Covid-19 Update

Lord Lansley Excerpts

Tuesday 29th June 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Lord is entirely right: those three things are linked. We cannot live in a world where there is a high infection rate in large parts of it, where new variants prosper and where we cannot travel. That would be inhuman and unpragmatic. I met with the CEOs of the major companies that manufacture the vaccines in Oxford during the G7, and we discussed this point in great detail. It is frustrating, but I also have optimism that the manufacturing capability in the hubs around the world—in the geographical places where populations live—are being built today and, by the middle of next year, there will be a huge amount of vaccine capacity in order to address this problem. It is frustrating that it cannot happen overnight, but vaccine manufacturing capability takes time to build up, as we know only too well. However, those investments are taking place, and I believe that, as a world, we can beat this pandemic together.

[Lord Lansley (Con)]

Notwithstanding the disclosures of the past few days, may I tell my noble friend that I, for one, very much appreciate what Matt Hancock did and the immensity of the effort he put in to combat Covid infection? Step 4 is not a return to normality, so, for example, self-isolation requirements will continue after contact tracing. The Government now have a lot of research to look at whether daily lateral flow tests can replace self-isolation both for schools and for businesses, which are must disrupted by self-isolation. Can my noble friend say when the Government may be able to proceed to allow some schools and businesses to shift to daily lateral flow tests?

[Lord Bethell (Con)]

My noble friend’s comments are very much appreciated and taken on board. On his question about daily lateral flow testing, he is very perceptive and correct. This is an area that we have been exploring for some months, and we are working extremely hard to bottom it out with rigorous clinical trials—clinical trials are difficult to nail down, by their nature, but we have invested substantially in them. He is right that, for schools, for international travel and for contacts—those three things—daily testing may well offer an alternative to 10-day isolation. That would be a huge relief to many in the country, and it is something that we are very focused on delivering.

Social Care Reform

Lord Lansley Excerpts

Tuesday 29th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, new legislation will increase integration between health and social care by removing barriers to data-sharing, enabling joint decision-making and putting more power and autonomy into local systems. The noble Baroness is entirely right on that. The Bill has been published and the noble Baroness is very welcome to engage in some of the engagement sessions that I have had on it already. I should be glad to run more, if that would be helpful to her. A White Paper and a public consultation are not planned.

[Lord Lansley (Con)]

My Lords, press reports suggest that the Prime Minister is in favour of including in social care reform the Dilnot commission recommendations that are now a decade old. In doing so, he could bring into force Sections 15 and 16 of the Care Act 2014, which this Parliament passed seven years ago. Will the Government now consider doing exactly that to enable a cap on care costs to be implemented rapidly?

[Lord Bethell (Con)]

My Lords, we are extremely respectful of the Dilnot commission report and the recommendations in it, particularly those highlighted by my noble friend on Sections 15 and 16. It is one of many proposals that we will look at very carefully. We cannot make a commitment to anyone in particular at this stage but, as I said to the noble Baroness, we will put forward a full plan by the end of the year and will remain true to that commitment.

Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) (No. 2) Regulations 2021

Lord Lansley Excerpts

Wednesday 16th June 2021 Lords Chamber

[Lord Lansley (Con) [V]]

My Lords, speaking from Cambridgeshire, like my noble friends Lord Cormack and Lord Blencathra I intend to support the Government’s regulations, but I do so with significant reservations. When we discussed the previous iteration of these regulations, I think my noble friend the Minister and I agreed that the time was fast approaching when we should move from legislation and enforcement to guidance. I think that moment is now very close.

Why have the Government decided to defer the date from 21 June? Looking at the four tests, it seems to me that they can have taken the decision only on the fourth; that is, if noble Lords recall, whether variants of concern have “fundamentally changed” their risk assessment. I do not think the data supports a fundamental change in the risk assessment, but Ministers quite understandably do not yet know why, for example, a Public Health Scotland study found that hospitalisations were at twice the levels of the alpha variant. I think they want to know why this is the case.

The observation from my noble friend the Minister that 1.2 million people over 50 or clinically extremely vulnerable have yet to receive their second vaccine dose is relevant but, at 175,000 second doses a day at present, there is no reason why in the week ahead—or a fortnight at most—those requiring a second dose who are most at risk should not all receive it.

This fortnight is about finding out whether the delta variant is a variant of concern or a variant of high consequence. It has not been designated as such by the WHO, the CDC or anyone else yet. It would be so designated only if it substantially reduced the effectiveness of vaccines against it. I do not think that has yet been proven, and I hope that Ministers will look at the data literally daily and, if it is obvious that the vaccine doses are effective against the delta variant, intervene and lift the remaining legal restrictions while keeping in place so many of the social distancing and other precautionary measures we should all take as matters of individual responsibility.

Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) Regulations 2021

Lord Lansley Excerpts

Monday 7th June 2021 Grand Committee

[Lord Lansley (Con)]

My Lords, I am glad to have the opportunity to follow the noble Lord, Lord Scriven, although I will not follow him in the criticism of process. I think the need for rapid legislation from time to time has meant that we are always catching up on some of the processes. I want to use this opportunity—which my noble friend has highlighted—to look at where we are and where we need to go in the week or two weeks ahead.

My first point, which I think my noble friend rightly emphasised, is that we are at the stage where we should move from legislation to guidance. One problem associated with the latest step 3 shift is that the public thought that everything the Government are asking them to do has to be in legislation. The enforcement of that has been quite burdensome from time to time. At the same time as moving to step 3, the Government added guidance, for example in relation to the eight local authorities that had the delta variant present. They did not publicise the guidance sufficiently and the confusion that arise from that was really regrettable.

Likewise, on 17 May, the ban on international travel was relaxed but at the same time Ministers were talking about the absence of international travel in ways that suggested that they were still enforcing a ban on non-essential travel. That was not the case. It is quite understandable that the public have become very confused. When the announcements are made for 21 June, we should stick with that date and make it very clear that we are shifting from a position where legislation has been required to one where guidance on future social distancing and preventive measures should be much clearer and consistent.

We should not be emphasising that from 21 June we are lifting all restrictions—we are moving to a new phase. In that respect, the noble Lord, Lord Scriven, is right, but I do not think that we need permanent legislation for this purpose. We need permanent adjustments in behaviour. We should be encouraging people to do things such as wearing masks, social distancing, working from home, ventilation, or having outdoor gatherings much more than indoor ones.

We have made enormous progress. I echo what my noble friend said about that. Obviously, vaccination is a really impressive achievement. Where testing is concerned, I do not share so many of the criticisms. The problem was not that test and trace did not expand its capacity but that people overestimated what it was capable of doing last year. We are at risk of underestimating what it is capable of doing this year.

When we shift the guidance, we should make large-scale lateral flow testing freely available, as we are doing now. On the basis of what we have seen in schools, we should encourage workplaces and employers to use lateral flow tests every other day to enable them to be confident that their staff are free of the infection. On that basis they can return to work, they can meet and they should be able to undertake international travel.

At this stage we need to make a distinction between travel for leisure and travel for work. British companies should be able to send people abroad and bring them back without long periods of isolation as long as they are having lateral flow testing. We have to get away from four PCR tests. That is a very burdensome thing to ask people to do, whether for leisure or for employment purposes. It is something approaching £400 per person, per visit and that should not be applied over the months ahead. We have a substantial vaccination programme that is giving people a high degree of protection. We are seeing every hope that we are breaking the link between infection, severe disease and hospitalisation. To the extent that that happens with doubly vaccinated people, we should go with it.

Finally, on international travel, I ask my noble friend why are we not including some countries on the green list? Look at Malta, for example. It now has no cases and the best vaccination record among European Union countries. It is iniquitous that we are not distinguishing those countries that should be on the green list and giving them the benefit of that designation.

Osimertinib Cancer Treatment

Lord Lansley Excerpts

Tuesday 18th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, we are watchful of the concerns to which the noble Lord refers but it is our hope and aspiration that there will not be the kind of delays or trouble that he explained. The Northern Ireland protocol means that Northern Ireland will stay aligned with EU rules, particularly for this kind of specific cancer medicine, but that does not mean that there need to be any delays. However, we are watching the situation carefully and the report that he described will give a full account of the problems, if there are any.

[Lord Lansley (Con)]

Can my noble friend, in this instance at least, explain the divergence between the MHRA and the European Medicines Agency? On 22 April, the EMA’s Committee for Medicinal Products for Human Use gave a positive opinion under an accelerated assessment, but the EMA has not yet given the new indication of marketing authorisation. What is the potential gap between MHRA authorisation and EMA authorisation?

[Lord Bethell (Con)]

My noble friend is, as ever, all over the detail. It is my understanding that the gap is a matter of weeks rather than there being any clinical divergence in assessment of the evidence. However, I am afraid to say that I would have to leave it to the EMA to think for itself on that.

Botulinum Toxin and Cosmetic Fillers (Children) Bill

Lord Lansley Excerpts

2nd reading
Friday 16th April 2021 Lords Chamber

[Lord Lansley (Con)]

My Lords, I congratulate my noble friend on bringing this Bill forward and on her excellent presentation, which set out very clearly its purposes and justification. I very much support it.

My noble friend will know, and the House may well recall, that the Bill is in line with one of the recommendations from the Review of the Regulation of Cosmetic Interventions led by Sir Bruce Keogh and published in April 2013. Of course, as Secretary of State, I asked him to lead that review back in January 2012, following the PIP breast implant scandal disclosed the previous month. It is fixed in the memory of Health Ministers across the globe—the problems were disclosed by the French Government the day before Christmas Eve, so we all lost our Christmas in 2011. One of the consequences was that the many issues and problems associated with cosmetic interventions and medical devices were exposed. Indeed, the Keogh review did a great deal to help to bring that forward. I think this Bill will be extremely welcome.

While I have this moment, I would mention the Cosmetic Surgery (Standards) Bill in my name, which is way down in the Lords list of Private Members’ Bills. It is not going to have the benefit of the House’s attention in this parliamentary Session; I hope it may in a future one, perhaps even with the benefit of support from the Government at some point. It also follows up one of Bruce Keogh’s recommendations. It was very good that our honourable friend the Member for Sevenoaks was able skilfully to bring this Bill through. I know how difficult it is in another place to get a Private Member’s Bill through, even if one is fortunate to get a place in the ballot.

I briefly mention two other things. First, Kevan Jones, who also supports my Bill, spoke in the other place about the issues associated with advertising cosmetic interventions, increasingly on social media these days, and he was right to do so. That is an issue raised in the review that needs to be followed up. I also hope that, in line with my Bill, the Government will encourage the General Medical Council, regardless of legislation or otherwise, to use the Royal College of Surgeons interspecialty committee’s work on certification for cosmetic surgery to try to ensure that it is indicated on the medical register, so that people can identify who is properly certified and qualified to provide cosmetic interventions.

Bruce Keogh’s review said—I think I quote correctly—that, in

“our view … dermal fillers are a crisis waiting to happen.”

It is not a crisis in respect of which young people should be the victims. I am very glad that my noble friend has brought the Bill forward, and I hope that we will be able to pass it into law before the end of this Session.

Covid-19: One Year Report

Lord Lansley Excerpts

Thursday 25th March 2021 Lords Chamber

[Lord Lansley (Con)]

My Lords, I am grateful to my noble friend for his introduction to the debate. I hope he will forgive me if I do not look back at all. I want to look forward. There will be occasions to look back and review what has happened, but what is more important at the moment is to look forward constructively at how we take things from here.

Therefore, I will focus on the road map. I would be very surprised if this is not the experience of noble Lords across the House and those in the other place: we are constantly being asked by people what the rules are and what it is they are supposed not to do, or are allowed to do. The noble Baroness, Lady Donaghy, just illustrated the point. One can see the point about homes overseas on page 70 of the steps regulations. If one owns properties abroad, one is able to go there for the purpose of buying it, selling it, letting it and enabling people to move in; one is not allowed to go there to have a holiday in it. That may or may not be the right decision, but that is what the rules say. It is absolutely illustrative of the general problem. The public are becoming very confused about whether we are going back to tiers. What is a “step”? What are the four steps relative to the tiers? What are the four tests that we have to apply?

However, I think the public have in their minds, correctly, that there has been a first modest relaxation, there will be a second on 12 April, a third on 17 May and a final one on 21 June. These instruments will then expire on 30 June. I urge my noble friend the Minister and the Government not to shift those dates. Although I would not go all the way with my noble friend Lady Noakes’s argument, she was quite correct to say that the down sides associated with maintaining a lockdown are now substantial. We have suffered a tragic loss of life and a deeply depressing loss of livelihood, but we are now getting on top of the virus in this country.

My point is that, of those tests, the vaccine rollout is doing better, the reduction in hospitalisations is going faster and the reduction of pressure on the NHS is going better than any of us dared to hope. The only other is variants of concern, which are clearly being managed well by test and trace and the approaches we are taking in this country, but less well in other countries. The issue is not about sustaining large-scale lockdown in this country but about focusing on the borders. Let us look at the circumstances in which people enter this country. I am with my noble friend Lady Noakes: I do not think we are in the business of stopping people leaving the country, but we have to be very careful about the circumstances in which they return and what then happens. That does not mean hotel quarantines for the population generally, but obligations to self-isolate and to undergo testing.

I strongly urge on my noble friend Minister that we focus on that, and insist that we want to maintain this road map and those dates, and that we want to end the lockdown. We do not want further mental health problems, isolation for the elderly and loss of livelihood for many industries. We therefore need to co-operate collectively very strongly on making sure that if any of these variants—Brazilian, South African or any others that may come along—emerge here, we get test and trace to hit them very hard. The arguments about test and trace have always been misplaced. When the virus is widespread in the community, test and trace can barely do its job, but with the variants of concern, where there are relatively few, test and trace is—and has shown that it can be—a very effective instrument. I urge that that is where we put our effort and that we focus on our borders.

Covid-19 Update

Lord Lansley Excerpts

Thursday 4th March 2021 Lords Chamber

[Lord Lansley (Con)]

My Lords, the speed and scale of the vaccine rollout is indeed a remarkable achievement and reflects great credit to all involved. The House will have noted the publication this morning of the REACH study based on data from February. Among its findings was that there was some regional variation in prevalence, particularly in the later part of February. Will the Government on this basis consider regional variation in the pace at which restrictions are lifted, rather than necessarily assuming that it will be a uniform, national approach?

[Lord Bethell (Con)]

My noble friend is entirely right to raise the issue of regional variation. It had been our profound hope to be able to adjust and to focus lockdown arrangements on geographical locations so that national measures were not the only tool in our toolkit. The evidence from last year suggests that the amount of travel that individuals do makes regional and local lockdowns only partially effective. This has put a massive question mark over the way in which we can use regional and local lockdowns. There is more work to be done to understand exactly how that works but he is right to raise it as a considerable issue.

Covid-19 Vaccines Deployment

Lord Lansley Excerpts

Thursday 11th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I have heard the noble Lord’s concerns about this matter when he has brought them up previously, but I simply do not recognise the story he is telling. I would remind him that 95.6% of those aged 75 to 79 have had the vaccine. This is not the story of people who are concerned about going to mass vaccination centres. There are GP centres up and down the country that are closed because they do not have supplies, and it is supply that is undoubtedly the rate-limiting factor. That is because, as he knows, the supply comes in large boxes. If GPs do not have enough people to use up a large box, we have to prioritise those who have longer lists.

[Lord Lansley (Con) [V]]

My Lords, I want to ask my noble friend about the Moderna vaccine. I understand that we have 17 million doses on order, the first batches of which are likely to arrive in the spring—let us say, in May. Where will the vaccine be used? It seems that with a trial taking place in America of its use among 12 to 17 year-olds, there is an argument for it to be reserved for use in vulnerable younger people or, indeed, given its relative significant effectiveness, to be reserved for use later in the year as a booster vaccine for the most vulnerable groups. Can he tell us the Government’s thinking about the use of this vaccine?

[Lord Bethell (Con)]

As ever, my noble friend is extremely perceptive in his insight. The Moderna vaccine is indeed an interesting one that may well prove to be a useful complement to the Pfizer and AstraZeneca vaccines, which are the bulwarks of our vaccination deployment at the moment. As he probably knows, the MHRA has already sanctioned the use of existing vaccines in some children where there may be a strong clinical need, and under the advice of their clinicians. However, it is our aspiration to spread the vaccines as widely as possible. Unfortunately, children are a vector of infection and it may be that there are strong arguments for vaccinating not just vulnerable children, but perhaps a large number of children. We will look at various different vaccines for that, and Moderna may possibly be a candidate for the kind of A-B double-dose vaccine that I alluded to earlier.

Social Care Funding (EAC Report)

Lord Lansley Excerpts

Thursday 28th January 2021 Grand Committee

[Lord Lansley (Con)]

I am pleased to follow the noble Lord, Lord Campbell. It is an abject failure on the part of our political system that the reform of social care funding has not been achieved to date. I will refer briefly to what was my responsibility. In 2010, I asked Andrew Dilnot to prepare a review and make recommendations. His proposals continue to form a part of what should be the reform of social care funding in the future, but I do not think that people quite appreciate the value of what he proposed. It was not just that there would be a cap on the costs people would have to meet, creating, as it were, a fundable and insurable proposition. It is also that there would be a substantial increase in the capital thresholds and a taper, such that under his proposals nobody would have had to lose more than 40% of their total assets.

That would give people the reassurance, even if they were to self-insure or be self-funders, that they would not work all their lives and then find, as a consequence of the catastrophic effects of Alzheimer’s or dementia, for example, that they lost everything and their families got nothing. We have to arrive at this point and make this funding reform happen. I absolutely agree with the noble Lord, Lord Forsyth, and his committee that the cost will not be met simply by the Dilnot reforms. It will require a major injection of government funding. The cost of personal care support should be shared between individuals and the state. To my mind, the great benefit of Andrew Dilnot’s proposals is that people pay towards their costs with only a proportion of their assets; they do not lose all that they have built up during their lives.

I want to make one other point. Why did it not happen? We legislated for it in the Care Act 2014 and it was supposed to happen after the 2015 election. I was not a part of government at that point. I remember somebody in the Treasury saying to me that because part of the process of paying for this involved removing the domiciliary care exemption for people’s own homes, 200,000 people would pay more and only 100,000 would benefit. This quite ignored the fact that most of the 100,000 who would benefit at any time would themselves, on some previous occasion, have been the recipients of domiciliary care.

The noble Lord, Lord Hunt of Kings Heath, is quite right: if we go down this path and do not remove the anomaly of the domiciliary care exemption for one’s own home, we will have an enormous increase in domiciliary care relative to residential care. This would not be desirable, so it has to be paid for. National insurance on older workers is clearly one part of it and removing the domiciliary care exemption is another, but a broader contribution from taxpayers will inevitably be part of it too. But it should not be taxpayers alone, otherwise the intergenerational lack of fairness of young people contributing to the future care of older people, in circumstances where those older people do not contribute but have large assets, would be intolerable.