Covid-19

Lord Kamall Excerpts

Monday 15th November 2021 Lords Chamber

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

My Lords, with the leave of the House, I shall now repeat a Statement made earlier in another place. The Statement is as follows:

“Mr Speaker, I will start by saying a few words about the incident that took place at Liverpool Women’s Hospital yesterday. This is an ongoing investigation into what has now been declared a terrorist incident by police so it would not be appropriate for me to comment in any detail, but I express my thanks to all the NHS staff and emergency services who responded to the incident. They showed the utmost professionalism in the most difficult of circumstances and my thoughts—and, I know, the thoughts of the whole House—are with them and anyone who has been affected.

With permission, I shall make a statement on the Covid-19 pandemic and the life-saving work of our vaccination programme. A year ago today, we were in the midst of our second national lockdown, a time when we endured major restrictions on our life and liberty and when we observed a period of remembrance where we could not come together and pay our respects in person in the way that we would all have wanted to. Our country has come very far since then. We have put over 109 million vaccine doses in people’s arms through our world-leading vaccine programme, which means that we can approach this winter with the best possible chance of living with the virus. The data clearly demonstrates that vaccines work. This month’s figures from the ONS show that, between January and September, the risk of death involving Covid-19 was 32 times greater in unvaccinated people than in those who are fully vaccinated.

However, although we have built up that huge protection, this is not a time for complacency. Earlier this month the WHO’s Europe director said that Europe was

“back at the epicentre of the pandemic”.

Just this weekend, the Netherlands and Austria have put in place partial lockdowns after surges in cases.

We also still face the risk of new variants just as we have seen with the emergence of AY.4.2, the so-called delta-plus variant. The latest data shows that it now accounts for around 15% of cases in the UK. Although delta-plus may be more infectious than the original delta variant, our investigations indicate that our vaccines remain effective against it. Still, we know that there will be more variants in future, and we do not want to go backwards after all the progress we have made. So we must stay focused on the threat in front of us and seize every opportunity to bolster our vital defences as the winter moves in.

That includes our vaccination programme, which is our primary form of defence. Last week, I announced to the House that health and social care providers in England must make sure that all workers other than those who are medically exempt, are fully vaccinated against Covid-19 so that vulnerable patients have the greatest possible protection against infection. Today, I shall update the House on more measures that we are taking to keep ourselves on the front foot.

First, we are expanding our booster programme, which is essential so that we can keep upgrading our protection in this country. Our vaccination programme has given us a strong protective wall, but we need to use every opportunity to shore up our defences. Evidence published this month shows how protection against symptomatic disease, hospitalisation and death from Covid-19 gradually wanes as time passes, and this is more likely if you are older or clinically at risk. Even a small drop in immunity can mean a big impact on the NHS; if protection drops from 95% to 90% against hospitalisation in those who are double-vaccinated, that would mean a doubling of hospital admissions in that group of people, so topping up our immunity through booster doses is essential to our security for the long term.

Today, the UKHSA has published the first data on booster vaccine effectiveness in the UK. It shows that people who take up the offer of a booster vaccine increase their protection against symptomatic Covid-19 infection to over 90%, and protection against more severe disease is expected to be even higher. So we are intensifying the booster programme ahead of the winter. Over 12 million people have now had their top-up jab, and over 2 million were given it last week. We have also made changes to the national booking service so that people can prebook their top-up doses a month before they become eligible. Last Monday, we saw almost 800,000 bookings in a single day in England, which is a new record.

Secondly, we are taking another step forward. The JCVI has recommended offering all adults aged 40 to 49 a booster dose six months after their second dose, using either the Pfizer or Moderna vaccines. I have accepted that advice, and 40 to 49 year-olds will be able to get their top-up jab from next Monday if they are eligible. The JCVI has also said that, in due course, it will be considering whether boosters are needed for all 18 to 39 year-olds, along with whether additional booster doses are required for the most vulnerable over the long term. I look forward to receiving that advice in due course.

Just as we extend protection through booster doses, we are also ramping up our efforts to protect younger people. Our programme for 12 to 15 year-olds is progressing at pace. Yesterday, we hit the milestone of 1 million 12 to 15 year-olds being vaccinated in England. We are also offering a vaccine to 16 and 17 year-olds. I would like to update the House on some further steps that we are taking.

In August, we decided, in line with JCVI advice, that all 16 and 17 year-olds could be offered a first dose of a Pfizer vaccine. That was apart from a small number of those in at-risk groups who were offered two doses. Now, the JCVI has advised that all 16 and 17 year-olds should also be offered a second dose, and that it is even more confident about the safety and benefit of doses in 16 and 17 year-olds. As Dr June Raine, the chief executive of the MHRA, said this morning: “As the data have accrued, we’ve become more and more reassured that the safety picture in young people and teenagers is just the same as what we’ve seen in the older population.”

The JCVI advises that, unless the patient is in an at-risk group, the second dose should take place 12 weeks after the initial dose, rather than eight weeks. I have accepted that advice. The NHS will be putting it into action. Once again, these jabs will start going into arms from next Monday. This will extend the protection of a vaccine to even more people and strengthen our national defences even further.

Our vaccination programme has paved our path out of this pandemic and given us hope of a winter that is brighter than the last. Today, we are going even further, extending our booster programme and offering great protection to younger people, so that we can fortify the defences that we have built together and help our nation to stay one step ahead of the virus. I commend this Statement to the House.”

--- Later in debate ---

[Baroness Tyler of Enfield (LD)]

My Lords, I thank the Minister for repeating the Statement. At this afternoon’s No. 10 press conference, Professor Chris Whitty made it very clear that doctors and scientists are increasingly concerned about the average of 37,500 cases over the last week and the high number of Covid cases in hospitals. Professor Whitty said that it would be a tough winter and added that, in addition to the nearly 9,000 Covid patients in hospital, all other areas of the NHS are under growing and intense pressure. He recommended that, in addition to getting their vaccinations, everyone should use face masks and ventilation to help reduce the number of cases.

This morning, Oliver Dowden, who was just referred to, said “It is in our hands” whether further restrictions in plan B are put in place this winter, but clearly the Government’s current communications on just encouraging using face masks and ventilation indoors and on transport are simply not cutting through. It certainly was not on my Tube journey in today, where distressingly few people were wearing a mask. Even if the Government do not want to implement the whole of their plan B, why will they not at least mandate face masks and improving ventilation on public transport and indoors when so many people across the spectrum are crying out for this to happen?

Leaving it to individual choice and personal responsibility is far too weak and inconsistent a message. It is crystal clear that the Prime Minister does not want to implement plan B, but is the reality not that he is far more likely to have to do so—or, indeed, move straight to plan C, a total lockdown—if mask-wearing is not made mandatory immediately? Does the Minister agree with me, and the point just made by the noble Baroness, Lady Thornton, that all parliamentarians and most particularly Ministers have a duty to set a clear example of mask wearing inside and on public transport?

Professor Whitty highlighted the stark figure that 98% of pregnant women admitted to hospital had not been vaccinated, and that same ratio applied to those in intensive care. What specific steps are the Government and the NHS taking to talk directly to pregnant women to encourage them to have their vaccinations?

It was worrying this afternoon when the Prime Minister said that he “hoped” that booster and third jabs could be logged on the online system “soon”. We have been asking questions about this system for weeks now. Can the Minister look into Pinnacle, one of the systems that logs people’s Covid status, to find out why practitioners are not yet able to record a third jab for the clinically extremely vulnerable, as well as a separate listing for booster jabs for everyone else over 40? As the Prime Minister said this afternoon, evidence of booster jabs will be required for travel this Christmas, but because third vaccinations and booster doses are still not appearing separately on the NHS Covid app, there is a great deal of anxiety and frustration among people who will need not only to have had the jabs but to be able to provide the evidence. Can the Minister say—I underline the point made by the noble Baroness, Lady Thornton—when all third doses and boosters will be on the online system?

Finally, although I welcome the announcement that it is safe for 16 and 17 year-olds to receive a second dose, can the Minister explain where 16 and 17 year-olds will be able to get that second dose? Too often, young people wishing to have their initial jab were put off because they had to travel to a centre some way away, often by bus, train or car, often involving parents providing the transport. Will the Minister undertake to look into ensuring that there are centres in town centres and other easily accessible places so that young people can more easily access their second dose?

[Lord Kamall (Con)]

I thank the noble Baronesses for those sets of questions; I will answer them as best I can. I will work backwards, starting with where people can get their vaccines: the same places where the rest of the population can get their vaccines. Only last week, I booked my booster and was reassured to find that, rather than having to go even to my local doctor—which I was quite happy to do—there were two or three pharmacies, or chemist shops, near me that were giving the booster. One of my sons has booked his vaccine and that will be at the same pharmacy. So, clearly, we are rolling out the vaccines to more accessible places than initially; I do know someone considered clinically vulnerable who had to go quite far before, but we are now bringing the vaccines as close to people as possible.

I will try to answer some of the other questions. We are focused on building a wall of defence across the country. More than 261,500 hospitalisations have been prevented in those aged 45 and older, up to September 2021. Estimates suggest that 127,000 deaths and 24 million infections have been prevented as a result of the Covid-19 vaccination programme. This is why we are keen to stress that vaccination remains the best defence against this virus.

We are also working hard to make sure that as many people as possible have their jab as soon as they can. While we are very encouraged by the booster uptake and the record numbers, only today I have been in meetings where we have been talking about how to reach those hard-to-reach communities. I know that we have spoken about this before in this House. I have, very kindly, been offered advice from noble Lords across the House and I have been working with some noble Lords in relation to their experience as community organisers or working with certain communities where the demographics have shown a lower uptake. We are rolling out the programme, and there will be a publicity programme rolling out as well. As we get more data, the JCVI and others are even more reassured by the safety of the vaccines and want to stress that as much as possible.

As I said, we are rolling out the booster programme. Nearly 10.6 million people have now received their third dose, and we are looking to vaccinate children as quickly as possible. We are working closely with schools, colleges et cetera to make sure that we get as close to people as possible.

I had hoped to be able to give a date for the booster appearing on the app. A number of noble Lords raised this with me both formally and informally, and I got straight on to NHSX to try to get an answer. I had hoped to be able to announce a date today, but I am still not able to do that. I am told, however, that good news will be available soon, and I hope it will be announced as quickly as possible. I think there are a few more checks to go through; those who have been in government before will understand how this works.

On the issue of NHS capacity, as of 12 November the number of beds occupied by Covid-19 patients had decreased by about 4% across England in the last week. Regionally, there was a drop of 4% in the east of England; a 2% increase in London; a 5% drop in the Midlands; an 8% drop in the north-east and Yorkshire; a 5% drop in the north-west; no real change in the south-east; and a drop of 8% in the south-west. Hospital admissions have decreased by 10% across England last in the week. There was a drop of 16% in the east of England; an increase of 1% in London; a drop of 11% in the Midlands; a drop of 15% in the north-east and Yorkshire; a drop of 11% in the north-west; a reduction of 8% in the south-east; and a drop of 10% in the south-west. Rates of admission to hospital with Covid-19 therefore appear to be decreasing. Hospital admissions in England were at 821 people per day as of 10 November. There were 6,777 patients in hospital in England as of 12 November, including 838 patients in mechanical ventilation beds.

In line with the approach that we have taken, we are constantly relying on data from the JCVI and its judgment, and this is constantly being reviewed in terms of rollout to different age groups. We are very fortunate to have secured a steady supply and delivery of Covid-19 vaccines. Many will also be aware of the other method by which the dose can be taken.

On making sure that we are focusing on elective care recovery, we have given £2 billion to help tackle the backlog that built up during the pandemic and have committed £8 billion over the next eight years. We hope that that funding will deliver the equivalent of 9 million more checks, scans and procedures to tackle the backlog, and we hope to have 30% more elective activity by 2024-25.

Turning to care homes, one of the campaigns being launched is the “made with care” campaign, which is advertising the fulfilling careers that can be had as social carers. It is very much focused on people who want to make a difference to other people’s lives. There is £550 million, including £162.5 million on the “made with care” campaign, and noble Lords will see that campaign rolling out.

Fortunately, 90% of staff in in older-adult care homes have received both doses, and 94% of such staff have had at least one dose. The data we are getting shows that, where care home owners are able to sit down with the workers who may have some doubts, there is an increase in uptake. Also, on a temporary basis until 24 December, people who have a medical reason why they are unable to have a Covid-19 vaccine can self-certify that they are exempt on medical grounds until that can be proven one way or another.

I am trying to make sure that I am answering all of your Lordships’ questions. If there are some that I have missed, let me assure noble Lords that I have not done so deliberately, and I will write to them to fill that information gap.

[Viscount Stansgate (Lab)]

My Lords, I hope the House will forgive me if I emphasise an issue that has already been raised by both Front-Bench speakers: when this booster jab, which I am very glad the Minister has had, as have I, is going to be recorded. As I hope the House knows, it will prevent people, many people in this House, travelling to various countries—I mention France and Israel as only two of them—unless we can prove that we have had it. Although I am very pleased to know from the Minister that he has had the booster jab, and of course I believe him, I would like to know in what way he can prove it to me by showing it to me on his phone.

[Lord Kamall (Con)]

I apologise if I have misled the House: I have booked my booster jab but I have not had it yet. I was able to book it in advance but I cannot have it until—perhaps I should not make this public, but they have given it to me one day before the six months is up. This will be all over the front pages tomorrow, it will be a huge scandal and noble Lords will be calling for my head. I understand that.

On the serious point, I share the frustration of all noble Lords who have brought this issue up. I was hoping to be able to announce a date today, but it was scratched at the last minute. I think there was some technical reason, but we hope to have good news soon. I know that will be as frustrating to many noble Lords as it is to me. Believe me, I would rather have good news than to be seen to be avoiding answering the question.

[Baroness Finlay of Llandaff (CB)]

I shall follow up on the question asked by the noble Baroness, Lady Tyler, in relation to pregnant women in particular. There were maternal deaths early on. It would be most helpful if we could have the data on the number of such women, the pattern of vaccination and the pattern of maternal deaths from Covid and severe infection. Women are still worried and hesitant because there was a failure to vaccinate early on, because the data on safety was not there. Having data on the drop in the number of deaths will help to persuade women of childbearing age to pursue being vaccinated, whether they are already pregnant or not.

[Lord Kamall (Con)]

The noble Baroness raises a very important point and I apologise for not spotting it and answering it earlier. Many noble Lords will be aware of the very sad story of a young lady who died because she felt that the vaccine was not safe; her mother is encouraging other pregnant women to have the vaccine. For that reason, we want clearly to communicate that the vaccine is safe and will not affect fertility, so getting the vaccine is the best way to protect yourself. Pregnant women are more likely to get seriously ill from Covid-19, and we know that vaccines are safe for them and make a huge difference. In fact, no pregnant woman who has had two jabs has needed hospitalisation with Covid-19. We need to make that clearer, and I will take this back to the department and the Government to make sure that we communicate more clearly. We all share the same will to share that message more widely.

[Lord Pannick (CB)]

On the NHS app, it is not simply the inconvenience to those travelling but the waste of time of NHS practitioners who are being asked to provide letters to people who are travelling. It is vital that the Minister uses his best endeavours to make sure this problem is resolved very speedily. My understanding is that those of us who travel with children under the age of 16 who have had one jab have no means through the NHS app of proving that they have had the vaccine. Is that right? If so, can the Minister do something about it?

[Lord Kamall (Con)]

The noble Lord’s first point repeats what other noble Lords have said, but for a good reason. I hope that our mentioning this more than once this evening stresses to the NHS and NHSX that it must be sorted out as soon as possible. As I said, I had hoped to have a date to announce this evening, and I am as frustrated as everyone else. We all want to travel and, importantly, there are countries that require proof of the booster.

In terms of children travelling, a solution has been developed to allow fully vaccinated children aged 12 and over to demonstrate their vaccination status. Up to now, some countries have required no proof from children aged 12 and over, but I am being told that a solution is being developed. I will try to push for that date as well, but I definitely want to get a date for when the booster will appear on the NHS app. All I can do is apologise that we have not done this yet.

[Lord Cormack (Con)]

My Lords, as we are clearly going to have to live with this vaccine for several years to come, could we have quite soon a programme for annual jabs worked out? It is clear that that is going to be necessary, and we ought to advance-plan. On the subject of masks: where one is in close proximity with others, they really should be obligatory. I came up on the train this morning, and at least half the people in the carriage were not wearing them. I am on my own on these Benches tonight, but I always wear one when others are around me, and I think that it is very important indeed that we take this elementary step so that it is compulsory on public transport, in shops and other places where people are in close proximity.

[Lord Kamall (Con)]

On future vaccinations, my noble friend raises an important point, and many will have seen in the media and elsewhere all the discussion about living with this vaccine. At the moment, we have boosters at six months; as the technology and the understanding get better, it seems likely that we will move to annual vaccinations, as we do flu jabs. I cannot say that for definite, but the trend is going that way, given the development of the virus, the variants and the waning immunity over time. The effectiveness of each vaccine at the moment is six months, but one can see the longer term. However, please do not take that as a given—if that is incorrect, I will update the House.

On public transport: I went to a funeral today, and as I was travelling back on the underground, it said, quite clearly, that you must wear a mask, so that is being encouraged. It is part of plan B if we have to move to plan B, but all that data is being analysed and constantly updated with different factors. There is no one trigger for moving to plan B. In previous appearances at the Dispatch Box, I have read out the list of all the factors that are considered. At the moment, the main message is: the vaccine works. We want to encourage people to get the vaccine and especially try to reach those communities that have not even had their first or second vaccine yet.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I declare an interest as a trustee of the GMC and the Royal College of Ophthalmologists. Can I ask the Minister about the impact on the NHS generally and the pressure it is under? He will be aware that the Academy of Medical Royal Colleges issued a statement a few weeks ago on its concern about the abuse of NHS staff. What are the Government doing to ensure that NHS staff are able to go about their work without the horrific abuse that many have had to endure?

Secondly, I refer the Minister to the report of the Royal College of Physicians, a census that shows that 48% of advertised consultant posts across the UK were unfilled last year? Does this not show that Covid has exposed the frailties in the NHS? Unless the Government grip this workforce issue quickly, the pressures on the service are going to get worse and worse. What are the Government doing?

[Lord Kamall (Con)]

The noble Lord raises a really important point on staff, doctors, nurses and other healthcare workers in our health system. The Government have a zero-tolerance approach to abuse and harassment; we are investing in better security at GP surgeries and are committed to working with the NHS to make sure our primary care workers feel properly supported. We are also constantly having conversations with trusts and the NHS generally about making sure that staff feel safe to work and how we can make sure that that happens. Anyone who has visited a hospital recently will have seen the signs about zero tolerance.

We are constantly talking to NHS England about workforce pressures. We are looking at specific campaigns—for example, we have announced social care recruitment—and other campaigns to attract more workers to the NHS.

[Baroness Bennett of Manor Castle (GP)]

My Lords, on the Minister’s comment about masks on public transport, my understanding is that that is only in London and is not the case in the rest of England. I draw to your Lordships’ attention my experience in Edinburgh Waverley station yesterday evening. Scotland of course does have a mask mandate, and it was very clearly announced at extremely regular intervals. Additionally, it came with a message that said, “That means that you are not allowed to eat anything in the station”, which I have never heard in England.

The Statement says that

“we must stay focused on the threat that is in front of us and seize every opportunity to bolster our vital defences”.

As most of the Front-Bench questions pointed out, this Statement entirely focuses on vaccines. We have been very aware of the issue of aerosol transmission for a very long time now. The last figures that I have been able to find—from a week ago—show that fewer than the promised 300,000 carbon dioxide monitors for schools have actually been delivered. They were promised by the end of the autumn term. Of course, all those CO monitors do is identify the problem—the lack of air circulation. They do not actually deal with it. Will that target be met, and will schools get their carbon dioxide monitors? More than that, are the Government providing adequate support for schools and indeed other organisations that identify a problem with ventilation?

I notice that the UK Health Security Agency is funding a trial of air purifiers of different sorts in 30 Bradford primary schools. This is two years after the pandemic started, and we have known for a long time about aerosol transmission and the problem of unventilated rooms. Not all school rooms or rooms in general—including in your Lordships’ House—can be ventilated. Are the Government really paying the attention that they should be to dealing with aerosol transmission, ventilation and air purification?

[Lord Kamall (Con)]

A lot of investment has gone into making sure that there is ventilation in schools. I will talk to my counterpart in the Department for Education to see what more can be done, but I know that the department is very aware of this issue and is looking more into it.

On the noble Baroness’s first question, we want to be clear and not confuse the message: vaccinations work and are our best line of defence. We do not want people to get a false hope that there are other ways to protect themselves. Not all people who do not take the vaccine are anti-vaxxers: some of them think that just wearing a mask may well protect them.

We want to focus on this message: get vaccinated; if you have been, get your booster; and if you have had your first vaccine, get your second one. There is nothing to fear from getting vaccinated. We are not only sending that message out but actively looking at different campaigns to reach those difficult-to-reach individuals in many communities.

[Lord Young of Norwood Green (Lab)]

My Lords, on the importance of vaccination, what are the Government doing to combat the anti-vax message? My second point is on the terrible situation in hospitals, where paramedics are forced to stay and wait with patients. There must be something that we can do to alleviate that situation until there is a long-term solution. Have we identified best practice? The Government ought to be thinking outside the box about what we can do to stop paramedics being trapped in hospital, denying them the ability to deal with other urgent cases.

[Lord Kamall (Con)]

I am sorry, but my memory has gone. What was the noble Lord’s first question?

[Lord Young of Norwood Green (Lab)]

It was on anti-vaxxers.

[Lord Kamall (Con)]

The issue of anti-vaxxers is very difficult in a society where we believe in freedom of speech. Clearly, if they are impeding people from attending school, going to certain places or getting vaccinated, that is obstruction. However, if they are saying that they do not believe that the vaccines are safe or whatever, it is really difficult and we have to get that balance right. We are clear that we want people to be vaccinated but, at the same time, we believe in freedom of speech. Quite often, if you really believe in freedom of speech, you have to allow people to say things that you disagree with, I am afraid. However, where they are actively blocking people from getting vaccinated, I think we have work to do.

As for thinking outside the box, we are looking at a number of different areas. For example, the other day I heard a case of someone who had forgotten his asthma inhaler. His partner told him, “Stay here, I’ll get you another one from the all-night chemist”. The all-night pharmacist said, “I can’t administer that”. She then went to A&E with her partner’s details. A&E said, “No, he has to come in here”. In the end, when she went back to the hotel, the hotel said, “We’ll have to call the ambulance”. All that could have been avoided had there been a way for the person who had forgotten his inhaler simply to get another one, rather than having to call in paramedics. Therefore, there are a number of different ways that we can think outside the box to make sure that we do not put undue pressure on the NHS at this time.

Clinical Negligence Claims

Lord Kamall Excerpts

Wednesday 10th November 2021 Lords Chamber

[Lord Storey]

To ask Her Majesty’s Government what assessment they have made of the increase in the value of clinical negligence claims, which are expected to cost £8.3 billion from incidents in 2019-20.

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

The costs of clinical negligence are rising at an unsustainable rate, eating into resources for patient care. Annual cash payments have quadrupled in the last 15 years to £2.2 billion in 2020-21. That is equivalent to 1.5% of the NHS budget and these costs are forecast to continue rising. This is despite our substantial safety programmes. The Department of Health and Social Care is working intensively across government to address these issues.

[Lord Storey (LD)]

I thank the Minister for his reply. I have raised this issue every year and have heard a similar response from the Minister sitting there every year. When a child is born severely disabled, the parents have to fight to get compensation or money to be able to look after that child. That can often take years. Does the Minister agree with the former Secretary of State for Health, Jeremy Hunt, that we should look at the Swedish model in which, if a child is born severely handicapped, the money is made available straightaway and the parents do not have to wait for the courts to provide support?

[Lord Kamall (Con)]

The Government have looked at a number of different schemes from abroad. It is always very important to learn from good and bad practice, but what happens in a number of those cases is that the costs of compensation end up increasing. So We are looking at various solutions.

[Baroness Davidson of Lundin Links (Con)]

My Lords, the new indemnity scheme for historical clinical negligence that was brought into effect last year, the Existing Liabilities Scheme for General Practice, initially applied only to general practice members of the Medical & Dental Defence Union of Scotland, with general practice members of the Medical Protection Society due to come under its purview a full year later, in April just past. So I ask the Minister to update the House of any formal or informal assessments of the workings of this scheme in Scotland, the level of uptake and lessons learned, before it was further rolled out.

[Lord Kamall (Con)]

Before I respond, I wish to give a belated welcome to my noble friend Lady Davidson. I have worked with her often in the past, and she displays a wisdom beyond her years and a sense of humour that excels that of many on our Benches. To answer my noble friend, the Existing Liabilities Scheme for General Practice covers the historical liabilities of GPs, where the department has agreed commercial transactions with the previous indemnity providers. The scheme applies only to general practice in England and is part of the state indemnity reforms introduced in England in 2019. These 2019 reforms mean that GPs in England now benefit from more stable and affordable indemnity to cover future negligence claims. I understand that similar arrangements were introduced in Wales at the time. I am afraid that the policy on state indemnity is a devolved matter, but officials in the department are in regular contact with their counter- parts in the devolved Administrations.

[Baroness Stuart of Edgbaston (CB)]

My Lords, some 10 years ago the NHS Litigation Authority concluded in its maternity claims report that

“the most effective way to reduce the financial and human cost of maternity claims is to continue to improve the management of risks associated with maternity care, focusing on preventing incidents involving the management of women in labour”.

Yet, in the intervening 10 years, the number of claims has gone up from 391 in 2009 to 765 in 2019-20. Is it not about time that we put patient safety first in these considerations rather than looking at what happens to lawyers, and take some lessons from the airline industry where, if something goes wrong, we start by looking at no-fault and do not allocate blame but look at improving the system?

[Lord Kamall (Con)]

The noble Baroness raises an important point. However, in looking at the system overall, there is no evidence to suggest that the rise in overall costs is due to a decrease in NHS safety. Nevertheless, safety and learning from incidents are essential in their own terms. Our ambition is for the NHS to be the safest in the world and for maternity safety to be a priority, and there are various schemes in place.

[Lord Hunt of Kings Heath (Lab)]

My Lords, can the Minister tell me why the Government do not move to repeal Section 2(4) of the Law Reform (Personal Injuries) Act 1948, which essentially disregards treatment that the claimant may receive under the NHS? Can he also do something about the record of NHS Resolution in paying damages in 80% of litigated cases, with its lawyers being paid on a win-or-lose basis and therefore incentivised to carry on with unsustainable defences?

[Lord Kamall (Con)]

The noble Lord raises an important point about how we resolve a number of these issues. As many noble Lords will be aware, when the NHS does a wonderful job, we all support it but, sadly, when it does not do such a good job, there is a culture of delay, defend and deny. Sometimes it is incredibly difficult, and I have heard of people who have had terrible experiences in trying to get someone to resolve their issue. I heard of a very sad case: a young official in the department told me that a friend of hers, a young Afro-Caribbean lady, 24 years old, lost a baby and, miraculously, the papers have disappeared. They are now trying to gaslight this poor patient. It is really important that we resolve this.

In terms of the cost, NHS Resolution negotiates large-scale contracts for defendant legal services, using its position as a bulk purchaser to obtain the best expertise. NHS Resolution is looking to resolve claims promptly and most claims are often settled without court proceedings or going to trial. It is a difficult balance because while we may be concerned about the fees of the injury lawyers, they are able to shine a spotlight on the NHS delay and denial, as it were, and go further when many patients themselves or their families are in distress.

[Baroness Walmsley (LD)]

My Lords, the element of compensation in clinical negligence cases which relates to the cost of further health treatment is based on the cost of care in the private sector. Why is this so when NHS treatment is as good or better? Should not private health costs be provided only where the patient cannot get treatment on the NHS?

[Lord Kamall (Con)]

Quite often patients choose to go on the NHS and when they are unable to do so because of various factors they will go private. I wonder whether we should be giving preference. We want to treat all patients equally.

[Baroness Eaton (Con)]

My Lords, given that the key to reducing the overall cost of clinical negligence is to have less of it, the real issue is the need to increase joined-up patient safety learning across the NHS. Does my noble friend the Minister accept that the cost of current legislation—that is, damages and claimant legal costs—is reducing in any event, as detailed in the NHS Resolution annual reports of 2020 and 2021, and that the overall payment for claims in 2019-20 was therefore £2.2 billion?

[Lord Kamall (Con)]

My noble friend raises an important point. The Government remain committed to continuous safety improvement, particularly on developing learning cultures in our health system and tackling the issues of denial and delay. While we strive towards this goal, we have seen that the cost of clinical negligence claims has quadrupled in the last 15 years, and there is no guarantee that reducing harm would necessarily result in fewer claims. In many cases, the overall costs are being driven by increases in the average cost per claim. Indeed, claims have recently levelled out, falling from £2.26 billion to £2.17 billion but this is largely due, in least in part, to the coronavirus pandemic.

[Baroness Wheeler (Lab)]

My Lords, the annual cost of clinical negligence has risen from £1 million in 1975 to £2.2 billion last year, as we have just heard. The Medical Defence Union’s evidence to the Health and Social Care committee’s inquiry into NHS litigation reform predicted that any money raised by the new health and social care levy would be entirely swallowed up by the amounts being paid out each year in NHS clinical negligence claims. What assessment have the Government made of this claim, how does it impact their plans to reduce the huge NHS waiting lists for treatments, and what money will be left for social care?

[Lord Kamall (Con)]

The noble Baroness raises an important point that spending more on compensation means less money for the care of patients. That is why we are committed to looking at various ways of reducing this and are working with the Ministry of Justice. Issues include the role the royal colleges play and the training they give to their medical staff, while needing to instil a culture of more openness when things go wrong. When things go right, we are ready to praise but when things go wrong, they have to stop hiding, delaying and denying, and be open.

[The Lord Speaker (Lord McFall of Alcluith)]

I call the noble Lord, Lord Walney. He is not present. I call—

--- Later in debate ---

[Lord Walney (CB)]

Thank you. I accept entirely what the Minister says about learning from experience but was this not supposed to have been baked into the NHS after numerous reports in recent years? Does he accept that we need to look again at the way in which the NHS trusts are often slow in learning from their mistakes, rather than allowing this culture to continue?

[Lord Kamall (Con)]

I completely agree with the sentiments behind the question. It is important that at all stages we bake in a culture of openness in the NHS so it can no longer hide behind the fact that we are full of praise for it when it does things well. However, when things go wrong, I am afraid that it shuts up shop and hides behind various techniques. It is important that we are as open as possible in trying to make sure we tackle some of the problems and learn in the future.

Covid-19 Update

Lord Kamall Excerpts

Wednesday 10th November 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I declare my interest as a vice-president of the Local Government Association. I also thank the Minister for repeating this Statement. Covid-19 Statements are now taking on the role of London buses—large gaps for a while and then suddenly two in one week on vaccines. It feels as though arguments were going on behind the scenes for such a quick second vaccine Statement to be repeated in less than two or three working days.

Like the noble Baroness, Lady Thornton, my honourable friend Daisy Cooper MP asked yesterday about the publication of the long-awaited impact statement —Making Vaccination a Condition of Deployment in Health and the Wider Social Care Sector—that this Statement refers to. It would have been helpful for MPs to have had sight of it at the same time as the Statement. As the noble Baroness, Lady Thornton, said, frankly we needed to see it a long time ago, given that the social care deadline starts tomorrow. It was finally published overnight, and I have some questions on it for the Minister.

The Statement announces that all NHS and social care staff will have to have to be fully vaccinated by 1 April 2022. The deadline for care home staff remains tomorrow. The predicted numbers on page 4 of the impact statement are pretty staggering—up to 126,000 staff, of whom 73,000 are expected to be NHS staff. Page 6 of the impact statement also says that the modelling cost of replacing unvaccinated workers is between £162 million and £379 million. That is also staggering, given the financial pressures and backlog of cases across a health and social care sector that at the moment is still struggling with the pandemic.

From these Benches we really want to see staff vaccinated but would prefer that it is voluntary and remain concerned about the consequences of tomorrow’s care homes deadline. Page 6 of the impact statement published overnight talks about the disruption to health and care services. But for social care that disruption has already started. Many care home staff have already left or this week are being fired, with a good number moving to the NHS and to retail and hospitality roles.

Large homes are reporting closing down wings of beds due to lack of staff and some smaller homes are handing back state-funded patients to local authorities. Both the Statement and the impact statement are silent on how patients will be looked after before we even get to the consequences of social care homes without beds.

So can I ask the Minister what emergency plans there are to help areas? By the way, answers that say “It’s down to local authorities” are not helpful. This is a crisis created, at least in part, by mandatory vaccines, and there are no staff or beds that can just magically appear. Or is what Sajid Javid said at the Conservative Party conference the reality: namely, that families will be expected to step up to the plate to look after their loved ones in the absence of care home beds? If so, it would be good to see Ministers’ planning for that and the consequent problems for the workforce.

The Statement says that other parts of the social care system—for example, domiciliary care—that were excluded from the original care decision will now be included, but neither the Statement nor the impact statement is clear about the deadline for those in the social care system now being drawn into mandatory vaccination. Can the Minister say what the deadline is for these new groupings? It surely cannot be that the deadline for domiciliary workers is this week. Is this just for full-time staff employed by the care sector, or will others offering regular services such as activities in care homes or subcontractors working in hospitals now be included? There are staff working as sub- contractors for the NHS who have front-line access to patients; for example, delivering meals. Are they included or excluded?

The table on page 4 of the impact statement lists the total number of staff in each sector exempt from vaccination. I cannot find anywhere the criteria for exemption. Can the Minister please tell the House what those criteria are?

I have now asked the Minister at least twice in the past fortnight about the online vaccination form which sits behind the GP records and the app. How many of those who were vaccinated overseas and those who took part in clinical trials are now on the records system? Has it increased from the 53 people that he talked about last week, and are the arrangements for logging third doses for the severely clinically extremely vulnerable, as distinct from the booster doses for everyone over 50 and health staff, now sorted out? I am still getting reports that they are not.

Finally, there has been considerable concern that the Prime Minister was not wearing a face mask at Hexham hospital yesterday, against all NHS advice. This morning, Dr David Nabarro, the World Health Organization’s special envoy for Covid-19, said on Sky News:

“I’m not sitting on the fence on this one … Where you’ve got large amounts of virus being transmitted, everybody should do everything to avoid … getting the virus or inadvertently passing it on. We know that wearing a face mask reduces the risk. We know that maintaining physical distance reduces the risk. We know that hygiene by regular hand washing and coughing into your elbow reduces the risk. We should do it all, and we should not rely on any one intervention like vaccination on its own. So … please, would every leader be wearing face masks, particularly when in indoor settings? … This virus is unforgiving, and we need to do everything possible to prevent it getting in between us and infecting us.”


Can the Minister explain why the Prime Minister was not wearing a face mask, in breach of Hexham hospital’s rules, and will he pass on those words from Dr Nabarro to No. 10 Downing Street?

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

I thank both noble Baronesses for their questions and the important points they made. It is important that we are clear about many of the issues that they have brought up.

Let us be clear that the best mitigation against this is to encourage those who are vaccine hesitant to take up the offer of vaccination. In both health and social care, we have worked extensively with key stakeholders and arm’s-length bodies to encourage vaccine take-up. This has involved a number of different measures: bespoke communications materials, paid advertising, stakeholder toolkits, positive messaging using influencers and leaders, content in different languages, briefings with different faith groups, webinars with clinical experts, vaccine champions and practical support including vaccination at places of work, flexible access to vaccine hubs, digital booking support and monitoring and support from NHS England. We will continue to encourage uptake in the run-up to the requirements coming into force.

The NHS has also focused in recent months on a targeted approach to improve uptake in hesitant groups by undertaking specific, targeted campaigns directed towards, for example, midwifery staff, ethnic minority groups in certain areas that have been hesitant and students, as well as using the booster campaign as an opportunity to re-engage staff. I thank noble Lords across the House for the advice that they have given me on how we can address hesitancy in some communities and for their very useful suggestions. I have discussed this with a number of other people, and we are looking at potential pilot projects, one working, for example, with faith communities in inner-city areas and mapping the data from Public Health England and the relevant offices.

It is interesting to see how many absences are due now to the unvaccinated. The seven-day average to 6 October 2021 shows an average of 74,863—nearly 75,000—absences in NHS trusts per day, of which more than 15,500 were for Covid-19-related reasons, including the need to isolate. This benefit would be reduced if we relied only on testing, although that remains part of our armoury.

I was asked a number of questions about scope and who this extends to. It applies to all providers, both public and private, of a CQC-regulated activity. This obviously covers a wide range of services, including hospitals, GP and dental practices, and social care providers. Further support on implementation for the sector will be provided through continuous guidance. The policy does not apply to those services and activities which are not regulated by the CQC. Children’s and social care services which are CQC regulated will be in scope of the requirement, but it will not apply to services that are provided as part of shared-living arrangements. Many of these reasons are of course as a result of the extensive consultation that has been undertaken.

I was asked for the number of uptakes. The vaccination uptake figures for NHS staff show that nearly 93% have had at least one dose. Uptakes still vary, from 84% to 97% for the first dose, among NHS trusts. Among primary care workers, this ranges from 94% in the south-west to 76% in the east of England—so we would welcome the advice of any noble Lords who have experience of the east of England. In adult social care, nearly 84% of domiciliary care staff have received one dose of the vaccine, and nearly 75% have had a full course of a Covid-19 vaccine, as of 14 October, which we believe represents the best proxy for the workforce in scope of the policy in other settings, too. So, despite our best efforts, there is still much more that we can do. I personally feel very uncomfortable about compulsion, but I also understand the arguments on both sides when I meet many patient groups and others who tell me that, if they were in hospital or a care home or had relatives there, they would feel much better if the staff were vaccinated and were protected.

What more can we do? The Covid-19 vaccines have been approved by the MHRA as safe and effective, and we continue to send that message out. Analysis suggests that the Covid-19 vaccination programme prevented more than 100,000 deaths in England as of 20 August. We continue to have targeted engagement. The NHS plan also includes one-to-one conversations for all unvaccinated NHS staff with their line manager, with clear guidance on how to do this. We have found that such one-to-one conversations are working in some cases. We want to make sure that we listen as well, hearing concerns that are seen to be legitimate as well as concerns that are not medical reasons but other reasons that staff may have for being so hesitant. It is really important that we understand, and that was all part of the extensive consultation.

We are trying to increase the number and diversity of opportunities. We are using the booster campaign, walk-ins and pop-ups for not only the public but staff as well.

A question was asked about pregnant women. Short-term exemptions from requirements are available to those with short-term medical conditions, but also including pregnancy. For pregnant women, the exemption expires 16 weeks after childbirth. This will allow them to become fully vaccinated after the birth. We will set out these arrangements, as has been called for by noble Lords, in the guidance on exemptions.

As noble Lords acknowledged, we set out yesterday an assessment of the impacts alongside the laying of the regulations. We also published a full impact assessment yesterday for the original care home regulations, and I thank the noble Baroness for acknowledging that. As committed to by my right honourable friend the Secretary of State in the other House yesterday, we will publish a full impact assessment for the regulations as soon as possible, and before Members vote on the proposed legislation. I recognise that Peers will be keen to understand the impacts of the policy as soon as possible and as part of consideration of the regulations. However, I hope that noble Lords will appreciate the necessity of trying to move as quickly as possible to ensure that patients are protected and that workers are given as much notice as possible. We will set out the statement of impact, which noble Lords will be able to consider, and it will be published before Members cast a vote.

We have done a number of things on vaccine hesitancy, and I have laid them out already. We want to encourage as many people as possible to take up the vaccine ahead of the regulations, which is one reason why we have the grace period until 1 April next year. The individual worker maintains a choice as to whether they decide to have the vaccine. Even if they choose not to have the vaccine, the registered person may redeploy them to a non-patient-facing role. When that is not possible, the worker cannot be employed or otherwise engaged by the registered person. This is incredibly important when it comes to patient-facing staff, especially for the families of those patients who are deeply concerned that their loved ones may be infected by unvaccinated staff.

I was asked how the measure will be enforced. On the approach to vaccination requirements, it is the CQC’s role to monitor and take enforcement action. At the time of registration and when inspected, health and care providers would need to demonstrate that they have effective systems in place. There are a number of measures in place to support care home workers. The majority of care home staff are now fully vaccinated, but there are a number of different programmes. Given the time, I shall not go into them but, if noble Baronesses would like more details on those encouragement programmes, I should be happy to write.

--- Later in debate ---

[Lord Kamall (Con)]

I thank the noble Lord for giving me notice of his question just before we came in. I tried to get an answer as quickly as possible, and I apologise that that answer has not arrived. I want to make sure it is absolutely right and that I am certain that I do not mislead the House unintentionally.

[Baroness Walmsley (LD)]

My Lords, as we move towards 1 April, I want to raise the issue not just of the concerns of staff, which the Minister has rightly mentioned, but the concerns of patients. Could patients in a ward, an NHS clinic, primary care or any other health setting be informed as to which members of staff have not been vaccinated? Would they then have the right to politely request that they are treated only by vaccinated staff?

[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.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as a mental health nurse, as outlined in the register. I am concerned about the unintended consequences of making vaccines mandatory for healthcare staff, despite the fact that I fully support the vaccine and have had three doses myself. It is a relatively small number of healthcare staff who are not vaccinated—I accept that it varies across the country—but is it right to give no authority at all to boards in trusts to decide the best way forward for the minority of staff who do not wish to be vaccinated? I am concerned that there will be unintended consequences associated with a lack of care staff, particularly nurses, in mental healthcare environments, which may result in poorer care for patients than if we carefully supported that small number of staff in working perhaps with patients who do not want to be vaccinated themselves.

--- Later in debate ---

[Lord Kamall (Con)]

I start by thanking the noble Baroness, not only for her question but for the conversations that we have had to help my understanding of the subject and the consequences of some of these actions. I welcome the expertise from across the House when it comes to a number of health-related issues.

The consultation quite clearly said that many felt that vaccines remain our best defence against Covid-19 and that the vaccination programme has prevented thousands of hospitalisations and deaths in the UK. The more staff who are vaccinated against Covid-19, the more likely it will be that vulnerable people in their care, and other colleagues, are protected. Several studies have provided evidence that vaccines are effective at preventing infection and transmission—and beyond preventing infection have an additional benefit of reduced transmission by those individuals who become infected despite vaccination because of a reduced duration or level of viral shedding.

On the specific question, I am sure that the noble Baroness recognises—as I know from when we discussed these issues—how complex this issue is. There are ethical and health issues, and the concerns of patients and their families, who feel much more comfortable about being treated by staff who are vaccinated.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, I think that there are probably very few people, apart from hardened anti-vaxxers, who do not accept that vaccination is good and that it has done a huge amount to reduce the impact of the pandemic, which has had such devastating effects. However, following on from the question from the noble Baroness, Lady Watkins, it would appear likely that there will be not unintended but predictable and intended consequences as a result of this policy, which is that some NHS staff, and, more immediately, some social care staff, will simply give up doing what they do. In those circumstances, what advice is the Minister or his Government offering, particularly to private sector care homes, as to what they should do if faced with staff losses other than simply to reduce their capacity to take in new patients?

I noticed that the Minister did not pick up the question from the noble Baroness, Lady Brinton, about the example that people in public life—I name nobody in particular—can set by wearing their masks, appropriately, on all occasions when it is sensible to do so. What encouragement can he offer to the rest of us about further examples being set on that front?

[Lord Kamall (Con)]

There clearly are concerns. These were expressed in the stakeholder engagement that occurred with both the social care sector and other sectors that will need to bring this in from March next year—we are bringing it in now but with a grace period until next March. A lot of this engagement and consultation discussed how we can support staff who are unwilling to be vaccinated as well as understanding their concerns and whether employers see these as legitimate.

Thinking back to the beginning of the crisis, one of the reasons this was called for in care homes as quickly as possible was the data from the early part of the pandemic, when there were a disproportionate number of deaths in care homes. A number of people, including patient groups and families of patients, were quite adamant that if their relatives were in a care home, they wanted to make sure that they were being looked after by staff who had been vaccinated.

There is another vaccine that is a condition of deployment, that for hepatitis B. I have asked medical staff whether they are concerned about this and a number have said no, because they are already compelled to have the vaccine for hepatitis B. That is a condition of deployment and staff see this vaccine as just as essential. That assuaged some of the concerns I had over compulsion. These are difficult, unprecedented times. We would not ordinarily want to go with compulsion, but the health of the nation is at risk and many people want to feel much more reassured that they, or their family members who are receiving care, are looked after by people who have been vaccinated.

[Lord Scriven (LD)]

Evidence-based policy is really important on this. Statistics from the Nuffield Trust show that, with the mitigations that healthcare and hospitals are putting in place, hospital-acquired Covid rates have been coming down since the middle of the year, while rates in the community have been rising. The reason for that is that the mitigation includes face-covering measures which, as the NHS Chief Nursing Officer, Ruth May, said in July,

“will remain in place across healthcare settings so that the most vulnerable people can continue to safely attend hospital”.

If that is the case, why was the Prime Minister not wearing a face covering when in a hospital this week?

[Lord Kamall (Con)]

I thank the noble Lord for that question and other noble Lords for their questions. I am not the Prime Minister’s keeper; it is as simple as that. We all decide for ourselves. I wear a mask whenever I can and when I talk to different people, I make sure that we are seen to be wearing masks. I thank noble Lords across the House who are leading by example by wearing a mask.

[Baroness Pitkeathley (Lab)]

Patients in care homes and hospitals suffered very badly from not receiving visitors during the three lockdowns. Family ties were strained and a lot of extra distress was caused. From next April, if all, or the majority of, health service staff are vaccinated, what plans do the Government have for ensuring that visitors do not bring Covid into hospitals and care homes?

[Lord Kamall (Con)]

In many cases, that decision will be left to the individual trust or care home. We know that a number of care homes and different trusts are already concerned about unvaccinated visitors. Many will know already that during the previous lockdowns it was very difficult to visit your loved ones in hospital. I was not able to see my father between January last year and when he died last September. It was incredibly challenging, but we understood the reasons given by the care homes.

[Lord Watts (Lab)]

The wearing of masks is a public health issue. It should not be left to individuals to make a decision on whether or not to wear a mask when they are coming into contact with vulnerable people. Can the Minister explain why the Prime Minister takes the view that he does not need to wear a mask?

[Lord Kamall (Con)]

I thank the noble Lord for pressing on that point, as a number of others have. I am assured that the Prime Minister and his team followed all the rules that they were required to follow in that hospital, whether about face masks or otherwise. This is what I have been informed and it is all I can report.

[Baroness McIntosh of Hudnall (Lab)]

Since we have a little time left, could I ask the Minister to go back to the question of the support that care homes, hospitals and other healthcare settings may need in the not unlikely event that they will lose staff as a result of this policy? I completely understand that vaccination is highly desirable and that the intention is to encourage people to be vaccinated. However, it is pretty clear that some will not be and that will have an impact. What support will be on offer in healthcare settings to people who are having to cope with the impact of losing staff as a result of this policy?

[Lord Kamall (Con)]

In consultation with the social care sector and the wider NHS, including trusts, discussions have looked at the impact and what would happen, but also how to make the message more positive, how to encourage staff to take up vaccines and how to listen to their concerns. In some cases, employers have said that they do not feel that staff have given a legitimate reason for not taking up the vaccine, but they are also under pressure from patients’ families to make sure that they employ care staff who have been vaccinated. They are trying all the different areas of persuasion, including targeted campaigns and one-to-one conversations in some cases, to encourage them as much as possible. At the end of the day, even before the introduction of vaccinations as a condition of deployment, many care homes were already trying to push their staff to take vaccinations because they are concerned about their patients.

[Lord Scriven (LD)]

As we have time, the Minister has just said from the Dispatch Box that the Prime Minister was following the rules of the trust he visited. That trust says on its website that you must

“wear a face covering when you enter the hospital until you leave”,

and adds:

“You must ensure that you wear your covering or mask throughout your visit and you must not remove your face covering/mask or kiss your loved one.”


By not wearing a mask, in either a clinical or non-clinical area, how was the Prime Minister carrying out the policy of that trust to try to save vulnerable people from being contaminated with Covid-19?

[Lord Kamall (Con)]

Whenever I have visited hospitals during the lockdowns or restrictions, we have sought advice from the staff around us. We have asked what measures are appropriate and whether we should keep face coverings on at all times. There have been times when they have said that, in particular areas, you can take your mask off. I was not at the visit yesterday, as I am sure the noble Lord will acknowledge—in fact, I was here answering questions—so I cannot go into detail. However, having visited hospitals myself, I am aware that you go in wearing a mask by default, but there are times when staff say, “In this area, you can take it off”.

[Lord Campbell-Savours (Lab)]

Is not the answer to the question asked by my noble friend that the Prime Minister was acting irresponsibly and was wrong?

[Lord Kamall (Con)]

I am afraid that I was not there, so I do not know what advice he had been given at that moment by that particular trust. Noble Lords can do trial by TV as much as they like, but while you go in with a mask on by default, when you are there with workers from the NHS who are often giving advice, they may say at times, “In this part, it’s fine. You do not need to do that.” That may well have been the case, but I am afraid that I do not know the details.

Gametes and Embryos: Storage Limit

Lord Kamall Excerpts

Tuesday 9th November 2021 Lords Chamber

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

The department has been working with the regulator, the Human Fertilisation and Embryology Authority, to ensure that it gets a chance to input into how the new scheme is implemented and that the fertility sector is properly prepared for any future legislative changes. The department has just completed a focused technical consultation that informs the final policy detail for certain categories of storage. We will bring forward legislation to enact the new policy when parliamentary time allows.

[Baroness Deech (CB)]

My Lords, I declare an interest as a former chair of the HFEA. For years, there has been disquiet over the arbitrary 10-year storage period for frozen eggs, which has forced women to make less than optimal decisions about their careers and fertility. My Bill to extend the period was in 2019 and the Government’s consultation closed in May 2020. In September 2021, the Government rightly responded that the period should be extended to 55 years, but that has not happened yet. Thousands of women know that the period will be extended but face the misery of seeing their eggs destroyed because it has not yet happened. The two-year pandemic extension will soon expire. Will the Government commit to making that change now by an amendment to the Health and Care Bill or by regulation? Will they put a moratorium on the destruction of any frozen eggs right away?

[Lord Kamall (Con)]

The Government are still considering the responses from the technical consultation in terms of extension of storage, but as I said previously, and I hope the noble Baroness will be assured by this, we hope to bring forward legislation to enact a new policy when parliamentary time allows. If an amendment is laid, we will give it due consideration.

[Baroness Walmsley (LD)]

My Lords, accurate information about the benefits, risks and success rates of egg freezing is essential to enable women to make their own decision. What progress is being made by the Competition and Markets Authority and the Advertising Standards Authority to investigate whether the provision of information is done accurately and ethically?

[Lord Kamall (Con)]

I thank the noble Baroness for raising this very important issue, because not everyone is aware of the biological facts around fertility, particularly the decline of fertility with age. If a woman freezes her eggs in her 20s, she has a higher chance of success than if she does it in her 30s. In fact, while IVF treatment has improved over the years, the success rates of IVF are still only around 30%, so it is important that as many women and couples know as much as possible. On the detailed questions that she asked, I will write to the noble Baroness.

[Lord Bethell (Con)]

My Lords, I am enormously encouraged by the Minister’s warm words and look forward to holding him to account for them. We know that women have a much better success rate when freezing their eggs at a younger age. However, the Minister knows that there are also proposals to introduce requirements to renew storage permissions every 10 years. What arrangements is the Minister considering to put in place to ensure that this does not become a bureaucratic nightmare and does not create disappointment for those who somehow do not keep up to date?

[Lord Kamall (Con)]

I thank my noble friend for his work on the subject when he was the responsible Minister to help change the policy so that all people, regardless of medical need, may benefit from greater choice about when to start their family. The 10-year renewal periods will be put in place to give people the opportunity to decide whether they wish to continue with their storage of gametes or embryos. The department is currently working with the Human Fertilisation and Embryology Authority to set out the plans for detailed implementation, including on how the renewal periods should be handled by fertility clinics to ensure that they work.

Fertility clinics will be expected to contact people storing their gametes or embryos a year before a renewal period has ended, so there would be 12 months’ notice. In addition, people will have a six-month grace period following the expiry of any renewal period, in which they can get in touch with clinics to re-engage storage if they wish. I am sorry that I am going on longer than usual, but this is an important issue. It is our view that we would provide an appropriate amount of time for clinics to contact their patients, and for patients to decide what they wish to do with their gametes or embryos in storage.

[Baroness Thornton (Lab)]

My Lords, I return to the question of the noble Baroness, Lady Deech, because we need some clarity here. For some people, months count. They will be having their eggs destroyed now, in the next few months. Therefore, while I congratulate the Government on the regulations that added two years to the 10-year period in recognition of the need to provide an extension during the pandemic, the Minister needs to be absolutely clear because time is fast running out. Are the Government going to provide interim transitional arrangements before the legislation is before the House? From these Benches, we are very keen and across the House there is an enormous amount of support for this to happen. Frankly, if the Minister brings forward the regulations tomorrow, they will go through.

[Lord Kamall (Con)]

I thank the noble Baroness for that very kind offer, but we have already stated that it is the Government’s intention that no one misses out on the opportunity to extend the storage of their eggs, sperm or embryos. As she will be aware, in 2020 in light of the Covid pandemic, we took steps to extend the storage. We are currently considering options to make sure that no one misses out on the benefits of the new policy. Given the detailed consultation we have just been through, we hope to announce details in due course. Of course, if an amendment is laid to the forthcoming Health and Care Bill, we will consider it.

[Baroness Barker (LD)]

My Lords, the Minister will have seen in the press today the case of Megan and Whitney Bacon-Evans, a lesbian couple required to undergo 12 cycles of treatment before they can access NHS-funded fertility treatment. In effect, that makes it impossible for them to access safe, well-regulated healthcare in this country. That is contrary to the aims of the Act under which lesbians were enabled to access fertility treatment, so will the Government move to stop it?

[Lord Kamall (Con)]

The noble Baroness raises a very important point about same-sex couples’ access to insemination services. In England, details of the local fertility services are determined by the clinical commissioning groups, which take account of the NICE fertility guidelines. These were updated in 2013 to include provision for female same-sex couples who have demonstrated a clinical infertility. The criteria in the guidelines were developed as a way of achieving equivalence between opposite-sex and male or female same-sex couples. However, it is clear that the NICE guidelines are now outdated, and the department has therefore agreed with NICE to start a review of these fertility guidelines. We want the same thing as the noble Baroness: equality.

David Fuller Case

Lord Kamall Excerpts

Tuesday 9th November 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

[Inaudible]—but that such a prolonged period of abuse was able to take place without it being noticed. We echo the sincere condolences to the families and friends of Wendy Knell and Caroline Pierce, as well as the many families and friends of those whose bodies David Fuller so foully desecrated.

The Statement says that the families and friends will have access to mental health support and counselling. That is good, but can the Minister confirm that it will be available for as long as they need it and will not be time limited? Will the staff at the mortuaries and hospitals, as well as the police and the over 150 family liaison officers involved in this case, also have access to counselling? They too have had to deal with this very distressing series of events.

We must obviously be very careful in our discussions today pending the sentencing of David Fuller, but we welcome the Secretary of State’s announcement for the upgrading of the trust’s independent review to an independent inquiry, to be chaired by Sir Jonathan Michael.

In August 2018, the Health Service Journal reported that 58 mortuaries that had been inspected in 2017-18 revealed that more than 500 “shortfalls” were exposed during that period. Worryingly, that included eight critical failings. At that time, the Human Tissue Authority as regulator and the various other regulated bodies undertook to look at the large increase in failings that year and to review practice. What actions were taken following those 2017-18 reports and were measures on access by staff to mortuaries among them? I ask this because, looking at the Human Tissue Authority’s codes of practice online, almost the entire focus seems to be on those whose role is to be involved with bodies. In Code A: Guiding Principles and the Fundamental Principle of Consent, the only reference I can find that does not relate to those with direct responsibilities for bodies is in paragraph 14 on page 7, which begins:

“Quality should underpin the management of human tissue and bodies.”


It goes on to say that this means that:

“practitioners’ work should be subject to a system of governance that ensures the appropriate and safe storage and use of human tissue and which safeguards the dignity of the living or deceased”,

and that

“premises, facilities and equipment should be clean, secure and subject to regular maintenance”.

One of the concerning issues relating to this case is that Mr Fuller ceased to be an employee of the Tunbridge Wells health authority in 2011 when the maintenance contract was subcontracted out. Will the inquiry look at not just whether employees of subcontractors working in sensitive areas are subject to DBS checks but whether there is a duty on their employer to report any findings to the hospital, or in this case the mortuary? Mr Fuller had a previous criminal record, but it is reported that the hospital did not know this.

There is another issue which I have not heard referred to either here or in the Statement in another place yesterday, and that is our criminal justice system’s approach to the desecration of bodies. The respected criminologist Professor Jason Roach from Huddersfield University has analysed the policing of and law in Britain towards necrophilia. He found an almost complete absence of case studies, which is not true in the rest of the world. Indeed, it was not until the Sexual Offences Act 2003 that necrophilia became a criminal offence in its own right, but he says there is no evidence that anyone has ever been prosecuted. He reports that, as part of his research in 2016, he was told by one senior police officer that it was very unlikely that the police would ever urge the Crown Prosecution Service to charge an offender.

One hypothesis that Professor Roach explores in his 2016 work “No Necrophilia Please, We’re British” is that

“the attitude of the British criminal justice system towards necrophilia echoes that of the British public, i.e. one of embarrassment, whereby those caught are either not charged with a criminal offence or, perhaps for the sake of the deceased’s family, are charged with a less degrading offence such as grave robbing. Both routes will produce less attention-grabbing stories”.

Can the Minister say if the review will look at police and criminal justice system attitudes towards necrophilia or other forms of desecration of bodies? One of the deeply unsatisfactory legacies of Jimmy Savile’s extended abuse is the suspicion of his undertaking such activities. However, perhaps through embarrassment, there has been no real examination of that case and the cultures of the places where he was able to have access to the dead.

Can the Minister say if any lessons learned so far will be reported and implemented straightaway, before the full independent inquiry reports, to give the public confidence that hospital mortuaries are safe and secured? As ever, if the Minister does not have any of the answers to my questions to hand, please will he write to me with them?

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

My Lords, this is one of the most difficult issues that we have had to address and discuss in my short career at the Dispatch Box. It is one of those crimes that are beyond imagination. Who could think that an act of such depravity would occur? David Fuller has pleaded guilty to the murder of Wendy Knell and Caroline Pierce, and all our thoughts are with Wendy and Caroline’s families and friends.

In recent days the courts have heard about a series of David Fuller’s shocking and depraved offences. He is yet to be sentenced, so I am sure noble Lords will understand that it would not be appropriate for me to comment on the details of the case while the legal process is still in progress. However, I will try to address as many of the questions about the response as possible.

This is a profoundly upsetting case that has involved distressing offences within the health service. I apologise to the friends and families of all the victims for the crimes that were perpetrated in the care of the NHS, and for the hurt and suffering that they are feeling. It has taken months of painstaking work to uncover the extent of this man’s offending. The fact that these offences took place in a hospital, somewhere all of us would hope to feel safe and free from harm, makes it all the more harrowing. This has been an immensely distressing investigation, and I thank the police for the diligent and sensitive way in which they have approached it. I also thank Maidstone and Tunbridge Wells NHS Trust for co-operating so closely with the police.

I am sure that in the inquiry all matters will be considered and that it will be as full and comprehensive as possible, but it is critical that we investigate this case thoroughly to ensure that lessons are learned. My right honourable friend the Health and Social Care Secretary is replacing the trust investigation with an independent non-statutory inquiry, which will look into the circumstances surrounding the offences committed in the hospital as well as their national implications. That will help us to understand how these offences were allowed to take place without detection in the trust and then to consider the wider national issues, including for the National Health Service. My right honourable friend has also asked the Human Tissue Authority to advise on whether changes are required to the existing legislation.

What will the independent inquiry do? We thank the NHS trust and its leadership for its quick initial work in setting up the investigation, but we have a duty to look at what happened in detail and to make sure that it never happens again. The Secretary of State has appointed Sir Jonathan Michael to chair the inquiry. Sir Jonathan is an experienced NHS chief executive, a fellow of the Royal College of Physicians and a former chief executive of three NHS hospital trusts. He has been leading the trust investigation and will be able to build on some of the work that he has already done. The inquiry will be independent and will report to the Secretary of State.

The noble Baronesses asked about the timeframe. Sir Jonathan will split his time into two parts. The first report will be an interim one, which has been asked for early in the new year. The second and final report will look at the broader national picture and the wider lessons for the NHS and other settings. We will publish the terms of reference in due course. Sir Jonathan has been asked to discuss with families and others to ensure that their feelings are fully considered and that they input into the process. Sir Jonathan’s findings will be public and will be published.

We all know that this is a shocking case. None of us ever thought that we would have to take part in a discussion such as this. Specialist police officers have contacted the families of the victims directly and privately. We want to, and we must, respect the families’ privacy at this difficult time. There is a comprehensive package of support for the families affected. This includes dedicated caseworker support, a 24/7 telephone support line and specialist support, such as mental health support and counselling, as needed and as appropriate. The trust is also talking to family members who wish to be contacted.

Kent Police has set up a major incident public portal and contact centre to manage calls, collect any relevant additional information and direct people to other sources of support. If people are interested in looking at that, they can search online for the major incident public portal and select Kent Police and Operation Sandpiper. We know that this is distressing for many people, both the families and more widely.

Wider support can also be accessed through the Ministry of Justice Victim and Witness Information page, which provides links to local support according to postcode, the 24/7 Victim Support helpline and My Support Space, a platform providing many guides and tools and access to a 24/7 live chat function. The trust has worked closely with the police to put in place a comprehensive package, and we thank the NHS trust for the measures it has put in place. We also recognise that, as the noble Baroness said, all those working in the trust and wider health service are profoundly shaken by the nature of these offences. The trust has put support in place for affected staff.

The trust and NHS Resolution are considering the right approach to compensation, but that involves getting further legal advice. The trust will provide support to the families concerned. As we have said, it is also important that we understand what is happening.

The police have so far found evidence of 100 victims of the offences committed in the hospital mortuary and have been able to formally identify 81 victims. They are seeking to identify all the victims, as is appropriate. Specially trained family liaison officers have spoken to all the families of those identified to date.

It is important to make sure that this is investigated thoroughly, and I want to be careful not to pre-empt the inquiry’s findings. Under the current regulations, the Human Tissue Authority regulates licences and inspects organisations that run mortuaries where post-mortems are carried out. Mortuaries that do not carry out post-mortems may not need to have a licence from the Human Tissue Authority. It is the responsibility of the organisation running a mortuary licensed by the HTA to ensure that the HTA’s licensing standards are met, including those relating to security. It is also for the organisation running the mortuary to ensure that safety procedures are in place.

I was asked about the DBS regime. In July the Home Office announced an independent review of the disclosure and barring regime. The review will consider the adequacy of current arrangements for criminal record checks for jobs that entail contact with the deceased. Ministers are finalising arrangements for the review, and further details will be announced as soon as possible.

I apologise to noble Lords if I have not answered their questions. I hope I will be able to follow up with answers.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am sure that the appointment of Sir Jonathan Michael will be very welcome; I have no doubt that he will do a very robust piece of work. My noble friend mentioned support for families, and the Minister made a number of comments about the support given, including care worker support and compensation. If families wish to appear before the inquiry, will the department consider making financial support available to those families in relation to legal advice, so that they can articulate their concerns before the inquiry?

[Lord Kamall (Con)]

I am afraid I am not able to answer the noble Lord’s question directly, because clearly there are some legal issues around it. I am sure he will understand if I try to find an answer and write to him.

[Lord Brownlow of Shurlock Row (Con)]

My Lords, I declare an interest as a former police officer, although it was some years ago. I warmly welcome the Statement made in the other place, particularly its tone in reference to the victims and those left behind. Among all those who have taken part in this horrendous episode, I pay particular tribute to the police and police authorities, particularly for the £1.5 million victim support package and the training and deployment of 150 family liaison officers. When does my noble friend the Minister, or the Secretary of State, expect the NHS England report to be made on the progress of measures? If he does not know at the moment, could he write to me?

[Lord Kamall (Con)]

As my noble friend anticipated, I am afraid I do not have a detailed answer. I am sorry; I wish I did have the answers, but I will write to him.

[Viscount Stansgate (Lab)]

My Lords, the Minister has quite correctly said that Sir Jonathan Michael has great experience of the NHS. Sadly, it is in the nature of this shocking case that his inquiry will have to range more widely than the NHS. Will the Minister therefore suggest to Sir Jonathan that he consults the National Association of Funeral Directors? It has a lot of experience, through the guidance it has issued on access to mortuaries, and advice that it could give the inquiry. I think it would welcome consultation. We must do all we can to restrict access in mortuaries to only those people who have an essential reason to be there.

[Lord Kamall (Con)]

I thank the noble Lord for that suggestion. As far as I understand, the inquiry will be as wide ranging as it can be and wants to include input from as many people and stakeholders as possible who are affected by, or will be affected by, the implications of the investigation. There are already a lot of calls. A number of people have spoken to me today informally, for example, with a number of suggestions, making me recognise how much wider this goes. It is not just about the storage of bodies in hospitals but in other places, including funeral directors’ premises. I am sure that the suggestion will be considered, but I will confirm that.

[Lord Faulks (Non-Afl)]

My Lords, I welcome the Statement and welcome the inquiry that is to be set up. I hope that lessons will be learned from it. The Minister mentioned the question of compensation and how legal advice was being sought in relation to that. I think that advice will indicate that the law is extremely complex in this area, unsurprisingly perhaps. Of course, it is also complex in the criminal area, as the noble Baroness, Lady Brinton, pointed out.

On the question of civil compensation, there have already been certain stories to the effect that millions of pounds of compensation are going to be obtained. There is the likelihood, I suspect, of there being some great case—as there was, for example, in the Alder Hey body parts litigation, and I declare an interest as being one of the lawyers involved in that. I respectfully suggest that that is not something that will benefit very much all those affected by these dreadful events. I respectfully suggest to the Minister, for consideration by his department, that, rather than embark on long, complex and uncertain litigation, it would be wise to set up a scheme to provide some form of statutory compensation for a set amount which would be an appropriate recompense for these dreadful events.

[Lord Kamall (Con)]

I thank the noble Lord for that suggestion. As we are all aware, there is a wide range of experience across this House, and it is important that we draw on that when it comes to considering the terms and parameters of the inquiry. The trust and NHS Resolution are considering the right approach to compensation and, as the noble Lord acknowledged, that does involve getting further legal advice. The trust has been quite clear that it will provide support to the families concerned. One of the things that this Statement has brought out is the wide range of experience and the suggestions that have been made by noble Lords for helping the inquiry along. I welcome those suggestions and will feed them back into the department.

[Lord Selkirk of Douglas (Con)]

Will the Minister very kindly pass on the condolences of this House to the families concerned? Will he accept that the presence of CCTV, as used by local authorities, can readily deter a great deal of crime, due to the fear of crimes being caught on camera? Pilot schemes have been tried out in Scotland and have been found to be very effective. I ask the Minister not to rule out the possibility of CCTV playing an increasing role against appalling crimes.

[Lord Kamall (Con)]

I thank my noble friend for that suggestion. In conversation today with my officials, as I was preparing for the response to this Statement, the issue of CCTV did come up. At the moment, it is clear that we do not want to draw any conclusions yet. The inquiry will be as wide as it possibly can be and will carefully consider such suggestions but also make sure that we are aware of the consequences of any suggestions, including possible unintended ones, and where there might be concerns about further use of CCTV. We have to make sure that we get the right balance. We know that, where CCTV has been deployed in the past, there have been concerns about civil liberties. That may or may not be relevant here, but we always have to be aware of concerns that, whenever the solution might appear simple to us, we understand the consequences, intended and unintended.

Public Health England (Dissolution) (Consequential Amendments) Regulations 2021

Lord Kamall Excerpts

Tuesday 9th November 2021 Lords Chamber

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

My Lords, I thank the noble Baroness for securing this important debate on secondary legislation in relation to the Government’s public health reforms, and also for this opportunity to explain why they were made, and the context.

Since the outbreak of the coronavirus pandemic, the country has faced its greatest health and economic challenge for decades. The pandemic has highlighted the immense economic, societal and personal costs that ill health can bring, particularly to the most vulnerable. It has also identified weaknesses in our public health system. That is why, in August 2020, the Secretary of State for Health and Social Care announced the Government’s intention to reform the public health system in England. Since that announcement, we have worked to transform our national health protection capabilities to put prevention of ill health and the tackling of health inequalities at the heart of government and to more deeply embed prevention and health improvement expertise across local and national government and the National Health Service. These reforms are driven by lessons learned from the pandemic and by the need to make sure that we have a public health system fit for the future.

From 1 October this year, a new public health landscape was established, and Public Health England was closed. The health protection capabilities of Public Health England, the at-scale operational capacity of NHS Test and Trace, and the analytical capability of the Joint Biosecurity Centre have been brought together into the new UK Health Security Agency to lead the response to Covid so that we now have an organisation dedicated solely to identifying, preventing and managing threats to health. As some noble Lords have acknowledged, the new Office for Health Improvement and Disparities has been created in the Department of Health and Social Care, and the OHID will help our health system to go further in promoting good health and tackling the top preventable risk factors for poor health and disparities.

One noble Lord raised the issue of prevention and cure. One of the conversations I have had with many health experts in my short time in this job has been about how we make sure that we save more money and lives and achieve better health by focusing on prevention rather than, necessarily, cure. I know that noble Lords will remember the debate we had the other day on obesity and what is being done by the OHID there. Now, working with a new cross-government Cabinet committee for health promotion, we will drive and support the whole of government to go further in improving health and tackling health disparities. Alongside this, we have strengthened NHS England’s focus on prevention and population health, transferring to it important national capabilities that will help drive and support improved health as a priority for the whole NHS. Important national disease registries have also moved to NHS Digital.

On the recently laid secondary legislation and the question of ensuring that there is consultation and scrutiny, the amendments themselves do not give effect to the establishment of the UK Health Security Agency, or OHID, or the dissolution of PHE. Public Health England and the UK Health Security Agency are executive agencies of the Department of Health and Social Care, and NHS Test and Trace was part of the department. The restructuring of public health functions in England was therefore an administrative process. The regulations in question were made and laid in accordance with the negative resolution procedure. They make minor consequential amendments to existing legislation, to ensure that the statute book accurately reflects the administrative changes that have taken place. They are not the vehicle for implementing the substance of our public health reforms. There will be further regulations containing references to Public Health England, which need to be updated. I assure noble Lords that they will be amended in accordance with the affirmative resolution procedure and will be debated in Parliament.

I turn now to some of the individual points made. On engagement with stakeholders, since the reforms were announced, a senior stakeholder advisory group was established to advise the Department of Health and Social Care on the best arrangements for national prevention and health improvement functions. I thank the noble Lord, Lord Hunt, for pointing out that praise for Public Health England was not universal. Many will have read articles from health experts, probably the most damning of which was You Had One Job. Questions had to be asked, but we looked at the stakeholder advisory group—its membership and terms of reference are published—and the group included public health, the third sector, think tanks, the health service, local government and other expertise. It worked quickly and we are grateful to all who contributed. Throughout the reform programme, we actively supported and welcomed views from key stakeholders across the spectrum of public health.

We have engaged quite widely, commensurate with the need to make quick progress and not foster a lingering uncertainty for staff, delivery partners and stakeholders. A Written Ministerial Statement was made in March, when we formally established the UK Health Security Agency from 1 April. We also published our evolved proposals in March, including the establishment of what is now OHID, and we invited views on a number of questions to support the successful implementation of the reforms.

Going forward, there is a new cross-government Cabinet committee for health promotion. This means that, across government, we will drive forward action on the wider determinants of health, ensuring that health is a shared outcome and priority. We will make sure that we work across government in a joined-up way.

Also, the creation of OHID—with the “D” for disparities—makes sure that, right at the centre of public health, we are looking at inequalities in the system. Far too often across this country, public health has been seen as the preserve of the privileged white middle class, as opposed to poorer communities. It is important that we make sure that this is no longer the preserve of the privileged white middle class, but of the working class, other people and immigrant communities, who understand some of these disparities in their communities.

Our reforms are explicitly designed to ensure that the different dimensions of public health have the dedicated national attention that each threat faces. The UK Health Security Agency focuses on health security; the Office for Health Improvement and Disparities, on better health and tackling these health disparities; NHS England, on delivery of NHS services to protect and improve health; and NHS Digital, on securing our gold-standard disease registers.

This year, we increased the local authority public health grant and allocated over £100 million of additional funding to local authorities. We are also investing £500 million over the spending review period to improve the Start4Life offer, and we have confirmed additional investment of £300 million to help people to achieve and maintain a healthy weight. Rather than proposing a one size fits all, we are also looking at pilot projects. We look at this as a process of discovery; we all have to admit that we do not have infinite knowledge and sometimes do not always foresee unintended consequences. By piloting projects and allowing the discovery process to take place, we can learn more.

In terms of the pandemic and future pandemics, the UK Health Security Agency’s sole purpose is to ensure the UK is protected from all future health threats, including pandemics, and to make sure we continuously assess our preparedness plans for infectious disease outbreaks. In future, critics can no longer say, “You had one job; why didn’t you do it?” We are focusing on health security.

We are hoping that the Office for Health Improvement and Disparities will work on prevention across all parts of government, given the cross-cutting nature of public health, making health improvement and disparities a focus of government. We are looking at a number of projects and key Covid programmes, making sure that we build back better and that we learn from the issues.

The noble Lord, Lord Hunt, asked about independence and accountability. The public health system in government needs a trusted source of independent scientific advice on health improvement to support evidence-led national decision-making and a focus on health inequalities. The Office for Health Improvement and Disparities will continue to make available and publish public health advice, research, evidence and data analysis, as Public Health England did previously, through a newly recruited Deputy Chief Medical Officer. The Chief Medical Officer will provide professional leadership for the Office for Health Improvement and Disparities, while Ministers will remain in charge of and responsible for policy decisions in that direction.

We hope that these reforms to the public health system that have been explained today will do that, and keep us safe and healthy into better times ahead. Vigilance, prevention and reform are the key words to keep us all safer and, I hope, improve the health of the nation, not only in certain communities but to tackle those disparities where they may have felt ignored in the past.

[Lord Cormack (Con)]

Does my noble friend accept that scrutiny by Parliament is essential?

[Lord Kamall (Con)]

Maybe it is because I speak rather quickly, but in my remarks just now I talked about the difference between the negative and affirmative procedures, and the affirmative procedure needing parliamentary scrutiny—so I do agree.

[Baroness Merron (Lab)]

My Lords, this Motion has given an opportunity to put dissent and concern on the record, and we have heard that through voices from across the House. I am left thinking as a result of this debate that any reorganisation, particularly one such as the one we have discussed, would have greatly benefited from proper parliamentary scrutiny. I literally regret that this was not the case.

I am grateful to noble Lords for their thoughtful contributions and consideration. I echo the words of my noble friend Lord Howarth of Newport in giving thanks and appreciation of Public Health England and the entire team, led by the chief executive as was, Duncan Selbie.

Improvement of the health of the nation and the equal chance to live a long, happy and healthy life is paramount. As my noble friend Lord Stansgate said, sidelining Parliament is not the way in which to tackle this advance. Similarly, my noble friend Lord Hunt highlighted the fact that there had been a shift of blame from Ministers to officials—which again, as we have heard in this House, cannot be an acceptable way forward. I hope that the Minister heard his noble friend, the noble Lord, Lord Lansley, who called for an inquiry and for Ministers to think again about the best way in which to manage public health responsibilities. I am sure that the Minister will listen to those words as well the others that we have heard today.

While I appreciate that the Minister has been left somewhat holding the baby on this one, I have heard what he has said. Although I am disappointed in many of the conclusions that he has drawn, I beg leave to withdraw.

Cancer Drugs: Licensing and Approval

Lord Kamall Excerpts

Monday 8th November 2021 Lords Chamber

[Baroness Morgan of Drefelin (CB)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and declare an interest as chief executive of the charity Breast Cancer Now.

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

NICE is committed to publishing draft guidance on cancer drugs around the time of licensing, with final guidance published within three months of licensing wherever possible. The MHRA and NICE work closely together to ensure that licensing procedures and health technology assessments are as streamlined as possible. For cancer drugs, the NHS in England provides funding from the point of draft positive NICE guidance, delivering faster access to promising new cancer treatments.

[Baroness Morgan of Drefelin (CB)]

My Lords, the delay between licensing and NICE technology appraisal has been dealt with in the case of two out of the three drugs approved under Project Orbis, through agreements between NHS England and the drug company concerned. Unfortunately for women with secondary incurable breast cancer, for which there are very few treatment options, no agreement has been made with the drug company Gilead, and this creates a new treatment lottery. Are interim access agreements meant to be the permanent solution, and if not, what can be done to address this lottery and close the gap between Orbis licensing and NICE appraisal?

[Lord Kamall (Con)]

I thank the noble Baroness for her Question. Clearly, there is distress and concern at the delay between MHRA approval and NICE licensing. The drug Trodelvy was licensed by the MHRA for both unresectable locally advanced and metastatic triple-negative breast cancer through Project Orbis. On NICE’s appraisal of Trodelvy to determine its clinical and cost-effectiveness for use in the NHS, NICE hopes to have guidance next year but, in the meantime, NHS England, NHS Improvement and NICE continue to work with the manufacturer to explore options for interim access to Trodelvy.

[Lord Hunt of Kings Heath (Lab)]

My Lords, despite what the Minister says, the fact is that innovative new drugs such as the cancer drugs the noble Baroness mentioned are reaching patients in this country far too slowly. We lag behind many other countries. How can we expect to be a centre of science and research if the NHS is so slow to develop the medicines that are produced?

[Lord Kamall (Con)]

I think noble Lords will agree with that frustration at the speed of approval and licensing, but in most cases it does happen speedily. One of the central issues is making sure that there is confidence in the ability to purchase. We are looking at a number of different ways to accelerate the process, including through ILAP—the accelerated partnership—while also making sure that MHRA and NICE can speak where they are allowed to, given some of the legal restrictions on their discussions. For example, I went a couple of weeks ago to a board-to-board meeting between MHRA and NICE at which they discussed issues of common concern.

[Baroness Brinton (LD) [V]]

My Lords, picking up on the point of the noble Lord, Lord Hunt, there is a particular problem in the United Kingdom with NICE and MHRA appearing not to talk together as much as they should to help streamline the process, where that is appropriate. An academic paper in March demonstrated that the CDC in America has a much stronger, streamlined system that works, with far fewer drugs being delayed. How can NICE and MHRA learn from what is happening abroad?

[Lord Kamall (Con)]

It is important that we learn the best lessons from abroad on incredibly important issues such as this. Where NICE and MHRA are allowed to talk to each other and co-operate—there are some restrictions, as I am sure many noble Lords are aware—both clearly recognise that there are great concerns and distress on the part of the many patients who want access to these drugs, and they are trying to work out how they can speed up the process as much as possible.

[Baroness Masham of Ilton (CB) [V]]

My Lords, how can we speed up the process once new, innovative medicines have been approved by NICE so that patients get their benefit? Is the Minister aware that other countries, especially Germany and France, are leading the way with cancer drugs while England is near the bottom of the list? That is not good enough, is it?

[Lord Kamall (Con)]

I thank the noble Baroness. It is important that NICE, MHRA and others hear some of the concerns, and the fact that we are being held to account today shows how important this is. Unfortunately, some existing legislation restricts MHRA’s ability to share information with partners, including NICE, which would help them to plan their processes more efficiently. NICE, MHRA, NHS England and NHS Improvement are talking about the concerns raised by noble Lords and generally about delays in the process. They are talking about how they can improve access, including through initiatives such as the Innovative Licensing and Access Pathway launched in January 2021, and sharing as much information as they can upfront. Both MHRA and NICE are aware of the concerns and made that clear when I met them recently after their board-to-board meeting.

[Baroness Thornton (Lab)]

My Lords, I will follow up on questions that noble Lords have already asked. The ongoing NICE methods and processes review missed the opportunity to propose a new process to mirror accelerated regulatory processes. There are concerns that capacity constraints will limit NICE’s ability to publish decisions as close to marketing authorisation as possible, including for oncology drugs, through the new Project Orbis route, as has been the case with the secondary breast cancer drug, Trodelvy. Have the Government assessed whether the system is fit for purpose in achieving the objective which the noble Lord has articulated: to deliver quick patient access to new, clinically effective treatments? What concrete steps have been taken so far to address any concerns?

[Lord Kamall (Con)]

Both NICE and MHRA are aware of the concerns, particularly regarding the delay between approval and licensing. That is why they are having conversations with NHS England and NHS Improvement to make sure, as far as possible, that they can discuss co-operation to ensure the speedy approval of drugs.

[Lord Robathan (Con)]

My Lords, regarding the efficacy of cancer treatment, so far this year, six friends of mine have died from cancer; all were under 80 and three were younger than me. I know of many more who have terminal cancer, regrettably. I also knew one person who died from coronavirus aged 55. She had leukaemia, or blood cancer, which destroyed her immune system, and she caught the virus while she was being treated in hospital. To put cancer in perspective, how many people under the age of 80 have died this year from cancer and how many people under the age of 80 have died in this terrible pandemic, which has shut down society, damaged our children’s education and mortgaged their future for decades to come?

[Lord Kamall (Con)]

I thank my noble friend for his question. The focus was on fighting Covid and making sure that people were vaccinated as quickly as possible. As noble Lords know, economics is about the allocation of scarce resources and there are always trade-offs. Sometimes there are unintended consequences of focusing on one condition rather than another. I will write to my noble friend with an answer to his specific question.

[Baroness Stuart of Edgbaston (CB)]

My Lords, so far, we have spoken about England. The drugs are licensed for the whole of the United Kingdom and NICE regulates what happens in England. Wales is aligned to some extent and Northern Ireland much more closely; Scotland applies a different system. Will the Minister undertake to look at whether other parts of the United Kingdom are dealing with this more efficiently? As he does so, will he also take care that NICE is not being used as a back-door way of rationing?

[Lord Kamall (Con)]

The noble Baroness raises an important point, especially given that health is devolved to the devolved Administrations. As much as possible, we work England-wide, but we also ensure that we co-ordinate UK-wide and that Ministers and officials regularly meet with those from the devolved Administrations.

[Lord Hannan of Kingsclere (Con)]

My Lords, some of the territories in the world which have the cheapest, safest and widest choice of medicines do not have their own regulators. Instead, they automatically recognise the decision made by globally acknowledged licensers. Does my noble friend agree that one way of addressing the question of expedition that the noble Lord, Lord Hunt of Kings Heath, and others raised would be for global Britain to work for the consumer as well as the drugs companies and to recognise automatically drugs licensed by the FDA, the European Medicines Agency and other equivalent bodies?

[Lord Kamall (Con)]

I thank my noble friend, who has been an advocate for free trade, for his question. Sometimes in the conversation about recognition, there is a debate between harmonisation and mutual recognition but also unilateral recognition. One of the concerns often raised when looking at unilateral recognition is that negotiators feel that, sadly, they are losing a bargaining chip. The other thing to recognise is that one country’s standard is often another country’s non-tariff barrier. MHRA is the UK regulator and I have been told that it thinks it important that we have our own arrangements in place for the regulation of medicines.

NHS: Fracture Liaison Services

Lord Kamall Excerpts

Monday 8th November 2021 Lords Chamber

[Lord Black of Brentwood (Con)]

I beg leave to ask the Question standing in my name on the Order Paper and note my interest as co-chairman of the APPG on Osteoporosis.

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

I thank my noble friend for raising this issue and for the work he has done as part of the all-party group. I look forward to reading the report it is writing on this important service. The NHS has prioritised the fracture liaison service as a key part of its elective recovery plans, after this was a recommendation from the best musculoskeletal health pathway improvement programme. NHS England is working closely with integrated care systems to support the implementation of this and other services.

[Lord Black of Brentwood (Con)]

I thank my noble friend for that Answer. He will be aware that fracture liaison services are vital for the identification and treatment of osteoporosis. That silent disease, as it is known, causes over half a million broken bones each year—one every minute—and as many deaths, resulting from fractures, as lung cancer and diabetes. The FLS is the world standard for fracture prevention, yet too many suffering from osteoporosis are unable to access the service. Is my noble friend aware that, when the Royal Osteoporosis Society surveyed NHS trusts in England, only 51% confirmed they provided the service and many of those are underfunded? Can he tell us what action the Government will take to reduce such clear health inequalities and make sure that fracture liaison services are available to all?

[Lord Kamall (Con)]

I thank my noble friend for highlighting the importance of this issue. There are MSK leads in local regions who have the ability to focus on what is best for their local region, with the incorporation of key performance indicators related to the FLS within the national clinical audit. NHS England has also convened a group of key clinical opinion leaders to develop an evidence-informed integrated secondary fracture prevention pathway for sharing with integrated care systems. There are many other issues that I could mention, and I would be happy to write to my noble friend.

[Lord Brownlow of Shurlock Row (Con)]

My Lords, I declare my interest as a donor to and patron of the Royal Osteoporosis Society and a member of the osteoporosis APPG. As my noble friend said, fracture liaison services are the world standard for secondary fracture prevention. According to the Royal Osteoporosis Society, for every £1 spent on FLS in the United Kingdom, the taxpayer can expect to save £3.28. By levelling up FLS provision to cover everyone over the age of 50 in the United Kingdom, we could prevent just under 5,700 fragility fractures every year, saving the taxpayer £65.7 million. Could the Minister confirm that the Government will invest further in prevention as well as cure?

[Lord Kamall (Con)]

I very much agree with my noble friend that the prevention of illness is as important as the cure. In conversations I have had with the NHS and other healthcare professionals, there is a focus on prevention. Some noble Lords may remember the debate we had a couple of weeks ago, focusing on the prevention of obesity rather than treating its symptoms. The NHS is prioritising FLS and similar services when it comes to prevention, understanding that this benefits not only patients but taxpayers.

[Baroness Bull (CB)]

My Lords, I declare my interest as an ambassador for the Royal Osteoporosis Society. Vertebral fractures are the most common osteoporotic fractures, but with 70% of these going undiagnosed, the opportunity for early identification of osteoporosis is missed. Does the Minister support the recommendation of the Royal Osteoporosis Society that all diagnostic imaging services should be required to routinely look for and report on vertebral fractures in any spinal imaging they undertake, whatever its primary purpose? Does he agree that this reporting should be unambiguous and actionable, via the FLS where possible, so that patients are put on the right pathway for osteoporosis assessment and care as soon as possible?

[Lord Kamall (Con)]

The department and the NHS continue to work with interested groups to expand the understanding of the wide-ranging needs of people across the country. One example is NHS England’s Covid-19 MSK—musculoskeletal—stakeholder group, which is advising on the impact that lockdowns have had on the physical and mental health of those with MSK conditions. Collaborating with NHS England were the British Orthopaedic Association, the British Society for Rheumatology, the Chartered Society of Physiotherapy, the Arthritis and Musculoskeletal Alliance, and Versus Arthritis. Self-managed resources for patients are being developed. I will write on the specific question that the noble Baroness asked.

[Baroness Walmsley (LD)]

My Lords, could the Minister say what research is being carried out to establish the extent to which universal provision of fracture liaison services could relieve the pressure on hard-pressed GPs, ambulance services and A&E departments?

[Lord Kamall (Con)]

NHS England and others are well aware of the need to reduce the pressure on GPs and other services that the noble Baroness mentioned. That is why they very much welcome the investment in 100 community diagnostic centres, not only on NHS premises but in places such as football stadiums, shopping centres, and so on, making sure that there is more access to these services and that patients can be seen quicker and more speedily.

[Baroness Merron (Lab)]

My Lords, there is no inevitability about osteoporosis and broken bones as the result of getting older, and yet osteoporosis affects 50% of all women, with those going through the menopause and after menopause experiencing it at a higher rate of incidence due to the reduction in oestrogen levels. Does the Minister acknowledge that two-thirds of women are not getting the treatment that they need, and that this was the case even before the pandemic? What steps are the Government taking to improve access by women to HRT and treatment for osteoporosis?

[Lord Kamall (Con)]

The noble Baroness raises an important point. A number of people are still waiting to be seen; NHS England is very much aware of the backlog and wants to address it. As a key part of the elective recovery plans, NHS England is working with a number of local integrated care systems to establish a greater number of clinics, as well as with community diagnostic centres, and is developing business cases. NHS England is also working with experts in the field of musculoskeletal health to improve patient pathways and to find new opportunities that, over time, will improve patient care and access.

[Lord Lexden (Con)]

Do the Government accept the estimate provided by experts that some 90,000 people a year are missing out on the bone-strengthening medication that they need? What is being done to tackle this problem?

[Lord Kamall (Con)]

My noble friend raises an important point. We accept this estimate; we are working hard to remedy it and to provide the healthcare that people need. The NHS has established the Best MSK Health national improvement programme, which is focused on improving the whole pathway for those with MSK conditions. That programme will include identifying and tackling variations in access, outcomes and experiences. I am also encouraged to see that the NHS is keeping FLS as a priority in its recovery plan, which includes plans to deliver more of these services across the country. On top of that, the Office for Health Improvement and Disparities is looking specifically at the issue of disparities, not only for MSK conditions but for others.

[Baroness Masham of Ilton (CB) [V]]

Can the Minister ensure that people living in rural areas who are at risk of osteoporosis will be able to be diagnosed by a DEXA scan? Is he aware that this opportunity has been turned down for the local hospital at Northallerton, despite the wishes of the consultant and the Friends of the hospital who raised the money to buy one? What can be done about that?

[Lord Kamall (Con)]

I am not sure about the specific case that the noble Baroness raises, but I will write to her. However, generally, there is an investment of £2.3 billion to increase the volume of diagnostic activity and to roll out at least 100 community diagnostic centres, to make sure that we are taking diagnosis closer to patients in their communities.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I do not understand. The noble Lord and his Ministers are taking powers in the health Bill going through the Commons at the moment to issue directions to NHS England. So why on earth can he not issue a direction to NHS England to simply say that every integrated care system must have one of these services, given the evidence that noble Lords on his side of the House have given about the benefit of doing so?

[Lord Kamall (Con)]

The Government recognise the importance of FLS, as does the NHS. That is one of the reasons why they are looking to roll out these community diagnostic centres, to make sure that the technology and the scanning is as close to the patients as possible. Just this morning, I had a meeting with one supplier who is talking about a partnership with a number of integrated care systems to make sure that they roll out the systems as close to patients as possible.

[The Deputy Speaker (Lord Faulkner of Worcester) (Lab)]

My Lords, the time allowed for this Question has now elapsed. That concludes Oral Questions for today.

Covid-19 Vaccinations

Lord Kamall Excerpts

Monday 8th November 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, from these Benches, we add our thanks to all those involved in the current delivery of vaccinations, whether they are GPs, nurses, healthcare assistants or volunteers at vaccination centres, and we thank more broadly our NHS and care-sector staff who are still working extremely hard to reduce the backlog of cases while coping with over 9,000 patients currently in hospital with Covid.

The Minister knows that the Delta variant and its subvariant, which is thought to be behind the growth of cases in the west country and Wales, remains highly transmissible. Doctors are reporting daily that double-jabbed patients are catching Covid and passing it on. Why have none of the mitigations in plan B been carried out? Many scientists, including some members of SAGE and Independent SAGE, believe that we should be operating them now to reduce the high numbers of cases and not be faced with a second Christmas being cancelled by the Prime Minister at short notice.

From these Benches, we have asked time and again for the wearing of facemasks inside and on public transport, as well as room ventilation in schools and other public venues, to be mandated, and for social distancing to remain. There are now, on average, 35,000 new cases daily, a shockingly high number. Professor Peter Openshaw, the chair of NERVTAG, said today that it was clear that immunity from the vaccines is waning. Yes, and vaccination is vital, but with cases at this level why are the Government not making mask mandates and social distancing formal?

Today, the Prime Minister once again reminded people to get their jab, whether first, second, third or booster, the ONS data showing that the risk of dying from Covid is 32 times greater in unvaccinated people. Can the Minister tell us why last week it was announced that vaccination centres are now closing at 6pm? Surely it should be easy for people to get vaccinated at a time that works for them, when they leave for work or get home from work?

The last time we spoke about Covid, I asked the Minister what the Government were doing to prevent some of the very unpleasant anti-vaxxer interventions at school gates and outside some vaccine centres. Has any action been taken on their disgraceful leaflets, which deliberately look like an NHS document but are full of direct lies and mistruths? It is important, because, by the Minister’s own numbers in this Statement, only 22% of 12 to 15-year olds have had their vaccination so far. I think Ministers now recognise that cases in this age group are driving cases in the older age groups, which is probably why hospital numbers are going up.

The noble Baroness, Lady Thornton, referred to the muddle between booster and third doses. The pandemic is far from over for immunocompromised and immunosuppressed people. I declare my interest as one of the clinically extremely vulnerable, as I have said before. I discovered by chance, reading something online, that I am now in the third-dose category. My GP did not know it and I certainly did not know it either. That is the problem. GPs and vaccination centres have not been told about the distinction. I have read the NHS guidance on the third dose, but many other clinically extremely vulnerable people are saying that their surgery or vaccination centre does not understand which category they fall into.

This is not helped by the problems with the online form which I asked the Minister about last week. Does the online form now specify the third dose, which is for around 800,000 people, according to current estimates, not for 400,000 people, as the noble Baroness, Lady Thornton, said, as distinct from the booster, which is for around 20 million? It is important, because the third-dose patients must have a booster in a further few months. If the system is not even recording the third dose, how will it know to call them back?

With the end of the shielding programme on 17 September, Sajid Javid wrote to all those on the patients’ list to inform them that it had finished, that the Government would no longer be offering specific advice and that we should go to our hospital clinicians. But many of us do not have an appointment in the diary, and there is not likely to be one because our clinicians are catching up with the backlog of cases, and those who are specialists in immune diseases are working on the Covid wards as well. So can the Minister say how on earth the clinically extremely vulnerable are meant to know what to do in the meantime?

Will the Minister ensure that the Government will work with patient organisations, clinicians and employer to produce clear and meaningful guidance that promotes safe working practices for this group and, in particular, let employers know that they have to help employees either to work from home or, if they have to go in, to make sure they do not have to go in by train or bus at peak hours? Please will the Government appoint a dedicated national lead to co-ordinate the support and guidance available to people in this group?

The news in the Statement of the approval of the Merck and Ridgeback antiviral Molnupiravir is also good news. I see that just under half a million courses of doses have been ordered. It was good to hear on Saturday of the success of the Pfizer clinical trials elsewhere, but I gather we are some way off from that being approved, because further trials of people who are clinically vulnerable are needed. Can the Minister tell the House the likely timescales of the actual delivery of both these different antivirals?

Finally, I am aware that I have asked some technical questions. If the Minister cannot answer them today, please will he write to me with the answers?

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

I thank the noble Baronesses for their questions and for raising some very important points, on which I and others have been in discussion not only with health professionals but with departments and other advisers. I will try to answer their questions in detail. The ones that I do not answer because of their technical nature—as the noble Baroness, Lady Brinton, acknowledges—I will try to answer later if I am unable to answer now.

First, I join the noble Baronesses, Lady Thornton and Lady Brinton, in praising our wonderful doctors, nurses and other healthcare staff. Also, we should not forget all the wonderful people who have supported them: the delivery staff who brought stuff to their homes and delivered food, and the local civil society projects. We saw a massive upsurge in voluntary work and volunteerism. Whatever our politics, whatever part of the spectrum we are on—whether we call it co-operative socialism, local libertarianism, community conservatism, or just humanity and people helping each other—I thought it was a wonderful expression of what we can do when we all pull together.

We also have to remember, as the noble Baronesses, Lady Thornton and Lady Brinton, reminded us, that this is not over. That is one of the reasons why the Secretary of State felt it was important to make this Statement and this point. There has been a level of complacency in encouraging people to come forward. We have not been strong enough, which is why we are pushing now and emphasising the fact that we want as many people as possible to come forward and get the booster. It was announced over the weekend that it is not necessary to wait for six months after the second dose; people can book from five months. In fact, today I tested the system and took advantage of it and was able to book my booster. I hope many others will be able to do so to.

I would ask noble Lords across the House that if anyone comes to them with experiences of not being able to use the service—we have had a couple of reports of a few technical hitches—please let me know so that I can pass them on to NHSX, so that we make sure that we are aware of problems as soon as possible. So far—I want to try to touch some wood somewhere—it seems to be working.

Let me now turn to some of the detailed questions that I was asked by the noble Baronesses. The JCVI has advised that people with severe immunosuppression at or around the time of their first or second vaccination receive a third primary dose as a precautionary measure. Some individuals who are severely immunosuppressed due to underlying health conditions or medical treatment may not achieve the same full immune response to the initial two-dose Covid-19 vaccine course. The third dose aims to bring them up to nearer the level of immunity. As with the vaccination of other at-risk individuals, eligible individuals will be identified and invited by the hospital where they receive care under a consultant and/or GPs.

If either of the noble Baronesses or any noble Lord here today is aware of that not happening, please let me know so that I can make sure that we push on this. I am told that the NHS is writing to all patients who may be eligible so that they can talk through their options with their GP or consultant if they have not done so already. Any patients who have not yet been contacted but think they may be eligible, for example because they have previously been advised to shield, can contact their consultant for an update. If noble Lords know of any problems or are aware of any issues, I hope that they will let me know as soon as possible so that I can chase on them.

On the booster, while there are many stories saying that we have not done that well, we have 12% booster vaccination. When we look at booster vaccination in other European countries, the highest is Israel with 45%, but Spain is at 2%, Italy is at 3%, France is at 4% and Germany is at 2%. This is why we are emphasising the importance of booster vaccinations. My right honourable friend the Secretary of State and others are keen to push people to make sure that they have their booster as soon as possible. It is the best defence against Covid and it is important, especially as protection wanes, that people are getting their boosters.

On plan B, I repeat what has been said previously: there is no set threshold. We consider a range of evidence and data, as we have done throughout the pandemic, to avoid the risk of placing unsustainable pressure on the NHS. For example, while the number of Covid-19 patients in hospitals is an important factor, the interaction with other indicators, such as the rate of increase of hospitalisations and the ratio of cases to hospitalisations, will also be vital.

The Government monitor and consider a wide range of Covid-19 health data. I shall go into some of them in a bit of detail. We look at cases, immunity, the ratio of cases to hospitalisations, the proportion of admissions due to infections, the rate of growth in cases and hospital admissions in the over-65s, vaccine efficacy and the global distribution and characteristics of variants of concern. We also look at the risk to the NHS. One of the issues, as many noble Lords will know, is about making sure that the NHS is not overwhelmed. In assessing the risks to the NHS, the key metrics include hospital occupancy for Covid-19 and non-Covid-19 patients, intensive care unit capacity, admissions in vaccinated individuals and the rate of growth in admissions. The Government also track the economic and societal impact of the virus to ensure that any response takes into account those wider effects.

On some of the measures that are being proposed in the potential plan B, clearly a number of people with other health conditions, including mental health conditions, would be incredibly concerned were we to go to some of the more severe measures under plan B. We always have to balance them up. As noble Lords will be aware, questions have been asked about those awaiting elective surgery and the unintended consequences of focusing on Covid-19, for example whether it has led to a disproportionate number of deaths from other diseases or conditions.

Covid booster jabs have been delivered or booked in almost nine in 10 care homes as the NHS vaccination programme accelerates ahead of winter. Around 6,000 care homes have already been visited, while a further 3,700 homes have visits scheduled in the coming days and weeks. The new figures also show that residents in more than half of care homes have received their booster jab. When I asked about the discrepancies in the small proportion that have not yet been booked or vaccinated, I was told that there may well be cases of Covid in those care homes and they are waiting for the delay after the positive test to ensure that it is safe to go there.

I was asked about the breakdown of different types of care home. Based on the latest CQC annual report on care, we can say that the CQC inspects a number of these care homes.

To answer some of the other questions, as I said, the NHS is writing to all patients who may be eligible so that they can talk through their options. On the issue of whether to make NHS staff take their vaccinations, we have consulted on vaccination as a condition of employment in wider health and social care; I am told that my right honourable friend the Secretary of State will set out the position very shortly. The important thing to remember is that we want people to take the booster, and we want to make sure that we reach those communities and demographics who have not had even their first or second vaccine yet.

I have had a number of conversations with noble Lords from across the House—I thank them for their advice and suggestions—about how to reach out to some of these communities. For example, I was in conversation with one right reverend Prelate about how we could work in conjunction with interfaith communities in local communities, for example in certain parts of London where there is a low uptake. Sometimes people may not be of faith, but they respect faith leaders—vicars, imams, priests et cetera. We are looking at how we can work on this, and I very much hope that we will be able to roll that programme out further. If any noble Lords are interested in or have any suggestions on that area, I would welcome them.

I apologise if there are technical questions that I have not answered; I will make sure that I write to noble Lords.

[Lord Pannick (CB)]

The Minister mentioned the importance of the booster dose. Can he explain why the valuable NHS app does not prominently display that the individual has received a booster jab, as is the case with the first two doses? The information is hidden away on the app and cannot be downloaded. This is a serious defect because some foreign countries—the Minister mentioned Israel, which is one example—now require proof of a jab in the past six months, given the waning effect of earlier doses. There are many domestic contexts where the ability to prove easily that you have had a booster dose would be valuable.

[Lord Kamall (Con)]

I thank the noble Lord for that question. I have been made aware of this by more than one noble Lord today. I contacted NHSX; it said that it is looking into it and trying to work on a fix as soon as possible. If the noble Lord is aware in a couple of days that that has not been fixed, I hope he will remind me so that I can prompt NHSX.

[Lord Campbell-Savours (Lab) [V]]

My Lords—[Inaudible]—very closely to the wise words of Gordon Brown on the need to distribute surplus vaccines internationally. Vaccine expiry is inexcusable. Gordon has made it his life’s work to defend, promote and support the interests of those in need. The third world is in need; if we fail to meet the challenge then not only it but we will lose out. I urge the Minister to listen to him and take this call back to the department for action.

[Lord Kamall (Con)]

I thank the noble Lord for that point. I think noble Lords agree that it is really important that we make sure that we vaccinate as much of the world as possible. There is no point in us being vaccinated if we then travel to areas in the rest of the world where people are exposed. We are co-operating on a number of international programmes, including COVAX and others. One of my portfolio roles in the department is on international agreements and liaison. I have been speaking to a number of Health Ministers from a number of different countries about how we can help more. I have also been talking to some of the suppliers of the vaccines about how we can make sure that, where we do not order domestically, we can redirect some of those orders for international help. I completely agree with the sentiment of the question from the noble Lord that it is really important that we play our part in helping the international community.

[The Deputy Speaker (Baroness Henig) (Lab)]

My Lords, there are four remote speakers. I shall now call the second of them, the noble Baroness, Lady Harris of Richmond.

--- Later in debate ---

[Lord Kamall (Con)]

I am afraid I am going to have to repeat the answer I gave earlier to the noble Lord. We were made aware of this only today and as soon as I heard, I got hold of NHSX and asked what was happening because, clearly, a number of people are experiencing the same issue. We have chased NHSX and I hope that NHSX will fix it as soon as possible. If it does not, please chase me up.

[The Deputy Speaker (Baroness Henig) (Lab)]

My Lords, the noble Baroness, Lady Masham of Ilton, is taking part remotely and I invite her to speak.

[Baroness Masham of Ilton (CB) [V]]

My Lords, what is the situation with vaccination against coronavirus for inmates and staff in UK prisons? Prisoners often get transferred to other prisons and they move in and out when released and recalled. Many live chaotic lives, but it is important that they all get vaccinated. Is there a system to see that this process is safeguarded, so that jabs are fully completed? Prison health must not be forgotten.

[Lord Kamall (Con)]

The noble Baroness raises a very important point. As far I am aware—I will confirm this—the population of prisons is being treated the same as the wider population in terms of encouragement to take the vaccines and the booster. I will double-check and write to the noble Baroness.

[The Deputy Speaker (Baroness Henig) (Lab)]

My Lords, the noble Baroness, Lady Thomas of Winchester, is taking part remotely and I invite her to speak.

[Baroness Thomas of Winchester (LD) [V]]

My Lords, will the Minister look into booster vaccines for vulnerable people such as me who need to be vaccinated at home? There is never any information about this cohort of people who are at the mercy of there being a healthcare professional from a local surgery available. There is a danger that they may be overlooked by surgeries, some of which might be overwhelmed at this time.

[Lord Kamall (Con)]

The NHS is writing to all patients who may be eligible so that they can talk through their options with their GP or a consultant if they have not done so already. I understand that that includes the option to be vaccinated at home, but I will double-check and write to the noble Baroness.

[Baroness Andrews (Lab)]

My Lords, two questions were put to the noble Lord that he has not had time to answer. First, I should say that, like him, I have received my booster invitation for Thursday and I am absolutely delighted. Two questions, which I do not think were technical, were asked by the noble Baroness, Lady Brinton. One was about why centres are closing. Clearly, with this big push now, spearheaded by the Government, we need to keep as many open as possible. The second relates to something the Minister said that surprised me: he talked about a level of complacency. It is indeed possible, I think, to see the failure to make masks mandatory as an indication of complacency. Will he say a little more about what he meant by the level of complacency and how making masks mandatory might help to meet that?

--- Later in debate ---

[Lord Kamall (Con)]

On the noble Baroness’s first point, about the centres closing at 6 pm, this is the first time that I have been made aware of that. I welcome any feedback about what is working and what is not. This is not necessarily political; we all want it to work, so I welcome any information on that. I will double-check it.

The noble Baroness referred to complacency. It is very interesting when people say that most people are in favour of measures on masks. It is quite often like polling, when we see a difference between stated preferences and revealed preferences. It is claimed that a number of people are in favour of masks and want to wear them, but, when it comes to public transport and the revealed preferences, we see that it depends on the mode of public transport—sometimes take-up is less than 50%. I have said to people, “Make sure you get your boosters”, but maybe we have to take some responsibility for not making it clear that the boosters were important and for not pushing them as much as possible. The first and second vaccines were taken up with such enthusiasm because people wanted to return to as close to normal as possible, but when it came to the booster, it really needed all of us to push it to make sure that more people took it.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as a nurse. Would it be helpful to reinforce the message that some of the most vulnerable people should contact their specialist nurse practitioners, who in many cases are much more obtainable than both consultants and general practitioners? I would really like the Government to emphasise that.

Turning to 12 to 15 year-olds, I declare my interest in that my daughter is a secondary schoolteacher in south London. Anti-vaxxers outside schools are creating a real problem. I understand that the Government have powers to reduce their access within the area of a school. Is this being seriously considered? The uptake of vaccines in the 12 to 15 year-old age group requires the consent of an adult. Therefore, it is imperative that schools are part of that system.

[Lord Kamall (Con)]

I thank the noble Baroness for that really important point: it is about not only consultants and GPs but nurse practitioners. When you go to book a booster jab and look at availability, you might well expect it to be at a hospital or a surgery, but many community pharmacies are offering it. It is important that we have those conversations. I agree with the noble Baroness on the advice that she has given.

I also share the noble Baroness’s concerns about the anti-vaxxers. It is a difficult balance: I believe in freedom of speech, but they should not inhibit people. It is really important that we make the case. As of 2 November, 24% of 12 to 15 year-olds had received their first dose. They will have received it through school. The NHS is also working closely with schools to offer vaccines to young people as soon as parents or guardians consent. We are also expanding our programme of walk-in centres to make sure that we can provide parents with extra choice over where and when their children are vaccinated. The vaccines are safe and will protect children from Covid-19. We repeat this. The current advice is to give the majority of children a single dose, which means that they will be afforded a high level of protection.

On people protesting outside schools, the Government have explained their concerns about that. At the moment, I have no further information. As soon as there is further information, noble Lords will be informed.

[Baroness Uddin (Non-Afl)]

My Lords—

--- Later in debate ---

[Baroness Walmsley (LD)]

My Lords, is the Minister aware of an article in the Health Service Journal today in which a highly respected chief executive of a highly rated acute trust said that his hospital was struggling on every front and that it was far worse than in January? He said that the emergency department was at record levels and elective referrals were increasing as exhausted staff turned down extra shifts needed to reduce the growing backlog. One in five of his beds is filled with medically fit people who cannot be discharged because they cannot find a care package. There have been more than 65,000 Covid admissions to English hospitals in the last three months; that is double the same period last year when, of course, there were no vaccines. Does the Minister agree with this chief executive when he said, “This time the vaccine hasn’t saved us”?

[Lord Kamall (Con)]

The most important thing is getting the third vaccine. The Government are monitoring and considering a wide range of factors, including cases and immunity, but also advice from the NHS as to whether it is feeling overwhelmed. That is the situation at the moment. We continue to monitor it; it is not a static situation. We are trying to get the booster out as much as possible and are really driving home the message that the booster is the most effective way to fight against Covid. We are making sure that we get as many people as possible vaccinated and taking up the opportunity of a booster.

[Baroness Uddin (Non-Afl)]

My Lords, the Minister talks about mask hesitancy in public spaces. It would be extremely helpful for the Government to take direct action and actually mandate masks. That would be very helpful for members of the public.

In the past eight weeks our family members have directly experienced the NHS, with Covid remaining a severe threat. Ward-based mental health services are in dire straits and lack sufficient funds for essential support and care. Are they also receiving vaccinations? The other thing is the incredibly outstanding services of the Medway Maritime Hospital intensive care unit, where a family member lies critically ill and is really struggling with their care.

--- Later in debate ---

[Lord Scriven (LD)]

I do; you went on for two minutes.

[Lord Kamall (Con)]

I thank the noble Baroness for her question, I think. To be fair, she has made a number of points, especially about disparities and inequalities. It is quite sad that there is low uptake of the vaccine in a number of communities. I know that the noble Baroness has done a lot of good work in the past in Tower Hamlets and other areas with minority communities.

The most important way we can tackle this issue is to encourage people to be vaccinated. We want to roll out the booster as quickly as possible and, sadly, too many people have still not taken their first and second vaccines yet. I know that noble Lords across the House have many contacts in many communities, so it is important, please, to come to me with suggestions and ideas. I have spoken to a number of noble Lords across the House about how to tackle this and how best to reach people who are hesitant and who may not trust authority, and encourage them to take the vaccine. I thank the noble Baroness for her question.

[The Duke of Somerset (CB)]

My Lords, many other countries have introduced a form of green pass as a proof of vaccine to gain entry to places for public gatherings, such as restaurants and theatres. This has resulted in a higher take-up of the vaccine, as people have been encouraged to have these passes to access the things they want. Surely we should introduce a similar mandatory proof of vaccine, either paper or electronic, which will help to drive up rates of vaccination.

--- Later in debate ---

[Lord Kamall (Con)]

Apart from the technical hitches in getting data on to it, which a number of noble Lords have referred to, the NHS app has a record of vaccination, which is important. The measures to which the noble Duke refers are being considered as part of plan B, but at the moment the advice is not to move to plan B but to focus on getting people vaccinated. The Government are concerned that other messages may confuse the picture somewhat. The message is simple: get vaccinated—vaccine one, vaccine two or booster. If there are any problems, please let me and others know so that we can push. Sometimes people do not always talk to each other—let us put it that way—so let us make sure that this is as joined-up as possible.

[Viscount Stansgate (Lab)]

My Lords, I ask the Minister about the latest advice received by the Government from the Scientific Advisory Group for Emergencies. First, has SAGE advised the Government that Covid is moving into its endemic stage or does it continue to advise the Government that we are dealing with a pandemic, which needs additional measures? Secondly, does the Minister regret the resignation of Sir Jeremy Farrar, the director of the Wellcome Trust and an eminent scientist, from membership of SAGE?

[Lord Kamall (Con)]

The Government welcome advice from a range of stakeholders and have listened to SAGE and others throughout to balance their different views. In fact, I remember that when Jeremy Farrar was resigning he insisted that his departure should not be interpreted as a fresh disagreement with the Government. The Government listen to a range of views and balance them all.

[The Deputy Speaker (Baroness Henig) (Lab)]

The time for Back-Bench questions has now elapsed.

Public Health Grant to Local Authorities

Lord Kamall Excerpts

Tuesday 2nd November 2021 Lords Chamber

[Lord Scriven (LD)]

My Lords, in begging leave to ask the Question standing in my name on the Order Paper, I declare my interest as a vice-president of the Local Government Association.

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

Since 2016, the local authority public health grant has decreased by 2% in cash terms, but we increased the grant in 2020-21, and in 2021-22, and it now stands at over £3.3 billion. We are maintaining the grant in real terms over the next three years to enable local authorities to deliver preventive and front-line health services which will improve the health and well-being of their communities.

[Lord Scriven (LD)]

My Lords, even with the recent cash increases, the public health grant has been cut in money terms since 2016 by £1 billion, curtailing services such as smoking cessation, healthy families, and sexual health clinics. If the Government really are committed to preventing poor health, why did the Chancellor not restore in the Budget the £1 billion to improve public heath, rather than prioritising giving banks a £4 billion tax break?

--- Later in debate ---

[Lord Kamall (Con)]

The public health grant will be maintained in real terms over the spending review period, and we will confirm local authority allocations in due course, but this is not the only money going to public health. In addition to the grant, the Government are investing £300 million over the SR period to tackle obesity and £500 million over the SR period to improve the “best start in life” offer available to families. The NHS is spending over £1.3 billion on national public health services.

[The Lord Bishop of London]

My Lords, during my time as the Government’s Chief Nursing Officer for England I witnessed the unique value of public health nurses in the community. The pandemic has further highlighted the importance of such roles and the significance of a whole-system approach. Given this, will Her Majesty’s Government consider increasing funding specifically to build up or rebuild the capacity of public health nurses to tackle localised health inequalities?

[Lord Kamall (Con)]

The Government have allocated more money for local authorities but we think that it is best left to local authorities to decide how to spend that portion of their grant, for they are closer to the people in the communities that they serve.

[Baroness Neville-Rolfe (Con)]

Does my noble friend agree that a public health capability in local authorities is very important? I was very impressed by the work the head of the public health office did in my home town of Salisbury during the poisonings of the Skripals. I have heard reports that some of the duties of the office or its funding might be transferred to the NHS, which has enough on its plate. Is there any truth in this report?

[Lord Kamall (Con)]

It is true that some of the allocation for the National Health Service is being used for public health spending, but we want to make sure that across the health system the NHS not only focuses on prevention and therapeutics but works in partnership with the public health authorities.

[Lord Laming (CB)]

My Lords, the good news is that in the Budget last week, it was announced that local councils are to receive £1.6 billion in grants for each of the next three years. The bad news is that that does not take them close to what the councils were receiving and spending in 2010. Will the Minister do all that he can to press for adequate funding, especially for the public health services but also to meet today’s needs and not those of a decade ago?

[Lord Kamall (Con)]

There are many bodies tackling public health and raising awareness of some of the worst health problems we have—not only the Office for Health Improvement and Disparities and public health officials in local authorities but the NHS, which wants to move more towards prevention because in the long term that saves money.

[Lord Whitty (Lab)]

My Lords, the noble Lords, Lord Laming and Lord Scriven, have pointed out that the loss of £1 billion over the last decade or so from the public health teams’ budgets has impaired their ability to deal with issues, including those related to Covid. Does the Minister recognise that the increase just announced goes nowhere near to closing that gap? Does he also recognise the parallel problem that the limitation on local authorities’ support for care homes is greatly impairing their ability to care for the health of elderly and other disadvantaged people resident in care homes?

[Lord Kamall (Con)]

As noble Lords will know, the Chancellor has confirmed additional spend for public health, and the public health grant will be maintained in real terms over the spending review period, enabling local authorities to invest in prevention and front-line services such as child health visits. There will also be continued funding of £100 million per year over the period to tackle obesity in adults and children, as well as investment in a new start for life offer for families, with an additional £66 million in 2024-25. We know and recognise the importance of public health. At the same time, the NHS is committed to rebalancing between public health, prevention and therapeutics.

[Lord Young of Cookham (Con)]

Has my noble friend seen analysis by the University of York showing that expenditure on public health is three to four times more effective in terms of health outcomes than investment in the NHS? Will he take steps to ensure that we now invest in the resilience of the public health network to ensure that we are better placed for any future pandemics?

[Lord Kamall (Con)]

I thank my noble friend for that very important question. We continually assess our preparedness plans for infectious disease outbreaks and pandemics to ensure that they remain as robust as possible. This assessment includes, as appropriate, incorporating lessons learned from exercises that test the readiness of our plans and from our experience in responding to pandemics, disease outbreaks and other types of incident in the UK. The UK Health Security Agency will be dedicated to ensuring that we are protected from all future threats, including pandemics.

[Baroness Merron (Lab)]

My Lords, areas of greater deprivation have disproportionately borne the brunt of cuts to the public health grant, despite many people in these areas having poorer health. In Blackpool, ranked as the most deprived upper-tier local authority in England, the per capita cut to the grant has been one of the largest, at £43 per person per year. Can the Minister explain to the House how and why these decisions are made, and will he ensure that fairness in funding is restored for those who need it most?

[Lord Kamall (Con)]

The noble Baroness raises a very important point about needing to tackle disparities across our nations. The ring-fenced grant that we provide to local authorities to spend on public health services comes with a condition that they consider the need to reduce health inequalities in their areas. Also, the grant’s distribution is heavily weighted towards areas facing the greatest population health challenges. Per capita grant funding for the most deprived decile of local authorities is nearly 2.5 times greater than that for the least deprived. In addition, noble Lords will be aware of the new Office for Health Improvement and Disparities. The pin-light focus of that office is on health disparities and how we tackle them.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I must say that that is a rather surprising answer. The Minister will know that the Prime Minister has promised to help level up the health expectancy of the poorest areas, but I take the Minister to his answer. The Health Foundation stated in the summer that there is no sign of concerted action to do this and:

“Current plans appear to be partial and fragmented, and many deprived areas where people are likely to have poorest health have not been identified as priorities for investment.”


Will the Minister reconsider his answer to my noble friend?

[Lord Kamall (Con)]

The noble Lord raises a very important point about how we tackle these disparities. This is one of the reasons. Given that a lot of powers to intervene at local level are in the form of local authority grants and local public health officials, it may well sometimes come across as fragmented. This is why the Office for Health Improvement and Disparities is very important to take an national overview of areas of disparity and target them.