Covid-19: Vaccinations
Baroness Brinton Excerpts(3 years, 10 months ago)
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Baroness Thornton (Lab) [V]
My Lords, I thank the Minister for allowing this Statement to be taken. This is a challenging moment in the handling of the pandemic. We have growing infection rates; we are in lockdown; businesses are shut; schools are closed. Tragically, more than 80,000 people have already lost their lives to this awful virus. However, the vaccine provides us with a light. It is a glimmer of hope; a way to beat the virus, save lives and get us back to normal. I congratulate the Government on investing in multiple vaccine candidates —that has definitely paid off. But a vaccine alone does not make a vaccination programme. Given the Government’s record with test and trace, and the procurement of PPE, it is right that the Minister will face many questions about the delivery and implementation of the vaccine programme.
The plan that has been launched is quite conventional. Aside from big vaccination centres, it uses traditional delivery mechanisms, operating within traditional opening and access times. If the Secretary of State’s target for the number to be vaccinated is to be reached, exceptional circumstances call for an exceptional response. Why did the Government believe that 24/7 access is something that people would not be interested in? What is that view based on? However, I see that, in a characteristic U-turn, Prime Minister Boris Johnson has said today that the coronavirus vaccine programme will operate 24 hours a day, seven days a week, “as soon as we can”. What does this actually mean? When will the details of the plan to provide this service be published? The Secretary of State has said that the only limiting factor on the immunisation programme will be the speed of supply. Can the Minister confirm that this plan will receive the supply which is needed?
I think we can all see that the logistics of vaccinating a nation are huge, and we now hear many anecdotal stories about the reliability of supply, the organisation of vaccination, cancelled appointments and uncertainty of supply. On 17 December, I asked about the inoculation of our NHS staff, as it seemed obvious to me that, if we did not give vaccines to those dealing with the most sick Covid patients, and given the spike we are now experiencing, we would find many of our precious NHS staff becoming ill—as indeed we have. We are now experiencing the consequences. We are currently missing around 46,000 NHS staff for Covid reasons. When will all our NHS staff have been vaccinated?
What consideration has been given to vaccinating patients who are going to be in hospital? I am thinking, for example, about maternity services. Has it been considered that expectant mothers, and those who have just given birth, should also be vaccinated?
London currently has by far the highest rates of Covid in the UK, yet it is receiving fewer doses of the Pfizer and Oxford vaccines per head of population. Will the Minister commit to providing those desperately needed additional supplies urgently?
We are all reassured to see pharmacies included in the plan. They are at the heart of the communities of our country. They are trusted and are all ready to deliver mass vaccination. It is slightly odd that the number being trailed publicly is of 200 participating pharmacies, given that there are in fact 11,500 community pharmacies in England. Can the Minister clarify whether that is right? Why are not more involved, or is that number wrong? Can the Minister share with us what the number is?
On social care, it seems that about 23% of elderly care home residents have been vaccinated compared with 40%—which is brilliant—of the over-80s. Given their top prioritisation, can the Minister tell us when all care home residents will have been vaccinated? Will it be the end of the month, as has been promised?
When is it likely that our school and nursery staff will be vaccinated? I can see that the prioritisation lists are difficult and demanding—there is huge demand on this vaccine—but if we are to return to any semblance of normality, we need to get our children back to school.
Baroness Brinton (LD) [V]
My Lords, I welcome this Statement on the on the vaccine strategy and rollout, which we have been asking for from these Benches, in both Houses, since before the first lockdown. The Government have rightly set themselves stretching targets and we agree with them, especially in the light of the new variant’s high levels of transmission. The news this week of the severe problems that our NHS is facing across the country shows how out of control the virus is at the moment. Individuals must comply with the spirit and the rules of lockdown to help to reduce cases as soon as possible.
The Prime Minister has talked repeatedly about a vaccine signalling the end of the pandemic. I fear that lax messaging about the hope that vaccines bring is hampering the message about lockdown. It is a relief to hear in this Statement a more measured tone about this being a staging post in a long journey. Please can somebody tell the Prime Minister? The Minister will know that epidemiologists repeatedly make the point that we are a long way from life returning to normal. I note, for example, that in the debate about the vaccination priority list, the advice to clinically vulnerable people from government is that, even after their vaccine, they must remain shielding until told that it is safe for them not to shield.
On supply, we remain concerned that the Government will struggle to reach 2 million a week by next week—mid-January—given the numbers of vaccines being delivered this week. We are also receiving reports from GP surgeries of fewer doses arriving than ordered or, worse, short-notice cancellation of orders causing administrative chaos for already hard-pressed administrative surgery staff. While the opening of super vaccine hubs is welcome, can the Minister say why the hubs are vaccinating only during the day? If it is truly a priority to vaccinate as many people as possible, arrangements should be made for close to 24/7 delivery. I hear that, in the last hour, the Prime Minister has announced that the Government will try to start a pilot of some 24/7 hubs as soon as supplies permit—but how soon is soon? What are the vaccine supply pinch points? It is clear that targets are already slipping. This week, the target of 2 million a week has moved from mid-January to the end of January, and it is now the end of March instead of the end of February for the top five priority groups. Is this for the supply of all three approved vaccines, or just the AZ vaccine, where there is a much larger order to be rolled out with more substantial delays if there are supply pinch points? Also, it is because of a shortage of glass vials, or vaccine manufacture and regulation checks?
What are the Government doing to ensure that vaccine hubs are not superspreader locations? There have been worrying reports about people being asked to change masks and sit and wait less than two metres away from other people in the vaccine hubs. Given that the first five priority groups are all high-risk people, the last thing the NHS should be doing is encouraging them to go to areas that do not follow the government guidance on “hands, face, space”. Inevitably, there are glitches with any new process. We are still hearing of problems with the Pinnacle IT system that is being used for vaccinations. Some hubs were resorting to pen and paper in despair, and there are further problems reported with patients being asked to give the same detailed answers to a group of questions about Covid symptoms and allergies as they arrived, as they were registered and then as they were being given their jab. Any effective IT system should enter that information once. IT delays are reported as causing major delays, queues outside centres and daily targets missed at hubs. Can the Minister say what is being done to remedy these problems?
Can the Minister also say whether the vaccine dashboard will separate out the number of care home residents vaccinated? I see that care home cases are increasing again, which we deplore. As earlier this year, we strongly object to Covid patients being sent from hospitals into care homes, unless they are specialist Covid-designated units separated from other non-Covid residents. Even better would be to follow the example of Southampton hospital, which is using local hotels as step-down facilities. Will the Government endorse this and ensure that care home patients are kept safe through this surge until they are vaccinated?
The Government have announced that fewer than 1,300 surgeries and pharmacies are approved to deliver vaccines. The large hubs are all in urban areas. What will the Government do in rural areas, where elderly people do not have access to transport and may have to travel considerably further than the 90-minute journey for vaccinations announced this week? Are there plans as yet unannounced to increase substantially truly local-level provision, at a high-street level, in every rural village and small town—whether at a local surgery, pharmacy or visiting mobile vaccination unit—to ensure that vulnerable people who cannot travel or take the risk of infection will get access to the vaccine? It is not good enough for the Government to say that vaccines have been offered if the patients concerned cannot get to the vaccination delivery point.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I am enormously grateful for the detailed questions from the noble Baronesses. In particular, I endorse the words of the noble Baroness, Lady Thornton: it is indeed a remarkable achievement to have invested in such a broad array of candidates and to have purchased such an enormous quantity of doses—367 million. This is indeed a profoundly important step by the Government and one that we should celebrate and take pride in.
However, I acknowledge the searching questions from the noble Baronesses, so let me try to cover as much ground as I possibly can. The noble Baroness, Lady Thornton, asked about the digital backbone. This is absolutely critical to vaccine delivery. In many ways, injecting it into arms is the simple bit. Capturing the records, getting the invitations out right and the process of establishing identity are absolutely critical; in any project of this scale and complexity, that is where the problems are most likely to happen. That is why I pay tribute to colleagues at NHSX, NHS D, Test and Trace, PHE and elsewhere in the NHS who have done an amazing job of bringing together patient records around the nation to ensure that the invitations are sent out promptly and accurately and that the records are captured correctly. That information will be absolutely essential to both pharmacovigilance and the policy assessment of key issues such as transmissibility and efficacy. It employs the yellow card system to spot adverse incidents, and all data will go straight into the GP record, which is profoundly important when it comes to the research and analysis of the rollout of the vaccine. These may seem like prosaic details, but it is the most enormous digital achievement and one that will have an amazing impact on the health of the nation. I enormously encourage everyone in the country to ensure that they know their GP number, that they are properly registered with their GP and that they respond to any correspondence about the vaccine.
The noble Baroness, Lady Thornton, characterised the vaccine rollout as “traditional”. Can I just push back gently on that suggestion? There is nothing traditional about the sheer scale of this rollout, or about its speed and complexity. Our approach has been to work through the NHS, and from that point of view it might seem traditional, but I reassure noble Lords that not only is the latest technology being used but there is also the complexity of the collaboration between all the different parts of government—the Army, the NHS and PHE. Every single relevant part of government is being employed in this huge task, and it is something we should be enormously proud of.
The noble Baroness, Lady Thornton, asked about the supply figures. I am pleased to tell her that AstraZeneca has confirmed that it will be supplying 2 million vaccines a week. That is an enormous sum and it will mean that we can hit some really ambitious targets. Some 14.5 million people will be vaccinated by mid-February. Those are in categories 1 to 4, which includes care home residents and residential care workers, and they represent 88% of the mortalities in hospital. That will be transformational to the resilience of our healthcare system and to our approach to the pandemic. Some 17 million further people from categories 5 to 9 will be vaccinated by the end of spring, and all adults over 18—52 million of them—will be offered the vaccine by the autumn. That is a massive achievement.
The noble Baroness, Lady Brinton, quite rightly emphasised that this does not change absolutely everything overnight. She asked, quite reasonably, about schools and workplaces. I can confirm that there is still a huge amount to do by the entire nation to ensure that we do not have high infection rates, that we still deploy testing in order to break the chains of transmission and that we understand how to keep infection down—because the tragic thing about this awful virus is that it hits the old and infirm, who can be protected by the vaccine, but it also hits the young. It has become very clear from recent hospital admissions and from our growing understanding of long Covid that this disease hits all parts of society, and although we will have the most afflicted vaccinated by the spring, this is still going to be a societal challenge for months to come.
The noble Baroness, Lady Brinton, mentioned the letters to those shielding, which suggest that people should still remain shielded. That is a really important point and one we have to resolve, because those who are shielded who may go out into the community can themselves still be vectors of transmission. Those very people who we have done so much to protect may themselves be transmissible. Therefore, people are going from being protected to being potentially dangerous to others, and this is going to be a mind shift that we will all have to go through.
The noble Baroness, Lady Brinton, asked about GP surgeries. I acknowledge her point. There have undoubtedly been stories of GP surgeries which have set up queues of people to be vaccinated and then there has not been a delivery of the vaccine. However, I reassure the Chamber that it has been a very small minority. More than 95% of vaccination deliveries have happened on time, and in the grand scheme of things I take the view that if some GP surgeries have stood people up and asked them to come back another time, that is a small price to pay to ensure that the greatest number of people can be vaccinated as fast as possible.
The noble Baroness, Lady Thornton, asked about London. It is true that if we look at the infection rate, London has a relatively small distribution of the vaccine, but we are a young city here in London, so it makes sense that we have a lower proportion of vaccination. There are 2.8 million people who are more than 80 years old in the country. Not many of them are found in London, which is why the London figures look as they do.
On pharmacies, I reassure all noble Lords who have asked me about this that my colleague in the other place, Nadhim Zahawi, is incredibly energetic in engaging pharmacy chains and community pharmacies. It is true that we have a pilot with hundreds of pharmacies already running in it, but it is very much our intention to work closely with pharmacies to deploy the vaccine. As noble Lords know, vaccines come in plates of 1,000. It is much easier to deploy those plates in large centres than in small ones. We are working extremely hard to break those packages down into smaller groups and to get those groups into smaller locations but, quite reasonably, in order to get the vaccine into the most arms possible, we are starting with the big centres.
The noble Baroness, Lady Brinton, asked me about hygiene management in the distribution of the vaccine. She is entirely right: if you have a small room, such as a GP surgery, and you have a large queue of people, it is going to be extremely difficult to keep them all separated. That is why the development of these seven massive distribution centres in such places as the ExCel and Millennium Point in Birmingham is such an important development, because there is the space to be able to move very large numbers of people safely through the process. They will have a huge impact when they are opened next week.
On 24/7 vaccination, I am pleased to say that the Prime Minister has made an announcement on that. I must share with noble Lords that there has not been an overwhelming consumer demand for vaccinations at 4 am, but we are going to try this out as a process, and if there is indeed a big demand for late-night vaccination, then we will step up to the opportunity.
I was asked about rural distribution. Yes, it is incredibly important to get through to rural communities, particularly as many of the elderly and infirm can be found outside the city centres. I reassure noble Lords that, before very long, we will have vaccination centres within 10 miles of all communities. The noble Baroness, Lady Brinton, is entirely right to say that there will be some people for whom we have to take the vaccination to them; we cannot expect them all to drive to a vaccine centre. Provisions are being made through local health authorities in order to ensure that that is delivered.
Covid-19: Vaccine
Baroness Brinton Excerpts(3 years, 10 months ago)
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Lord Bethell (Con)
The noble Lord is entirely right: the second dose is important. However, it is important not for efficacy but for durability. We have put in substantial data provisions to record every single dose into every single arm, and to put a follow-up dose into exactly those arms. We are using the NIMS system and every single vaccination is put into the GP record. They will be tracked down extremely diligently for exactly the reasons that the noble Lord describes.
Baroness Brinton (LD) [V]
My Lords, a number of scientists have expressed concerns about delaying the second dose of the Pfizer/BioNTech Covid vaccine. On the excellent Radio 4 programme “How to Vaccinate the World”, Professor Sir David Spiegelhalter said that, as the RNA technology used is new, there is less data to give confidence on spacing. But he suggested that, given a number of people have received their first dose, now is the perfect time to do a small randomised research trial on comparing those receiving their second dose at 21 days and others receiving it at 12 weeks, which would then perhaps give more confidence. Is that happening?
Lord Bethell (Con)
Who can hold a torch to Professor Spiegelhalter and his analysis of the data? Although I did not hear him, I completely welcome his comments. I reassure the noble Baroness that enormous efforts are being put into the pharmacovigilance around this vaccine. Some of this is of a clinical and scientific nature, and it takes a while to read out. We have therefore put in parallel systems to get an early read-out on exactly the kinds of questions that she has asked.
Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020
Baroness Brinton Excerpts(3 years, 10 months ago)
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Baroness Brinton (LD) [V]
My Lords, the Minister has outlined the severity of this third wave of coronavirus and, with over 1,000 deaths yesterday, it is now all too evident in large parts of the United Kingdom. But I disagree with him, along with my noble friend Lord Greaves, about whether this is less serious than in March. The signs were all there well before Christmas and once again SAGE, with other medical and scientific experts, as well as politicians of all parties, said “Please lock down” before Christmas. Regretfully, once again, our Prime Minister delayed and, despite our wonderful clinicians and support staff, we now see the overwhelming of our NHS in London and the south of the country, with other regions following a few short weeks behind. Today, the Health Service Journal reports that hospitals in the Midlands are likely to be overwhelmed within two weeks. We can see the numbers going up in hospitals all over the country.
All eyes are now on the Government, as vaccines begin to be rolled out. With a more transmissible variant spreading across the country, the infection rate spiralling and hospitals under severe pressure, the Government must use this new lockdown to provide time to roll out vaccine support for those who need it, and to build trust with the public to control the virus, so that we can have a realistic route map back to safety and certainty for the future.
As a nation, we have never sought to vaccinate so many people in such a short time. To ask hospitals, GPs and other health trusts to manage this while they simultaneously try to prevent the NHS being overwhelmed is, frankly, extraordinary and worrying in equal measure, especially in light of the difficulties with barriers to using people such as retired doctors and nurses as vaccinators. Can the Minister say how other volunteers and the military will be used to get to every small town and village in the country to deliver the vaccine 24/7—and I do mean 24/7? If we need to get to 2 million a week before the end of January, and to 30 million to 40 million by Easter, it has to be at that level. It must be available at the most local level and preferably on every high street, whether in a surgery, pharmacy, village or town hall or sports stadium.
So far, all the evidence points to an urban and suburban process, managed by the NHS for the territory it knows, that assumes people have access to private transport. There are reports of people in Cornwall being asked to travel to Bristol for a vaccine, of hundreds of over-80s queueing for hours in the wet and cold to get into surgeries that are too small, and of short-notice delivery cancellations creating chaos and work for hard-pressed NHS staff.
I heard today of a vaccine hub where cars filled with over-80s queued for about 40 minutes beyond the appointment time because there was no space in the car park. Many of the elderly were too frail to even walk from the car park into the centre. Lots of elderly people who seemed cold were shuffling across the car park and then across a road to get into the hub. The wi-fi was down, so registration had to be done on paper, and it was very difficult to socially distance. That all-important 15-minute period of recovery time to check for adverse reaction was in a marquee where the heaters had broken down. The NHS workers and volunteers were all extremely helpful in doing all they could to improve the situation, but the issue was the logistics, including not understanding that elderly people need extra support before and after—as well as when—they receive their injection.
Why is the logistical expertise of the military not being used to its full extent? They demonstrated with the building of the Nightingale hospitals, and then with mass testing in Liverpool, that their expertise is second to none. We need this organisational burden removed from the NHS. Why has Public Health England announced that there will be no deliveries of vaccines on a Sunday? That immediately reduces the capability, when we have plenty of volunteers available to deliver the vaccine into arms. Why are only large pharmacies being used, rather than providing volunteer support to enable them to manage vaccination in small rural areas and villages?
The Minister rightly welcomes the approval of the Oxford/AstraZeneca vaccine as a game-changer but, as my noble friend Lord Scriven has pointed out, the virus will be with us for a long time. Even yesterday, the Prime Minister was still talking about being out of this by the spring. The Government’s communications with the public have been woeful—always trying to give us a bit of good news, which people inevitably cling to when they are worried. Alternatively, the Government have made decisions too late, making people cross and confused, as with the announcement of this lockdown, which once again meant frustration and further exposure to the new variant virus for children, school staff and their families.
We know from epidemiologists that it is likely that we will have future variants and outbreaks, whether small or large, whether here or abroad, for a long time. We must continue to have a full test, trace and isolate system available to respond to this—preferably locally based, as we know that local trace experts and isolation support are much more effective than call centres. Our own data over the last nine months has shown that.
Countries that have implemented successful test, trace and isolate systems have seen fewer cases and far fewer deaths, and built the trust needed to encourage a culture of voluntary compliance with the rules. An isolation policy will work only with effective long-term local test and trace systems, which have to continue to be in place. Yet the Government are silent on how they are to be used, not just during lockdown but after it. Even after many millions of people have received their vaccine, it will still be necessary to keep infection numbers low if we are to lift restrictions successfully and return to normal life. Can the Minister confirm what plans there are to maintain test, trace and isolate for the longer term, so that we do not repeat the problems of the last 10 months? Will the Government look at paying full wages to those on lower incomes who are self-isolating, to help them manage and not leave home?
This morning, I asked the Lord Privy Seal if she could help with the problems faced by care homes, now that insurance for designated Covid settings is almost impossible to get. Without indemnity cover, they cannot take Covid patients; she referred me back to the noble Lord the Minister. NHS Providers is begging the Treasury to help, as hospital beds need to be freed up, but the Treasury is refusing. Please can the Minister take this up with the Chancellor as a matter of extreme urgency to help with this problem, which is not of the care homes’ own making, and which is now blocking beds in hospitals at exactly the time when they need them released at a time of national crisis? Please will he keep me up to date with progress?
On these Benches, we believe that people want to do all they can to bring Covid-19 under control to keep those who they know and love and our communities safe. I ask the Minister: will decisions, messaging and communicating with the public be more honest, timely and realistic? The vast majority of people want to do the right thing. We all need to work together in this national crisis, and together come out of this third national lockdown back into a safe and secure future, where the safety net is in place in case there are future outbreaks.
Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 2) Regulations 2020
Baroness Brinton Excerpts(3 years, 11 months ago)
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Baroness Brinton (LD) [V]
My Lords, I would like to start from these Benches by thanking all those working in health and social care over the last few weeks, and especially those who have had no break over the Christmas holiday. Everyone has talked about Christmas being different this year, but for those staff on Covid wards, those on equally pressurised non-Covid wards, staff in primary care, in laboratories processing tests, those tracing contacts of patients, those working on 111 or running our paramedic services, this has been a really tough end to an already tough year. In tier 4 areas, where cases continue to rise alarmingly, everyone in the extended health system has risen again to do everything they can to keep people safe despite being exhausted. We salute you and we thank you.
These three statutory instruments are, as has become common, already out of date before Parliament has a chance to debate them. Some of that is understandable: this pandemic continues do its best to battle us at every turn and, make no bones about it, we are at war with Covid-19. The role of the scientists and medics is to warn us of the next skirmishes and battles, and the role of government is to provide the resources to defeat the next attempted incursions. Over the last few weeks members of SAGE, Independent SAGE and many front-line doctors and nurses have told us repeatedly that we must act now to prevent further surges.
From these Benches we have been critical of the patchy nature of the tier system, and specifically of the fact that this Government have repeatedly introduced new arrangements, whether local or national, much later than scientists and medical experts have recommended. Over the last three weeks they have said that the Government should take strong action now across England.
However, on Radio 4 this morning the Secretary of State for Health and Social Care once again said that he will go against this, refusing to take that strong action to get on top of the virus, despite many reports across the country that health services are already under extreme pressure, with patients being treated in ambulances and corridors, and some hospitals again facing low oxygen pressure, others with high levels of staff sickness or staff in isolation, and others converting more and more wards for Covid patients. This all seems horribly familiar.
To those who have been saying either that we should not have restrictions or that they are not convinced by them, and that the needs of the economy should take precedence, just before Christmas Dr Tedros Ghebreyesus from the World Health Organization reminded nation states that
“there is no excuse for inaction. My message is very clear; act fast, act now, act decisively. A laissez-faire attitude to the virus, not using the full range of tools available, leads to death, suffering and hurts livelihoods and economies. It’s not a choice between lives or livelihoods. The quickest way to open up economies is to defeat the virus.”
Worrying news was reported overnight in the Health Service Journal that patients with the new high-transmission Covid variant from London and Kent are likely to be moved into hospitals in regions with much lower levels of the Covid variant. What happens when the receiving hospitals in Devon, Newcastle, Sheffield and elsewhere are filling up with patients from the greater south-east, but their own local cases increase and there are no beds for them? Is there enough PPE available for hospitals for a winter wave larger than the spring wave we have already seen?
Before Christmas it was reported that NHS England had not yet signed any new deals with private hospitals because of arguments over costs. Now that some non- Covid services—including elective and cancer services —are beginning to be paused in these overburdened hospitals, are we using private hospitals to full capacity to ensure that those patients are not left behind?
We are hearing that pressure is now being put on care homes in tier 4 areas to take both Covid and non-Covid patients from hospitals. Can the Minister assure those who live or work in care homes that there will not be a repeat of untested patients being moved into care homes, and that care homes will have access to full testing, early vaccines and appropriate levels of PPE?
I would like to build on the question asked by my noble friend Lord Scriven. In the spring Ministers said that the Nightingale hospitals were the NHS safety net. The military delivered them in record time ready for use—for which both it and Ministers deserve credit. Yet, with the exception of the Exeter Nightingale, they lie unused. Can the Minister say when and how will they operate? We keep being told that staffing is the problem, but surely when they were planned there was also an emergency plan to staff them? If there was not, what have Ministers been doing over the last nine months since they were built? As Andy Cowper of the Health Service Journal has asked, were they just theatre?
Finally, the Minister began with news about the MHRA approval of the Oxford University/AstraZeneca vaccine—which is indeed great news, and they are to be congratulated on their joint work which started in January. The logistics for delivering 2 million doses a week if 50 million people are to be vaccinated by the summer are extraordinary. I hope that this House will have a chance to debate the detail of that, with a repeat of the Statement Matt Hancock is making this afternoon in the Commons. Can we debate it preferably next Tuesday?
Covid-19: Vaccinations
Baroness Brinton Excerpts(3 years, 11 months ago)
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Lord Bethell (Con)
The noble Baroness makes the case extremely well; I pay tribute to her personal testimony. I looked into this matter after giving my answer to the question last week. I assure the noble Baroness that those who are terminally ill are, of course, clinically vulnerable by nature. We will ensure that those who are clinically vulnerable will get the vaccine when it is clinically appropriate to do so, which I hope brings her some reassurance.
Baroness Brinton (LD) [V]
What provisions and logistics are in place for those not registered with GPs to receive the vaccine?
Lord Bethell (Con)
Those who are not registered with GPs and would like to take the vaccine need to register with GPs. We have put in place provisions to allow easier registration processes, we have updated our data arrangements and we are expecting a large number of people to seek out registration. That will be one of the benefits of the vaccination programme: clearer, better records of those in this country who are part of the NHS family.
Coronavirus Vaccine
Baroness Brinton Excerpts(3 years, 11 months ago)
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Lord Bethell (Con)
I remind the noble Lord that the criteria sent out by the JCVI is extremely simple and mainly driven by age, so the selection procedure is very straightforward. He is right that the distribution of the vaccine is limited by both the size of the vials and the need for cold storage. That is why there will be an emphasis on hospitals over GP surgeries. That represents a challenge in places such as rural areas that may be distant from hospitals, but I reassure him that the deployment team is doing all that it can to ensure that no one is left behind.
Baroness Brinton (LD) [V]
Does the Minister agree with the JCVI’s decision not to prioritise unpaid carers—most of whom are caring for clinically, or extremely clinically, vulnerable people—when unpaid carers are not just prioritised but encouraged and chased by the NHS to have the flu vaccine in order to help protect the person they are caring for?
Lord Bethell (Con)
My Lords, difficult decisions have to be made by everyone in this. The JCVI has looked very carefully indeed at the challenge of how to prioritise this vaccine, taking representations from a large number of groups. Ultimately, its priority is to protect life and the NHS, and its clear decision has been to have a prioritisation based on age because this is the greatest driver of mortality.
Health Protection (Coronavirus, Restrictions) (All Tiers) (England) Regulations 2020
Baroness Brinton Excerpts(3 years, 12 months ago)
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Baroness Brinton (LD) [V]
My Lords, we are debating more than 70 pages of changes to the Covid regulations with only 24 hours’ notice of the detailed impact statement that many sought and with which, as we have already heard from both sides of your Lordships’ Chamber, people are not happy; we heard from the noble Lord, Lord Robathan, that he is particularly unhappy.
From these Benches, we have some differing concerns. Ever since the pandemic made its presence known, we have pushed to follow the best scientific advice. We have pushed Ministers to lock down earlier and have not been heard. We have pushed Ministers to set up an effective test, trace and isolate system locally and fund it right from the start, following the excellent examples set in South Korea, Taiwan and Germany, all of which had a steadier path with Covid-19. Test, trace and isolate, to be kind to the Minster, is still a work in progress. Above all, we have asked for clarity and consistency of message to the public so that each and every one of us can play our part as citizens in the fight against the pandemic.
Despite the apparent reduction in cases because of the lockdown finishing tomorrow, we now face these tougher tiering arrangements. We agree that we have not yet got control of Covid. Perhaps these new arrangements would not have been necessary if the Prime Minister had approved a lockdown three weeks earlier when it was obvious to most of us that we were entering a second wave. People are confused about what they should be doing. A poll a couple of days ago showed that two-thirds of people are worried about how safe they feel under these arrangements.
Although we remain concerned that the Government still have not got a grip on the pandemic, we firmly reject the proposals from others who say that there should be no lockdown arrangements at all. Data yesterday showed a worrying rise in excess deaths. Those with disabilities and learning disabilities still face a particularly tough journey in the pandemic. Can the Minister confirm that those with learning disabilities, many of whom are clinically or extremely clinically vulnerable and appear to fall through the testing net, can now access regular testing?
More worryingly, we are picking up reports that young people with learning disabilities at school and college are being charged by their GPs for a letter to set out their specific category to their education institution. The Down’s Syndrome Association told me today that this is not about one or two cases; it is getting reports from all over the country. Shockingly, one young man was charged £38 for a letter to his college. This is disgraceful. Can the Minister take this up urgently and immediately instruct CCGs and GPs not to charge vulnerable young people?
I am afraid that the same is happening to adults with disabilities, who have been asked by their employers to produce evidence that they should work at home. Can the Minister ensure that there is no charge for letters relating to the pandemic for anyone in the clinically vulnerable group?
Finally, I return to one of my regular topics. The Minister knows that I am on the shielding list—now known as the extremely clinically vulnerable list—along with a million other people. Last Thursday, I looked up the new guidance mentioned in passing by the Prime Minister in his announcement a couple of days before about the new tiers. I wanted specifically to look at the advice about Christmas. I have said in your Lordships’ Chamber before that the previous iterations of advice to shielders were verbose—two-page letters with four pages of detailed explanations as an appendix—but they were short memos compared to the new guidance. It is 16 pages long and full of complex advice about tier 1, tier 2, tier 3 and Christmas. Even my eyes, used to reading formal guidance, glazed over. Therefore, I focused on the Christmas advice. As with previous advice, the message was “Please do not mix with people” and the greater risks were repeatedly evident.
Here I have sympathy with the scientists and civil servants writing this document. The Prime Minster wants families to get together. However, the advice is much more cautious. It says:
“If you do decide to form a Christmas bubble it is advised that you maintain social distance from those you don’t normally live with at all times, avoiding physical contact. Everyone should wash their hands regularly and it is important to keep the space where you spend time with those you don’t normally live with well ventilated and to clean touch points regularly, such as door handles and surfaces. You may want to think about who you sit next to, including during meals, and also consider wearing a face covering indoors where social distancing may be difficult as well as encouraging others to do the same.”
Grandma is going to be really popular, going around the house opening windows, wiping doors, wearing her mask and asking to be moved at the table because she is not convinced that Uncle John understands, or cares about, social distancing.
Will any letter to those shielding be made easier to understand and considerably briefer? Will it be available in all accessible forms, including an easy-to-read version for those with learning difficulties, so that everyone shielding can make informed decisions? If the real advice is not to visit family, please can it say so? Just do not show it to the Prime Minister.
Covid-19: Vaccination Prioritisation
Baroness Brinton Excerpts(4 years ago)
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Lord Bethell (Con)
I hear loud and clear the conundrum expressed by the noble Lord. These prioritisation questions are very difficult. I hear his plea loud and clear and I undertake that these kinds of considerations will be considered in the prioritisation process.
Baroness Brinton (LD) [V]
What provision is being made for another group who feel totally forgotten by this Government—namely, extremely vulnerable children, whether they have medical conditions or physical or learning disabilities, many of whom have been unable to access carers or schools since March? When is the review that the Minister just spoke about likely to publish its results?
Lord Bethell (Con)
It will not be possible to publish any results until we have the clear data on the vaccines. Individual vaccines may behave quite differently with different groups of people. There may be some vaccines that work well with the elderly, some that work well with those with clinical conditions and some that work well with children. It is only when we know that data that the final prioritisation can be published.
Health Protection (Coronavirus, Restrictions) (Leicester) Regulations 2020
Baroness Brinton Excerpts(4 years, 4 months ago)
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Baroness Brinton (LD) [V]
My Lords, as my noble friends Lord Scriven and Lady Jolly and other noble Lords have commented, these regulations came into force on 4 July, well over three weeks ago, and indeed other towns and areas have had partial lockdowns since. However, there is a real problem with the constant delaying of presenting these regulations to Parliament, which shows that the Government are really not taking seriously the job that we have to do, which is to scrutinise legislation. Can the Minister therefore assure us that when we return in September and virtual Grand Committee comes into operation, we will return to the pre-pandemic timetable of notification and presentation of SIs to your Lordships’ House?
A number of noble Lords who have local knowledge of Leicester and the surrounding areas, including my noble friend Lord Rennard, have explained well the problems with the speed—or lack of it—of the Government’s response to the Leicester lockdown, and I agree. Local lockdowns will work only when Ministers and the NHS silo work at speed and openly with affected local authorities. On Friday, I asked the Minister why the leader of Oadby and Wigston Council had not been involved in the decision about his borough remaining in lockdown, despite much better figures than Leicester City Council. I am sorry to say that Councillor John Boyce, the leader of Oadby and Wigston, has still not heard from Matt Hancock, despite the latter saying publicly that he had spoken to him. However, it is not just the leader of the council. Many local residents are extremely concerned, as are senior councillors and officials, about the possibility of unrest if they continue to be treated unfairly compared to their neighbouring councils.
More generally, directors of public health report that communications are improved, and I thank the Minister and his team for that. However, the data still does not always arrive consistently or when it is requested, which effectively ties the hands of the local directors of public health behind their back. They say that this flow needs to be urgent, reliable and consistent if they are able to knock the local spikes on the head.
I echo my noble friend Lady Barker’s questions about the slowness of getting data to the local authorities and my noble friend Lady Walmsley’s concerns about care homes. Today’s Public Accounts Committee report recognised that care homes were “thrown to the wolves”, so what are the Government doing to protect care homes from now on, given that the Prime Minister and others say that there is not a second wave and that we are already in it?
This Saturday sees the guidance to 2.2 million shielders change. I and other Members of your Lordships’ House are shielding. On 22 June Matt Hancock and Robert Jenrick wrote to us all to set out the changes for shielders that would take place on 6 July and this Saturday, 1 August. We are told that shielding “will be paused” on 1 August, but throughout the four-page letter shielders are warned that they must continue to adopt strict social distancing as they are
“still at risk of severe illness if you catch Coronavirus, so the advice is to stay at home where possible”.
As I said on Friday, this letter also warns shielders who live alone that their government and local government support—for example, food parcels and medicine deliveries—will cease. For those who work, if your workplace is Covid-safe the Government say you should return to work. Alongside this, furlough and other payments will cease, so even if you cannot get to work or work from home, you have to throw yourself on the mercy of your employer.
I am grateful to the Minister for writing to me overnight to set out the Government’s position. I have also seen the recently updated guidance on the department website, which reiterates the points I have just made.
If I thought that the 22 June letter was contradictory and confusing, I am now even more confused. Only yesterday the Prime Minister said:
“Let’s be absolutely clear about what’s happening in Europe, amongst some of our European friends, I’m afraid you are starting to see in some places the signs of a second wave of the pandemic.”
Overnight, Oldham has joined the list of towns with local constraints and lockdowns, and Stockport is on notice. The World Health Organization says countries that relax arrangements because they are waiting for the second wave need to realise that this is the second wave and cases are popping up all over Europe. We lifted our lockdown later than these countries and so are a few weeks behind them, but I am afraid the trajectory looks clear.
For shielders, the Government say in one breath that you must avoid contact and strictly socially distance at all times, but in the new advice the onus is put on the clinically most vulnerable to leave home and go to work, the pharmacy and the supermarket. They have to be ultra-cautious about seeing people and preferably not do it. Medical charities and NGOs are getting calls from concerned shielders to ask what on earth they should do with this contradictory information, so I ask the Minister the following questions: has he formally raised with the Chancellor of the Exchequer the extension of furlough and other payments to shielders who cannot work? Does he recognise that this small, vulnerable group are highly likely to lose their jobs without continuing support? Is it safe for people whom doctors believe to be at extreme clinical risk to go to supermarkets and pharmacies when these places have little power to enforce the wearing of face coverings by other people? Will shielders be notified as a matter of extreme urgency if there is a local or partial lockdown? Will the emergency support be immediately reinstated for them?
Covid-19: Response
Baroness Brinton Excerpts(4 years, 4 months ago)
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Baroness Thornton (Lab)
My Lords, I gave the Minister notice on Friday that, because we had not taken a Statement about Covid for three weeks, I will need to address the three Statements that are outstanding.
Parliament entrusted this Government with huge powers to deal with Covid-19 when we put the emergency powers on the statute book in March. Certainly, in this House, at the time of the passage of the emergency legislation we sought and received undertakings from the Minister and the Government about the need for effective scrutiny, timely debate, consultation and trust. So how will accountability be achieved during the Recess and the autumn in this fast-moving world? All three Statements raised vital issues that deserve more time and scrutiny than we were able to give them, and I am grateful for the extra time that the usual channels have found for Back-Bench colleagues.
Before I address these Statements, I want to ask Minister about the sudden announcement this weekend of quarantine measures for those returning from Spain. These Benches have made it clear that we support evidence-based protective measures at the border. We have long called for the scientific evidence to be made public and for track, trace and isolate systems to be in place, to avoid the need for the blunt tool of 14-day quarantine. Does the Minister agree that the latest decision-making process regarding Spain and the short notice for travellers have created a sense of panic and suggest a loss of control? Will he agree that proper contingency plans should be in place to support people coming home where there is no guarantee that their employers will allow them 14 days of work flexibility? Why do the measures apply to the whole of Spain? As my honourable friend Jon Ashworth MP said yesterday, “We’ve got an outbreak here in Leicester, but the whole of Leicestershire is not locked down and the whole of the East Midlands is not locked down, so why are the Balearics and the Canaries included when their infection rate is so low?”
On the announcement on 14 July about face masks and shopping—a month after it became mandatory to wear masks on public transport—why did it take so long and why was the messaging so confusing? We have long known about airborne transmission. The Secretary of State warned long ago about asymptomatic transmission. The Secretary of State’s own advice published on 11 May advised in favour of wearing face masks, so it is a shame that it took two months to make that advice mandatory; it came into force last Friday. How will it be enforced? As a former member of USDAW, I am very concerned for shop workers. USDAW says:
“We are also deeply concerned that enforcing the wearing of face coverings could present a further flashpoint for abuse against our retail members.”
It makes the point that full government guidance was released only hours before the changes came into effect, so how were employers to have adequate time to put the policy in place to support their staff during these changes?
On the Leicester lockdown announced on 16 July, the people of Leicester are now in the 17th week of lockdown. We will discuss that issue on Wednesday, but will the Minister confirm what lessons the Government have learned from what they did and did not do in Leicester, for when they face other local flare-ups? Will the Minister guarantee—I would like a yes or no answer—that local authorities will now get the specific data that can facilitate action, that it will be timely and in the form of person-identifiable data, not just postcodes, and that it will include not just positive but negative results so that they can understand the overall infection prevalence? Will they receive the contact tracing data so that they will know who has been asked to isolate by test and trace and can follow them up? Will they receive the data on a daily basis? Once a week is not good enough. The virus does not wait a week, so why should local directors of public health have to wait a week?
Moving on, the financial Statement said that £10 billion had been allocated to test and trace. It would be helpful if the Minister could itemise what that £10 billion has been spent on and with whom. A letter to me lodged in the Library would probably suffice for that question. On 20 July last week, the Secretary of State made a comprehensive Statement—a sort of end-of-term report; I can pick out only one or two important matters and hope that other noble Lords will cover the rest. The news about vaccine progress was very welcome and exciting, but will the Government ensure that there is equitable access to a vaccine when it is developed? The Minister knows that we stand shoulder to shoulder with the Government in taking on poisonous anti-vax propaganda. However, if a vaccine does not become available, what scenario planning is taking place right now, should we be confronted with that awful prospect? Will the Minister take this opportunity to update the House on R? Are we still below 1? Which parts of the country are not?
On social care, we welcome the fact that families are now able to visit their loved ones in care homes and we also welcome the extra funding for the NHS announced by the Prime Minister. But there was no extra funding for social care. Will social care get any more resources this winter? This is underlined by the Government’s failure to reimburse care homes properly for PPE and testing costs during the pandemic. They will actively have to meet the additional costs of ensuring that care homes stay safe for residents, staff and visitors. It must be cost-effective that they do so. The Local Government Association has today called for a social care reset after reflection on the Prime Minister’s pledge to fix social care a year ago. That representative body has urged the Government to publish their timetable for social care reform prior to Parliament’s return from the Summer Recess in September. Will the Minister tell the House whether that is possible?
Baroness Brinton (LD) [V]
My Lords, from these Liberal Democrat Benches, I thank and congratulate all the millions of people, whether paid staff or volunteers, who have worked tirelessly over the last five months to combat this pandemic, serving people and providing support during what is the most extraordinary health crisis in 100 years. As the noble Baroness, Lady Thornton, outlined, it is very disappointing that the Government Whips’ Office has resisted giving your Lordships’ House the opportunity to have a timely discussion on each of the three Covid Statements, on 14, 16 and 20 July. Each covered different, urgent and serious matters for our country that should be scrutinised by your Lordships’ House, so I too will use all three Statements as the basis for my questions to the Minister today.
First, given that the report of 20 July has a strategic and end-of-term report feel, we have an overarching concern about the Government’s repeated mantra in Statements about protecting the NHS at all costs, including the preparations for a second wave. Unfortunately, it appears that lessons have not been learned from the consequences of that single priority, not least those from throwing our care sector to the wolves without adequate testing, PPE or financial support for its massively increased costs. So I ask the Minister again: do all parts of the care sector now have repeat and regular testing, the PPE they need to practise new standards of infection control and continuing financial support for the consequences of both?
As I mentioned on Friday in the debate on the coronavirus regulations, a further group feel they have been left high and dry: people who shield, whether they are disabled, elderly or have serious underlying conditions. So I again ask: will the Minister explain why the letter to shielders dated 22 June insists that shielders lose all the support for shielding from 1 August? The letter instructs recipients to follow strict social distancing at all times and to stay at home where possible but, in complete contradiction to that, also instructs people to return to work if it is Covid-safe and removes access to furlough pay and sick pay, so if it is not safe to return to work and shielders cannot work from home, they are now at high risk of losing their jobs. Blood Cancer UK is extremely concerned about this risk for people who have been shielding as from August they will face an impossible choice between returning to work and risking their health or staying at home and risking unemployment. It asked the Government to extend the furlough scheme for the small number of people involved for up to three months or to provide alternative financial support to protect them from life-threatening ill health, and we agree. Will the Minister undertake to raise this with the Chancellor of the Exchequer as a matter of urgency and write to me?
Lifting the lockdown also brings into sharp relief how much real progress has been made by the Government on testing, tracing and isolating as a key tool to manage outbreaks. To that we must again add quarantine arrangements. On the news today, following the Spain quarantine regulations, we heard the Government say that they will not be monitoring any quarantine arrangements. They are still experimenting with temperature screening at airports and are not routinely testing people as they arrive in the country. If we are serious about having a proper system for people arriving in this country and quarantining safely, when will that be put in place?
We also hear that testing capacity will shortly reach 500,000 a day, which is welcome, but there seems to be no routine to test that capacity to the full. It is still not universal, despite repeated requests, regularly to test NHS and care staff to keep them safe. We hear that many local testing centres are closing down and that the test at home system is to stop. Can the Minister reassure your Lordships’ House that a full test, trace, isolate and quarantine policy is in operation, not least to test the larger-scale, effective system that we will need in the event of a second wave? How many people were tested on Friday?
Finally—the Minister can probably recite my next question as I have asked it so often, but I will be grateful if he could answer my actual question, not repeat the usual mantra because just saying that local authorities are being given more data at postcode level is not enough—when will all local authorities and directors of public health get the full data that they have requested and signed data protection releases for on a daily basis and at a more granular level than postcode, without which they cannot effectively tackle spikes in cases swiftly? The Minister saying that he is giving them more data is not enough. It must be the data that they need and for which they have already signed data protection releases.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
My Lords, I thank the noble Baronesses, Lady Thornton and Lady Brinton, for their detailed questions, which I will go through as speedily and thoroughly as I can.
On accountability during the Recess, there are long-standing precedents on this and we will obey them, as is normal.
On the arrangements for Spain, I reassure the noble Baroness, Lady Thornton, that there is a very thorough system of regular meetings to assess the exemptions on travel. This is done at several levels of government and detailed intelligence from the front line is provided to those meetings. However, the situation in many countries is fast changing, and the Spanish situation is a good example. The information we had at the beginning of last week was quite different from the information we had by the end of the week. Fast turnaround decisions are not a sign of panic or weakness; they are a sign that the system works and is working well. We are trying to be as flexible as we can and we respect the country’s desire to travel, but when the infection rate in overseas countries moves, we have to move quickly as well. Within individual countries, there is no way for us to control intra-country transport. It is therefore very difficult and challenging to have a regional exemption list. That is why we have not been able to give exemptions to the Balearics, and I say that with a personal interest in the matter.
Our guidance on face masks is based on trust. There is no compulsion and they are not mandatory. In some countries they are mandatory, but not in this country. That is why the science is so important to us, and it is one reasons that we may have moved behind some other countries. The guidance we now have on face masks is extremely clear. I pay tribute to the large and growing number of people wearing them. I believe this country is moving in the right direction.
We are concerned about shopworkers. USDAW makes a good case for the need to protect shopworkers who may be put in an awkward situation. That is why we work closely with the police to ensure that the right protections are in place.
I say a profound thank you to the people of Leicester, who have done an incredible amount in a difficult situation. The signs are that the prevalence of the disease has come down a long way in Leicester thanks to their commitment. The lessons we have learned include some of the most obvious lessons you could learn, but there is no replacement for local contacts and the involvement of local communities. However, there are hard-to-reach communities where our message has not got through and we need to do more to reach them. In particular, I am grateful to faith leaders in Leicester who are working with us on preparing for Eid and ensuring that the message on social distancing gets through in time for that important celebration.
Full details of the budget for NHS Test and Trace will be published when the time is right, and when that time arrives I will be glad to place a copy in the Library as requested.
I completely agree with the noble Baroness. Having an equitable distribution of the vaccine in this country and overseas is key to the Government’s policy. That is why we are working hard with the World Health Organization, GAVI and others to ensure that vaccines are shared as a global resource. We hope that a vaccine can be found, and the indications from Oxford are encouraging, but we recognise that vaccines for coronaviruses, particularly those affecting the respiratory system, are difficult. That is why we are making a massive investment in the test-and-trace programme and in therapeutics and why we remain vigilant over local lockdowns—to rid this country of this horrible disease.
Both noble Baronesses spoke about social care. I do not recognise the phrase used by the noble Baroness, Lady Brinton, that the care sector has been “thrown to the wolves”. I find that an unhelpful characterisation. I say yes to regular testing, yes to PPE and yes to financial support—we have given £3.7 billion to local authorities to help them pay for the cost of Covid-19, and on 2 July we gave a further £500 million to the social care sector. We remain vigilant with regard to the financial resilience of the social care system and we are working very closely with social care providers on the ongoing costs of both testing and PPE, as well as the financial resilience of the entire sector.
On shielders, the noble Baroness, Lady Brinton, makes a very good case. The handling of those who need shielding is one of the most delicate challenges that we face. Those who through no fault of their own are particularly vulnerable to the effects of the disease are put in an invidious situation, and we are extremely grateful to all those who have gone through the hardship of extreme shielding during this long and difficult time. I take on board all her comments and extend my profound thanks to all those concerned. I will look into the question of the parcels that she raised in the debate last week. My inquiries are ongoing on that, and I will respond to her, as I promised to last week.
On the arrangements for travel, it is true that the current medical advice is that we are currently sceptical whether temperature testing is effective and therefore we have not imposed it.
On testing, it is a frustrating but unavoidable truth that a test today does not necessarily mean that you do not have Covid and that you may not display both the symptoms and contagiousness of Covid in the days ahead. That is why snap testing at airports cannot be a sure-fire and safe route for protecting the country, which is why we have to look at isolation as a way of protecting the country.
On the mandation of isolation, as in other matters to do with Covid, we apply a voluntary principle because we believe that trust is the best way to keep the public on side, and we have neither the legal nor the other resources necessary to impose mandation.
On the questions from the noble Baroness, Lady Brinton, about the state of the testing programme, I reassure her that testing at home is not stopping and that NHS staff are regularly tested. There is a very clear plan, that plan is heavily resourced and we are continuing to invest in it with innovation, manpower and legal support where necessary.