Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020
Lord Scriven Excerpts(3 years, 3 months ago)
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Lord Scriven (LD) [V]
We have a national emergency. The number of people catching the virus is rocketing; the NHS is struggling to provide urgent care to all those who require it; and there is the tragedy of early death for so many families. Everyone must do all they can to keep people safe. As difficult as these regulations will be for so many, these Benches support them. We do so with suggestions the Government should listen to and will hopefully take forward. I offer improvements for self-isolation; others will make other suggestions.
We are now vaccinating, but virologists say it is highly likely that we will have to live with the virus for years to come. Fully funded localised test, trace and isolate systems will therefore be important. Changing the number of days for which a person has to self-isolate is totally useless if less than 20% do so. We must deal with the cause of this, which for many is the lack of financial security and support. The present financial support is not enough; SSP works out at £2.59 per hour, and even if a person claims the £500 grant, that still works out as below the rate of the national living wage. What percentage of eligible people apply for and receive the £500 one-off grant for self-isolation?
To improve the numbers of people who self-isolate, the Liberal Democrats request that the Government pay lower-paid people their normal income for the period of isolation, along with a bonus for completing the required days to thank them for doing the right thing. This must be supported by fully funded Covid community teams that are in regular contact with people isolating to offer full practical and well-being support. These two things would give people the security and support to self-isolate. It is a blind spot of the Government and needs to be addressed. They should start to plan and prepare for when we come out of lockdown and not be caught off guard again. With the right government actions and support, it becomes easier for my actions to save your life and for your actions to save mine. That is why self-isolation payments and support must be addressed urgently.
Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 2) Regulations 2020
Lord Scriven Excerpts(3 years, 4 months ago)
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Lord Scriven (LD) [V]
My Lords, we are at the point of a national emergency. If things continue as now, the NHS will fall over in the next few weeks. The virus is moving at frightening speed, yet the Government have not kept up. The time for the Government to follow public health and not public opinion is now. Hope is on the horizon with the vaccines, but short-term action is more important to keep people alive than extenuating future positives.
These regulations were too little, too late. Today the Government have to go further. The balance between the economy and saving lives is difficult, but you cannot contribute to the economy if you are dead. Government policy based on balancing the splits in the Tory party over lockdowns has to stop. The number of new cases, people dying and the stress on the NHS show that further action is required now, to slow the spread of the virus, keep people alive and protect the NHS. The Government have to follow the SAGE advice and implement a lockdown until R is well below one.
Evidence shows that secondary school pupils do spread the new variant, and therefore action is required on secondary school openings. Not to do so will endanger public health. To mitigate the educational issues facing young people, a Covid-19 premium must be implemented and given to schools so that young people get the support they need to catch up. This should be in place for the whole of this Parliament and not just a payment to schools for the next few months.
The NHS is getting to the point of not being able to cope. When will the promised insurance policy Nightingale hospitals be open to take, in London, say, 100 Covid-19 patients, rather than transferring people over 300 or 400 miles? People seek decisive and evidence-based leadership from government—not to do so is the biggest gift for the virus. These regulations have not stopped the speedy spread of the virus and deaths. Further action is required now.
Covid-19: Vaccinations
Lord Scriven Excerpts(3 years, 4 months ago)
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Lord Bethell (Con)
I take on board the noble Baroness’s points on the NHS. Its staff have been under huge pressure, which is likely to be sustained into the new year. I pay tribute to their hard work. The JCVI has looked extremely carefully at the prioritisation. The most important thing is to avoid pressure on ICUs and the threat of mortality. That has been done by prioritising age over role. I also pay tribute to the St John Ambulance service, which has done an amazing amount of work in gathering 40,000 inquiries for training on delivering the vaccine. By undergoing training, those people will relieve NHS staff of an enormous amount of the pressure that the noble Baroness rightly describes.
Lord Scriven (LD)
My Lords, following on from my noble friend Lady Brinton’s question, it is estimated that between hundreds of thousands and millions of people are not registered with a GP. Some have the most chaotic lifestyles, do not speak English and are not plugged into the most basic services. How will the Government make arrangements for people who are outside normal registration processes to be vaccinated?
Lord Bethell (Con)
The noble Lord makes the point well. He is right that there are undoubtedly communities that conventional NHS outreach has not got to; we have learned that fact during Covid. Our immediate priority is to reach the over-80s and ensure that the deployment programme works for those groups that are most at risk. We will be turning our attention to the groups that he describes, but I cannot avoid the fact that, if you are going to get a medical service, you need to be registered with a GP. That is something that some people are going to have to make part of their life.
Ockenden Review
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Baroness Thornton (Lab) [V]
My Lords, I first declare an interest as a non-executive director for a London hospital trust. I thank the Minister for the debate today. This is a harrowing report, and the latest in a series of reports over recent years. It follows on the heels of the Morecambe Bay report, and we know that the East Kent report was launched earlier this year to investigate 54 babies dying between 2014 and 2019.
I first congratulate Donna Ockenden on this interim report. As she rightly says in her letter to the Secretary of State,
“we want to bring to your attention actions which we believe need to be urgently implemented to improve the safety of maternity services at The Shrewsbury and Telford Hospital NHS Trust as well as learning that we recommend be shared and acted upon by maternity services across England.”
The scale of the findings in this interim report is distressing in the extreme. The relentless campaign of parents Rhiannon Davies and Richard Stanton, and Kayleigh and Colin Griffiths, must be recognised, and we must pay tribute to and thank them. At a time of greatest grief—the loss of a baby—they have done something vital to ensure that other parents do not suffer the losses they have.
Babies suffered fatal skull fractures from forceps use; women were left screaming in agony for hours; infants developed long-term disabilities as a result of terrible maternity care. There were baby deaths, high maternal deaths, and a catalogue of incompetence, neglect and cruelty. There was failure to handle high-risk cases correctly, an overzealous pursuit of natural, vaginal births leading to a reluctance to perform caesarean sections, and inadequate consultant supervision. Struggling mothers were mocked and called lazy. Mothers were blamed for their baby’s death. Parents were not listened to; legitimate questions were not responded to and blocked; responsibility was not taken.
There was poor assessment of risk and no discussion of risks with mothers. Practice in assessing ongoing risk was poor. Escalating problems were spotted too late, leading to delay in transfer to hospital and death. There was poor ability to spot the refusal to acknowledge. Escalation was seen by midwives as a slight on their ability, not a prudent response to risk. As bad was the internal culture which allowed this to carry on without proper, effective management or regulatory oversight. There were adversarial attitudes between doctors and midwives. Perhaps the Royal Colleges need to talk to each other about the lack of mutual respect for their particular expertise and experience, and the value placed on these.
This is an interim report because Ockenden is rightly concerned that change needs to start immediately. One hopes that it has already been happening in the trust, rather than waiting for the full report and for the Government to take time to consider it. That might literally cost lives. It might mean more babies suffering damage, which means disability for the whole of their lives. This concerns not only deaths but sometimes severe disabilities, which cause huge suffering for the child and have a huge impact on and cost for their families and, indeed, for the state.
It is now clear that the Ockenden review will be far larger and take far longer than was originally intended. Can the Minister assure the House that the review has the resources necessary to complete the final report as soon as possible? There are seven immediate and essential actions outlined in this interim report. What progress is being made to implement these recommendations? What actions is NHS England taking to implement these interim recommendations across England? The turnover of leadership at board and officer level in this trust was surely a warning sign that something was amiss. Why was there not earlier support and intervention by NHS England? I know how appointments are made at senior level; they have to be signed off by NHS England. It must have known. What happened? One needs to ask the same questions of the CQC, both in terms of leadership instability at the trust and why the glaringly obvious warning signs of infant and maternal death were not acted upon sooner.
More broadly, can the Minister explain what action is being taken to ensure that there are enough staff in all maternity units? Perhaps the Government can, this time, commit to legislating for safer staffing levels. What is being done to tackle the current estimated 3,000 midwife vacancies?
Finally, for the vast majority of us who give birth in NHS hospitals, it is a wonderful experience, and a very safe one. We want that to be available to all women.
Lord Scriven (LD)
I declare an interest, as my husband is a medical director for NHS England, but not in the region where this hospital is located.
From these Benches, I want to start by sending our heartfelt love and admiration—as, I am sure, do many across the House—to those parents and families who will have an empty place in their home this Christmas, due to the poor care they received at Shrewsbury and Telford Hospital NHS Trust maternity services. This report is distressing and shocking to read. It is hard to comprehend that it describes a care system in this country, in this century. It describes everything from the lack of basic things like human empathy, compassion and support, to poor medical practice and lack of carrying out best practice and adhering to agreed professional standards. This has led to grief, long-term disability, lifelong complications and the unnecessary deaths of newborn children and mothers.
This is not the first case of poor practice in maternity care that has come to light after brave families and parents have refused to be cowed and silenced. Morecombe Bay should have been a wake-up call for ensuring that systematic, integrated changes took place. It is clear that cultural and systematic change at scale and in depth has not happened, despite previous warnings. The healthcare regulator this year reported that four out of 10 maternity services do not meet the safety threshold of care. I ask the Minister why, in 2020, that is an acceptable statistic.
In 2017, the £8.1 million national maternity training fund was withdrawn. Does the Minister now, in hindsight, regret this, and will he seek to re-establish this fund urgently? Will the Minister inform the House who is responsible—politically and managerially—within NHS England for ensuring that, this time, the changes highlighted are implemented, particularly in the seven areas seen to be urgent? What is the timetable for implementing the seven immediate and essential actions required across the NHS? What resources will be allocated to implement the 27 local and 7 immediate and essential actions required?
This must not be another report that gets sympathetic words from those with political and managerial responsibility but then ends up on a shelf gathering dust. That is why the Minister needs to outline a timetable for implementation, what resources will be allocated and who, ultimately, is accountable for ensuring that the systematic, deep changes happen, so that no family has to deal with the kind of grief and trauma that so many families in this report have had to deal with.
Coronavirus Vaccine
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Lord Bethell (Con)
I welcome the noble Lord’s challenge and completely endorse his point that tracing will remain important. Not everyone will take the vaccine initially; it will not be available to everyone for months, as the Deputy Chief Medical Officer made plain in his briefing earlier today. Tracing remains a really important feature of our fight against this disease. However, I respectfully suggest that his information is a little out of date: the amount of collaboration on tracing between the national and local efforts, particularly with DPHs such as the one in Cumbria, has come on in leaps and bounds, even in the last few weeks. From my briefings and meetings with DPHs, I know that they have been provided with an enormous amount of data, support and access to tracing resources in order both to bring their local intelligence and insight to bear and to support the national tracing effort. I applaud all those DPHs who have stepped forward in this way, and I am very hopeful that the local-national combination on tracing will pay massive dividends.
Lord Scriven (LD) [V]
My Lords, in the first priority group, there are over 3.2 million people aged 80 or over. As the UK will get doses for 400,000 people initially, what access framework is in place to ensure an ethical approach to the vaccine rollout for these first 400,000 people that is not based on having the sharpest elbows or the chance of having a hospital appointment?
Lord Bethell (Con)
My Lords, the noble Lord raises an important challenge there; fairness and equity are important in this important time. However, I will try to assess the situation: we have 800,000 doses of a vaccine that is incredibly difficult to transport, requires cold storage and is in vials containing more than 100 doses each. Therefore, practical considerations are pre-eminent at the moment, rather than sharp elbows.
HIV: Pre-exposure Prophylaxis
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Lord Bethell (Con)
The noble Baroness makes an entirely fair point. Access to PrEP is not as even as it could or should be. It is a very important tool in our fight against the transmission of HIV, and it is a programme that we support wholeheartedly. However, it takes time to roll out a therapeutic such as this through the entire healthcare system. We have focused its supply through sexual health units because they are the most thoughtful and reliable places for the kind of consultation and expertise needed for a delicate new therapeutic like PrEP. However, she raises a good point that perhaps this should be and could be updated.
Lord Scriven (LD)
My Lords, since 2017, both Scotland and Wales have supplied uncapped access to PrEP, so will the Minister tell us what is stopping uncapped access to PrEP in England, so that we do not have a postcode lottery for access?
Lord Bethell (Con)
The noble Lord will be aware that there is a detailed conversation with local authorities about ensuring that we get exactly the right balance for funding. As the noble Baroness rightly pointed out, we need to make sure that the supply of PrEP is conducted in a way where there is good consultation and where those who are applying for the therapy are given good advice. That is best done with help from local authorities, and we are trying to hammer out a deal to ensure that that is done thoughtfully. That deal has been delayed by Covid, but we are looking forward to announcing a resolution of that before the next funding round finishes.
Health Protection (Coronavirus, Restrictions) (All Tiers) (England) Regulations 2020
Lord Scriven Excerpts(3 years, 5 months ago)
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Lord Scriven (LD)
My Lords, when government Ministers have to spend two days explaining when and how you can eat a Scotch egg to help slow down the transmission of a deadly virus, you know the simplicity of the rules and the clarity of the message, so vital to the task, have been lost. It is an indication of the confusion that has been created by constantly changing the rules that both individuals and businesses must adhere to. This is not helped when the former senior adviser to the Prime Minister clearly broke the rules and the full weight of the Prime Minister’s office was used to defend breaking the law.
People want to do the right thing to protect their loved ones, businesses, jobs and the community they live in. However, listening to people, you get a real sense that they do not understand what they are being asked to do anymore. The Government have complicated not only the message but the rules people must abide by. These regulations, 70 pages long, with nuanced rule after nuanced rule depending on which tier you live in, will cause further confusion.
The next four weeks highlight how this is not about creating a sensible, calm, strategic set of rules to slow the transmission of the virus but a bureaucrat’s dream and Ministers trying to control things from a Whitehall office. On 2 December, we are into tiers and a new set of rules; on 16 December, the tiers are reviewed, and we could have a new set of rules to live and work by; on 23 December, we throw the tiers out, and we can have Christmas; on 27 December, we are back to the tier rules of 16 December; on 30 December, the tiers are reviewed again, and we could have to contend with a further set of rules. In all reality, can the Minister say that potentially having to live under five sets of rules within one month is going to create trust, stability and clarity and give people and businesses the platform to be able to plan their everyday lives as well as fully understand what they are being asked to do to slow the transmission of this deadly virus?
The country requires richer, deeper understanding of the triggers that put an area into a set of restrictions and, just as importantly, the trigger points that release them from the most restrictive rules. The analysis that the Government have provided is not a serious attempt to explain. It is a commentary without the clear evidence that is required for people to understand and plan their lives. I asked the Minister: rather than a broad-brush approach, what empirical evidence will the Government bring forward to show how the triggers are adopted for an area going into and out of a tier?
In Sheffield, we are bewildered as to why we are in tier 3. The latest set of figures indicate we had, on 25 November, 185 cases per 100,000 people. Hospitals are moderately busy but in no way full to capacity. The local Nightingale hospital for Yorkshire and the Humber sits empty; our case rates are falling. Meanwhile, some areas with greater hospital activity, less ICU capacity, higher case rates per head and rising cases have been put in tier 2.
It is also worth noting that the department of the director of public health for Sheffield City Council has written to local care homes suggesting that lateral flow tests are not specific enough and that it is seeking government data and assurance. I ask the Minister: are the Government totally confident that lateral flow tests are safe and reliable enough to be used in care homes so people can visit?
The country has had a £20 billion failing national system. The Government highlight the number of tests, not their quality or the speed of the results. There is a very poor record on tracing and almost a laissez-faire isolation system that keeps leading us back to these types of regulations.
Dealing with this virus does not have to be like this, with ream after ream of confusing emergency law. Some of us have been saying since February that, to minimise disruption, a localised test, trace and isolate system is required. It is now time to do things differently. We need to localise the test, trace and isolate system within a national framework that supports local areas with the expertise and resources to deal with real hard tracing and have proper and resourced community teams supporting people who need to isolate. It needs to be underpinned by a government commitment to reward people for doing their civic and national duty of isolating, like they do in Taiwan, by paying people their full income while they isolate. I ask the Minister if and when this could be done.
The Government need to listen and refocus test, trace and isolate. They need to understand the results that local test, trace and isolate can bring, support that and underpin it with an income guarantee for those who isolate. If this is not done, we will be back here, fortnight after fortnight, confusing people, with the Government taking knee-jerk powers that affect businesses and individuals, causing debt, strain and worry.
We are reaching the end of the path of just nodding through emergency regulations; it is time to review the whole strategic approach of how the country deals with slowing the transmission of the virus, taking from international examples, such as South Korea and Taiwan, about how to minimise disruption by getting a proper local test, trace and isolate system. The Government need to understand that they are now on warning to radically change the way they manage this virus, or future regulations will not be nodded through so easily.
Covid-19: Vaccines and Medical Equipment
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Lord Bethell (Con)
I entirely endorse the sentiment the noble Lord expresses. I offer my profound thanks to the devolved authorities for the immense spirit of collaboration which has characterised the response to the pandemic. Often, it would seem from the headlines that the nations are at odds with each other; that is not my experience. The Christmas negotiations he cites are a very good example of that, and I hope the vaccination arrangements will be the finest moment.
Lord Scriven (LD)
My Lords, on 25 September the JCVI reported the serious risk of disease and mortality from Covid according to deprivation and ethnicity. These issues have to be taken into consideration in the vaccination programme, so why does the present list of priorities for the vaccine ignore those factors completely?
Lord Bethell (Con)
My Lords, the noble Lord is entirely right that deprivation and ethnicity are key considerations in the morbidity of Covid; we are all acutely aware of them. The JCVI has looked extremely closely at a variety of different models for prioritising vaccination. Prioritisation based largely on age gives the most accurate and thoughtful prioritisation of the vaccine and is also simple to understand and deliver. That is why it has gone down that route.
Personal Protective Equipment: Procurement
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Lord Bethell (Con)
The noble Lord, Lord Triesman, misconstrues the nature of events. The Prime Minister made a number of public calls for help, which resulted in more than 15,000 offers. Of course, those had to be triaged. Not all were credible. Some were helpful and some were well-intentioned but not all were practical. We had to find a way of prioritising the most impactful. Anyone in our position would have done the same. This credible list included senior professional healthcare clinicians; members of former Governments of all parties; leaders of British industry; and all manner of helpful people, some of whom came from completely unexpected places. I should be happy to tell the stories of some of those unexpected offers another time. The noble Lord’s description of the prioritised channel is a misrepresentation. I regret that I cannot proceed as he asks.
Lord Scriven (LD)
My Lords, let us be clear. The issue is not that people stood up; it is what the Government then did to procure goods and services. Yesterday’s National Audit Office report states
“we cannot give assurance that government … mitigated the increased risks … or applied appropriate commercial practices”
at all times. That is technical-speak for not being able to rule out fraud or corruption. How can the Minister stand at the Dispatch Box and say with any credibility that all the rules were carried out and there were no conflicts of interest? Which should we believe, a line from the Dispatch Box or a report from the National Audit Office?
Lord Bethell (Con)
My Lords, I do not really recognise the noble Lord’s technical-speak interpretation of the NAO report. In fact, the report is crystal clear. Yesterday, I quoted from its references to Ministers and conflicts of interest, and I do not think that I need to repeat it: it was crystal clear. However, perhaps I may reassure the noble Lord. I do not pretend for a moment that every single piece of paperwork got done on time during the pandemic—quite the opposite. We rewrote the guidelines on 18 March and reissued them: there is no way that you can jump through the hoops of a normal tendering process when you are in the middle of a massive global land grab. I am not pretending that; I am saying that there were not conflicts of interest, that Ministers were not involved in the procurement decisions and that the nation should be proud of the way in which we responded to the pandemic.
Covid-19: Conflicts of Interest
Lord Scriven Excerpts(3 years, 5 months ago)
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Lord Scriven
To ask Her Majesty’s Government what assessment they made of conflicts of interest before engaging specialist advisers to inform their response to the COVID-19 pandemic.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, in our nation’s time of need we have been very fortunate to call on the talents of many, including colleagues old and new, some paid and some unpaid. Appointments are considered on merit and, when required, we ask candidates to declare any interests. We assess these on a case-by-case basis, but declaring an interest is not always a barrier to being appointed. There are, however, robust processes in place to manage any conflict. These ensure that no one gains unfairly from advising the Government.
Lord Scriven (LD)
My Lords, can the Minister give a logical reason why a company with no history of supplying PPE that is introduced by a special adviser can be passed from a Minister’s office, be fast-tracked and be 10 times more successful in getting a contract to supply PPE—which sometimes cannot be used because it does not meet the standards—than a company with a solid track record of supplying PPE that has no access to a special adviser or Minister?
Lord Bethell (Con)
My Lords, we are enormously grateful for the very many people who stepped forward to offer help during this time. When the Prime Minister made his public call for help, 16,500 people contacted us with various offers. It was, of course, necessary to triage and prioritise that huge list. In that list there were a great many people who had extensive experience in their area; there were people who were new to the game; there were have-a-go heroes; there were multinational companies. There were also those whose intentions were not as pure as one would hope. We approached each and every one on their merit, and there were official guidelines to guide the procurement processes. We have stuck to those guidelines every step of the way.