Covid-19 Inquiry

Lord Winston Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Lord Winston (Lab)]

My Lords, in 1917, at the height of the terrors of the First World War, Hilaire Belloc wrote to GK Chesterton and said, “Sometimes it’s necessary to lie damnably in the interests of the nation”. And 103 years later we had another, much smaller catastrophe: the pandemic that we are talking about now. It was not quite global but it came close—and it was certainly very serious. Something that we have not discussed very much about this report is the question of the believability of what we were hearing about the pandemic, and that is a more serious question to be answered.

I must say that it was a pleasure to work behind my noble friend Lady Thornton, who again and again, absolutely selflessly, led the way in the debates. What was encouraging to both of us—certainly to me; I must say that I have not discussed this with her—were the repeated answers of the noble Lord, Lord Bethell, for the Government, who, I think, tried to speak honestly and directly every time. He even answered emails almost immediately. He was sometimes somewhat indiscreet; I am not going to say exactly what his emails said—that is between him and me—but he certainly was one of the really good people in this. But, on the whole, not all the Government, in many people’s minds, come out quite so well.

It is also reassuring to consider that it was wonderful to see both Chris Whitty and Patrick Vallance—now the noble Lord, Lord Vallance—supporting the Government, but how difficult it was for them to be, with the Prime Minister in the centre, in a kind of showcase. This is very difficult for scientists who have to do their best to tell complete truth wherever they can and to be as objective as they can when, in fact, there are political considerations through no fault of any of them. Anyhow, one of the issues is that, since the pandemic, the reputation of politics has not yet got back to where it should be—that is rather important.

I want to discuss two issues. One has just been touched on by the noble Baroness, Lady Coussins: the question of track and trace. That is a very good example. At one stage, I remember, at a committee meeting, inquiring rather rudely of the noble Baroness, Lady Harding, who was then invited to lead track and trace, “Why is it that people don’t trust you?” She looked a bit amazed that anybody could ask her that question and her advisers and officials did not help. About 10 days later, I got a message asking whether I would respond to a phone call. It had to be done by the hour, so, at a certain time, she phoned me and said, “Is it really true that people don’t trust me?” I said, “Well, do you think that people are trusting track and trace? They’re not”. “Why not?” I said, “Well, being tracked and traced is an invasion of your privacy, for one thing; it gives you the risk that you might find out something that you don’t want to hear; it gives you the risk that you might not have wanted to be in the place that you were tracked from, and so on”. She said, “Well, what should we have done?” I said, “Well, it’s pretty obvious, isn’t it? One way of changing public opinion is by demonstrating that it would be good for the person concerned. So you say, ‘If you’re traced and diagnosed, you’ll get much quicker treatment before any serious consequences of the disease are present’”. “Oh”, she said, “I must run and tell the Prime Minister”.

That was not a brilliant example, but it is interesting because, thinking about it, the other issue I am tangling with is the reverse: the mistrust of vaccines. It was very clear that a lot of people were scared of the vaccine. That fear was increasingly caused because the politicians and people promoting the vaccine were not, or did not appear to be, trustworthy. To be fair, the vaccine had been produced almost like a rabbit out a hat—completely unexpectedly, like magic, very quickly, without thorough testing or going through the usual regulatory formulae. Of course, people started to get a few symptoms or side-effects, some of which were later quite serious.

There is an interesting connection between those two issues. A person who is ill might benefit from test and trace but, with a vaccine, it is best for everybody else but not you to be vaccinated. Herd immunity will suit you just as well and you would not run the risk of having the vaccine. We could have learned that from the outbreak of measles in London, just 15 years ago, when government officials were telling people that they must have the vaccine. We saw mothers holding their babies on television. The ethical responsibility of the mother concerned is to make certain that her baby is not harmed, but the great harm might well be the vaccine that she is about to receive for the baby. It is a failure of understanding and of dialogue between people.

We must recognise that we need to do much better with public engagement. The public engagement between the Government and the populace was woeful in the pandemic. The press and rumour-mongers often did not help, neither did the various media, but this is something important that we should consider.

I ask the noble Baroness to address this in her reply to the debate. The Blair Government made a considerable attempt to increase our understanding of how we might better engage the public by giving them better information and having dialogue with them. That worked very well. We were trying to tackle some big issues at that time. One was nuclear waste, another was genetic modification and another was the new nanotechnology coming into medicine, which was puzzling because of different effects at different cell levels.

We have to recognise that a Government cannot succeed unless they are trusted. I hope that this side of the House recognises that over the next few years. I do not pretend for a moment that it is simple to do. While I cannot comment on the Prime Minister at the time, Boris Johnson, I do not think that Asquith was trusted by the populace during the pandemic of 1918-19 and the Great War beforehand. But it is important that we try to find ways to trust.

One of the most interesting lessons was in the Reith lecture given by the noble Baroness, Lady O’Neill, who touched on this. We should go back and look at some of the things she said, as well as at our Select Committee report on science and society. We need to understand how we can do this better, because otherwise we will always have these problems in science. We need to be much clearer about how we will deal with them in the future, and I hope that this new Government try to renew interest in some of those issues.

--- Later in debate ---

[Lord Whitty (Lab)]

My Lords, as the last speaker from the Back Benches, I do not intend to comment on everybody’s speeches, but I do hope that the noble Lord, Lord Hannan, makes his own submission to the inquiry, because it is a vital point. I would like to see how the inquiry and its advisers deal with his point. I say no more.

It is probably just as well that I do not comment widely because my own expertise in the health field is limited to virtually nil and my experience with pandemics relates to my period as a Minister dealing with the foot and mouth epidemic; in other words, in the livestock area. While there are vast differences, and the authorities in livestock epidemics have means of controlling them that would not be acceptable to the human population in any civilised society, there are also some features that are the same. Principally, those are that the authorities in the agriculture and related sectors did not have a very clear plan; there was no mutual understanding between the industry and Defra; we changed our policy several times during the period; and probably more cattle—or beasts in general—lost their lives than needed to.

There have been inquiries into that epidemic and inquiries into this pandemic. On my count, there have been—I think the noble Lord, Lord Lansley, referred to this—six key inquiries into what to do in an epidemic, beginning with the one after SARS in 2003 and going right through to the recent one in 2018. The one common feature that is clear—the noble Lord referred to this—is that there were a lot of recommendations, some of them were taken up, many of them were not, and many of those that were taken up were dropped or severely modified. I hope that this inquiry produces recommendations that can be sustained and that health practitioners, scientists and everybody is convinced at least by the main thrust of the inquiry’s recommendations. The module that we have already received will be supplemented by much more detailed ones, but it already raises a number of very serious concerns.

The fact that those inquiries have not been followed through by successive Governments is a worry, and I hope that we can have a very serious follow-through by something like a resilience structure in government, which my noble friend Lord Harris referred to, and that that will have clear backing from Parliament and the new Government.

I want to end with one final, crucial area that has not been touched on. The theme of the report is referred to in terms such as “putting into place”, “failing to put into place” and “needing to put into place” contingency plans for a surge in resources, particularly during the immediate response. My namesake Professor Chris Whitty —no relation—expresses it as a way of stopping a pandemic in its tracks. Three things have to be in place to do that during any form of pandemic or virus-based epidemic: testing; tracing; and making sure that all the equipment required, from PPE to syringes and everything else, is already in place and can be stepped up according to the severity of the epidemic.

I asked Ministers in the previous Government about the recommendation in some of these reports that we get agreements in place well in advance to sort out not only the incredibly complex governmental structure—it is reproduced in the report and involves an incredibly complicated network of bodies—but the resources in private, university and research areas. For example, there needs to be an agreement so that, as soon as a pandemic becomes evident, a system makes available laboratories in the public sector and in the rest of society, together with testing arrangements, and makes the availability, specification and distribution of PPE clear well in advance. In order to do that, public sector bodies need to have in place as soon as possible protocols on those facilities becoming available as soon as a pandemic is declared. In the private, educational and research sectors, we need to have protocols—contracts, in effect—with money paid up front so that those private facilities will be transferred into producing as soon as possible the equipment needed to test and trace, and the materials and equipment needed for combating the pandemic. They would therefore drop research work and commercial ventures, because those stand-down contracts were already available.

I asked the previous Minister—it was not the noble Baroness, Lady Neville-Rolfe—some months ago whether such contracts were already in place, but I have to say that I got a rather equivocal answer. I ask the Minister, and the previous Minister if she cares to comment, whether, if a pandemic started or was clearly threatening us tomorrow, we would have available those facilities.

[Lord Winston (Lab)]

I am grateful to my noble friend for giving way. This is a time-limited debate, so I shall make just one point. There was a public service laboratory that was closed down. It was a wonderful institution that many noble Lords will remember. It is something we should have not just for a pandemic, but as a continuous resource for unexpected and unusual things that affect the nation, particularly bacteriology.

[Lord Whitty (Lab)]

I thank my noble friend for that. That shows that we are going backwards with public facilities, but private and other facilities also need to be mobilised immediately and a judgment made on how long we need to do that, according to the success or otherwise of our control of a pandemic. I put it to the Minister in the new Government that if that has not yet been put in place on a wide scale, it should be one of the priorities. I hope she can reply positively on that. I also hope that industry research labs of all sorts would respond. In the previous case, we were panicking to get them in place, and it led to some corner-cutting that in turn led to accusations of some dubious behaviour. I do not want to go into that, but if we had systems in place already, none of that would be a problem. Since nobody else has mentioned it, I hope the Minister and the ex-Minister can reply and give me some assurance on that basis.

Vaping Products: Usage by Children

Lord Winston Excerpts

Monday 2nd September 2024 Lords Chamber

[Lord Winston (Lab)]

My Lords, the House should be really grateful to the noble Lord, Lord Storey, for introducing this debate. There are a few matters that I would perhaps want to wrestle with him about on this.

First, smoking vapes has been going on for a lot longer than the noble Lord said. In fact, the first vapes that I came across were invented by Herbert Gilbert, a scrap metal dealer in Pennsylvania who had nothing better to do but smoke cigarettes—he smoked two packets a day. Eventually he devised a very similar machine to the one that we have now, which was battery driven—it has been around a very long time. However, it did not take off—he took out a patent but it did not work—and since then there have been several attempts from various companies. It is only recently that there has been this sudden massive surge in interest in vapes. Of course, that includes what is really important and what I think the noble Lord forgot to mention: the need for research into what is happening.

There are many serious unknowns in the things which people say are proven about vapes. I do not want to argue the toss entirely, but certainly one problem we have straightaway is that most of the studies in the literature—by the way, hundreds of studies can be seen which are recorded; for example, in the National Institutes of Health database—show that in fact, many studies have been funded by the tobacco companies.

The effects of vaping are still unknown. The amount of nicotine in a vape is about 1/20th of what it is in a cigarette, and a whole pack contains perhaps up to 200 milligrams of nicotine, while a vape contains probably something like 1/10th of that. However, one of the problems is that none of the researchers have really measured the number of puffs a day, nor the number of vapes which are taken, so some basic quantification is needed.

No clear health effects have been recorded in the literature. There are many suppositions about laryngitis and cancer—one of the very first things reported in the 1960s but which was probably from smoking cigarettes. There is no measure of dose, no numbers of puffs and so on, and such basic data are needed.

There is no question that there is possible serious damage from vapes, but it is not certain. For example, there is some evidence of possible cellular damage in the lungs and trachea, but nobody has found what one hoped to find—or, rather, did not want to find—which is carcinogenic effects. There have been no cancers in any research that I can find. There is no DNA damage, which is interesting, because cigarettes definitely cause DNA damage. There are psychotoxic effects. Cytokines such as interleukins and inflammatory products are occasionally produced, but this will happen, for example, during a heavy cold, and they do not lead to long-term effects. There is a problem with that.

Heat may be an issue with hot vapour. One problem now is that heat-not-burn cigarettes are available; they are used for marijuana, because it needs a much higher temperature to vaporise than does tobacco. You can heat tobacco just sufficient to get the nicotine but with marijuana you have to heat it much more. That may be much more dangerous, and certainly must be looked into.

Overall, it is clear from spectroscopy that has been done that there are at least 80 different compounds in the vapour of different vapes and they are not standardised. I argue that this is something that we need to think about. Clearly, there is no regulation of vapes and no regulation of what they contain. That is what we should argue for initially, until we understand it better. It is true that this has attracted American attention. President Trump was the president responsible for banning vapes for kids, which is interesting. We need to do that.

I end on a nice bit of good news. Vapes do not seem to harm fertility. I am pleased to tell you that studies by doctors in Germany have shown that neither fertilisation nor embryo growth are affected by this. This is important too, because women worry deeply about smoking in pregnancy. I am not going to say whether it is a good or bad thing in pregnancy; that is not the point. I want to emphasise that the research is not adequate at the moment to make very clear judgments about vaping.

Children’s Cancer Services

Lord Winston Excerpts

Wednesday 20th March 2024 Lords Chamber

[Lord Markham (Con)]

I am happy to go through the facts. I hope noble Lords know me well enough to know that I like to look at all the evidence, and, clearly, we are at that stage. I saw an excellent example just the other day in Cambridge, where we are building a new centre to put research and treatment under one roof. That, of course, is what the Royal Marsden has for children’s cancer, so I am aware of the benefits and they will be at the front of my mind.

[Lord Winston (Lab)]

My Lords, I am sure the Minister understands that cancer cannot be seen as an isolated disease. One aspect of that is how you provide for children in their entirety during the treatment, which does not always involve just cancer but other organs and other parts of the child.

[Lord Markham (Con)]

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

Anaesthesia Associates and Physician Associates Order 2024

Lord Winston Excerpts

Monday 26th February 2024 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as a NED of the NHS Executive. I support this order, for many of the reasons that the noble Lord, Lord Hunt, has just explained, but stress that I am extremely unhappy about the division between the reports from various medics and the associates that are planned. One of the big problems is that we do not value junior doctors enough. The phrase we use is inappropriate. I have been married for 43 years to a doctor who has been called a house officer, a senior house officer, a registrar and a senior registrar—those things would now be referred to as a junior doctor. I want to put that on record.

I also support what the two noble Baronesses have said, which is that we need a distinguishing factor for a qualified doctor, be that “MD” or whatever else is selected by the medical profession. I am a nurse, and I am proud of being a nurse. We have nursing associates, but I know that I am a registered nurse and I know that I have a doctorate, but I would never refer to myself as a doctor in the clinical area. These issues are difficult to deal with because we need to value people’s different experience and training.

I was appointed by a previous Secretary of State to chair the grandfathering of the paramedics on to the new register, when it came into being, and look at the success that that has been.

[Lord Winston (Lab)]

My Lords, I regret to say that I totally disagree with my noble friend speaking from the Front Bench, a person for whom I have the greatest respect, both as a colleague and as a previous Minister of Health in an earlier Government. He is not medically qualified; he is not a doctor who has been in practice. I speak simply as a fellow of the Royal College of Surgeons of Edinburgh and—it seems a bit immodest to say this—I was the triennial gold medal holder at the Royal College of Surgeons in London for innovative research. I never know quite how I got that award, but I did, and it hangs in my lavatory—I probably should not say that either.

There is a very serious issue here: anaesthesia. I do not want to frighten anybody, but I am not exaggerating when I say that there is no point at which a doctor has a patient closer to death than when the patient is anaesthetised under a general anaesthetic. It is then that things can happen which are completely unexpected, and there are all sorts of ways that the qualifications of that anaesthetist are incredibly important. Doing anaesthesiology is, most of the time, deadly dull; nothing goes wrong, you sit there quietly while the surgeon carries on acting out his wonderful role leading the operating theatre and controlling everything. The person who is really at risk is the person who is under anaesthesia, and that is something we should never forget; it is really important.

We do not even understand fully how anaesthetics work. It is true to say that even though we use gas and other agents, how they work exactly on the brain is not certain and we are still learning, years after the first anaesthetics in Victorian times. We have to recognise that this is quite a strange area of medicine, and that is why I am making this speech.

I want to tell a story about an anaesthetist friend of mine with whom I worked. Before I was doing regular in vitro fertilisation, I did a huge amount of reproductive surgery—surgery in the pelvis and telescope examinations, including laparoscopy. He and I worked as a team regularly on a very large number of patients, with complete success. On one occasion, I had a young woman, who was only 19, as my patient. She had severe abdominal pain, and I wondered, for somebody that age to have that pain, whether she had some unusual condition, and I thought she should have a laparoscopy.

My anaesthetist, as he always did, went to see the patient before the surgery and examined her to make certain she was well. He took her into the anaesthetic room and started with the anaesthesia, while I was waiting in the operating theatre. Then, quite suddenly, my anaesthetist friend wheeled the patient in on a trolley and said to me, “Robert, I think we have a spot of trouble here”. That was all he said, but there was something in his tone of voice and I thought, “This is really a weird thing for him to say”. The patient was unconscious and not intubated, and she remained unconscious. Her heart went and she had, in effect, died. We got her on to the operating table and I, as the surgeon, had a decision to make: what do I do? Do I, as the person leading the team, interfere, or do I leave it to my anaesthetist, in whom I had complete trust? I asked him whether he thought I needed to do heart massage or various other things. He said, “No, hang on for a bit”.

National Health Service: Key Targets

Lord Winston Excerpts

Tuesday 16th January 2024 Lords Chamber

[Lord Markham (Con)]

I definitely agree that it is more important, and that is why I am pleased that we have made such progress. If we look at one area in terms of hospital records being available and doctors’ records to patients, that has gone up since the beginning of the year from about 1% of GPs to about 90% today. About 90% of all our hospital records are now digitised, compared to less than 3% in Germany. We have made massive progress, and it is key to all of the reform and to improving productivity across the NHS.

[Lord Winston (Lab)]

My Lords, the Minister well knows that we have raised the issue of primary care again and again in this Chamber. Would he be kind enough to tell the House how the Government feel they are doing with regard to the retention of very highly qualified general practitioners at the height of their career, who are currently leaving early? Up to about 50% are considering retirement before the retirement age. Will he comment on how he feels that is going?

[Lord Markham (Con)]

Staff retention, particularly of GPs, is vital. That is why we listened to the number one reason they were retiring, which was the feeling that their pensions were being adversely affected. We changed the rules in the last Budget to try to address that; it is early days, but I hear that that is starting to make progress. Primary care is the front line. That is why I am pleased that we have increased the number of appointments by more than 50 million, ahead of our manifesto target. But it absolutely needs to be a key focus.

NHS Winter Update

Lord Winston Excerpts

Thursday 11th January 2024 Lords Chamber

[Lord Winston (Lab)]

My Lords, we are very grateful to hear the increasing focus on the need for urgent ambulance care. Obviously, for personal reasons, I am very grateful for that, because this is the sort of time when those things happen. I wonder, however, whether I could probe the Minister a little more. With regard to Covid, my impression—from making inquiries to various centres in London—is that the uptake has not been as good as they had expected. Does the Minister feel that we are doing enough to ensure that in particular those who are most vulnerable are coming to get vaccinated, first for flu and secondly, of course, for the coronavirus?

Domestic Violence and Brain Injury

Lord Winston Excerpts

Monday 23rd October 2023 Lords Chamber

[Lord Markham (Con)]

It is a very good point. As all noble Lords are aware, often the challenge is getting people to come forward when they have suffered domestic violence. Some of this research shows that there are tools, such as a spit test, to understand whether someone has suffered from a traumatic brain injury. Bringing some of those things into play, so that people are identified and encouraged to come forward, is vital.

[Lord Winston (Lab)]

My Lords, the Minister is to be congratulated on his call for more research. Would he care to comment on the use of organoids—clumps of generative stem cells—which act as an artificial brain in culture and show clear evidence of certain injuries, such as whether the brain may be easily propagated? That kind of research is important but is often condemned in the press. Can the Minister make sure that the Government will allow that kind of research to continue? It is completely harmless ethically.

[Lord Markham (Con)]

Yes. The main thing is that £9.5 million is being invested into research on traumatic brain injury, but this is a platform to allow spin-off research from there. When speaking to people on this, I am clear that this is not a cap: if we get good research proposals put forward in areas such as the one the noble Lord mentioned, the money is there to pursue that.

General Medical Council: Internal Guidance

Lord Winston Excerpts

Tuesday 17th October 2023 Lords Chamber

[Lord Markham (Con)]

People should always be treated with respect. That is why we are quite clear that the primary descriptor in this circumstance should be “woman”. However, in a few cases it has also been clear that a secondary descriptor is “people with a cervix”. It is quite clear that we are talking about a woman as a woman. By the way, that is very important for people with English as second language, so they understand very clearly that a woman is a woman. For completeness, in those cases where there might be a change of sex, we are being very clear that it is for everyone with a cervix.

[Lord Winston (Lab)]

My Lords, I intend no disrespect to anybody, but in view of the fact that the GMC has a really important role in regulating language, particularly for overseas graduates who come to Britain, can the Minister tell me how many male members of the GMC have given birth to a child? If he cannot tell me, maybe he would be good enough to send me a letter.

[Lord Markham (Con)]

I am very willing to hazard a guess that it is zero, but I will happily follow that up in writing with the exact number.

Paediatric Care: Wating Times

Lord Winston Excerpts

Monday 16th October 2023 Lords Chamber

[Lord Markham (Con)]

I am aware from personal experience that, when you have a child with neurodiversity or developmental needs, it is a long journey. We are seeing this manifest itself much more in recent years; I was talking to Minister Caulfield about this just this morning. One-to-one is always preferable but, where capacity is constrained, group education and help can sometimes lend themselves to this space. It is a long-term condition, and clearly it will not be solved by treatment over a few months but needs many years.

[Lord Winston (Lab)]

The Minister quite rightly referred to the brain development of a child being very rapid and resulting from experience, and to various experiences having a profound effect on children’s development. However, he did not mention the place of primary care and, particularly, general practitioners in this. Does he feel that general practitioners are getting enough resources to be able to assess children on a more routine basis? The app will certainly be useful, but it does not get them clearly involved with medical practice; we need some standard way of doing this. Can he give us some information about the role of the GP?

[Lord Markham (Con)]

The role of the GP is clearly vital. That is what I was trying to get behind in the Start for Life initiative and clear early warning indicators. Clearly, that needs to go right through the development of a child at different key stages along the way. On digital treatments, I was at Boston children’s hospital last week, and it has early indicators for dyslexia—for example, looking at pattern recognition via an app, as it is not until children are older that they can see letters. Similarly, early signs of neurodiversity can be seen in the way that children play online on certain apps. I think we can add some of these digital support tools, but clearly the GP has a primary role.

Cancer Referral Targets

Lord Winston Excerpts

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend is correct that there were knock-on implications of lockdown, cancer detection rates being one of them. Noble Lords have heard me speak of Chris Whitty’s concern about heart disease because those check-ups were missed, and mental health is another area. Clearly, these are some of the things we are hoping to learn from the Covid inquiry, so that we know the impact of lockdowns, not just on restricting Covid but more widely, on the population as a whole.

[Lord Winston (Lab)]

My Lords, have the Government made an assessment of the cost of false positive tests in this kind of screening and the cost to patients?

[Lord Markham (Con)]

When the noble Lord says this kind of screening, I am not quite sure which type of screening he is referring to.

[Lord Winston (Lab)]

For cancer.

[Lord Markham (Con)]

I did not know whether the noble Lord was referring to GRAIL and the comment from the noble Lord, Lord Patel, about false positives. This question probably deserves a detailed reply but, as with any test, it is not about just specificity but sensitivity, which is key, so that the number of false positives is minimised. I will provide a detailed reply.