NHS England Funding: Announcement to Media
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
I thank the noble Baroness for her question. Since 2010, we have increased the clinical radiology workforce by 48%, from 3,239 to 4,797 full-time equivalent posts. Numbers of diagnostics radiographers are up by 33% since 2010 and therapeutic radiographers are up by 44%. We are offering those who want to join the radiographic workforce at least £5,000 as a non-repayable grant for each year of their training to be a radiographer. Since 2016, we have seen a 26% increase in those studying diagnostic radiography and a 10% increase in those studying therapeutic radiography.
Baroness Brinton (LD) [V]
My Lords, the £5.9 billion in the Chancellor’s early announcement is to pay for physical infrastructure and equipment, not for current services. The NHS Confederation says that next year’s NHS funding allocations are nowhere near enough either. Last week, the Royal Cornwall Hospital declared a critical incident in its A&E department when it had 100 patients in the 40-bed department and 25 ambulances queuing. Its ambulance service is also under intense pressure, reporting that 50 ambulances have queued at times—again, that is much larger than the actual department. This is echoed across the country. How will Ministers help A&E departments and ambulance services in crisis right now?
Coronavirus Act 2020
Baroness Brinton Excerpts(3 years, 1 month ago)
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Baroness Brinton (LD) [V]
I declare my interest as a vice-president of the Local Government Association. I start by echoing the comments of my noble friend Lord Scriven and many other noble Lords. Regardless of where your Lordships stand on wearing masks, for example, we are all agreed that the way this Government have brought forward far too much Covid legislation as emergency items—
The Deputy Speaker (Lord Lexden) (Con)
My Lords, there is a Division in the Chamber. The Committee stands adjourned until all Members have cast their votes.
The Deputy Chairman of Committees (Lord Lexden) (Con)
My Lords, the Committee will resume. I invite the noble Baroness, Lady Brinton, to continue her speech.
Baroness Brinton (LD) [V]
My Lords, regardless of where your Lordships stand on mask wearing, I believe that we are all agreed that this Government have brought forward far too much emergency Covid legislation, much of which has not even been presented to Parliament before being brought into use. Why, once again, are regulations coming to the Lords for which the expiry date was well known in advance and is not an emergency at all? The Minister’s predecessor heard time after time over the last 20 months many noble Lords complaining that too many statutory instruments were being brought to us as emergency procedures, making a mockery of the scrutiny of your Lordships’ House.
The regulations talk about self-isolation. It remains vital for those who have Covid-19, but can the Minister confirm the rumours that many people are not taking lateral flow tests, even if they are symptomatic, in order not to have to report the results and to avoid self-isolation? I am also hearing that there has been a resurgence of the old problem we had last year of late pinging, presumably because of delays in a struggling test and trace system as case numbers rise dramatically.
The noble Lord, Lord Balfe, raised concerns about whether lateral flow tests are necessary and should be paid for from the public purse. Lateral flow tests are now proving extremely reliable. Actually, we are advised as Members of Parliament to have two lateral flow tests during any week in which we are present in Parliament. Many other workplaces demand even more tests per week than that. It is one of the safest ways we can catch Covid early in people, particularly if they are not yet symptomatic. If we are asking many people to have two, three or five lateral flow tests a week—as I know happens in some places—while the pandemic is still around, it should be paid for from the public purse.
I echo the Minister’s thanks to directors of public health, our local resilience forums and local authorities. Can he confirm that the funding for their work on Covid, including test and trace, is guaranteed for the next financial year and will not end, as is currently planned, in March 2022?
Once again, I ask why the messages from government Ministers repeatedly encourage us to believe that face masks are totally a matter of personal choice. Many noble Lords have expressed their concern about them and said why they do not want to wear them. Even the Secretary of State for Health, when pressed over the weekend, reluctantly said that he would use a mask. However, he refused to say that he would recommend it to his colleagues on the green Benches—although he thought that they should perhaps consider it—whereas the Leader of the House of Commons, Jacob Rees-Mogg MP, has completely eschewed the scientific advice and said that Tory MPs do not need to wear masks because they all know each other and get along so well. The new Minister for Vaccines was of a similar mind on the radio yesterday.
However, as my noble friend Lord Scriven said, vaccination on its own is not the sole answer to Covid. A third of cases at the moment are among people who have already had their vaccinations. With a seven-day rolling average of around 1,000 admissions to hospital per day and with more than 8,000 beds occupied—and with those numbers increasing—I asked the Minister just now, in the Urgent Question in the Chamber, about accident and emergency departments and ambulance services. Conversations with GPs show that they, too, are hard-pressed at the moment in dealing with the increased number of Covid patients calling them for help.
One of the advantages of vaccination is that many people do not get Covid so seriously, but anyone who listened to the “Today” programme from Lancashire this morning will have heard many people say that, even though they had Covid mildly, it was the most unpleasant thing they had had to deal with and that catching their breath all the time was very difficult. GPs are much in demand in offering advice, hopefully to turn people away from hospital and give them the help they need.
Case rates in unvaccinated children remain very high, and despite being told many times in 2020 that children do not get Covid, they clearly do.
On 17 September, Sajid Javid wrote to the 3.7 million people who are clinically extremely vulnerable; that is 5% of our population, though not as large as the 22 million of the over-50s, the clinically extremely vulnerable and NHS staff having booster shots. This group comprises those who have serious problems making antibodies and are at high risk of getting very strong Covid. I declare my interest as being within the severely clinically extremely vulnerable group. Its numbers have expanded from 500,000 to 800,000 over the last two to three months following the publication of a number of clinical trials which were able to show that more categories of people were taking immunosuppressants, which moved them into this group. The news of the antivirals is vital for the clinically extremely vulnerable, and I welcome that. However, as my consultant said to me, “We don’t want you in hospital at all; we absolutely do not want you to end up on many of the drugs coming through yet. You need to keep safe.”
For those of us who have low or no antibodies and were told on 17 September by the Secretary of State that our doctors would now tell us what we needed to do, the outside world is a worrying place. The letter from Sajid Javid said that I should ensure that I did not go into any environment where there were people who were not double vaccinated. I have joked before whether, before entering my local greengrocers, I should stand at the door and shout, “Everyone double vaccinated in here?” I do say that.
The noble Lord, Lord Robathan, can make his own decision about wearing a face mask, but 5% of the population, a mere 3.7 million people, remain at high risk even if they have had their booster jabs. They do not have the choice. I ask him please to reconsider; even when you think you are safe, you may be protecting someone as you may not know that you have Covid and are likely to pass it on.
The noble Lord, Lord Robathan, quoted our scientists in March and April 2020 as saying they did not see the evidence for face masks being helpful. He clearly missed the screeching U-turn in the summer of 2020 after our experts, both in the UK and at the World Health Organization, realised that Covid was much more airborne than they had understood. The noble Lord asked for evidence. This is from the World Health Organization in December 2020, and it is still current advice:
“Masks should be used as part of a comprehensive strategy of measures to suppress transmission and save lives; the use of a mask alone is not sufficient to provide an adequate level of protection against COVID-19.
If COVID-19 is spreading in your community, stay safe by taking some simple precautions, such as physical distancing, wearing a mask, keeping rooms well ventilated, avoiding crowds, cleaning your hands, and coughing into a bent elbow or tissue. Check local advice where you live and work. Do it all!
Make wearing a mask a normal part of being around other people. The appropriate use, storage and cleaning or disposal of masks are essential to make them as effective as possible.”
SAGE told Ministers in May that schoolchildren should wear masks. SAGE did not get rid of masks on freedom day; it was the Government. They decided against the advice. Frankly, it has not been a freedom day for the many people who have caught Covid since mid-July and been in hospital, or for the many who have died.
Sky News reported on 6 July on a report in the Lancet that showed why masks were effective. If noble Lords doubt me, they should just put “Sky News” and
“COVID-19: Do face masks work? Here is what scientific studies say”
into their browser. The evidence is there for the noble Lord, Lord Robathan. It includes that the American CDC reported an incident where two hairstylists with minor Covid symptoms
“were found to have interacted with 139 people during an eight-day period. The stylists and the clients all wore masks”
and a not a single one became infected. Sky News said that, on the USS “Theodore Roosevelt”,
“where living quarters and working environments leave little room for social distancing, a study found there was a 70% reduced risk of infection among those who used a face covering.”
The article also said:
“In Thailand, a retrospective case-control study found that among 1,000 people interviewed as part of contact tracing investigations”—
real people and real cases—
“those who reported always having worn a mask during high-risk exposures again experienced a 70% reduced risk of becoming infected compared with others.”
A quick search of the internet will produce many other examples.
The noble Viscount, Lord Ridley, said that many masks do not contain the aerosol droplets as well as the hospital-grade masks do. That is right, but too many people wear their masks insecurely—not pinching the nose frame or pulling back the ties properly. That is the point the World Health Organization was making. Worse, I am sorry to say that too many think they are protected when they wear their masks under their chins. That does not provide for any protection at all.
As before, the problem of recording third doses versus boosters remains. This is vital. The Minister’s predecessor said that this would be dealt with by the end of July. Because third-dose people need a booster in a few months, it has to be listed separately from ordinary boosters. When will the online system be able to record third doses? Those who took part in vaccine clinical trials or have had their vaccines abroad still cannot get them logged on to the systems. Again, the noble Lord, Lord Bethell, promised that this would be sorted before the summer break.
Since 19 July, when we released all mitigation measures here in the UK, why is it that France, Portugal, Spain and other countries have seen a rapid drop in case rates, while the UK has seen a rapid increase: from 320 cases per 100,000 to 488.5 per 100,000? It is very simple. Our plan B is, in fact, those countries’ plan A across western Europe. Those countries have mandates for masks, social distancing and ventilation. These are not studies but real-life examples.
The noble Baroness, Lady Foster, cited Denmark in her contribution. In Denmark, a country that has been particularly successful, there is not even a mandate but the public choose to wear masks and socially distance. They have accepted this because of the strong messaging right from the start by their Government and local government about taking personal responsibility for their friends, neighbours and community. By comparison, the UK stands alone in saying that a daily case rate of up to 100,000 and, from the Prime Minister’s own mouth, 50,000 deaths a year are acceptable. We are creeping towards those numbers right now. The noble Lord, Lord Hunt, referred to Ministers appearing to believe in UK exceptionalism. Perhaps this is exceptionalism of exactly the wrong kind.
I ask the Minister: why has SAGE been meeting only monthly since July? Who calls those meetings and, if SAGE members feel that they need to advise Ministers, do they have to wait for Ministers to seek that advice? That would be helpful to know.
I believe that every single noble Lord who has taken part in this debate would not want to see plan C having to be enacted, especially if it means that the Prime Minister will have to cancel another Christmas. Experts across our country, and even in the World Health Organization, have expressed real concern that if we do not take at least some of the mitigating measures in plan B right now, the Government will have to move to plan C. We do not want that, so please can the Ministers listen to SAGE and put in the mitigations that most of our neighbouring countries accept as normal and good behaviour, to prevent us ever having to retreat into draconian shutdowns again?
GPs: In-person Appointments
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Lord Kamall (Con)
What is important here is that we leave it to the relationship between the GP and the patient to decide the best form of consultation. Sometimes that will be face to face and, if the patient wants a face-to-face consultation but the GP is unable to provide one, they have to give a good medical reason why not. However, we can balance that with online and telephone appointments.
Baroness Brinton (LD) [V]
Many GPs are feeling as if they have been completely thrown to the wolves by Ministers, and even Jeremy Hunt has said that the proposed plan and the £250 million winter access fund to support GPs and reduce the pressures they face is little more than a sticking plaster and will not help, given that the real problem is the shortage of qualified GPs. There are not even locums in many places and no longer applicants for many GP jobs. Has the Minister talked to GPs about their current extensive workload, and will he reconsider the assistance needed to support our exhausted GPs?
Lord Kamall (Con)
It is important that we listen to GPs and understand their needs and how we can support them. We have committed to growing and diversifying the workforce and boosting GP recruitment. We have also committed to recruiting an additional 26,000 primary care staff to be embedded in multidisciplinary teams. The details of the training will be left to the trainers themselves.
Drugs: Black Review
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Lord Kamall (Con)
In September 2020, Kit Malthouse and Jo Churchill, the then Minister for Prevention, Public Health and Primary Care, co-chaired a UK ministerial meeting focusing on UK-wide approaches to drugs misuse. The second UK drugs ministerial took place at Hillsborough Castle in Belfast on 11 October. The Government maintain a commitment to consulting the devolved Administrations—or devolved Governments in many cases—as well as a number of expert speakers.
Baroness Brinton (LD) [V]
My Lords, the Government’s initial response welcoming Dame Carol Black’s recommendation to create a cross-departmental approach to tackling drugs misuse and related harm is welcome. However, they have not responded to many of the key recommendations, of which the most important is the introduction of multi-year ring-fenced funding for treatment services, distributed by local need, with at least £552 million invested in the treatment system annually by the end of year 5. When will the Government’s full response be published? Will Dame Carol’s recommendations be fully funded?
Lord Kamall (Con)
The Government have committed to giving a full response to Dame Carol Black’s review by the end of the year and have already taken action. Since part 1 of her review, the Government have announced £148 million of investment to tackle drugs misuse, supply and county-lines activity. That also includes £80 million for drug treatment and recovery services.
HIV Action Plan
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Lord Kamall (Con)
I am afraid I do not have a detailed answer to the question from the noble Baroness, but I commit to write to her.
Baroness Brinton (LD) [V]
My Lords, the Minister was right to highlight the fact that sexual health funding comes from public health budgets through local authorities. The Terrence Higgins Trust and British Association for Sexual Health and HIV report from 2019 showed that five years of cuts to public health and sexual health funding have had a direct impact on access to sexual health services. So can I push the Minister to confirm that there will be a real-terms cash increase, to fully fund the HIV action plan, to local authorities’ public health budgets for the next three years?
Lord Kamall (Con)
I thank the noble Baroness for her question. The department is currently developing a new sexual and reproductive health strategy and an HIV action plan, as she referred to. We plan to publish the HIV action plan later this year to coincide with World AIDS Day on 1 December. The action plan will set out clear actions to achieve the interim target of reaching an 80% reduction in HIV transmissions in England by 2025. Publication of the detailed sexual and reproductive health strategy will follow shortly afterwards.
Social Care in England
Baroness Brinton Excerpts(3 years, 1 month ago)
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Baroness Brinton (LD) [V]
My Lords, I declare my interest as a vice-president of the Local Government Association and a vice-chair of the All-Party Parliamentary Group on Adult Social Care. I am disabled as the result of a long-term condition and my husband is my unpaid carer.
I congratulate the noble Baroness, Lady Pitkeathley, on securing this vital and timely debate today. As she said, it is a repeated debate and, frankly, it will continue to need to be repeated until the Government tackle the issues raised in it. Her speech cogently set out both the long-standing problems and the current emergencies that are tipping the social care sector into real crisis, with our extremely vulnerable citizens now finding that it is harder to get social care support and, even more worryingly, vacant beds in homes along with homes closing meaning that some geographic areas face a real crisis.
The right reverend Prelate the Bishop of Oxford spoke movingly of the role of families in supporting their loved ones, and the dignity that this gives to both the person receiving the care and their carers. We on these Benches agree. People should be encouraged to stay in their homes and with their families for as long as is practicable.
The noble Baroness, Lady Finlay, reminded us that access to professional care is in extremely short supply. That so many people in that survey approaching the end of their lives could say that they felt they needed more help was not a criticism of the care that they received but a demonstration of how broken the system is.
My noble friend Lady Thomas of Winchester spoke from personal experience of the reality of the problems faced by the domiciliary care staff who work for her, and of how they are so low-paid yet highly skilled. This is an iniquity that needs to be remedied.
Care workers need to be paid at least at the same rate as an NHS healthcare assistant. If they were, they would receive an instant £2 per hour rise, which would cost the country £40 million. Healthcare assistants in the NHS are not particularly well paid either, but the key fact is that there is no wriggle room to pay those extra funds from the limited resources allocated to the social care sector. We should not have private beds in care homes helping to subsidise state funding; that is another iniquity.
Workforce issues are already forcing homes to refuse to take patients because they just do not have the staff to look after them safely. We know that these staff are skilled beyond measure but they are paid at the minimum wage because, shamefully, we as a society still regard social care as unskilled. The funding rates for residents are based on most staff being on the minimum wage, making it impossible now for employers in the sector to compete with retail, hospitality and even agriculture, where employers can charge customers more and therefore pay their staff more. Worse, these dedicated staff will be paying the increase in national insurance, which will further reduce their income at the exact same time as they face a cut in universal credit and an increase in energy costs and food and many other items.
The noble Lord, Lord Astor, spoke of the pressures on local commissioning. He spoke of staff territorialism and empire-building, but I think that is the wrong way to look at it. The current assessment system requires the NHS and local authorities to fight over whether personal care needs are caused by health issues or ageing, and this is demeaning at best. Staff with limited budgets argue over whether incontinence was caused by dementia or by a health issue, because of course in their eyes dementia is not paid for by the NHS. I think what he is referring to is not staff empire-building but staff with limited budgets desperately trying to protect their funds for the many more people who need it.
Over the last five years the public funding for social care via local authorities has not increased in line with demographic demand, so that now most councils say they are spending three-quarters of their funds on social care. Skills for Care forecasts that if the adult social care workforce grows proportionate to the projected number of people aged 65 or over in the population between now and 2035, an increase of just under 30% —around 500,000 extra jobs—will be required. That is an eye-watering number. The health and social care levy and the Build Back Better: Our Plan for Health and Social Care report do not even start to address that. What are the workforce plans? I understand that the specific extra amount for the next three years in workforce is about training, not for wages, let alone for pay rises.
Build Back Better: Our Plan for Health and Social Care, published last month, is not a plan for health and social care: it is a funding plan for the NHS, looking at how individuals pay for their social care and which elements will be paid for by the state. We have seen that the structures for paying the costs of these will need support beyond the proposed cap and, as others have mentioned in this debate, will not cover the accommodation and food costs laughingly called hotel costs. That means the public, who think the new arrangements that they are paying tax for mean they will not have to sell their homes, are in for a shock: they are going to have to sell their homes even if they get the health element paid for by the state.
Last week the Secretary of State for Health and Social Care told the Conservative conference that we did not need the care sectors, as families should just look after their own. It is as if he does not know that the cost of inaction and delay is already falling on the 11.5 million unpaid carers in the UK whose contribution to the current social care system is almost completely ignored. The cost of reform to the Government may seem large, but it is a fraction of the true cost to families across the countries. Carers UK has estimated that unpaid carers save the Treasury £193 billion a year already.
What analysis have the Government made of the Dilnot reforms? How will what they are proposing help unpaid carers with the challenges that they face —for example, in securing breaks from their caring responsibilities? Are the Government planning to put in place a cross-departmental and comprehensive carers strategy or action plan to ensure that those providing unpaid care get the support that they urgently need as we emerge from this pandemic?
My noble friend Lady Tyler of Enfield movingly explained the reality of the pandemic for those in care homes, with some 40,000 deaths of residents. That is deeply shocking and, as she said, a real national scandal. It has undoubtedly made the serious crisis in the sector much worse.
We have spent decades waiting for reforms. Fifty years ago, we still had remnants of provision in former workhouses; I know that because I visited elderly residents while I was still in school. Twenty-five years ago, too many local authorities had to close their homes as they did not have the resources to upgrade their accommodation, and that is when the private sector began to blossom. Ten years ago, though, austerity cuts started, not just in social care but in all the vital ancillary services that keep people independent and managing at home: supported housing, adult day services and community nurses. So it was hopeful 10 years ago when the three major parties all came together to support the report by Andrew Dilnot’s commission—but in 2014 the Conservatives walked away, and the crisis in the sector has worsened considerably.
The noble Lord, Lord Cashman, was right to highlight these services. Meals on wheels or lunches at day centres are often now a thing of the past in too many areas because the councils just do not have the resources. There are some good examples. In Cornwall, some services for school lunches for children are now combined with what was meals on wheels. In some really innovative areas, they are beginning to have lunch together. We know that it keeps people active to mix with younger people as well. Why are we not learning from good practice elsewhere? In the Netherlands, some care homes recruit students to live in and work part-time there to help fund their degree studies. That has been noted to reduce the progress of dementia. It keeps residents active and, vitally, changes the career choices of the students who take part in it.
We know that there are limits on publicly funded costs, and the position regarding privately funded beds must stop now, but this means that real rates need to be paid to reflect that cost. By the way, from these Benches we also echo the urging of the noble Lord, Lord Cashman, for real funding for local authorities to recognise their key role in commissioning services to keep people active and healthy. The Government’s proposed council tax increase of 5% per annum for three years to help fund social care is also iniquitous. Council tax is even more regressive than national insurance and, frankly, for some councils that 5% will not touch the sides of their new responsibilities under the reforms for assessment and commissioning.
The worry is that the Government are doing everything upside down. On Monday, your Lordships’ House debated and completed consideration of the Health and Social Care Levy Bill, but we have not yet seen the White Paper on social care that the PM promised on the steps of No. 10 Downing Street two years ago. We heard leaks over the weekend from the Government that there may also be an integrated services White Paper, streamlining health and social care. That is rich, given that the health and social care Bill is going through the House of Commons at the moment and is due in your Lordships’ House before the end of the year.
What is it about this Government that means they subvert the parliamentary process and force parliamentarians to vote on proposals before the details are published for wider consultation? I am afraid that just sets the real context of this debate about social care. For decades, social care has faced a crisis. The pandemic has exacerbated that. We face a real emergency and the Government need to act now.
Virginity Testing
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Lord Kamall (Con)
We completely agree with my noble friend’s sentiments. It is really important that we ban virginity testing and hymenoplasty as soon as possible. The issue on hymenoplasty in particular is that, unfortunately, because it is classified as a cosmetic procedure, introducing legislation in this space might take away the right for women to make decisions about procedures that they wish to have and be counter to current regulation on cosmetic surgery. It is important that we work out how we can ban this practice, but those objections have been raised—and if those legal objections have been raised, we have to be careful that we work properly to make sure that we ban these procedures.
I give the commitment that I shall push as much as possible to make sure that we ban both virginity testing and hymenoplasty as soon as possible. My noble friend mentioned the amendments in the other place. The Member who submitted those amendments has been in consultation with the Department for Health and Social Care, and we hope to be able to introduce those changes, particularly those bans, as soon as possible.
Baroness Brinton (LD) [V]
My Lords, I also welcome the noble Lord, Lord Kamall, to the Dispatch Box. I want to pick up on points that the noble Baroness, Lady Sugg, raised. Some private clinics advertise these procedures to women, which perpetuate myths around virginity, falling way below the standards of honesty and integrity that are rightly expected of doctors. Indeed, the GMC ethical guidance on communicating information explicitly outlines that, when advertising your services, you must make sure that the information that you publish is factual, can be checked, and does not exploit patients. We have waited far too long for this to be made illegal. Can the Minister please press to make this happen sooner rather than later?
Lord Kamall (Con)
I thank the noble Baroness for her question, but also for having a meeting with me to discuss some of the issues that we will debate in future weeks and months. All preparation and revision are welcome.
I give a pledge that I will push back at my department and push to have both these practices banned as quickly as possible. However, as I said, some concerns have been raised from a legal perspective, given that hymenoplasty is a cosmetic procedure. All of us would agree that this is an awful thing and that it should be banned, but I want to make sure that in doing it we are very careful. A few years ago, I was a research director for a think tank, and one issue that I always considered with any change of law was unintended consequences. We have to be clear that we do this in a proper way, and I hope that we can introduce these bans as soon as possible.
Social Care Funding: Intergenerational Impact
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Baroness Brinton (LD) [V]
My Lords, I declare my interests as a vice-president of the Local Government Association and a vice-chair of the All-Party Parliamentary Group on Adult Social Care. The quality of contributions from around the House demonstrates that this is a complex issue.
I agree with the IFF, the Resolution Foundation and my noble friend Lady Tyler that using national insurance is not equitable to those coming behind us baby boomers. That is why, on these Benches, we believe that income tax should be the mechanism, despite what the IFF says, given the combination that many people who retire after their retirement date pay tax up to that point, while many pensioners pay income tax because of the level of their private pensions, while the poorest pensioners do not. That is also progressive, as well as more generationally fair in terms of raising income.
By way of illustration, I want to make two brief comments about those affected badly by these proposals. The first is children who need to access social care and their families. If we think that the funding adult of social care is in crisis, social care provision for disabled children is much worse, with exhausted parents having to pick up the care 24/7. Can I ask the Minister, not for the first time, what plans there are to remedy that situation as a matter of urgency as such provision is excluded from these proposals?
My second point relates to those who care for our vulnerable elderly—the wonderful care home and domiciliary staff who will also be badly affected by the levy proposals. The 2020 Skills for Care workforce survey states that their average age is 44, average pay is £8.50 per hour and over a quarter are on zero-hours contracts. Worse, some are about to see £20 per week disappear from their universal credit at a time when energy and food bills have substantially increased in recent months. Now, they will also have to pay the increased national insurance contribution.
Worse, it appears that, unlike the NHS, social care providers will not get extra budget to cover the increased employer national insurance contributions, which means that there will be less funding available to increase the basic rate of pay of staff or spend on staff development and training.
However, the final unfairness for our younger staff and older people using social care is that it appears that, after the NHS has taken the bulk of the levy funding, virtually all the remaining levy will go towards the funding structures—as the noble Lord, Lord Lipsey, outlined—and not into care homes, meaning that funding for the essential front line of social care service just will not happen.
NHS: Hospital Visiting
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Lord Bethell (Con)
What a touching piece of testimony from my noble friend. The feelings he had as a child are felt by a great number of people, not only those in hospital and social care but their loved ones. We are mindful of the impact of visiting on the mental health and the good feeling of those in hospital. Visiting was suspended on 4 April last year, but that suspension was lifted on 5 June. Since then, we have sought wherever possible to put careful visiting policies in place. In October last year, the number of visitors was limited to one family contact or somebody important to the patient; since then, we have made huge strides in trying to lift those restrictions wherever we can. It is left to trusts to implement exactly those restrictions that are suitable to maintain infection control in their area.
Baroness Brinton (LD) [V]
My Lords, in his Answer to the noble Lord, Lord Farmer, the Minister said it was vital to keep hospitals safe from Covid infections. There are now over 8,400 Covid patients in hospital with around 1,000 daily admissions and rising. SAGE is concerned that, in a month, there could be 8,000 patients a day. Paragraph 36 of yesterday’s autumn and winter plan says that the UK HSA is reviewing easing specific infection prevention and control and social distancing to better manage activity. Can the Minister give assurances that this will not happen while cases in hospital continue to increase at this rate?
Lord Bethell (Con)
We are trying to have visiting policies that are proportionate to the situation. To reassure the noble Baroness, as she probably knows, the number of visitors at the bedside is currently limited to one close family contact and somebody important to the patient. Those are the guidelines we have in place. As I said, we leave it to trusts to run their own infection control measures. She is entirely right that the potential for nosocomial infections within hospitals, which was such a serious feature of the pandemic last year, is one that we are extremely wary of and careful about.
Covid-19
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Baroness Thornton (Lab)
Normally, of course, we would have taken these Statements separately but on this occasion, we can take them together. I hope we are working towards taking Statements on the day they are made in the Commons wherever possible.
I looked back at this week in 2020. This time last year, the Prime Minister introduced the rule of six—and really confused the nation. Covid marshals were introduced and the offence of mingling appeared on the statute book. We had infection rates rising, from the young to the middle-aged, and we were very concerned that that meant that they would move into the older cohort of the population. I of course acknowledge that vaccine and testing regimes have made a huge difference, but the lesson we need to learn from last year, and which is signalled in the recent SAGE report, is the need to take action in a timely fashion—which, I am afraid, the Government failed to do from time to time last year.
On Monday, we had confirmation of the vaccine programme for children, and we on these Benches welcome that and support the decision and recommendation of the CMO. Children may not have been the face of this crisis, but they have certainly been among its biggest victims. Yesterday, the Secretary of State also confirmed a booster jab and again, we on these Benches welcome and support that. The obvious question is: how will all this be done? In addition to the issues of our young people, booster jabs and the flu vaccine, we have areas of the country where vaccine take-up remains relatively low. For example, in Bradford, where I am from, second doses are running at 65%; in Wolverhampton, 65%; in Burnley, 69%; and in Leicester, 61%. The first question has to be: what support will be given to those areas and others so that they can boost their vaccine take-up?
Can the Minister explain to the House what the next stage in the children’s vaccination programme will look like and by what date he anticipates that children will be vaccinated? Will it be the responsibility of parents to arrange their children’s vaccination, or will the local NHS arrange it with schools, year by year, or class by class? Will the flu vaccine, which is this year being expanded to secondary schoolchildren, be delivered at the same time as the Covid vaccine or separately? Can the Minister explain what steps will be taken to ensure that parents are informed of the benefits and risks of the vaccination? Can he confirm the Government’s position in rolling out the vaccine and whether the consent of parents will be necessary, because surely the Gillick principle will come into play here? Can the Minister explain why, 470 days since SAGE warned about the importance of ventilation in schools and colleges, it looks as though not a huge amount of action has been taken?
Yesterday, in Grand Committee, I raised the issue of anti-vaxxers demonstrating outside our secondary schools. Given the creation of safety zones around hospitals to prevent harassment and bullying from anti-vaxxers and ensure the safety of our healthcare workers, patients and their caregivers, what will we do about our schools? Can the Minister confirm that the duty of schools, their leaders and the Government is to protect vulnerable children from any form of intimidation or demonstration at their school gates? What is his view of this matter?
Despite the success of the vaccine rollout, the delta variant continues to pose a considerable threat to people. Those who are sick with the delta Covid variant are twice as likely to need hospital care as those who contract the alpha variant. Of course, the UK has not yet experienced delta in the winter. The Government have acknowledged that there is a “plausible” risk of cases rising to an extent that would place the NHS under “unsustainable pressure”. Can the Minister advise the House at what point different measures in the plan will therefore be introduced?
The Government—and, indeed, the scientists—note that
“the epidemic is entering a period of uncertainty … It will take several weeks to be able to fully understand the impact of any such changes.”
In its report, SAGE stressed the “importance of acting early” if cases rise to stop the epidemic growing. It warned:
“Early, ‘low-cost’ interventions may forestall need for more disruptive measures and avoid an unacceptable level of hospitalisations … Late action is likely to require harder measures.”
Given that deaths are currently five times what they were a year ago, with hospitalisations four times as high, why are the Government not already pursuing light-touch measures, such as mandatory masks? The CSA, Patrick Vallance, said that the UK is now at a “pivot point” where, if the situation worsens, it could do so rapidly—so would light-touch measures not be prudent?
The Autumn and Winter Plan states that the Government want
“to sustain the progress made and prepare the country for future challenges … by … Identifying and isolating positive cases to limit transmission”.
Yet the Health Secretary said that no decision has yet been taken as to whether pupils in England will continue to undergo regular testing. Does the Minister share my concern that ending regular testing for pupils is contrary to that key plank in the winter plan?
Although we are still waiting to hear what changes will be made to Covid travel rules, the Health Secretary implied that PCR tests for fully vaccinated travellers will be replaced with lateral flow tests. What will this mean in terms of possible delays in identifying cases involving variants of interest or concern to the UK?
The Health Secretary also confirmed that, although the plans for mandatory vaccine-only Covid-status certification have been shelved for now, the Government may well pursue them in future under the plan B scenario. Can the Minister provide further details about which settings and scenarios will be involved? Can he confirm whether this will require primary legislation?
Baroness Brinton (LD) [V]
My Lords, the publication of the 33-page Covid Autumn and Winter Plan, including plans A and B, rightly talks about the need to resume life as normally as is possible while Covid is still around, but to move into restrictions faster if cases surge and the NHS is pressured. The World Health Organization’s special envoy on Covid, Dr David Nabarro, has said that the UK is right to find a way to live with the virus. However, he added:
“Speed is of the essence. We’ve been through this before and we know, as a result of past experience, that acting quickly and acting quite robustly is the way you get on top of this virus, then life can go on. Whereas if you’re a bit slower, then it can build up and become very heavy and hospitals fill up, and then you have to take all sorts of emergency action.”
Why does the Statement talk about the vital importance of mitigations, such as meeting outdoors where possible, ensuring ventilation if inside and wearing face coverings? Why are there no clearer, repeated messages for the general public about all these vital interventions, especially what we can all do now to slow down the increase in cases and hospital admissions?
At the No. 10 press conference on Monday, Professor Chris Whitty said:
“Anybody who believes that the big risk of Covid is all in the past and it’s too late to make a difference has not understood where we are going to head as we go into autumn and winter.”
He is right to be concerned. The seven-day rolling figure for daily hospital admissions is now around 1,000, with an average of 8,400 Covid patients in hospital beds. These numbers are considerably greater than they were this time last year. SAGE is very concerned that, as rules are further relaxed and people start coming back into work, the number of Covid patients going into hospital is set to increase substantially. This would put the NHS under real pressure, with perhaps as many as 7,000 admissions a day in six or so weeks, so it says.
The Statement announces the final decision on the booster scheme for those aged over 50, healthcare staff and the clinically extremely vulnerable, following the third dose for the half a million people who are severely clinically vulnerable. We welcome this. However, the World Health Organization reminded us that we should also be providing doses for low-income countries, but I see that the Government are planning only 100 million doses over the next few months. That is a drop in the ocean given that only 2% of the populations of low-income countries have been vaccinated. Will the Government agree to review and increase this number?
We on these Benches welcome the news on 12 to 15 year-olds getting vaccines. We accept that this was a difficult and complex decision, but we are pleased that there finally is one. There was an excellent slot on the “Today” programme this morning, with a group of 12 year-olds asking a paediatrician some questions; he had to look one answer up on Google. I hope that all parents and children will be able to access this sort of information because we know that it makes all the difference in coming to a decision.
However, as the noble Baroness, Lady Thornton, said, anti-vaxxers are causing serious problems. Good on Chris Whitty for what he said about one celebrity who attacked the idea of 12 to 15 year-olds having vaccines. However, today, yet another celebrity attacked him on social media, saying that he should be hanged. That is disgraceful. What are the Government doing about public servants like Professor Whitty being threatened in this way? As importantly, what will the Government do about the disinformation that people are now spreading at school gates, including leaflets with the NHS logo on them?
Ten days ago, Dr Jenny Harries announced that all clinically extremely vulnerable children in England—even those still on chemotherapy—would be removed from the CEV list and expected to return to school as term was starting, regardless of their underlying condition or the fact that there are no masks, bubbles or even, in many schools, proper ventilation. Although it is really important to have all children back in school, this cohort of children is at particular risk. Their consultants and GPs are as bemused as their parents, so why is Jenny Harries’s letter to the parents of these children, explaining why they are being removed from the CEV list, not on either the NHS or UKHSA website? Will the Minister write to me to explain this decision? We are hearing confusion from parents and medics alike.
Finally, last week, I commented on the continuing farce of Ministers U-turning daily on the use of vaccine passports for clubs. It is confusing to keep up with the U-turns on U-turns; I note that the Statement is trying to have it both ways. I suspect that Ministers could do with some new flip-flops.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
I thank the noble Baronesses, Lady Thornton and Lady Brinton, for such thoughtful questions. I am very pleased to be here to answer questions on both these Statements, and I thank the noble Baroness, Lady Thornton, for her kind remarks earlier.
I too welcome the decision to bring forward the vaccination of children. I reassure the noble Baroness, Lady Thornton, that it will be done in the same way that a large number of other vaccinations are run through the school process. As I am sure she knows, vaccinations for things such as HPV and flu have been done at primary school for some time and there are extremely well-established and thoughtful protocols for handling them. They are handled not by school nurses but by nurses employed by the local authority or on contract by the local CCG to deliver the vaccinations, and the consent forms are handled directly with the parents. There is an extremely well-established process for the very rare occasions where there is a difference of opinion between the child and the parents. It is important that we get that right. I reassure the Chamber that this process for vaccinations has been handled for years. The professionals who deal with such disagreements are extremely well trained and the Gillick principles, which are extremely well known, will be applied to the Covid vaccination. I think all noble Lords agree that that is entirely right. Children aged between 12 and 15 will be provided with information, usually in the form of a leaflet, for their use. The school- age immunisation provider will, prior to vaccination, seek consent for all the vaccination programmes.
The noble Baroness, Lady Thornton, quite rightly raised the question of children being pressured into taking or not taking the vaccine. I reassure her that the school-age vaccination programme and the clinicians involved are very well equipped and are well versed in dealing with vaccines in schools; this will not be a new thing for the schools or professionals involved. Their ability to gain consent and to communicate exactly why the Chief Medical Officer has gone ahead is an important element of the decision to accept the recommendation from the CMO on the back of the JCVI recommendation. The four CMOs have said that it is essential that children and young people aged 12 to 15 and their parents are supported in their decisions, whatever decisions they take, and are not stigmatised for accepting or not accepting the vaccination offer. Individual choice will be respected.
The rollout is starting immediately, at the beginning of next week, and we expect that it will end in schools by the end of November. The advice from Dr June Raine of the MHRA is that the flu and Covid vaccinations can happen contemporaneously—studies have supported that—but that will not necessarily happen in every case. The practicalities of the supply of Covid and flu vaccines are, as noble Lords know, extremely complex, and we do not want to make a complicated situation any worse by trying to force a combination if it is not possible.
The noble Baroness, Lady Thornton, asked about our arrangements for the current winter period and particularly about mandatory masks. I completely understand the concern of noble Lords in the Chamber about making masks mandatory. The noble Baroness, Lady Thornton, referred to it as “light touch”, but our feeling is that it is not light touch to mandate the wearing of masks; in fact, it is an intrusion into people’s life in the most intimate way. That is not to say that it should not happen at all, but we are at a stage of the pandemic where we are trying to move the responsibility for individual choices, such as wearing masks, on to people to take it for themselves. Of course, if the worst happens and we have to move into plan B, we have the legal and influential role to be able to mandate masks, but at this stage it feels proportionate to try to use persuasion rather than mandation.
I remind noble Lords that the messaging around the pandemic is not the only thing we are trying to do right now. In response to the remarks of the noble Baroness, Lady Brinton, about public messaging, I reassure her that I am the Minister who signs off the marketing around Covid and other health messaging. We are currently spending a substantial sum communicating our messages on Covid. The fact that she thinks they do not exist is an example of the public exhaustion that is an inevitable result of 18 months of relentless campaigning on Covid. We have to recognise that the public can hear us only so many times before they start tuning out the message.
There are other very important messages that we have to get through to the public, the most important of which is for those who show symptoms of other diseases to step forward to get their tests, so that we can catch people who are ill with non-Covid diseases. We have a massive backlog of diagnostics; the NHS figure on the expected numbers of people who have diseases such as cancer, and need to be seen by GPs and specialists, is huge. We need to get those messages across to people as well and, while it is not a zero-sum game, to be aware that these messages compete with each other. We are using this moment where there is a pause in the Covid epidemic to try to get people back into the GP surgeries and the diagnostic hubs—back into hospital—to try to catch diseases and reduce the lists. That fightback is extremely important and is one of the reasons why we are focused on the “Help us to help you” messaging.
The noble Baroness, Lady Thornton, asked about testing in schools. I reassure her that we have not only put a huge effort into the double supervised testing which, as she knows, kicked off the school term but are sustaining the support for school testing. There will be a review at the end of September but there are no current plans to end regular testing in schools. We have to ensure that there is value for money and that the testing is effective, but it is extremely well supported by schools. I believe it has made a serious impact on the spread of disease within schools and pay tribute to teachers, headmasters, parents and pupils for the high rates of uptake in schools. Around one-third of all positive cases are tracked down through asymptomatic testing, which is a really good indication of how effective it is at breaking the chains of transmission.
There is a review of our border arrangements in play, and I believe the Secretary of State for Transport will be making a Statement tomorrow. However, I reassure the noble Baroness that we take border control extremely seriously. We are very conscious of the threat from variants of concern. At the same time, however, we have to recognise that vaccination makes a big difference and be proportionate in our border arrangements. We are conscious that although travel is regarded as a voluntary matter, people may have strong family roots or good business reasons. Being able to travel is one of the great joys and loves of people’s lives, so we are seeking to be proportionate and reasonable in our travel arrangements. The Secretary of State will make further announcements on that tomorrow.
On the point made by the noble Baroness, Lady Brinton, on public servants, I could not agree more. The rhetoric that has been directed at public servants such as Chris Whitty and JVT sometimes leaves one feeling quite cold and disappointed at the British public. As she probably knows, we have made arrangements to put a big arm around those people who have been threatened and improve the security arrangements for them. I call on everyone to express support for our public servants, who have a very tough job. They are often communicating unpalatable, difficult truths to the public and challenging some of the assumptions and preconceptions of those who would like life to be slightly different from what it really is.
In particular, I noted the physical attack on the MHRA headquarters in Canary Wharf 10 days ago. Videos of that attack really disturbed me; it was brutal, nasty and ferocious. I pay tribute to the Metropolitan Police, who responded extremely quickly and emphatically, and to professionals at the MHRA who had steady nerves on that Friday afternoon. We cannot operate in a society where differences of opinion about public health policy lead to physical violence on the streets of London. I absolutely condemn those who participate in physical attacks of that nature, along with the kind of violent extremism that calls for people to be hanged. This is no time for that kind of extremism. Those who participate in it are trying to divide society. They really need to move on and find something else to do.
I am extremely pleased to hear what I think was the implicit support of the noble Baroness, Lady Brinton, for the principle of vaccine passports. It is right that we hold such an intimate and strong measure in reserve in case we need it for plan B. The technical and regulatory arrangements for the measures have been put in place but we have held off the implementation because it is not felt that it is needed right now. However, should it be needed either to break the chains of infection and restrain the spread of the virus or to encourage vaccine uptake, which is one of the benefits of such a measure, we will turn to it as part of our plan B measures. That is a proportionate treatment of that potent but very heavy state intervention.