National Health Service: Major Conditions Strategy

Viscount Stansgate Excerpts

Monday 18th September 2023 Lords Chamber

[Lord Markham (Con)]

This is all about prevention—letting people understand when there is something not right within themselves and trusting them to know that. That is why the self-referral part of this is so important, rather than always having a GP as a kind of gateway to it all. Most people know their bodies better than anyone else does. If we can arm them with awareness and give them the ability to self-refer to these centres, we can get them diagnosed that much quicker.

[Viscount Stansgate (Lab)]

Does the Minister agree that in the broadest sense, this strategy would be aided by the Powers of Attorney Bill that passed in this House last week and will shortly reach the statute book? With the indulgence of the House, I pay tribute to my friend and colleague Stephen Metcalfe, the Member for South Basildon and East Thurrock, who steered the Bill through the other place, my noble friend Lord Ponsonby of Shulbrede and the noble and learned Lord, Lord Bellamy, both of whom are in their places, for getting government and opposition support. I thank the officials at the Ministry of Justice who worked for years to make it possible. Does the Minister agree that lasting powers of attorney as applied to health will make a difference to the better?

[Lord Markham (Con)]

Absolutely. The Government, and in particular my noble and learned friend Lord Bellamy on behalf of the whole MoJ team, fully support the noble Viscount’s remarks on the Powers of Attorney Bill and warmly thank him, Stephen Metcalfe MP and all the others for their efforts on the Bill.

Social Care Sector: Staff Shortages

Viscount Stansgate Excerpts

Monday 21st November 2022 Lords Chamber

Asked by

[Viscount Stansgate]

To ask His Majesty’s Government what assessment they have made of the impact of staff shortages in the social care sector.

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

As acknowledged by the Chancellor, pressures in the social care sector are a serious issue. We are taking steps to boost the social care workforce, investing up to £2.8 billion of additional funding in 2023-24 and £4.7 billion in 2024-25 for adult social care, raising the national living wage to £10.42 and launching our national recruitment campaign. We will also be publishing a staffing plan for regulated professionals, including nurses and allied health professionals in health and social care.

[Viscount Stansgate (Lab)]

My Lords, I thank the Minister for that Answer. Last Thursday, the Chancellor said that there were 13,500 beds occupied by people who should be at home. When are the Government going to ensure that there are enough staff to look after them in the adult social care sector, given that you can earn more money in a supermarket than in a care home? How much money are the Government intending to save by postponing the Dilnot reforms? Does the Minister agree with Sir Andrew that this delay is “inhumane”? Will it not mean that many more people are going to have to sell their homes in order to pay for the large care costs? In short, does the Minister agree that the longer this Government remain in office, the more people are having to wait for decent, affordable, proper social care?

[Lord Markham (Con)]

The noble Viscount mentioned funding. Clearly, it was a difficult choice, but our priority was to make sure that the funding went into the supply of places over the next two years, because of the impact that has across the system. Noble Lords will have heard me mention many times how that affects the whole flow, which backs up into ambulance wait times and everything else. That is why I am delighted to say that we have secured £2.8 billion of extra funding in 2023-24 and £4.7 billion in 2024-25. That will obviously flow through the whole system, including into staff wages and recruitment.

Long Covid

Viscount Stansgate Excerpts

Thursday 17th November 2022 Lords Chamber

[Viscount Stansgate (Lab)]

My Lords, I thank my noble friend Lady Thornton for having secured the debate, to which I am very pleased to make a short contribution. There will be many tens, if not hundreds, of thousands of people and their families up and down the country who will be grateful to her for having given them the opportunity to have their experiences of what we call long Covid both explored and legitimised. Many interesting points have been made in the debate. I was struck by the reference of the noble Lord, Lord Bethell, to the economic impact, which is staggering and a point to which I will return. The House may know that there was a debate in the other place about long Covid six months ago, so it is high time that we had our own debate here today.

My first main point is that the outcome of the debate will be, I hope, that we agree on the need: for more research into all aspects of Covid, including long Covid; and to explore the link that may exist between long Covid and the recent exit from the UK workforce of so many people. I remind the House that it was the brilliance of scientific research, including research conducted in this country, that enabled the vaccines to be developed from which we have all benefited. Now we have the challenge of long Covid. One way of thinking about it is to say that it is the persistence of symptoms in those who have had, and thought that they had recovered from, Covid. It is interesting that the majority of people with long Covid are PCR-negative, which indicates microbiological recovery, although the chronic symptoms extend beyond 12 weeks. In other words, long Covid is the time lag between the microbiological recovery and the clinical recovery.

By May or June last year, some of the most commonly reported symptoms included the following: fatigue, cough, chest tightness, breathlessness, palpitations, myalgia, and a difficulty to focus. I will illustrate that with some direct evidence that I have received from long Covid sufferers. A person who fell ill with Covid in the first wave in 2020 wrote:

“I was knocked sideways by it. I have never been so ill.”


They were

“bed-bound for 2 weeks, coughing badly for 2-3 months thereafter. Feeling weak and frail.”

Now I want to introduce your Lordships to the concept of brain fog. Let me again use the words of another sufferer:

“Brain fog came on insidiously after an initial period of recovery. Unaware of it at first, but slowly it engulfed me.”


They

“had no name for what was happening … for a long time”,

and it was a

“relief when others started naming it and talking about it”.

This is where today’s debate comes in. It will be very helpful for people to know that their symptoms are being recognised. I have received a long list of some of the symptoms, which I am sure that many of your Lordships will recognise: the inability to write or concentrate; a short attention span, forgetfulness, memory loss, word lapses, sleep problems, eye problems, balance problems; a terrible sense of brain congestion, of which one person wrote that it felt

“sometimes as if my head would split”;

exhaustion, weariness, and others. Someone said:

“My vocation is gone and I am unable to write. As though a door has shut in my brain and I cannot work.”


Another mentioned:

“A desire to flee from company and crowds. I now avoid outings where possible. I am de-coupling from life.”


It is worth noting that many of those who suffered from long Covid did have vaccinations and boosters.

I understand that some people have taken private action to secure the drug ivermectin and that it had a beneficial effect in some cases, albeit for a short time. I mention that because I tabled Questions to the Minister’s department earlier this year about that drug, and I would be grateful to know what the department and Minister’s current views are about it.

This is not the debate in which to refer to the cuts in public expenditure announced by the Chancellor in another place while we have been sitting here, but of course cutting back on science research would fatally undermine research efforts. I hope that the Minister will be able to reassure the House today that the Government will protect the £50 million that is being invested in long Covid, as set out by the National Institute for Health and Care Research. As I understand it—I am grateful to the Library for this information—the NIHR has published its latest themed review, entitled Researching Long Covid: Addressing a New Global Health Challenge, in which it refers to: three studies considering who gets it and why; two studies looking at the biological causes; three studies looking at the diagnosis; four studies evaluating treatments; three studies considering recovery and rehabilitation; one study looking at the impact of vaccination; and two studies looking at how health services can treat the condition and the health and economic costs of the disease.

That brings me to my second major point, which I will have to truncate. What is the link between long Covid and the people who have left the workforce? As has been referred to, the Office for National Statistics has published several articles. Time does not permit me to give all the details, but it is clear that a huge proportion of those in the age bracket of 60 to 65 are unlikely to return to work, and the pandemic has affected decisions to leave the labour market. The report published in July 2021 by the ONS listed some of the major reasons that workers cited for not returning. Research by the Health Foundation indicates that economic inactivity in the UK has increased by about 700,000 people since before the pandemic. That is an absolutely enormous number, and the cost to the UK will be very great. It seems as though we are living through a pandemic of inactivity, as it were. The Health Foundation report concludes that

“these contributing factors are exacerbating a pre-pandemic trend of the increasing prevalence of poor health as a reason for inactivity”.

I will end there. We certainly need more research, and I hope that this debate might have what I might call a catalytic effect both on the discussion of long Covid and on the reply from the Minister.

Health and Social Care Update

Viscount Stansgate Excerpts

Monday 10th October 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness for reminding me that I failed to reply to that point earlier and for giving me the opportunity to do so, but I will need to investigate further. As I say, I do not have immediate knowledge of this issue, but I undertake to come back to the noble Baroness with a reply.

[Viscount Stansgate (Lab)]

My Lords, I welcome the Minister to the Dispatch Box. I am sorry I missed his first outing earlier today; in fact, I had a medical appointment. Whatever the definition of “challenge”, it must include the position of a Minister representing the Department of Health on the Front Bench of this House—so good luck. The Statement makes the bold claim that up to a million GP appointments can be freed by

“changing funding rules to give freedoms to GPs to boost the number of staff to support their practice.”—[Official Report, Commons, 22/9/22; col. 832.]

Can the Minister explain exactly what that means?

[Lord Markham (Con)]

I thank the noble Viscount for his good luck wishes. I do not understand completely the economics of the doctor’s surgery yet. I want to get my head around that, because I understand that a surgery needs to be set up so that it can be a successful business for them and can have the proper infrastructure. I am very interested in the dentistry field as well; as I said, I have an interest in terms of my wife. But I realise that in a lot of these situations, you are asking doctors and dentists, who are trained to be excellent medics, to effectively set up their own business. That is a quite different thing and demands quite different skill sets. I believe that we need to have a package of support to help them in this respect. As part of that, we need to understand exactly what funding can be used and whether it gives them the headroom—for want of a better word—to allow them to do those elements and have the support staff in the numbers they need. Understanding further this area is on my to-do list, and I would like to get back to the noble Viscount as soon as I can.

Covid-19: Restrictions

Viscount Stansgate Excerpts

Monday 14th March 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for reminding noble Lords that the virus has not gone away. That is one of the reasons why we laid out the Living with Covid-19 strategy. The UKHSA, the Office for National Statistics, and a number of academics, will continue to monitor it. Noble Lords who have read all the articles during the pandemic will be aware of how many scientists are also producing data. We continue to monitor all that data and balance it up when making decisions. We are also prepared to stand up rapidly should there be any variants of concern.

[Viscount Stansgate (Lab)]

My Lords, the Prime Minister has announced that at some stage there will be a major inquiry into Covid. Can the Minister assure the House that when it takes place, all scientific advice that has been received by the Government will be published? Can he also tell us whether he is aware of any scientific advice which has not yet been published?

[Lord Kamall (Con)]

If I was aware of any scientific advice that had not yet been published, I am not sure whether I would be unaware of it. I will try to find out. The Government have laid out the terms of the inquiry; only last week I sent the link to some people, which I am very happy to send to the noble Viscount, for the points that should be considered by the inquiry. During the pandemic, and even now, we continue to receive a wide range of scientific advice. The wonderful thing about scientists is that they continue to debate with and contest each other. Some say that we should never have had these measures, some that we lifted them too early, and some that you can never get the timing right, whatever you do.

Human Medicines (Coronavirus and Influenza) (Amendment) Regulations 2022

Viscount Stansgate Excerpts

Monday 14th March 2022 Grand Committee

Why now? There is a possibility—this year and next—for the industry, the Accelerated Access Collaborative and all the organisations that participate in it to work together and devise a scheme that is about not only streamlining regulation but using real-world data to trigger reimbursement. That reimbursement structure can then be put into the negotiation for the new voluntary pricing and access scheme, which starts from the beginning of 2024. My pitch to noble Lords and my noble friend is this: let us see that happen this year. I am taking this opportunity to ask if the Government will make it happen, through the AAC, during the course of this year.

[Viscount Stansgate (Lab)]

Am I allowed to ask a question before the Minister replies? I notice that one of the SIs has an impact assessment attached to it and the other, related to early access to medicines, does not. When I looked at the explanation, it said that it does not reach the threshold required to undertake a full impact assessment. What is the threshold above which you are required to provide a full impact assessment?

[The Deputy Chairman of Committees (Baroness Healy of Primrose Hill) (Lab)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite her to speak.

Health Protection (Coronavirus, Restrictions) (Self-Isolation etc.) (Revocation) (England) Regulations 2022

Viscount Stansgate Excerpts

Monday 14th March 2022 Grand Committee

My noble friend referred to the responsibilities of local authorities, which will have powers taken away from them under these regulations but will rely on the existing regulations. He did not say what resources would be made available to local authorities. I follow developments in North Yorkshire as closely as I can. I know that there is real concern there about looking after particularly vulnerable people, both in hospitals and in care homes. Will he say whether any extra resources are being given? In local authorities such as North Yorkshire and others across the country, London included, if it transpires that the big uptick in Covid cases leads to a surge, will he confirm that healthcare workers delivering care in hospital settings, homes and care homes will be alerted if a close relative has Covid, in the sense of their potentially needing to self-isolate in those circumstances?

[Viscount Stansgate (Lab)]

My Lords, I have another brief question for the Minister. I preface it by paying tribute to the wonderful work of the NHS, the department and the Minister, and in particular to the scientists who have been involved in producing the vaccines, on whom we all depend.

This little debate is part of the business of living with Covid. I am delighted to hear that the noble Lord, Lord Lansley, has recovered from his brief infection. That is a hopeful lesson for us all, as a number of members of my family, despite being vaccinated, have also recently got it, including my pregnant daughter-in-law, so we hope all turns out well.

As the Explanatory Memorandum to the statutory instrument says:

“The Self-Isolation Regulations played a vital and necessary role in breaking the chains of transmission.”


How will this SI be translated into the official advice on travel to and from the UK? I know that it is not his department; nevertheless, I presume that the regulations will change the nature of the advice given by the Foreign, Commonwealth and Development Office.

[Baroness Brinton (LD) [V]]

My Lords, just before the Grand Committee started, I heard a bit of a discussion about why this Motion was in Grand Committee today while I had a regret Motion tabled for the Chamber on Thursday. I had wanted to do just the regret Motion in the Chamber, but the Government Whips’ Office said that was not possible given the timing, so the only offer available was, essentially, for this statutory instrument to be heard twice. I apologise for that, but unfortunately it was the only possibility.

The lifting of the self-isolation regulations in England at the end of this month seems extraordinary and way too early. Only a couple of days ago, the World Health Organization reminded nations like the United Kingdom that, even when a virus becomes endemic, it needs managing, including by testing, self-isolation and mask wearing. Even if they are not required by regulation and law, the World Health Organization said that the message and communications from a Government are vital in ensuring that people take personal care in what they do.

We are still learning about the long-term effects of Covid. Recent research studies, published in the last two or three weeks, into long Covid are showing cardiac, respiratory and neurological problems that are already having consequences. In the future, it will be absolutely vital to watch for the currently not visible long-term consequences of Covid-19. There is an excellent book by Laura Spinney called Pale Rider: The Spanish Flu of 1918 and How it Changed the World, which has a good chapter near the end on the early deaths of Spanish flu survivors in the immediate aftermath of the pandemic. Such early deaths went on for two to three decades—interestingly, often with heart, stroke and respiratory problems. Without surveillance and self-isolation, we risk living with Covid at a very high level, and the consequences for the population may become apparent only when it is too late.

The problem with the living with Covid plan, which was announced on 24 February, was that the Prime Minister called it yet another freedom day and public behaviour has already changed. One doctor said on Twitter today that they are abused on the Tube for wearing a mask on their way to work. That is because there is not a strong clear message to people that living with Covid means that we still have to be careful about it. Can I ask the Minister—as I have asked him on many occasions before—whether the Government plan to have a strong communications message about these changes and about people taking personal care?

I would also like briefly to return to the question that I asked the Minister as a supplementary to the Question from the noble Baroness, Lady McIntosh, earlier today. Given that members of SAGE are now confirming publicly that Ministers did not ask for any modelling to be done for the living with Covid plan, how does that square with his answer to me that Ministers have to take modelling into account along with the wider needs of society? Everyone understands that dilemma for Ministers, but that was not my question. If Ministers did not ask for modelling, how on earth can they balance that risk? The Minister referred to the BA.2 variant, saying that they were watching it, but it is now the dominant variant. The one that we are watching is deltacron, and there may be others in the future.

I am grateful for the earlier comments from the noble Lord, Lord Lansley, and the noble Baroness, Lady Thornton, on the worries that those who are immunocompromised face. The Minister knows that I am one of those severely immunosuppressed people; I have had my fourth vaccination, although I have been warned that, because of my medication, it is probably already waning. There are people with blood cancer, for example, who cannot make antibodies or for whom the vaccine is contraindicated. Lifting self-isolation for them is a real risk. Under the current guidance to the clinically vulnerable—a number of people somewhere between 500,000 and 3.7 million—they will have to risk assess what they want to do. They are keen to do that, but they need the data.

The NHS daily dashboard used to be a good starting point for the public alongside the ONS data and the ZOE study, but the dashboard is now unreliable and the ZOE study is about to lose its funding along with others. That means that the vulnerable and their families, friends and work colleagues cannot see where Covid is. They will have to pay for tests—and let us be clear: offering free tests only to a small number of the most severely clinically extremely vulnerable is not helpful; it is the people who visit them and work with them who need to test before they see them. Many of the surveillance projects are, as I have said, also under risk. The REACT study is ending at the end of March and funding has been withdrawn—remarkably—from the ZOE study, the SIREN and VIVALDI studies and the CoMix social contacts survey. How do the Government plan to monitor the ongoing management of the pandemic—as WHO says they should—and assess the impact of ending restrictions with our vital surveillance systems down?

On what scientific and clinical evidence was the decision made to recommend that the CEV

“follow the same general guidance as everyone else”

in the living with covid plan? That is, frankly, a fantasy and has condemned the millions of CEV to self-imposed lockdown with no support. It is, by the way, also completely contradicted by the advice to them on the specific guidance page for the clinically extremely vulnerable and the NHS page on what to do if you have Covid, where people are told that if they have a positive test for Covid they should stay at home.

Covid-19: Vaccinations for School Pupils

Viscount Stansgate Excerpts

Monday 17th January 2022 Lords Chamber

[Lord Kamall (Con)]

The JCVI will continue to look at the new data as it emerges and recommend whether we boost 12 to 15 year-olds. But when we look at the vaccination strategy, we look not only at the tackling of the specific coronavirus or variant but also at the wider implications. For example, many noble Lords have spoken eloquently about the unintended consequences for mental health issues of lockdown. Beyond that, we have to look at societal and social issues and the way people, businesses, charities, et cetera are affected in doing their work. We always make sure we take a balanced approach, looking at the science, the wider medical issues and the unintended consequences.

[Viscount Stansgate (Lab)]

My Lords, the House is united on the importance of children’s education continuing, but it is the lack of vaccinations not just among children but among the teaching workforce that may interrupt their education. Do the Government have any estimate of the proportion of the teaching workforce that has not yet been vaccinated or is off work for Covid-related reasons?

[Lord Kamall (Con)]

The noble Viscount raises an important point. As we are expecting our children to be vaccinated, it is important that teachers are also vaccinated. It is one of the reasons we are looking at VCOD—vaccination as a condition of deployment—in the health service. In answer to the noble Viscount’s specific question, I am afraid I do not have the information with me, but I will try to speak to the Department for Education and write to him.

Covid-19 Update

Viscount Stansgate Excerpts

Monday 29th November 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Viscount raises a good question; I am afraid that I will have to double-check the answer.

[Viscount Stansgate (Lab)]

My Lords, the Government’s Statement says that close contacts of anyone who tests positive with a suspected case of the omicron variant must self-isolate for 10 days, regardless of whether they have been vaccinated. Can the Minister tell the House what specific scientific advice has been received in the recent past to support that? Or are the Government being excessively precautionary? If so, is this a permanent or a temporary provision?

[Lord Kamall (Con)]

The Government have taken these measures as a precaution and we will constantly review them as we get more data. We have already committed to reviewing the measures after three weeks. If the data becomes available and we are clear about whether or not this is effective, we may well have an announcement before then, but we have committed to reviewing this within three weeks.

Covid-19

Viscount Stansgate Excerpts

Monday 15th November 2021 Lords Chamber

[Viscount Stansgate (Lab)]

My Lords, I hope the House will forgive me if I emphasise an issue that has already been raised by both Front-Bench speakers: when this booster jab, which I am very glad the Minister has had, as have I, is going to be recorded. As I hope the House knows, it will prevent people, many people in this House, travelling to various countries—I mention France and Israel as only two of them—unless we can prove that we have had it. Although I am very pleased to know from the Minister that he has had the booster jab, and of course I believe him, I would like to know in what way he can prove it to me by showing it to me on his phone.

[Lord Kamall (Con)]

I apologise if I have misled the House: I have booked my booster jab but I have not had it yet. I was able to book it in advance but I cannot have it until—perhaps I should not make this public, but they have given it to me one day before the six months is up. This will be all over the front pages tomorrow, it will be a huge scandal and noble Lords will be calling for my head. I understand that.

On the serious point, I share the frustration of all noble Lords who have brought this issue up. I was hoping to be able to announce a date today, but it was scratched at the last minute. I think there was some technical reason, but we hope to have good news soon. I know that will be as frustrating to many noble Lords as it is to me. Believe me, I would rather have good news than to be seen to be avoiding answering the question.