Health and Care Bill

Lord Lexden Excerpts

Lords Hansard - Part 2 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Baroness Chakrabarti (Lab)]

My Lords, the aim of Amendment 174 is to learn from mistakes made during this pandemic and ensure that, in the event of a public health emergency of international concern, our Government share and support others to share critical knowledge, data, research and intellectual property relating to vaccines, tests, treatments and their associated materials. By sharing this information and intellectual property we can scale up and, crucially, diversify the manufacturing of pandemic tools to ensure equitable access around the world, expediting our ability to end the emergency for all by winning the race against new variants.

Less than 10% of people in low-income countries have been double vaccinated. Lower-income countries are not prioritised. The status quo pharmaceutical model of supplying to the highest bidder means that low-income countries have to rely on the good will of high-income countries and companies to provide donations. Evidently, this has not proven effective in achieving global equitable access. Many low and middle-income countries therefore want to manufacture their own vaccines, tests and treatments so that they can have greater oversight of supply volumes, timelines for dispensing products and prices now and for the future. However, pharmaceutical companies have widely refused to share their technology openly. In addition, the United Kingdom, the EU and Switzerland have continuously blocked South Africa and India in their proposal to temporarily waive certain provisions of the Trade-Related Aspects of Intellectual Property Rights Agreement—the TRIPS agreement—on all Covid-19 tools, vaccines, tests and treatments.

Amendment 174 seeks to remedy this. It calls for the Secretary of State to support or initiate a temporary global waiver of the TRIPS agreement within three months of a pandemic being declared at the WHO. This three-month period is there to give pharmaceutical companies the opportunity and the push to make plans for how they will voluntarily openly license their products and engage in transferring their know-how to companies with established manufacturing capacity. This time period is in step with the recommendations of the Independent Panel for Pandemic Preparedness and Response.

The pharmaceutical industry is an immensely powerful machine, and we need to work with it. But as history has taught us, through the HIV crisis, pricing for cancer treatments, and now with Covid-19, it does not always do the right thing. As we speak the WHO’s mRNA hub in South Africa based at a biotech company called Afrigen has managed to reverse engineer Moderna’s vaccine. As Moderna made a pledge not to enforce patents during the pandemic, Afrigen are doing well in its development. The project has been significantly slowed down by Moderna and BioNTech’s refusal to share their knowledge with the hub. This is just one example. There are over 100 potential mRNA producers across Africa, Asia and Latin America who could be producing vaccines now, if only they had access to the know-how and data, and were not restricted by the fear of patent infringement.

Amendment 174 is about encouraging the industry to do the right thing and the Government to take action to protect global health and live up to the slogan “global Britain”. It is not just political rhetoric but epidemiological fact that none of us are safe until we are all safe. If viruses are left unchecked, they will mutate and this pandemic is far from over; cases have risen hugely in South Korea, China and here in the UK of late. Talk of Covid-19 becoming endemic does not that mean it has disappeared. Malaria is endemic in many parts of the world, but it continues to kill hundreds of thousands of people every year.

This amendment will also initiate a great deal of cost saving for the NHS during pandemics. We are paying the highest recorded price for the Pfizer vaccine at £22 per shot. This amendment reaffirms our commitment to using in these emergency situations compulsory licences, one of the public safeguards in the TRIPS agreement to enable the domestic manufacturing of generic and biosimilar products, which would mean that any company within the UK with manufacturing potential could be making these vital medical tools.

Just today we heard that a draft copy of the waiver has been leaked, although it has been significantly watered down and reduced in scope. None the less it shows there is a global consensus that intellectual property monopolies are a barrier to accessing Covid-19 vaccines, tests and treatments. We need the Government to use this moment finally to do the right thing and support a waiver on all intellectual property covering vaccines, tests and treatments that can be utilised by all countries in the negotiations to come.

I also urge Her Majesty’s Government to use their influence as a faithful customer of Pfizer and Moderna to push them to share their technology with the WHO’s mRNA hubs and revoke the patents they filed on Covid-19 technologies. This amendment is about improving access to affordable life-saving health technologies for our NHS and worldwide during public emergencies. We can bolster pandemic preparedness and expedite our response to Covid-19 and future pandemics. I beg to move.

[The Deputy Speaker (Lord Lexden) (Con)]

I invite the noble Baroness, Lady Brinton, who is taking part remotely, to speak now.

[Baroness Brinton (LD) [V]]

My Lords, I have signed Amendment 174 in the name of the noble Baroness, Lady Chakrabarti. I thank her for introducing it and for making it clear that this aims for global pandemic preparedness. The World Health Organization set a target to vaccinate 40% of the world by the end of 2021. However, 92 countries missed this target due to a lack of access. Despite the funding from high-income countries to the WHO-run COVAX and Gavi schemes, low-income countries have remained at the back of the queue as high-income countries have been able to jump in ahead, using their money to get second and third doses for their own population.

Frankly, we need a better system for future pandemics. We need to understand that openly licensing newly developed Covid-19 technologies, waiving intellectual property rights and sharing the manufacturing know-how would allow more companies to begin producing life-saving vaccines, drugs and tests across the world. However, pharma companies have widely refused to share their technology openly. We also need to source other key critical control products, such as testing equipment, PPE and masks. Relying on too few suppliers in too few countries caused immense problems for the first six months of the pandemic, and again as subsequent waves hit those countries. In addition, the UK, the EU and Switzerland continue to block South Africa’s and India’s proposal to temporarily waive certain provisions of the Agreement on Trade-Related Aspects of Intellectual Property Rights—TRIPS—on Covid-19 tools.

Despite regular pandemic exercises in this country, and despite previous experience with vaccines for other diseases not being shared with low-income countries, we have not learned the lessons. This amendment sets out what a Secretary of State should do within three months of the WHO declaring a public health emergency. I really hope that Ministers are prepared to help make progress on this issue. If not, and if the noble Baroness, Lady Chakrabarti, calls for a Division, we will support her from these Benches.

[The Deputy Speaker (Lord Lexden) (Con)]

I now invite the noble Lord, Lord Campbell-Savours, who is taking part remotely, to speak.

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

My Lords, this is an important amendment. To me, it is the most important in the Bill. It concerns preservation of life in conditions of general pandemics. If you leave worldwide vaccine manufacturing programmes to the free market, you will never fully deliver. Profit will always trump the public good, unless the state intervenes in some regulatory form or another. This is basically why I am a Labour person.

With that in mind, it is clear that the more we are told that the current arrangements for licensing and manufacturing are necessary for reasons of quality control, the more I am convinced that this is not the only consideration in mind. There are other considerations—primarily the need to maximise profit. There is nothing wrong with profit if the justification is reasonable. It drives initiative and entrepreneurship. However, when there are wider issues involved, as in the case of a global pandemic which threatens the well-being of nations and the international economy, there must be a consideration of the wider public good and benefit. I am not convinced that, apart from the case of the AstraZeneca project, public benefit has been the driver.

In Committee, I set out in some detail a case wider than this amendment for worldwide licensing arrangements based on the original amendment of my noble friend Lady Chakrabarti. I remain confused by the Government’s position, which seems ever reliant on research and limited production at home, with volume production overseas. I would have thought that there are lessons to be learned about supply volatility from the case of oil from Russia. Equally, with both China and India leading the world in vaccine supply—at the same time as both countries remain reluctant to support us over certain areas of dispute and crisis in foreign policy—alarm bells should be ringing. I remain of the view that we in the United Kingdom should lead the world in this area of research, development, manufacturing, licensing and supply.

We are moving into an era of further pandemics as research-spawned accidental releases inevitably will reoccur, or perhaps they will not even be accidental in origin. There are huge foreign policy benefits to be gained arising out of being the world’s primary producer and licensee of these vaccines. When you help people, they remain indebted. That is the approach China is taking in many areas of its foreign policy.

I will give an example. The French Government funded my higher education in France 60 years ago. To this day, I remain indebted to France, with a lifetime feeling of obligation. This is often the case for foreign students. I believe that if we had been suppliers and licensees to the world over the recent period, in particular Africa and the third world, the payback would have been immeasurable, with huge implications for foreign policy.

I will exaggerate to make my case: suppose we had been supplier and licensee to China. Can noble Lords imagine what influence such beneficence would have had on Chinese public opinion and, perhaps ultimately, on Chinese foreign policy? A friend in need is a friend indeed—we should never forget that.

I appeal to the Government, even at this late stage in the current pandemic, to think long term, and create the vaccine supply, manufacturing and licensing programme that my noble friend Lady Chakrabarti is advocating. Her amendment seeks at least a temporary, time-agreed waiver. It is a start. I am using her amendment to argue a wider case, a new vision. Her excellent amendment puts in place a building block on which a longer-term strategy should be constructed. We should lead by helping others to help themselves. The rewards are inestimable.

Health and Care Bill

Lord Lexden Excerpts

Lords Hansard - Part 1 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, my amendment concerns patient data. I want to probe the meaning of new Clause 14Z61, proposed by Clause 20(2), which relates to the permitted disclosure of information by integrated care boards. It sets out, on page 27 of the Bill, a number of conditions under which disclosure can be made. They include when

“the information has previously been … disclosed to the public”

or

“the disclosure is made in accordance with any enactment or court order”.

That seems perfectly sensible. However, proposed new subsection (1)(f) contains a catch-all condition under which a disclosure can also be

“made for the purpose of facilitating the exercise of any of the integrated care board’s functions”.

That seems remarkably open-ended. My amendment seeks an assurance that this power excludes the personal data of patients.

We have already had one go at the issue of data and digital transformation, and I have told the House that I am right behind the efforts of the NHS and the Minister’s department to encourage the digital transformation of the NHS. The potential is clearly enormous. However, public confidence depends on the integrity of the system and having embedded in it a guarantee that every use of data will be consensual, safe and transparent.

The recent Laura Wade-Gery review, on which a number of noble Lords have commented, acknowledged some of those concerns. As she said:

“The field of data science is undergoing a revolution as new tools such as machine learning transform our ability to gain insights and improve outcomes. These advances, combined with the explosion of new data driven commercial business models, have caused citizens to be concerned about the privacy of their individual health data and the controls in place over its dissemination and use.”


There may be situations where a patient does not want a doctor—by the way, just for the Chief Whip’s reassurance, I have not spoken for 37 minutes as the clock says—to tell another doctor something about them, yet this can be ignored by those who want to copy records across a lifetime. Modern communications have created the capacity to copy medical records on a scale that can shatter medical confidentiality.

The experience of Care.data is surely a lesson for us. The decision to axe the scheme followed the publication of two reports that supported far greater transparency over what happens to the information, and opt-outs for patients who want their data seen only by those directly caring for them. A review by the late Dame Fiona Caldicott, and a second by the Care Quality Commission, recommended tougher measures to keep people’s medical information confidential. The Caldicott review said that there needs to be much more extensive dialogue with the public as to how their information can be used. As she said:

“Citizens have a right to know how their data is safeguarded. They should be included in conversations about the potential benefits that responsible use of their information can bring. They must be offered a clear choice about whether they want to allow their information to be part of this.”


This was brought home to me recently by NHS England’s announcement that it is to give trusts, as employers, access to the Covid and flu NHS vaccination records of their staff. I am fully behind the vaccination drive and sympathetic to the Government’s mandating of vaccines, but the announcement said:

“To assist Trusts with understanding the vaccination status of their workforce, we are providing a solution for Trusts to view the vaccination status of staff who are on the Electronic Staff Record … system. To do this, we are undertaking an exercise on Trusts’ behalf, to match ESR data, using NHS numbers, with vaccination data held in the National Immunisations Management System … which includes data drawn from all point of care vaccination systems. Following a successful import of ESR data into NIMS, a dashboard will be provided to each Trust detailing their workforce Covid and Flu vaccination uptake, drilled down to employee-level.”


Let me be clear: I support the vaccination drive, as I said, but am I the only one to worry about the access to confidential data that is being given? I recognise that we are talking here about electronic staff records as opposed to electronic patient records, but the principle of releasing patient data is the same.

I would like to hear some assurance from the Minister about the use of this clause and the open-ended nature of new Section 14Z61(1)(f), because, as I think we will shortly hear from the noble Baroness, Lady Brinton, such an open-ended disclosure provision in other legislation would be looked at with very great concern. Having said that, and having taken up 44 seconds, according to the Clock, I beg to move.

[The Deputy Chairman of Committees (Lord Lexden) (Con)]

My Lords, I have failed in my duty, and not for the first time. I should have stated before calling Amendment 145 that the noble Baronesses, Lady Brinton and Lady Harris of Richmond, will be taking part remotely. May I apologise, and invite the noble Baroness, Lady Brinton, to speak?

[Baroness Brinton (LD) [V]]

My Lords, this probing amendment from the noble Lord, Lord Hunt, is essential, because it protects confidential patient data from being given out by an ICB in contravention of the ethics rules of the General Medical Council and other regulatory bodies.

When the Police, Crime, Sentencing and Courts Bill arrived in your Lordships’ House in the autumn, it had clauses in it that gave the police, probation and prison services access to a patient’s confidential medical data as part of their role to reduce and prevent serious violence. As originally drafted, that Bill would have required GPs, CCGs and their staff to hand over that data. This was not just about those under suspicion; it could have been anybody involved in serious violence.

I had extreme concerns about this, and I tabled an amendment not dissimilar to Amendment 145. I was grateful for the support of the noble Lords, Lord Patel and Lord Ribeiro, the General Medical Council, the BMA and others in Committee on that Bill. We had meetings between Committee and Report with officials from the Department of Health and the Home Office, meaning that by the time we got to Report the Government had laid amendments to ensure that a patient’s personal data could not be demanded by the police, probation and prison services. It is now recognised that the medical regulators—the GMC, the Nursing and Midwifery Council and other bodies—actually have the responsibility and the excellent ethical standards by which their members are expected to judge what they should do if they are asked for personal data.

The amendment from the noble Lord, Lord Hunt, would address what data an ICB may disclose by adding a subsection to protect the Government in the same way as happened in the police Bill, so that the personal data of patients should not be disclosed. This is a vital amendment. The Government have already accepted in this Parliament that a patient’s personal data must not be accessible by those other than clinical and clerical staff dealing with it, who must abide by the confidentiality rules of their regulatory body or by their employment contract.

This is even more necessary, because the Bill says in new Section 14Z61(1)(g), on permitted disclosures of information, that

“the disclosure is made in connection with the investigation of a criminal offence”.

That is even broader than in the original police Bill. Patient confidentiality is a fundamental ethical duty. It is crucial to upholding the trust that lies at the heart of the doctor-patient relationship. The new section will give the ICB the right to override that.

New paragraph (e) is also more far-reaching than the investigation of any crime. It says that

“the disclosure is made to any person in circumstances where it is necessary or expedient for the person to have the information for the purpose of exercising functions of that person under any enactment”.

So it is not the doctor or the ICB that has the choice about disclosing that information; they must take the word of the person making that request. That is total free access for anyone who says that it is necessary or expedient for them to have that information. Where is the protection of a patient’s individual and confidential data?

It also removes the decision from GPs, despite GPs having very clear and effective guidance from the GMC on when, in exceptional circumstances, they can give out data. I will not quote the whole of the guidance, because we do not have time, but there are two vital points that a GP must consider: the patient must consent, whether implicitly or explicitly; and disclosure must be permitted or must have been approved under a statutory process that sets aside the common-law duty of confidentiality. The doctor also has a duty, even when they have made their decision, to use anonymised information if practicable, and they must be satisfied that the patient has ready access to information explaining how their personal information will be used. It goes on, but I will not quote the rest.

One might hope that Ministers assumed when drafting the clause that confidential patient data would never be included, other than for the treatment of the patient. However, paragraphs (e), (g), (h) and (f), as the noble Lord, Lord Hunt, outlined, put paid to that. If the argument is that the clause is needed because the ICB might have to share data with, for example, care providers or social workers carrying out assessments, that needs to be made clear, and it would be permissible. But, as drawn, it is far too brief.

The amendment from the noble Lord, Lord Hunt, at least protects the personal data of patients. It is very straightforward and provides the protection that every doctor, nurse and patient would expect. So I hope the Minister will say today that he is happy to accept the amendment. If he is not, please will he agree to a meeting with those who have spoken in this debate, and invite the GMC and the BMA? If progress is not made on this, I will lay an amendment on Report and am likely to press it to a Division.

[The Deputy Chairman of Committees (Lord Lexden) (Con)]

My Lords, the noble Baroness, Lady Harris of Richmond, is also taking part remotely and I invite her to speak.

[Baroness Harris of Richmond (LD) [V]]

My Lords, having spoken on just about every police Bill in this House for the past 23 years, I am afraid that I could not let this amendment pass without comment. I refer your Lordships to my policing interests in the register.

As my noble friend Lady Brinton has just said, the Police, Crime, Sentencing and Courts Bill, which has just gone through this House, had provisions that gave the police and other criminal justice bodies investigating possible serious violence, or plans to produce serious violence, the power to demand the confidential medical data of individuals. As drafted, unspecified police officers —that means any police officer, not just a senior ranking officer—could make requests to a GP’s surgery or a CCG, or their staff, to hand over the data.

What I found chilling was that the police would not be required to explain to the patient’s GP why they wanted the information, or whether the patient concerned was a potential criminal or possible victim—or even someone associated with the investigation, for example a possible witness or family member. After discussions with Peers, the General Medical Council, Ministers and the British Medical Association, the Government made their own amendments, making it clear that the police would not have this universal access to patient data. Instead, they would have to use the current, traditional method of approaching a patient’s GP directly and asking for the data, with the decision being made by the GP under the GMC code of ethics, as my noble friend Lady Brinton explained.

New Section 14Z61 gives the new integrated commissioning boards a duty to hand over personal medical data to a wide range of bodies that request them. However, I will focus on paragraphs (g) and (h), which are about police requests for data when they are undertaking criminal investigations. It is even more extraordinary that a health Bill is proposing to give the police even wider powers than in the recent police Bill. At least that Bill originally limited access to cases of serious violence. I will quote my noble friend from 25 October 2021, in debate on the Police, Crime, Sentencing and Courts Bill:

“It is quite extraordinary that this Bill proposes that any Home Secretary can, at will, demand that doctors and other healthcare professionals breach patient confidentiality, over and above their responsibilities of confidentiality to their patients and their commitments to their regulatory body.”—[Official Report, 25/10/21; col. 551.]

Health and Care Bill

Lord Lexden Excerpts

Lords Hansard - Part 3 & Committee stage
Tuesday 18th January 2022 Lords Chamber

[The Deputy Chairman of Committees (Lord Lexden) (Con)]

My Lords, in the next group of amendments, the noble Baronesses, Lady Brinton and Lady Masham, and the noble Lord, Lord Howarth of Newport, will be taking part remotely.

Amendment 47

Moved by

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

My Lords, to state the obvious, everyone will die. On average, one person dies every minute, and every 22 minutes a child loses a parent. Dying patients are seen in every part of healthcare, and the vast majority will have some level of palliative care need. I declare my interest as a specialist in palliative medicine over decades, and my roles with different relevant hospice and palliative care charities and being employed through the Velindre Cancer Centre.

Amendment 47 would introduce a specific requirement for clinical specialist palliative care services to be commissioned by integrated care boards in every part of England. Amendment 52 is to inform the debate as it draws on the World Health Organization definition of specialist palliative care. These amendments are strongly supported by Marie Curie, Hospice UK, Together for Short Lives, Sue Ryder and the Alzheimer’s Society.

Let me be clear; this is about specialist clinical services. General basic palliative care should be a skill of every clinician. But, until it is recognised as a core specialty, generic services will continue to view it as an extra and learning will not be integrated across all areas. Educating and training are crucial duties in upskilling others. In the pandemic, palliative care has been propelled centre stage as a driver of good practice. Specialist palliative care is a relatively new specialty, which is why it was not included in the early NHS legislation. The other truth, that everybody is born, was recognised by requiring every part of the UK to have maternity services. That has been reiterated in legislation and in Clause 16 of this Bill, along with dental and other services.

The hospice movement grew up outside the NHS, spearheaded by Cicely Saunders, who realised that bringing about change within the NHS was painfully slow. This has meant that a patchwork of services has developed in the wealthier parts of Britain. In some areas great, innovative integration with community social care is happening. But other areas of enormous need are left with almost no service, or no service at all. Now we depend on fundraising events for people to get expert support for pain and other symptoms, and for psychosocial distress. No one would advocate to have a cake sale so that a woman in obstructed labour can have a caesarean section, so why turn a blind eye to ways to improve the quality of life of those with serious and life-threatening illnesses and support their families? Debate in the other place suggested that palliative care is aftercare; it is not. It is not an add-on just before death. It must be an integral part of care so that problems are dealt with in a timely way, not left to escalate into a crisis.

In Section 3 of the NHS Act 2006, clinical commissioning groups had the same general duties as in this Bill, yet significant gaps in specialist palliative care services persist between clinical commissioning groups. Some populations fare particularly badly: people who are homeless or in prison, BAME groups, Gypsies and Travellers, LGBTQ+ people, people with learning disabilities and those living in poverty, alone or with dementia. Yet the way a person dies lives on in the memory of those left behind.

Marie Curie’s freedom of information requests to English CCGs revealed an average spend last year of as little as £19.02 per person aged over 65. Only 35% of CCGs responding offered specialist palliative care services in all care settings overnight and at weekends, yet such services are known to reduce pressure on NHS services and achieve savings by reducing the number of hospital bed days occupied and unplanned admissions.

Research from King’s College London and supported by Marie Curie reveals that of the 23 integrated care systems in England with published strategies, only six identified palliative and end-of-life care as a priority area. Five mentioned broad bereavement support and only three identified relevant measures of success, such as reduced hospital admissions.

In the pandemic, many hospices hit financial instability head on as fundraising dried up. The government bail-out was essential, and I think that everyone was very grateful. In 2008, Wales had tackled this problem head on, aware that if a hospice folded, the clinical core service would still be needed. With just over £2 per head of population investment, we moved to provide core specialist clinical palliative care through an agreed funding formula, moving to seven-day services and 24/7 advice to any health or social care professional with a patient needing help. These services cover hospitals, hospices and community, with increasing integration reaching areas where no services existed. We instigated a paediatric service and an all-Wales unified patient record across the NHS and voluntary sector providers, which I described last week.

The outcomes that we achieved warrant consideration. To quote one nurse:

“The patients have access to specialist palliative care nurses, advice and experience on the weekend, which is great, and if we weren’t there, they wouldn’t have that, and they’d suffer for it. Unfortunately, people deteriorate and die out of hours. They don’t all die Monday to Friday, nine to five.”


At the south-east Wales cancer centre, specialist palliative care is now embedded in the acute oncology service, whose audit revealed that almost three-quarters of the patients presenting to acute oncology had a level of unmet need in palliative care but were unknown to any services at the time. The majority then had same-day, face-to-face palliative care review or were referred to their local team. In the community last year, there were more than 3,700 patient contacts, over 1,000 being face to face. I remind the Committee that that covers a population of about 1.5 million. Many families have “just in case” boxes to make sure that medication is available, and the ambulance service can link in too.

For cancer centre in-patients, the palliative care audit showed that nine out of 10 symptoms improved during the patient’s stay, including pain, breathlessness, constipation and weakness, and nausea scores fell to zero by day seven. Multifactorial drowsiness persisted in some whose disease was progressing rapidly to death.

In England during the pandemic, specialist teams were in place. They have shown that they can facilitate discharge, support staff having difficult ethical and communication dilemmas, and support patients and families, but a Marie Curie survey of carers of people who died at home during the pandemic found that 76% said that their loved one did not get all the care and support they needed, 64% did not get pain management and 65% did not get the out-of-hours care.

This Bill arrives at a critical moment for improving care. In 20 years’ time, 100,000 more people will die each year in the UK. Demand is set to increase rapidly as our population ages and more people live for longer with multiple and complex conditions. The number of people dying with a need for palliative care is projected to increase by up to 42% by 2040. This cannot be left unaddressed, and the solution is at hand. I hope that the Government will finally recognise that they can improve care without increasing overall cost by adopting Amendment 47, to explicitly require the commissioning of specialist palliative care for local populations.

The NHS promised to support people from the cradle to the grave, and it can now realise that promise. I beg to move.

[The Deputy Chairman of Committees (Lord Lexden) (Con)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite her to speak.

[Baroness Brinton (LD) [V]]

My Lords, I thank the noble Baroness, Lady Finlay, for laying these amendments and pay tribute to her for her tireless work in the palliative care sector and in your Lordships’ House. I also thank Marie Curie, Hospice UK, Sue Ryder, Alzheimer’s Society and Together for Short Lives for their very helpful briefing.

Clause 16 provides integrated care boards with duties to commission hospital and other health services for those for whom they are responsible. While specific services are highlighted in the clause, there is still nothing for specialist palliative care as currently drafted. There should absolutely be a fundamental right to access palliative and end-of-life care and support services for everyone who needs them. It is vital to restate that palliative care and end-of-life care are not always the same thing.

Hospices, homes and special services at home help children and adults for more than just those last few days. However, far too many people already miss out on palliative care, as the noble Baroness, Lady Finlay, set out; estimates suggest that while as many as 90% of people who die may have hospice and palliative care needs, only around 50% will actually receive it. Like many others, I am afraid I know family and friends who were desperate to move to a hospice in their last few days but ended up dying in hospital. In my stepfather’s case it was because of the bureaucracy of the hospital—at the point at which they said it was possible to move him, they said it was too late.

If we can reduce unplanned and potentially avoidable hospital admissions, it would be considerably less distressing for the patient and their families and would also reduce pressure on our hospitals.

With people in the last year of their life in England accounting for some 5.5 million bed days, it is estimated that the total cost of these admissions is over £1 billion for our already pressed acute hospital trusts. I have a friend currently receiving end-of-life care who is also stuck in a hospital. The real problem is the lack of understanding of where and how the specialist services can be provided. That is vital, because otherwise people end up in hospital and cannot get out again.

During debate on a similar amendment in Committee in the Commons, the Minister of State for Health, Edward Argar, indicated that the Government’s view is that everything is covered by aftercare. As the noble Baroness, Lady Finlay, said, this is not aftercare. If you have ever seen the brilliant work of palliative care specialists, you will understand that it is real care at a vital time in people’s lives.

I mentioned Together for Short Lives in opening. I have a particular interest in children’s palliative and end-of-life care. One of the things that worries me most at the moment is that people often do not understand that respite care for families looking after young children with very serious illnesses and disabilities has been a vital way of ensuring that they can have some sort of break. They often work 18, 19, 20 hours a day, sometimes with help at home but often, during the two years of the pandemic, with no help at all.

Take the example of my local children’s respite centre, Nascot Lawn. The parents took the CCG to the High Court twice and won, but it closed down. It was not the first. Part of the problem we have with our hospices and other forms of provision is that they rely utterly on public fundraising. The last two years have been a particular problem. For children’s respite and palliative care, it is an absolute tragedy—far too many units are closing down around the country.

In addition, despite a version of the language used in Clause 16, on aftercare, having been in place since the 2012 Act, many CCGs do not currently commission sufficient specialist palliative care. Worse, in the case of Nascot Lawn, the entire onus was put on the local authority because, it was said, it was about personal care. One of my concerns is a muddle between personal care and aftercare, when all these children required specialist nursing.

It is vital that the funding element is looked at. The noble Baroness, Lady Finlay, is right that the NHS always proudly boasted that it was there for people from the cradle to the grave. Sadly, at the moment this is not true. It is the hidden gem of our public health system and we must find a mechanism to make it not hidden but apparent and something that everyone who wants and needs it can rely on in the future.

HIV and AIDS

Lord Lexden Excerpts

Wednesday 1st December 2021 Lords Chamber

[Lord Kamall (Con)]

I am sure that noble Lords understand the reasons for some of those cuts in terms of the pandemic and needing to redirect resources, but we are committed to continuing with funding and working at an international level. In fact, this issue has come up at a number of G7 international health meetings attended by UK representatives. The UK is seen on the diplomatic circuit as one of the leaders standing up for the rights of both gay people and people with HIV/AIDS.

[Lord Lexden (Con)]

Does the Government’s welcome new commitment, announced today, to ensure that home testing is available throughout the country mean that anyone who wants a test will be able to get one throughout the year?

[Lord Kamall (Con)]

I thank my noble friend for his question. I am pretty sure that the answer is yes.

NHS: Fracture Liaison Services

Lord Lexden Excerpts

Monday 8th November 2021 Lords Chamber

[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.

Coronavirus Act 2020

Lord Lexden Excerpts

Tuesday 26th October 2021 Grand Committee

[Baroness Brinton (LD) [V]]

I declare my interest as a vice-president of the Local Government Association. I start by echoing the comments of my noble friend Lord Scriven and many other noble Lords. Regardless of where your Lordships stand on wearing masks, for example, we are all agreed that the way this Government have brought forward far too much Covid legislation as emergency items—

[The Deputy Speaker (Lord Lexden) (Con)]

My Lords, there is a Division in the Chamber. The Committee stands adjourned until all Members have cast their votes.

[The Deputy Chairman of Committees (Lord Lexden) (Con)]

My Lords, the Committee will resume. I invite the noble Baroness, Lady Brinton, to continue her speech.

[Baroness Brinton (LD) [V]]

My Lords, regardless of where your Lordships stand on mask wearing, I believe that we are all agreed that this Government have brought forward far too much emergency Covid legislation, much of which has not even been presented to Parliament before being brought into use. Why, once again, are regulations coming to the Lords for which the expiry date was well known in advance and is not an emergency at all? The Minister’s predecessor heard time after time over the last 20 months many noble Lords complaining that too many statutory instruments were being brought to us as emergency procedures, making a mockery of the scrutiny of your Lordships’ House.

The regulations talk about self-isolation. It remains vital for those who have Covid-19, but can the Minister confirm the rumours that many people are not taking lateral flow tests, even if they are symptomatic, in order not to have to report the results and to avoid self-isolation? I am also hearing that there has been a resurgence of the old problem we had last year of late pinging, presumably because of delays in a struggling test and trace system as case numbers rise dramatically.

The noble Lord, Lord Balfe, raised concerns about whether lateral flow tests are necessary and should be paid for from the public purse. Lateral flow tests are now proving extremely reliable. Actually, we are advised as Members of Parliament to have two lateral flow tests during any week in which we are present in Parliament. Many other workplaces demand even more tests per week than that. It is one of the safest ways we can catch Covid early in people, particularly if they are not yet symptomatic. If we are asking many people to have two, three or five lateral flow tests a week—as I know happens in some places—while the pandemic is still around, it should be paid for from the public purse.

I echo the Minister’s thanks to directors of public health, our local resilience forums and local authorities. Can he confirm that the funding for their work on Covid, including test and trace, is guaranteed for the next financial year and will not end, as is currently planned, in March 2022?

Once again, I ask why the messages from government Ministers repeatedly encourage us to believe that face masks are totally a matter of personal choice. Many noble Lords have expressed their concern about them and said why they do not want to wear them. Even the Secretary of State for Health, when pressed over the weekend, reluctantly said that he would use a mask. However, he refused to say that he would recommend it to his colleagues on the green Benches—although he thought that they should perhaps consider it—whereas the Leader of the House of Commons, Jacob Rees-Mogg MP, has completely eschewed the scientific advice and said that Tory MPs do not need to wear masks because they all know each other and get along so well. The new Minister for Vaccines was of a similar mind on the radio yesterday.

However, as my noble friend Lord Scriven said, vaccination on its own is not the sole answer to Covid. A third of cases at the moment are among people who have already had their vaccinations. With a seven-day rolling average of around 1,000 admissions to hospital per day and with more than 8,000 beds occupied—and with those numbers increasing—I asked the Minister just now, in the Urgent Question in the Chamber, about accident and emergency departments and ambulance services. Conversations with GPs show that they, too, are hard-pressed at the moment in dealing with the increased number of Covid patients calling them for help.

One of the advantages of vaccination is that many people do not get Covid so seriously, but anyone who listened to the “Today” programme from Lancashire this morning will have heard many people say that, even though they had Covid mildly, it was the most unpleasant thing they had had to deal with and that catching their breath all the time was very difficult. GPs are much in demand in offering advice, hopefully to turn people away from hospital and give them the help they need.

Case rates in unvaccinated children remain very high, and despite being told many times in 2020 that children do not get Covid, they clearly do.

On 17 September, Sajid Javid wrote to the 3.7 million people who are clinically extremely vulnerable; that is 5% of our population, though not as large as the 22 million of the over-50s, the clinically extremely vulnerable and NHS staff having booster shots. This group comprises those who have serious problems making antibodies and are at high risk of getting very strong Covid. I declare my interest as being within the severely clinically extremely vulnerable group. Its numbers have expanded from 500,000 to 800,000 over the last two to three months following the publication of a number of clinical trials which were able to show that more categories of people were taking immunosuppressants, which moved them into this group. The news of the antivirals is vital for the clinically extremely vulnerable, and I welcome that. However, as my consultant said to me, “We don’t want you in hospital at all; we absolutely do not want you to end up on many of the drugs coming through yet. You need to keep safe.”

For those of us who have low or no antibodies and were told on 17 September by the Secretary of State that our doctors would now tell us what we needed to do, the outside world is a worrying place. The letter from Sajid Javid said that I should ensure that I did not go into any environment where there were people who were not double vaccinated. I have joked before whether, before entering my local greengrocers, I should stand at the door and shout, “Everyone double vaccinated in here?” I do say that.

The noble Lord, Lord Robathan, can make his own decision about wearing a face mask, but 5% of the population, a mere 3.7 million people, remain at high risk even if they have had their booster jabs. They do not have the choice. I ask him please to reconsider; even when you think you are safe, you may be protecting someone as you may not know that you have Covid and are likely to pass it on.

The noble Lord, Lord Robathan, quoted our scientists in March and April 2020 as saying they did not see the evidence for face masks being helpful. He clearly missed the screeching U-turn in the summer of 2020 after our experts, both in the UK and at the World Health Organization, realised that Covid was much more airborne than they had understood. The noble Lord asked for evidence. This is from the World Health Organization in December 2020, and it is still current advice:

“Masks should be used as part of a comprehensive strategy of measures to suppress transmission and save lives; the use of a mask alone is not sufficient to provide an adequate level of protection against COVID-19.


If COVID-19 is spreading in your community, stay safe by taking some simple precautions, such as physical distancing, wearing a mask, keeping rooms well ventilated, avoiding crowds, cleaning your hands, and coughing into a bent elbow or tissue. Check local advice where you live and work. Do it all!


Make wearing a mask a normal part of being around other people. The appropriate use, storage and cleaning or disposal of masks are essential to make them as effective as possible.”


SAGE told Ministers in May that schoolchildren should wear masks. SAGE did not get rid of masks on freedom day; it was the Government. They decided against the advice. Frankly, it has not been a freedom day for the many people who have caught Covid since mid-July and been in hospital, or for the many who have died.

Sky News reported on 6 July on a report in the Lancet that showed why masks were effective. If noble Lords doubt me, they should just put “Sky News” and

“COVID-19: Do face masks work? Here is what scientific studies say”


into their browser. The evidence is there for the noble Lord, Lord Robathan. It includes that the American CDC reported an incident where two hairstylists with minor Covid symptoms

“were found to have interacted with 139 people during an eight-day period. The stylists and the clients all wore masks”

and a not a single one became infected. Sky News said that, on the USS “Theodore Roosevelt”,

“where living quarters and working environments leave little room for social distancing, a study found there was a 70% reduced risk of infection among those who used a face covering.”

The article also said:

“In Thailand, a retrospective case-control study found that among 1,000 people interviewed as part of contact tracing investigations”—


real people and real cases—

“those who reported always having worn a mask during high-risk exposures again experienced a 70% reduced risk of becoming infected compared with others.”

A quick search of the internet will produce many other examples.

The noble Viscount, Lord Ridley, said that many masks do not contain the aerosol droplets as well as the hospital-grade masks do. That is right, but too many people wear their masks insecurely—not pinching the nose frame or pulling back the ties properly. That is the point the World Health Organization was making. Worse, I am sorry to say that too many think they are protected when they wear their masks under their chins. That does not provide for any protection at all.

As before, the problem of recording third doses versus boosters remains. This is vital. The Minister’s predecessor said that this would be dealt with by the end of July. Because third-dose people need a booster in a few months, it has to be listed separately from ordinary boosters. When will the online system be able to record third doses? Those who took part in vaccine clinical trials or have had their vaccines abroad still cannot get them logged on to the systems. Again, the noble Lord, Lord Bethell, promised that this would be sorted before the summer break.

Since 19 July, when we released all mitigation measures here in the UK, why is it that France, Portugal, Spain and other countries have seen a rapid drop in case rates, while the UK has seen a rapid increase: from 320 cases per 100,000 to 488.5 per 100,000? It is very simple. Our plan B is, in fact, those countries’ plan A across western Europe. Those countries have mandates for masks, social distancing and ventilation. These are not studies but real-life examples.

The noble Baroness, Lady Foster, cited Denmark in her contribution. In Denmark, a country that has been particularly successful, there is not even a mandate but the public choose to wear masks and socially distance. They have accepted this because of the strong messaging right from the start by their Government and local government about taking personal responsibility for their friends, neighbours and community. By comparison, the UK stands alone in saying that a daily case rate of up to 100,000 and, from the Prime Minister’s own mouth, 50,000 deaths a year are acceptable. We are creeping towards those numbers right now. The noble Lord, Lord Hunt, referred to Ministers appearing to believe in UK exceptionalism. Perhaps this is exceptionalism of exactly the wrong kind.

I ask the Minister: why has SAGE been meeting only monthly since July? Who calls those meetings and, if SAGE members feel that they need to advise Ministers, do they have to wait for Ministers to seek that advice? That would be helpful to know.

I believe that every single noble Lord who has taken part in this debate would not want to see plan C having to be enacted, especially if it means that the Prime Minister will have to cancel another Christmas. Experts across our country, and even in the World Health Organization, have expressed real concern that if we do not take at least some of the mitigating measures in plan B right now, the Government will have to move to plan C. We do not want that, so please can the Ministers listen to SAGE and put in the mitigations that most of our neighbouring countries accept as normal and good behaviour, to prevent us ever having to retreat into draconian shutdowns again?

HIV Action Plan

Lord Lexden Excerpts

Monday 18th October 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for her question. The department is currently developing a new sexual and reproductive health strategy and an HIV action plan, as she referred to. We plan to publish the HIV action plan later this year to coincide with World AIDS Day on 1 December. The action plan will set out clear actions to achieve the interim target of reaching an 80% reduction in HIV transmissions in England by 2025. Publication of the detailed sexual and reproductive health strategy will follow shortly afterwards.

[Lord Lexden (Con)]

Do the Government accept that their forthcoming action plan should have four key features: the expansion of testing; greater support for those living with HIV; increased funding for HIV prevention; and new national prevention programmes? Will the Government provide sufficient resources to achieve all four aims and so enhance their reputation as a global leader in combating HIV?

[Lord Kamall (Con)]

I thank my noble friend for his question. The four features he referred to are aligned with the independent HIV Commission’s recommendations. The Government have welcomed the HIV Commission’s report and are currently considering its recommendations to inform the development of the forthcoming HIV action plan. Our specific decisions regarding resources for the HIV action plan are being taken as part of the ongoing comprehensive spending review.

Covid-19 Update

Lord Lexden Excerpts

Tuesday 18th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right to cite the examples of Australia and New Zealand and the challenges they have had with staff manning managed quarantine facilities. I am extremely grateful to officials from both Australia and New Zealand for the very thorough briefings we had when we set up our managed quarantine facilities. We totally took on board their profound insight on that area and that was the number one thing they told us to get right. We focused on it, we have invested in it, and that has worked well to date.

[The Deputy Speaker (Lord Lexden) (Con)]

My Lords, all questions have been asked and answered.

Care Home Occupancy Rate

Lord Lexden Excerpts

Wednesday 28th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, as I mentioned earlier, DHSE has written to local authorities explaining how we recommend some of the unring-fenced £6 billion could be spent to support both those in social care residential situations and those at home. That is the correct mechanic for guiding the spending of the money, but it is the responsibility of local authorities, not of central government, to provide the support that the noble Baroness describes.

[The Deputy Speaker (Lord Lexden) (Con)]

My Lords, the time allowed for this Question has now elapsed. We now come to the fourth Oral Question.

Northern Ireland: Flight Passengers and Covid-19

Lord Lexden Excerpts

Wednesday 28th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I reassure the noble Lord that the issue is caused by no lack of friendship or spirit of collaboration between the two Administrations. The CAA and all the relevant authorities have a huge amount of commitment to resolving this. There are legal issues that require Acts of Parliament in Ireland and in Britain in order to resolve this; these are quite substantial legal commitments that need to be timetabled and conducted through Parliament, and that is what is holding things up. I am very grateful to all those who are trying to resolve the issue.

[The Deputy Speaker (Lord Lexden) (Con)]

My Lords, all supplementary questions have now been asked, and that concludes today’s Oral Questions.