Covid-19 Inquiry

Lord Reid of Cardowan Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Lord Reid of Cardowan (Lab)]

My Lords, unusually, I will not attempt a critical analysis of the last Government’s conduct of Covid. That is not due to a sudden surge of empathy; it is sufficient to describe the report, the subject of today’s debate, which is critical enough.

I welcome the Minister’s mention of mpox—I think she was the only one to mention it—because this report could not be more timely. If we needed any evidence of its relevance, it has surely come with the recent World Health Organization warning about the spread of mpox. Last month, it declared the ongoing outbreaks in Africa a global emergency, hoping to spur a robust global response to that crisis. Hope springs extreme in that case, because we will be and have been assured by everyone that mpox can be safely contained. However, the truth is that, to date, Africa has received a tiny fraction of the vaccines needed to slow its speed, especially in the Congo, where more than 18,000 suspected cases and 629 deaths have already occurred as of last week. It is surely not just a moral compulsion to make sure that that situation is remedied and contained, but dramatically in our self-interest.

Quite apart from mpox, as the Minister said, it is a matter of not just if but when we will be faced with another global pandemic. The nature of modern demographics, population growth, travel and legal and illegal migration all make that highly probable, if not inevitable. Faced with this prospect, the report makes sombre reading. Sadly, it highlights that, despite previous experiences with epidemics such as SARS, H1N1, CoV and swine flu, the UK’s preparedness for a pandemic of Covid-19’s magnitude was by any standards inadequate. The report exposes several critical areas where the UK fell short, offering a stark reflection of what needs to be improved.

We do not need reminding of the terrible cost of the Covid-19 pandemic: over 200,000 lives lost, countless families affected and widespread disruption to our daily lives, economy and mental health. The inquiry has sought to capture that reality not only to honour the friends and family we have lost but to ensure that their experiences inform future actions. It is true that the report concentrated on preparations. Some noble Lords have criticised that. Funnily enough, the objective of the first section of the report was to study preparations. We should not criticise people for addressing the very subject of the report as it was laid out. Of course there were serious economic implications. The UK’s economic preparedness was tested as businesses closed and unemployment soared. The inquiry recommends robust economic contingency planning—as my noble friend Lord Harris mentioned, this is essential—including support for businesses and workers, to cushion the blow of such crises in future.

One of the inquiry’s primary areas of focus is the Government’s response in the early days of the pandemic. I am very glad of the honesty with which the noble Lord, Lord Frost, addressed us this evening; I do not know if he said the word “shambles”, but that is certainly the picture he depicted. The report highlights significant delays in imposing lockdown measures and implementing appropriate testing and tracing systems. It is very easy to say that no one knew. There is an old saying: you do not need to look in the crystal ball—read the history books. In this case, that is Hansard. Read what the noble Lord, Lord Patel, asked in a PNQ in February 2020. He could see what was coming, so the question of why the Government could not naturally arises. It is imperative not to criticise what the Government did but to learn from their mistakes. A rapid response to future health crises is not just advisable but essential. Preparedness must become a priority on our national agenda, involving not only the Government but local authorities, public health agencies and communities.

Moreover, the report emphasises the critical role of communication during the pandemic. The initial confusion surrounding guidance and protocols led to a mixed reaction from the public. Clear and transparent communication should have fostered greater understanding, compliance and trust. As we strive to improve our public health response, we need to commit to maintaining open lines of communication, using clear language and engaging communities from the outset. Transparency, especially in times of crisis, is key to building that essential trust.

Another perhaps more poignant lesson from the inquiry is the highlight on inequalities within our society that the pandemic laid bare. The report illustrates how marginalised communities bore the brunt of the health crisis, facing high infection rates, poorer health outcomes and greater economic hardship. Women, ethnic minorities and low-income workers were disproportionately affected. Surely that should serve as a wake-up call for all of us. In rebuilding and restructuring our health systems, we need to ensure that equity is at the forefront. We must strive for policies that address these disparities, ensuring that everyone, regardless of background and circumstance, has access to healthcare, support and resources.

The findings in the report also draw attention to the crucial role of our healthcare workers, who faced extraordinary challenges on the front lines. One previous speaker mentioned the bravery and courage of those who went into Downing Street, risking the chance of catching Covid—though as far as I can remember, they spent a lot of time in the open air, in the garden—but the workers in the National Health Service faced that every single day. Their sacrifices and dedication cannot be overstated and the inquiry emphasises the need to better support our healthcare workforce through adequate resources, mental health services and fair compensation. We must prioritise their well-being, recognising that their health is intrinsically linked to the efficacy of our health system as a whole.

Furthermore, the report underscores the importance of data, which was mentioned by the noble Lord, Lord Bilimoria, who unfortunately is not in his place at the moment. Accurate and timely data collection was essential for tracking the virus’s spread and effectively responding to it. The inquiry highlights the need to enhance our data systems to facilitate informed decision-making and responsiveness in future pandemics. That includes not only health data but also socioeconomic data to understand the broader impacts of such a crisis on society.

All in all, this report represents, in my view, a thorough examination of our national response to the Covid pandemic, and one which we should very much bear in mind when the Government come to propose future planning. Of course, this may involve legislative measures. Yesterday evening, I received a communication from the Bingham Centre. It is not an institution I know and it is not an unfamiliar experience for noble Lords to receive and be inundated with emails the night before a debate—but its advice seems to me to be sound.

The Bingham Centre has suggested that among the considerations for that approach to legislation should be four factors. First, the four legislatures of the UK should be involved in government planning exercises for future public health emergencies—a point mentioned by the noble Lord, Lord Frost, about the apparent discrepancy and incongruity between the approaches of the four legislatures in the United Kingdom. It suggests that if a draft Bill is designed in anticipation of a public health emergency, it should be drafted only after the widest practicable stakeholder consultation and engagement, and that government should consider as an integral part of policy planning which public health interventions should be given a legal basis, which should only take the form of public health advice and how that distinction can be best communicated—unlike at the beginning of the pandemic. Finally, planning for future public health emergencies should identify points when certain groups should be consulted in a proactive, participatory manner to help embed human rights and equality considerations in policy-making.

All of these seem to me to be prudent and wise. It is now up to the new Government, of course, to fashion a health system that is more resilient, as the noble Lord, Lord Harris, said, and more equitable, ensuring that we are better equipped to face any future challenges. In the meantime, I for one certainly feel very grateful to the noble and learned Baroness, Lady Hallett, and the inquiry for the recommendations they have made so far.

NHS: Long-term Sustainability

Lord Reid of Cardowan Excerpts

Thursday 18th April 2024 Lords Chamber

[Lord Reid of Cardowan (Lab)]

My Lords, I congratulate my noble friend Lady Ramsey and I thank the noble Lord, Lord Patel, not only for securing the debate but for his sweeping overview of the coming years. I have a much more modest aim. I would like to tackle just one issue: the 7.5 million people who are on the waiting list, suffering sometimes pain and very often distress. I will look at the reforms to the NHS in the years 2000-05 and how they were tackled. There are a number of former Ministers in the House, and they will be well aware that think tanks rarely look back with kindness and positivity at our efforts. I was therefore somewhat surprised and pleased that the King’s Fund report of 2022, Strategies to Reduce Waiting Times, was unusually positive. Indeed, it argues that some of the NHS reforms I was involved in, along with the noble Lords, Lord Crisp and Lord Warner, actually worked. That was a first, I think, for a think tank’s review of ministerial activity.

The report starts with the overall judgment that:

“The years following the NHS Plan in 2000 provide important lessons for tackling long waits … successfully”.


I suggest, therefore, that we might look at some of the levers that we used, because we have so many people waiting in pain and distress at the moment, as I said. The simple judgment of that report is important, because it means that we do not need to be fatalistic about the large number of people waiting in care. We faced the issue before, and as a nation we succeeded in solving it, so let us briefly mention the reform levers that the Government might want to consider or to enhance.

From 2002 we developed the policy of paying NHS trusts more money if they carried out more work. Put like that, it sounds very simple, but at the time it was portrayed as an extremely controversial, right-wing point of view. Ironically, that came from some of the people who naturally assumed that if they produced more at work, they would get paid more, but they felt somehow that it was wrong for NHS entities to work on that basis. They argued at the time that it would undermine the NHS. It did not. It acted as a clear incentive to do more work, and because more work got carried out, waiting lists, among other things, began to fall.

Secondly, we realised that there was no point in providing an incentive to a trust to obtain more resource by carrying out more work if at the year end the trust had to give back any surplus to the centre. That is why in 2004 we created foundation trusts, which could roll forward the resources they made and reinvest them. Again, arguing for this caused many to attack the Government at the time for being too right-wing.

Thirdly, from 2002 we started to offer patient choice to those who had been waiting for more than six months. I was told at the time, as was my predecessor Alan Milburn, that this was no use because patients did not have the knowledge, the ability or the capacity to exercise that choice. Funnily enough, of course, that too was proved wrong because, rather than wait longer, most patients chose to go somewhere other than their local hospital, despite the disadvantages of travel, because they valued the shorter time before treatment.

Fourthly, the money followed that patient choice, putting patients, not providers of healthcare, in the driving seat and rewarding those carers who best met patients’ needs and satisfactions.

Fifthly, we not only used the private sector to provide services for NHS patients but created, through the independent sector treatment centres, a new form of private sector that increased productivity by each concentrating on one form of treatment.

Taken together, those were the reforms that effectively reduced massively the waiting lists. Of course, there were extra resources. The only criticism I would make of the noble Lord, Lord Patel, is that he referred to Tony Blair’s promise of a 6% increase per annum as uncosted. It was not uncosted. We costed it—we just had not told the Chancellor. That was the controversy. As I said, with each reform there was great political controversy.

My final point is that thereafter there is a mystery, because you would assume that after the Labour Government left office, the Conservative Governments that came in consecutively would not only adopt those practices but turbocharge them. In fact they dropped them and the practices disappeared, apparently disintegrating, until last year. I pay credit to the Minister who is replying today, because he was one of those who pushed for their readoption. The lessons of those five things are very important for any future Government, and I hope they will be taken on board by a future Labour Government.

Children’s Cancer Services

Lord Reid of Cardowan Excerpts

Wednesday 20th March 2024 Lords Chamber

[Lord Markham (Con)]

Yes, and the Royal Marsden has a very good track record on that. As was explained to me on the Cambridge visit, having all those services together under one roof is a definite advantage. When the pros and cons are weighed up, that will definitely be a pro.

[Lord Reid of Cardowan (Lab)]

My Lords, the Minister will be aware by now that there is considerable doubt, controversy and concern around this decision. He has said—and we all take it in good faith—that the Secretary of State is calling this in at this stage for fact finding. When does he anticipate that such a review of the facts might be finished?

[Lord Markham (Con)]

It is only now that the facts are starting to come to us. On something as important as this, we definitely do not want to be hurried into it. Normally, I would be saying at this Dispatch Box that I want to “go, go, go”, but on something as profound as this I want to make sure that we are not hurrying into it. All noble Lords will agree that we have a very good service in operation. For instance, I looked at the Royal Marsden’s stats on speed of treatment and diagnosis, and they are excellent. I am afraid I cannot give a timetable because, quite deliberately, I want to make sure that we do not rush into any decision until we know all the facts.

NHS GP Surgeries: Purchase by US Companies

Lord Reid of Cardowan Excerpts

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

I totally agree with my noble friend. I like to think that we will take advice from whoever is best placed to give it, whether they are public sector, private sector, UK or international.

[Lord Reid of Cardowan (Lab)]

My Lords, I thank the Minister for referring to me in the context of patient choice. I am proud of that and would like to see more of it. The problem as regards GPs is that it is not just the right to choose but the ability to exercise that right that is prevented if every GP’s list of patients is so large that you cannot jump from one GP to another. The key to exercising the quality and the choice that the Minister quite correctly mentioned is to create more GPs. As long as we have a shortage of GPs, we will negate the choice of the patients.

[Lord Markham (Con)]

The noble Lord is absolutely correct that it is all about supply and the quality of that supply. That is why, again, I am pleased to say that we have a record number of GPs in training. We can learn from innovative measures. I have been looking at an advanced draft of the workforce plan. The number of doctors in the most advanced medical systems in the world—those of Japan and the US—is lower per head of population than here, but the number of nurses is higher. They have altered their staff mix to get the optimum performance, and we should be open to these innovative approaches to get the best output.

NHS Waiting Times

Lord Reid of Cardowan Excerpts

Tuesday 22nd November 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord. As I have said previously, innovation, and being able to back that up with investment, is key. The House will see that we have protected a lot of the research funds so that we can do exactly that. That is the direction of travel. The new hospital programme, which I look after, is very much about looking at best practice and innovation around the world and making sure that we employ the best in our new hospitals and across all our trusts.

[Lord Reid of Cardowan (Lab)]

My Lords, the Minister is relatively new to his department, but even in the number of weeks he has been there, he must recognise that, whatever statistics on inputs he announces at the Dispatch Box, it is not working. There was a time, two decades ago, when we managed as a Government to reduce the maximum waiting time from three years to 18 weeks and the numbers on the waiting list from 1 million to 500,000. There are now 7.2 million on the waiting list—incidentally, there were 4.2 million before Covid. Whatever the Government have been doing for 10 years is not working and people are remaining in pain for prolonged periods, quite apart from the effect on the economy. Will the Minister institute an immediate review centred particularly around patient choice, which is the only thing that will drive down waiting times and waiting lists? It should never have been abandoned in the way it has been by the Government.

[Lord Markham (Con)]

I believe that customers—call them patients—should drive performance and improvements. Inputs are important, but I totally agree that in a performance culture outputs are very important. I give credit to the work done in the early 2000s, from which I have tried to learn in the short time I have been here, to really bear down and create a performance culture to get waiting lists down by holding trusts, and now the new ICB CEOs, to account. That is definitely the direction of travel, and I am very happy to learn from things that have worked well in the past.

NHS: Winter Challenges

Lord Reid of Cardowan Excerpts

Monday 10th October 2022 Lords Chamber

[Lord Markham (Con)]

I do not have the detail on the 12-hour wait-list at this moment, but I will come back to the noble Baroness with a detailed written response.

[Lord Reid of Cardowan (Lab)]

My Lords, I welcome the Minister. I am delighted that he has his position but I have to say that I do not envy him. Some months ago, I pointed out to his predecessor—who, very fortunately, is sitting next to him—that the number of people on waiting lists had increased over the past 20 years from 0.5 million, which the last Labour Government still regarded as far too high, to 4 million before Covid and 6 million when I asked the question. I asked the then Minister what the Government were doing about it. He kindly explained what they would do, but since that time the number on waiting lists has moved from 6 million to 6.8 million. Since that means that 6.8 million people are waiting in pain, trepidation and fear, will the Minister make it his highest priority to bring what business acumen he can to make sure that choice is extended to patients? It is choice for patients that will bring down the waiting lists, whether they wish to go to another NHS hospital or to a hospital in the private sector provided free at the point of need.

[Lord Markham (Con)]

I agree with those excellent points. As someone who is also responsible for the new hospital build programme, which can give that choice and make sure we have the most effective system, that is top of my agenda.

Polio

Lord Reid of Cardowan Excerpts

Thursday 23rd June 2022 Lords Chamber

[Lord Kamall (Con)]

Part of the public health message has been focused on making sure that people come forward, even before this was detected in the sewage works. One thing we saw as a result of lockdown was that some parents in some areas had not taken their young children to their doctor to have the vaccine. Let me be clear: at eight, 12 and 16 weeks, a child gets a 6-in-1 vaccine; at three years and four months, as part of the 4-in-1 preschool booster, they get it; and at 14 years they get one at school as a teenage booster. Some of those are pre school. We are encouraging people to check their red book, check their vaccination record and make sure they take their child in for their vaccine.

[Lord Reid of Cardowan (Lab)]

My Lords, one of the paradoxes of ministerial Statements on issues such as this is that the more transparent Ministers are, the more the risk that it will create a sense of concern in the public. The history of public health problems over the past 50 years gives us the knowledge that the best way to deal with these issues is the maximum transparency at the most regular and immediate opportunities. That is the way ultimately to relieve concern and I recommend it to the Minister. On a specific issue, can the Minister give a little more detail on the decline in vaccinations throughout the country, particularly in London, during the Covid pandemic? I assume that the natural concern with vaccination for Covid led to a fairly substantial decline in vaccinations for other diseases. Can he give us a little more information on that?

[Lord Kamall (Con)]

First, I thank the noble Lord for his recognition of one of the challenges of ministerial office, as he will know from his own experience. It is important that we recognise that vaccine-derived polio has the potential to spread, but it is rare and the risk to the public overall is limited. The majority of Londoners are fully protected against polio and will not need to take any more action, but the NHS will begin reaching out to parents of children under five in London who are not up to date. But we are asking for it both ways and for parents to check their records. Let us be clear that the UK is considered to be free from polio, but we recognise a potential risk given our world-leading surveillance of sewage.

On the noble Lord’s specific question, we are quite clear that people must come forward for all vaccines. Sometimes during lockdown people were unable to see a doctor or nurse in person, and the NHS is catching up with that anyway, but the NHS will keep sending the message to try to identify people who have not been vaccinated. At the same time, we are encouraging people to check their records. Let us be clear: we detected this very early in the chain, and it has perhaps come from someone who took an oral vaccine overseas and has excreted it into the system.

International Healthcare Outcomes

Lord Reid of Cardowan Excerpts

Thursday 19th May 2022 Lords Chamber

[Lord Kamall (Con)]

The Government are doing a lot on the anti-obesity strategy in conjunction with the Office for Health Improvement and Disparities. We have brought together a number of issues. We have existing actions to halve childhood obesity by 2030 with new interventions. We have invested large amounts in weight management services. However, it is not only about reducing the calories taken in but about burning off those calories and getting the right balance between activity and consumption.

[Lord Reid of Cardowan (Lab)]

My Lords, just over 20 years ago, the waiting list for operations in the National Health Service was around 1 million people. That figure was considered so horrific that there was a massive effort in finance, recruitment and restructuring which over four years reduced the waiting list to 400,000—still too high but significantly better. The waiting list is now 6.1 million people. It cannot be blamed on Covid, because even before Covid it was over 4 million. What are the Government going to do to take those people out of fear and out of pain?

On a lighter note, given the Minister’s previous concern about my spring booster jab, within three days of my birthday, I received an invite and had it two days ago, and it all went very well.

[Lord Kamall (Con)]

I appreciate the fact that the noble Lord has had his spring booster. I would love to take some credit for it, but that must go to our wonderful health and care staff and how they deal with these issues.

The noble Lord is absolutely right: the waiting list, however big, is too big. However, when we analyse the waiting list on the backlog, we see that 80% of people on it are waiting for diagnosis, not surgery. Of those waiting for surgery, 80% can be seen within a day and do not need to stay overnight. We understand the granularity of the waiting list and are taking targeted action to ensure that it is focused on needs.

NHS: Pre-pandemic Facility Levels

Lord Reid of Cardowan Excerpts

Tuesday 29th March 2022 Lords Chamber

[Lord Kamall (Con)]

My noble friend will be aware from when he was a Minister that there were other priorities in tackling Covid, trying to get a vaccine and procuring much-needed equipment. This was therefore all delayed, but we are now working with stakeholders to ensure that the updated capital strategy sets a clear direction for the system, taking into account significant events since the first publication. The multiyear settlement confirmed for 2021 allows us to take the next step forward. We expect the paper to be published at some time in 2022.

[Lord Reid of Cardowan (Lab)]

My Lords, did not the noble Lord, Lord Austin, hit the nail on the head when he said, regarding GPs, to give the patients choice? Back in the days when we reduced the waiting list from 1.1 million to just under 400,000, we reduced waiting times in hospitals from over three years down to 18 weeks. We did that primarily by giving the patients the choice to go to another hospital if they were not getting the service they needed and making the money follow the patient’s choice. Is that not the way to solve the GP problem?

[Lord Kamall (Con)]

Yes.

Covid-19: Restrictions

Lord Reid of Cardowan Excerpts

Monday 14th March 2022 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for those questions and will try to answer them as best I can. We are now transitioning to a stage where we are able to live with Covid, and we have just announced our living with Covid strategy. At the same time, we are looking at the best way to help those who are particularly vulnerable medically or economically, who should still be entitled to free tests, for example, and issues such as affordability. We continue to monitor the new variants, the BA2 and the deltacron, and we will also continue to have the ONS surveys.

[Lord Reid of Cardowan (Lab)]

My Lords, given the fact referred to by the noble Baroness, Lady McIntosh, about the reversal of what was a very welcome decline in numbers, has any advice been given to the Government by the bodies to which the Minister referred about a further, fourth jab—another booster jab—for the elderly population? I suppose I should declare an interest.

[Lord Kamall (Con)]

I thank the noble Lord for declaring an interest. We are reviewing all scientific advice and looking at the spread and potential of new variants. Advice has been given on an additional booster, particularly for those over 75. I will not ask the noble Lord his age, but I commit to write to him.