Health and Care Bill

Lord Scriven Excerpts

Lords Hansard - Part 1 & Committee stage
Tuesday 18th January 2022 Lords Chamber

[Baroness Whitaker (Lab)]

My Lords, I declare an interest as a patron of the British Stammering Association; indeed, I am a stammerer myself. I regret that I could not join in at Second Reading. I support all the amendments in this group, as does the Royal College of Speech and Language Therapists.

I want briefly to add my support for Amendments 141, 151 and 177. As the noble Lord, Lord Shinkwin, said, Amendment 141 would improve the lot of some 10% of children in the United Kingdom. That is a large proportion. Those are the ones who have identified speech, language and communication needs, which, as has already been said, affect their life chances in many ways. The way to do this, as the right reverend Prelate said, is to have the vital structure of accountability for their needs being identified and met.

There is a big equality issue here. I remind noble Lords that up to 50% of children in areas of social disadvantage start school with delayed language or another identified communication need. The 2010 Marmot review on health inequalities emphasised that

“giving every child the best start in life … is our highest priority recommendation.”

The review identified reducing inequalities in the early development of physical and emotional health and cognitive, linguistic and social skills as a priority objective, noting communication skills as crucial for “school readiness”. Levelling up is for children too; arguably, it is particularly important for them. The national accountability framework in Amendment 141 must include metrics on speech, language and communication development at the population level and outcomes for children and young people with communication needs.

On Amendment 151, I can do no other than echo the words of the noble Lord, Lord Shinkwin, with whom I agree entirely.

I strongly endorse Amendment 177, which would put the guidance on a statutory footing. One advantage of this, which should be done for all sorts of reasons, is that it would enable the postcode lottery to disappear or at least be very much reduced. Of course, it ought to include specific guidance on supporting speech, language and communication development at the population level, explaining how the needs of children and young people with communication needs will be met. I hope that the Government will pay attention to this often rather neglected aspect.

[Lord Scriven (LD)]

My Lords, I support Amendment 20 in the name of the noble Baroness, Lady Meacher, and in so doing declare my interest, as laid out in the register, as a vice-president of the Local Government Association and a non-executive director of Chesterfield Royal Hospital NHS Foundation Trust.

NHS England defines the better care fund as being there to support

“local systems to successfully deliver the integration of health and social care in a way that supports person-centred care, sustainability and better outcomes for people and carers.”

So why is that not the case for 30% of the population, children and young people, who have the same complex needs and the same need for integration as adults do to help and support them on their journeys? The better care fund has been around since 2014. My guess is that this was an oversight rather than a deliberate means to keep children and young people out. Having looked at examples of what the better care fund can achieve in integration and outcomes for adults, I believe that this oversight needs to be addressed. Children and young people need to be on the face of the Bill.

I think that the Government accept that things need to happen, because we have the children’s social care innovation programme, which is particularly about looking at innovation in social care along with healthcare partners. The problem, however, is that it is a bidding system and it is not for all local authorities. If you win the bid, you can do it. Children and young people across the country deserve and should expect the right to have innovation in integration to improve their outcomes regardless of where they live. It should not be conditional on their local authority being successful in a bid.

I can see no reason why, as the noble Baroness, Lady Meacher, said, the Government would not want to do this. It is an oversight in the better care fund. Putting children and young people on the face of the Bill would ensure that they received the integration and better outcomes that adults achieve through the fund.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I offer the support of the Green group for all the amendments in this group. My name is attached to Amendments 51 and 87 and it would have been attached to others had there been space. I can only commend the noble Baronesses, Lady Meacher, Lady Tyler of Enfield and Lady Finlay of Llandaff, for identifying a serious lacuna in the Bill and for providing practical, careful and sensible solutions to that.

The noble Baroness, Lady Finlay, said that the Bill was “by adults for adults”. The other amendments in the group address only half that phrase. It addresses the “for adults” part but not the “by adults” part, which is what my Amendment 103A aims to address. Young people are experts in being young people. We may think about the life experiences of a 12 year-old or an 18 year-old, but none of us really knows what it is like to be 12 or 18 at this moment. A phrase often used particularly by marginalised groups is “Nothing about us without us”—given the hour, I will spare noble Lords the Latin version.

Young people are undoubtedly a marginalised group in our society in that their voice is far too rarely heard. As I have reflected previously, they are hugely underrepresented in this place and in the other place. The under-18s do not have the vote. The under-25s in the voting population, for structural reasons that could be fixed but have not been, do not have the same kind of voice.

I entirely accept that, among paediatricians and social workers, there are many older people who have much expert knowledge, but it is crucial that we actually hear. My amendment seeks to address ICBs and sets out that, in statute, there should be an advisory board consisting of young people on every ICB. I believe that this is an important addition to ensure that young people’s voices are heard. It might be said that many ICBs may set up such a structure, but that is not the same as it being statutory, ensured in the Bill with a message from Parliament saying, “You have to listen to these young people’s voices”.

I doubt that I need to address this in detail, particularly with the occupancy of the Chamber for this group, but I want to mention the Children’s Society’s Good Childhood Report 2021, which looked at 10 to 17 year-olds. Among them, one in 15 were unhappy with their lives—the highest level in a decade. We know that children who are unhappy at the age of 14 are significantly more likely to display symptoms of mental ill health, to self-harm or, sadly, to attempt to take their own life by the time they are 17.

As the report makes clear, the pandemic is only part of this story. There is a climate emergency and a pervasive fear about the future that young people have lived their entire lives through. We are talking about people whose whole life experience, virtually, has been since the financial crash. One thing that we know addresses a sense of powerlessness, with all its negative effects on mental and physical health, is giving people a sense of empowerment—that is, a sense that they can take control of their lives, make choices and make a difference. I often see this with young climate strikers.

I believe that the measure proposed by my Amendment 103A would ensure that this group of amendments collectively addresses the two sides of the problem that the noble Baroness, Lady Finlay, identified. I want to take this forward and I invite noble Lords who are interested to talk to me about it. This should be included in the Bill. Let us hear from children and young people and make sure that ICBs listen to the children and young people they serve.

--- Later in debate ---

[Lord Davies of Brixton (Lab)]

My Lords, I speak to my Amendment 45. This is a disparate group of amendments, dealing with the issue of integrated care boards. I strongly support the comments already made. My amendment addresses another issue. There are questions about what the boards are; the issue is for whom they provide services, and how they are defined.

I have been made aware of a case that raises real questions about how this is going to develop. The case was reported in September, in the Manchester Evening News, about a woman who suffered burns while on holiday. She returned to her local urgent care centre in Rochdale and was advised that, because of long waiting times, she should go to another A&E in Bury. When she arrived there, she was told that that centre did not treat people from Rochdale, because of rules laid down by the integrated care board predecessor, which had established the rules in that part of Lancashire. She was left literally on the pavement, unable to obtain the care that she required.

That is a specific case under the existing rules, but it points out the lack of clarity in the Bill about how the integrated care boards will operate. The fear is that they will be membership bodies along the lines of health management organisations in the United States, which are responsible for providing services to members. That contrasts with the residential basis on which the NHS was based, at least up to 2012.

Proposed new Section 14Z31(4) gives the Secretary of State astounding power to set out which ICB is responsible for a particular individual’s care. I hope that the Minister will be able to provide some reassurance, but the problem with membership-based organisations is that, first, there will be cherry picking of patients and, somewhat counterintuitively, at the same time they will be competing for the less expensive patients. Without far more clarity through the Bill from the Minister, people will have reasonable fears over how these new organisations will work and how people will attain the services that they currently expect from a seamless provision of services. My amendment seeks to address the issue of it being a single service. We have these 43 ICBs, or whatever they are, but it is a single service, and patients can access services wherever it is best for them and not best for the service.

[Lord Scriven (LD)]

My Lords, I echo the comments from the noble Lord, Lord Hunt of Kings Heath.

We are living in a parallel universe. We are discussing the legislative framework for this new system while, out in the real world, the foundations and the bricks are being built. People are in place. Dates are being set. People are being told that they cannot be on boards. This Parliament has not decided. Under what legislative framework are these organisations working? They have no legitimate powers or approval from Parliament, yet they are being set up. People are being put in place. Chairs are being appointed. Councillors are being told that they cannot sit on ICBs.

This Parliament has not decided that yet. Letters are going out from NHS England telling the system when it will start, and Parliament has not gone through the legislative process. This is not collaborative working at a local level, because many local authorities feel that they are not even in the car let alone in the driving seat; the car is leaving and they are being asked to join at a later date. This is not a good start for collaborative working. It has to stop. NHS England has to be reined in and told that, until there is a legislative framework, the system must stay still.

In that sense, I support Amendment 23, because, significantly, it would give local authorities powers to determine their own destinies. As a former NHS manager, I am not somebody who says that this is a bunch of bureaucrats who are a waste of time. I understand the importance of NHS leaders and managers, but they cannot start drawing lines on a map and ignore local authorities’ democratic mandate. This system is not just about administrative convenience; there are real questions about the identity of local authorities, which have built regional boundaries.

Some local authorities look two ways. Let me give noble Lords an example, not a health example but something that happened in south Yorkshire and in which I was involved. The people and the authority of Barnsley, on the edge of south Yorkshire, look to west Yorkshire as well as looking to, and being administratively in, south Yorkshire. As I am sure the noble Baroness, Lady Bennett of Manor Castle, will know, because she knows the local area, when we set up the economic framework it caused a lot of distrust and bad blood for four years, simply because the local authority was not allowed to use the democratic mandate that it had been given and people from the centre were pushing how local economic partnerships and mayoral authorities should be set up.

If we are talking about local authorities and the National Health Service working in a collaborative way, the democratic right of local authorities must be taken into consideration. They know the nuances of their local people in a way that NHS managers do not. I say that having been an NHS manager, a councillor and a leader of a council. It is important to establish the democratic mandate in the system right from the beginning. I can tell you now that if you get a system where two local authorities out of four are forced into an area that they do not want to be in, I can tell you now that it will not work. There will be years of fighting and distrust. This is not just a plea; this is really important. The system has to stop. It has to be a collaborative approach in which local authorities’ elected mandate is key, but NHS England must also take its foot off the brake and wait until this Parliament has set the legislative framework before the system gets going. This is a parallel universe and it has to stop.

Health and Care Bill

Lord Scriven Excerpts

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

[Baroness Hodgson of Abinger (Con)]

My Lords, I too have put my name to these amendments, so ably introduced by the noble Baroness, Lady Finlay of Llandaff. Because this is the first time that I have spoken at this stage of the Bill, I remind your Lordships to refer to my Second Reading speech and entry in the register of interests for my experience and links around the topic of health. The hour is late, so I shall try to be very brief.

Although Clause 16 currently lists a number of services that the ICBs are required to commission, it fails extraordinarily to include palliative care. We have already heard that current estimates suggest that, although as many as 90% of people who die have a palliative care need, only 50% currently receive that care—only half. I find it somewhat horrifying that, as the noble Baroness, Lady Finlay, told us, a Marie Curie survey found that 64% of people who died at home did not get adequate care, with pain management.

Like others who have spoken, I know from personal experience of family members how hard it was for them to get the care they needed at the end of their life. I am sure that everyone here can share examples of exceptional local hospices, especially facing the challenges of the pandemic, that currently have to fundraise to be able to do the work to fill these gaps—as the noble Baroness, Lady Finlay, told us, they sell cakes. It is quite extraordinary. I pay tribute to the outstanding work of the hospices and the wonderful palliative care doctors for the amazing support they give to those who are dying and their families.

Although I recognise the Government’s concerns about overprescribing the list of services that integrated care boards should commission, it seems anomalous for the Bill to proceed with priority given to ensuring that ICBs commission maternity and other services but have no explicit requirement to commission palliative care services. I am sure that this was not the Government’s intention, but I am concerned that the current drafting implies that health services for people at the end stage of their life are less important than health services for people at earlier stages. Surely the end of life is one of the times when care is needed most. I find it extraordinary that we are even having this discussion.

The addition of these amendments offers a unique opportunity to ensure that nobody with a terminal illness misses out on the care and support that they need, both now and in the future. I look forward to hearing the Minister’s views on these amendments, which will help us to ensure that all of us have the end-of-life experience that we would hope and wish for when our time comes.

[Lord Scriven (LD)]

My Lords, if we were having this debate about any other service in the NHS, people would be aghast. Can noble Lords imagine the response if we said that your access to dental treatment would be determined by the number of books sold; that your access to maternity services would be based on the number of jumble sales held; or that, ultimately, your access to ophthalmology would be dependent on the number of cakes and coffees sold at an afternoon party? These examples are no different from that of specialist palliative care, a service that is meant to be from cradle to grave. The unfortunate reason why the noble Baroness, Lady Finlay of Llandaff, has had to table her amendment, supported by other noble Lords, is that, for too many years, promises have been given but the services have not been delivered because the NHS does not commission parity of service across England.

I know quite a lot of people who work in the health service who are decent, hard-working and genuine, but the fact is that palliative care is seen by too many as an add-on and not central to the services they are providing. I do not blame them for that because, unfortunately, that is the behaviour that sometimes happens when the NHS does not have a mandate to provide specialist palliative care and people think that the local charity shop funds it. The noble Baroness has had to table Amendment 52 because we need to be clear about what this service is. It is not about just those last few days or weeks; it is not about just putting someone in a hospice. It is about giving psychological and medical care and support throughout a whole process to people with a life-threatening illness or who are at the end of life. This service needs to be commissioned against a clear understanding and definition of specialist palliative care.

I agree with many noble Lords: people across this country have waited far too long for access to specialist palliative care funded by the taxpayer. This does not mean that some of the charitable work would not continue, but such care should be a right and a service, funded by the taxpayer, which says that people will be looked after from cradle to grave.

[Baroness Hollins (CB)]

My Lords, I applaud my noble friend’s continuing persistence and commitment in seeking proper recognition of the role of specialist palliative care within our health and care services. I speak with around 40 years of clinical and clinical academic experience, first in general practice but mostly in psychiatry, and as a past president of the British Medical Association. Cicely Saunders taught me as a medical student, and she inspired my interest in this area.

Other noble Lords have stressed the shortfalls—I will not repeat them—but we know too that certain groups face significant barriers in accessing palliative and end-of-life care. Marie Curie’s A Place for Everyone report found that this included people living in poverty, alone or with dementia, as well as people with learning disabilities. My own research in clinical practice has included a focus on end-of-life issues, including decision-making, for people with learning disabilities and autistic people. Most people with learning disabilities still do not get equitable end-of-life care, despite over a decade of inquiries and recommendations.

Personalising end-of-life care for everyone is in the NHS Long Term Plan. It must surely be enshrined within the duties of the ICSs. We have already heard about King’s College’s findings of a shocking lack of planning by the vast majority of ICSs. That is a problem; it cannot be left to chance. The truth also is that depression and anxiety are quite common among both those who are dying and those who are bereaved. From my perspective as a psychiatrist, I would say that we need palliative and end-of-life care to improve the experiences of both children and adults who are becoming bereaved. We know, for example, that adverse bereavement experiences in children, such as watching a family member dying in pain, are a predictor of difficulties in adulthood, in addition to affecting their educational achievements.

To achieve a comfortable death, it is imperative that the psychological distress of both the person who is dying and their nearest and dearest is understood and attended to, as well as any physical symptoms. This amendment should need no further discussion. Cicely Saunders would be horrified. I hope that the Minister will accept it. It would be a false economy not to go ahead with this provision.

Health and Care Bill

Lord Scriven Excerpts

Lords Hansard - Part 1 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, I support all the amendments in his group but particularly Amendment 68, in the name of the right reverend Prelate the Bishop of St Albans, about health inequalities faced by those living in rural areas. When you live in a rural area, it is often difficult physically to access a GP practice—if you do not have a car, try getting a bus in a rural area whose timetable coincides with the opening hours of your surgery—and to access health information if your internet is not up to scratch. There are many rural areas where connectivity still leaves a great deal to be desired. Pharmacies, too, can be difficult to access; although some run outreach services, they are by no means universal.

In rural areas, the important non-clinical services mentioned by my noble friend Lord Howarth are largely dependent on the voluntary sector. During the pandemic, when village halls, with their plethora of exercise, dance, art and social support services, were closed, many older people in rural areas were cut off completely, with disastrous effects on their mental health.

The problems of delivering social care in rural areas are also well known. When care workers are paid for home visits only for the time when they are in the home and not for travelling time—time that will of course be extended by the spread-out nature of those visits—it is no wonder that many private and voluntary agencies are handing back social care contracts to local authorities because they simply cannot deliver them.

Poverty, the underlying cause of inequality, is more widespread in rural areas than is often acknowledged. Escaping to the country is a nice idea, but unless you recognise the particular inequalities faced by country residents, it is not as you see it on the television. Moving as a couple approaching retirement is a different picture when one—usually the husband, both the gardener and the driver—dies, leaving an isolated widow in declining health. The cost of fuel is also more acute in rural areas, and you will find many older people who may own a nice-looking cottage having to choose between heating and eating, with consequential effects on their health and future dependency.

I very much hope that when the Minister replies, he will emphasise that when integrated care boards are considering the provision of services for the purposes of achieving equality of access for patients, they will consider those living in all parts of the board’s area.

[Lord Scriven (LD)]

My Lords, this is my first intervention on the Bill. I draw the Committee’s attention to my relevant interests in the register, namely as a vice-president of the Local Government Association and a non-executive director of Chesterfield Royal Hospital NHS Foundation Trust.

I support this suite of amendments—particularly Amendments 11, 14, 65, 94, 186 and 195—which explicitly puts the issue of health inequalities in the Bill and makes it central to the aims of the NHS. It also deals with reporting and holding people to account for helping to reduce health inequalities.

The reason for my support is simple. I speak as a former NHS manager who, as a rookie many years ago, in the very early 1980s, was on the general management trainee scheme. For the first three months, our aim was just to go around. I remember asking the very naive question: “Who’s responsible for quality?” I expected the person who was showing me around to say, “Everyone”, but he said, “Follow me.” We went in his car for five miles outside the hospital to the health authority. We then went into a lift, down into the basement and through lots of corridors, and finally came to a door at the end of the corridor. The door was opened and in a dimly lit room was a middle-aged woman, surrounded by piles of paper. I said, “Who’s this?” I was told, “This is Gladys. Gladys is responsible for quality.” It was seen as someone else’s job.

That is why I have cringed a little when the Minister has said, in previous debates and Answers on health inequalities, that the Office for Health Improvement and Disparities is being established. That is well and good, but that office is not responsible for reducing health inequalities; everyone in the healthcare system and its partners must work together to reduce health inequalities. That is why it is really important that this is explicit. It is not just about health issues; it is about people’s income, work, environment, green space and transport. It should be explicit in the Bill as part of the triple aims—which will become four aims—and become part of monitoring. This issue must become central because something that I have learned about the health service is that unless the centre asks for it, and asks for it to be monitored, it just does not get done because it is not seen as important. That is why monitoring this at both local and national level will hold people to account so it does not become Gladys’s responsibility.

The Bill gives us a once-in-a-lifetime opportunity not just to put health inequalities centrally in the Bill but to make them explicit in the way that the NHS and its partners work. With a little extra legal push to the mill, so to speak, as well as the monitoring, the data and holding people to account, I believe that we can finally start to deal with these issues in a systematic way that shows improvement and will allow the NHS and its partners to know where to push a bit harder to get this done. That is why I support the amendments.

[Baroness Finlay of Llandaff (CB)]

My Lords, this debate has shown clearly that attacking health inequalities must go beyond the bounds of the NHS as the impact of external factors is massive. I remind the Government that in 2015 poor housing alone was estimated to cost over £10 billion. That was in part because of the poor housing but it was compounded by inactivity and, as a result, obesity.

We should look at the antecedents of complex problems. Marie Curie’s report Dying in the Cold revealed failures in healthcare, bereavement and grief and the challenges of providing care for those with complex needs. Learning difficulties and autism, for which we often do not know the underlying causes, are disproportionately prevalent among people who are socially excluded and at high risk of homelessness, yet for them managing homelessness alone is particularly difficult because of their overall vulnerability. It has been estimated that autism alone has a twelvefold prevalence in those who are homeless compared to the general population.

The antecedents of many of the problems go back to childhood. They carry a life sentence of their trauma, which feeds into worsening health inequalities, aggravating factors such as alcohol and drugs consumption and other behaviours. Unless we strengthen the wording in the Bill to monitor and do something about the data that comes forward, the proposal of my noble friend Lord Kakkar—it is essential that we address this as a core problem to be tackled—will not be realised. I hope that when the Minister replies he will provide some assurance that the Government will consider strengthening the wording in the Bill in the light of this debate.

Ambulance Queues: Health Outcomes

Lord Scriven Excerpts

Thursday 13th January 2022 Lords Chamber

Asked by

[Lord Scriven]

To ask Her Majesty’s Government what assessment they have made of the impact on health outcomes of the time spent by ambulances waiting in queues to transfer patients into hospital Accident and Emergency departments.

[Lord Scriven (LD)]

My Lords, I beg leave to ask the Question standing in my name and draw the House’s attention to my interests in the register.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

We recognise that waiting times can impact outcomes, so patients in queues remain under constant clinical supervision and care and are prioritised according to need. Delays tend to be concentrated in a small number of hospitals, with 29 acute trusts across 35 sites responsible for 57% of the 60-minute handover delays nationally so far this winter. These trusts are receiving intensive support to improve, including through placement of hospital ambulance liaison officers and the safe cohorting of patients.

[Lord Scriven (LD)]

My Lords, half a million acute bed days each year are lost due to delays in discharge directly attributable to non-availability of social care, which leads to bottlenecks in emergency departments and ambulances being unable to unload patients. Does the Minister agree that the split of money raised by the health and social care levy over the next three years therefore needs to be more generous to social care, so people stop having to wait up to seven hours in the back of ambulances?

[Lord Kamall (Con)]

As the noble Lord will be aware, when the charge was initially announced it was intended to help with social care, which has been neglected for a number of years under successive Governments. Given the pressures of the backlog, the NHS has decided to divert some of those resources to help tackle it. We have invested money in social care in the short-term winter plan, and in the longer term we have announced extra investment to ensure that social care is an attractive career and offers real prospects.

Care Workers: Professional Register

Lord Scriven Excerpts

Monday 10th January 2022 Lords Chamber

[Lord Scriven (LD)]

When providing care for some of the most vulnerable in our communities, staff such as art therapists and occupational therapists have to have mandatory registration to practise. What is so different for social care staff who provide professional care as part of a multi-disciplinary team to such vulnerable people?

[Lord Kamall (Con)]

Only last week we opened a consultation on whether or not to make registration mandatory and to move towards it. When I spoke to people in the department about why it is currently voluntary and not mandatory, they said it was because they did not want to inadvertently put people off registering. They were worried that some people might leave the sector if registration was mandatory now. The noble Lord can shake his head, but this is a very real concern. We want to make sure it is voluntary first and we are consulting on the steps towards mandatory registration.

Public Health: Night-time Working

Lord Scriven Excerpts

Thursday 6th January 2022 Lords Chamber

[Lord Kamall (Con)]

I start by thanking the noble Baroness for the article that she sent a link to, which addressed some of the issues around her Question. The sleep review is looking at all these issues. As she rightly says, there are some links between fatigue and certain ailments and diseases. On some of them, the academics are still challenging each other, but that is all part of the review.

[Lord Scriven (LD)]

My Lords, a wide body of research has revealed that a number of health conditions are related to night-shift working. In the Netherlands, breast cancer is now recognised as an industrial disease for female night-shift workers. What policies are the Government undertaking to deal with this body of research that points to health for night-shift workers being unequal?

[Lord Kamall (Con)]

The Government commissioned a review of sleep and health from the former Public Health England for 2020-21. That reported just before Christmas and is now being considered by Ministers and other officials. We are hoping that the Office for Health Improvement and Disparities will publish the findings in 2022. The review looked at a number of different things, including trends over time, optimal levels of sleep, links between mental and physical health, the economic impact and factors that hinder interventions to promote sleep. As the noble Lord rightly says, there is research out there about how workers can experience gastrointestinal disturbance and sleeping disorders and the possible association with breast cancer, cardiovascular disease and diabetes. All that will come out in the review, I hope.

Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 6) Regulations 2021

Lord Scriven Excerpts

Wednesday 15th December 2021 Lords Chamber

[Lord Bilimoria (CB)]

My Lords, with plan B, while we have measures to keep the economy open, we have messages that have ended up closing much of it. There is fear and there are confusing messages, including the advice to work from home—just look at trains, buses and restaurants, which have seen a collapse in demand. We have to consider how necessary all this is, with a major South African study of 78,000 omicron cases showing that symptoms are significantly less severe than with the delta variant and that the vaccines still afford protection. There are many fewer hospitalisations and admissions to ICUs.

As president of the CBI, in July we produced a document called Living with the Virus. We are now updating it to Living with the Variants, in which we say that, if we follow these steps, there should be no necessity for a plan B or a plan C. First, there should be forward guidance to support businesses and organisations to adapt. We should prioritise mass testing over mass isolation or working from home. We should utilise all Covid-secure tools available to build employee and customer confidence. We must maximise our world-leading vaccine programme, of which we are all so proud—hats off to Kate Bingham and what she did. We should also use our antiviral programme as much as possible. We should prioritise border control so that we keep our country and economy open and, if there are restrictions, government support must move in lock-step with them.

If we follow these steps, there should be no need for a plan B or plan C. I am very proud that I was one of the first people in this country to call in August last year for lateral flow tests to be widely available. I am so glad that the Government eventually listened; they are very effective, as the noble Baroness, Lady Walmsley, said. Will the Minister confirm that the supply of lateral flow tests will be there and that they will be freely available—at the moment they are not even available—to businesses and the public until at least March next year, if not longer, as necessary?

Will he also confirm that the Government will put effort and urgency into the approval of antivirals? The best example I have is the Pfizer antiviral—tablets given for five days—which has shown in trials that it reduces hospitalisations and deaths by 89%. Can the MHRA approve drugs such as that as soon as possible? Can they be widely available, so that every GP has them and anyone, if they test positive and has symptoms, can take these tablets, which will lead to an 89% reduction in hospitalisations and deaths? That in itself could be “game over” for this wretched virus.

Can he also confirm that we will do everything possible to make sure that schools, colleges and universities are never shut again? Use daily lateral flow tests; do not have a bubble system or a million children isolating. It is completely unnecessary. The Oxford trial that took place between April and June last year proved that using lateral flow tests is the way forward, so that staff and students do not miss a single day of school. Can the Minister please assure us of that? Our children and parents have suffered so much. We should not let our children suffer any more.

[Lord Scriven (LD)]

My Lords, first of all, you will have heard me coughing—but I have done PCR and lateral flow tests and it is a chest infection. But I have found that coughing quite a bit is a way to get a seat on a train at the moment.

I have not prepared a speech, because I wanted to listen to the debate and see what happened. The most powerful speech so far has been that of the noble Lord, Lord Fowler. Let us be clear: political philosophy is not a tool that you use to deal with a health crisis. You have to listen to public health advice and the people who collectively advise the Government on that public health advice. There will of course be outliers—that is the nature of science—but SAGE is the body which brings scientists together to have those discussions and come to the best collective view on what is in the best interests of keeping people safe. This is not a political discussion about freedom or trying to say that you are the purest freedom fighter of all. I have to say to the noble Lord, Lord Robathan, that political jibes about other parties’ philosophies are not what is required to bring about a safe and stable approach to keeping this country safe.

The clear issue in this is about test, trace and isolate. Those are the three pillars of public health policy, which will not end infection but will mitigate transmission by taking out as many chains of transmission as possible while people are infectious. The concept is as simple as that, but it is difficult in practice—and that is what government policy should be about.

This virus has shown itself to be complex. It mutates, which means that, at times, emergency legislation will be required—and because of this variant, emergency legislation is required. The Minister will know that I have been sceptical about some of the statutory instruments and whether they are an abuse of parliamentary procedure—I think some of them have been. However, these regulations are required in an emergency. We are talking about 2 million people potentially being affected by the end of next week, and it only takes a small proportion of those to be hospitalised to cause great damage to the NHS. The backlogs and the pressures on cancer treatment are because the health service cannot cope—not just with coronavirus but with the effects of the everyday procedures it needs to carry out.

I declare an interest: I am a non-executive director of Chesterfield Royal Hospital NHS Foundation Trust. It would be interesting to know whether those who have talked about the pressures on the health service have actually been to talk to the staff who are dealing with this, who are psychologically, as well as physically, drained. They are drained from the wave of difficulty that they have had to deal with, not just with coronavirus but the pressures of having to deal with people with ongoing problems and acute procedures. This wave is coming and it will mean that, yet again, more people will end up in intensive care and more people will die.

What can we do to try to minimise that? We test, we trace and we isolate. I have heard arguments that this is about the economy or public health, but it is not that binary; they affect each other. If you have 5 million to 6 million people infected, it affects the economy and it affects the NHS’s ability to cope with this. We have to go back to what the experts are saying and to these regulations: test, trace and isolate.

There are a couple of issues that I want to raise with the Minister, because I am a bit perplexed. I have no view that he is deliberately trying not to introduce test, trace and isolate procedures, but some of the things are contradictory and do not lead up to that approach.

The issue of self-isolation is about taking out chains of transmission, so that people are not circulating when they are most infected. But on the reduction of self-isolation and the use of lateral flow tests, paragraph 7.6 of the Explanatory Memorandum states:

“Close contacts of positive cases will be advised (but not required by the regulations as amended) to take daily tests for up to 7 days”.


That means that people are not required to test and to isolate, and there will be no tracing. What is the effect of that? I ask the Minister why it is not mandatory to test and upload those results, so test, trace and isolate can kick in. It seems to be a fundamental flaw in these regulations that people who have been in contact with somebody with Covid, and in particular with this most virulent strain, are told not to isolate and also not to test. If the key to public health is to test, trace and isolate, and we are taking out isolation and testing, how do we trace, particularly as we are told that the R rate could potentially be 3—so every person who is infected could infect another three people? This is a fundamental flaw, so will the Government look at this as a matter of urgency? It is vital.

I continue on some of the issues raised by my noble friend Lady Walmsley about the effectiveness of Covid certification. This is a chocolate teapot approach; it is not going to work. The reason for that has been laid out. If I have not had the booster, I may still have my certification and will be able to show it—but it could have been 10 or 11 months since I was vaccinated if this continues until March. That will mean I am 40% protected going into a large venue where I may actually infect people. The way to do this is a lateral flow test at the point of entry. That would not be 100% effective—nothing is in this type of pandemic—but it would be a damn sight more effective than relying on certification that is out of date, does not require a third dose and actually means that you are putting more people at risk of getting and spreading this than you would be if there was a lateral flow test on entry. Again, I urge the Government to look at this.

Finally, on the wearing of face coverings, lots of studies can be quoted but most come down to this fact: the argument is not about whether they are effective, apart from certain outliers that have not been peer-reviewed, but the extent to which they actually reduce transmission. In this case, where we are talking about numbers doubling every two days and up to 1 million or 2 million people being infected a week, it is important to do everything possible to minimise transmission, as part of a systematic approach. That is why face coverings are important.

Just as important as wearing them is who will enforce the wearing of them. It is unfair to leave it solely to private enterprise to deal with, so what is the enforcement regime? My noble friend Lady Walmsley referred to our noble friend Lady Pinnock and, similarly, I came down on an East Midlands train on Monday. I had to ask six people to put on their face coverings. One was quite verbally violent towards me. I was not doing it to be difficult; I was trying to protect people in that carriage. The evidence is that we wear masks not to protect ourselves but to try to stop the spread of a disease that could kill somebody—and I do not know who it will kill. Who is going to enforce? So I will not be voting for the amendment tabled by the noble Lord, Lord Robathan, on face coverings.

I might vote for the noble Lord’s amendment on certification simply because, for me, it is not a political issue but a practical one about whether certificates will work, because I think lateral flow tests will. Generally, I want this debate not to be about who is the purest of all in upholding a political philosophy. I want it to be about listening to SAGE and the collective view of scientists, and about doing everything possible to follow the public health view of test, trace and isolate, and trying to keep as many people as safe as possible and reducing the risk of death and serious illness to people in this country.

Covid-19: PCR and Lateral Flow Test Providers

Lord Scriven Excerpts

Monday 13th December 2021 Lords Chamber

Asked by

[Lord Scriven]

To ask Her Majesty’s Government what due diligence they carry out on companies listed on GOV.UK, that offer travel PCR and lateral flow tests for COVID-19.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

The private sector has stepped up extremely rapidly, and most of the tens of thousands of travellers have had an excellent and professional service. However, we do not tolerate any providers taking advantage of customers. All providers in the PCR international travel market are required to meet robust minimum standards, and we remove those we identify as having fallen short of them. Since we launched the travel service, we have removed over 100 providers.

[Lord Scriven (LD)]

My Lords, for many people that is just not their lived experience. The approved supply list for the two-day PCR test on GOV.UK is fundamentally flawed. Many thousands of people either do not receive the test results within the two-day timeline or at all. Despite many people reporting these companies to NHS Test and Trace, they remain on the list as of today, making tens of thousands of pounds while undermining the public health effort. What will the Minister do to ensure that this kind of procedure stops?

[Lord Kamall (Con)]

It is important to distinguish between PCR tests if you are contacted by NHS Test and Trace and PCR tests for travel purposes. If you are contacted by test and trace, you are sent a PCR test for free. But when it comes to travel, the view is that the traveller should bear that cost rather than the taxpayer. After I saw this Question, I went on to one of these websites and tested it out for myself. As the noble Lord says, the price quoted is often not the first price. I have had a conversation with those that provide it, and they are looking at a number of different solutions.

Medical Schools: Training Places

Lord Scriven Excerpts

Monday 13th December 2021 Lords Chamber

[Lord Kamall (Con)]

The Government follow strict ethical guidelines on international recruitment, in line with WHO guidance, which says we should not be taking nurses and doctors from countries and depriving their health services. But where countries have a surplus—a number of developing countries around the world actually train more people than they have a use for in the local system—they see it as a valuable source of income.

[Lord Scriven (LD)]

My Lords, it is not just a question of the total number of doctors but the number in certain specialisms where there is already a dearth of professionals. What are the Government doing to ensure that, as more doctors come on, they are particularly geared to specialisms where there is already a dire dearth of doctors?

[Lord Kamall (Con)]

When it comes to workforce plans, particularly in local areas where there is understaffing, we are very much focused on specialisms that are understaffed.

Covid-19 Update

Lord Scriven Excerpts

Wednesday 8th December 2021 Lords Chamber

[Lord Kamall (Con)]

I attended a meeting this afternoon with leading epidemiologists, showing the data and separating the omicron variant, the delta variant and the original coronavirus. They have the data, and one of the reasons we have made this announcement is because we are able to distinguish between them. We are constantly reviewing the data for the original coronavirus and the variants but, if the noble Lord has any more scientific or medical questions, he should let me know or attend the briefing with Jenny Harries on Friday.

[Lord Scriven (LD)]

My Lords, the Statement says that the Government are looking to introduce daily tests for contacts instead of self-isolation. I have a couple of questions. My noble friend Lady Brinton asked what the false negative rate is for lateral flow tests at the moment. Secondly, what will be the legal obligation for a person to take this test and then to upload the result so that people know that contacts are taking the lateral flow test?

[Lord Kamall (Con)]

I am not quite sure about the latest data, because clearly more people have been taking them, but accuracy was in the very high 90s. However, I will commit to write to the noble Lord. On his second question, I will make sure that we get that information out as quickly as possible.