Covid-19

Baroness Brinton Excerpts

Thursday 15th July 2021 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for taking this Statement, although I have to say—and I know this is not in his gift—that Monday to Thursday is probably too long a gap, but taking the Statement today might in this case prove useful because we have seen the reaction to the nearing of so-called freedom day, nationally and internationally. We have also seen the Government becoming progressively more cautious. That is not surprising because in England 42,000 Covid infections and 49 more deaths were recorded yesterday, hospital admissions have increased to more than 500 a day, up 50% on last week, and we now see routine operations being postponed and cancelled.

The NHS is rightly focused on waiting lists, which are at their highest level over the past decade at 5.3 million, and 336,733 people have been waiting more than a year, more than 76,000 have waited for at least 18 months and more than 7,000 have been waiting for two years. Emergency care is grappling with some of the highest summer demand ever, and this is in the context of NHS staff being exhausted and facing burnout. The NHS is also losing a significant number of staff to self-isolation, which has led to much reduced capacity due to infection control. As infection rates get worse and increase, what is the Government’s plan to deal with this situation?

Since Monday we have seen an increasing number of announcements and questions about how to safeguard against further increases in infection and the impact it is having on our NHS, schools, businesses and communities. Indeed, our own Lord Speaker wrote:

“Members are still expected to wear a face covering both in the Chamber, in indoor crowded spaces and when moving around the Estate, in line with general advice from Public Health England and the Chief Medical Officer. Members are strongly encouraged to use the testing facilities provided.”


On these Benches we intend to follow that advice, and I regret that some Members have already abandoned their masks when moving around the building and in the Chamber. We have staff to look after us who may not yet be fully vaccinated and, anyway, have no choice but to be here and who will continue to wear their masks to protect us. We should afford them the same consideration. Does the Minister agree?

On the “Today” programme a few days ago Professor Graham Medley, the chief modeller for the SAGE committee said: “Wearing face masks is worth it but only if everyone does it, not just 70%. I understand the Government’s reluctance to actually mandate it. On the other hand, if it is not mandated, it probably won’t do any good.” In other words, my understanding is that unless more than 70% wear masks, the protection for those who are still vulnerable will not work.

I fear we have been here before, with the Government back-pedalling and, in doing so, creating confusion and ambiguity—exactly the circumstances for the virus to thrive and mutate. The guidance issued by Ministers yesterday was stronger than businesses expected, many of which feel that they have been led astray, given the Government’s repeated characterisation of 19 July as “freedom day” and the end of most restrictions. The truth is that the guidance is hardly different from the current rules, except that businesses are now “encouraged” to keep many of their Covid adaptations rather than required to do so. Businesses now have just five days to decide how to implement the rules and how to communicate that to their customers. Does the Minister accept that the Government’s mixed messages have left many in legal limbo?

The new guidance gives little clarity to the 3.8 million extremely vulnerable people who are being told to avoid all unvaccinated people. How are they supposed to know whether or not someone is vaccinated? Does the Minister share the concerns raised by charities and patient groups that guidance has effectively told the extremely vulnerable to shield, without backing that up with any formal support from the Government for working or food shopping? Government advice to the clinically extremely vulnerable is to go to the shops at quieter times of the day after 19 July. I am not sure if that can be dignified as “support” for those most at risk of serious illness from Covid-19.

Is it true that the Government have not had anyone in post to deal with the clinically extremely vulnerable for three months, since Dr Jenny Harries was appointed chief executive of the UK Health Security Agency? If that is true, it is deeply concerning and it may explain why the Government have failed to prioritise support for these 3.8 million people.

What are the contingency plans for surging hospital admissions, which may remain high until the end of August, as called for by members of SAGE? The new guidance also says that businesses should encourage customers to check-in using the NHS app or otherwise leave their contact details. Can the Minister confirm reports that plans to reduce the sensitivity of NHS contact tracing have been reduced because of the surge in cases? What assessment have the Government made of the effectiveness of the app as an infection control tool, given reports that more than 20% of adults and a significantly greater proportion of young people have actually now deleted the app and many more are ignoring the advice to self-isolate?

I turn to those working from home. Despite the lifting of guidance to work from home, the Government say they expect and recommend a gradual return to offices. This is very confusing. What protection is proposed for those who are vulnerable, and for whom “freedom day” is not freedom day but a further lockdown day? If their employers demand that they return to work, even if they are immunosuppressed, for example, travel and enclosed places pose a threat to them. Under these circumstances, we need to be grateful for the good sense of the Mayor of London in following the science. Sadiq Khan has said that Transport for London will continue to enforce the wearing of face masks on services in the capital beyond 19 July.

While industry bodies said on Tuesday that no domestic train operators or major bus and coach firms will require customers to wear masks, the city mayors and others are calling for mask wearing on all public transport. Does the Minister agree with them? If Tracy Brabin, Andy Burnham and the other mayors had the power to enforce mask wearing to protect drivers and passengers, they would do so. They are doing the Government’s job for them.

What support are the Government going to give those areas with the lowest vaccination rates? Local authorities in London have, variously, 35%, 36% and 42% of their populations vaccinated. Does the Minister support the leaders of those authorities who say that they wish mask wearing to continue until they have got their populations caught up with vaccination?

[Baroness Brinton (LD) [V]]

My Lords, the Prime Minister told us 10 days ago that we were heading for “freedom day” and that all the data was going in the right direction; all restrictions would be lifted, and now was the time to take personal responsibility for our behaviour and for the Government essentially to step back. The Secretary of State’s Statement on Monday confirmed that, although with a marginally more cautious note about taking care. I echo particularly the comments made just now by the noble Baroness, Lady Thornton, about the mixed messaging in the new guidance for business and on returning to work, which conflicts with what was said both in the Statement and by the Prime Minister.

However, since the Prime Minister’s and Mr Javid’s confident assertions on Monday, there has been an outpouring of disbelief from senior scientists and doctors. Cases are currently doubling every nine days, and yesterday there were 42,000 new daily cases—a level last seen at the beginning of the January total lockdown. If there is no slowing of that doubling rate, we will have hit 100,000 new daily cases by the beginning of August. And that is before the Government’s expected extra cases as a result of “freedom day” on Monday.

Ministers constantly say that there are fewer people in hospital, that fewer people need ventilation and there are fewer deaths, but what they do not mention is that those numbers are a matter of ratios, and that with the current level of cases our hospitals are already reporting A&Es with the equivalent of a winter surge and more wards being turned into Covid wards for patients. A letter published a few days ago in the BMJ, initially signed by 1,000 doctors, is at over 7,000 signatures and still rising. The data is already clear that the surge in new cases from three weeks ago is increasing hospital admissions right now. So what are the Government doing to support and protect our NHS from this sharp increase and pressure on doctors, nurses and hospitals right now?

While many people are being responsible, still following the guidance and using their face masks, sadly there are many who are not. I was talking to a young security guard who told me that, this week, she is finding it impossible to persuade people to put masks on in their local shopping mall, despite the fact that the rules are still in place. Yesterday, my local community pharmacist told me in despair that two people arrived separately asking him for PCR tests as they each had Covid symptoms and thought all the previous rules had just finished. Not for the first time, much of this is about the Prime Minister’s muddled communication style. In the light of the fact that Scotland, Wales and Northern Ireland are going to retain the face mask mandate, and that the metro mayors, including Sadiq Khan and Andy Street, would like to do so, will the Government please reverse the lifting of the face mask mandate immediately, so that it remains in place, especially on public transport?

I turn to the new guidance for the clinically extremely vulnerable. I have to say that I have never read such an inconsistent and contradictory formal guidance note from the Government—and I have read a few. You should stay at home to be safe but if you cannot work from home, go in; you must remain socially distanced from everyone outside your bubble, even if they do not have to; you must not mix with unvaccinated people, outside or inside. I ask the Minister to tell me how on earth you know who is unvaccinated. As one of the CEV, do I stand in the doorway at opening time at my local greengrocer’s—a quiet time—and shout out to any customers and staff, “Anyone not vaccinated in here”? Of course not. The inevitable logic of this is the restart of shielding but without any of the previous support.

Worst of all, on Friday evening Public Health England put out a press release in which it mixed up advice to the clinically vulnerable and the clinically extremely vulnerable by citing vaccine efficiency research relating to the former in advice to the latter. That paragraph has been repeated in the formal guidance published on Monday. It is plain wrong. In a total administrative muddle, no one has gone through the nine pages of this guidance and updated it, so it is littered with references to the need to follow other rules and guidance for the general public in place at 17 May and 21 June, all of which goes next Monday. Please will the Minister ensure that the guidance is reviewed immediately to remove these anomalies?

All this, and the lack of answers to my questions last week about who the clinical lead is on the clinically extremely vulnerable, tells us 3.8 million former shielders that we have been not just forgotten but thrown to the wolves. Please will the Government actually review the guidance to keep the CEV group safe and provide the support that they need?

I also gave the Minister notice of the following two questions, as they both concern urgent and slightly unusual elements of lifting restrictions. First, for a couple of weeks now, Malta has said that it will not accept UK citizens who have received particular batches of the AZ vaccine manufactured in India, about 5 million doses of which have been given in the UK. Earlier this month, the Prime Minister reassured the press, saying:

“I am very confident that it will not prove to be a problem.”


However, holidaymakers are being turned away from Malta right now. When will the Government resolve this problem?

Secondly, those thousands of wonderful people who came forward to take part in the AstraZeneca clinical trials have been told that their vaccine status cannot be put on the NHS app, which means that they cannot go abroad, either to work or on holiday, or do certain jobs in the NHS that require this evidence. In early June, there was a blog on the BMJ website that set out these problems, but three months on from this issue being initially raised, there is still no resolution. It is utterly wrong that these publicly-minded people have now been left in limbo. Can the Minister say when this problem will be resolved and their vaccine details uploaded?

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

My Lords, I am enormously grateful to the noble Baronesses, Lady Thornton and Lady Brinton, for their thoughtful questions. The noble Baroness, Lady Thornton, put it extremely well: we are at a delicate inflection point. It is a moment when the whole country needs to be cautious about rushing into change, but it is also a moment when the vaccine is having an enormous impact and change is therefore appropriate.

Infection rates are rising dramatically, but we cannot avoid the fact that hospitalisations and deaths are holding relatively steady. Today, there are 2,970 Covid patients in beds and 470 on ventilators. This is a massively smaller proportion than in the pre-vaccination spikes, when the connection between infection, hospitalisation and death was much firmer and more profound. At the same time, as the noble Baroness, Lady Thornton, rightly pointed out, waiting lists are huge and the gap for diagnostics for severe diseases, such as cancer, is extremely concerning. It is our responsibility to step up to that deficit and not be wholly distracted by Covid. This is therefore a moment when we have to balance competing demands on our healthcare; we are trying to hit the right balance.

On masks, I pay tribute to the Lord Speaker for his leadership in this area and on asymptomatic testing. I saw his Twitter post where he was being swabbed for his LFD test—a commendable sign of leadership. He and the noble Baroness, Lady Brinton, are entirely right: we should wear masks out of consideration for others, including others who may not have had the vaccine or may not be able to have the vaccine. However, it is also entirely right that central government cannot mandate every aspect of human behaviour for months and years to come. I take great pleasure in the sight of local leaders using their influence to inspire the public in this matter. I remind the noble Baroness, Lady Brinton, that DPHs are able to bring in mandatory measures where there are areas of outbreak. People need to know that the wearing of masks has an impact, and we are hopeful that they will go along with that. Although legal restrictions are being removed, the guidance will recommend that masks continue to be worn in certain situations, and businesses will be encouraged to support staff and customers who continue to wear masks.

In line with businesses, public services have always been free to set their own entry policies as long as they meet their existing obligations, including under the Equality Act. Public services must continue to protect workers and others from risks to their health and safety, including from Covid. That is only right and fair.

On the very important question of the immuno- suppressed and the immunocompromised, both noble Baronesses made extremely powerful points. I want to express in very clear terms my personal sympathy for all those who have concerns about the impact of the vaccine and for whom the rise in infections presents a very real threat to their health. However, I flag the Public Health England report on the clinically extremely vulnerable group as a whole. It makes it clear that there is little reduction in vaccine effectiveness for them compared to those who are not in high-risk groups, with between 76% and 93% effectiveness after a second dose. The PHE data also suggests reduced effectiveness for the immunocompromised and the immunosuppressed, particularly after one dose, but effectiveness after two doses is much higher. These general figures mask substantial variations, which we have discussed before—we would expect this between one set of compromised systems and another—but future studies will provide much more granularity on that. It is not right, however, to suggest that all those with compromised immunities are left unprotected by the vaccine.

The guidance for those who are clinically extremely vulnerable was updated and published on 12 July, as the noble Baroness, Lady Brinton, pointed out. This confirms that changes to social distancing rules in step 4 will also apply to the CEV, who are advised to continue considering additional precautions that they may wish to take on board. I hear very clearly the noble Baroness’s points about anomalies in the guidance; I will take those back to the department and try to tidy up the documentation as she advises.

I can inform the House that we are writing to NHS clinicians to update them on them on the latest position regarding vaccine effectiveness for these groups and provide information on potential treatment options currently under development, such as monoclonal antibody therapies and novel antivirals, as well as access to antibody testing. This guidance will support clinicians in their conversations with patients. This is such a variegated group that that kind of personalised advice is critical.

The interim JCVI advice is that all clinically extremely vulnerable people, including immunosuppressed individuals and their household contacts, should be prioritised for a booster vaccine in the autumn. We are continuing to invest in the OCTAVE study, which will provide further data on patients with suppressed immune response. Interim results for the immediate response to the vaccine will be available from the middle of July.

We are absolutely focused on ensuring that the population is given clear guidance. The NHS app is undoubtedly an area that needs to evolve. Its effectiveness as a technological tool in giving people counsel and advice when they have been in close proximity to someone with the infection is extremely valuable. We are looking at ways in which that value can be enhanced.

On the specific question of the noble Baroness, Lady Brinton, about Malta, it is for member states to determine what they accept at their borders regarding vaccines. Foreign travel advice recently published for Malta misleadingly reported that it would not accept the specific batches received from the Serum Institute of India in the UK. This has now been resolved with agreement from the Maltese Government, and Malta is now accepting proof of vaccination from any Covid vaccine administered in the UK.

Turning to those who, as the noble Baroness, Lady Brinton, rightly pointed out, stepped forward for the critical AstraZeneca vaccine clinical trials, being on a vaccine trial absolutely should not disadvantage them. The Government intend to take any action available to ensure that that is the case. We are working with clinical research sites to add participant information of vaccine clinical trials to the national immunisation management service—NIMS—to allow participants to access their NHS Covid pass for both domestic and international travel purposes.