Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2026
Lord Herbert of South Downs Excerpts(2 weeks, 1 day ago)
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Lord Herbert of South Downs (Con)
My Lords, I want to add to the comments and questions made by my noble friend Lady Harding about the potential impact of this regulatory change on horseracing. It is a very important sport, as the Minister responsible knows, and a sport that is already under considerable financial pressure, despite its tremendous popularity. There is concern about what the unintended consequences of this significant change may be, the bureaucratic burden that could be created by the extension of the CQC’s jurisdiction into event medicine and the cost, so I seek reassurance that Ministers are alive to these issues.
I want to raise a particular issue, which has also been raised by other noble Lords, about the possibility of exempting from registration the healthcare that is provided to athletes, performers and officials, as opposed to the healthcare provided to the public. I understand that that exemption exists already for treatment provided under arrangements between employers and employees, but not more widely. However, much medical provision might not be on an employer-employee basis and therefore would not be covered by the exemption. That would create an anomaly.
Ministers are of course right to draw attention to the importance of this issue, given the terrible events in the Manchester Arena nearly a decade ago, the awful loss of life and the very large numbers of people injured. But the extension of the CQC’s remit, as a consequence of the inquiry’s recommendation, was precisely to improve healthcare provision for the public. I am not aware that there was any perceived problem with healthcare provided for athletes and competitors—a much narrower group of people. That was not, of course, what the inquiry was thinking about when it proposed this extension, but the extension at the moment covers them, so there may be significant unintended consequences.
We know that one survey suggests that over a third of the doctors who currently provide medical cover for racing may not continue if required to register, because of the bureaucratic burden. There is obviously a tremendous reassurance job that has to be done, at the very least, but it seems that we also need to address the fundamental issue. I wonder whether the Minister would accept that there is a difference between the care that is provided for the public, which is what the inquiry was all about, and the arrangements for athletes and competitors, which are different and where there was not a problem that needed to be addressed. However, accepting that an event healthcare standard is a good thing, and that Ministers will look at the potential for exempting from registration healthcare provided for athletes, performers and officials on that basis, this instrument would seem to be commonsensical.
Lord Addington (LD)
My Lords, this is one of those debates where you think, “Who do I disagree with?” I am afraid that I have not disagreed with anything from anybody. As I speak for my party, it is important for me to restate that things went wrong with the treatment of the Manchester Arena disaster. We should do something about it—that would be great.
The problem here is that we seem to have gone far too wide. As the noble Baroness, Lady Finlay, asked, how far down do you go when covering an event? For instance, for small rugby union clubs—my own sporting background—you are lucky if there are three men and a dog watching. That is your crowd, but a local cup game could have a couple of thousand. Where does that support structure kick in? That is something that all amateur sport will confront from time to time. This is merely the first opportunity for the Minister to correct these perceptions. We need to have some cut-off points, going from when it is enough simply to have a first-aider within earshot to when we need better medical support and structure. When that changes and how they interact is really what the discussion here is about.
When it comes to sport, please let us not do anything that stops sporting events happening. There is a fear that we will do so inadvertently by providing a greater bureaucratic burden on providing help. We hope that the Government will not do that. I hope that the Department of Health will not do something that will make the country intrinsically less healthy. That is really what we are looking at.
Let us look at other specialist events. This is not an interest, but I live in the village of Lambourn so, even if I did not want to be, I am very aware of things to do with equestrian sport and particularly races. Anything to do with horses is intrinsically dangerous; indeed, we have a rehabilitation centre for neck and back injuries in Lambourn. When it comes to racing, as my wife has often pointed out to me, there are not many events when an ambulance follows you down the course as you are taking part—so there are structures there. If something that organised is raising concerns—it is not because they want it to be there but because it has to be there—there might well be something worth listening to. We must make sure, when we deliver this, that we do not throw the baby out with the bathwater and that good intentions are erased out. We should go through all those things.
The Government need to start doing something to get better information out there about exactly what they are doing, where the barriers are and what will happen. A series of meetings might help—possibly with parliamentarians and certainly with larger groups—and they should get the information out quickly. It will dramatically help to let the information out in dribs and drabs—as and when they see fit as they go forward—setting out their intentions, and we will bring in stuff behind it. That way, if there is a real fault-line here, as opposed to a fear of one, we will find out. Then we can start to do something about it.
Can the Government give us something that reassures us on our worries about the extra bureaucratic burden, given that people are terrified? They are one newspaper report and a few tweets away from people having a panic about everybody being sued every time anybody gets cuts in an amateur football game. What are they doing? Where are the structures going? That is what is required here.
We all want the big events to be safer, but they will have got it wrong if they apply this to an open mic night at a pub and a Sunday league football game at the same time. We must make sure that people know where those fault-lines are. The exemption for people taking part in sports events is a no-brainer. Can we make sure that this happens and that people know about it? It is clear that they do not, at the moment, and that is a fundamental flaw in the Government’s approach.
Sexually Transmitted Infections
Lord Herbert of South Downs Excerpts(2 years, 4 months ago)
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Lord Markham (Con)
The noble Lord is correct: about 50% of all cases are of chlamydia, and it is undetectable in a lot of people. That is why we have started screening programmes of chlamydia in women, so that it can be picked up when it has been undetected, which we know can be done. As the noble Lord mentioned, we have a programme of chlamydia vaccinations for both females and males. From memory, I think the rate of boys vaccinated is about 30%, but I will come back in writing with the exact numbers.
Lord Herbert of South Downs (Con)
My Lords, the biggest single cause of death of people with AIDS globally is tuberculosis. Coinfection is a real issue. Although this problem is not nearly as serious at home, there are still thousands of cases a year and they have started going up again. Will my noble friend confirm that, post Covid, the Government will look again at what more needs to be done to eliminate tuberculosis—an entirely treatable disease—from our shores?
Lord Markham (Con)
Yes, absolutely, as we are in all cases. I want to be clear on this. My noble friend mentioned AIDS: the UN targets are 95%, 95% and 95% for diagnosis, treatment and viral load detection, and we are at 95%, 98% and 98%. We are beating the targets and leading the world on this.
Polio
Lord Herbert of South Downs Excerpts(3 years, 10 months ago)
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Lord Herbert of South Downs (Con)
My Lords, the World Health Organization pronounced Europe free of polio 20 years ago, but that was clearly not the case globally. Its emergence here is surely a reminder that a highly infectious disease anywhere can become a highly infectious disease everywhere. Is it not also a reminder of the need therefore for vigilance against such infectious diseases, which are not beaten until they are fully beaten globally? There are other diseases such as TB where there is not even a vaccine. Will my noble friend consider the importance therefore of renewing the UK’s commitment to the Global Polio Eradication Initiative to ensure that, once and for all, this beatable disease is beaten?
Lord Kamall (Con)
My noble friend makes a very important point. Even though a number of countries have been declared polio-free, including the UK because of our high level of polio vaccination, we should be clear that it has been detected and it has derived from someone having had a polio vaccine, probably an oral vaccine—the sugar cube that many of us will remember from our youth, rather than the injection that a person receives now as part of their 6-in-1. That has the potential to spread, and it is why the UKHSA is monitoring it. The important message is to remind everyone: check your red book, check your medical records, check your vaccination record. If you have not been vaccinated against polio or have not had the booster, go to your GP and get it as quickly as possible.
Children: Cancer
Lord Herbert of South Downs Excerpts(3 years, 11 months ago)
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Lord Kamall (Con)
The noble Baroness raises an important point about how we raise awareness, and that goes right across not only the population but patients themselves. NHS England and NHS Improvement are developing plans for future phases of their Help Us Help You campaign to raise awareness of key cancer symptoms. To date, the campaign has contributed to the record high levels of urgent cancer referrals that the NHS has seen since March 2021.
Perhaps I may take the opportunity to address the question from the noble and gallant Lord. Covid clearly affected the backlog. One of the things about the waiting list is that now 80% of people on it are waiting for diagnosis. One of the issues we are looking at is how you push out more community diagnosis centres around the country, not only in hospitals but in shopping centres and sports arenas, so that effectively we go to the patient and detect as early as possible. We hope that all that, in conjunction with things such as blood testing and genomic sequencing, will lead to earlier diagnosis.
Lord Herbert of South Downs (Con)
My Lords, brain tumours are the single biggest cause of death among children and adults under the age of 40 of any cancer. The Government made a generous commitment to increase funding, which is absolutely essential for brain tumour cancer research, but, so far, they have not met the target that they themselves set. Will my noble friend undertake to review this situation, given the seriousness of the position?
Lord Kamall (Con)
One of the things about answering a question like that is that we are now aware of so many different types of cancer. For example, a blood test that has been trialled identifies 50 different types of cancer. Sadly, my mother-in-law died of a brain tumour, and I have asked questions about that in the department. If my noble friend will allow me, rather than read out a short answer I will write to him in more detail.
Covid-19
Lord Herbert of South Downs Excerpts(4 years, 9 months ago)
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Lord Bethell (Con) [V]
My Lords, I have complete sympathy with the noble Baroness about the fast-changing nature of our response to this pandemic. However, as I have said from these Benches before, it is the virus that chops and changes and delivers us surprises. Who would have expected two or three months ago that the delta variant would have hit us as hard as it did?
We are trying to be agile and to adapt to changing circumstances. The guidelines on nightclubs and pubs will be published and when they are published, they will, I hope, be clear. The arrangements for September are being arranged right now. On mandatory vaccination in the NHS—which I think is what the noble Baroness inquired about—we have signalled our intention to consult on mandatory vaccination across the healthcare service. I hope that I will be able to share further details on that with the House at a future date.
In terms of an inquiry, of course I hear Sir Jeremy Farrar. However, I and many others are already working all the hours that God gives us on responding to this pandemic. There is no extra bandwidth for dealing with an inquiry. We are doing our best and we will look back and learn the lessons when the moment is right.
Lord Herbert of South Downs (Con) [V]
My Lords, given the growing number of people now being pinged and required to isolate, would it not make sense now to extend the sensible and welcome provision for critical workers so that those who have been doubled jabbed and then taken negative PCR tests need not isolate? I appreciate my noble friend’s point about breaking the chain of transmission but there is a danger that people will quite reasonably not see isolation as a proportionate requirement when they have been double vaccinated and tested. As well as the growing impact on businesses and public sector organisations of losing staff for up to 10 days, is there not also a need to maintain public confidence in the NHS Covid app? That is clearly now a serious concern.
Lord Bethell (Con) [V]
I hear loud and clear the concerns that members of industry and critical services have about isolation of the workforce and the impact that is having on supply chains and the provision of services. However, I cannot hide from my noble friend that the infection rates are higher. It is important that people who have been close to someone who is infected isolate themselves. If they do not, infection rates will go higher still, and if we have sufficiently high numbers of infections, although the vaccines are incredibly effective, that will roll into hospitalisations, severe disease and worse. This is a moment for holding steady and keeping the line. I am hopeful that this moment of acute discomfort for industry and services will pass soon.
Covid-19: Self-Isolation
Lord Herbert of South Downs Excerpts(5 years, 2 months ago)
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Lord Herbert of South Downs (Con)
My Lords, the challenges for effective testing, border security and the development of effective vaccines have obviously all increased hugely with the emergence of new variants, which continues and is causing great public concern. Can my noble friend say what the Government are doing to use the expertise that we have in the UK in genomic testing, which has enabled us to identify these variants, to help other countries do the same? In the end, it is not only the right thing to do morally, but it helps us too.
Lord Bethell (Con)
My noble friend is entirely right. We can only be safe here in the UK if we understand what variants of concern are developing elsewhere in the world, if the countries where those variants are emerging are testing and are identifying those variants, and if measures are put in place to tackle them. That is why we have put together an international platform where we will accept samples of new variants from anywhere in the world and use Britain’s substantial genomic testing capacity to help countries process them. We are sending machines from the UK and providing expertise for all those who need to supplement their genomic testing using the considerable resources of Public Health England, the Sanger Institute and our genomic testing capabilities.
Covid-19: Restrictions
Lord Herbert of South Downs Excerpts(5 years, 3 months ago)
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Lord Bethell (Con)
My Lords, I pay tribute to the advocacy of the noble Baroness and her colleagues on this important point. I acknowledge the financial pressures on those of limited means who are required to isolate. We have put in provisions for statutory sick pay and the £500 Covid bonus to help to support those people, and there are local authority funds and provisions to provide additional support. The point that she makes is made well and we completely acknowledge the challenge.
Lord Herbert of South Downs (Con)
My Lords, does my noble friend share my incredulity that those who are opposed to lockdowns continue to make their arguments, in spite of the fact that cases are obviously rising very fast, in spite of the advent of the new variant, which is more infectious, and in spite of the current very serious pressure that our hospitals are seeing? Is it not the case that, in the end, their arguments boil down to the callous suggestion that somehow elderly people who have pre-existing conditions but might nevertheless expect to live for many more years are expendable, when they are clearly not?
Lord Bethell (Con)
My noble friend puts it well. I always welcome the challenge of noble Lords on any subject whatever, but I agree that underlying many of the objections to lockdown appears to be an assumption that some lives matter less than others. Whether you are asthmatic, diabetic, infirm or just old, I think that your life is worth just as much as everybody else’s. That is why I am extremely proud of the national effort to work together to protect those who are less advantaged and to protect our health service.
HIV: Ending Transmissions
Lord Herbert of South Downs Excerpts(5 years, 4 months ago)
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Lord Bethell (Con)
The noble Baroness refers to one of the most interesting of the recommendations of the commission’s report. I took a briefing from the commission yesterday; members made that point very clearly, and their arguments were extremely persuasive. We have learned a lot during the Covid pandemic about opt-out testing; I completely understand the value of it, and I will take that recommendation to the department to look at it very closely.
Lord Herbert of South Downs (Con)
My Lords, I pay tribute to the long-standing work of the Lord Speaker on HIV and AIDS. I have campaigned beside him in South Africa and have seen the passion with which he devoted himself to this role over many years.
Does my noble friend the Minister agree that the HIV Commission’s recommendation for a plan that the Government should commit themselves to is a wise one which they should adopt? After all, it is D minus 10 now—10 years before AIDS should be beaten, according to the SDG. We have the tools, now we need to implement them.
Lord Bethell (Con)
I reiterate the tribute of my noble friend to the Lord Speaker. Over three decades, he has campaigned tirelessly on these issues, and was instrumental as Secretary of State for Health and Social Security in launching the ground-breaking “Don’t Die of Ignorance” campaign, which made an indelible mark—its impact is remembered today. The tenacity that he has shown in making evidence-based decisions in the fight against HIV is a model for us today.
My noble friend makes a very valid point on the need for a plan. We will issue a sexual health and an AIDS plan in short order; they have been delayed by Covid. He reminds us that it is D minus 10, a goal that we take extremely seriously.
Covid-19: South Yorkshire
Lord Herbert of South Downs Excerpts(5 years, 6 months ago)
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Lord Bethell (Con)
The right reverend Prelate makes a very touching appeal, and I reassure him that both the representatives and the people of Manchester are massively valued. I do not want to cite all the details, but many people in this Government, including me, have spent a vast amount of time in Manchester, value the city, love the people and are greatly distressed at the thought that anyone thinks otherwise. The practicalities of this epidemic have been very regrettable on travel. As a Minister, I regret massively the fact that I have not been able to travel up and down the country. It is not possible to visit cities for face-to-face negotiations in the middle of an epidemic. That would strike the wrong note. It is a contagious threat and that is not possible, but I reassure the right reverend Prelate that everything is being done to value the opinions of the representatives of Manchester, and it will continue to be so.
Lord Herbert of South Downs (Con)
My Lords, I agree with the Minister’s main point, which is that local lockdowns are really the only choice available to us at the moment if we wish to avoid a national lockdown—which will penalise those areas that do not have the relevant levels of Covid and cause further economic hardship—and are to reject those voices which, through things such as the Great Barrington declaration, suggest that there should be no restrictions at all other than shielding the vulnerable, which would exact a tremendous humanitarian toll. That being the choice, surely local lockdowns, backed by the relevant economic assistance, must be the current policy. If people are looking for bigger solutions, those ought to lie in the advance of either rapid testing or a vaccine. Can my noble friend update us on the potential timetable and likelihood of a vaccine and how prioritisation will be organised to ensure that it is available to those who most need it first?
Lord Bethell (Con)
The feedback from the Vaccine Taskforce is very promising. It has six contracts for vaccines on four different platforms. The Oxford vaccine is by far the front runner, but what is really encouraging is the substantial pipeline of other vaccines coming through. I am afraid I cannot commit to the timing on that, but all the news we have is extremely encouraging and we are putting deployment protocols in place to be able to deliver it as quickly as possible. I also flag that the therapeutic drugs and rapid testing also provide strong answers to the threat of coronavirus.
O’Neill Review
Lord Herbert of South Downs Excerpts(9 years, 1 month ago)
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Kevin Hollinrake
My hon. Friend makes an excellent point. The key element of the fight against antimicrobial resistance is its global nature. We absolutely must not isolate ourselves from the rest of the world—we must collaborate—but we must take national action, too, and I will come on to that shortly.
That figure is of course a prediction—it could be lower, but it could also be higher. Predictions have been made about other contagions, such Ebola, Zika, HIV and Creutzfeldt-Jakob disease, and our scientists, academics and clinicians thankfully have managed to mitigate the worst effects and worst predictions for those diseases. But there are three reasons for us to be more alarmed this time: first, antimicrobial resistance is already happening; secondly, the problem is spreading rapidly and by all available means; and thirdly, research is not being carried out on anything like the scale required.
Nick Herbert (Arundel and South Downs) (Con)
A quarter of all the deaths that are predicted to happen as a result of drug resistance will be caused by tuberculosis, a disease that already kills 1.8 million people a year. Does my hon. Friend agree that research and development is essential if we are to develop a vaccine to prevent tuberculosis? No epidemic has ever been fully beaten without a vaccine.
Kevin Hollinrake
I absolutely agree. The difficulty is that due to the reward mechanisms in the system, such research and development is not happening. I will turn to that shortly.
This is not an apocalyptic prophecy. Antimicrobial resistance causes some 700,000 deaths globally and an estimated 12,000 deaths in the UK every year—similar to the number of people who lose their lives from breast cancer. Quite simply, if the bacteria that cause infections become resistant to antibiotics, people die. This issue is listed in the national risk register of civil emergencies, a five-year Government register, which states that an
“increasingly serious issue is the development and spread of”
antimicrobial resistance and points out that much of modern medicine will become unsafe. Minor surgery such as organ transplants, bowel surgery, cancer treatments and caesarean sections will become high risk—there will be more illness and more deaths.
Dame Sally Davies, our chief medical officer, pointed out that antibiotics have extended life by an average of 20 years—20 years of our lives may therefore be lost—and 40% of our population could die prematurely if this situation is not resolved. Operations would become unsafe due to the risk of infection during surgery or chemotherapy. Influenza pandemics would become much more serious. The national risk register states:
“The numbers of infections complicated by AMR are expected to increase markedly over the next 20 years. If a widespread outbreak were to occur, we could expect around 200,000 people to be affected by a bacterial blood infection that could not be treated effectively with existing drugs”.