Health and Social Care Update

Baroness Andrews Excerpts

Monday 22nd March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am grateful to the noble Lord for his tribute to the NHS, both the front-line staff and those who have organised the vaccine rollout. He is right to say that this has been a huge national achievement. However, I do not accept the characterisation he has made of other aspects of our pandemic response, including the provision of PPE, which, by the way, involved a huge global competition for extremely rare materials and led to a massive increase in domestic production. I also do not agree with his characterisation of the test and trace programme, which has developed into becoming one of the largest testing programmes in the world. It is now extremely effective, with tracing completion rates above 90%.

[Baroness Andrews (Lab) [V]]

My Lords, further to Minister’s exchange with the noble Lord, Lord Forsyth, can he update the House on plans to increase the manufacture of vaccine in the UK and when and where that might happen?

[Lord Bethell (Con)]

My Lords, I am not sure that I have at my fingertips the precise rollout plan for domestic manufacturing. All I can do is reassure the noble Baroness that we are exploring all options equally hard and are working 110% on every opportunity we have for delivering vaccines into the UK. I reassure the noble Baroness and all noble Lords in the Chamber that we are doing all we can and that at this stage we are hopeful and confident that the supply chain will deliver the vaccines we need in order to vaccinate all adults by the end of July.

Women’s Health Strategy

Baroness Andrews Excerpts

Tuesday 9th March 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Lord makes a really good point. I am not sure whether we have considered the gender aspect of the clinical trials work programme in our G7 agenda. It has been very much about pandemic-preparedness and ensuring that next time we are able to share clinical trial information. Of course, we pat ourselves on the back for our own vaccine clinical trials in the UK, which, I think, have met a new standard for gender representation. He makes a good point, however, about making that case in our G7 work programme, and I will take it back to the department for further consideration.

[Baroness Andrews (Lab) [V]]

My Lords, I welcome the consultation and hearing women speak for themselves. It is very encouraging that there has been such an immediate and very positive reaction. We have known for a very long time that health inequalities affect women specifically and disproportionately, and we can take action without necessarily waiting for the consultation—for example, the 2018 BMA report on women’s health showed that even women’s life expectancy had deteriorated, and it recommended changes in medical training and education. As the Minister says, getting this consultation right is a big challenge, but can he assure me that, however challenging it is, the findings will be heard, followed up, acted on and invested in?

Covid-19 Update

Baroness Andrews Excerpts

Thursday 4th March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am grateful to the noble Baroness for her insightful question about the obscure but vital question of data architecture. If there is going to be one powerful legacy of this awful disease, it will be the way in which data helped drive medical research, medical insight and the treatment of individuals. I am not sure if we need a new registry, a national Covid registry; what we need is for our existing data to be able to talk to itself. I can tell the Chamber that we are making enormous progress on that. I pay tribute to the unsung heroes, the CTOs who meet weekly at the NHS data architecture meeting, an obscure but vital forum where an enormous amount of good work is done by NHSX, NHSD, test and trace and others in primary and secondary care who are working incredibly hard, so that if one takes a test today, it goes into one’s patient record tomorrow and can be used the day after by a researcher looking at long Covid, dexamethasone, recovery or whatever. This is how modern healthcare should work. We have not done it well enough to date. We are making great progress on it tomorrow and we must not stop.

[Baroness Andrews (Lab) [V]]

My Lords, like everyone else, I could not agree more that the NHS rollout has been absolutely brilliant. I should also say that the Minister has been resilient, and we all appreciate that. However, I return to what is a more uncomfortable subject, I suspect, and follow up the question on airport testing. The Minister said that far fewer people are travelling and that the pursuit of quarantine conditions is more effective than it was. Given that fewer people are travelling, is it not possible to do what my noble friend Lord Winston suggested and pursue those people through test and trace and airport testing, as many other countries are doing successfully? How can the Minister say that quarantine testing of people in self-isolation is more effective? Can he give us more details on that?

[Lord Bethell (Con)]

My Lords, I thank the noble Baroness, Lady Andrews, for her questions. Perhaps I may tackle the specific question of airport testing, which has been raised a couple of times. The honest truth is that the arrival of families in south Gloucestershire and Aberdeen who had done a pre-flight test and subsequently developed symptoms demonstrates, I am afraid, that pre-flight and airport testing is not as effective as one would hope. If it were, we would not have to impose a 10-day testing regime with tests on the second and eighth days. That is the only rigorous way in which one can do it. It is estimated that airport testing catches perhaps between 10% and 20% of infection, and that is why managed quarantine is so important. The infection rate among those who arrive in the UK is high enough for us to be seriously concerned and to impose the kind of isolation that we have done. Until that infection rate is reduced, I am afraid that we have to look forward to managed quarantine and isolation being a part of the travel experience for some time.

Covid-19 Update

Baroness Andrews Excerpts

Thursday 4th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, they do have a scheduled weekly meeting: it is called PMQs. It is up to either side to decide how well it goes. To reassure my noble friend, we publish absolutely everything on the vaccine. We even publish the formula of the vaccine itself. The data is shared with local authorities—it is out there on the internet—and we could not be more transparent if we tried. We have worked very closely with the Information Commissioner; we have a massive data analytical team; and we are as open as we possibly can be because we believe that trust in the vaccine is absolutely essential to uptake, and therefore it is in our interests to take an open and transparent approach.

[Baroness Andrews (Lab) [V]]

My Lords, the Minister said, quite rightly, that the priority for the vaccine is saving lives. Adults with learning difficulties have death rates comparable to those of the over-80s. Given the success of the vaccine rollout, is there any flexibility now for prioritising highly vulnerable groups, particularly when we know that the variants have to be controlled with extra vigilance?

[Lord Bethell (Con)]

My Lords, the noble Baroness is right, and I am grateful to her for giving me sight of her question in advance. Her point is completely valid and I support her interest in this. The JCVI has made it plain what the initial rollout of priority groups 1 to 4 will be, but there is a mechanism whereby it reviews and reassesses the rollout of further priority groups. That will be the moment when it can look at the kind of questions she raises about groups, such as those with learning difficulties, who have a high rate of mortality. I can reassure her that it is conducting a rolling review of the rollout of the vaccination and will take these matters into account.

Medicines and Medical Devices Bill

Baroness Andrews Excerpts

Report stage & Report stage (Hansard): House of Lords & Report: 1st sitting & Report: 1st sitting: House of Lords
Tuesday 12th January 2021 Lords Chamber

[Baroness Andrews (Lab) [V]]

My Lords, it is a pleasure to follow the noble and learned Lord, Lord Judge, and his magisterial assertion of parliamentary sovereignty, which I entirely agree with. I am pleased to support the amendments in the name of the noble Lord, Lord Sharkey; at the same time, I apologise to your Lordships’ House for not having been able to do so in Committee.

In his opening statement on this amendment, the noble Lord made an irresistible case in principle, as well as explaining with great clarity the process by which a super-affirmative order enables effective parliamentary scrutiny in a way that the simple affirmative procedure—however the Government argue it—cannot. In using it, the implementation of this extremely important Bill becomes a less risky and unpredictable affair.

On Second Reading, I said that the Bill was good in many ways but that, as a skeleton Bill, it created unnecessary risks. Despite the Government’s amendments and their very recent and welcome response to the DPRRC’s scathing report—I am very pleased to say I am a member of that committee—they have still not strengthened the process of parliamentary scrutiny in such a way that should satisfy either the DPRRC or this House.

It is worth reflecting that our wrath as a committee was directed as much at the casual flimsiness of the reasons offered and the false dichotomies between primary and delegated legislation that were set up as at the sheer and extraordinary sweep of the powers across the whole fields of medicine and veterinary science. “Free rein” was one of the milder terms the committee used. Failing at least to take the option of a super-affirmative procedure on these delegated powers still in effect gives the Government free rein. We would be able to challenge the statutory instruments but not change them, however strong the grounds, weighty the evidence or serious the anxieties and risks.

It is significant that, in their response to the committee published this week and in their amendments, the Government recognise that there are risks in the breadth of the powers, but to remove those risks they have merely tightened focus, improved transparency in some cases and assured us that those who use the powers will do so with great care. While any movement was welcome, the Government have refused to acknowledge what is right and proper here—as both the noble Lord, Lord Sharkey, and the noble and learned Lord, Lord Judge, have said, and as the committee made clear—which is a way to engage with and not bypass Parliament.

While under many circumstances the affirmative order is accepted as an appropriate level of scrutiny, it is most certainly not in this case, particularly when the Government choose not to accept that the powers were designated as inappropriate in the first place by the scrutiny committee. A super-affirmative order at least gives Parliament the opportunity to press for further thought, advice and amendment as initiated by the Government. As the noble Lord, Lord Sharkey, said, the amendment has been trimmed so that it deals only with significant changes. This is hardly revolutionary; it is in fact the least that one could insist on, but it is significant. It acknowledges that risks persist but can be reduced and that changes are made to prevent perverse consequences. Surely, in a Bill of this significance, that cannot be too much to ask.

The arguments that the process is too long, slow and cumbersome were dealt with by the noble Lord, Lord Sharkey, in Committee and today. They are but the most recent reiteration of the arguments we hear all the time when we put the case for primary legislation in the face of inappropriate delegation, where speed and technical detail are usually deployed frivolously. They are hardly powerful or relevant when considering the scope of these regulations.

I regret to say that, in their short career, this Government have shown in different ways that they do not welcome interrogation and fear scrutiny. A confident Government would welcome both as a way of avoiding mistakes and creating precedents which in Opposition they could not change. This is a modest opportunity to strengthen this Bill and I hope the amendments will secure the support of the House today.

[Lord Naseby (Con) [V]]

My Lords, I disagree with this amendment. I had the privilege of being the Chairman of Ways and Means and Senior Deputy Speaker in the other House from 1992 to 1997—possibly, legislatively, one of the most challenging periods. I certainly found that MPs were highly creative in their interpretation of the rules of debate and in holding the Government to account.

Noble Lords have only to read Erskine May to see that we have two procedures for SIs that are normal and have been with us for decades: the negative procedure, where no amendments can be taken in your Lordships’ House; and the affirmative resolution. The affirmative resolution is not just a weak tool that puts us on the side; it is a very powerful tool if used properly by Members of Parliament and those of your Lordships’ House who take an interest in these matters. They can ensure that the Government of the day have to listen.

Frankly, I find that the super-affirmative procedure does no more, really, than involve an additional stage of scrutiny where Parliament has considered a proposal for a statutory instrument before the statutory instrument is formally presented. Today this procedure is used for statutory instruments that are considered to need a particularly high level of scrutiny. Quite frankly, we have Select Committees, in the other House in particular, dedicated to particular departments, and there is a very active Select Committee on health matters.

In addition, yes, there are some specialised categories of statutory instruments that are used for those particular purposes, and they can be considered under the super-affirmative procedure. But these statutory instruments usually amend or repeal Acts of Parliament. Examples would include legislative reform orders, localism orders, public bodies orders, regulatory reform orders and remedial orders. It is not usual to have them as part of the primary legislative process.

It is time that we as politicians understood that this country will be successful only if we get on and understand the needs of British industry. It has to have some certainty that things are going to proceed at pace, not be delayed even further because some noble Lords feel that they want to have another bite of the cherry. We already had quite enough bites, in my judgment, on this Bill as we worked through it, and it is being done very thoroughly. It has been done in Committee and is being done on Report. But we have to understand that this all adds to delay and, even worse, possible confusion in the commercial world.

I think adequate procedures are already available. All this does is stretch the thing out for very little marginal benefit. I personally will vote against this proposal with enthusiasm.

Health Protection (Coronavirus) (Restrictions) (England) (No. 4) Regulations 2020

Baroness Andrews Excerpts

Wednesday 4th November 2020 Lords Chamber

[Baroness Andrews (Lab) [V]]

My Lords, on 13 October, I asked the Minister why the Government were so resistant to following the SAGE advice of 21 September. I said that I could see us back here in this Chamber debating a national lockdown within weeks, during which time more lives would have been lost. I have never been less gratified at having been right, like so many other people. If this Government reject hindsight, they have certainly failed at foresight.

Yesterday, in response to questions from my noble friends asking why the Government have chosen now to commit to a national lockdown, the Leader of the House said:

“We were presented with national data that we could not ignore.”—[Official Report, 3/11/20; col. 682.]


Can the Minister tell me why, having been presented with evidence that they could not ignore in September about exponential rates of infection, the Government chose to do just that? What evidence were they acting on? SAGE was clear that national measures were needed and was clear about the urgent need for more rapid, more stringent interventions that would more quickly reduce incidents, prevalence and Covid-19-related deaths.

Since the start of this epidemic, we have known that a second wave of infections this winter was probable. We in this House have asked constantly what evidence was being used to assess risk and what had been learned from the first wave about preventing the spread of infection. We asked what was being done to prevent spillover from areas of high to low infection. We asked time and again what was being done to support local authorities and correct for the diverse failures of the test and trace system. Over the months, we have had no answers; there were none because it was just drift and dither and now a bit of panic. It is no wonder that, even now, with a reluctant lockdown that is subtly different from the first, there is still a sea of confusion and deep anger across the country. No one underestimates the seriousness of what the Government are asking people to do or the impact that the next month will have on mental health, jobs, family and social life. I welcome the fact that schools are being kept open but it needs extra vigilance.

In a spirit of hope over experience, therefore, I shall ask the Minister some more questions. What is the current state of intensive-care hospital capacity in the south-east, where, like the south-west, the virus is rising faster? When will those beds be full? What range of criteria will be used to determine when the lockdown can be lifted on 2 December? People want certainty that it will end but if they are expected to comply, they want to know the plan and what it is based on. People also want to believe in the prospect of a vaccine, so can the Minister tell me what steps the Government are taking on all current vaccine candidates to license production in the UK to ensure that a supply is assured, regardless of which is approved? Who will get priority?

Finally, people want to be able to trust the scientific consensus and to know that the Government do too. But the Government have undermined that trust through their inconsistency, which has fuelled the scepticism that we see in this evening’s amendments expressing regret. Therefore, I agree with the noble Lord, Lord Robathan, in this respect: the management of the epidemic is an object lesson in the failure of leadership, governance, management and communication. However, I am sure that the House will support the regulations.

Covid-19: Intensive Care Treatment

Baroness Andrews Excerpts

Thursday 29th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am grateful for the opportunity offered by the noble Baroness to reinforce the point. Age discrimination is absolutely forbidden by the NHS constitution. The CMO wrote to NHS trusts on three occasions to reiterate that point. I quote a letter published on 7 April:

“The key principle is that each person is an individual whose needs and preferences must be taken account of individually. By contrast blanket policies are inappropriate whether due to medical condition, disability, or age.”

[Baroness Andrews (Lab) [V]]

My Lords, the Minister’s response is indeed very reassuring. Does he agree that many elderly people will have been very worried by the Sunday Times report? They will welcome the assurances that have just been given by the NHS and the professional bodies that triage was never intended or used as a strategy for implementation. However, we have to be mindful of the fact that, as the pandemic is accelerating, fears are rising. Therefore, it is vital to get this message out as loudly as possible, just as the NHS did in April, when it said at the start of the epidemic that, far from rationing ICU care:

“All patients should be treated respectfully and equally and should receive the best available care.”


Can the Minister say now what the Government will do to support the NHS in reassuring every potential patient, irrespective of their age?

[Lord Bethell (Con)]

We go into the second wave in much better shape in relation to coronavirus because we know so much more about the virus. In terms of medicines, the therapeutics, the practices, the training, the configuration of our wards and the building of the Nightingales, there is a huge amount of skill, learning and capacity in the NHS to ensure that everyone has the opportunity to receive the best possible care. I remind noble Lords that these claims not only worry patients, they are deeply offensive to NHS doctors, nurses and therapists who have cared for more than 100,000 Covid patients to date in hospital settings and are committed to providing the best possible care in a second wave.

Covid-19: South Yorkshire

Baroness Andrews Excerpts

Thursday 22nd October 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness alludes to a glitch that the noble Baroness, Lady Thornton, raised yesterday, which I looked into overnight at her suggestion. It is true that if someone lives in a household with several other people who have been reported to have Covid, they are, at the moment, each receiving emails or calls, not on a household basis. We are looking at this and I hope to have it fixed in the next few days. I am grateful to the noble Baroness, Lady Thornton, for raising it.

[Baroness Andrews (Lab) [V]]

My Lords, scientific evidence now suggests that one of the reasons for the spike in cases in the northern regions is due to the fact that Covid has been more virulent and persistent there, and that restrictions were lifted too soon. What have the Government learned from that? Returning to the questions asked by my noble friend Lady Thornton, what will be the criteria in determining when it will be safe to move from the latest restrictions? The Minister spoke movingly of how fearful he was that they would not work. Difficult though it is, the question is: when will we know whether they are working? What will be the elements and criteria of the exit strategy?

[Lord Bethell (Con)]

My Lords, the exit strategy question is extremely important and I am grateful to the noble Baroness for raising it. We have not published strict criteria for each exit strategy for moving from one tier to another. It is part art and part science, in any case. We look at a large number of indices, including hospitalisation, transmission and incidence rates, and so on. What the Government and local authorities can do is to figure out local Covid plans with inherent exit strategies. We will be working on those as a matter of priority.

Covid-19

Baroness Andrews Excerpts

Tuesday 20th October 2020 Lords Chamber

[Lord Bethell (Con)]

The right reverend Prelate puts it extremely well. We completely recognise that not only does the virus attack the most vulnerable, but those who are least fortunate bear the huge brunt of the lockdown and the measures needed to crack down on the virus. In these matters, I emphasise that it is worth stepping back and reminding ourselves that the Government are not the source of the problem; the virus is. All the Government can do is take measures to save lives, protect our healthcare service and keep our schools open. In that way, it is not right to demonise central government for taking measures.

Central government can take measures to help protect the vulnerable, and I acknowledge the right reverend Prelate’s point on this. I reassure her that we have put in place the Job Support Scheme to ensure that those affected by business closure are still paid; we have made £465 million available to help local authorities implement and enforce restrictions; we have provided £1 billion of extra funding to local authorities across the country; and we are committed to working with local authorities to allocate testing and tracing locally.

On the message the Government deliver, I recognise the phenomenon described by the right reverend Prelate, but I reassure her that there is no intent by government to make an association between poor behaviours and results. The data is there. We have published every piece of data we can and, to an extent, it does not lie. It is an uncomfortable truth, but some communities have consistently higher prevalence and infection rates. There is some responsibility on those communities to address the causes of that. It is an intent shared by government, local authorities, communities and individuals. There is no avoiding the fact that you cannot pin responsibility on any one of those four pillars.

Lastly, the right reverend Prelate is entirely right that faith communities pay an important role. I pay testimony to those faith communities in cities such as Leicester and Bolton, which have worked with us to great effect. We continue to put our relations with faith communities at the centre of our outreach to communities.

[Baroness Andrews (Lab) [V]]

My Lords, is the Minister aware that, today, a highly respected member of SAGE, Professor Stephen Reicher, said that the three-tier system is

“the worst of all worlds … where there is no sense of clarity. There is a growing sense of inequity and resistance”?

Wales has decided to go for a circuit break, with the situation deteriorating, and a poll suggests that public opinion is very much moving towards recognising that this is necessary and will support it. What evidence can the Minister provide to show Professor Reicher that he is wrong?

Health Protection (Coronavirus, Local COVID-19 Alert Level) (Medium) (England) Regulations 2020

Baroness Andrews Excerpts

Wednesday 14th October 2020 Lords Chamber

[Baroness Andrews (Lab) [V]]

My Lords, in the time available, I want to ask the Minister a number of questions about this SI and the decision to leave so much of the country designated as “medium” level, but I join other noble Lords in saying how much we appreciate the Minister’s very hard work, stamina and patience on this series of SIs.

It seems that the “medium” level areas are precisely those where there is still a marginal chance that lessons can be learned, and early and swift action can be taken to prevent escalation. One of the most perverse and unwelcome outcomes of how this disease has developed is that, as the WHO said recently, it thrives on poverty and poor housing, and “exasperates inequalities”. One of the very worst things that could happen would be for this already divided country to be driven further apart because those traditional post-industrial communities of the north and west, the Midlands, south Wales and Scotland were to suffer disproportionately. We are certainly not all in this together at the moment, but I sense that it is only a matter of time before we are. Large areas of the country designated at the lowest tier also contain large poor urban communities, where the pandemic takes a fierce hold.

That is why I say, “Thank God for the leadership of the local authorities.” They have stepped up magnificently to protect and provide for their local communities. The most effective thing that the Government could do is to listen more closely and act more swiftly on the advice they are getting from local authorities. They are still not in the driving seat when it comes to NHS Test and Trace, but they need to be. London is the outstanding case in point. Infections are now rising above 100 in 100,000 in several boroughs. The Mayor of London is urging the Government not to wait four weeks, until London has caught up with the worst scenario in the north, but to act now to break the circuit of infection. What is the Government’s response to this? Is the Prime Minister talking to the mayor? Why delay when, as surely as night follows day, and as the Deputy Chief Medical Officer has said, the evidence is that there will be a predictable exponential increase in infection and eventually in hospitalisations. What is the Government’s strategy to deal with London in all its diversity?

Turning to more general questions about the decisions to leave most of the country designated as “medium” level, how is risk defined in those areas so designated? Is there any differentiation within these areas? What are the ranges of the R number? What modelling is being done by SAGE or other groups, and at what level, to establish transmission routes or speed of transmission from areas of high infection to areas of low infection? What advice are the Government giving public health leaders in the south-eastern region, for example, about what they might expect and what they should be preparing for? Given that there are many universities in the south-east, what assessment have the Government made of likely sites for the spread of infection? What advice is now being given to universities across those areas, especially on testing? What precise trigger point would escalate the decision to move regions to tier 2? Which pillars of the Covid-testing strategy are informing these decisions? Given that SAGE has confirmed that the NHS Test and Trace system is having a marginal effect on areas with the highest rates of infection, what evidence is there that it is having a more effective impact, in terms of contact tracing, on areas of medium risk? Have the Government assessed the relative advantages of a Serco track and trace system over those of local authorities?

We are all shocked by the resistance that the Government showed to SAGE advice three weeks ago. Now we are told that the Government might be considering a circuit-breaker. I beg of them not to dither any more, because I predict that we will be here in a few weeks’ time debating a temporary lockdown. The tragedy is that we will have wasted weeks, when we could have saved lives in the process.