Health and Social Care

Baroness Brinton Excerpts

Monday 6th December 2021 Lords Chamber

[The Deputy Speaker (Lord McNicol of West Kilbride) (Lab)]

I call the noble Baroness, Lady Brinton, who is taking part remotely.

[Baroness Brinton (LD) [V]]

I, too, thank the Minister for the Statement and I start by thanking all our NHS and social care staff, at all levels—back room or front line—for all they are doing to keep the NHS and social care going while under the most extraordinary, sustained pressure.

Like others, I am struggling to see what is new in the Statement, which admits that the funding mentioned is not new. Although there is marginally more detail on how some of it will be spent, it is very light on by when the extremely urgent investment will deliver the help that our NHS and the public who use it desperately need.

Repeatedly, the Statement, and the accompanying so-called policy paper, The Health and Social Care Approach to Winter, refer to the urgent need to recruit more staff for both the NHS and the social care sector. However, it reports that currently, the NHS has an 8% vacancy rate at all job levels, and the social care sector, which has had more than 100,000 vacancies for some time, has had a further 3% reduction in staff since March this year.

Although there are proposals to increase staffing, can the Minister please explain where those staff will come from if they have not been able to be recruited over the past few months? How long will it take to recruit them? It is good that money is being put into the workforce, but I struggle with any suggestion that that will help to deal with the current winter crisis. When will the staff who are desperately needed in health and social care be available to join the teams out in the wards?

Both the Statement and the report talk about using locum services for doctors and agencies for nurses and social care staff, but health and social care employers tell the public daily that the extra qualified people are just not there. One of the problems in social care at the moment is that the NHS is poaching nurses from care homes. Please can the Minister explain who is going to fill those roles, given that training those skilled personnel takes a lot longer than a few months?

I echo the comments of the noble Baroness, Lady Thornton, about delayed discharges. We have all been asking the Minister and his predecessor about specific plans to help the social care sector overcome its problems in the workforce, not just for months but for years. The high level of staff vacancies continues to worsen. Can the Government help in the short term? For example, NHS Providers made the very helpful suggestion today that the Government help to fund a winter retention bonus for social care staff. NHS Providers understands that we must get the log-jam moving, and if the only way to do that is for the Government to help, please will they consider that proposal very seriously?

The Statement says that the NHS needs to be able to offer more appointments, operations and treatments, which is absolutely right, including with the NHS itself. However, the capacity to change to innovative ways of working, with a heavy load of staff vacancies and the current sustained 20 months of intense pressure, seems to be extraordinary. To illustrate this, in the second week of November, there were 966,406 more GP appointments in England compared with the same week last year—and we were not in lockdown at that point last year.

The Statement talks about the transformation funding for elective recovery, announced in September. The plan lists the hospitals that have been successful in getting their schemes approved. I know, from experience in my local area in Watford, that some of the modular ward proposals can move ahead very quickly. Can the Minister tell us the likely earliest delivery date for any one of these projects? Once the buildings are there, when will extra staff be available to make these new wards work? We certainly do not want to see a repeat of the Nightingale hospitals.

The plan says that NHS Test and Trace will be carrying out contact tracing, so will the Minister say whether local test and trace will continue? It is noticeable that this was not mentioned at all, yet only two months ago Ministers were saying that this was where the focus of contact tracing would be. May I repeat the questions that I have asked on at least two occasions to the Minister? What is happening to the funding for the local resilience teams for Covid tracing and other pandemic work from April, given that, at the moment, there is no money in the budget whatever for the next financial year?

Last week, the Minister wrote to my noble friend Lady Thomas of Winchester about the delivery of vaccines to the vulnerable housebound who cannot go out either to their GP’s surgery or to vaccination centres. He wrote to her after the Question, confirming that GPs have a duty to offer vaccines to the housebound. He went on to say:

“If there are no GP practices signed up to phase 3, the CCG will make these alternative arrangements instead.”


Today’s Daily Telegraph talks about more than 300,000 people—more than two-thirds of the housebound—having yet to receive their booster doses. This is not hesitancy in people coming forward; it is clear that there is a problem. With many GP surgeries having withdrawn from delivering booster jabs because of their increased workload, can the Minister tell me when CCGs will be setting up these new systems and, most importantly, contacting and reassuring this vulnerable group of people about when they will get a visit from the mobile vaccination team? Putting the booster programme on steroids for all adults is of no use if the most vulnerable are not even being contacted. I look forward to hearing from the Minister. If he does not have the answers at his fingertips, I ask him to write to me.

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

My Lords, I thank both noble Baronesses for their questions and for acknowledging that I may not have all the answers immediately; I will commit to write to them if I do not.

I will start with the questions on hospital beds and discharge. We are very aware that we have put in £478 million to get patients out of hospitals, freeing up beds. The NHS is also giving ambulance trusts an extra £55 million to boost numbers. It is our priority to ensure that people are discharged safely from hospital to the most appropriate place, and that they receive the care and support that they need. Our guidance sets out how the health and social care system is continuing to support the safe and timely discharge of people in hospital. People who are clinically ready are supported to return to their place of residence where possible, where an assessment of longer-term needs takes place using the discharge-to-assess Home First model.

New or extended health and care support is funded for up to four weeks, until the end of March 2022. During this period, a comprehensive care and health assessment for any ongoing care needs, including determining funding eligibility, should take place. Since March 2020, we have made nearly £3.3 billion available via the NHS to support enhanced discharge processes and implementation of the discharge-to-assess model. This approach means that people who are clinically ready and no longer need to be in hospital are supported to return to their place of residence. We are also reviewing the way that we look at this scheme and how it works. We are very much aware of the issues raised about how we make sure that people are discharged in the most appropriate manner.

On the issue of investment, a number of trusts were asked to bid for funding, very much on the basis of which of those schemes could be delivered immediately and which were longer-term. Trusts have now been informed that their bids have been approved, and they are beginning to work to deliver them. NHS England and NHS Improvement will be monitoring the programme closely. Schemes were selected that could deliver immediate solutions that will support elective recovery this winter, as well as over the next three and a half years and beyond. This is just one element of how we are looking to make sure that we are dealing with things in the short term.

As the noble Baroness, Lady Brinton, acknowledges, some of these modular systems can come up to speed quickly, and that was considered in the bids that were put forward. Funding was allocated on a regional basis, based on the number of people living in each area, to ensure that funding is equally spread across the country. NHS regional teams identified and prioritised individual schemes and DHSC evaluated and approved them to ensure that the schemes that had the highest potential to help us reduce waiting lists for elective care were selected.

We have looked at a number of areas and, looking at the regional breakdown, we have had about £112 million in the north-east and Yorkshire; £97 million in the north-west; £131 million in the Midlands; £78 million in the east of England; £105 million in the south-east; £69 million in the south-west; and £109 million in London. There are a number of different schemes at various hospitals, on which I would be very happy to go into more detail if asked.

Turning to waiting lists, we need to recognise that 75% of people waiting do not require surgical treatment; 80% of those requiring surgical treatment can be treated without an overnight stay; and 20% of patients are waiting for ophthalmology treatment for eyes, or orthopaedics for bones, muscles and joints. So we are looking at how, on a targeted basis, we can address that backlog. We hope that, with the new diagnostic centres rolling out, we should be able to tackle a lot of that backlog.

Adult Social Care

Baroness Brinton Excerpts

Thursday 2nd December 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I thank the Minister for the Statement. It is no exaggeration to say that we on these Benches, along with many other noble Lords, have been repeatedly pushing Ministers to publish this White Paper for years. It is now two and a half years since the Prime Minister announced from the steps of 10 Downing Street:

“My job is to protect you or your parents or grandparents from the fear of having to sell your home to pay for the costs of care. And so I am announcing now—on the steps of Downing Street—that we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve … that is the work that begins immediately behind that black door.”


We were pushing because it was evident even then that adult social care was already in crisis. High levels of staffing vacancies, and cuts to local government meant that fewer people who had been entitled to state support would receive it, as the criteria for eligibility were repeatedly tightened. Even then, it was common knowledge that private patients were having to subsidise those funded by the state, as the amount given to local authorities did not match the actual costs of that care.

Even allowing for the inevitable delays caused by the pandemic, this Government have insisted on continuing with their structural reforms, rushing through the Health and Care Bill—which NHS leaders are now asking to be delayed because of the continuation of coronavirus and its pressure on all NHS services—as well as the health and social care levy, rushed through your Lordships’ House in one day, six weeks ago, which now requires amendment in the Health and Care Bill, which will mean that house owners outside the greater south-east will end up paying a higher percentage of their assets than those in the greater south-east. So much for protecting them from the fear of having to sell your home to pay for the costs of care—yet another broken promise from this Prime Minister.

In setting the scene, we and others have pushed for the publication of the White Paper prior to the Bill starting its journey in the Lords, because we cannot understand how any Government could restructure integrated care services between the NHS and the care sector without knowing what plans they have for the future of the adult social care sector. Yesterday’s paper was deeply disappointing—but I think the Government know that, which is why Ministers announced yet another White Paper next year on integration. But hang on: was that not why this White Paper was due to be published? If there is to be another White Paper, the timing is important. Can the Minister say when this new White Paper will be published? This one certainly is not the answer.

Allocating some money to developing the workforce in five years’ time will not even start to address the current crisis in social care: with well over 100,000 vacancies; with social care providers still having to pay for expensive PPE that is provided free to the NHS; and with providers handing back state-funded payments to their local authorities because they cannot provide a safe service for those patients. It does not address the current practice, caused by lack of funding, of domiciliary care workers not being paid as they travel between clients. It does nothing to change the experience of unpaid carers. There are lots of great ideas about following best practice and getting people to talk together, but there is no real offer of funding for regular respite care or other benefits and support.

Reading the full White Paper, the truth about the promises in the Statement begin to be revealed. The Minister knows that, from these Benches, we have repeatedly emphasised the importance of housing in relation to care and support for adults of all ages. It was, therefore, perhaps encouraging to read the recurring phrase

“Making every decision about care a decision about housing”,

but closer examination of the funding for disabled facilities grants increases shows that there will be £570 million a year in 2022–23, 2023-24 and 2024–25. The current budget for this year is already £537 million. Although continued funding is welcome news, this is only a £33 million—or 6%—increase, which, given rising costs of labour and materials, will barely keep up with inflation. It is not the transformative grant that the Statement trumpets. On the funding for

“a new service to make minor repairs and changes in peoples’ homes, to help people remain independent and safe”,

for which most authorities are able to offer only £1,000 to £2,000 per person before they have to look at their assets, no cash amount is specified, but it is hoped that this will give a boost to handyperson services that are so highly valued by older people and provide such a great return on investment.

It is impossible to transform way our social care provision works, keeping people in their homes, unless this White Paper demonstrates the practical support that the Government can give to make that happen. The real difficulty we face is that staff in the sector, providers, the NHS and, above all, the users and their families are severely let down by the White Paper. The word “dignity” is used repeatedly in the Statement. The reality is the opposite: no vision, no real reform and, worst of all, no attempt to deal with the current crisis.

[Lord Kamall (Con)]

My Lords, I thank the noble Baronesses for the points they raise. But let us be clear that for many years—not just five, 10, 15 or 20 years; some noble Lords have said that we knew this issue was coming after the war, in the 1950s—the demographics of the country meant that we were going to have an ageing population, and successive Governments of all colours have not grasped the nettle. They have commissioned a report, it has gathered dust on the shelf and another report has come along. Many noble Lords, including my noble friend Lord Lilley and others, have written papers for various think tanks, but those also gathered dust and nothing has been done. When I have spoken to friends of all political colours, they have said that, frankly, it was too difficult and there were other priorities. So the Government should be given some credit for finally grasping the nettle.

We have set out a vision. Before you set out a strategy, you have to set out a vision, and we have done so. This is a 10-year vision, and we have committed to the first three years. Throughout the White Paper, we have said that we will continue to consult the sector—experts, carers, both paid and unpaid, local authorities and nursing or care home providers—to make sure that we get the right balance and understand the issues. As technology develops—medical technology, information technology and other technology that enables people to live in their own homes—we will see how the vision might adapt, rather than laying out everything from day one. We have laid out the vision and the spending for the first three years, but we will continue to consult to ensure that we are adapting to the changing technology and circumstances.

Compared to the current system, more people will be supported with their social care costs and have greater certainty over what they pay and receive higher-quality care. We think the plans announced represent the best value proposals. As many noble Lords will appreciate, that means balancing many issues: how many people are supported; how much they are supported; and the cost to taxpayers of offering that support. We believe that the plan sets out an appropriate level for the cap and balances that with people’s personal responsibility for planning for their later years. A number of experts have written recently asking why financial advisers advise people to build up ever-larger sums of money but they then leave it to their children at the end of their lives, rather than depleting their assets as they get older to look after themselves. We were clear that the £86,000 would be the amount individuals will need to pay towards the cost of their care, and the amendment to the Health and Social Care Bill reflects the changes. We believe the new system is necessary, fair and responsible.

We admit that the Care Act 2014 was landmark legislation informed by a range of partners, and we want to build on those strong foundations, rather than reinvent the wheel. Many of the provisions in that Bill act as a platform for better, even more joined-up health and social care in future. We are the first Government to announce that we are going to integrate health and social care, and that we will have a system of healthcare all the way through—not social care as a bolt-on afterwards—from your birth all the way through your life.

The Health and Social Care Bill contains several provisions built on the Care Act 2014. We have looked at assurance, with a new duty on the Care Quality Commission, and we have looked at data, to make sure we have the appropriate data on adult social care. People should pass from hospital to social care with no delay and as seamlessly as possible. We have looked at provider payments and the better care fund. The Bill also proposes to put integrated care systems on a statutory footing, which will make sure that, in each area, working with local authorities, account is taken of the needs of social care, joined up with the other parts of the healthcare system.

On 3 November, we published the adult social care winter plan, because we recognise that this is a long-term plan, but we have constantly been listening to stakeholders and have drawn up recommendations with a number of people, including Sir David Pearson, who reviewed last year’s adult social care plan, advisers from SAGE and UKHSA. So we have listened carefully to make sure that we meet some of the short-term issues that we are facing. We have looked at how we can increase spending, where relevant, to make sure that we tackle some of those issues.

Across the House, noble Lords will want to pay tribute to social care workers, both paid and unpaid. We have a track record of responding to workforce pressures—for example, the £162.5 million workforce recruitment and retention fund and the £388 infection control and testing fund. We will continue to keep this situation under control. We are also increasing the rate of the national living wage, which means that many of the lowest-paid care workers will benefit from pay rises. We are also investing at least £0.5 billion in the way we support the development and well-being of our social care workforce—an investment in knowledge, skills, health and well-being, and how we drive the retention of existing staff and boost recruitment. This will set the conditions for professionalisation over a longer period, giving carers recognition. When we look at the social care workforce and how much they are valued, one of the great issues has to be recognition of their skills and giving them a professional development pathway.

In the longer term, as set out in the White Paper, we remain interested in working with commissioners and providers to make that sure care workers have the best terms and conditions possible, including being paid for all the hours possible. This is already set out in our existing market-shaping and commissioning guidance. We will also explore how we can champion best practice and support local authorities, including through the new CQC assurance framework. We acknowledge the prevalence of zero-hours contracts in the social care sector and we are interested in working with commissioners, providers and care workers to understand how those contracts impact this sector.

Chapter 6 of the White Paper sets out three key aims for the workforce strategy over the next three years, backed up by £500 million of investment. We want to create a workforce that is well-trained and well-developed, healthy and supported, sustainable and recognised. We want to make sure that social care is seen as a rewarding career—that it is not only heart- warming but has professional recognition. I should stop there and take some more questions at this point.

Health Protection (Coronavirus, Wearing of Face Coverings) (England) Regulations 2021

Baroness Brinton Excerpts

Wednesday 1st December 2021 Lords Chamber

Finally, I shall say something about people who are very vulnerable. The noble Baroness, Lady Brinton, raises this time and again, and the Government need to take it very seriously. Even before the discovery of the new variant, people with underlying health conditions were being widely ignored, despite the fact that their case numbers remained high. Months after the official shielding programme ended, the Office for National Statistics figures from October showed that almost one in four clinically extremely vulnerable people were still shielding and that 68% were leaving the house but taking extreme extra precautions. Ministers have only made matters worse with this. Over the last few months, the Government have removed many measures that would have helped clinically vulnerable people. In England, the legal requirement to wear a mask ended as far back as July, apart from in healthcare settings and care homes, and once furlough ended in October, clinically vulnerable people had fewer options to shield themselves. Many were sent back to offices or public-facing roles without the legal right to work from home or to be paid if they could not. If the Minister cannot answer the questions about the guidelines and what should happen to clinically vulnerable people, I am very happy for him to write to me and put the answer in the Library.

[Baroness Brinton (LD) [V]]

My Lords, I thank the Minister for introducing these two statutory instruments retrospectively reintroducing face masks and rules for self-isolation. From these Benches, we repeat our thanks to the scientists in South Africa for their early-warning system and their excellent genomic sequencing of omicron. I also thank the Secondary Legislation Scrutiny Committee for its swift advice to your Lordships’ House.

The Health Protection (Coronavirus, Wearing of Face Coverings) (England) Regulations 2021 set out clearly the doubling of fines if somebody fails to comply without a reasonable excuse, up to a maximum of £6,400. When these regulations were first introduced last year, very few fines were issued. Face coverings are not required everywhere, which makes it even harder for this to be literally policed, as in the police intervening and issuing fines. I repeat the questions that the Secondary Legislation Scrutiny Committee asked: why were some places chosen and not others and, because the list is complex, how on earth will members of the public be able to understand where and when a mask must be worn? We completely agree with the Secondary Legislation Scrutiny Committee. The Minister knows that I have already raised this with him this week, and I heard his attempt in Grand Committee to defend the absolute nonsense about sitting in theatres versus walking around a shop or even sitting in a café in a shop, where one would, I presume, be required to wear a mask.

I also raised with him the vexed issue of local government, where since January councils have by law from central government had to meet in person, although many of them would like to return to virtual arrangements when there is a massive rise in cases. Cases are surging in certain parts of the country, and it is just extraordinary that the Government dictate to local government how it can meet. I raised this with the Minister yesterday and was grateful for his response, but I raise it again after a plea overnight from a councillor in Devon, where cases are rising very fast at the moment.

This regulation is due to expire on 20 December. Once again today, we are seeing emergency legislation to protect the public laid after it was enacted, but in this case understandably. However, it is set to expire at a point when not only will we have just risen for recess but the emerging facts of the omicron variant are only just going to be understood. The scientists say that they need a good three weeks to really understand this, so why were these regulations not set for expiry after 60, or even 90, days? It is comparatively easy, as we saw yesterday in Grand Committee, for your Lordships’ House to meet for early expiration of a regulation. It is much harder to justify setting this one for such a short period. It is treating Parliament with contempt as well.

I am really sorry to hear that Co-operative stores and Iceland have already made decisions not to follow the face mask guidance. It points to a big hole in the system that we from these Benches have repeatedly raised: which is how the regulations can be policed. The real answer, as the noble Baroness, Lady Thornton, outlined, remains front-line retail staff, often low paid, or security staff, who do not have the authority of the police. The Co-op has rightly said that it will not put its staff at risk of attack from customers, which it says happens to tens of staff per day across the country.

This regulation is the stick, but we need a carrot too. We need to see on a daily basis senior Ministers wearing masks. I understand that the Leader of the House of Commons was finally seen wearing a mask in the Chamber today, so I presume fraternal conviviality is no longer going to protect Members on the Conservative Benches from Covid. But both his and the Prime Minister’s frankly appalling record of not wearing masks has not helped the wider public to be encouraged to take precautions themselves. By the way, I note that the Government have today confirmed that it is still essential for everyone to wear face masks in hospitals, all the time.

It was concerning that yesterday in a No. 10 press conference reference was made to a case of omicron in Croydon, but unfortunately the director of public health and the local council in Croydon had not been notified before it was made public. That would have been helpful, because they had lots of inquiries about what on earth was happening. When will this sort of information be joined up? It is vital that the experts in each area are informed before the wider public about what is going on, so that they can set up systems to reassure and support their public.

I echo the points made by the noble Baroness, Lady Thornton. I also heard Jenny Harries on the “Today” programme yesterday, and I thought she answered very sensibly. She has asked us repeatedly over the past 20 months to consider risk when we go into any environment. She was clear that, in winter and especially at Christmas, moving into an environment, probably mostly inside and cold, where people huddle together is not ideal and people need to think about whether they go to their usual social events. How extraordinary to have that flatly contradicted by the Prime Minister. Perhaps he needs to get a grip. That is particularly relevant in light of the other story today, about the Christmas parties at No. 10 last year after London had been asked to go into tier 3—effective lockdown.

I also ask the Minister about air filtration units for schools—and I do mean air filtration units and not CO₂ monitors. This is in light of an innovative air cleaning device developed by Cambridge University and Addenbrooke’s Hospital in Cambridge. When they placed the relatively inexpensive air filtration machine in Covid-19 wards, it removed almost all traces of airborne SARS-CoV-2. It is a very interesting article.

On the self-isolation regulations, from these Benches we just repeat our regular plea. This Government have chosen not to pay low-paid workers a proper rate when they are asked to self-isolate. Those people are doing a public duty. They may be required by law to do it, but to offer them sick pay for that period does not reflect the duty they are doing. We know that it really matters for some people on zero-hours contracts, and that some people have not been coming forward even for tests when they suspect they have Covid because they do not know how they would put food on the table if they had to isolate for 10 days.

We are glad that the vaccination rate paid to GPs has been increased after their pleadings, but how on earth does this reduce the other pressures on primary care? I note that NHS leaders have today called for support from the military on vaccines. Running in parallel with all this is the phenomenal pressure that other NHS services are under, from the crisis in ambulance services and A&E that we discussed earlier in your Lordships’ House to delayed discharges. As the Minister knows—I am really grateful for the comments of the noble Baroness, Lady Thornton—people who are clinically extremely vulnerable, especially the severely clinically extremely vulnerable and their families, were already worried about this winter, but they have been shaken further by the uncertainty surrounding the new variant.

Ambulance Response Times

Baroness Brinton Excerpts

Wednesday 1st December 2021 Lords Chamber

Asked by

[Baroness Brinton]

To ask Her Majesty’s Government what assessment they have made of current ambulance response times; and what steps they are taking to reduce them.

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

We recognise the unprecedented pressures that the ambulance service is facing, and strong support is in place. A £55 million investment by NHS England and NHS Improvement will provide 700 additional staff in control rooms and on the front line to improve response times. This is alongside £4.4 million to keep an additional 154 ambulances on the road this winter. NHS 111 is recruiting an additional 1,100 staff, alongside a £250 million winter GP capacity fund to avoid unnecessary ambulance calls and visits to A&E.

[Baroness Brinton (LD) [V]]

Last week, the BBC reported that Shropshire had run out of ambulances, as every ambulance was queueing outside hospitals. Yesterday, the Shropshire Star reported that the West Midlands Ambulance Service had apologised that ambulance-hospital handover times were now four hours. This is happening all over the country, and people are dying waiting for paramedics. This is before the expected winter surge starts, so what is the Government’s emergency plan right now?

[Lord Kamall (Con)]

The Government understand that the reason for a number of these waits is related to the Covid pandemic and increased callouts, and we have stats for that. Ministers are in regular contact with NHS England and NHS Improvement about the performance of the emergency service care system, including the ambulance service. One Minister of State has meetings that track the improvement effort at all times, including in ambulance trusts. In addition, there is investment of £55 million to boost ambulance staff by more than 700 and £4.4 million to keep an additional 154 ambulances on the road. Also, we are looking at ways to stop people calling out an ambulance when they do not need to—when their calls could be handled without the need to call out an ambulance.

Coronavirus Act 2020 (Early Expiry) (No. 2) Regulations 2021

Baroness Brinton Excerpts

Tuesday 30th November 2021 Grand Committee

[The Deputy Chairman of Committees (Lord McNicol of West Kilbride) (Lab)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. Can we beam her in?

[Baroness Brinton (LD) [V]]

My Lords, this is beginning to have the feeling of “Star Trek”, which is certainly not my intention. Thank you, Deputy Chairman. I declare my interest as a vice-president of the Local Government Association.

From these Benches, we will not oppose the expiry of these 12 provisions, although we have some comments on them. It was really good to hear the Minister outline the “hands, face, space” guidance, readopted in the past couple of days. Will there be a public communications campaign to reinforce it because, sadly, I suspect that not many people will have heard it in Grand Committee today in Parliament, let alone in the outside world?

Yesterday, in the Statement repeat, we debated masks and self-isolation; we will do so again tomorrow when we look at the SIs. On vaccination, it was good to hear the Prime Minister and the Secretary of State refer to the clinically extremely vulnerable in this afternoon’s press conference. I promise the Minister that I will not repeat all the questions I asked him yesterday, but not one of them has yet been answered. Delivering either the fourth, or a booster, jab for 3.7 million clinically extremely vulnerable people will not work effectively without clearer information systems on exactly who the CEV are and which jab they should get; there is still a lot of uncertainty there. I thank the Minister for his offer of a meeting during yesterday’s Statement. With today’s announcement, vaccination is becoming urgent; I look forward to hearing from him shortly about when it can happen.

From these Benches, we want to make a brief comment on the assessments for local authority care and support. I note that the Explanatory Memorandum says that only

“eight local authorities used these powers between April 2020 and June 2020. No local authorities in England have used them after 29 June 2020.”

That is good to hear, but it is evident that assessments are still happening very slowly. It is one of the problems that hospital trusts across the country are facing, with people in beds awaiting an assessment. Some of that is much more about workforce availability, both in the NHS and in the local authority system, than about the arrangements to reduce these assessments.

Reference has already been made to local authorities having virtual meetings. Members from these Benches and others objected when the Secretary of State decided that all local authority meetings had to cease being virtual in January this year. It has meant that a number of councillors have been unable to attend their council meetings through no fault of their own. If the Lords can have a handful of people contributing virtually, and with cases going up and certain areas having problems, is it possible to return to virtual meetings and leave the matter as a choice for the local authority concerned?

I note that the Explanatory Memorandum says:

“This instrument does not relate to withdrawal from the European Union/trigger the statement requirements under the European Union (Withdrawal) Act 2018.”


However, it is only fair to point out that Section 25 gives early expiration to the power to require information relating to food supply chains to avoid serious disruption. In principle, we do not have a problem with that as a provision during the pandemic, but I say to the Minister: that statement may be true in treaty and UK legislation terms but, as we face this Christmas, there are increasing concerns about disruption to food supply chains, for three reasons.

One is a direct consequence of Brexit. European providers of food and many other products have significantly reduced or stopped exporting to the UK because of the complex, slow and, for both exporter and importer, expensive costs now that we are outside the European Union. Since Brexit, the reduction in the number of EU abattoir workers—as they leave the UK—has meant, this week and for the past month, thousands of pigs and other livestock being culled but not brought into the food chain. Worse, the increase in avian flu cases and the restrictions placed on all poultry farms mean that there are concerns about the supply of birds for the Christmas dinner table. Thirdly, there is a delay in foods and other goods coming in from around the world as a result of the pandemic. This is what one might describe as a perfect storm. Is the Minister confident that, given all these factors as well as trying to manage omicron in its early stages, it is appropriate to expire this particular provision?

We accept the expiry of emergency volunteering leave and compensation for emergency volunteers, although I do want to comment on the problems with the Bring Back Staff scheme, especially for doctors and some nurses. It was absolutely fine in principle, until it hit human resources in trusts. I know of two doctors who had recently retired and were kept hanging around for five months. One was a doctor teaching trainee doctors; however, she was unable to be used because the system just made it impossible for her. If there is any cause to reintroduce this particular provision, will the Minister ensure that we do not gold-plate the complex HR arrangements, making it impossible for staff, former staff or those who might come back on a temporary basis to do so?

We do not believe that the extension of time limits for retention of fingerprints and DNA should remain. We objected to that a year ago, when it was brought in.

Finally, I wrote to the Minister earlier today with real concerns about the problems that some returning international travellers are facing, following the new regulations that came into force at 4 am today, arising from concern over omicron. This is a logistical problem with the change from lateral flow to PCR tests and the passenger locator form. As of this morning, it was still possible to put only the details of your lateral flow test on to the passenger locator form, not the arrangements for the PCR test. One cruise company has 700 people coming into a UK port tomorrow and, despite talking to officials, it cannot get a sense of how the passengers will be able to get off if their details are not on the passenger locator form. I hope another method has been found, otherwise this may be a bit of a problem.

It is right that the Government made the provisions we face today, even if we do not agree with all of them. But I say to the Minister that, as with other statutory instruments, holding on to some of these provisions for a little longer, even if unused, might be useful in case the pandemic takes us down a course that not one of us wants, as the Government and other public services might need to call on them at short notice.

[Baroness Merron (Lab)]

My Lords, I thank the Minister for his most helpful introduction to these regulations, which we will not be opposing. As he acknowledged, when the original Act came into force, we were in extraordinary times and they required unprecedented legislation. However, as time moves on and experience and circumstances change, it is right that we seek to remove powers that are no longer needed. The move to do so today is welcome because, in those circumstances, such provisions should not remain in statute.

Examples of those include Section 56 and Schedule 26 powers relating to magistrates’ courts; Part 1 of Schedule 16, which provides for the temporary closure of education and childcare settings, and was not used; and Section 78 powers around local authority meetings, which need to go because the provisions are simply out of date. On this, I add my voice to a point I made previously in Grand Committee: as the Minister has heard from noble Lords today, surely how a local authority meeting is conducted must be the responsibility of the local authority itself. In the case of these regulations, I accept that the provision is out of date, but perhaps the Minister will apply his consideration to that more general point. The provision of powers to detain infectious people was particularly controversial and it is right that it is removed, having been used only 10 times, the last being October last year.

I will raise a few points with the Minister and I first emphasise the need for clarity of communication from the Government. With that in mind, I refer to the comments of Dr Jenny Harries, the head of the UK Health Security Agency, which she made on BBC Radio 4’s “Today” programme. She said:

“If we all decrease our social contacts a little bit, actually that helps to keep the variant at bay”.


However, a spokesperson for Prime Minister Boris Johnson said that he does not share her view. I understand that the Government have sought to reassure the public that they have no plans to tell people to limit their social contacts with others, which is in direct contrast to the view of this leading medical expert. I would be extremely grateful if the Minister could clear this up for us today.

Covid-19 Update

Baroness Brinton Excerpts

Monday 29th November 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for repeating the Statement from today and for the Statement from Friday. I add my thanks to the scientists in South Africa for their prompt sharing of this information, as unwelcome as it may be.

We understand that scientists believe that it will take two to three weeks before they can establish whether the omicron Covid variant is more transmissible, causes more severe disease or can make vaccines less effective than was the case with delta, or all three. We support the Government’s strategy of tougher travel restrictions and mandatory face masks, as far as it goes. It seems that there is already real-world evidence from South Africa and Hong Kong that omicron is highly infectious, which begs the first question: why are the Government limiting the mandating of mask wearing to travel and to shops, and not extending it to indoor meetings and social events? Mask wearing is the single most effective public health measure in tackling Covid according to the first global study of its kind, which found that the measure was linked to a 53% fall in the incidence of the disease. As Dr David Nabarro said recently:

“We know that wearing a face mask reduces the risk. We know that maintaining physical distance reduces the risk. We know that hygiene by regular hand washing and coughing into your elbow reduces the risk. We should do it all, and we should not rely on any one intervention like vaccination on its own.”


On these Benches, we support taking swift action and the inclusion of new countries on the red list. We do not want a repeat of the inertia that saw the delta variant run rampant through the country and, as the Minister said, we must protect the progress that we have made. We welcome an increase in the availability of the booster jabs. The only question that I would ask him is about the capacity of the NHS to deliver the massive increase that the Government have reported today.

We support the move to PCR testing, but there are still holes in the testing programme. Ministers have not introduced pre-departure testing and there is little, if any, follow-up on PCR test results, so we need action on this if we are to take it seriously.

The Government could, of course, go further to keep people safe. Fixing sick pay, improving ventilation and properly utilising antivirals remain crucial to ensuring that we reduce the spread of this deadly disease. Do any of these feature in the Government’s plans?

I agreed with my right honourable friend the former Prime Minister Gordon Brown when he said:

“Whatever happens to this particular variant, we’ve got to realise our failure to vaccinate the rest of world … is going to come back to haunt us.”


He said that the new variant was a “wake up call” for rich nations with surplus vaccines. There seem to be surplus vaccines which will expire within the next month. How many vaccines in the UK will pass their use-by dates before Christmas, and will these be destroyed? I am afraid that Ministers have not met the commitments made at this summer’s G7 to roll out the vaccine to other parts of the globe. There is now sufficient vaccine to reach almost every adult in the world. I agree with the Minister that we need to play our part in ensuring that everyone around the globe has access to vaccines to stop the emergence of new variants.

This variant is indeed a wake-up call. The pandemic is not over. We need to act with speed to bolster our defences to keep the virus at bay. In that context, I ask the Minister about preparedness for new Covid variants in general. Both Clive Dix and Kate Bingham, former chairs of the Vaccine Taskforce, have expressed worries about our preparedness for dealing with new variants. Mr Dix has said of a paper that he sent to No. 10 in May:

“I wrote a very specific proposal on what we should put in place right now for the emergence of any new virus that escaped the vaccine.”


It seems that, thus far, No. 10 has not responded, so perhaps I can ask on Mr Dix’s behalf what the Government’s plan is for an escape variant? What is the plan for resistance for the future? The country needs to know. He suggested that a strategy should involve a co-ordinating team to seek out new vaccines and give the company involved a fast track to a swift trial, access to the data and regulatory approval in return for early access to vaccines. If that sounds familiar, it is exactly what the Government did at the start of the pandemic, and it needs to be repeated. Is this in the Government’s plan?

Reports from South Africa and other places indicate that the new infection seems to manifest itself with nausea, headaches, fatigue and a high pulse rate, but not the original and distinguishing features of loss of taste or smell, nor the headaches, sore throat, runny nose, fever and persistent cough which have been the most common in the delta variant. Will the NHS stick to the old symptom guide or will it update it to allow those running test and trace to recognise that they are not necessarily looking for things like loss of taste and smell but for other symptoms?

If the Government intend to report again in three weeks’ time, if not before, it takes us into the Recess, so I would like the Minister to ensure that colleagues will be briefed appropriately. On Saturday evening, the Secretary of State held a Zoom call to brief MPs about the new world that we now entering. I hope that the Minister will do the same for all Members of your Lordships’ House.

We must all be concerned that any spike in serious cases from this new variant could coincide with the NHS’s peak winter period, particularly given that the service is already at full stretch. We all want to enjoy Christmas but, most of all, we all want to stay safe.

[Baroness Brinton (LD) [V]]

My Lords, I thank the Minister for repeating today’s Statement. The World Health Organization and many globally respected scientists and doctors have been warning us that variants of Covid-19 might pose a serious risk, especially when a Government think that we are winning the war against the virus and that we can all afford to relax. Omicron reminds us that the battle is not won until it is won across the world. From these Benches, we also thank the South African scientists for their genome sequencing that has alerted the world, and I hope that the UK and the other G7 countries will offer them not just gratitude but countries in southern Africa more practical support.

I echo the comments of the noble Baroness, Lady Thornton, about arrangements for international travel and test and trace. I also support her request for a briefing for Peers. For some bizarre reason, the Liberal Democrat MPs were not included in the MPs’ briefing. Please could the Minister make sure that we are included in any such meeting in the Lords.

In April, before the Minister was appointed, we warned Ministers that the Government were responding far too late to the reports of the delta variant in India. So we warn again. While the face mask mandate in shops and on public transport is welcome and well overdue, we are absolutely bemused that it excludes hospitality and that the advice to schools excludes classrooms. Professor Chris Whitty said in Saturday’s No. 10 press conference that when there is a risk we should go in hard, so can the Minister explain how the virus will be kept at bay in those indoor settings where masks are not required? Why is there no encouragement for people to work from home where possible? Trains and buses are crowded and unventilated. Risks will remain there too, even if lessened with masks.

I have said before that I am in the clinically extremely vulnerable group. I have had my third dose of the vaccine and now look forward to my fourth, or booster, dose. But many of those who should be getting the third dose still face a series of problems in the NHS about who should get it, as opposed to a booster, and how it is recorded. Indeed, today, in response to a Written Question to my honourable friend Daisy Cooper about the recording of a third dose, the Minister, Maggie Throup MP, replied:

“Work to assess the need to include boosters in the NHS COVID Pass is ongoing and we will provide a further update in due course”,


so even the records cannot distinguish. Can the Minister say when “in due course” is? I am afraid this is symptomatic of the way the clinically extremely vulnerable have been ignored and left to fend for themselves.

I will ask a question that I have asked the Minister’s predecessor repeatedly since June of this year. In May 2021, Jenny Harries left Public Health England to set up the UKHSA. For the preceding 12 months she had specific responsibility for co-ordinating all the different elements of Covid issues for the CEV and for shielding. When she left, no one was given that responsibility, and it was noticeable that all communications with CEV people and the different parts of the NHS on Covid just stopped when shielding stopped. Can the Minister tell us which senior person in the NHS has that managerial responsibility? It has been five months since I first asked and there are 3.7 million worried people still waiting for answers. It would be good to know which Minister has the responsibility to co-ordinate all Covid matters for the CEV or former shielders. This is important, because the last letter from the Secretary of State tells the CEV not to go into any environment where people have not been double-jabbed. There is no mention of boosters, and obviously no mention yet of omicron.

Is there a confirmed register that distinguishes between the CEV and the severely CEV? Unlike in Scotland, hospital consultants in England do not have access to individual patient records that GPs use or even to the Covid app data. Can the Minister say how NHS England will be able to communicate directly with eligible people if they do not have a register? Is there a specific communications plan to ensure that primary care, secondary care and the 119 vaccine helpline are fully aware of plans and processes for this group? Reports are coming back of blood cancer patients being told at vaccine centres that they do only boosters—there is no knowledge or understanding of the third dose.

I recognise that I am asking the Minister a large number of questions on the immunocompromised. I really do not expect answers to them today—written answers are always very welcome—but please will he agree to meet with me, Blood Cancer UK and the Anthony Nolan Trust to discuss these key questions, not least because we are now in a different situation, with the 3.7 million, which is 5% of the country, left in limbo?

As the noble Baroness, Lady Thornton, said, it is too early to say whether omicron is more dangerous than delta or beta, or whether treatments such as Ronapreve and the current vaccines might not be as effective. The Government are right to be cautious. I echo her comments about Clive Dix, the former head of the Government’s Vaccine Taskforce. What plans are in place for vaccine development for an escape variant?

At a time when manufacturing is one of the key issues slowing down the delivery of vaccines worldwide, why is the Vaccine Manufacturing and Innovation Centre at Harwell, which has received in excess of £200 million of public funding via UK research and development, now up for sale, long before the pandemic is over? We still need its expertise. Selling off a publicly funded, not-for-profit organisation during the pandemic, if at all, seems, frankly, bizarre.

Finally, the Statement has a passing reference to test and trace domestically. It says:

“We have a much greater capacity for testing, enhanced ability for sequencing”.


Genome sequencing in the UK has been a real strength of UK science and has undoubtedly helped us considerably in this pandemic. But, in recent weeks, with the Government’s determination to open up and return to normality, test and trace has been scaled back, with reduced centres and reduced hours for those that remain open. Can the Minister say what plans there are to increase these back as needed? Are directors of public health and their local resilience forums receiving funding for the current omicron problem? It also appears that there is no Covid funding for them next year at the moment. If omicron is a viable variant, we must plan to fund them to keep these safety nets of test and trace in place, because without an effective test, trace and isolate system, including proper payments to those who need to isolate, we will not manage, let alone control, this virus. Defences are not defences when there are large holes in them.

[Lord Kamall (Con)]

I thank both noble Baronesses for their questions. I will try to answer as many as I can.

On the first issue of face coverings and why not all places, we are taking temporary, targeted and proportionate action as a precaution while we learn more about this new variant. Face coverings have been introduced as part of the temporary measures being put in place to slow the spread of the omicron variant. We know that face coverings are effective at reducing transmission indoors when people are likely to come together—for example, on public transport or in shops—while having a low impact on our daily lives. We continue to encourage everyone to wear face coverings in settings that are crowded or where they meet or come into contact with people they do not normally meet, but we are also guided by the advice of our scientific and medical experts. We are constantly keeping these under review.

One of the reasons why our advice is not the same for hospitality venues is that the advice has been that it is not seen as practical for people to wear a face covering when eating or drinking. It is not recommended that face coverings are worn when undertaking strenuous activity, including exercising and dancing. That is the advice we have had to date on that one.

Questions were asked about NHS capacity. The NHS can respond to local surges in demand in several ways, including through expanding surge capacity in existing NHS hospitals, mutual aid between hospitals, and making use of independent sector capacity and accelerated discharge schemes. The NHS is the Government’s key spending priority. That is why we committed to the historic settlement of the cash increase of £33.9 billion a year by 2023-24, and other investments we have made to make sure we have that capacity.

The booster vaccine will be offered in order of descending age groups, with priority given to older adults. This will probably be the most complex phase of the NHS vaccination programme so far, but the NHS is working through updated guidance and will set out how this will be operationalised shortly. It will contact you when you need to act and book in for your life-saving vaccination.

On helping the rest of the world, the UK remains committed to donating 100 million doses by mid-2022. We will have donated more than 30 million vaccines by the end of 2021 and we have announced plans for 70 million doses in total so far. We will continue to work to ensure that any vaccine that the UK does not need is reallocated to other nations that require it, wherever possible.

On future preparedness for variants and future pandemics, as noble Lords will know, the UK Health Security Agency, which focuses on health protection, became fully operational on 1 October 2021. It will operate as an integral part of our health system and utilise state-of-the-art technologies and ground-breaking capabilities in data analytics, including genomic surveillance, as acknowledged by the noble Baronesses. The UKHSA will play a critical role in the route to developing vaccines that are effective against new and emerging variants. In the longer term, to make sure we learn the lessons, we will build on the infrastructure developed for Covid-19 to tackle and prevent other infectious diseases and external health threats. This work will include a strong focus on the life sciences, strengthening relationships with academia, research organisations and industries that have developed and grown through the pandemic, in which there are now several centres of expertise.

We are delighted to see students back at schools and higher education settings, but to reduce transmission we are keeping some sensible measures in place across education and care settings. These include access to twice-weekly testing in secondary schools and the provision of CO₂ monitors to all schools. We have said that education settings must continue to comply with health and safety law, and we are working between the Department of Health and the Department for Education to make sure we have the right and appropriate response in our education settings.

The noble Baroness, Lady Brinton, asked about severely immunosuppressed individuals—I thank her for the acknowledgement that I will not be able to answer all the questions in detail and that it probably would be better if I write to her in more detail. So far, however, the individuals who have completed their primary course of three doses should be offered a fourth booster dose with a minimum of three months between the third primary and fourth booster dose. If they have not yet received their third dose, they should have that now to avoid further delay.

The other point I will make is that it is not too late for anyone who has not yet had their first or second dose. Please do not think that, because we are advertising for boosters, it means that you have missed the boat. In fact, we are working very hard—and I have received a lot of advice from noble Lords across the House—on how to address the low take-up of vaccines among certain communities and demographics. I am grateful to noble Lords for that. I also reiterate the point that it is not over. I humbly disagree with the statement that we have given the impression that it is over. We have been quite clear that it is not and that we must continue to be vigilant.

In terms of briefings, I will commit to giving a briefing to all Peers. I thank the noble Baroness for that suggestion. I have apologised for not being more proactive on that—maybe I should have done so on Sunday afternoon or evening after the Secretary of State. To the noble Baroness, Lady Brinton, I can only apologise for not having an answer sooner to the questions she has asked in the past. The best way to resolve this is for me to commit to the meeting that she has requested so that we can try to answer the questions that she has outstanding. I apologise to her for those questions not being answered previously.

NHS: Primary Care Surgeries

Baroness Brinton Excerpts

Wednesday 24th November 2021 Lords Chamber

[Lord Kamall (Con)]

The standards of care that CCGs expect are clear in the contracts that they sign with GPs. However it is provided, patients should continue to expect the same standards of care.

[Baroness Brinton (LD) [V]]

My Lords, one of the concerns is the transparency of agreements between clinical commissioning groups and these private companies. Are CCGs required to make absolutely transparent any arrangements they have made with these private companies?

[Lord Kamall (Con)]

The noble Baroness will understand that it is not for the Government to intervene in the decisions of CCGs. All who believe in devolution and decisions being made as close to the people as possible believe that we should not be interfering. These decisions are made by CCGs and it is not for the Government to interfere.

Food (Promotion and Placement) (England) Regulations 2021

Baroness Brinton Excerpts

Tuesday 23rd November 2021 Grand Committee

My final, brief third question is this. How will whoever is going to enforce these regulations, whether it is trading standards or environmental health officers, be resourced to enforce these complicated and important new laws?

[Baroness Brinton (LD) [V]]

My Lords, I declare an interest as a vice-president of the Local Government Association. I thank the Minister for his introduction to these regulations. The comments of the noble Lord, Lord Brooke of Alverthorpe, as chair of the APPG on obesity, were particularly helpful.

These regulations sit behind recently revealed alarming figures showing that nearly a quarter of children are overweight or obese when they start primary school. That figure has risen to a third by the time they leave at 11. The Government are right to be concerned about the overconsumption of food and drink high in calories, sugar and fat, which leads to obesity and associated obesity illnesses. I will come on to the regulations shortly, but from these Benches we want to make two other comments.

First, the Conservatives in government have consistently cut public health budgets to local authorities over the last six years. The King’s Fund says that, on a like-for-like basis, the 2019-20 budget is 15% less than that of 2013-14, including a more than 5% cut to obesity services. In addition, the reduction in school nurses as well as health visitors over the last decade has meant that some of the vital early face-to-face advice on nutrition to parents of young children has gone.

Worse, some of the excellent work done by chefs such as Jamie Oliver and by the campaign of Henry Dimbleby—both of whom over the years encouraged much healthier eating in schools—has been reduced if not lost. In fact, recent reports say that high-fat, high-carbohydrate foods such as the dreaded turkey twizzler are re-emerging on to school menus.

The second issue from these Benches is the decline in fitness of our primary school children. This has been a long-standing problem, but the sale of playing fields and focus in the curriculum on core subjects have all led to a reduction of time when children can exercise, take up sports and essentially get the habit early, which will also impact on their weight. This January, Sport England noted that children’s activity levels were down in 2019-20—pre pandemic—with only 44% of children and young people meeting the Chief Medical Officer’s guidelines on taking part in sport and physical activity for an average of 60 minutes a day. Now is the perfect time, as restrictions have been relaxed, to increase the time that young children can undertake sports and exercise. Can the Minister say what influence the Department of Health and Social Care has with the Secretary of State for Education in remedying this matter and what plans there are to fund more opportunities for young children to participate in sport and exercise?

Turning to the regulations, I note that this follows a decade of trying to encourage large supermarkets to reduce salt and sugar in their own direct products, as well as encouraging their suppliers to reformulate. However, not all of them have achieved enough, nor have they changed their attitudes towards promotions.

If the Grand Committee will permit me an anecdote, one of my adult children used to work as a buyer for a major supermarket, and its department had been asked to go back to suppliers to ask them to reduce sugar, salt and fat. My son was responsible for, among other things, dairy products. Most products and many suppliers were happy to work with the supermarket to achieve reductions, but both sides were completely stumped by one product: brandy butter. It has not just sugar and fat, but alcohol too. On this occasion, it was agreed there was very little they could achieve, other than to highlight its very red traffic light and recognise that it was a truly seasonal product that was not part of people’s everyday habits. But it is good they were thinking about it.

While the public health responsibility deal has improved matters a little bit, it is not nearly enough. One key area remains obvious. That is the influence of promotions targeted at children and their parents, both in store and on television. Other speakers have referred to multibuys, end-of-carousel promotions and queuing eye-catchers—far too often, junk food and sweets. While the public health responsibility deal has helped a bit in those larger supermarkets, it is certainly not enough, and it is good that healthier choices will be much more visible in shops and that buy one, get one free and three-for-two offers on high fat, sugar and salt products will be restricted.

On food scope, it was worrying to read in the past few days that a high level of juice in baby and toddler food, which has a very high fructose content, is not labelled as high sugar because the juice is natural and not added, processed sugar. Most parents of babies and small children believe that such products are not high in sugar. Surely, this needs to be added to the formulation list for HFSS products. Is the department looking at this?

It is right that environmental health food authorities should be responsible for enforcing this in localities, but I ask, as others have, whether there will be extra funding for environmental health to be able to carry this out. We need to remember that members of environmental health have many other responsibilities too, including the vital role during the pandemic of test and trace, working with local resilience forums. The Government cannot keep loading extra responsibilities on to beleaguered local authorities without funding them properly. Will there be funding for this for the enforcement bodies?

From these Benches, we regret that the food sector has not responded well enough to remove the need for this regulation, but we believe that the long-term health implications for our children are being damaged by current custom and practice. But this cannot be done without other actions too: funding more sport and exercise opportunities and funding enforcement are just two critical elements. The minimum of another five years to implementation, as outlined by the noble Lord, Lord Brooke of Alverthorpe, is too slow. Can the Minister please ensure that these changes are speeded up?

[Baroness Merron (Lab)]

My Lords, I appreciate the intent behind these regulations and thank the Minister for his introduction to them. I want to comment on the current situation and raise a number of questions following on from those that we have already heard, because I feel that it is the detail of the regulations that is wanting rather than what they are about.

To emphasise the points that have already been made in this debate and have been heard in your Lordships’ House on many occasions, the UK has among the highest childhood obesity rates in western Europe. One in four children is overweight or obese when starting primary school, and the number is one in three by the time a young person gets to secondary school. These children are obviously more likely to become obese adults—let us remind ourselves that, at present, one in four adults is obese—and therefore at greater risk of conditions such as diabetes, heart disease, fatty liver disease, cancers and mental ill-health. As we know, the situation is worse in poorer communities. Indeed, one in three adults in the most deprived areas is obese, compared with one in five in the least deprived—a clear inequality if ever we saw one. The discrepancy among children is even more alarming: more than twice as many children are obese in the most deprived communities as in the least, and that gap has nearly doubled under this Government.

There is no doubt that in-store promotions are incredibly effective in influencing what we buy. Research shows that we buy 20% more than we intended when faced by promotions. Cancer Research UK has shown that greater volumes of high fat, sugar and salt are likely to be purchased by those who are already overweight or living with obesity, so we see a correlation between promotions and obesity, and it is right that these regulations seek to tackle that. So, yes, it is right to take action to address this situation, not by limiting people’s freedom of choice but instead by supporting them to make healthier choices.

However, these regulations alone will not be enough, and it is this point that I want to emphasise to the Minister. We need a radical obesity strategy that goes much further, ensures that families are able to access healthy food and supported local leisure facilities, and ensures that poverty can be tackled. Without that, there will be no levelling up. All we will see is a continuing widening of the already considerable gap between those who have the means to manage their weight and those who do not.

New Hospitals

Baroness Brinton Excerpts

Thursday 18th November 2021 Lords Chamber

[Lord Kamall (Con)]

I completely agree with the sentiments expressed by my noble friend. Surely what we should focus on is output; surely what we need is the best healthcare system across the country. We need up-to-date healthcare with the best information from patients to make sure that we can diagnose and give them appropriate treatment, working with the very latest technology such as artificial intelligence to spot patterns, to make sure that we can also build in prevention when we look at tackling health issues in the future. I welcome my noble friend saying that we have to focus on output—modern digital infrastructure and modern digital hospitals fit for the future.

[Baroness Brinton (LD) [V]]

My Lords, my local hospital, Watford General, is on the list of 40 so-called new hospitals, although the plans have been in place and supported cross-party for close to two decades, and its infrastructure is failing. Despite a clear promise of funds by the Prime Minister during a visit to the hospital in October 2019, the trust is yet to be allocated funding from the Treasury and it remains a pathfinder. I want a clear outcome. When will funding be confirmed and granted?

[Lord Kamall (Con)]

On the point about the noble Baroness’s local hospital, I am afraid that I am not aware of where she is situated geographically, but I can tell her that six of the 48 hospitals are already under construction and one is now completed. I hope that the noble Baroness will write to me on the hospital that she referred to so that I can give her an answer.

Dementia: Fuelling the Moonshot

Baroness Brinton Excerpts

Tuesday 16th November 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I add my congratulations to the noble Baroness, Lady Greengross, on securing this important debate, and to the All-Party Parliamentary Group on Dementia on the publication in September of the very powerful report Fuelling the Moonshot. I also thank Alzheimer’s UK and the UK Dementia Research Institute for their briefings. It is especially good to see the research side and the community-facing side coming together to work. I have seen this in the arthritis field, and there are real benefits it can bring.

There is nothing to beat evidence-based care, as the noble Baroness, Lady Greengross, has already said. She noted that 850,000 people are living with dementia, and that the number will increase as we in the baby-boomer generation come to our later years. Some 11% of deaths in 2020 were from Alzheimer’s and dementia. But past data on the number of dementia deaths is difficult to ascertain. My family knows about this from our own experience. In my father, a broadcaster and later an MP 40 years ago, who died over a decade ago, we saw the consummate communicator that he was change as vascular dementia took over. When he finally went into hospital and died, it said “cancer” on the death certificate. My stepmother had to ask for “dementia” to be added. His last years were blighted by dementia, but it appeared then that it was not recognised. It was added—although in a different-coloured pen, which seems bizarre. Even that caused problems later, with people querying why a cause of death had been added in a different colour. So it is good that it is now routinely listed on death certificates, and I thank my stepmother and those like her who, over the years, have fought for this to happen.

It is shocking that dementia research has been funded so poorly compared with many more “attractive” medical issues, given the high number of people who have it. But it is not just an issue of research; the current crisis in social care speaks volumes about the way dementia and elder care are funded by the state, and how they are misunderstood or even ignored by too many of the public. Today’s debate is about finding that elusive cure, and this report is excellent for setting out a road map for the Government to help fund, facilitate and encourage.

The words in the Tory manifesto, already mentioned by other noble Lords, are absolutely clear and set out in the moonshot report. The Conservative Party’s 2019 election manifesto made a commitment to save millions of people and their families from suffering the agony of a slow decline due to dementia. The party promised that it would make

“finding a cure one of our Government’s biggest collective priorities—one of the ‘grand challenges’ that will define our future … This will include doubling research funding into dementia and speeding up trials for new treatments.”

The party also committed to investing

“more than £1.6 billion … into research over the next decade to find a cure for dementia under a Conservative majority government”,

which would provide the

“largest boost to dementia research ever in the UK … double current funding levels”

and set

“Britain’s finest scientists to work on a ‘Dementia Moonshot’”.

These are fine words, but worryingly, in the Budget, Rishi Sunak announced a two-year delay to the funding of the £22 billion “sciences superpower”. Can the Minister say if this includes a delay to the £1.6 billion promised for dementia research in the manifesto? The wording in that Tory manifesto is unequivocal: it is

“one of our Government’s biggest collective priorities … that will define our future”—

except that if it is delayed, it is not. If there are concerns about it being included in the delay, I hope the Minister will undertake to put pressure on the Chancellor to ensure that dementia research is not part of this delay.

The recommendations in the report set out a number of key methods for achieving the moonshot, and I want to address one or two of them. The first is the

“novel methods for early diagnosis, such as blood and other biomarkers”.

It is noticeable that other diseases have benefited from such research. For example, 30 years ago someone with suspected coeliac disease could be diagnosed only by going into hospital and having a very uncomfortable gastroscopy procedure. Now, a simple blood test tells your GP if you have the markers, so you can then be referred speedily to a gastroenterologist. Other autoimmune diseases have benefited from similar ground-breaking research. Inflammation markers found through regular blood tests are now commonplace; I have blood tests monthly to monitor mine. There are many other markers that provide early diagnosis for other diseases, but not yet for dementia. Many other biomedical and translational research for other diseases, notably cancer, have also had access to long-term government planned funding, but not yet dementia.

For me, the most exciting moonshot report recommendations are about creating more centres of excellence and ensuring that anyone newly diagnosed gets the support they need at the start of their journey. The practical multidisciplinary approach is already using technology to help people to live well with their dementia. Professor David Sharp, the director of the DRI Care Research & Technology centre at Imperial College, is using technology in a pilot to help people living with dementia avoid hospitalisation. It is shocking that 25% of hospital beds are currently taken up by people living with dementia. These new technologies can monitor people in their homes and enable the early identification of risks such as sleep disturbance, incontinence, or infections. They know that this works. The early detection of these risks could enable people with dementia to live at home safely for longer. Access to that funding would allow the trials to happen on a larger scale, and then perhaps become commonplace. There is another benefit too: it will reduce the costs to and pressures on our hospitals.

I move now to the workforce to deliver the moonshot. The fourth recommendation in the report is

“to establish a specific fund of £40m to support both clinical and preclinical postdoctoral research positions”.

These are vital if talent is to be attracted and retained in dementia research. Can I ask the Minister if this is also part of the manifesto promise and if it, too, might be delayed? Dementia has in the past been a poor relation, and it becomes harder to attract clinical postdoctoral research students. If there is no money, there are no students, and no students means no future research scientists and professors, and without a long term well-funded scheme it will not get the momentum that it so badly needs.

There is a particular importance in attracting talent from abroad, which our universities and research establishments have thrived on for many years. On the power of research funding, the report says:

“The creation of institutions like the UK Dementia Research Institute has attracted world-leading talent to the UK from across the globe.”


It says that the director of the UK DRI, Professor Bart De Strooper, estimates

“that around a third of its research Group Leaders have come from overseas”,

and that he

“himself moved to the UK to lead”

the work here,

“being impressed by the UK’s research infrastructure and ambition to be a world leader in the field.”

However, we know that, at present, it is harder to attract first-class talent from abroad, so a scheme such as this, with government support, would be very beneficial.

For the UK DRI’s new report, Race to Cures, it conducted a survey of more than 200 researchers, which found that 90% think that new treatments for dementia will be found in the next 10 years. Nearly three-quarters think that the pace of discoveries and breakthroughs is increasing, and 100% think additional funding is important to enable breakthroughs. As someone who has seen grandparents and parents living and dying with dementia, I am really encouraged that researchers think new treatments will be found within the next decade. But that cannot happen on thin air, and the moonshot report from the all-party group sets out the mechanisms by which the Government can deliver their manifesto promise. I urge the Minister to help deliver the funding needed to make this a reality, so that dementia is no longer a grim sentence that people really fear.