Hospital Waiting Lists
Baroness Brinton Excerpts(3 years, 5 months ago)
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Lord Bethell (Con)
My Lords, there has been an enormous pandemic, which has, of course, had a huge impact on the healthcare system. During the pandemic, the financial support for the NHS—as well as the system support—has been huge and had a huge impact. We are looking at a backlog and working hard to get through it, but noble Lords should be in no doubt that we are thoroughly committed to getting back to full operational capacity.
Baroness Brinton (LD) [V]
My Lords, around 10 million people across the UK are affected by arthritis, and the widespread impact of rheumatology conditions costs the NHS over £10 billion a year. The recent British Society of Rheumatology report, Rheumatology Workforce: A Crisis in Numbers, lays bare the shortage of all multidisciplinary staff, including the consultants, nurse specialists and physiotherapists who are needed to deliver the NICE treatment guidelines. This shortage of staff and funding is already impacting severely on rheumatology waiting lists. Can the Minister say how this funding and workforce gap can be addressed with immediate effect? If he does not have the figures and answer to hand, please can he write to me?
Lord Bethell (Con)
The noble Baroness points very well to exactly the kind of challenge that we face at the moment. She is entirely right that conditions such as arthritis and rheumatology require complex combinations and collaboration between many different staff, as well as the application of new and effective treatments and therapies. That is exactly where we are working hard to catch up. I will go back to the apartment, dig out any statistics I can and write to her accordingly.
Social Care Reform
Baroness Brinton Excerpts(3 years, 5 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell)
My Lords, the commitment to publishing a review of social care is absolutely heartfelt. We have delivered on Brexit and the vaccines, and we will deliver on social care. The Prime Minister has made it crystal clear that that will be done by the end of the year; that commitment remains in place. It will require enormous financial commitment by the whole nation at a time when our finances as a nation are extremely stretched. Therefore, it is entirely right that very careful consideration is given to it. It will also involve a very large amount of engagement with other parties and the relevant stakeholders. Again, this is not something that has been rushed. We have just been through the most awful pandemic; it is not possible to do a review of this generational nature at the same time as fighting this awful disease, but we will be true to our commitments and deliver the plan as promised.
Baroness Brinton (LD) [V]
My Lords, in last Thursday’s debate on social care and carers, the Minister said
“a plan for reform absolutely is under way. We have before us the building of foundations, which will be laid in the social care measures in the health and care Bill, which will support us in working together”.—[Official Report, 24/6/2021; col. 447.]
Arising from that, is it planned to publish a White Paper or any other consultation document or, as the Minister’s speech implied, will the reforms be published as part of the health and social care Bill without any wider consultation? Given his answer just now to the noble Baroness, Lady Wheeler, will parliamentarians be ask to make decisions on the health and social care Bill without seeing the details of the future social care reforms?
Lord Bethell (Con)
My Lords, new legislation will increase integration between health and social care by removing barriers to data-sharing, enabling joint decision-making and putting more power and autonomy into local systems. The noble Baroness is entirely right on that. The Bill has been published and the noble Baroness is very welcome to engage in some of the engagement sessions that I have had on it already. I should be glad to run more, if that would be helpful to her. A White Paper and a public consultation are not planned.
Covid-19 Update
Baroness Brinton Excerpts(3 years, 5 months ago)
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Baroness Thornton (Lab)
My Lords, I start by saying how much these Benches identify with the words the Government have issued about the horrifying treatment of Chris Whitty, our Chief Medical Officer. It was completely shocking and disgraceful. For a truly amazing public servant to be treated like this is unacceptable at any level.
I thank the Minister for presenting the Statement and echo the words of my right honourable friend John Ashworth yesterday in welcoming the new Secretary of State to his position. It was pleasing to see the new Secretary of State at St Thomas’ Hospital yesterday; I hope it is the first of many visits to our inspirational and dedicated NHS and social care staff. I hope the Minister’s new boss will be more receptive than the previous one and make arrangements for them to receive a fair pay rise, and not the real-terms pay cut that is currently pencilled in.
Yesterday the Secretary of State let it be known that the 19 July reopening will, in effect, go ahead. He told the news that there is “no going back” and that lifting the restrictions will be “irreversible”. It is probably not an exaggeration to say that many across your Lordships’ House will give a collective and noble eye- roll at these words. Like many here—and unlike the Secretary of State—we have responded to a lot of these Statements in the last 15 months. We heard that there was “nothing in the data” to suggest that 21 June could not go ahead. Noble Lords will remember that children returned to school for one day before the January lockdown and the words “It will all be over by Christmas.” Some time last spring, I think the words “We will send it packing in 12 weeks” were used.
The context this time is that there has been a rise of 84,000 cases in the past week—an increase of 61%. Yesterday saw the highest case rate since January. If these trends continue, we could hit 35,000 to 45,000 cases a day by 19 July. We know that this variant means fewer hospitalisations and fatalities, but it also means that young people will become ill and some will have long Covid. It will again mean disruption to our schools and our youngsters’ learning and socialisation. When will we see a review of the arrangements in schools?
We also all know that this is a race between the vaccine and the infection, but I fear it will not be won by the vaccine in the next three weeks, so if we are looking at possibly 200,000 people infected with Covid on 19 July, the Minister needs to tell us what impact that will have on the road map out of restrictions. Can he confirm whether “irreversible” means the Government are now ruling out restrictions this winter? Have they abandoned the plan that the previous Secretary of State and officials were drawing up for that?
The Secretary of State has promised to give the NHS everything it needs to get through the backlog, so will the hospital discharge and support funding be extended beyond this September, or will trusts have to make cuts instead? We have already had some discussion about the backlog today; for example, when will the NHS again guarantee that 95% of patients will start treatment within 18 weeks of referral? How long is it likely to be until we can reach those sorts of targets again? When will the Government give primary care the resources to meet the challenge of the hidden waiting list of over 7 million patient referrals that we would have expected since March 2020?
Given the pressures on primary care, is it still the Secretary of State’s plan to press ahead with the GP data transfer? Frankly, if this department cannot keep its own CCTV footage secure, how does the Minister expect it to keep our personal data secure? I think that is a legitimate question.
Given the pressures across the whole healthcare system, will the Government now abandon the ill-thought-out top-down reorganisation of the NHS that the previous Secretary of State was about to embark on?
Finally, I have raised with the Minister the importance of the Nolan principles which must guide the ethics and behaviour of us all, particularly those in government. The Good Law Project today published emails which used the noble Lord’s private address. Transparency is the word I am looking for here. The spotlight has been turned on the Minister in recent days, including a formal complaint to the Lords commissioners about the issuing of passes.
The Minister might do well to consider a couple of things: actually referring himself to the commissioners about that matter, if there is a chance he may have acted outside the rules, and—he has had to deal with this question several times and is very robust about it—making his emails and communications transparent and explaining them. He is sure that he has done nothing outside those rules; he would therefore be wise to be transparent about that. It is not the original scandal that gets people in the most trouble—it is the attempted cover-up, or the chance that there might be one. Transparency is the best advice I can give the Minister today.
Baroness Brinton (LD) [V]
My Lords, I echo on behalf of these Benches the concerns about the treatment of Professor Chris Whitty. It is totally unacceptable, and it is good news that the police are now investigating this.
Just now, in reply to my question on the Urgent Question, the Minister said that the health and social care Bill has been published. Over the last few minutes I have been searching the web, but I cannot find it— can he help me any further?
Yesterday’s Statement from the new Secretary of State struck an interesting new note. The department is clearly no longer going to be led by data but by dates. Yesterday, 22,868 new cases of Covid were reported. This time last year, when lockdown was finally lifted, daily cases were under 1,000. Even with the high level of vaccinations, this is causing illness and pressures on the NHS—even if it is a different kind of pressure to that of a year ago. On Sunday, Andrew Marr reported on his programme that his own experience of catching Covid had been difficult. He said that, while he had not needed to go to hospital, he was more ill than he had ever imagined possible, and it was not an asymptomatic experience. In the light of this and the reports of growing numbers of people living with long Covid, can the Minister say why data will now clearly not factor into the decisions about 19 July?
On these Benches, we believe that we need to learn to live with this disease, but unlike the Statement from the new Secretary of State, we do not believe that this is just about vaccination, important though that is. This week, Israel has found that, despite early and comprehensive levels of vaccination, the delta variant is ripping through its communities. We have argued since February 2020 that controlling outbreaks is vital. Can I ask the Minister about the provision of test, trace and isolate arrangements moving forward? Specifically, have local directors of public health been given access to emergency funding for the provision of surge testing and tracing and vaccination in their communities? When will the pilots for increased support for those needing to self-isolate be published? We still believe that people should be paid their wages if asked to self-isolate. As that number is considerably fewer than six months ago, it would be not only cheaper for the Treasury but a much more effective way of ensuring that the spread of the virus is reduced.
Usually the Minister agrees with me on the importance of test, trace and isolate, even if we perhaps disagree on how that should be funded and supported. Can he respond to the concerns of the doctors and scientists who are appalled with today’s proposals that company directors will be able to temporarily leave quarantine for business meetings? People are still furious that the Prime Minister delayed adding India to the red list, with the resultant rapid spread of the more transmissible and more serious delta variant. As Professor Christina Pagel says:
“luckily elites don’t get or transmit covid.”
Stephen Reicher, the eminent behavioural scientist, said he was horrified by the
“scandalous misuse of science as a cover for political decisions … which is putting us all at risk.”
When commenting on the DCMS report published on Friday, he said:
“The headlines and the political response isn’t just an exaggeration, they directly contradict what the report says. It warns that the research wasn’t designed to draw any conclusions about the effects of events on transmission and mustn’t be used to do so”.
Yet Ministers and the press are all reporting that these events in the trial had no effect on infections and were safe to reopen.
Yesterday, a No. 10 spokesperson explicitly denied that government Ministers have used private email addresses. They said:
“Both the former health secretary and Lord Bethell understand the rules around personal email usage and only ever conducted government business through their departmental email addresses”.
This is directly contradicted by the Second Permanent Secretary in meeting minutes published by the Sunday Times. Those minutes clearly state that former Health Secretary Matt Hancock
“corresponds only with private office via a gmail account”.
As the Good Law Project has reported, on 19 April 2020, the noble Lord, Lord Feldman, emailed the noble Lord, Lord Bethell, at his private address, about the availability of Covid-19 test kits via a Canadian company, saying:
“Certainly worth contacting … to see if they can help … and the pricing seems competitive.”
Self-evidently, this is government business, and specifically within the portfolio of the noble Lord, Lord Bethell. The noble Lord, Lord Feldman, once co-chair of the Conservative Party, was writing to the Minister at his private email address on government business. In addition, I note that the Minister’s meeting with Abingdon Health on 1 April 2020 was not disclosed on the ministerial meeting schedule.
We note that, unlike the response from the noble Lord, Lord True, on the earlier UQ, it is not possible for the public to access private emails; the Freedom of Information Act specifically excludes it. Not going through the formal government-approved routes, whether for emails or declarations of meetings, gives the impression that perhaps the Minister has something to hide from his dealings with a former chairman of the Conservative Party and the company he was acting for. I note that the company was awarded an £85 million contract after the meeting and the emails.
There has been considerable speculation about the role of Ms Gina Coladangelo as a lobbyist, unpaid adviser to Matt Hancock and then a non-executive director for the Department of Health and Social Care. The press and media have also reported that the Minister gave Ms Coladangelo a parliamentary pass last year. Can he tell the House what personal parliamentary service she provided for him during that period? Does the Minister feel that his position is tenable, given this evidence?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I am enormously grateful for those extremely thoughtful questions. As ever, I welcome the challenge and scrutiny that the House of Lords always provides on these matters.
I completely endorse what the noble Baronesses, Lady Brinton and Lady Thornton, very thoughtfully said about Chris Whitty. Chris Whitty and JVT are both complete legends, and both have been accosted in public. This is completely unacceptable. We must look at the security of those who serve us so well, and we must somehow address the disrespect that often happens when public figures walk in public. It is a great regret that this has happened.
The noble Baroness, Lady Thornton, asked about nurses’ pay. I repeat to her what my right honourable friend the Secretary of State for Health said yesterday: this absolutely remains a priority. We must have a fair pay settlement. That pay settlement is going through the pay review process at the moment, and we look forward to receiving the output on that.
Both the noble Baronesses, Lady Brinton and Lady Thornton, asked about the basis for the optimism that we have at the moment. I have stood at this Dispatch Box for 18 months as the purveyor of difficult news to the House, and have lived through some very difficult moments in that time. I am acutely aware of the concerns that noble Lords have. I think the questions put were very reasonable and deserve a clear answer, so let me explain why we are a bit more optimistic than I think we ever could have been in the recent past. The case rates are slowing down, for both over and under-60s. Hospital admissions among the over-60s have started to fall, and while there are signs in both measures that the rate of growth is slowing, there is just not enough to fundamentally change our assessment of the risk of delta. In the last two weeks, we have seen case rates fall in both Bolton and Blackburn. That is an incredibly important observation, and one that bears testimony to the effectiveness of the local authorities, test and trace, and all of those who have contributed. It is mainly driven by the under-60 group, but not wholly. Rates among older people are plateauing right across the country at a lower level, and hospitalisations and severe illness are being prevented by people being doubled vaccinated against Covid-19. There are very clear signs that the vaccine is working in lots of ways.
By 19 July, two significant things will have changed that may give us stronger confidence. First, we will have offered a first dose to all adults in the United Kingdom. The NHS states that it can do this by 19 July. We will have also given a second dose to a higher proportion of over-40s, giving them more protection against hospitalisation. Secondly, we will be very close to the school holidays, which start on 26 July, and school-aged children being out of school. This will significantly reduce transmission among the population which is unvaccinated and has driven case growth. Universities should also be out.
We are monitoring the data every day. So far, we have not seen indicators that substantially change our assessment of the four tests. I hear loud and clear what the noble Baroness, Lady Brinton, says about Andrew Marr and his experience. Vaccination is not a panacea. It does not save everyone from any illness at all, but it has a significantly strong effect for us to move on to the next stage.
In terms of the backlog, I assure the noble Baroness, Lady Thornton, that we are putting funds in place to do whatever it takes to get us back to where we began. I cannot give the specific reassurances she asked for on whether specific funds will be extended, but it is our aspiration to work as hard as we can. On GP data, I assure her that the clinical trial progress that we have made on things such as Regeneron in the last few days gives us such a clear inspiration and motivation for ensuring that we get this project right. On trusted research environments, we have demonstrated that we listen and that we will change how we implement the GP data transfer, but our objective remains resolute. We are committed to continuing with this programme of work.
I will give a very clear response to the very important question regarding emails, asked by the noble Baronesses, Lady Brinton and Lady Thornton. I am absolutely rigorous in ensuring that government business is conducted through the correct formal channels. Contracts are negotiated by officials, not by Ministers. Submissions from officials are handled through departmental digital boxes, and that is right. Official decisions are communicated through secure governmental infrastructure.
I have read the Ministerial Code; I have signed it and I will seek to uphold it in everything that I do. The guidelines are clear that it is not wrong for Ministers to have personal email addresses. I have corresponded with a very large number of noble Lords in this Chamber from both my parliamentary address and my personal address. That is right and I will continue to do so. In their enthusiasm, third parties often seek to engage Ministers through whatever means that they can find, including their personal email. That is not the same as using a personal email for formal departmental decision-making. Those who have seen material on the internet should judge it extremely sceptically, because distorted fragments of evidence do not provide sufficient grounds to rush to judgment on how Ministers do their business.
I do not recognise the substance of the comments of the Second Permanent Secretary, as referred to by the noble Baroness, Lady Brinton, and he has indicated to me that he does not recognise the substance of those comments. I completely recognise the comments that were made regarding the meetings with Abingdon Health. The meetings schedule from that week was overlooked because of an administrative oversight. It has now been uploaded to the internet. I will be glad to share a link to that register. On the complaint made by Anneliese Dodds, I have written to the Parliamentary Commissioner for Standards and would be very glad to share that letter with the noble Baronesses, Lady Thornton and Lady Brinton.
I take this post extremely seriously. During the work of the pandemic, many people—officials, Ministers and those in industry—worked extremely hard to address the severe epidemic that we face, and I am extremely proud of how that business was conducted.
Social Care and the Role of Carers
Baroness Brinton Excerpts(3 years, 5 months ago)
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Baroness Brinton (LD) [V]
My Lords, I declare an interest as a vice-president of the Local Government Association. I thank my noble friend Lady Jolly for instigating this debate and for her wonderful service to the Liberal Democrats’ health team, and to your Lordships’ House, in speaking calmly and authoritatively on health issues for over a decade.
The right reverend Prelate the Bishop of Carlisle was so right to start with the suggestion that we need to go back to the absolute fundamentals of social care, because the current system is plainly not working. Over the last two hours we have heard many stories alongside examples and statistics of how the system is failing. As my noble friend Lady Walmsley said, this needs to extend to housing too. Habinteg has produced homes for life standards that cost only a fraction more when a place is built new but can mean people then stay in one place for their entire life, with very minor and cheap adaptations.
The noble Baroness, Lady Cavendish, is right that we need to think in completely different ways. I, too, want to mention an exemplar from the Netherlands, where students are now living alongside residents in care homes. In return for accommodation, they are also providing some support. Not only has it proved career-changing for the students but the record of dementia has reduced because of regular contact with younger people. That is the sort of radical idea we need to think about.
From these Benches, we are calling on the Government not to delay any longer but to engage urgently in cross-party talks on the future of social care. Our Prime Minister, Boris Johnson, pledged during the 2019 election and then from the steps of No. 10 to
“fix the crisis in social care once and for all”.
With social care services in such crisis, it is time that he and the Chancellor acted. People are selling their homes to pay for care and more than 1.5 million people are missing out on the care they need. Others are stranded in hospital, unable to leave because the follow-up care just does not exist. This is putting an increasing strain on the NHS, which also does not have the cash to cope.
The Dilnot review has been repeatedly referenced, including by my noble friends Lady Jolly and Lady Tyler, and by the noble Viscount, Lord Chandos, who is right that Dilnot’s proposals demonstrated that this is not difficult. I also agree with the noble Lord, Lord Rooker. In 2010, all three major parties agreed on proceeding with Dilnot and then the Conservatives pulled out. A decade further on, nothing has happened.
The noble Lord, Lord Forsyth, might feel that his committee is long in the tooth now but its report was exemplary and will last the test of time. He is right that this is all about money. As many other speakers have said, people’s lives are being damaged because the system has fallen apart. If the Treasury is the block, we must now commit to extra funds to make this work. We cannot continue with this broken system.
In England, publicly funded but means-tested adult social care is primarily funded through local government. It constitutes the biggest area of discretionary spend for local authorities, which are already cash-strapped due to repeated cuts and extra responsibilities. If the adult social care workforce grows at the same rate as the projected number of people aged 65 and over, the number of jobs in that sector will increase by one-third to around 2.17 million by 2035. We are not even thinking about the growth in our demographics and its consequences. Everyone is thinking about mending the short-term problem.
As the noble Baroness, Lady Donaghy, pointed out, new analysis for the Care & Support Alliance found that since the Prime Minister stood in Downing Street and promised to fix social care once and for all, 2 million requests for formal care and support from adults aged over 18 have been turned down by their local councils. This is equivalent to about 3,000 requests being turned down every day, putting immense pressure on unpaid carers as well as the NHS. These numbers show the human cost of the Government’s dither and delay. Will Ministers please stop their internal spats and off-the-record briefings, and start the urgently needed cross-party talks, involving the sector, so that we can look at fixing this urgently?
The cost of inaction is also far higher, as 11.5 million unpaid carers are bearing the brunt of the Government’s failure to reform social care. The pandemic has exacerbated the immense pressures they were already under; many have not had a single break since the crisis began. It is clear that any reform of social care must consider the impact on unpaid carers and include ways to alleviate the pressures that they face. Will the Government commit today to the emergency funding that would give unpaid carers across the country at least a weekly break? Will the Minister also commit to involving unpaid carers and carer organisations in talks on reforming social care services?
Last week, 50 organisations wrote to the Prime Minister, calling on him to fix social care. They wrote in the letter:
“During the pandemic tens of thousands died before their time in care homes from COVID-19. The best possible legacy we can give all those who have lost loved ones would be to ensure that we fix the care system so that a similar tragedy cannot happen again.”
The Local Government Association tells us that the ongoing recruitment and retention problems show that a high vacancy and turnover rate is really affecting service quality. As others have outlined, many staff have uncertain incomes because of the prevalence of zero-hours contracts. Temporary shifts in these patterns due to Covid-19 have highlighted the need to deal with these issues permanently. A recent Skills for Care report on the state of the social care market found that pay in adult social care is on average 25% lower than in the NHS, that the adult social care sector in England still needs to fill more than 100,000 job vacancies on any given day, and that the staff turnover rate of directly employed staff in that sector was 30% in 2019-20.
The ability to attract and retain staff with the highest skillset is hampered by poor pay, poor reward and a lack of coherent career structures that allow people to think beyond temporary work in social care. We need better pay and rewards to form part of a package of reforms and to transform the sector. All this means that we should have a 10-year workforce plan. It is vital that this is part of any proposals made by the Government. Professionalism is key but so is the registration of healthcare professionals in the social care sector, along with proper pay scales and funding for the sector, so that local government is not put in impossible positions. The pressure should certainly not end up with care providers.
My noble friend Lady Thomas of Winchester is right: being a carer is not a low-skilled job. The skill must be recognised. I noted she said that carers are often from overseas and face racial abuse, especially from clients as they slip into dementia. That is another reason why carers need to be trained properly: to help and understand their clients in what is and is not appropriate.
Thanks so much to my noble friend Lady Scott for talking about the role of volunteers in our communities; her speech was very powerful. The noble Baroness, Lady Uddin, referred to disabled children. I repeat her question about proper funding for respite care for the families trying to manage the most vulnerable children in our society.
Unpaid carers can also be children. Our own experience as foster parents to two children who lost their mother through a long terminal illness demonstrates that in addition to missing school, which was already reported on, there are other long-term psychological issues in having to face the death of a parent when they are your sole parent. I give particular thanks here to CAMHS, which provides a service but, as my noble friend Lady Barker said, mental health support is woefully limited at the moment and needs to be tackled.
The cost of inaction and delay is also falling on the shoulders of the 11 million unpaid adult carers in the UK, whose contribution to the current social care system is almost completely ignored by government. The cost of reform may seem great, but without these carers—particularly if they themselves break down—the burden will fall further on government itself.
The Lib Dems are also calling on government to immediately raise the carer’s allowance by £1,000 a year to support unpaid carers and to recognise the huge financial pressure that many of them are facing during this pandemic.
The noble Baroness, Lady Browning, noted that half the social care budget is going on working-age disabled people. That is also important, because there are not often houses to sell afterwards. That is why we have to review everything and completely rethink the way our social care system works. I will end on another point on which I agree with the noble Baroness, Lady Browning. Everybody today has said that we have waited far too long for these reforms. The only block to progress is the Government, specifically the Treasury. Act now. Bring it on.
Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) (No. 2) Regulations 2021
Baroness Brinton Excerpts(3 years, 5 months ago)
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Baroness Brinton (LD) [V]
My Lords, I declare my interest as a vice-president of the Local Government Association. I join in the thanks for the Minister’s briefings to Peers, which are helpful in the ever-changing landscape of the Covid pandemic. These Benches are pleased that we are debating these two SIs prior to them being enacted. We warned weeks ago that renewal was almost inevitable given the way that the delta variant had seeded so quickly and case numbers were increasing steeply, as they still are.
It is obvious that the delta variant is much more transmissible than the previous dominant variants. PHE has said today that the variant may have an R number as high as seven without measures. It is clear that we are at the start of a further major surge in infection and to do anything other than renew these regulations now would be a major mistake. This time last year, when the first lockdown restrictions were lifted, the daily case rate was below 1,000. Two weeks ago, it had crept up to more than 3,000. Today’s rate is a shocking 9,000. The delta variant is spreading fast, hospital admissions are increasing and in the north-west ITU beds have also increased, so my first question to the Minister is: if in two to three weeks’ time the data shows that restrictions need to continue, will he guarantee that further renewal of these SIs will be before they are brought into effect and before we go into recess?
This afternoon, it has been announced that business evictions will now be stayed until March next year. That is something, but on its own it is not enough. Why are residential evictions proceeding? For those struggling to find alternative housing, this is a real crisis. I am afraid it also sums up this Government’s attitude. They will help business tenants, but not individuals who are likely to end up homeless. Can the Minister explain why other government support for people and businesses is not being extended? The furlough scheme rates are about to reduce on 1 July and it will be abolished in September, despite hospitality not being able to open up fully, the creative sector still not being able to work and all workers still being advised to work from home if at all possible. Other support for businesses also remains firmly locked on the “freedom day” of 21 June, which is now clearly anything but.
I echo the points made by my noble friend Lord Scriven on the Government’s delay in putting India on the red list. There is only one reason why we are having to extend these regulations: the Prime Minister’s trip to India.
The Speaker of the House of Commons made it plain on Monday that the Prime Minister and his Government should not make announcements to the press first, yet today our papers are full of news that Ministers plan legislation to force social care home staff to have vaccinations. When will this be announced in Parliament? Given that the leaks seem to cover a lot that was not part of the original consultation, will the Minister answer the following questions? Will the scheme cover just care home staff? There are mutters about the wider social sector, so will it include supported living staff, staff in sheltered accommodation and staff at residential boarding schools for pupils with medical or learning disabilities? If not, what are the differences?
What will the Government do to assist the sector? Many small care providers took legal advice about whether, if they could not redeploy unvaccinated staff elsewhere, they would be liable to be sued by any staff who are sacked on Government orders. Only the Government can help to answer that. What will be the effect of this proposal on the social care workforce? Care providers are currently reporting that staff are leaving to go to work in the hospitality sector, where substantial pay increases are being offered as restrictions are lifted. Agriculture is also short of workers and is reported to be offering £20 an hour, which social care just cannot match. Will all agency staff have to be vaccinated too? What is the timescale to introduce this?
I support the call of my noble friend Lady Walmsley for proper funding for those who have to self-isolate. From these Benches, we continue to ask repeatedly for wages to be paid and, as a last resort, sick pay to be increased to a sensible level. That will increase the numbers of people self-isolating.
Overall, the proposed measures are sensible and continue part of the process of enabling local, rapid response on the ground, run by directors of public health, local authorities and local resilience forums, without the need to constantly return to central government. This process needs to include more powers over protective measures to be taken in schools, so that locally they do not need to ask the DfE for permission. With the delta variant growing in schools, rapid action needs to be taken.
To the noble Lord, Lord Robathan, I say that the tripling of cases in a fortnight, and hospitals in surge areas seeing an increase in patients—even if not as severe—are preventing our NHS from being able to tackle the backlog of urgent cases, including cancer and other serious and life-changing illnesses. I have known three people who have died of Covid—but, much more worryingly, a young family friend in her 30s has been diagnosed with terminal cancer, which was missed because of a missed smear test last year. We have to have an NHS that can operate and look after the whole population and is not just trying to catch up with Covid.
One thing is evident: with the delta variant, we are going to have to learn to live with Covid and its restrictions, whether on mask wearing or ventilation inside. At times like this, we must continue the current arrangements in some form while the variant can be seen to be working its way round to those who are still vulnerable. If we do not manage these restrictions well, we will find ourselves back in a much more stringent lockdown, which not one of us wants. We must continue to take these precautions to keep ourselves safe. We must continue to test, trace and isolate to keep everyone safe. That is why, from these Benches, we cannot support the fatal Motion of the noble Lord, Lord Robathan.
Covid-19 Update
Baroness Brinton Excerpts(3 years, 5 months ago)
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Baroness Thornton (Lab)
I thank the Minister for this Statement. These Benches agree with Mr Speaker; in the statement he made prior to the Secretary of State’s Statement last night, he expressed a deep frustration on behalf of all parliamentarians about the Government’s conduct. The announcement yesterday was both predictable and, sadly, predicted. I sigh, because the Prime Minister is now referring to 19 July as “terminus” day instead of freedom day, which has probably brought eye-rolls everywhere. When will the Prime Minister learn that caution and the use of data means also being cautious about how you express these matters?
The Minister will know that on these Benches we support the Government’s decision to delay the move to the next stage of the road map, but do so with a deep sense of anger, if not despair, that this should be necessary. Since the delta variant of coronavirus, first discovered in India, was detected in the UK in April, cases have surged across the country, with the variant now making up 96% of new infections. Experts confirmed last week that the variant is 60% more transmissible than the alpha variant, first discovered in Kent in 2020. Scientists at the Wellcome Sanger Institute have used genomic sequencing to produce maps which show how rapidly the delta variant has taken over in England, and I commend them to noble Lords. They are alarming in that they show the rapid spread to almost the whole country by the end of last week. It is doubling week by week—still with small numbers now, but that will change if this doubling continues.
There were warnings of a new variant in India on 25 March. It is reported that Ministers first learned that the delta variant was in the UK on 1 April. I must ask the Minister: is that true? The Government red-listed Pakistan and Bangladesh on 9 April, but did not red- list India until 23 April, by which point 20,000 people had arrived from India. As my right honourable friend Jon Ashworth said yesterday in the Commons,
“Our borders were as secure as a sieve, and all because the Prime Minister wanted a photo call with Prime Minister Modi.”—[Official Report, Commons, 14/6/21; col. 77.]
On 20 April I said to the Minister:
“With regard to protecting our borders, this week Hong Kong identified 47 Covid cases on a single flight from Delhi.”
We were closing our borders on 23 April, and I asked him:
“there will be hundreds of people arriving on flights from India. Is this not very risky?”—[Official Report, 20/4/21; col. 1769.]
I now return to that question. How many people arrived from India carrying the virus during the period from when the Government were aware of the variant at the beginning of April to 23 April, when India joined Pakistan and Bangladesh?
It is unforgiveable that Ministers have consistently promised to take control of our borders and conspicuously failed to do so, particularly at the very moment when it mattered most: when we were succeeding in the vaccination rollout and the gradual loosening up. The Prime Minister not only opened the back door to this variant; he failed to take measures to suppress it when he could.
There has been growing prevalence of this variant among school-age children, yet mandatory mask-wearing has been abandoned in secondary schools. I have raised this with the Minister at least once before. He has to explain why this has happened, despite being repeatedly asked in both Houses. We also know that isolation is key to breaking transmission yet, 16 months on, people are still not paid adequate financial compensation to isolate themselves. When asked about this at the Select Committee last week, the Secretary of State claimed that people would game the system. Does the Minister believe that this is true? After all the sacrifices and rule-following of the public, does the Minister have the same low opinion of our fellow citizens as his boss?
Yesterday, the Prime Minister and the Secretary of State supported extending restrictions by pointing to plans to go further on vaccination. But even after extending the doses as outlined in the Statement, large proportions of the population will still be left unprotected —having had one dose or none—and exposed to a variant that, if left unchecked, will accelerate and double every week. That would mean more hospitalisations, more long Covid, more disruption to schools and more opportunities for variants to emerge. What will happen under these circumstances? Will the Prime Minister still lift the restrictions?
My reading of this announcement and the terms in which is it couched is that the science points to us being in a very dangerous position. We could lose the battle that is going on between the vaccine and the virus. Will there be vaccine surges to counter this in areas where the virus is most prevalent? What is the plan to bring down infections and extend vaccination rates in hotspot areas? We have learned that in some places—Leicester, Chorley, Tameside, Salford and Wigan —the dose numbers have gone down. Has vaccination surging been abandoned in those hotspot areas? Will the Government bring forward accelerated second doses, and how are they working further to overcome vaccine hesitancy?
The Chief Medical Officer said last night that we would be lifting restrictions were it not for the delta variant. The Prime Minister should have moved at lightning speed to prevent the delta variant reaching our shores. Instead he dithered, and today he is responsible.
Baroness Brinton (LD) [V]
My Lords, we on these Benches echo the support of the noble Baroness, Lady Thornton, for the Commons Speaker’s statement yesterday on the Government’s continued abuse of Parliament.
We repeatedly warned the Government that sending out mixed messages about lifting restrictions on 21 June would cause problems. Even in March, the Prime Minister made it evident that he wanted us out of restrictions “irreversibly”—his word—by next Monday. What is worse is that we are now in a fourth Covid wave because of his desire to visit President Modi in India in mid-April. The resultant dangerous dithering about putting India on the red list contrasted sharply with the TV news. Every evening, we saw that the then delta variant was scything through India. Even then, Indian epidemiologists were talking about a much faster transmission. We on these Benches have repeatedly asked why India was not added to the red list on 2 April.
At yesterday’s press conference we were warned that the current delta variant wave will likely peak in mid-July, as cases, hospital admissions and patients needing ICU increase steadily. Even if vaccines mean that hospitals are not being overwhelmed, there is an increase. The UK now faces continuing restrictions entirely because of the Prime Minister’s delay.
The academic paper Estimating the Failure Risk of Hotel-based Quarantine for Preventing COVID-19 Outbreaks in Australia and New Zealand, published in February this year, calculated the risks and likely seeding of variants in the light of infection control and surveillance used locally. It now provides an essential baseline to assess seeding of cases coming from abroad. Devan Sinha of Oxford University and other UK scientists have used this to look at the seeding of the delta variant in the UK. He noted that 96% of the seeding of the delta variant occurred after 2 April—that is, after Pakistan and Bangladesh were added to the red list but India was not. He estimates that putting India on the red list on 2 April would have delayed the current wave by a further four to seven weeks. That four to seven weeks would have meant that all over-40s had had access to a second dose and, at seven weeks, most over-30s. He said that the wave would have been
“much smaller and mostly neutered”.
What have the Government learned from this delay? Why did it take so long for the delta variant to be moved from a variant of interest to a variant of concern? Despite MPs, Peers and scientists all asking in early April, Matt Hancock told the Commons that it would be listed as a variant of concern on 20 April. In fact, it was not listed until 7 May. Even worse, surge testing did not start until May either. If it was serious enough for India to be added to the red list by 23 May, why was it made a variant of concern only on 7 May? Was the delay with PHE or with Ministers?
The necessary continuation of restrictions at the current level means that a number of support schemes are now out of kilter with the restriction levels. These include lifting the embargo on evictions, the reduction in furlough support while people are still being asked to work from home if possible, and other business support mechanisms. Please can the Minister say whether they will be extended until we know that we are lifting restrictions completely? When, oh when, will any of these Statements or communications make it clear to the clinically extremely vulnerable and their families and friends what they are expected to do?
The Statement lists the areas where restrictions are to be lifted, many of which will be welcome, especially the 30-person limit on attending weddings, receptions and commemorative events, and out-of-school residential visits in bubbles of up to 30. But I ask again about mask wearing in schools, given the continuing increase in delta variant cases among children. Will there be specific guidance for these events, including lateral flow testing before and after, so that any outbreaks at a wedding could be tracked and managed? What level of new Covid cases per day would change the pilots on large events with higher capacities, especially the ones planned at full capacity?
It is good to see the removal of enforced quarantine for care home residents after trips out of homes. I never did understand that one, given that staff and visitors did not have to self-isolate.
It was good to hear the emphasis in the statement from Professor Whitty and Sir Patrick Valance on the importance of the second dose. I repeat my regular plea that all Ministers use this as a reference point. Far too many only ever use the number of people having had the first dose. With the delta variant, it is even clearer now that two doses are essential.
Why on earth did the Prime Minister say yesterday that 19 July is definitely the terminal day for restrictions? We all hope that he is right, but if he and Ministers are led by data, how can he say that?
Finally, the Statement refers to surge testing in areas where the variant is also surging, but maps show such a steady rise in cases across the country. Can the Minister confirm that there are enough test, trace and isolate staff to manage effectively this fourth wave of Covid?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I am enormously grateful to the noble Baronesses, Lady Brinton and Lady Thornton, for such thoughtful and searching questions.
Covid-19: Vaccines and Pregnancy
Baroness Brinton Excerpts(3 years, 5 months ago)
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Lord Bethell (Con)
I am extremely grateful for those constructive suggestions from the noble Baroness. We have a very large amount of materials specifically for pregnant women, including guidance for pregnant women and a guide for women who are of childbearing age, pregnant or breastfeeding; those are widely distributed by GPs. However, as I said, a lot of pregnant women do not know that they are pregnant, so it is not possible to reach all of them all the time. At the moment, our priority is to ensure that those aged over 50 take their second jab. We will sweep up other demographics, and we will make that a priority when we reach it.
Baroness Brinton (LD) [V]
A close family member rang her surgery to ask for advice about being called for vaccination while breastfeeding. They said that it was nothing to do with them and told her to ring the main vaccine booking line. That person said, “Just ask the person who vaccinates you”, who said, “Oh, I don’t know. I’ll have to check”. Last week, Channel 4 reported that this is a widespread problem for pregnant and breastfeeding mums. It is evident that there is no clear guidance for front-line staff on what to tell mums. Can this be remedied as a matter of urgency?
Lord Bethell (Con)
The noble Baroness alluded to a problem that is, I am afraid, commonplace in the healthcare system: an acute sensitivity about giving advice to those who are pregnant because people are very concerned about giving the wrong advice, which sometimes leads to no advice being given. We are aware of this problem but I assure the noble Baroness that material is given to those on the front line—I have mentioned some of the materials that we have published—and GPs have all that material at their disposal. We have recognised this problem, we have moved on it and we are making as much material as possible available to the right people.
Carers: Support
Baroness Brinton Excerpts(3 years, 5 months ago)
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Lord Bethell (Con)
My Lords, I can reassure the noble Baroness that economic considerations absolutely will be borne in mind. It is a huge challenge to take on the massive economic benefits of unpaid carers, and I will be glad to meet Carers UK—I have in fact already begun scheduling a follow-up meeting to this morning’s call.
Baroness Brinton (LD) [V]
Too often, the family carers of children with the most serious and complex health needs are at the back of the queue for care breaks, and many had no breaks during the pandemic at all. Research by Together for Short Lives has found that cash-strapped English local authorities fund just 1% of the care costs of children’s hospices which provide these short breaks. Does the Minister agree that the Government need to fill the £400 million funding gap in social care for disabled children as a matter of urgency, to ensure that these carers get the breaks they desperately need?
Lord Bethell (Con)
My Lords, as the noble Baroness knows, we have worked very closely with hospices to fill the funding gap that hit them hard during the pandemic, and I pay tribute to those who worked so hard looking after younger vulnerable people. The pressure on care breaks has been intense during the pandemic.
NHS Digital: Primary Care Medical Records
Baroness Brinton Excerpts(3 years, 5 months ago)
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Lord Bethell (Con)
My Lords, I am grateful to the noble Baroness for her kind remarks. As she knows, there is an incredibly rigorous system for ensuring the safe curation of this data, and I pay tribute to the Caldicott Guardians, the ICO and the IGARD board, which has put in place a very tough and rigorous surveillance system to ensure that all the data sharing that goes on within the NHS complies with the legal requirements and the guidelines laid down by law and by the NHS. These are tough conditions and they are applied very rigorously.
Baroness Brinton (LD) [V]
My Lords, it is a relief to hear that there will be a delay, but I am astonished that the Government have left it this late. When will the data protection impact assessment for this be published, and will the Minister place a copy of the DPIA in the House Library, so that Members can read NHS Digital’s own statements about the privacy risks and the impact of the programme? It might help the ICO in its deliberations about whether the system proposed is safe.
Lord Bethell (Con)
I am grateful for the question. I will look into that date and share whatever materials are available.
Covid-19: Government Handling and Preparedness
Baroness Brinton Excerpts(3 years, 5 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I absolutely join the noble Baroness in paying tribute to all carers, particularly unpaid carers, who have shouldered a huge burden in the past 18 months. The role that they have played has been a real example of the sense of service and commitment that characterises the social care community in this country. We have put in place a large amount of resources through local authorities and payments to local authorities to support carers. That has helped in infection control and to reduce the itinerant nature of some social care in order to prevent the spread of the disease. But it is undoubtedly true that the burden on unpaid carers remains immense, and we continue to support, both through local authorities and through charities, the work that they do.
Baroness Brinton (LD) [V]
My Lords, in the national Carers Week, it is worth remembering that the 2017 report on Exercise Cygnus said:
“Local responders also realised concerns about the expectation that the social care system would be able to provide the level of support needed if the NHS implemented its proposed reverse triage plans.”
It also recommended that local support should be developed and planned for social care and health. Was that recommendation put into practice? Were the concerns expressed by local responders borne out last year? Will the Government now publish their internal review of pandemic preparedness to ensure that the lessons have been truly learned?