NHS Digital: Primary Care Medical Records

Lord Hunt of Kings Heath Excerpts

Tuesday 8th June 2021 Lords Chamber

[Lord Bethell (Con)]

I am grateful for the question. I will look into that date and share whatever materials are available.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am fully behind the sharing of information, for the reasons that the Minister explained. But does he agree that to ensure public confidence, the Government have to do something about the current clunky opt-out approach that they have taken and make it easier, and publish the names of the companies to whom this information will be given and what they are paying for it? The Government must not hide behind commercial confidentiality. We as patients have an absolute right to know this.

[Lord Bethell (Con)]

My Lords, I agree with the noble Lord that the opt-out system deserves to be looked at. We are undertaking a review of the opt-out system to streamline it along the lines that he described. However, he peddles a slightly false impression. There are extremely detailed considerations in the IGARD minutes, available online—39 pages from the last meeting—which go into great detail on the arrangements for the sharing of each piece of data. On payment for the data, I remind him that—as I am sure he already knows—these are payments for costs and not payments for any kind of charge. All data is shared for very strict reasons to do with research and planning. There are no other reasons for sharing the data.

Covid-19: Variant B.1.617.2

Lord Hunt of Kings Heath Excerpts

Wednesday 26th May 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Lord is entirely right, and I am grateful that he has looked at the dashboard as carefully as he clearly has done and drunk deeply from the rich array of data that we have available there. On a more serious point, there are some significant outbreaks—they are listed very clearly on the PHE dashboard—where we have put in place significant outbreak management procedures, including surge vaccination, surge testing and additional communication with the community. But the noble Lord is right that the Indian variant is proving to be extremely competitive with the Kent variant, and we should expect that to start to spread around the country.

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, can the noble Lord update the House on the potential vaccination of secondary school children?

[Lord Bethell (Con)]

I am afraid I do not have a specific update for the noble Lord. It is an area that we will be extremely interested in looking at, but there are regulatory processes to be gone through at the MHRA and vaccine policy procedures to be gone through at the JCVI. They will both be looking at that. At the moment, our focus is on getting the vaccine into as many arms as we possibly can, particularly among the high priority groups, but we will turn to that at some point in the future.

Covid-19 Update

Lord Hunt of Kings Heath Excerpts

Tuesday 18th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the Tedros principle of us being safe only when we are all safe remains the most profound insight. The noble Baroness is entirely right: we must do more to try to help those in the developing world. The frustrating truth is that the world simply does not have enough capacity for the manufacture of these very complex and tricky substances. We are straining every sinew to try to deliver the 9 billion vaccines we need to deliver worldwide vaccination, but the rate of manufacturing is not as high as any of us would like. I take my hat off in particular to AstraZeneca, which has provided licences for the vaccine worldwide on a no-profit basis, but I also pay tribute to the other vaccine companies, which, despite what one might read in the press, are trying all they can to set up manufacturing sites all around the world. Progress is being made.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I too salute AstraZeneca for its noble efforts. However, I would like to take the Minister back to the SAGE meeting of 13 May, when the Government were warned:

“In the areas where numbers of infections are increasing rapidly … an even faster increase can be expected if measures are relaxed”.


The Government went ahead with relaxing the measures yesterday. I know that Mr Dominic Cummings can perhaps not be regarded as the most reliable of commentators, but was he not right to say that fast, hard and effective action is the best policy for the economy, as opposed to always delaying taking decisive action? When it comes to the next stage, can we be reassured that the decision will not be taken until the evidence in June is fully assessed and evaluated?

[Lord Bethell (Con)]

My Lords, I am a big supporter of the “fast and hard” principle. In our response in Bolton, Bedford, London and elsewhere, we have demonstrated that principle in our handling of the Indian variant. I point out that the use of testing and social distancing measures in schools has been enormously effective. One of the remarkable aspects of the infection rate so far is that transmission levels among school-aged children have not increased in the way that SAGE and others, including myself, once feared. We should take a “glass half-full” moment to applaud that fact. I reassure the noble Lord that we will absolutely make these decisions on the data. Space has been put in between the steps for exactly that reason, and we are not going to rush it.

Health Protection (Coronavirus, Restrictions) (Steps and Local Authority Enforcement Powers) (England) (Amendment) Regulations 2021

Lord Hunt of Kings Heath Excerpts

Monday 17th May 2021 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to the Minister. The debate takes place as we take the next step out of lockdown, but it also comes as concern rises about the impact of the Indian variant. Getting the balance right between getting back to normal as soon as possible and understandable caution about the risk of opening up too soon will always be an incredibly difficult judgment. But the Government’s record of vacillation and delay over key decisions does not inspire confidence, and the delay in placing India on the red list is at least questionable, given the rate of Covid cases in that country at the beginning of April.

The SAGE meeting on 13 May pointed to the multiple fast-growing clusters of the B16172 variant, most noticeably in the north-west of England, with transmission faster than that of the B117 variant most prevalent in the UK. SAGE concluded that it is a “realistic possibility” that the Indian variant is

“as much as 50% more transmissible”

and warned:

“In the areas where numbers of infections are increasing rapidly under the measures”


then

“in place, an even faster increase can be expected if measures are relaxed.”

Of course, today, they have been so relaxed. SAGE warned that if the Indian variant

“were to have a 40-50% transmission advantage nationally compared to B.1.1.7 … it is likely that progressing with step 3”—

which we are doing today—

“would lead to a substantial resurgence of hospitalisations.”

SAGE concluded:

“Progressing with both steps 3 and 4 at the earliest dates could lead to a much larger peak.”


It is therefore legitimate to ask the Minister why, in view of that, we are going ahead with step 3 today. What factors will be taken into account in respect of a decision to go ahead with step 4? What will the Government use as metrics to decide whether tougher restrictions need to be imposed nationally or locally? As we will not know until mid-June at the earliest the full impact of step 3 on hospitalisations and deaths, does the Minister agree that decisions on further steps out of lockdown must be considered after this information becomes available?

SAGE also pointed out that

“increasing regional vaccination in areas where it is prevalent could dampen growth in infections”.

Why do the Government seem to have been so slow to respond to health bodies in the north-west which wanted them to approve an emergency vaccination programme? The Minister may have seen reports today that health officials in Bolton have fast-tracked vaccination to residents as young as 17. What is the Government’s view on that?

National Health Service (Charges and Pharmaceutical and Local Pharmaceutical Services) (Coronavirus) (Amendment) Regulations 2021

Lord Hunt of Kings Heath Excerpts

Monday 26th April 2021 Lords Chamber

Moved by

[Lord Hunt of Kings Heath]

That this House regrets that the National Health Service (Charges and Pharmaceutical and Local Pharmaceutical Services) (Coronavirus) (Amendment) Regulations 2021 (SI 2021/169) do not address the underlying funding problems faced by the pharmaceutical sector, which may affect the capacity of local pharmaceutical services to respond to future emergencies.

Relevant document: 47th Report from the Secondary Legislation Scrutiny Committee

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, I welcome and support this statutory instrument. In fact, it is an excellent example of the contribution and innovation that community pharmacies make. Disappointingly, this has not always been recognised by the NHS, nor financially supported by the Government. As the Pharmaceutical Services Negotiating Committee has pointed out, community pharmacies have remained open throughout the Covid-19 pandemic; they have adapted to provide services in a Covid-secure way for their local communities, and they are offering face-to-face advice and healthcare on a walk-in basis. As well as delivering more than 1 billion prescription items a year, they have delivered healthcare advice at the rate of more than 48 million consultations a year. They have been a buffer for the NHS, helping their local communities and reducing pressure on other NHS healthcare providers.

The PSNC audit earlier this year, to be published this week, is fascinating. It says that 1.1 million informal consultations are taking place in community pharmacies in England every week. That comes to more than 58 million consultations a year. Every week, pharmacies provide advice on symptoms to more than 730,000 people. Nearly 38 million people per year—76% of pharmacy advice consultations—are people who have self-referred into the community, and 8.6% of those people seeking such advice said that they had been unable to access another part of the healthcare system. One in four informal consultations in pharmacies also involves advice and support relating to Covid-19. That means that 270,000 patients every week are seeking advice from pharmacies on Covid. Pharmacies giving advice save more than 2 million GP appointments every month, or 24 million every year. An additional 70,000 people would go to A&E or an NHS walk-in centre every week if they could not get advice from their local pharmacy.

Pharmacies, therefore, make a huge contribution. They can also make a contribution to the national Covid-19 vaccination effort. Some community pharmacies are already doing so, but all of this impressive work is at risk if they are not given adequate financial support. They cannot be expected to subsidise the NHS.

Work by the Company Chemists’ Association has shown that the community pharmacy sector is facing a real-terms cut in funding of more than 25% during the period 2014 to 2024. In 2016-17, funding for pharmacies was cut by more than £200 million a year, and, as a direct consequence, community pharmacies of all sizes have closed. We are now two years into the current five-year community pharmacy contractual framework, which was due for an annual review last year but which did not take place due to Covid. So the sector has been left, after those cuts, with a flat funding position for five years in a row, when the cost of service delivery continues to rise and the NHS prescribes more medicines year after year. We know that the additional cost of providing Covid-safe care has been significant. The sector has spent more than £400 million extra—out-of-pocket expenses—to sustain the service. The Government have provided some extra funding, but this falls way short of covering the full costs incurred.

The systematic underfunding of the community pharmacy sector, combined with the pressures to which I have referred, is putting many pharmacy businesses in a critical position. Many pharmacy owners are having to reduce services, opening hours or staff levels to cut down on costs. Large pharmacy chains have also announced significant cost-cutting and reorganisation measures over the past year. A study of independent community pharmacies found that 28% to 38% were in financial deficit already, and that this would rise to 64% to 85% without a funding uplift.

Already, we have also seen more than 400 net closures of pharmacies since funding cuts were introduced in 2016; 327 of them have been in the 30% most deprived areas. This has a knock-on effect on local high streets and potentially contributes to growing health inequalities. It is surely counterintuitive that we should have pharmacies closing in the middle of a pandemic—but without funding support, we expect more closures, which means more communities losing their primary link to the NHS.

The Government did provide £370 million in emergency funding loans to help pharmacies to stay open during the pandemic, in 2020. As I have explained, that money has been spent on covering the more than £400 million of NHS costs. Cash-flow modelling suggests many pharmacies cannot afford to pay back these emergency moneys. In summer 2020, HM Treasury made an initial offer on reimbursing pharmacy costs throughout the pandemic, but this was very constrained. Will the Minister tell us today whether the Government will write off the £370 million in advance payments that were made to pharmacies at the beginning of the crisis? I hope that he can bring a positive message. This would go some way to bridging the cost gap. Importantly, any shift to claw back this advance money from an already underfunded network will lead to further financial difficulties and potential closures.

I opened by describing some of the fantastic work done by community pharmacies. They are a critical part of the NHS and they have much more to offer to benefit patients, local communities and local healthcare systems. They are working with local GPs to roll out referrals from general practice, so that patients can get quick and convenient access to advice on minor illness, but they could do so much more. Over the coming months and years, pharmacies could really help on prevention, on levelling-up health inequalities, on identifying people with undiagnosed high blood pressure and other cardiovascular diseases, and on helping to tackle obesity and other health factors that have contributed to the UK Covid-19 death rate. They could provide enhanced community and public healthcare. I have already said that they could boost our vaccination effort and provide a first port of call to support GPs to return to pre-Covid activities. The new community pharmacy consultation service has the potential to enable pharmacies to meet the currently unmet need in urgent care, but it is currently failing due to a lack of engagement by, and referrals from, GPs and NHS 111.

It is very important that, in addition to providing financial support to the sector, the NHS trusts patients to know when their pharmacy is the right place for them to receive their care. Patients should be allowed to choose pharmacy as a place to receive their urgent NHS care. Part of the problem is that community pharmacy does not have a place around the table when it comes to the decision-making bodies at local level. I give notice to the Minister that I expect the NHS Bill, which we will see in the next Session, to put this right. We argued when the Bill went through that removing pharmacy from the boards of CCGs was a mistake. My goodness me, it has been a mistake.

Surely we should all come together to unlock the potential of community pharmacies and help the NHS get back on its feet as quickly as possible. I come back to funding: the current funding envelope for the community pharmacy network is unsustainable. We need to do better. The NHS could learn and benefit hugely from the pharmaceutical sector. I hope that this debate will encourage the Minister to take a much more positive look at what the sector can provide. I beg to move.

--- Later in debate ---

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, this has been a very good debate. I am grateful to all noble Lords, and the Minister, for their interesting contributions. Although this was essentially about the funding of community pharmacy, the huge contribution that it makes—and can make in the future—became very apparent in this debate. I hope that this is what will draw us together.

The noble Baroness, Lady Barker, drew an interesting distinction between provision in south London and that in south Lancashire. The irony is that it looks as though community pharmacies are most vulnerable in the most deprived areas and we really have to deal with this.

I was interested in what the noble Baroness, Lady McIntosh, had to say about dispensing doctors. When I was the Minister responsible for community pharmacy 20 years ago, we established a joint committee, between the PSNC and the BMA, of community pharmacists and dispensing doctors, to try to resolve some of the tensions. I am not sure whether we succeeded in doing that, but I echo the noble Baroness’s comments about the role of dispensing doctors.

I also thought that the noble Baroness, Lady Wheatcroft, gave an interesting analysis of the financial challenge facing the sector. She and the noble Baroness, Lady Brinton, referred to the EY report. What she said about the general impact that community pharmacy has on high streets was very important and we should not forget it.

We should also not forget what the noble Baroness, Lady Brinton, said about the unsustainable financial framework for many community pharmacies at the moment and the Government’s consultation and recommendations for structural financial change. I also echo what she said about resources for training pharmacists in new services.

In her winding, my noble friend Lady Thornton made the important point that community pharmacies did not close; they carried on and were of huge benefit to us. That is why it is so frustrating that there are so many local examples of where the NHS does not see the potential of community pharmacy. I come back to what I said earlier about the need to ensure some kind of statutory provision for community pharmacy representation around board tables, at local level. You could say the same for opticians and dentists; all too often, they are neglected by the decision-making bodies. When we no doubt come to debate these matters on the Queen’s Speech, in a couple of weeks, I hope we come back to the structure of the future NHS that the noble Lord wishes to bring us.

The noble Lord, Lord Bethell, chided me a little, I think, about using this SI as a way of raising general issues, but what are we to do? We have largely been deprived of Questions for Short Debate over the last year, and I am afraid that this SI is an excellent vehicle to raise more general issues. I have no problem whatever with the SI before us. I am grateful to the Minister for saying that he has heard my concerns and that there are discussions and negotiations going on, and that he will report back to us. But—and it is a big “but”—there is a tremendous risk that we will undermine the very fabric of community pharmacy unless we take action, which is what I urge on the Government. Having said that, I beg leave to withdraw my Motion.

Motion withdrawn.

Crohn’s Disease and Ulcerative Colitis

Lord Hunt of Kings Heath Excerpts

Thursday 15th April 2021 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what assessment they have made of the variation in the standard of care received by patients with (1) Crohn’s disease, and (2) ulcerative colitis; and what plans they have to work with NHS England to implement a framework to improve care and outcomes for such patients.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, on the basis of the IBD audit, NHSEI is working closely with front-line clinical experts, patient representative groups and leading charities, including Crohn’s & Colitis UK, to develop evidence-based improvement tools to address possible variations in service. This work includes an important new inflammatory bowel disease right-care scenario, setting out what high-quality, joined-up care looks like at every stage of the patient journey.

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, I am grateful to the Minister. He will know that over 500,000 people are living with inflammatory bowel disease, often with debilitating long-term symptoms and complications. Given the current huge variation in standards of care to which the noble Lord referred, will the Government appoint a national clinical director for IBD, solely to concentrate on spearheading a drive to implement the national IBD standards, which are backed by 17 healthcare professional and patient organisations?

[Lord Bethell (Con)]

We are doing a huge amount in this area, as the noble Lord rightly points out. In particular, we are working with Crohn’s & Colitis UK on the scenario work I mentioned. That is on top of working on diagnostic waiting times, formal personalised care, access to specialist treatment and formal, structured education. I will look into the possibility of having a formal leader to oversee all these strands, but my impression is that, at present, the work is best done by the individual workstreams I mentioned.

Covid-19: One Year Report

Lord Hunt of Kings Heath Excerpts

Thursday 25th March 2021 Lords Chamber

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, I first thank the Minister for his speech, and also for his very hard work over the past 12 months, which has been much appreciated. I thought that his speech was noticeable for what it did not say as much as for what he included. Of course he was right to praise the work on vaccines; I salute the brilliance of the scientists, the scale and diversity of the UK vaccine procurement, and the magnificent effort of the NHS in vaccinating so many people. I also pay tribute to the Joint Committee on Vaccination and Immunisation, which has taken tough decisions, held its nerve and got it right.

However, in the words of my noble friend Lady Thornton’s Motion to Regret, the Government’s handling of the pandemic has resulted in

“one of the highest death tolls in the world and the worst economic crisis of any major economy”.

This has been compounded by the fact that the most vulnerable in this country have been the hardest hit. We should not overlook the Government’s slow and uncertain response. Their record has been one of delay, indecision and vacillation. The failure to lock down early enough last spring, despite clear evidence of the need to do so, was compounded, as the Resolution Foundation points out, by being repeated in September and then in December. Many Conservative MPs wish to do the same today by opposing the continuation of the provisions in the Act.

On this country’s high death rate, we should never forget the inexcusable 20,000 Covid deaths in English care homes in 2020 or the fact that mortality rates in the most deprived areas have been almost twice those in the least deprived.

The review that accompanies these regulations speaks of the Government’s commitment to protecting people’s jobs and livelihoods. There is much to commend but there have been some real problems too. Many of the self-employed fell through the net. Some 2 million low earners are excluded from receiving sick pay; when they are asked to isolate at home without any protection of their employment, many have felt unable to do so. That contributed to the weakness of the test and trace system, which has been unable to provide an alternative to lockdowns.

An excellent analysis this week by the British Academy points to the many impacts that flowed from lockdowns, including people being unable to see family and friends, travel or take part in leisure activities. These impacts should of course ease quickly as lockdown comes to an end, but there is a set of deeper impacts on health and well-being, on communities and cohesion, and on skills, employment and the economy, that will have profound effects upon the UK for many years to come.

The worsening economic situation has exacerbated existing inequalities. Vulnerable people are more likely to be made redundant; women are more likely to bear economic and caring burdens; and private renters are more likely to have lost income than homeowners. There is a significant risk that an ongoing economic crisis could further exacerbate existing racial inequalities and deepen long-term scarring for younger people. If levelling up is to mean anything, it must lead to a determination to mitigate those significant impacts on generational inequalities, as the ripple effects are seen in housing, security, health, employment, social opportunities and relationships.

I ask the Minister: when do the Government intend to set up an inquiry into the handling of the pandemic? I echo what the noble Baroness, Lady Brinton, had to say on that. It should be soon. Earlier this week, the noble Lord, Lord Kerslake, wrote, in relation to the huge scale of deaths in the UK, that some very big questions needed to be asked. Were we adequately prepared? Did the lockdowns come soon enough? Why was the handling of care homes so seriously misjudged? Could more have been done to protect those from BAME backgrounds? We also need an inquiry, because we must be better prepared for next time. Unfortunately, it may be all too likely that there is a next time.

I conclude by saluting all those who have made such a success of our vaccination programme and all the other work that has been done in the past year. But the repeated failure to act speedily to prevent the spread of the virus has not only cost thousands of lives but served as a warning that we can never be complacent. Never should we lower our guard and we should, without question, ensure that the essential provisions in the Act are retained.

Folic Acid

Lord Hunt of Kings Heath Excerpts

Tuesday 23rd March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I pay tribute to both the stamina and the passion with which the noble Lord puts his case. He puts it extremely persuasively. We have worked hard to engage with policymakers on this, meeting mill owners, including artisanal mill owners, and those who are engaged in the supply of food. The supply of food has been a difficult area in the last year. It is difficult to lay this extra burden on the trade. It is extremely open to the option and we remain optimistic that this is a route we can walk down. There has simply not been an opportunity to make that commitment as yet, but I will update the House as soon as I possibly can.

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, yesterday, the Minister said that the health of the nation had to change emphatically. The recent NHS White Paper, to which my noble friend Lord Rooker referred, actually promised a more direct government role in improving people’s health. For instance, as president of the British Fluoridation Society, I was delighted that the Government are now committed to fluoridating water supplies. Given that, would it not be a very important indicator if the Government were to announce very shortly that they are going to go ahead with this?

[Lord Bethell (Con)]

My Lords, the noble Lord blows my own words in my face very effectively indeed. He is entirely right—we are committed to preventive medicine in the round. Fluoridation is one graphic example of that and the use of folic acid to address neural tube defects is another good example. That is why we did the consultation in 2019 and are considering the responses, and it is why I have made the commitment to return to the House once we are able to give an update.

Health and Social Care Update

Lord Hunt of Kings Heath Excerpts

Monday 22nd March 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Lord is entirely right to emphasise this incredibly important aspect of our toolkit to manage infection rates down. The workplace is an area of infection threat and asymptomatic testing is a way to keep workplaces safe. We have put in place until the summer the free provision of lateral flow tests for those who wish to do workplace testing, and we are looking at ways in which we could potentially extend that, particularly in circumstances where the infection rate crept up again. We are working very closely with BEIS colleagues to look at the kind of regime that would be necessary. I pay tribute to DfT colleagues who have trail-blazed this area with the test to release programme, which uses private testing capacity for that important transport corridor, and to colleagues at UKAS who have put in place the accreditation necessary to create an independent, private ecology of the kind that the noble Lord refers to.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I come back to the point raised by the noble Lord, Lord Cormack: the SPI-M-O consensus statement of 24 February showed that while 95% of care home residents had had the vaccine, only 70% of staff had. We really must do better on this; does the Minister agree?

[Lord Bethell (Con)]

My Lords, I could not agree more heartedly; the vaccination of staff is a massive priority. Those figures give us cause for some reflection on how we can increase them. The adoption rate of vaccines by all healthcare workers has been much more impressive than on previous vaccine rollouts, so we are encouraged overall, but we are determined to hammer out all the last rock pools where people have not been persuaded. As I alluded to my noble friend Lord Cormack, we are looking at all methods to make sure that we get there in the end.

Health Protection (Coronavirus, International Travel) (England) (Amendment) (No. 7) Regulations 2021

Lord Hunt of Kings Heath Excerpts

Monday 22nd March 2021 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I echo the congratulations to my noble friend Lady Chapman on her excellent maiden speech. I agree that my party has hard lessons to learn.

I am going to have to agree with the noble Lord, Lord Robathan, when it comes to the issue of parliamentary scrutiny. That is twice that we have agreed with each other in the last three weeks, which is deeply worrying.

I want to reflect on the trenchant comments of the Secondary Legislation Scrutiny Committee. The SI that we are debating today has already been updated, as I understand it, by the amending Covid travel regulations Nos. 8 and 9. The Explanatory Memorandum provided with regulations No. 8, which we have yet to debate, was particularly poor, says the committee, and the DfT had to replace it immediately. As the committee says, when instruments are brought into effect immediately, it is even more important that their intent and effect be made clear to both Parliament and the public.

One would have thought that the lesson would have been learned but, according to the scrutiny committee, it has not. Regarding regulations No. 9, which we anticipate debating fairly shortly, it says:

“The Explanatory Memorandum was particularly thin … and the supplementary information provided remained opaque.”


The committee draws those regulations to the special attention of the House on the grounds that

“the explanatory material laid in support provides insufficient information to gain a clear understanding about the instrument’s policy objective and intended implementation.”

I am of course aware of the huge pressure on Ministers and their officials at the moment, and I support my noble friend in wanting a quicker and tougher approach to travel rules and quarantine. However—and this is the point that the noble Lord, Lord Robathan, was making—I also accept that we are putting severe restrictions on people’s personal liberties, and that is something that cannot be swept away. It is unacceptable if departments cannot even provide clear statements in Explanatory Memorandums of what the regulations are about.