Covid-19: Vaccination
Debate between Lord Ribeiro and Lord Bethell(3 years, 2 months ago)
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Lord Bethell (Con)
My Lords, if I understood the noble Baroness’s question correctly, I reassure her that absolutely everyone’s details are registered in the national immunisation database, so everyone will receive an invitation for their second dose, as I mentioned earlier. However, the reason for having this longer period before the second dose is completely pragmatic. Every 250 doses saves a life, so it is absolutely essential that we get the maximum number of first doses out as quickly as possible. The MHRA, the JCVI and others have looked at the safety and efficacy of this approach, and they have found reassuring evidence that this will work extremely well. I take great joy in the fact that we have found a way to get the highest number of doses to the greatest number of people as quickly as we possibly can.
Lord Ribeiro (Con) [V]
My Lords, mindful of the impact of Covid-19 on front-line health staff during this pandemic, and given the report in the Times today of reduced supplies of the Pfizer/BioNTech vaccine during January and February, can the Minister say what plans there are to ensure that these front-facing health staff in hospitals and care homes are prioritised as a matter of urgency to protect them from the pandemic? As someone in his late 70s who is waiting for the vaccine, I am happy to forgo mine until such time as the health staff I mentioned are protected.
Lord Bethell (Con)
I am enormously grateful for my noble friend’s important gesture and pay tribute to his generosity of spirit. However, it is absolutely essential that he gets his vaccine as soon as he can, because he is at the top of the list. Morbidity is determined by age, not proximity. Healthcare staff are of course of deep concern to all of us, but those who are in PPE and in protected conditions have no greater chance of getting the disease than members of the general public. It is essential that we put those who have the highest risk of morbidity—the oldest—at the front of the queue, which is why we have the prioritisation list that we have.
Covid-19 Update
Debate between Lord Ribeiro and Lord Bethell(3 years, 7 months ago)
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Lord Bethell (Con)
Our message remains clear and the same as when we started this epidemic. There is no other better alternative than the three principles articulated by the noble Lord, Lord Patel: clean hands, clean face, and social distancing. That mixture of hygiene and social distancing is the only thing that can beat this virus; that is our first line of defence. Test, trace, and isolate is our second line of defence. Face masks—in situations where social distancing is a challenge—can provide some secondary back-up, but they are not our primary form of defence.
Lord Ribeiro (Con) [V]
My Lords, the statement by the CMO and CSO today fired a shot across the bows of Government and demands action now to prevent the second wave getting out of hand. The message is sobering. As noted by my noble friend, we could see 50,000 cases a day by mid-October if no action is taken, leading to 200 deaths per day by mid-November. They refer to transmissions at home and in social settings. This should direct our attention to pubs and restaurants and whether they should remain open as potential vectors of infection.
We have learned many lessons from the first wave, particularly that there may have been a reluctance on the part of hospitals to refer patients to the Nightingale hospitals, lest this be seen as a sign of failure. This is a war on a pernicious virus, and we need leadership and central direction to ensure that we use these facilities more effectively. I welcome the £450 million earmarked to upgrade and expand A&E units, but we need a plan for the following points. One, triage patients to Nightingale hospitals once capacity in NHS hospitals exceeds 60%. Two, A&E holding bays for suspected Covid patients, who are transferred to Nightingale hospitals if they test positive. Three, a point of care test, be it the new flexible test the Minister mentioned earlier, to ensure we get quick results. The purpose of the Nightingale hospitals must be to enable the wider NHS to fulfil its obligations to maintain elective and emergency services. Can my noble friend the Minister confirm whether this is the Government’s strategy?
Covid-19: Response
Debate between Lord Ribeiro and Lord Bethell(3 years, 8 months ago)
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Lord Bethell [V]
My Lords, it is a horrible truth that this disease hits hardest those with vulnerabilities. We have put in place a massive national programme to seek to protect the most vulnerable, and those with disabilities have been very much the focus of our attention. I cannot make the commitments that I know the noble Baroness wants me to make, but I reassure her that those with disabilities are the focus of what we are trying to do.
Lord Ribeiro (Con) [V]
My Lords, the London Nightingale hospital was mothballed in mid-May and remains at standby for a second wave of Covid-19, having treated just 54 patients since it opened on 3 April. In a recent report of 19 July, Harrogate Borough Council questioned how the 500-bed field hospital based in Harrogate Convention Centre would be deployed. Given that £3 billion has been allocated to maintain the seven Nightingale hospitals until the end of March 2021, and noting that the Harrogate centre has not treated a single patient since it opened, can my noble friend the Minister say what the strategy is for those hospitals? Should they not be designated Covid centres to which all local hospitals can refer their patients, thereby allowing the NHS to resume its routine work and centres such as the London Nightingale hospital, which could reopen in six days with 250 beds, to provide assisted ventilation, hemofiltration and dialysis to support seriously ill Covid patients?
Lord Bethell [V]
My Lords, the Nightingale hospitals have been a huge success in helping us to protect the NHS at a time when our needs were greatest. Since then, when prevalence rates were lower, we reallocated resource into restarting the NHS to gain ground during the summer months on our backlog of business-as-usual work. Those resources are needed in the hospitals where people usually work. The mothballing of the Nightingale hospitals allows us to use that capacity for what is most needed right now.
Covid-19 Update
Debate between Lord Ribeiro and Lord Bethell(3 years, 9 months ago)
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Lord Bethell
The noble Baroness talks of an incident that I do not know the details of, but I do not deny that we are on a learning curve. We will publish new guidelines tomorrow on our local outbreak response; we are publishing guidelines on the opening of venues for 4 July; and we are working extremely hard to stitch together much better relations between the centre, where a lot of the data inevitably ends up in a big system, and the insight of local actors in local PHE, local infection, NHS and local authority bodies. This has been happening for many weeks and we have already made huge progress, but there is still more to do.
Lord Ribeiro (Con) [V]
My Lords, the noble Lord, Lord Hussain, referred to the risks for the BAME population. The PHE report found that those of Bangladeshi ethnicity were at twice the risk of death compared with people of white British ethnicity. That, of course, is particularly relevant in relation to Leicester. The PHE follow-up report, Beyond the Data: Understanding the Impact of COVID-19 on BAME Groups, which came out last month, identified long-standing inequalities exacerbated by Covid-19. Occupation, population density, the use of public transport, housing conditions and the risk to key workers are all factors in acquiring Covid-19. What actions will the Government take to address the seven recommendations in the report?
Lord Bethell
My Lords, we take the PHE report extremely seriously but there is still work to do in understanding how the disease affects different groups, including ethnicities. Some effects are behavioural, such as obesity; some are social, such as population density, to which my noble friend alluded; and some might be genetic. It is not clear which of those three is the main driver and what the balance is between the three. We are investing a large amount in medical and clinical research to understand that dilemma. In the meantime, we are prioritising the safeguarding of BAME workers in the NHS who might be at risk and in need of specific treatment.
Covid-19: Track and Trace System
Debate between Lord Ribeiro and Lord Bethell(3 years, 10 months ago)
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Lord Bethell [V]
My Lords, we are enormously grateful to the people of the Isle of Wight for their collaboration on the pilot. There is no question of them needing to stand down. Other measures for “test and trace” are working extremely well on the Isle of Wight, and both the pilot app and the manual “test and trace” have helped break the chain of transmission. We remain extremely grateful for their support.
Lord Ribeiro (Con) [V]
My Lords, six weeks ago, the contact tracing app was launched on the Isle of Wight, since when, the emphasis has shifted from the app to the use of 25,000 call centre workers to identify the contacts of people testing positive for Covid-19. What lessons have we learned from countries such as Australia, Singapore, Italy and Switzerland, which all launched contact tracing apps, and is the purpose of the “test and trace” app to help end this pandemic or to protect us from the next?
Covid-19: Response
Debate between Lord Ribeiro and Lord Bethell(3 years, 10 months ago)
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Lord Bethell
The noble Baroness makes a powerful point. The frustrating truth is that many in the groups and communities of which she speaks take the fewest number of tests. Getting through to these groups is extremely important, so they can seek the clinical help they need if they are suffering from Covid. We have worked extremely hard with our marketing department to ensure that hard-to-reach communities get the marketing messages that will be effective. The noble Baroness provides a really reasonable reminder and I will redouble my efforts to ensure that those marketing messages are focused on the right communities.
Lord Ribeiro (Con)
My Lords, I appreciate that “test, trace and isolate” is in its embryonic phase and that we have yet to learn the lessons of the pilot on the Isle of Wight, but at the height of the pandemic Sir Paul Nurse and other academic researchers offered, in the spirit of Dunkirk, to assist the Government with their “little boats”. Sadly, this approach failed to find favour, with a central approach then being used. Will my noble friend assure me that, as we head to a national rollout of “test, trace and isolate”, the Government will remain open to offers of help from those in the security and medical fields?
In addition, the PHE report identifies worrying outcomes from BAMEs who contracted Covid-19, as others have said, but the analyses did not cover comorbidities such as hypertension, which is common in the Asian and African populations, diabetes or obesity, which was mentioned in 21% of Covid-19 death certificates. Can my noble friend say when these factors will be considered, in order to provide a clearer picture for BAMEs who are at risk of contracting Covid-19 now and when the next wave comes in the winter?
Lord Bethell
My noble friend makes an incredibly perceptive point on the BAME research. He is entirely right that this important aspect of our understanding in relating the ethnic, social and behavioural elements of the response to the disease is essential. The report has not covered all the ground yet: that work is being done at the moment, as I mentioned earlier. Frankly, only when all those elements are linked together will we get a full picture.
Regarding the “little boats”, we absolutely celebrate them. In order to get the industrial-level testing numbers up, it was correct to back big laboratories that could do the automation necessary to achieve that. I am a huge admirer of Sir Paul Nurse and have spoken to him often. The role of laboratories such as his is in connection with their local NHS trusts. Many local laboratories are doing extremely good work with local NHS trusts and we are putting measures in place to facilitate and encourage such connections.
Hospitals: Patient Safety
Debate between Lord Ribeiro and Lord Bethell(3 years, 11 months ago)
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Lord Bethell
My Lords, I acknowledge the expertise of the right reverend Prelate the Bishop of London, who, in a former life, was the Chief Nursing Officer. She raises an important point; the mental health of staff is of enormous and grave concern to the NHS, to the department and to social care. We are investing money in providing additional mental care support and are working closely with the colleges to find out how best we can provide that important support.
Lord Ribeiro (Con)
My Lords, the specialist guidance on the management of non-coronavirus patients needing acute treatment, issued on 20 March, put senior decision-makers at the heart of triaging patients referred for admission. To assist them, what role would testing for Covid-19 play on admission, and what proposals are there to utilise the Nightingale hospitals as a step-down facility for Covid-19 patients, thus reducing their numbers in NHS hospitals and allowing those hospitals to deal with the backlog of cases?
Lord Bethell
My Lords, there was some interruption in hearing my noble friend’s question but, if I understood him correctly, the answer is that all patients are now tested on entry to hospital. Until their test result has arrived, they are treated as though they have Covid-19 and isolated wherever possible.
Care Homes: Covid-19 Testing
Debate between Lord Ribeiro and Lord Bethell(3 years, 11 months ago)
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Lord Bethell
My Lords, I completely acknowledge the threat of a second peak. It focuses the mind and is very much a priority for the Government, but there is no squabble of the kind the noble Baroness describes. I pay tribute to colleagues at the CQC, Public Health England, the NHS and the private care providers with which we work. Care home testing is offered to all care home staff and patients who need it. We are prioritising those who ask for it first and working through the list for any who need it by early June.
Lord Ribeiro (Con)
My Lords, given the press briefing by Dr Jenny Harries on Wednesday 13 May, when can we expect testing of all residents and staff in care homes? Covid-19 infects older people in care homes at different times. Therefore, a test is valid only on a specific day. Do the Government understand that one test per resident is not enough? Repeat tests are often required. Can my noble friend the Minister say what steps have been taken to increase the number of tests in care homes to save lives?
Lord Bethell
The noble Lord is correct: it is one test per resident for each infection. I pay tribute to the many care homes which have no infection at all, which have applied the correct disciplines and systems and for which no demand for the tests is currently present. We are prioritising homes that have infection and working through all their residents and staff, offering second and regular testing until the infection is eradicated. That logical prioritisation is exactly the right way to use the resources of both time and supplies, which are necessarily limited.
Psychiatrists
Debate between Lord Ribeiro and Lord Bethell
Lord Bethell
The noble Baroness is quite correct to suggest that the issues of psychiatry recruitment are complex. They are not simply a matter of funding; the Government have put a large amount of money behind mental health. It is not just a question of places—a large number of vacancies are available in psychiatry; it is one of the employer brand. The employer brand around psychiatry is not where we would like it to be, and safety is a difficult and challenging issue to address. We are focused on that. The campaign by the Royal College of Psychiatry addresses this very issue, and we will continue to work on it.
Lord Ribeiro (Con)
My Lords, two years ago, Sir Simon Wessely, then president of the Royal College of Psychiatrists, identified a serious problem with psychiatric recruitment, particularly among trainees as the Minister has mentioned. As it takes five years to get a trainee through to becoming a doctor, and bearing in mind that we are nearing Brexit or the effects of it and that many doctors come from the European Union, what action are the Government taking now to deal with this problem?
Lord Bethell
I am grateful for my noble friend’s question. He is correct that Brexit is a challenge, but I draw his attention to the interim people plan, which is focused on the issue of psychiatry recruitment. It addresses pension tax concerns—a key hurdle for those later in their careers—and increasing university clinical placements, and it bolsters the workforce through greater international recruitment. I remind my noble friend that there were 2,000 more EU nationals working in the NHS in June 2018 than in June 2016.