Covid-19 Update
Lord Scriven Excerpts(3 years, 10 months ago)
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Lord Bethell (Con)
The noble Lord is entirely right to raise this issue. There is the awful possibility that the mutant vaccine escape virus could get around the vaccine altogether. We need a plan B, which might be dependent on antivirals as an alternative way of managing the disease. That is what happened with HIV, as we discussed last week. The therapeutic taskforce is looking at antivirals and putting together a plan to upscale our investment in that area. I am aware of Synairgen and ACTIV-2, but he is entirely right that this should now be a greater priority. I will take the matter back for the department to look into further.
Lord Scriven (LD) [V]
My Lords, virologists tell us that, even with vaccines, we will be living with Covid for years to come. The Statement says:
“Our mission must be to stop its spread altogether and break those chains of transmission.”
To ensure that this happens, what changes have been made during this lockdown to improve the outcomes of the £22 billion test, trace and isolate system, for when the restrictions are eased?
Lord Bethell (Con)
My Lords, I pay immense tribute to the test and trace system, which, at 11 am, published remarkable performance figures, as the noble Lord probably knows; 92% of tests were turned around before the next day, and 86% of contacts were traced. This is an incredible performance. On his specific point, the creation of a variant-of-concern tracing group that is targeted at those rare appearances of VOCs in the community is the important development that we have put in place in reaction to the mutant variants. I pay tribute to Steve McManus, who is running that programme, for the impact that he has already made on the problem.
Covid-19: Vaccines
Lord Scriven Excerpts(3 years, 10 months ago)
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Lord Bethell (Con)
The noble Lord is entirely right: the vaccines are a hugely important development, but so is investment in all therapeutic drugs. We are extremely blessed to have had a contribution towards dexamethasone, tocilizumab and other therapeutic drugs which have greatly improved outcomes for patients in hospitals. He is right that antivirals also present an opportunity. The reason we have supported research into antivirals through the urgent regime in our clinical trials is to ensure that there is sufficient commitment in hospitals and primary care on antivirals. We are tasking the Therapeutics Taskforce with a specific mandate to look at antivirals and whether we should give greater resources to this avenue of therapeutic development.
Lord Scriven (LD) [V]
My Lords, having the second dose of the Pfizer/BioNTech vaccines in the right quantities in the right place at the right time is vital. Will the Minister guarantee that people will be able to get their second dose of it at the local GP hub where they had their first dose administered without being directed to a mass vaccination centre to receive it?
Lord Bethell (Con)
In response to the noble Baroness, I said that we were confident that we had the supplies of the vaccines to do the second dose. It is not our policy that anyone has the second dose of anything other than the vaccine they had the first dose of. We will work with people to give them the most convenient place to have the vaccine, but I cannot offer the guarantee that the noble Lord seeks.
Vaccine Rollout
Lord Scriven Excerpts(3 years, 10 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I am extremely grateful for that question, because it will help me to clear up a misconception in this area. Having an NHS number is very important. We cannot know who has had the vaccine and who has not if we do not know what their NHS number is. That is extremely important for their own treatment; it is also best practice. As any clinical practitioner will tell us, it is imperative to know the identity of the person being treated. It is also very important for pharmacovigilance and for the research that will come on the back of the vaccine. If we were to vaccinate a large proportion of the population without knowing who they were, we could not do the research necessary. There will be some people who do not have an NHS number, and we have put in place protocols to ensure either that they can get an NHS number or that a workaround can be found. Those we are pursuing with haste. I emphasise to noble Lords that this is an opportunity to ensure that everyone in this country, whether a visitor or a resident, has an NHS number by the end of this programme.
Lord Scriven (LD) [V]
My Lords, here in Sheffield, approximately 45,000 people have been vaccinated, owing to the excellent work of our local GP hubs, but because of lack of vaccine supply, 10 out of 15 of those will be closed and will not be able to get the jab into vulnerable people’s arms again until the middle of next week. Yet the new Sheffield mass vaccination centre has opened today and has vaccine. Local GPs have asked me to ask the Minister why the distant megacentre has been given priority for vaccine supply over the local and effective GP hubs.
Lord Bethell (Con)
It is not a question of one place taking precedence over another. I take a moment to applaud and pay tribute to GPs in Sheffield, and to all those who have proceeded at pace and got through their allocation as quickly as they could. That is absolutely the right priority and the right approach, and it is how we are going to get through the population very quickly. However, some people will get through their list more quickly than others, and it would be a mistake then to start asking them to move down the list when there are still those with very high priority who need to be vaccinated. Although I understand that it may be frustrating for a GP to stand idle, those are the practicalities of what we are doing. The mass vaccination centres are essential to deal with the very large numbers of people that we plan to vaccinate over the next few months. That is why the Sheffield vaccination centre is such good news.
Covid-19: Variant
Lord Scriven Excerpts(3 years, 11 months ago)
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Lord Scriven
To ask Her Majesty’s Government when they first became aware (1) of the new variant of COVID-19, and (2) that such a variant of the virus was prevalent in the areas placed into Tier 4 on 20 December 2020.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, the second variant is a very serious matter. On 8 December, analysis of all genomes available in Kent showed that a new variant was circulating. Ministers were notified on 11 December. On Monday 14 December, the Health Secretary informed Parliament, PHE released a statement and the Government held a press conference on the new variant.
Lord Scriven (LD) [V]
My Lords, variant B117 was identified in October. From the second week of December, virus cases started to rocket in London and the south-east, yet the Government’s focus was on how to keep people mixing at Christmas, not on dealing with the alarming spread of the virus, ignoring public health experts who said that a tight lockdown was urgently required. What message of apology does the Minister have for those families attending funerals because the Government acted too slowly to help save lives?
Lord Bethell (Con)
My Lords, I am afraid that I just do not recognise the noble Lord’s proposition. Hundreds, if not thousands, of new variants are appearing all the time. Many of them have passed through the process, but identifying those that are threatening, have more transmissibility and are significantly different is extremely complex. As I said very clearly, it was on 8 December that, after analysing all the genomes available in Kent, we showed that an important new variant was circulating.
Covid-19: Vaccinations
Lord Scriven Excerpts(3 years, 11 months ago)
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Lord Bethell (Con)
I am extremely grateful for the noble Lord’s kind words. I know lawyers looked at the question he raises on informed consent; I am afraid I do not have the precise answer at the Dispatch Box right now, but I will be glad to write to him with a clarification.
Lord Scriven (LD) [V]
Up here in the north, the Yorkshire Post is running a “shot in the arm” campaign to get the Government urgently to allow the local community pharmacists who are screaming out to get jabs in people’s arms to do so. Why are the Government using excuses about batches of 1,000 for the AstraZeneca vaccine getting in the way of using these safe places on the high street that will improve access in the take-up of the vaccine?
Lord Bethell (Con)
My Lords, I am not sure we are using excuses; we are observing practical matters. The priority, quite reasonably, is to get the vaccine in as many arms as possible. We are totally committed to comprehensive distribution of the vaccine that reaches into rural communities and will include working with community pharmacies as important distributors. However, be under no illusion: our priority is speed and reach, which is why the deployment has taken the shape it has.
Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020
Lord Scriven Excerpts(3 years, 11 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, 11 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(4 years 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
Lord Scriven Excerpts(4 years ago)
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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
Lord Scriven Excerpts(4 years ago)
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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.