NHS: Staff Numbers after Covid-19

Baroness Brinton Excerpts

Thursday 4th March 2021 Grand Committee

[Baroness Brinton (LD) [V]]

My Lords, the Government must tackle the long-term underlying problems of training clinical and associated healthcare staff in a sustained and future-proofed way. We had serious gaps in capacity long before the Covid pandemic.

During Covid, exhausted and stretched staff have doubled, or even tripled, ward capacity in a makeshift manner to save lives over the past year. We must be better prepared for the future. Will the Minister commit to increase funding for the workforce development budget and internal education? We need a flexible, nurtured, resilient workforce to face the health challenges of tomorrow and incentives to retain our excellent NHS heroes.

These issues were urgent prior to the pandemic, and this has been a contributing factor to the appalling death toll in this country. The Government must make fully funded workforce planning a central aspect of any upcoming reforms.

Covid Contracts: Judicial Review

Baroness Brinton Excerpts

Monday 1st March 2021 Lords Chamber

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

My Lords, I am grateful for the question from the noble Baroness, Lady Thornton. During those hectic days, more than 15,000 suppliers approached us. Many of them were credible, but many sadly were not. It was entirely right and the best practice to have a high-priority lane to triage and prioritise those who were the most credible. A sample of 232 suppliers in that lane reveals that 144 came from Ministers, 21 from officials, 33 from MPs and 31 Members of the House of Lords not in the Government—including many who chose to write to me personally with the names of recommendations. I am enormously grateful to those who got in touch.

[Baroness Brinton (LD) [V]]

My Lords, the Prime Minister said last Monday in the House of Commons that

“the contracts are there on the record for everybody to see.”—[Official Report, Commons, 22/2/21; col 638.]

However, the evidence questions that statement. Can the Minister say how many PPE contracts entered into in the first wave of the pandemic, up to the end of June, remain unpublished? If the number is not to hand, please will he undertake to write to me with it?

[Lord Bethell (Con)]

From memory, it is my understanding that 99% of the contracts are published and 1% are outstanding. I am happy to check that and confirm it to the noble Baroness.

Health Protection (Coronavirus, Restrictions) (All Tiers and Self-Isolation) (England) (Amendment) Regulations 2021

Baroness Brinton Excerpts

Monday 1st March 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, here we are again, discussing legislation that was presented to Parliament on 28 January and came into force the following day. Only a month later are we now debating it.

Given that the Government’s intention is to deter people from breaching self-isolation and increase compliance at a time when adherence to self-isolation is crucial, ensuring that infected individuals and their close contacts self-isolate has to be one of the most powerful tools for controlling transmission of Covid-19. If that is the case, can the Minister explain why the new £800 fines that were brought in a month ago are still not published on the Government’s guidance page under the section “if you break the rules”? How on earth can they be a good deterrent if people do not know about them? In short, these regulations are about compliance, enforcement and data sharing but frankly, it is all stick and no carrot.

The Liberal Democrats have been extremely concerned about the half-hearted nature of the approach the Government have taken to self-isolation and quarantine. As others have said, and we agree, we know that in general most people do comply and only very few deliberately choose not to. That is not the issue, as my noble friends Lord Scriven and Lady Tyler have said.

The role of the state is to encourage as well as to force compliance in public health emergencies such as this pandemic. We have repeatedly asked for these carrots to be created and made visible to the public. We know from those nations that run successful self-isolation and quarantine systems that telephone support, food and medicine deliveries and, most important, payment of the equivalent of a minimum wage are what makes them work—not, noble Lords should note, a one-off grant that is almost impossible to get, and sick pay at a level that is a joke and requires the poorest families to decide between isolation and putting food on their table. It is time the Chancellor responded to our calls, because the best way to support people and to help them follow the guidance is also the best way to keep everyone safe.

We note that the regulations increase data sharing for police, including contact details, how the individual was notified to self-isolate and the test result. Has the Department of Health and Social Care monitored whether data sharing has had an impact on people’s willingness to seek help and share their data? Can the Minister say how the data will be kept safe and secure?

May I repeat a question that I asked him 12 months ago, when we discussed the early regulations: what assurances can the Minister give your Lordships’ House that the data will only be used for the purposes of Covid regulations and that the police and any other authority will delete it as soon as it is no longer needed for Covid matters?

All of this is brought into sharp relief with the news headlines today about the travellers who arrived from Brazil last month, and the one whose test result form did not have contact details on it. Without knowing much more about that case, I ask the Minister some questions of first principle. Can a traveller evade registration or notice as they come into the country? Given the remarks of the noble Lord, Lord Balfe, that his forms on coming in were not checked, what guidance is given to border staff to check? Are any links made between the data collected from travellers quarantining at home and NHS Test and Trace, their GPs or local council via the director of public health, or are the two systems completely separate? If so, why are they not joined up? At what point do local councils and tracers become aware of someone coming in from a red country, whether directly or indirectly? Having that local contact could be vital, if a traveller were subsequently to alert key officials if they feel unwell and need a test. It makes the whole issue of support and further testing of contacts so much easier.

If the test form is not completed fully, as in today’s case, can it be checked back to the QR code for the test kit issued, either in a centre or by post, and then reverse-engineered back to small numbers of people and, hopefully, to the individual? Or is it true that it is possible to send it back without contact details and that the laboratory never checks back and queries it? If so, why is that the case? What lessons are being learned from this, very quickly, given that, once again, one of the key elements to managing this virus is putting the lifting of lockdown at risk?

The noble Lord, Lord Blencathra, suggested that the social care sector had decided to introduce a “no jab, no job” policy, and he wondered whether the NHS might follow. I thought that it was the other way around: that the NHS has vaccine rules in its employment contracts with clinicians, but the care sector has not, in the past. The care sector is now applying them to new staff, but is unable to back-date this because of employment law. More importantly, can he say what plans there are to support and encourage social care staff to have their vaccinations, as the low numbers are very worrying? Is the refusal because staff are low-paid shift workers, often without the means to get to vaccine centres, or is it disinformation about the vaccine?

Finally, like the noble Lord, Lord McCrea, I hope that this is the last lockdown, but the end to lockdown is a partnership between the people and government. Compliance is part of it, but people want and need the tools to make it happen. Can the Minister tell us if government will now do that?

Future of Health and Care

Baroness Brinton Excerpts

Tuesday 23rd February 2021 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, I thank the Minister and declare my interests as a former member of a CCG and a non-executive director of a foundation trust.

The Lords Labour health team—myself and my noble friends Lady Wheeler and Lord Hunt—are veterans of the infamous Lansley Bill, which became the Health and Social Care Act 2012. Many noble Lords will take part in the new legislation—including, of course, those on the Lib Dem Benches, who supported the Lansley Bill. I hope that they have come to their senses since then.

We cannot sweep under the carpet, as the Secretary of State and the Minister would have us do, the fact that many of us warned that the huge bureaucracies and implementation costs of something like £3 billion would be a terrible waste of public money and time. They resulted in a loss of initiatives and innovations that lies at the Minister’s door. Some indication of lessons learned would be welcome.

We are in the middle of the biggest public health crisis our NHS has ever faced. Staff on the front line are exhausted and underpaid. The Royal College of Nursing says that the NHS is on its knees. Primary care and CCG staff are vaccinating and will be doing so for months ahead. Today, we learn that 224,000 people have been waiting more than 12 months for treatment. The Secretary of State and the Government think that now is the right moment for a structural reorganisation of the NHS. It might be significant that, in the Statement, I cannot find a single explanation of how patients will benefit from this reorganisation. It is all about systems.

Apart from the timing, some very serious matters need to be addressed. This is a Conservative NHS plan, and it shows. Without the money, none of this is worth discussing seriously. Without a workforce plan funded by that money, it will not work. This Bill should not go ahead in its current breadth until the solutions for social care and public health are also set out. Although reform of the Mental Health Act is welcome, it also needs to fit into the wider solution that is missing around social care.

Why does the White Paper not include an option simply to delete Part 3 of the existing Act, thus abolishing the market and competition regimes that created the burdensome bureaucracies and which, it must be said, many CCGs and ICSs have worked hard to get round in recent times? Let us take some time to work out the rest, bring forward the promised social care reforms, let our exhausted NHS recover and have a system co-created with local government.

I suspect that the need to move powers to the centre is a poisoned chalice. Is the Minister proposing simply to dump the Lansley structures and bring back the situation where the Secretary of State has the power of direction over all and any parts of the system? Although I welcome the place-based commitment, it is woefully undefined. This plan ought to be co-owned and co-developed with local government nationally as well as locally, with real parity of esteem. Far more is needed to remove barriers, but the biggest local barrier now is the absence of any solution for social care and public health.

Looking at the NHS’s history, we should be sceptical of structural reform necessarily leading to changes in care delivery that make services more integrated and benefit patients. We know from Wales, Scotland and Northern Ireland that integrated care systems have not brought about integrated care. It is necessary to remove system barriers but not sufficient. The bigger challenges lie around culture and vested interests, which are not even mentioned in this White Paper. It is all far too complicated, with health and well-being boards and HealthWatch still in place as well as the proposed new structures. It needs a clear explanation of who controls the money. Can you have two boards at the same time and call it integrated, and be sure where the accountability sits and whether good governance can be assured?

There is little about how decisions are made on who sits on these boards. Is it proposed to bring back independent appointments commissions to guarantee the diversity required? Will staff representatives and patients have a seat where it matters? Surely there can be only one body with the power to set the local strategy and sign off the plans that bring the money. This proposal seems to have many bodies, meaning that governance and accountability are at risk. Having providers, and even independent providers, with a place in the decision-making about resource allocation is clearly unacceptable. If there are to be some contracts awarded by competition, there must be clear rules about who is entitled to compete. These organisations and companies must pay their taxes, for instance, and must offer fair and comparable terms and conditions to their workforce. For example, we know that social enterprises totally fulfil those conditions, but one must ask why we need competitive tendering when you can hand out contracts to chums from the stables, the golf course, and the pub, as we have seen in the last year.

The White Paper is silent on the future of foundation trusts, silent on the role of governors, silent on a whole range of potentially competing governance issues which will have to be resolved. How much acute and tertiary care can be brought into locality-based structures? Integration of primary, community and social care is clear, but, as everyone knows, the acute side is far more complex and a single solution, as proposed in this White Paper, almost certainly will not work. The big players such as teaching hospitals do not fit into any single locality, or even single ICS, but are vital players. Will there be extra layers of governance above the ICS, which is not defined at all?

We will of course study the legislation carefully when it is published, but the test of reorganisation is whether it benefits patients and communities, brings down waiting lists and times, widens access, especially for mental health care, drives up cancer survival rates and improves the population’s health.

[Baroness Brinton (LD) [V]]

I am grateful to the Minister for the short-notice briefing just as we were rising for recess.

If you had said to most people in the health and social care sector three weeks ago that the Secretary of State for Health and Social Care was announcing a new White Paper, virtually everyone would have assumed that it was the extremely long overdue White Paper on social care, promised by the Prime Minister in his party’s manifesto in the 2019 general election and repeatedly further promised at the Dispatch Box over the last 14 months. This Statement refers to it appearing at some point later in the year.

Instead, we have a comprehensive White Paper that focuses, despite the references to care, on the NHS and health systems, undoing some but not all of the 2012 Lansley reforms. This White Paper talks grandly of integrated systems, but you cannot integrate systems if one of the key parties is on its knees as a result of appalling neglect for many years. We agree that our clinicians, managers and associated health and social care staff have great ambitions for moving our health and care structures into the 21st century, and we compliment them, and Ministers, on their ambition, but we have been here before. A decade ago, the Government announced and legislated for a Dilnot-style cost model for social care, which, unfortunately, was later scrapped. We went from a point where all three main political parties were in agreement, but, sadly, the Conservatives withdraw from that agreement. As with manifesto promises on the care sector over the last three general elections, when will the Government start the long-promised cross-party talks to find a solution for the care sector? We remain ready and waiting.

The Statement makes the point that the pandemic has brought the structural difficulties in the care sector into sharp relief. That much is true. With more than 25,000 care home deaths, 10,000 of which have occurred since the lockdown started in January, what will it take for the Prime Minister to make good on his promise to fix social care? Why did it take weeks longer to arrange for residents and staff in care homes to get testing, whereas the NHS had reliable access as soon as it was available? Worse, the care sector’s experience of the Department of Health and Social Care taking its orders of PPE out of lorries and diverting them to protect the NHS first—which happened—and the NHS discharging Covid patients into care homes, while reassuring care staff that it was not doing that, has undoubtedly damaged trust. I do not deny that there has been a really strong attempt to get people to work cross-department, but this sort of behaviour has really not helped.

The Statement talks about making Ministers accountable again. A good step would be for the Secretary of State to come to Parliament and explain why he did not publish PPE and other contracts within the appropriate timeframe. There are concerns, too, about cronyism and possibly even corruption. So I say to Ministers: beware of what you wish for.

A further problem of the White Paper in front of us is the need to undo some of the perverse bureaucracies and expenses created by the 2012 reforms. The “internal market” was one such. I cannot see the logic of having a CCG of GPs overriding NICE and a hospital team on a medication pathway because it wants to spend the money elsewhere. The Minister told me that there will be changes and that there will be some representation from trusts, but, from what I hear, it is not enough to leave the clinicians who are expert in charge able to follow the advice of NICE.

The Statement also talks about the portrait of Sir Henry Willink, who published the 1944 White Paper from the Dispatch Box. But Sir William Beveridge’s report that led to that White Paper, and then to the post-war Labour Government’s creation of the NHS, had a clear structure. The five great evils that Beveridge, as a Liberal, set out could be tackled only by a cross- departmental approach, of which health was a vital component but not the sole driver.

When my grandfather was dean of St Mary’s Hospital Medical School, he always used to say that it took only 20 years for the NHS to move to a “national illness service”, as demand and costs in hospitals increased exponentially and any budget that was not for hospitals was squeezed. That is why, in the 2012 reforms, we in coalition wanted at least elements of public health moved to local government, where it could more effectively work with the other parts of the system fighting Beveridge’s five great evils and, through the health and well-being boards, be accountable at a local level. The examples of the excellent directors of public health during this pandemic have shown that it can and does work, despite the NHS finding it difficult to delegate to them. It is no surprise that inequality is one of the greatest predictors of serious Covid illness or death. Can the Minister reassure us that, whatever happens to public health, it will have its funding ring- fenced to tackle these inequalities?

Next week, we have the Budget, in which the Chancellor will have to face the highest levels of national debt since the Second World War. After the publication of his report, Beveridge expressed concern, saying that the Government should be bold:

“Now, when the war is abolishing landmarks of every kind, is the opportunity for using experience in a clear field. A revolutionary moment in the world’s history is a time for revolutions, not for patching.”


Now, too, is the time for such revolutions. This pandemic has left us with a health and social care system that needs not just reform but proper funding. Without it, integration and effective joint working will fail. Can the Minister assure us that there will be bold actions to ensure that any changes are fully funded? Without it, Atlee, Beveridge and Willink will be turning in their graves. Worse, these proposed reforms will fail the UK people, whether patients or just those living in their communities—the very people who need it most.

Covid-19 Vaccines Deployment

Baroness Brinton Excerpts

Thursday 11th February 2021 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, it is clear that we will live with Covid-19 and its mutations for a long time, so a full vaccination programme seems the best way to get out in front of it. Obviously, everyone was very pleased to hear the study results regarding the Oxford/AstraZeneca vaccine reducing transmission and maintaining protection for over 12 weeks. While the daily cases begin to fall, it is vital that the Government do not repeat previous mistakes and take their foot off the gas just as things look like getting better. Could the Minister update us on whether he expects similar trial data to be published for the Pfizer vaccine?

Would the Minister care to comment on the—how can I put this?—forceful comments of his honourable friend Sir Charles Walker MP on “Channel 4 News” when he accused the Government of robbing people of hope and said:

“We cannot cancel life to preserve every life”—


whatever that means? Apart from the fact that, in my own view, that sounds like a petulant child, it is concerning that these are the pressures being brought to bear on the Government, and it is to be hoped that they will bear up and previous mistakes will not be repeated.

It seems that the Government are on track towards their promise of vaccinating the top four Joint Committee on Vaccination and Immunisation priority groups by the middle of this month. That is to be applauded. Regarding data, though, I think everyone is concerned about the reports of lagging take-up among black, Asian and minority ethnic communities as well as among poorer communities. We know that these groups have been the worst affected by the pandemic and we need to get them to take up the vaccine, but I am conscious that much of what we hear is based on anecdotal stories rather than hard data at community level split by ethnicity. What data does the Minister have on that? When can colleagues get council ward level data so that they can be part of the effort to drive uptake?

As the first phase is coming to an end, can the Minister update us on the number of care home staff who have received their first dose, and perhaps what the plan is to encourage those who have not done so to take up the vaccination?

It appears that one in five over-80s in London has yet to be vaccinated; that is what the latest figures suggest. Some 78% of over-80s in the capital have had a first dose, lower than for other groups, while the figures are 83% for the 75-to-79 age group and 79% for the 70-to-74 group, so we still have some way to go in London.

When we get to the beginning of April, those who have had their first dose will be expecting and needing their second one. Can the Minister give an assurance that there will be enough supply to ensure that everyone who is due their second dose will get it?

Also, we do not want the vaccine rollout across Britain to be undermined by a vaccine-resistant strain entering the country, which the Government’s failure to secure our borders risks jeopardising—but we will be coming on to that in the next Statement.

Will the Minister say what conversations are now taking place with the JCVI and what changes might be made to the priorities of the people who will be due the vaccination? For example, will the JCVI be reviewing key workers? Data has shown that those who work closely with others and are regularly exposed to Covid-19 have higher death rates than the rest of the population. By prioritising those workers alongside the over-50s and over-60s and people with underlying health conditions, surely we can reduce transmission further, protect more people and keep the vital services that they provide running smoothly—which, of course, includes reopening schools.

[Baroness Brinton (LD) [V]]

My Lords, I start by congratulating everyone working in the vaccine sector: the scientists, still working behind the scenes to ensure that there are vaccines that will be effective against the South African and Manaus variants; those involved in the manufacture and supply chain; and all those on the front line, making sure that the vaccines are delivered into arms safely and swiftly by clinicians, with administrators, staff, the military and volunteers helping. A notable reason why the UK has been able to manage this so well has been the expertise of Professor Chris Whitty and our vaccine research community, which has so many years’ experience in epidemics, including the Ebola outbreak in west Africa.

The Joint Committee on Vaccination and Immunisation has also kept our focus on who should be protected first, and the government delivery group, led by Kate Bingham, has also done well. The numbers vaccinated in the top four priority group continues to grow and I, for one, hope that the target for next week will be achieved.

The Statement says:

“We … visited every eligible care home possible with older residents in England and offered vaccinations to all their residents and staff. That means we are currently on track to meet our target of offering a vaccine to the four most vulnerable groups by mid-February.”


However, I still cannot find the actual number and percentage of social care staff vaccinated, whether those working in care homes or domiciliary care staff providing essential support to keep people living in their own homes, so please can the Minister provide the number and percentage of social care staff who have now had their first dose of vaccine? Once again I ask: why are care staff not disaggregated from NHS staff in the published data?

The target of “offering” a vaccine to those in or working in homes is, frankly, no target at all. We know that, after Christmas, an alarming number of cases were diagnosed in care homes, which has resulted in residents and staff being refused vaccine until all cases are over in those homes. With very limited visits by families, the only way that Covid could have come in is, unfortunately, via staff, who probably picked it up from others over the Christmas break. Today, the ONS has said that one-third of all Covid cases in hospital during this pandemic have been over the past month. That is truly shocking.

Was the Prime Minister’s bold statement last year that Christmas should not be cancelled and his encouragement to allow people to mix, against all the expert advice from SAGE and alternative SAGE, worth it? How many deaths will have resulted from those cases, which could have been avoided if that expert advice had been followed earlier?

There are reports of some surgery teams arriving at care homes with enough vaccine only for residents and staff being redirected to large hubs, many miles away. This is unhelpful when staff work shifts and are on low wages, with no access to the transport needed to get to a hub. What is planned to ensure that all care home staff can be vaccinated at their place of work by their local vaccination teams?

Another bit of ONS data this week has shown that there were more than 30,000 Covid-related deaths of disabled people between mid-January and mid-November last year, representing 60% of all Covid-related deaths in that period. I remain concerned that many of those under 70 who are disabled or learning disabled and live in homes are still not on a priority list. We know that those requiring close personal care are at very high risk. The ONS data proves that. When will the Government add them to the top four priority lists?

The opening of large hubs is welcome, but they must not replace very local access to vaccines, whether through GP surgeries or local pharmacies. Worrying reports are emerging of GPs running out of supplies and being told that the large vaccine hubs are being prioritised over them. I thank the Minister for the excellent briefing that MPs and Peers had earlier this week on vaccines and possible treatments for Covid-19. The Statement says:

“This trial will look at whether different vaccines can be safely used for a two-dose regime in the future to support a more flexible programme of immunisation.”


It goes on:

“I want to reinforce that this is a year-long study, and there are no current plans to change our existing vaccination programme, which will continue to use the same doses.”


However, the green book on the vaccination programmes states:

“For individuals who started the schedule and who attend for a vaccination at a site where the same vaccine is not available … it is reasonable … to offer a single dose of the locally available product”


to complete the schedule. If safety has not yet been established, why does the green book say that potentially unsafe dosing regimes can go ahead?

The Minister is correct to say that no one is safe until the whole world is safe, and it is good that the UK has made a commitment of £548 million to COVAX with match funding to provide 1 billion doses of vaccine this year to developing countries. I hope that the Prime Minister will use his chairing of the G7 to encourage other countries to donate their share to make this happen. The examples of the South African and Manaus variants are a wake-up call to all of us that we must work as a global community to protect all people and the world’s economies from Covid-19.

[Lord Bethell (Con)]

My Lords, I am enormously grateful for the thoughtful questions from the noble Baronesses. They are entirely right to applaud the progress of the vaccine. I start by sharing some pretty formidable statistics on that. An absolutely remarkable 95.6% of those aged 75 to 79 have received their first dose. I have never seen a government statistic quite like that. It is an astonishing figure. Such a very large proportion of a target population have come forward, have been efficiently vaccinated and are now protected from the worse effects of this awful disease. It is an enormous success story. Of those over 80 years old, 91.3% have received their first dose and 74% of 70 to 74 year-olds have received their first dose. Up to 9 February, an astonishing 13,580,298 people received their vaccine. These are extraordinary figures. It will have a huge impact not just on the personal lives of those who have been vaccinated and their families but on the workings of the entire NHS. It is a massive game-changer and will dramatically reduce the amount of hospitalisation for and deaths from Covid. We are determined to take full advantage as a country of this enormous success story.

We are enormously pleased with the WHO readout on the AstraZeneca vaccine. It is exactly what we hoped for and what we understood from the clinical trials of the vaccine, and it is pleasing to see worldwide recognition that a 12-week gap between the two doses is the right approach and that the AstraZeneca vaccine is good for over 65 year-olds. I greatly thank those at the WHO who have done that. We are completely committed to the vaccine rollout and we will not take our foot off the pedal in any way.

I completely understand the point of those who are concerned about the impact of the lockdown. The noble Baroness alluded to the words of Charles Walker, who is entirely right that the lockdown has a huge impact on the economy, the public mood and particularly on those who cannot make it to school. However, the approach we are taking—a slow and steady approach of not rushing into anything—is exactly the one that will pay the greatest dividends for the economy. It is hugely supported by the general public and it will mean that, when we release the lockdown and return children to school, we can do it with the confidence that we will not have to go back again.

We are concerned about the lag in take up, particularly in black African communities. There are clearly, among the really good stories of take up, one or two areas where we are concerned. The work of the communications team on anti-vaxxers’ stories and the support we have got from social media firms has been really good across the board, but this is one area where we are enormously focused. The data is not always crystal clear, and we have not published it all yet, but this is one area where the noble Baroness is entirely right and we are very concerned.

The noble Baroness asked for reassurance on the second dose: will everyone get a second dose, and are there enough supplies in the warehouses for everyone? I reassure her and all noble Lords who may be concerned on that point that we are absolutely committed to the second dose. Everyone will get it, and they will get it on time. The supplies are in place.

The noble Baroness, Lady Brinton, asked about whether it was our policy to give a difference second dose to the first. I will be crystal clear: this is not our policy. If you are given a dose of “A” then your first dose will be “A” and your second dose will be “A” as well, and not “B.” We are looking into clinical trials that seek to understand whether an “AB” combination might be safe and may even be better. There are examples in other spheres where mixing two different vaccines can have a benign effect on the body and can stimulate a greater antibody response. We are looking at this very carefully. The COM COV clinical trial has been given £7 million to look into this. It is a long-term clinical trial and we are not expecting a readout any time soon but, if there are benefits, we will chase those down.

I completely agree with the noble Baronesses, Lady Thornton and Lady Brinton, on variants of concern. We have all been alerted to the grave danger that a mutation might have enhanced transmissibility, increased severity and escapology. Should such a variant emerge that could somehow jeopardise the Ming vase of our massive vaccination success story, we would be extremely concerned to address it. We are shortly having a debate on borders, and I shall save my comments for that debate, but I completely endorse the concerns of both noble Baronesses.

The noble Baroness, Lady Brinton, mentioned Professor Chris Whitty. To all those who missed it, I mention the presentation he gave yesterday on the investment in therapeutic drugs and antivirals, which was unbelievably impressive. We are enormously lucky to have someone like Chris as our Chief Medical Officer. Indeed, the Deputy Chief Medical Officers, Jonathan Van-Tam and the others, have all served us extremely well. I also praise others who have stepped up to public life in our time of need, including Kate Bingham and the noble Baroness, Lady Harding. They have both done an enormous public service and deserve enormous praise.

The noble Baroness, Lady Brinton, asked about disabled people. She is entirely right: there are those who are disabled or who have learning difficulties, and we are concerned about the impact of Covid on them. Many who are clinically extremely vulnerable are already in the priority level 4 and will already be in the prioritisation list. Others will be in prioritisation level 6. We are looking at whether we should change the prioritisation system in any way, and the JCVI keeps a running watch on this. I reassure the noble Baroness that all those in a high-risk group will be prioritised in a reasonable fashion. We will be reaching prioritisation level 6 very soon indeed.

The noble Baroness, Lady Brinton, talked about the importance of sharing vaccine with other countries. Tedros is absolutely right: we are not safe until everyone is safe. Britain has taken leadership role in CEPI, Gavi and ACT; we continue to support the global distribution of vaccines through our contribution of IP, our massive financial contribution and our diplomatic leadership. We remain committed to that, and we will continue to use our chairmanship of the G7 to influence other nations to step up to their responsibilities.

Covid-19

Baroness Brinton Excerpts

Thursday 11th February 2021 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, a hotel quarantine policy has been debated for months and was finally announced two weeks ago, yet the legislation underpinning the scheme has not been laid. That means that, yet again, Parliament cannot scrutinise and vote on the regulations until after they have been brought into force. Can the Minister advise the House when they will be published and when we will get the opportunity to debate them? I hope that he will be able to assure me that they will not be laid at the 11th hour, as so many other coronavirus regulations have been, which would mean that people who are impacted by this policy and need to implement it will have to get up to speed very fast indeed to make the necessary arrangements.

The UK’s quarantine policy is due to come into effect on Monday. It is exactly a year to the day since I raised this exact issue in your Lordships’ House in response to a Statement repeated by the Minister’s predecessor, the noble Baroness, Lady Blackwood. Her answer was basically that the Government would be putting the resource into dealing with quarantine immediately. A year later, “immediately” has not really happened, which is a shame. We have possibly borne the burden of deaths as a result of that, too.

It is also clear to see that there are gaping holes in the Government’s new hotel quarantine system. Figures suggest that thousands of people travelling from higher-risk countries will be missed by the scheme every day. Analysis of passenger data suggests that 10,000 passengers will arrive in the UK on Monday from countries where the South African or Brazilian variants of Covid-19 are circulating but which are not yet on the Government’s “red list”. These people—roughly 19 out of 20 passengers —will avoid hotels and ask to quarantine at home. Yet just three in every 100 people are being checked to ensure that they comply with home quarantine. Does the Minister think that that is good enough? Given that we know that the South African and Brazilian variants of the virus involve a key mutation, E484K, which may help the virus evade antibodies and render the Pfizer and Oxford/AstraZeneca vaccines less effective, the Government’s failure to secure our borders risks jeopardising the fight against Covid-19 just at the moment when it looks like we are making significant progress. So I hope that the Government will urgently review the policy and extend quarantine to all travellers arriving in the UK.

I turn to the implementation of the policy. Will the Minister update the House on the number of beds in hotel rooms that have been secured for travel quarantine measures? Can he confirm whether they are seeking to expand capacity in anticipation of extending the policy to further countries? What steps are being taken to ensure that staff in quarantine facilities are given adequate PPE? I would also be grateful if the Minister could outline what support and financial assistance will be in place to help people seeking to return to the UK from “red-listed” countries who cannot afford the up-front £1,750 quarantine cost. This is very important, given that, among the numerous categories of travellers, there are likely to be people who had to go abroad at short notice for family emergencies.

Finally, it has been announced that people found to have omitted to reveal that they have travelled from a “red list” country could possibly face up to 10 years in prison under the Forgery and Counterfeiting Act 1981. While the penalties for non-compliance are a core part of any regime, does the Minister accept that a 10-year prison sentence is really disproportionate? It is more severe even than sentences given out for some violent and sexual offences. Sir Keir Starmer has, quite rightly, pointed out that pretending judges would sentence anyone to that long in prison, in court cases that—given the current backlog—will not be heard for several years, is not going help anyone and probably will not deter anyone.

[Baroness Brinton (LD) [V]]

My Lords, the Minister is right to say that it looks as if the corner has been turned on cases, and even on hospitalisations, in this most recent surge. I too, like the noble Baroness, Lady Thornton, look forward to actually seeing the quarantine regulations being laid in Parliament. We keep asking for sight of them as early as possible. We have known that this quarantine arrangement was coming in—leaks started in December.

The BMA and other medical groups are concerned that those without GPs must have access to the vaccine. Last week, the Government announced that undocumented migrants can register with GPs for a Covid vaccine without fear of being prosecuted by the Home Office. This is good news, as we need everyone possible in the country to be vaccinated, to keep us all safe. However, the law currently requires the NHS to report those without a defined migration status. This amnesty announcement, based on the suspension of so-called immigration data sharing between the health service and the Government, is temporary, only during the pandemic. What safeguards are there that this data will not be shared after the pandemic is over? A temporary amnesty will not encourage people to come forward if their data can later be shared.

According to Ministry of Justice data, 2,400 Covid-positive cases were recorded in prisons in December—a rise of 70% in a single month. Given that the Government have a legal duty to provide equivalent healthcare to those in prison, can the Minister explain why prisoners in priority groups 1 to 4 started to be vaccinated only from 29 January?

Will the Minister answer a question I asked earlier this week without a response? There have been number of reports of Sitel and other call centre contractors having their contracts reduced by government and immediately sacking track and trace staff because, as a Sitel manager said,

“At this point in time as a business we need to reduce the number of agents because we have done our jobs.”


Can the Minister please confirm or deny that the Government have asked for track and trace staff numbers to be reduced? Do the Government still believe that test, trace and isolate remains a vital part of coming out of this pandemic, or are they totally relying on the vaccine? Everything that the scientists and doctors are telling us is that we will have to continue to take all precautions, such as “hands, face, space”, and will also need all the protection tools, such as test, trace and isolate, for some time to come, otherwise we will be hurtling towards yet more cases, hospitalisations and deaths.

That brings me to borders. On 22 January last year, alongside the noble Baroness, Lady Thornton, I asked the Minister’s predecessor what steps were being taken to monitor flights from places where Covid-19 had been confirmed or was suspected. I have repeatedly raised worries that the UK was not following either the World Health Organization advice or the actions of the CDC in America, which has resulted in many cases coming into the UK from China and the Far East and, during February, through those returning from skiing holidays in Italy, France and Austria. Every step of the way, the Government have been too slow in making arrangements to monitor passengers, whether placing them in quarantine at home or, as is now proposed, in quarantine hotels.

Some countries have learned through experience that early action at borders is vital. South Korea, Australia and New Zealand are notable examples. Taiwan should be a role model for us all. It began monitoring passengers arriving as early as 31 December 2019, and shortly afterwards created formal quarantining, both at home and in hotels, with electronic monitoring by health teams. Its Government’s clear communication with its people, providing the carrot of a support package for anyone quarantining, as well as the stick of substantial fines, has meant that a country of 23 million people had, in 2020, fewer than 800 cases, with only seven deaths. One city alone has 3,000 hotel rooms reserved for quarantining; the Government here are proposing 4,000 for the whole of the UK. And the fines in Taiwan are not small, at up to 300,000 New Taiwanese dollars—about £7,500—with one businessman who breached quarantine seven times in three days fined more than £26,000.

Taiwan’s approach is as much about self-isolation as it is about quarantine for those coming from abroad, and the view of the Taiwanese public is that everyone should do their civic duty, helped by the clarity of messaging from the Government and their medical experts. So it is a shame that our Government’s key message is all about the maximum prison sentence. We need as much of the carrot in our approach, rewarding people for self-isolation, preferably by paying their wages and by supporting them with care calls and delivering shopping and medicines, most of which has been notable by its absence to date.

Two things are clear from the worries over the new variants. The UK public want to do their duty. The vast majority of people are complying with lockdown. They also understand that the nature of Covid-19 is changing, and that new variants mean we must change the way we live too. So will the Government please make the changes that we on these Benches have asked for, for over a year, regarding borders? Otherwise, we risk losing all the progress made with vaccinations, we risk children not returning to school, and we risk further and substantial damage to our economy.

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

My Lords, I am enormously grateful for the questions from the two noble Baronesses. By way of introduction, both the noble Baronesses are entirely right that the variants of concern have been a massive game-changer and the reason for this profound inflection point in our approach to border control. Having invested so much in vaccine deployment, having got it right so emphatically, having been ahead of the world in the identification, development, purchase and now deployment of vaccines, and having got so many people who were at threat of sickness and death into a position of safety, it seems entirely right that we now protect the country from mutations that might escape the vaccine by taking tough measures on the border.

That is different from the situation of a year ago: we had comparable infection rates and were all facing the same virus, which did not seem to mutate for months on end. At that point, the priority was to keep our borders open in order to keep the flow of goods, medicines and essential supplies in the planes, trains and boats that are necessary to support Great Britain. But the variants of concern have completely changed that view. That is why we brought in this new, robust and emphatic regime. It depends, in very large part, on existing legislation, but I reassure noble Lords that our plans are to bring in new regulations, where necessary, at the earliest moment. I hope that that will be very soon.

The noble Baroness, Lady Thornton, asked about international surveillance. That is an important part of our overall plan. In Britain, as noble Lords know, we have the most advanced investment in genomic sequencing anywhere in the world, by far. We are hugely investing in a great dash on capacity, turnaround times, accuracy and the geographic distribution of that surveillance in the UK. But we are also investing in international systems. We have made an open-hearted, big and generous offer to the countries of the world to do genomic sequencing for them, wherever necessary. If anyone wants to send their specimens to the UK, to the Sanger at Cambridge, we will do that for them. We are sending machines, often from Oxford Nanopore, the British diagnostic company, to diagnostic centres in countries that have some genomic capability, to enhance their testing and speed up their turnaround times.

The noble Baroness, Lady Thornton, asked about the enhanced measures we are putting in place to check when people arrive in the UK. I can reassure her massively, because the system for the passenger landing form has been digitised and hugely enhanced. We have dramatically increased the amount of validation of the data put into the PLF. The pretesting certificates are linked directly to the PLF, and we are working on linking it to the hotel booking and testing forms. We are also putting in enhanced surveillance of those isolating at home, which includes phone calls, SMSs and an increased investment in police time to follow up where there may be suspicion of a breach. We are also making a crystal-clear communication to those who have access to private jet travel that we will not tolerate those who have the resources to pay the fines but feel that they can, or want to, get around these measures.

The application of the hotel quarantine measures to all countries—both red list and amber—is something that we keep under review. There is a rolling review of the red list, and we are putting in place the necessary infrastructure, should it be required, for a blanket hotel quarantine protocol on all travellers to the UK.

The noble Baroness, Lady Brinton, kind of answered the question on the number of hotels, for which I am enormously grateful. We have currently booked 16 hotels with 4,600 rooms. However, I reassure her that this is an on-call framework, and we will have access to a massively increased number of hotel rooms if that should prove necessary.

But I have to be clear: the signal from the British Government and the instruction from the Home Office and the Department of Health and Social Care is that there should be no need to travel other than under the most exceptional circumstances. We are not trying to encourage anyone to travel, and we expect the number of people travelling to and from the UK to remain at a low level for the foreseeable future. For those who are currently overseas and seek to return but are experiencing some hardship because they were not expecting, did not plan for and cannot afford the considerable cost of the hotel quarantine, we will publish schemes to spread the payment of that to help people out.

Regarding the legislation, the noble Baroness, Lady Thornton, made a big point of saying that a sentence of 10 years was too long for a breach of contract. I remind her that Section 1 of the Fraud Act 2006 creates a general offence of fraud and introduces a number of ways of committing it, including fraud by false representation and fraud by failure to disclose information. Committing fraud is a very serious offence. Not everyone who commits their first fraud will get a custodial sentence, but if people repeatedly breach these restrictions or put the lives of others at risk, it will be up to either the magistrates’ court or, ultimately, the Crown Court to decide on the sentence. The maximum sentence is 10 years and it is quite right that it should be. The noble Baroness, Lady Brinton, made a very good point when she referred to Taiwan, which I shall mention in a moment.

The noble Baroness, Lady Brinton, asked about the data flows on undocumented migrants and the temporary amnesty. I reassure her that it is absolutely our intention to get everyone in the UK vaccinated, whatever their status. We are completely status blind when it comes to distribution of the vaccine, but we need to know who you are before we inject you with drugs—that is a basic clinical need and one that we cannot avoid.

She asked specific questions about the flow of data and whether this would be a temporary amnesty or would last longer. I do not have access to the precise answer to that question but am happy to commit to write to her on that important point.

The noble Baroness asked about prisons. She is entirely right to be concerned. We have had a terrific track record on protecting prisoners from this disease over the year, but she is right that in recent weeks epidemics have emerged in prisons. We are working incredibly hard to deploy a very large amount of testing and, where necessary, implementing isolation, and the vaccine has been rolled out to those who are qualified.

Turning to Sitel managers, I assure the noble Baroness, Lady Brinton, that we are enormously thankful to all those who have contributed to the tracing operation. We balance the workload between a variety of providers, and Sitel is just one of several that we have. There is no question of our backing off from our tracing operations—quite the opposite. Test, trace and isolate remains an important part of our armoury and it only increases. In recent times, we have doubled up on our commitment to the Lighthouse labs, which have proved cost-effective, accurate and fast. The genomics turnaround in tracking variants of concern has been remarkably efficient. On tracing and VOCs, Project Eagle is working extremely well and I saw incredibly impressive numbers on that this morning. Pharmacovigilance around the vaccine is being supported by test and trace, and the creation of the NIHP is apace.

Finally, the noble Baroness, Lady Brinton, mentioned Taiwan. Given that I am married to a Taiwanese wife, I can absolutely bear testimony to the remarkable achievement of that island nation. Taiwan was hard hit in 2003 by SARS, a time I remember well, since my Christmas was cancelled. It learned the lesson and applied important measures. The island has the advantage of social cohesion, but both the stick and the carrot were thoughtfully used, as the noble Baroness rightly pointed out. It created a green list country with a remarkably low level of infection and death, and that is a lesson we can all learn from.

The public are doing their duty and absolutely understand the threat of variants of concern. It is incredibly impressive and I am optimistic for the future.

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) Regulations 2021

Baroness Brinton Excerpts

Monday 8th February 2021 Grand Committee

[Baroness Brinton (LD) [V]]

My Lords, these regulations once again are being hurried because of their expiry date, before the Prime Minister addresses Parliament and the country on 22 February with his route map out of lockdown. I ask the Minister: what evaluation have the Government done of the tiered system and the total lockdown? Do they think that the slow decline to around 15,000 cases per day and just under 9,000 deaths per week means that it is safe to consider easing lockdown next month?

We note that the regulations make minor changes to the tiers legislation, including on elite sports competitions, the exemption to leave home to collect goods ordered via click and collect and from libraries, cafes and canteens in post-16 education centres being open, and marriages and conversions under marriage being permitted. I do not believe that these are contentious. But, as my noble friend Lord Scriven said, it is the bigger, more strategic approach to what needs to happen to unlock the “stay at home” orders that must be considered.

As my noble friend Lady Walmsley outlined, too many people still think that vaccines alone are the answer, but in the light of the spread and strength of the new variants, can the Minister say how the surge testing in the postcodes announced last week is proceeding? Are there effective results in further isolating both the South African and UK variants? Are there any indications yet about the spread of these variants that might affect the easing of lockdown?

For 11 months, we from these Benches have urged the Government to run an effective test, trace and isolate system. The need for that will be even more important as part of the route map out of lockdown, so I echo my noble friend Lady Barker’s concerns that the Secretary of State is reducing or curtailing some contracts with tracing firms, which have summarily sacked their staff. On Friday, Sitel—one of the contractors—said:

“At this point in time as a business we need to reduce the number of agents because we have done our jobs.”


But while there is some reduction in case numbers, the daily level, at around 15,000, is substantially higher than the 1,000 a day when the first lockdown was lifted last year. As the Minister said, the numbers in hospital and number of deaths remain too high.

Does this mean that the Minister no longer believes that test and trace is an essential tool? Perhaps it means that, at long last, local test and trace teams, which have always had a much better success rate at contacting people and persuading them to isolate, will be increased. Can the Minister please explain what is going on?

Last week, in a reply to my noble friend Lord Scriven, the Minister said that 86% of contacts were now being traced, appearing to show a substantial improvement. However, “More or Less”, the Radio 4 programme, reported last week that if a tracer tells one person in a house of five that they must all isolate, that apparently now counts as five separate successes. Is this correct, and does it explain the rapid increase in tracing rates for call-centre companies such as Sitel? What arrangements are in place to give confidence that everyone in any household is self-isolating after they have been asked? Can the Minister say whether this higher level of success is connected to the new way that tracing data is assembled?

From these Benches, we have repeatedly listed the key steps needed for successful test, trace and isolation, especially the latter. Those self-isolating need to be paid their proper wages, as they are performing a civic duty. The Government’s sick pay levels are pathetic, with a theoretical, one-off £500 grant that hardly anyone can access because, local government tells us, the rules are too hard and complicated. Those with dependants, such as unpaid carers looking after disabled or elderly family members who are not allowed to be in the same room for their self-isolation as those they care for, may also need particular support.

As my noble friend Lady Tyler commented, there should be state-funded places in pandemic hotels for those who cannot effectively self-isolate at home, especially when there are many other family members living in a confined space. There should also be a proper care package of support for those isolating, as in Germany and Taiwan, with regular calls to check on mental health, and to ensure that food and pharmacy supplies are getting through. Most importantly, there should be consistent, strong, clear messaging to the public every day. That would provide confidence for those who currently have to choose between feeding their families or self-isolating.

Finally, as we approach 31 March, when the emergency pandemic legislation expires, I echo the comments of my colleagues on the broader issues relating to these almost daily Covid SIs. The Government took to themselves extraordinary Henry VIII powers on the understanding that SIs were to be brought to Parliament in a timely fashion for debate. They are not. Far too often they are enacted weeks ahead of when the Commons debates them, and we have to wait a number of days before they then come to the Lords. The Government must start consultation on the renewal of these powers with both Parliament and the wider public as soon as possible. When will this happen?

Covid-19 Update

Baroness Brinton Excerpts

Thursday 4th February 2021 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for this debate on the Statement made in the Commons on Tuesday. I start by joining the Minister and everyone across Parliament and government in sadness at the death and in celebration of the life of Captain Sir Tom Moore. I also join everyone in celebrating the fact that 10 million people, 15% of the population, have now been vaccinated with a first dose. That is a fantastic achievement and I am so grateful to the NHS and all those who have contributed to this amazing national effort. Another Statement about vaccines is being taken in the Commons today, so I think we can see that this is a fast-moving world that requires Parliament to be quick on its feet to make an input and provide both scrutiny and support.

However, we are all aware of some people who are refusing the vaccine, including care workers. Can the Minister advise the House how many people in the priority vaccine groups have refused the vaccine? If he does not yet have these figures to hand, can he say when the figures, broken down by area, age, gender and ethnicity, will be available? This data seems to be crucial to understanding and tackling vaccine hesitancy moving forward. I am sure that the Minister will be aware of the research carried out by Professor Tim Spector and his team at King’s College London into why people are refusing or doubtful about the vaccine. Only yesterday there was a webinar about this. What was quite clear from that is that communication and example setting are important, and I hope that the Minister can share some of the thinking that may be going on about how to tackle this.

I turn now to the vaccination of the most vulnerable. I thank the Minister for his letter today in response to my question last week about how the bedridden and the homebound, and their carers, are being vaccinated. I would appreciate it if we could have some numbers showing how many people are in this vulnerable cohort. Only yesterday on the news we saw the example of an elderly man living alone who is recovering from cancer. He is isolated and his family are very anxious indeed that he has not yet been vaccinated.

According to recently released figures, Covid-19 deaths in care homes in the week ending 22 January represented 46% of all deaths in homes. That was the highest proportion of deaths since the beginning of the pandemic, surpassing even the previous high of 39.2% set last May. During that week, 1,817 care home deaths involved Covid-19, taking the total to more than 25,000. Gavin Terry, head of policy at the Alzheimer’s Society, said that, given the worsening figures

“staff vaccinations must be urgently prioritised along with rapid rollout of second jabs.”

The Government are being optimistic in saying that vaccines have been offered in care homes—but that is not the same as them having been taken up. Time is rolling on for older people who have not been able to see and touch their loved ones for almost a year. We all admit that this is cruel. In many ways, it underlines the dreadful inequalities that Covid has revealed in our society and its care of the most vulnerable.

If the current rate continues, the UK will be on track to have offered a dose to everyone in the top four priority groups by mid-February and to complete the remaining five priority groups in early April, when the need for the second dose begins.

The Minister will be aware of concerns as to whether medical and administrative staff can continue at the current pace for many months at a time, when many are already working seven days a week. What steps are the Government taking to relieve the pressure on staff and ensure that the pace of vaccination remains sustainable in the weeks and months ahead?

The new research from Oxford shows that the AstraZeneca vaccine is 76% effective after one dose and can reduce transmission by 67% over 12 weeks. This is fantastic news. Will the JCVI review this evidence and consider using the AZ vaccine to help prevent spread of the disease—not just serious illness and death—once everyone in the priority groups has received two doses? This would allow public health directors to speed up the vaccine rollout in more deprived communities, including among black and ethnic minority groups, and in hotspots where the disease is threatening to run out of control.

We all agree that children’s health must always be a priority. On current plans, how many teachers will be vaccinated as part of bands 5-9? How many teachers and support staff will have to wait until the period between Easter and summer to be vaccinated? Last September, it was reported that 25,000 teachers had been off sick with Covid-related illness, further disrupting children’s learning. How can the Government ensure that we do not see the same disruption again from March, when it is hoped that the schools will return? I hope that the JCVI will prioritise this as part of its review because, once schools have reopened, we need them to remain that way.

Finally, high infection rates, death rates and the identification of the South African variant in the community and the E484K mutation in the infectious Kent variant are deeply worrying. Although the noble Baroness, Lady Harding, claims that this was

“something that none of us were able to predict”,

the Minister must know that scientists have long warned of new variants as the pandemic unfolds and that the likelihood of mutations increases when there are high rates of transmission. It is more urgent than ever that this hole in our defences is fixed.

Increased testing is always welcome but will ultimately be insufficient unless test and trace is made to work for everyone. This week, the noble Baroness, Lady Harding, advised that at least 20% of people—she reckons approximately 20,000 a day—who should be self-isolating are not abiding by the rules. These figures demonstrate the need for both decent sick pay to break the chain of transmission and for test and trace to work properly.

[Baroness Brinton (LD) [V]]

My Lords, we also express our condolences to the family of Captain Sir Tom Moore. He was an inspiration and an example to so many.

The health Statement reminds us that this is HIV testing week. HIV Prevention England rightly says that the message about early HIV testing must be well publicised. I pay tribute to our Lord Speaker for his key role as Health Secretary in the 1980s in managing urgent and uncompromising messages to the public about HIV and AIDS. This Government could learn much from those campaigns about communicating clear messages.

From these Benches, we also echo the excellent news that 10 million people in the first four priority groups have been vaccinated so far. Last week, I asked the Minister whether the vaccine dashboard could break down vaccine take-up below national level. I note that this Statement says that this is happening at local health and local authority level. However, there is still no breakdown between health and social care staff. On Tuesday, the United Kingdom Homecare Association reported that only 32% of its staff had been vaccinated so far. It said that invitation to vaccinate care staff was a local lottery, with some areas having excellent arrangements, but others not. Live-in carers face even harder access to vaccines, as they are often completely left off local vaccination lists.

Further, we know that some care staff have concerns about taking the vaccine, so dialogue is vital. Recently, there was an excellent radio interview with a GP from the north-east who explained how they had talked to staff who were worried about vaccinations at the care home where they worked. Those staff were reassured and were vaccinated. Too many social care staff are just referred to large vaccination hubs with no opportunity to discuss it with a known and trusted GP. Will the Minister ensure that GP surgeries can still have vaccine doses for everyone in groups 1-4, including social care staff, so that the barriers to vaccination are tackled and removed? Please can we see the NHS and care staff separated out on the vaccine dashboard?

This Statement also raises the emerging problems with the South African variant, with further restrictions in some postcodes. These, as well as the new changes to the UK variant discovered in Bristol and Liverpool, remind us that Covid-19 is still challenging us at every turn. I say well done to the local directors of public health and leaders of councils, working with their local NHS, on their excellent speed of response and the clarity of their local messages to people in the relevant postcodes.

I have a couple of questions for the Minister. First, Ministers have said that the new South African variant problems were discussed and planned for last Thursday. So why was there not an announcement before the weekend, ensuring that affected residents could protect themselves and their neighbours as soon as the risk was apparent? Secondly, the Statement says that everyone in these areas must have a PCR test—good. However, a letter sent from the NHS to hospital staff said that no staff were to go to work until they had had the results of a PCR test. Given that hospitals already have a large number of staff off sick or self-isolating, what help are they getting to deal with further staff absences?

The Minister will remember that I have urged the Government to include unpaid carers in the priority list in order to protect those they care for. The announcement of their inclusion in priority group 6 is welcome. However, they are not in the summary lists in the vaccines delivery plan. Will the Minister commit to clear up any confusion by explicitly including unpaid carers in government communications and by publishing specific guidance on making sure that they are vaccinated as part of group 6?

Finally, we look forward to hearing the Prime Minister speak on 22 February about the route map out of this third lockdown. Progress on vaccination is vital, but test, trace and isolate is also essential if we are to avoid a fourth national lockdown. We on these Benches believe that people who are self-isolating should be paid their wages and have access to a proper care package, as in Germany and Taiwan. We have been asking for this for 11 months. The failure of people to comply with self-isolation rules demonstrates that the current system is not working. Will the Government urgently review the arrangements for isolation and encouragement to comply?

Yesterday, Chris Whitty and the Prime Minister were clear that this third lockdown cannot be lifted until it is safe to do so. Yet already MPs and some Peers are pressuring the PM to open schools immediately. Strong, clear messaging is needed every day—as strong as on the AIDS campaign by the noble Lord, Lord Fowler, 30 years ago. We know from polling data that the vast majority of people want to do the right thing. The Government’s role is to tell us what and why and to provide support for those who need help to do it.

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

My Lords, I am enormously grateful to both the noble Baronesses for their thoughtful and provocative questions. I join the noble Baroness, Lady Thornton, in paying tribute to Captain Sir Tom Moore. His story touched on something we have talked about in this Chamber this year: the way in which someone, in their 99th year, can make a tremendous impact on the whole country, bringing us together and raising money for NHS staff. It was an amazing achievement so late in life. It demonstrates that every year of every life, however late in that life it is, is valuable. That is why this Government are extremely proud of the measures that we have put in place to protect the lives of, and avoid severe harm to, the elderly and infirm.

I also share in the noble Baroness’s tribute to NHS staff and the vaccination rollout. She is entirely right; there is huge mental and social attrition across the NHS at the moment. The hard work that goes on, particularly in intensive care, is having a tough impact on those who work there. We hear of the need for some form of respite for NHS staff, loud and clear, but I have to be candid: when we are done dealing with the hospitalisations for Covid, there will be a massive wall of work to manage the huge backlog and restart business as usual. We are looking at the human investment needed. I pay tribute to my colleague Helen Whately, the Minister who covers the NHS workforce. She speaks to the NHS and social care workforce daily. We are looking extremely carefully at the investment that will be needed to support healthcare staff in the difficult year ahead.

The noble Baroness, Lady Thornton, asked about those who refuse the vaccine. I am afraid that those statistics do not exist, because people do not identify themselves as vaccine refusers. However, the overall picture is extremely positive at the moment. Those in categories 1 to 4 are stepping forward for the vaccine in tremendous numbers, and we are extremely encouraged by that. I take on board the insight of Tim Spector and others who have spoken thoughtfully about the barriers. I pay tribute to civic and particularly religious groups, which have often put vaccination sites in their temples, synagogues, churches and other religious settings. That is exactly the kind of trusted civic engagement that has led to vaccine deployment reaching deeply into communities that might otherwise have been worried or suspicious.

The challenge that we will face will be when we turn our attention to the younger. To answer the other question from the noble Baroness, Lady Thornton, we will be rolling out the vaccine to all age groups. The very good news from AstraZeneca about the vaccine being an extremely effective agent against transmissibility is exactly what we need to know, because it gives a green light to using the vaccine to avoid not just severe illness, hospitalisation and death, but transmissibility. We have to get the message across to those whose lives are not necessarily saved by the vaccine—it saves someone else’s life—that taking it is important and something they should feel trusting about and obligated to do. That will be the second phase of the vaccine rollout, and we are thinking carefully about how to do it as effectively as possible.

The noble Baroness, Lady Thornton, alluded to staff vaccination. She is entirely right about the very high number of Covid deaths in homes at the moment, and I reassure her that vaccines have been offered to every person in every home. There is an email address, which I would be happy to share with all noble Lords, for anyone who thinks that they have not been offered the vaccine. There is an absolute backstop for anyone who thinks that they have been overlooked or have missed out. We are doing our level best with an effective deployment and rollout programme to ensure that all social care homes, whatever their status, and all staff in them are protected by the vaccine.

I will say a word about schools and teachers. I completely support the views of the noble Baroness, Lady Thornton, and many other Peers who have spoken thoughtfully and emotionally about the importance of getting schools back. The Government and I agree that this is our priority. I spoke to the Schools Minister, Nick Gibb, about this yesterday. I pay tribute to the work of the Department for Education in rolling out testing in schools. Either today or very soon, we will have had the millionth test in schools, which is a great tribute to the work that schools, teachers and the DfE have done on asymptomatic testing in schools. It is an important way to cut the chain of transmission and to protect all those in schools, from both the disease and being agents of transmission to those who are more vulnerable. I support all the measures on social distancing, PPE and testing that we can put in place to keep schools open.

When it comes to vaccinating teachers, I emphasise that saving lives and avoiding severe harm is the priority for the vaccination programme. While we are sympathetic to teachers and will definitely have them on the prioritisation list, the protection from harm and death is our current priority.

We take the news on mutations from South Africa, Brazil, California, Kent and Bristol, and all the other manifestations of mutations, extremely seriously. The noble Baroness, Lady Harding, spoke about not expecting a mutation, but of course it was not the virus mutating that was not expected—that is commonplace. The CMO spoke about that impactfully and early, in February and March; he utterly predicted that mutations would lead to a second wave. But the virus had not mutated much last year. In fact, it was a phenomenally rigid and consistent virus for a long time. What was not easy to predict was that a highly transmissible disease would emerge that completely outperforms its previous classic manifestation. We saw that only when the infection rates started to climb extremely quickly. We changed our tack accordingly, and we continue to change our tack.

As I have said from the Dispatch Box previously, we are in a different game now. Previously, the focus was on keeping a lid on infection rates and getting the prevalence levels low. That remains an important feature of our battle against Covid. On the other hand, we have to protect the vaccine. We are aware of the potential for a mutation to emerge that escapes the vaccine. That has been seen in other diseases and could be seen in this disease. That is why we have mobilised Operation Eagle to track down the South African variants that have landed in the UK, where we do not have a clear chain of transmission. That is why we are going door to door, offering PCR testing to all those—around 10,000 people—in each of the relevant postcodes, to put a lid on any community transmission. That is why we have deployed a special team, tracing variants of concern, which is tracking down the origins of each infection to stamp out and suppress variants of concern, where they emerge.

This is exactly the kind of capability that we need to put in place should a highly transmissible vaccine-escaping variant manifest itself. I pay tribute to those in test and trace who have put together this capability extremely quickly and are implementing it so thoroughly.

Both the noble Baronesses, Lady Thornton and Lady Brinton, alluded to the important issue of isolating. I hear those points loud and clear. We support those who are isolating, and make a £500 payment to those on benefits, who need it. Charities and local authorities support those who isolate. But I hear the point made about additional measures, and we are looking at further ways to support those who are required to isolate, either because they are infected themselves or because they are the contact of someone who is infected.

The noble Baroness, Lady Brinton, spoke thoughtfully and movingly about the role of the Lord Speaker in fighting HIV and AIDS, and I join her in paying tribute to the Lord Speaker, whose 83rd birthday was earlier this week. The messaging in that campaign was poignant, it cut through and we all remember it very well.

I also pay tribute to those in the communications team who have, during the last year, put through some incredibly impactful campaigning around the Covid messages. There has been massive societal behavioural change because of the clarity and the impact of the campaigns that we have done. Those campaigns have got better and better, and the most recent “look into my eyes” campaign, as it is now called, is one of the most impactful. When we look back on this campaign, we will think very highly of the marketing and communication skills of those in the Department of Health, the Cabinet Office and other departments, who have worked so hard in this area.

The noble Baroness, Lady Brinton, alluded to the vaccination of social care staff. She is absolutely right to allude to lists. One of the current difficulties is that we do not have proper lists of all those who work in various roles in social care, either as domiciliary staff or in unpaid roles. My colleagues are looking at this, and we are moving quickly to address it. I know that the noble Baroness feels very strongly about the vaccine dashboard; I have taken it back to the department and spoken to the vaccine team about it and I will raise the matter with them again. Regarding the unpaid carers and the delivery plan, I will take that to the department again. I will be happy to write to the noble Baroness.

International Year of Health and Care Workers

Baroness Brinton Excerpts

Monday 1st February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Baroness makes a completely fair point. Her observation is entirely right and her recommendation is one that the Prime Minister has made clear is part of his thinking. Social care workers have done a phenomenal job during this pandemic. Their role in supporting the elderly and infirm is extremely valuable to the whole country. It is only right that they should be treated fairly; a review of their pay and circumstances will be part of the social care package when that is announced.

[Baroness Brinton (LD) [V]]

My Lords, the WHO notes with concern the increase in international health worker migration; there are also concerns about their workplace treatment in their host countries. The 14% of brilliant non-British NHS staff are essential in holding up our healthcare systems, as has been especially evident during this pandemic. Last week, there were worrying press reports that hospital trusts were telling non-UK NHS staff without NHS numbers that they were not eligible for the Covid vaccine. Please, can the Minister say whether all NHS staff are eligible for the vaccine—and if he cannot, will he explain why not?

[Lord Bethell (Con)]

I take this opportunity to confirm to the noble Baroness that all NHS staff qualify for the vaccine. I would be very grateful if she could communicate to me any incidents where an NHS trust has said otherwise. We are enormously grateful in this country to all those who migrate to support our social care services. We are profoundly grateful for those efforts, and I want to ensure that everyone is treated well in their workplace. Generally, those in the social care workplace are treated well; there are exceptions, and we crack down on those exceptions extremely hard.

Social Care Funding (EAC Report)

Baroness Brinton Excerpts

Thursday 28th January 2021 Grand Committee

[Baroness Brinton (LD) [V]]

My Lords, I declare an interest as a vice-chair of the Adult Social Care APPG. This has been an excellent debate on an excellent report, and almost without exception everyone has said that they support virtually all its recommendations. Those who have had issues have had one or two specific points only. But here we are—again—in another year with yet another debate where we discuss the scandal that is the funding of social care in this country.

In fact, this problem is more than just four or five years old. Twenty-five years ago, when I was a member of Cambridgeshire County Council, there was cross-party agreement that the social care funding system was in deep trouble and needed urgent reforms. Sometimes it really does feel like Groundhog Day. However, this report provides a megaphone to government by expertly identifying the urgent issues facing our social care system. It has made a series of excellent recommendations that have received broad consensus across the parties, and even across the sector.

This debate has also demonstrated that the problems are well known and, in policy terms, much has been done to start to address them. Along with other parties, so ably listed by a number of Peers including my noble friends Lord Razzall and Lord Campbell, and the noble Lord, Lord Young of Cookham, we note that the Conservatives had reforms to social care as key manifesto promises in 2017 and 2019, yet here we are still waiting for even the first and most basic of initial announcements. Why are the repeated calls of this House, the Commons, the sector, residents and their families still falling on deaf ears? I urge the Minister and this Government not to start from scratch again with further prolonged consultation or a Green Paper. What we need now, as my noble friend Lady Tyler said, is action and a White Paper which truly addresses the unfair way in which social care is funded and provided.

The comparison has already been made this afternoon between dementia care and cancer care; it is always worth repeating to demonstrate the total unfairness. Worse than that, the noble Baroness, Lady Browning, just mentioned the case conferences where the NHS and social services are at loggerheads about deciding whether something is personal care. I have witnessed this myself when sitting in on a meeting where a discussion about incontinence was whether it was actually due to the dementia, in which case it would be personal care, or due to osteoporosis and a crushed vertebra, in which case it would be nursing care. This is ridiculous. One of the problems with the current system is that it pits one part of it against the other, and that should end.

The founding principle of our much loved NHS is to provide care that is free at the point of use and ensure that no one is bankrupted or pays catastrophic costs for their care. This principle must also apply to long-term care. We need to revisit and update the Dilnot commission to make sure that the amount people are expected to pay out of pocket is capped with, as the report says, the cost shared between the public purse and the social care user.

The pandemic has rightly drawn attention to the plight faced by our social care workers, and I very much agree with Sir Andrew Dilnot’s evidence to the committee. He said:

“It is easy to neglect how wonderful the people providing this care are and, by and large, they are fabulous people working in circumstances that many people would not find desirable.”


During the first lockdown, we saw evidence of care workers leaving their families and going to stay in care homes for its duration to look after and protect their residents. That is the sort of commitment we see from the workers, so it is wrong that social care staff are not regarded in the same light as NHS healthcare staff. There needs to be a complete attitude change, in government and more widely, about the workforce: their supply issues, their pay levels and parity of investment, treatment and esteem between the sector and the NHS. I believe there should also be a royal college for social care to confirm their status and develop best practice, and to raise the esteem of social care workers.

As the noble Baroness, Lady Pitkeathley, outlined, unpaid carers face a really difficult task and this past year, particularly, has been a major problem with the pandemic. These carers have to navigate ever-changing, complicated government guidance to care for those they love, while facing increased anxiety as there is no one to take over if they fall ill or have to self-isolate. Unpaid carers must be part of the conversation on social care reform. Currently, there are just under 1 million full-time carers, relying on the carer’s allowance of just £67.25 a week. It is the lowest benefit of its kind. What does that say about how we value this sacrifice and commitment as a community? Raising the carer’s allowance would certainly be a start. However, it is not sustainable for mostly female, unpaid carers to continue to hold up the care sector with their free labour. We need to take the report’s recommendation and restore access to local authority funding to ease the pressure on friends and family carers.

I add here a brief word about young and child carers. Their education often suffers and although there are things in legislation about it, they are not universally applied. These young people need that support because they face a real difficulty in trying to manage caring for their relative as well as their education. I applaud local government, where some councils have extremely good young carers’ groups, whose work should be spread across the country as good practice.

As well as funding and support, we need to start being innovative in our approach to social care. This means thinking about how we could enrich lives and our communities and not regard those who need care as perhaps a burden. Schemes such as the Humanitas home in Holland, where university students are offered free accommodation in exchange for volunteering with residents, demonstrate how we can look across sectors to find inventive solutions to societal issues. Good adult social care can transform lives and, in turn, prevent mental and physical ill health, providing savings for the National Health Service in the long term and, most importantly, improving the quality of life for all the residents, whatever their age. Those Dutch university students said that it transformed their views about what they wanted to do in their future lives.

Working-age adult social care patients were mentioned by my noble friends Lady Jolly and Lady Tyler, and the noble Lord, Lord Forsyth. They all made the vital point on adult social care being about so much more than the elderly. That those with long-term disabilities and learning disabilities are treated as if they are in the same category as those who have perhaps led a full life must be remedied sooner rather than later. A fair system would recognise that they are different to those who have had the advantage of 40 years’ working.

Finally, many noble Lords have demonstrated that the impact of the pandemic has laid bare the perilous financial position of our care sector. Let me be clear: I am not referring just to the emergency short-term funding via local authorities, which has been vital. The pandemic has exposed the imbalanced relationship between the NHS and the care sector, demonstrating the need for the long-term financial commitment required to fulfil the recommendations of this report. I am referring to the paucity of local authority funding—not the fault of local authorities, because their own funds have been cut so badly, as so well outlined by my noble friend Lord Shipley—for those who cannot fund their own care. This results in even higher barriers to access local funding, as the boundary below which you cannot get funding is raised higher and higher.

As for the care providers, they have faced extraordinary increases in rising insurance premiums and exclusions, and insufficient clinical indemnity. I note that the Government have come in to help on indemnity, but only until the end of March. Please will the Minister look at this and address it? Care homes are already overwhelmed and it is not as if they are going to solve this in the next six to eight weeks. Although the Government have introduced that cover, it does not provide the broader indemnity required after the pandemic to put homes on a parity with the NHS in future. Worse, the future viability of some care homes is at risk, with staff shortages causing reductions to capacity, not least as a result of workers leaving the country following our Brexit. Beds are not being filled because people are reluctant to go into homes after the high death rate in the first lockdown. The big warning, though, is that any future pandemic preparedness must take into account the impact on the social care sector, with clear guidance on how to protect residents and those requiring care.

What do we think has been the impact of the two years of inaction since the committee’s report was published? How many individuals have not had access to the care they need, or been bankrupted to pay for care? How many individuals have reached a crisis point and put pressure on our NHS in its time of crisis, as they have not had access to appropriate community care? This excellent report makes it clear that the time for action is now. Will the Minister please make sure that happens?