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

Lord Harris of Haringey Excerpts

Friday 24th July 2020 Lords Chamber

[Lord Harris of Haringey (Lab)]

My Lords, for us to move safely from lockdown, there must be effective testing, tracking and tracing. We are told today that the Government are abandoning self-testing administered by those who cannot attend a test centre. Such tests require the subject to insert a swab up the nose and into the back of the throat, obtain a suitable sample and return it by post for analysis. In an earlier debate, I pointed out that this requires a degree of precision and dexterity that not all of us will have, and means overcoming the natural reaction of the body if something is inserted up the nose or put to the back of the throat.

I submitted a topical Question on 14 May on this. It should have been answered a week later; it has still not been answered 10 weeks on. So I ask the Minister again, what proportion of the tests sent out were returned within three days and were returned but unusable, and what is the Government’s estimate of the proportion of false negatives? Will the Minister agree that self-testing, like the track and trace app, is another expensive but predictable failure?

Independent Medicines and Medical Devices Safety Review

Lord Harris of Haringey Excerpts

Wednesday 15th July 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is right about culture change, but we are aware that having a big, clunking fist of financial threat hanging over individuals who are considering the admission of mistakes is not the right combination to create a culture of self-awareness and acknowledgement. We have to move extremely delicately to encourage people and make them feel safe enough to acknowledge the mistakes that might have happened and to embrace the kind of dialogue with patients that is necessary to deal with these results. That delicate balance is one of the most important things to get right in our reaction to this report.

[Lord Harris of Haringey (Lab) [V]]

We have heard some of this before. Thirty-four years ago, I submitted to the then Secretary of State—now our Lord Speaker—a patients’ charter prepared by the association of CHCs, which talked about listening to patients, putting them at the centre of every decision, and having a proper system of redress. Since then, every White Paper published by every successive Secretary of State has paid lip service to those principles, as the Minister has today. But the noble Baroness, Lady Cumberlege, has shown how shallow the commitment has been. The Minister talked about a patchwork quilt of safety mechanisms; can he convince us that this time it will be different? When will the Government say not only that they accept her recommendations in full, but what robust arrangements there will be to make sure that action and culture change actually follow?

[Lord Bethell]

Let me reassure the noble Lord that this report is taken seriously. But I acknowledge the fact that some of these issues are extremely complex, and when dealing with issues such as sexism, bullying, racism and a failure to engage with patients, there are not single-shot solutions like patients’ charters that will somehow transform the ecosphere. We have to look at it in the round, and that is why there will be major interventions like the HSIB, the people plan and the focus on fairness in the workplace that will ultimately make a big difference.

Coronavirus

Lord Harris of Haringey Excerpts

Monday 22nd June 2020 Lords Chamber

[Lord Bethell]

My Lords, the progress on testing in social care is dramatic. The rollout of testing to all care homes is complete, and tests have been offered to all those who are symptomatic. The focus is very much on staff who travel between more than one home, and asymptomatic testing. As for the economy, all those who show symptoms can have a test, but we are talking to business about how businesses can also contribute to their own testing regimes, and we look forward to developing those plans.

[Lord Harris of Haringey (Lab) [V]]

My Lords, knowing who has and who has not had the virus is clearly essential in knowing who should be isolating themselves. The Minister has failed to answer my questions on what proportion of the self-testing kits are being returned, and on the estimated number of false negatives as a result of people not swabbing themselves properly or because of inherent weaknesses in the test itself. However, at the moment, NHS staff are being given antibody tests and many who have palpably had the virus and been exposed to it are showing as negative. What is the department’s working estimate of what proportion of false negatives there will be in those antibody tests?

[Lord Bethell]

My Lords, the noble Lord makes an important point. How it is that some people have palpably had the virus, as he rightly says, but do not show a positive antibody test, is a mystery that we do not fully understand. It seems that the tighter—more minimal—the amount of antibody left in the bloodstream, the less likely it is to register in the test. We are undertaking a massive antibody testing programme through the health service to understand this phenomenon more closely, and we look forward to publishing those results as a priority.

Covid-19: Masks

Lord Harris of Haringey Excerpts

Thursday 11th June 2020 Lords Chamber

[Lord Harris of Haringey (Lab) [V]]

I am grateful to my noble friend for giving us this opportunity to discuss another government U-turn. Originally, masks were not recommended: we were told that they were counterproductive, ineffective and would produce a false sense of security. What has changed and why? Is it advice from SAGE, Dominic Cummings or a focus group?

I have four questions for the Minister. First, will sufficient masks be available for those who are now required to use them? Secondly, what measures are there to make sure that the masks available to the public are of an appropriate quality? Thirdly, will there be a kitemark so that the public know whether what they are buying is of good quality? Finally, what are the Government doing to prevent retailers hiking up prices and making excessive profits on the masks they sell?

Covid-19: Personal Protective Equipment

Lord Harris of Haringey Excerpts

Thursday 23rd April 2020 Lords Chamber

[Lord Bethell]

My Lords, I share the noble Baroness’s endorsement of the tremendous response from British manufacturing. Some 176 firms have applied to the scheme and we are processing their suggestions. My noble friend Lord Deighton is a powerful advocate for the Make programme. I thank in particular Don & Low, Ineos and Survitec, which have already made a considerable contribution to production.

[Lord Harris of Haringey (Lab)]

My Lords, NHS Providers warned last night of a very real risk that front-line staff’s confidence and trust in national leaders could be significantly undermined unless trust leaders and staff are confident that they are receiving adequate supplies of the right equipment at the right time. On Saturday, Robert Jenrick promised that a very large consignment of PPE would arrive from Turkey on Sunday. In fact, it was not until yesterday that half of the promised 84 tonnes arrived. Trying to grab headlines with a dubious promise is hardly likely to help staff confidence. Is it true that Turkey was asked to facilitate this shipment only the day after the Minister’s promise? Could the Minister tell us what is the daily requirement for PPE in the NHS and how it compares with the Turkish shipment?

[Lord Bethell]

My Lords, it is not correct that Turkey was asked to intervene only at the last minute. We have been in constant, daily and regular contact with the Turkish Government. We are grateful to the Turkish Government for their help and involvement and we continue to work with Turkish companies on this order. On the NHS’s requirement, this virus undoubtedly requires much more protection than any other disease that we have encountered. The demand for PPE will continue to rise. We will meet that need through our Make programme and continued strong relationships with foreign providers.

Coronavirus

Lord Harris of Haringey Excerpts

Thursday 12th March 2020 Lords Chamber

[Lord Bethell]

I thank my noble friend for his question on deep cleaning. I reassure him that no one is suggesting that the best efforts of any employer to protect the welfare of their staff is in any way irrelevant or undervalued. Cleaning is an important response to this virus and those who decide to put resources into cleaning their premises are entirely to be lauded. There is clear guidance on the PHE website. I have put that guidance in the Library and would be happy to arrange for it to be emailed.

Let me try to explain the nub of the question. The CMO has not put the daily deep cleaning of offices or any work premises at the top of his priorities. The reason for that is that it takes only one person to touch a doorknob at 7 am for that doorknob to be contagious for the rest of the day, whereas a pair of hands can be cleaned many times a day. If you do the arithmetic of how the virus is spread—as the modelling professionals do at SAGE—constant handwashing, which we bang on and on about, is the most effective way of preventing the virus spreading. When that no longer proves an effective measure, the CMO will undoubtedly change the guidance and publish that guidance widely.

[Lord Harris of Haringey (Lab)]

My Lords, I am slightly surprised by that answer. I was not going to ask about this but, none the less, I will. Surely, what the noble Lord, Lord Forsyth, is asking is: if an employer wants to go above and beyond the current minimum level of requirement, where can they get guidance? That seems quite important. The question I would like to ask the Minister is this: obviously, we wish Nadine Dorries all the best for her recovery, but is the line by which she acquired the virus yet clear? If it is not possible to answer that, of those people who have been confirmed to have the virus, in how many cases is the route by which they acquired it known? If that route is not known, clearly this is much more endemic than has previously been said.

[Lord Bethell]

My Lords, not wishing to return to question of deep cleaning too many times, I just reassure the noble Lord that the published guidance is very clear. It says that this virus can be cleaned with conventional soaps and conventional detergents, of the kind already freely available and used by cleaning companies. There is nothing technically challenging about the cleaning of offices, homes or hands in the case of this virus. It is just about thoroughness. That guidance exists. If it would be helpful, I would be happy to share it with noble Lords in this Chamber.

It is not possible to discuss Nadine Dorries’s case in detail. On community contagion, which is the nub of the question, we have reached the stage where the origin of every positive case is not known. In other words, there are people who have picked up the virus for whom no simple explanation can be given for where they got it. Therefore, the CMO has stated clearly, including in briefings to noble Lords, that his opinion is that the virus is present in the community but, as I explained, that the levels of positive testing suggest that it is not very prevalent. The CMO in his briefing estimated that between 5,000 and 10,000 people had the virus earlier this week. Those are the kinds of proportions we are talking about at this time.

NHS: Dangerous Waste and Body Parts Disposal

Lord Harris of Haringey Excerpts

Wednesday 10th October 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right to highlight this issue. As I said when repeating the Statement, the items that we are talking about are stored securely and I am assured that there is no risk to public health from the stockpiling. Clearly there is a requirement to dispose of them; this is a contractual obligation of the company, which it has not fulfilled. That is why we have entered into this situation.

[Lord Harris of Haringey (Lab)]

My Lords, what lessons has the Department of Health learned from this incident?

[Lord O'Shaughnessy]

That is an incredibly fair question; I think that the point about monitoring has been raised. We need better visibility of the performance of contractors to fulfil their contractual obligations.

Mental Health Units (Use of Force) Bill

Lord Harris of Haringey Excerpts

2nd reading (Hansard): House of Lords
Friday 7th September 2018 Lords Chamber

[Lord Harris of Haringey (Lab)]

My Lords, I am grateful to my noble friend Lady Massey for bringing this Bill forward in your Lordships’ House. I am also grateful to my honourable friend Steve Reed for the work he did in bringing the Bill through the House of Commons following the death of Seni Lewis at Bethlem Royal Hospital in 2010. We should pay tribute to the persistence of the family of Seni Lewis in wanting to see positive change as a result of their truly traumatic experience. I talked to Steve Reed about what he wanted to achieve when he was at first successful in the ballot for Private Members’ Bills in the House of Commons and I am very pleased that we have reached this stage today.

This Bill is extremely important and valuable in its own right, but I am afraid that I do not want to talk about what is in the Bill itself, but about what is not in the Bill. I should also make it clear that I have no intention of moving amendments in Committee, because every effort should be made to get this Bill intact on to the statute book. I will raise in this speech issues that were raised in Committee in the House of Commons—along with a lot of other stuff, as it happens. I aim to get greater clarity from the Government and get the Minister to reflect on these points and take them back to his department.

I bring to this Bill my experience for a number of years as chair of the Independent Advisory Panel on Deaths in Custody. My panel was responsible for looking at deaths in the custody of the state and what more should be done to protect the lives of those to whom the state holds specific obligations in terms of Article 2 of the European Convention on Human Rights. Our remit covered deaths in prison and in police custody as well as the deaths of those detained under the Mental Health Act. If you die in prison, your death is automatically investigated by the Prisons and Probation Ombudsman, and the report of that ombudsman subsequently informs the inquest. If you die in police custody, the death is automatically referred to what is now the Independent Office for Police Conduct, formerly the IPCC, and again the report produced informs the inquest.

I am not pretending that either of those two processes—for prisons or for police custody—is in any way perfect. I certainly have many criticisms of them, and will continue to do so. But those are not a matter for today. The important issue of those processes is that they happened automatically and were both palpably independent of the institutions concerned. What is more, they were thorough enough to ensure that the coroners’ court had drawn to its attention the key issues of substance.

Another point is relevant to the Minister and the Department of Health and Social Care. Those two specialist bodies developed a level of expertise and experience through looking at those types of death that meant that not only could they be more effective in terms of their investigation, because they had seen similar things before and the investigators had worked on similar issues, but the Prisons and Probation Ombudsman or the IPCC could report thematic findings that could helpfully influence the practice across the police or prison services. Because of that expertise and the fact that they were looking repeatedly at similar types of incident, they could come back to the institutions as a whole or the relevant government departments and say, “This is a common theme. These are issues that need to be addressed across the system”. That is what is missing from the arrangements that we have at present, and even the arrangements that will exist after the passage of this Bill.

Like many noble Lords, I have received briefing from the charity Inquest, which I have known for many years and worked with in my work on the independent advisory panel. It has extensive casework involving families affected by deaths in state custody. Inquest believes that the current system of investigations following non-natural deaths in mental health settings is simply not sufficient. A system of truly independent, pre-inquest investigations, equivalent to others in detention settings, with a mechanism for national oversight and learning, is absolutely necessary to reduce the number of deaths and serious incidents such as those involving the use of force. But they will also illuminate other categories of death as well. Frankly, it is iniquitous that institutions that are responsible for the treatment and care of mental health patients should not be subject to the same scrutiny as other institutions of detention such as the police, prison and immigration detention. This risks leaving ongoing injustices for bereaved families.

I am sure that we will hear from the Minister about level 3 investigations as part of the 2015 serious incident framework. They are a step forward compared with what there was before, which I can—no doubt totally unfairly—characterise by saying that you would ask the guy sitting next to you in the office to investigate the failings of the service for which you were responsible. That was deemed a sufficient inquiry. Yes, there is an arrangement under the serious incident framework. It is the only mechanism for independent investigation and scrutiny prior to the coroner’s inquest. But the issues with the mechanism is that level 3 investigations are used inconsistently and rarely take place. Perhaps the Minister can do something about that. In many cases, given the seriousness of the death, you would have expected an independent investigation to take place within the framework, but there has been a failure to do so. This Bill looks specifically at restraint. I would have thought that any death involving restraint must automatically be one where serious questions are raised around wider issues of practice and should be subject to a full and proper level 3-type enhanced investigation.

While the serious incident framework may provide for an independent team to conduct an investigation, the commissioning and management of the independent process is not institutionally or practically independent as it continues to sit within the NHS management structures. There is also no oversight outside of the NHS on whether investigations should take place and no oversight or external assessment of the quality of those investigations. Moreover, the investigations that do take place under the serious incident framework are of varying quality. They are often deficient in terms of their scope, timeliness, quality, independence and family involvement. There are also concerns about the lack of publication of investigation reports and the methods of identifying learning beyond that of the individual trust or provider. That is a key point because we want to make sure that if there is relevant learning, it will almost certainly apply not just to the individual institution, but much more broadly than that. The internal nature of the investigations means that there is no visibility or oversight around the implementation of the recommendations or identification of common themes and issues which may be of relevance nationally.

I have heard it argued that such an investigation is not necessary because that is the job of the coroner’s court, but my experience of looking at coroners’ investigations is that they are always enhanced and facilitated by the receipt of an independent report setting out the key issues. That provides a scope for the coroner’s inquiry and investigations. This is something that has to be revisited in those terms. I would ask the Minister to take this aspect away and look at it again, although not in the context of this Bill. Is the Minister confident that he is really fulfilling his personal Article 2 obligations in the absence of a more robust and independent system? Can he say, hand on heart, that he believes that the systems which are currently in place will identify wider lessons and enable them to be disseminated throughout the mental health sector?

My second and final concern, for those who feel that I am going on for too long, is about the funding of the legal costs of inquests for the families of those who die in mental hospitals. One of my most vivid memories from the listening days that Inquest organised for my panel was an account of a family whose family member had died in a mental hospital. I do not know how many noble Lords have been to a coroner’s court, but they are often held in bleak environments without even the grandeur of a court setting. For a bereaved family, for whom the whole process is very emotional, the atmosphere is both bewildering and demoralising. This family found themselves having to share the rather small waiting area with not only those whom they felt might have been responsible for their loved one’s death but the large teams of lawyers, funded at public expense, representing each and every one of those people. The family described to me how they walked down the corridor, trying to get to this small waiting room first to get a seat, and heard the trundling of the lawyers with their wheelie suitcases full of papers coming down the corridor behind them. They had to walk faster and faster to make sure that they got three seats in the room. That is a graphic image and a reminder of how isolated the families concerned will feel.

The purpose of an inquest is to find out what happened and determine the cause of death, yet every person involved will be legally represented at our—the public’s—expense to put the position of the client’s actions in the best possible light. Only the family of the person who lost their life in such circumstances will not automatically be represented publicly. I have no problem with people engaged in the issue being funded and supported, but it is grotesquely inequitable and unfair that the family—unless they have substantial means—are not similarly represented to ensure that the coroner is able to pursue all the issues that need exploring. No doubt the Minister will have been briefed that families can obtain legal aid. In practice, this is unlikely and difficult. The income rules are onerous and the pot is already small.

At present, the legal costs of the trust, the commissioner, if it is a relevant party, the nurses, the doctors and the police—if they are involved—and so on are all covered by the public purse; all except the group of individuals who care the most about knowing what happened to their loved one. What is to stop the Minister saying today that in the interests of fairness, of justice and of making sure that lessons applicable elsewhere can be identified, he will instruct the trust responsible for the individual who has died to meet the legal representation costs of the bereaved family? In practice, this will only be a small proportion of the legal costs associated with the death. If he feels that this is too difficult and too onerous a burden on the trust concerned, perhaps those costs should be borne by his department or NHS England, which would incentivise both organisations to ensure that such deaths are minimised in future. I look forward to the Minister’s reply but in the meantime, I look forward to this valuable Bill passing through your Lordships’ House without amendment.

NHS: Deficit

Lord Harris of Haringey Excerpts

Wednesday 22nd November 2017 Lords Chamber

Asked by

[Lord Harris of Haringey]

To ask Her Majesty’s Government, in the light of the quarterly performance report published by NHS Improvement on 16 November, what is their current projection for the aggregate deficit of NHS provider organisations at the end of this financial year.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O’Shaughnessy) (Con)]

Prior to today’s Budget settlement, recent figures from the NHS suggested that trusts will end the year with a combined deficit of £600 million. The vast majority of trusts are on plan to balance their budgets or better, and for those trusts in financial special measures, significant support is available to return them to good financial health.

[Lord Harris of Haringey (Lab)]

My Lords, I am grateful to the Minister for that Answer. He glided over the fact that the level of deficit in trusts seems to be rising rather more rapidly than the Government can cope with. Two weeks ago, the Nuffield Trust, the Health Foundation and the King’s Fund produced a joint report that said that the levels of funding then planned for the NHS were,

“far below what is needed to maintain standards of care”.

They said that £25 billion would be needed by the end of the Parliament and £4 billion was needed urgently next year. The Government have given £1.6 billion in today’s Budget for next year. This is at a time of rising numbers of mixed-sex wards, and of trusts delaying payments to small business suppliers and having to take out bank loans to pay their staff. Is this a case of the Government not caring about the NHS and wanting to see it wither on the vine?

[Lord O’Shaughnessy]

That is a completely unfair accusation and unjustified, both by the funding settlement that the NHS had and by the improved settlement today. First, deficits have been falling year on year for the past couple of years in terms of both outturn and forecast, and that is before today’s announcement on additional funding. The Chancellor today announced over £2.5 billion-worth of extra revenue funding over the next two years. That means that the actual value of the spending review settlement will end up being £11.5 billion compared with £8 billion, so I reject the idea that this Government are not funding the NHS properly.

Healthwatch England

Lord Harris of Haringey Excerpts

Tuesday 26th April 2016 Lords Chamber

Asked by

[Lord Harris of Haringey]

To ask Her Majesty’s Government why, when advertising the post of Chair of Healthwatch England, the Department of Health stipulated that the successful candidate would require private sector experience, and why the governance arrangements for Healthwatch England have been changed so that its Chief Executive is subordinate to the Chief Executive of the Care Quality Commission.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, the chair appointment was open to applicants from all backgrounds. Public appointments benefit from a diverse mix of skills, experience and backgrounds. In some cases, private sector experience may be sought to bring a different perspective that adds real value to the work of the board or committee. The Healthwatch England CEO has always been a CQC employee and this will not change. They will also continue to be responsible for delivering the committee’s priorities.

[Lord Harris of Haringey (Lab)]

My Lords, I am grateful to the Minister for his Answer. However, it is a fact that when the post of the chair of Healthwatch England was advertised, it specifically—I think in the first line, virtually—said that the Government were particularly seeking somebody with private sector experience. Why was that given preference over and above somebody with, perhaps, a background in consumer representation? The CQC chief executive had a direct line of accountability to the Secretary of State. That has now changed. Perhaps the noble Lord can tell us why he thinks his right honourable friend the Secretary of State for Health has acquired a reputation for not wanting to hear contrary views about the state of the health service.