want to say a few words about the functions and funding of smaller hospitals, with particular reference to the possibility of direct public funding for specific projects. Along with others, as the then Member of Parliament for that part of Suffolk, I fought successfully to keep open Hartismere Hospital in Eye and, after its refurbishment, I was given the honour of performing the opening ceremony in 2012. Hartismere now provides a large number of excellent services for which everyone involved is extremely grateful. But this gratitude is tempered, at least in my case, by what it does not provide and what I had expected it would provide. Perhaps the clue was in the change of name. It is no longer called Hartismere Hospital; it has become Hartismere Health and Care.

Hartismere is 45 minutes from the nearest hospital—not from the nearest acute hospital but from any hospital. This was one of the main reasons for keeping it open. Your chances of surviving a stroke in Eye are a fraction of those you would have from within striking distance of Ipswich, Norwich or Bury St Edmunds. A stroke unit is perhaps too much to expect but we do not have even an X-ray unit. How can you possibly have a hospital that cannot X-ray patients? The other big reason for keeping Hartismere was to provide beds. We were assured that beds would be provided to give proper medical care for patients on their way into or out of the other hospitals—what are commonly called step-up and step-down beds. They went when the old hospital was closed. These beds have not appeared, and although beds have been made available in the nearby Paddock House care home, serviced by a community nursing team, it is not the same. It is really not as efficient—with great respect to all those who run the service well—and it is certainly not what was promised. A large care home development is planned for part of the hospital site and it is hard not to wonder whether the medical services provided and the needs of the local people are not coming second to the development plans. I feel sure that mutualisation— the kind of thing that my noble friend Lord Naseby talked about—would prevent this sort of situation arising and ensure that priority was always given to the medical needs of the local people.

I would like to tiptoe very gingerly on to hallowed ground. I say at once that I have absolutely no wish to disturb the current financial arrangements of the NHS. I am talking about extra funding for hospitals such as Hartismere. At the moment, the Hartismere Hospital League of Friends does a splendid job in raising funds but cannot possibly find the amounts needed on a regular basis to make a significant difference. The following are rough figures that I have put together. The two district councils in the catchment area of Hartismere are Mid-Suffolk and South Norfolk. The total number of households in these two areas is 100,000. If every household was happy to contribute as little as, say, £10 a year to Hartismere, that would total £1 million. That might well get the hospital an X-ray unit. It is the principle I am interested in. One pound per week per household would produce £5.2 million. Perhaps the Government could provide matched funding, in which case the prospect becomes quite exciting. To satisfy those contributing to the scheme, there would have to be some very strict rules. The money would have to go directly to the hospital and not come into contact with any NHS funds or management. It would be administered by a small team of mostly medical people and be used for a specific purpose. The households concerned would have to be consulted and give their consent. I feel sure that for the returns that would be received these amounts of money would be forthcoming.

The principle of taking small amounts of money from lots of people for their mutual good is sound and long established. Provided that consent is given and the scheme is soundly and tightly controlled, it could work; and at a time when the NHS is in a perilous state in many ways, this could provide a welcome boost for improved care in our smaller hospitals. I look forward to the Minister’s response.