Health Protection (Coronavirus, Restrictions) (No. 2) (England) Regulations 2020
Baroness Brinton Excerpts(4 years, 3 months ago)
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Baroness Brinton (LD) [V]
My Lords, many Members have spoken again about the frustration at the delays of three weeks or longer in this House being able to debate the regulations. All sides of your Lordships’ House have repeatedly said that they understand the pressure that Ministers found themselves under earlier in the pandemic, but I respectfully remind the Minister that now that the urgency is easing, surely arrangements to debate regulations could begin to return to a more realistic timetable.
I add the frustration from these Benches that we are now three Statements behind the House of Commons, and it looks as if the usual channels—or the Government Whips—will not allow Statements, which of course explains why so many people spoke earlier in this debate on the regulations.
The noble Lord, Lord Robathan, spoke eloquently, in his brief minute, on contradictory advice, and my noble friend Lady Tyler referred to the last-minute guidance on face masks, published only one day before the new rules came into force this morning, despite the announcement about 10 days ago. The guidance seems much less definitive than the Prime Minister’s announcement. This raises a recurring problem that lies squarely at the feet of Ministers: a blurring of distinction between what is law and what is guidance means that the all-important communications strategy once again lies in tatters. This is not just confusing to the public, shopkeepers and takeaway owners; it also puts the police in an invidious position about how to police this requirement. Surely, as other noble Lords have pointed out, we need people to wear masks to protect the wider community from either local spikes or a second wave.
There remain other contradictions. For those who are shielding, and therefore not able to take advantage of the regulations that we are looking at today, all formal support ceases on 1 August, yet the letter to shielders says that
“you can go to work, if you cannot work from home, as long as the business is COVID-safe”.
Three bullet points later, it says that
“you should remain cautious as you are still at risk of severe illness if you catch coronavirus, so the advice is to stay at home where possible and, if you do go out, follow strict social distancing”.
However, from 1 August there are no emergency food packages and no financial support for those who cannot return to work nor work from home. Worse, this has not been communicated more widely, so everyone else apart from shielders assumes that shielders will be just the same as everyone else. Saying that new guidance will be published on 1 August is too little, too late, and once again shows that shielders, especially disabled people, are being left isolated.
In his introductory remarks, the Minister referred to Leicester and Oadby and Wigston. I am sorry to say that the leader of Oadby and Wigston had to write to Matt Hancock on 22 July, saying:
“I would like you to correct the inaccurate statement you made in the House of Commons this afternoon. You stated that you had consulted all Council Leaders. This is clearly not true as you and I have never spoken. As you will see from the attached email I was not consulted by the Leader of the county council either. The decision not to include other areas of the county is flawed. Either there is an objective measure by which”
the lockdown
“is judged or there is not. The Borough is in a better position regarding Covid than some of the areas you released today. If you release them so you should release us.”
This is extremely concerning. Once again, we have a Minister making Statements and talking about strong communications with local government while the reality is anything but.
I note that these and other regulations say regarding “Impact”—this is paragraph 12 in the Explanatory Memorandum on the first set of regulations—that there is no need for impact assessments, as these regulations are a short-term measure and have sunset clauses. However, on Monday 20 July, government lawyers admitted that the Government had been in breach of testing and tracing data protection laws since the test and trace system was introduced in May because they do not adhere to privacy regulations. Despite the Open Rights Group asking repeatedly for answers to questions, the Government came clean only after legal letters were sent. Government lawyers said on Monday that impact assessments were being worked on. Can the Minister tell the House when the DPIAs that meet legal requirements will be in place for testing and tracing?
I echo my noble friend Lady Benjamin’s concerns about protection for our BAME communities who are at such high risk, especially as the success rate for tracing in these communities is consistently lower than for others. In Leicester, it is down to 65%, whereas 80% is the level deemed necessary for safety.
Finally, in the last two hours, the ONS has released statistics with shocking mortality data, showing that from 1 March to the end of May, those living in the most deprived areas had a death rate of 139.6 per 100,000 whereas those in the least deprived areas had a death rate of 63.4 per 100,000. What specific resources are being given to councils, directors of public health and local resilience forums to ensure that they can support our people in the most deprived areas, most particularly the data that they, I and many other parliamentarians have asked for time after time?
Covid-19: Personal Protective Equipment
Baroness Brinton Excerpts(4 years, 4 months ago)
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Lord Bethell [V]
I completely reject the implications of the noble Lord’s question. While British companies have stepped forward and we are pleased to have made many contracts, there are not, I am afraid to say, thousands of domestic producers capable of providing the billions of items we need in the British health service. I pay respect to all the companies that moved quickly and contracted under difficult circumstances for major contracts. I also salute the companies overseas with which we have good relationships, and which remain our trusted partners.
Baroness Brinton (LD) [V]
My Lords, alongside PPE we must have a comprehensive test and trace system to prevent a second wave. Today, the Health Service Journal reports that virtually all the top team of test and trace are leaving, and that McKinsey is contracted to review the governance and entire form of test and trace. Why would the Government bring in a multimillion-pound consultancy firm to review a so-called world-beating test and trace system?
Lord Bethell [V]
My Lords, turnover of the test and trace team is an inevitable consequence of an organisation that was set up using temporary staff, many of whom are on short contracts and need to return to their previous roles. It is regrettable, but I owe them a huge debt of thanks for the work they have done. The work of McKinsey is focused on governance, not on HR. It was commissioned some time ago and it is an entirely proper and regular appointment.
Independent Medicines and Medical Devices Safety Review
Baroness Brinton Excerpts(4 years, 4 months ago)
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Baroness Thornton (Lab) [V]
My Lords, I thank the Minister for the Statement. I start with the words of the chair of the review, our colleague, the noble Baroness, Lady Cumberlege, who said when she launched the report last week that she was shocked by the sheer scale and intensity of suffering. She said:
“I have conducted many reviews and inquiries over the years, but I have never encountered anything like this … Much of this suffering was entirely avoidable, caused and compounded by failings in the health system itself.”
I congratulate the noble Baroness on conducting an inquiry over the last two years that has been praised by everyone concerned, particularly the patient groups and those affected.
Some of us have been discussing the problems addressed in this report for many years. We have heard about the hormone pregnancy test Primodos, the anti-epileptic drug sodium valproate and, in recent years, use of vaginal mesh in surgery. It is important to pay tribute to the bravery and persistence of the patients and patient groups, but also to the parliamentarians whose work helped to persuade the Government to establish the inquiry two years ago. The All-Party Groups have been vital, as have Yasmin Qureshi MP, Norman Lamb MP, Owen Smith and Sharon Hodgson MP, to name but a few.
On the surface, the three medical issues are separate. What links the medicines and devices is that they were all taken or used by women—in two cases, by pregnant women. As my honourable friend Alex Norris MP said last week in the Commons,
“these cases reek of misogyny from top to bottom—and ageism and ableism as well.”—[Official Report, Commons, 9/7/20; cols. 1148-49.]
We also have to look at the reaction of the healthcare system, which, according to the report, failed to monitor the use of these medicines and medical devices, then failed to identify and acknowledge the things that had gone wrong, then failed to work to improve. The review sets out the missed opportunities when something could or should have been done to prevent harm. Instead, there was a culture of denial, disjointedness and defensiveness that failed to listen to patients’ concerns.
Our NHS failed to protect these women and their families. It is therefore right and welcome that the Minister’s first reaction has been immediately to offer an unqualified apology, which is the first of the nine recommendations in the report. The Secretary of State said that listening and humility are in order. That is right, but it now needs to be followed by action to make the process worth while and to address the suffering. I hope that in this discussion the Minister will be able to outline what the Government will do to implement the rest of this report and to what time- scale. The most sensible way forward is the ninth recommendation, which is to set up a task force to implement the other recommendations. Will this be done, and by when?
On recommendation 2, I can see that progress has already been made. But can the Minister explain what legislative underpinning would be needed for a patient safety commissioner? Some of us are very puzzled as to where the delightfully named HSSIB is—the patient safety Bill—and whether that would have been a good complementary vehicle.
Recommendation 3 calls for:
“A new independent Redress Agency for those harmed by medicines and medical devices”
to create a new way of delivering redress in future. It suggests that manufacturers and the state should share the costs. Would the Minister care to tell us how that might be achieved?
Recommendation 4 suggests:
“Separate schemes … for each intervention—HPTs, valproate and pelvic mesh—to meet the cost of providing additional care and support to those who have experienced avoidable harm”.
How might that be achieved? I also have one question relating to mesh and all other implants. How will the Government ensure that they are safe to use? A register is obviously a good step forward and is in the Bill that we will discuss in the next few months, but why do the regulations on implants not provide for trials, as with medicines?
On recommendation 6, will the Minister commit to amendments to the Medicines and Medical Devices Bill to strengthen the Medicines and Healthcare products Regulatory Agency’s regulatory regime? On these Benches, we are committed to implementing the nine recommendations in this excellent report. We will seek to use the forthcoming MMD Bill to do so, and we wish to work with the Government to explore how best to achieve that.
Baroness Brinton (LD) [V]
My Lords, on behalf of the Liberal Democrat Benches, I too thank the noble Baroness, Lady Cumberlege, and her team for such an outstanding report. It is not only comprehensive but blunt in its language, so that no one can misunderstand the failings of all levels of the healthcare system, whether in our NHS or other health and research settings, over many years. We too pay tribute to those women, and their children and families, for continuing against all the odds for years when too many ears, including the Government’s, were deaf. I also pay tribute to the many parliamentarians, including Norman Lamb, who over the years supported them. They pushed for this review in Parliament and raised it in any way they could.
Ministers have apologised for these failings, including for the system not listening and for not acting soon enough, over the decades since patients first started to raise the problems with these three medical interventions. Last week, when I asked the Minister about the timetable for implementing the recommendations, he said that
“it will take some time for the Government to study these recommendations … and to come back on the timetable”.—[Official Report, 9/7/20; col. 1224.]
The noble Baroness, Lady Cumberlege, says in her letter introducing the report:
“Over the past two years we have found ourselves in the position of recommending, encouraging and urging the system to take action that should have been taken long ago.”
She also said:
“Implementation needs to be approached with a new urgency and determination, founded on the guiding principle that our healthcare system must first do no harm.”
When the interim report was published, leaving this House in no doubt about the direction in which the review group was proceeding, many people expected action at that point.
I am grateful to Epilepsy Action for its briefing, which demonstrates exactly why urgent action must be taken now. Epilepsy Action, the Epilepsy Society and Young Epilepsy jointly surveyed over 500 women and girls who had taken sodium valproate since the pregnancy protection plan was introduced two years ago. One in 10 were unaware of the possible risks of birth defects. Almost half said that they had not discussed the risks of taking medicine with their health professional in the last 12 months, and only four in 10 said they had signed the annual risk acknowledgement form. For patients and families who have suffered as a result of these interventions, urgent action needs to be taken on government departments such as the DWP regarding the way it assessed the damage caused, and on how government as a whole compensates them for this gross injustice.
So I ask the Minister again: when will the Government return to those affected and to Parliament with clear recommendations and a timetable to do honour to the report and to all those affected? And when will the various bodies in our healthcare sector be set a deadline to publish the list of recommended actions that they will take that will not need parliamentary action? Last week, the Minister told your Lordships’ House that the Government had moved ahead on one of the recommendations—the creation of a patient safety commissioner—but their version is not independent, as asked for in the report.
So much of this report is about changing cultures: we still have not learned from Mid Staffordshire, East Kent and Shrewsbury maternity care, all of which Ministers have rightly been appalled by. For all the excellence and commitment of the individuals who, singly and collectively, provide our unique healthcare in the United Kingdom, there remains an unhealthy culture in some parts that does not listen to patients, does not understand conflicts of interest and resists change. That must change, it must change soon and it must be led from the top by the Government.
The report quotes Professor Ted Baker, chief inspector of hospitals for the CQC:
“I have to say 20 years later it is very frustrating how little progress we have made. It’s clear to me we still have not got the leadership and culture around patient safety right. As long as you have that culture of people trying to hide things, then we are not going to win this.”
Armed with this blunt and excellent report, I hope that the Minister can demonstrate the Government’s support with firm actions and dates, and not just with warm words that will drift away. The hopes of patients and their families and the future safety of our healthcare system depend upon it. When, Minister, when?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I start by reiterating the tributes from both noble Baronesses, Lady Thornton and Lady Brinton, to my noble friend Lady Cumberlege and her team, who have worked indefatigably on a high-quality report that does justice to this important cause. Most of all, I pay tribute to the patient groups, the specialist groups and those who campaigned on these important issues and who have brought attention and a huge amount of official focus to causes that had been overlooked for years and decades. I pay tribute to their patience, their expertise and their stamina in bringing these important causes to attention. It is entirely right that the Minister, my colleague Nadine Dorries, made an apology to those groups, and I reiterate that apology on behalf of the healthcare system to all the families affected by the report, for the time it has taken to listen and to respond to their concerns.
Both noble Baronesses referred to the culture that led to these issues being overlooked. I think that that is one of the most important learnings from this report. As Nadine Dorries said, I thought very movingly, in her speech in the House of Commons, the system has to learn to listen much more clearly. Listening must happen not just from the top but also at the level at which patients engage with the system itself. I think that trying to change that culture is one of the most important challenges facing us today. It is not just a question of bringing in punishment and retribution for those in the professional world who have failed; it is trying to create a culture where mistakes are recognised and accepted and where people address and take on board the concerns of patients themselves—and on that important cause we are hugely focused.
The noble Baroness, Lady Brinton, asked what we are doing. Already, much has been done. There has been progress in lots of areas. We already have 12 different types of patient safety function in place within the NHS: the Patient Advice and Liaison Service; commissioners of NHS services; the Parliamentary and Health Service Ombudsman; Healthwatch; the NHS Complaints Advocacy service; the CQC; the NHS Friends and Family Test; the professional regulators; the Healthcare Safety Investigation Branch; the Professional Standards Authority; the National Director of Patient Safety; and the complaint systems within individual trusts.
That patchwork quilt of patient safety and patient advocacy is an enormous function within the NHS. The report teaches us that it has not been enough to identify the major themes of failures—in this case, involving medical devices—and there has not been the patient advocacy necessary to see complaints through when they have really mattered. It is that question which we are turning to: how do we make these considerable and important efforts to put patient safety at the heart of the NHS more effective?
The noble Baroness, Lady Thornton, asked about the regulatory implementation of that response. The most important legal implementation is the registry of medical devices, which was in an amendment to the Bill on Report in the House of Commons, and it has enormous support from the Government. That registry, which is an incredibly important source of accountability and of clinical information, is the key to preventing such terrible events concerning medical devices in the future.
The report was published only last week, and it will take some time to focus on all its other recommendations. I can update the House on the specialist centres that the report quite reasonably recommended should be set up: NHS England is assessing bids from NHS providers to be specialist centres for mesh inserted for urinary incontinence and vaginal prolapse.
The noble Baroness, Lady Thornton, also asked about the MHRA regulatory review. The MHRA has begun a comprehensive and far-reaching programme of change, which will include enhancing its systems for adverse event reporting and medical device regulation. The MHRA has taken important steps to put patient advocacy at the centre of the work that it does.
There is nothing we can do today to make good the harm done in the past. However, as both noble Baronesses have rightly pointed out, there is much we can do to put patient safety at the heart of the NHS and to ensure that we have the technology, the systems and the culture to make sure that these mistakes never happen again.
Independent Medicines and Medical Devices Safety Review
Baroness Brinton Excerpts(4 years, 4 months ago)
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The Deputy Speaker (Lord Duncan of Springbank) (Con)
Yes. The next speaker is the noble Baroness, Lady Brinton.
Baroness Brinton (LD) [V]
My Lords, the country owes an enormous debt of gratitude to the many campaigners who have fought tirelessly over decades to get their issues raised and to ensure that this never happens again. It is good that the Government have apologised on behalf of many Governments, and it is reassuring to hear that there will be some amendments to the Medicines and Medical Devices Bill, but the people who are affected need redress urgently. Can the Minister give us an indication of when this will happen?
Lord Bethell
I share with the noble Baroness, Lady Brinton, my personal respect and admiration for the campaigners, who are described in the report as having lived through the most awful experiences and who, through personal commitment and determination, have brought attention to these huge failures and have pursued their cause with enormous patience. We owe them a huge debt of gratitude. In terms of commitments on the individual recommendations, I have mentioned what we have done so far and what we have on the near horizon. However, it will take some time for the Government to study these recommendations—to understand from my noble friend Lady Cumberlege herself her detailed recommendations—and to come back on the timetable that the noble Baroness requested.
Social Care
Baroness Brinton Excerpts(4 years, 4 months ago)
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Lord Bethell
My Lords, the role of carers during the epidemic is one of the great stories of commitment and sacrifice. I pay tribute to all those who have given up their time and taken the risks necessary to perform this important community role. On encouraging people to stay home, there are clear guidelines on who is recommended to stay at home. It depends on clinical need and people’s precise circumstances, according to their GP’s recommendations. I urge all people to follow those guidelines.
Baroness Brinton (LD) [V]
My Lords, I remember that there was cross-party support 10 years ago for the Dilnot review’s proposals. I support warmly the comments of the noble Baroness, Lady Pitkeathley, about the need for a national care service. Will this review and White Paper also look at matters that are often forgotten in a care setting: housing standards for life, and sheltered and community settings, to make sure that we do not yet again end up looking at just adult social care and care homes?
Lord Bethell
The noble Baroness is quite right to shine the spotlight on those who are in social care but not necessarily aged over 65. Half of all social care costs are now dedicated to those under 65. Housing standards is an important question. The stock of housing for social care will be considered in any forthcoming review. It is imperative that we have a modern and up-to-date industry.
Covid-19
Baroness Brinton Excerpts(4 years, 4 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My understanding regarding the 1984 Act is that the regulations are published under the appropriate section. They have been published as is appropriate, but they are not brought to the House for debate. If I am wrong, I will be happy to write to the noble Baroness.
Baroness Brinton (LD) [V]
Today, the Public Accounts Committee has reported real concerns that the Government have no realistic plan for supplying PPE in the event of a second wave. Can the Minister comment on that? I know I ask this regularly, but can the Minister tell the House when all NHS and social care staff, including those working in people’s homes, can get regular, repeated testing that is not dependent on symptoms? Yesterday, Matt Hancock said that, finally, some day centres, sheltered living and non-care home settings will be able to access tests. Which ones and when? I noticed that, on Monday, the Covid data dashboard was changed, removing posted-out but not returned tests. Does that mean that, in future, posted-out tests will not be counted unless they are returned?
Lord Bethell
On PPE, I pay tribute to my noble friend Lord Deighton, who has performed an amazing task in providing an enormous supply of PPE. There is sufficient PPE in the NHS, social care and other parts of the healthcare system for all those who need it. There is a PPE hotline for those who would like to order it directly and, at this stage, stockpiles are being created to get us through the winter months. On tests, a testing portal is available to all of social care. It can be accessed either by social care employers or, if employees or residents want a test, they can order one themselves through the public testing portal. It is my understanding that posted tests are no longer counted in the same way: they are counted not on dispatch but when they are processed. The “test and trace” programme initiated this change in the recent change of data, which I think was 10 days ago.
Independent Residential Care
Baroness Brinton Excerpts(4 years, 4 months ago)
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Lord Bethell [V]
My Lords, we are enormously grateful to all those working in the care home sector, who have protected residents through this awful epidemic, and we continue to support them. We have increased recruitment in the area, and are in the midst of an enormous recruitment marketing campaign to bring new, qualified people into the care home sector. The Secretary of State wrote to relevant stakeholders on 14 May, inviting them to cross-party talks on the care home sector. We are continuing those conversations and hope to bring them to a head at the earliest opportunity.
Baroness Brinton (LD) [V]
Yesterday, our Prime Minister said that
“too many care homes didn’t really follow the procedures”.
In March, the care sector asked for testing for patients discharged from hospital. The Government’s reply—not necessary. The sector could not get the promised PPE as government supplies failed to appear. All our amazing 1.6 million care home workers needed testing from March—it took the Government three months. Complex government guidance changed frequently, sometimes even daily. Our care homes have had to cope with 30,000 excess deaths in three months and massively increased costs. Does the Minister agree with our Prime Minister, or with the National Care Forum, which said that Boris Johnson’s remarks were, “frankly, hugely insulting”?
Lord Bethell [V]
I thank all those who work in the care home sector for the enormous amount of sacrifice and commitment that they have shown to protecting residents. The noble Baroness, I think, portrays the situation unfairly. Guidelines have changed quickly because the situation changed quickly. PPE demand could never have been expected at the levels it reached; the Government responded incredibly quickly to move PPE into both NHS and social care. On testing, we started from a very low base; testing has now been introduced in care homes for both patients and staff. The Government will continue to be committed to protecting both staff and residents in the care sector.
Medicinal Cannabis
Baroness Brinton Excerpts(4 years, 4 months ago)
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Lord Bethell
The noble Baroness shines a spotlight on an uncomfortable but realistic fact of life in our medical service: those with money are able to pay for treatments beyond the reach of those who rely on the NHS for absolutely everything. Another area that concerns me is that those who have relied on fundraising have found that Covid has restricted the amount of money coming from donors. That is why we have put money into medical research charities and support charities that can help support those fundraising for their medicine.
Baroness Brinton (LD) [V]
Since the law changed in 2018, only two children with severe epilepsy have accessed whole-plant cannabis medicine via the NHS. Recently, a child ended up in intensive care in the middle of the Covid pandemic and almost died because her parents could not fundraise the money to buy her medicine privately. Does the Minister accept that this is a complete failure of the policy and that a new regime for the regulation and control of access to medical cannabis is now required?
Lord Bethell
The noble Baroness’s point on fundraising is well made, and I think I answered it in my previous answer. We are looking at it closely. On policy-making in this area, it is extremely tough to regulate innovative drugs that simply do not have clinical trials and evidence bases behind them. We have put a huge amount of effort into this area. We are working closely with industry; I call on industry to do everything it can to help this process. We are trying our hardest to provide the right regulatory environment. As the noble Baroness pointed out, we have already made important changes to the law.
Covid-19 Update
Baroness Brinton Excerpts(4 years, 4 months ago)
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Baroness Thornton (Lab) [V]
My Lords, I thank the Minister for providing the Statement.
Many in Leicester are wondering why it has taken so long to act, when authorities knew that there was a surge of Covid-19 cases in early June and the Health Secretary called it “an outbreak” a fortnight ago, on 18 June. Why did it take so long for pillar 2 information to be shared with the council and public health leaders in Leicester? Is the Minister aware that published data for Leicester recorded just 80 new positive tests between 13 and 26 June, but the Secretary of State has revealed that the complete figure for that period was 944?
In the last 30 minutes, a leading respiratory doctor and consultant at Glenfield Hospital has confirmed what my right honourable friend Sir Keir Starmer said at Prime Minister’s Questions an hour ago—that the true numbers and demographic data were not shared. Why is the Prime Minister trying to pretend that the information was made available when the truth is that it was late? Given that the Minister is in charge of testing in the UK, he might owe Leicester an apology for this disrespectful and dangerous treatment. Does the Minister agree that areas that see flare-ups will need a faster response?
This is important, because new statistics show that coronavirus cases have increased in 36 parts of England; Bradford, my home city, is number two. I learned from the Public Health England website that many of the places on the list with increased infection rates have large BAME populations, so why are PHE’s recommendations regarding the disproportionate effect of Covid-19 on our BAME populations not in play here? Given the diversity of a city such as Leicester, why have none of the PHE recommendations that have been implemented included the mandatory collection of ethnicity data?
Can the Minister confirm whether the Government anticipate announcing further local lockdowns in the coming days? The Prime Minister has used the rather ridiculous and flippant words, “whack-a-mole” strategy, regarding tackling local outbreaks. If that means moving quickly and firmly, then frankly it is of no use to the people leading the response on the ground, including Public Health England local leaders, if they are not given the most accurate, up-to-date data possible as soon as it is available. Does the Minister agree? Can he ensure that it happens without centralised bureaucracy getting in the way?
Leicester City Council has been waiting to be given pillar 2 data from commercial labs that process at-home and drive-through tests for many days, and the mayor, Sir Peter Soulsby, said that he was only given access last Thursday after he signed a data protection agreement. A data protection agreement? Why have local authorities not routinely been given pillar 2 information about their residents who test positive? Will the Government confirm why a data protection agreement needed to be signed and whether there is a data-sharing exemption for public authorities on public health grounds? Do the issues go beyond the availability of the data and also concern its quality and the speed with which it is disseminated? I note that data flows more quickly in Wales where the Welsh Government publish both pillar 1 testing data from hospitals and pillar 2 data from commercial labs on a daily basis. Will the Government commit to publishing this data for England moving forward?
It was not until after 9 pm on Monday that we and the people of Leicester learned that there would be an increased lockdown with non-essential shops prohibited from opening with immediate effect. In fact, the mayor got an email about the strategy at 1 am on Monday morning. The Health Secretary said that the decision had been taken in the last two hours, which is why people were given such little notice.expand-col2 That is wholly inadequate. Many businesses and communities on the Leicester boundaries are unsure about whether they and their staff are permitted to work. It was not clear until 9.30 am on Tuesday which areas were included in the lockdown, by which point some businesses had just minutes’ notice that they would have to close again. It was not until Tuesday afternoon that the Government confirmed that those workers who had previously been furloughed would have access to the scheme again.
Will the Minister explain why the decision was taken so late in the day, given the mounting evidence of rising cases? Why were key details, including boundaries and furlough eligibility, not confirmed immediately, leading to further confusion and anxiety? Will he confirm whether people are permitted to travel to work in other cities from Leicester because of the lockdown and, if not. whether they will be eligible for support too?
The situation may have been clearer had the regulations been laid immediately alongside the announcement, so will the Minister confirm when the regulations relating to Leicester will be laid? Given that the Government have long been advised to prepare for local spikes and first floated the idea of local lockdowns in May, why are we still waiting for these regulations? We are also waiting for the latest coronavirus regulations to be laid, which concern changes due to come into effect on Saturday 4 July. Is it true that accident and emergency departments have been told to treat Saturday evening as if it were New Year’s Eve? What on earth do we think we are doing? Again, it is very disappointing that the Government have yet to lay these regulations, which were first announced three weeks ago.
The Minister is well aware that the House and the Select Committee on Statutory Instruments have urged the Government to ensure that legislation follows more closely from any announcement that they make and that even a short gap between regulations being laid and their coming into effect would better enable those affected to prepare, having seen the actual detailed requirements rather than just headline announcements.
Baroness Brinton (LD) [V]
My Lords, first, on behalf of the Lib Dem Benches, I once again pay tribute to all of those who are helping to curb the coronavirus pandemic, whether in the front line or behind the scenes, and especially in Leicester. We know that there are many unsung heroes who continue to work long hours in stressful and ever-changing environments. Secondly, on behalf of these Benches, and in memory of the outstanding report by William Beveridge, I extend our congratulations to the NHS on its birthday, and note that of the five evil giants, many are still present in those most affected by Covid.
If the Minister is unable to answer all the questions asked, will he write to noble Lords with an answer? I hope that I can speak for other Members of your Lordships’ House when I say that we understand that the nature of a pandemic means that there are many questions to raise, but to repeatedly not have answers from Ministers is disappointing.
On that note, I ask the Minister for the fifth time in just over two weeks what the problem is with ensuring that every local council and director of public health has full test and tracing data as it becomes available. Over the past three weeks, it has become clear that full data has not been provided, and directors of public health, council leaders and mayors have all had to beg for data so that they can intervene early to prevent further cases, hospital admissions and deaths. Information is being dribbled out and it appears that pillar 2 testing lies at the root of the problem.
Stella Creasy MP asked a Written Question in the Commons, which was replied to by Minister Nadine Dorries on 11 June. It states:
“The contract with Deloitte does not require the company to report positive cases to Public Health England and local authorities.”
Does that remain the case, or has the contract now been varied to ensure that that information is made available immediately to key partners? The issue of why any such contract should not require positive cases to be reported is quite extraordinary but for another day; however, with low transmission, tracing pillar 2 cases is absolutely critical. Are all local authorities and directors of public health now getting full data, including pillar 2 data immediately so that they can prepare for small or larger local outbreaks? That is important because there are reports from across England of areas with increasing cases—indeed, as the noble Baroness, Lady Thornton, said, Sky News reported this morning that 35 other local authority areas may face locking down if their cases do not reduce quickly.
That raises an issue about the powers of local lockdown. It was rather strange to hear Matt Hancock saying on Monday evening that he would bring forward legislation for local lockdown, but this morning on Sky News he said that he would rather not do that by legislation but by consent. So I put what I hope is a hypothetical case to the Minister. If this Saturday a number of Leicester residents get in their cars, what powers to the police have to prevent them from going to Loughborough, Derby or Sheffield to be able to go into a pub? Clearly, at the moment, local authorities do not currently have the powers to stop them: their powers relate only to single buildings. But if the Secretary of State believed on Monday that there needed to be legislation, why not today?
This feels very much like policy by press release, and local legislation enforcers, whether they are police or local authorities, need to know what powers they have as a matter of extreme urgency. I also ask again, why will Ministers not give the powers of local lockdown to local authorities and directors of public health, obviously working with Public Health England, the NHS and Ministers? For any final decision to rest with the Secretary of State inevitably slows down processes, as we have seen in the Leicester case over the past three weeks. Above all, we must keep people safe.
Finally, will the Minister inform the House whether there is sufficient supply of PPE in Leicester and other areas where cases are increasing for hospitals, primary care, care homes and care in the community? The Health Service Journal reports today that there is still much panic buying of PPE, with some orders costing 10 times the amount that would have been paid before March.
This Saturday marks the lifting of lockdown for most of England except for those of us shielding and the people of Leicester. Will the Minister ensure that the wider public will remain safe with the increases in cases in at least 35 other local authority areas? Will the Government move much more quickly to ensure that public safety is guaranteed?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I thank the noble Baronesses, Lady Thornton and Lady Brinton, for their thoughtful questions. To answer directly, it is extremely important that we are currently here debating the outbreak in Leicester, because in a way it is a tribute to the success of the hygiene, isolation and social distancing strategy that has borne so heavily down on this disease that we are now in the position of focusing on those rock pools of the epidemic that have been left behind by the tide of this disease going out. But I completely accept the importance of this outbreak management. That is where the Government’s focus is centred.
I reassure both noble Baronesses that the data that local authorities and local directors of public health require is being given to them and access is being provided. All local authorities were issued with data-sharing agreements to access personally identifiable local testing data on 22 June. After signing those data-sharing agreements, the first local authorities accessed the data on 24 June. Leicester accessed it with its log-in details on 25 June. An enormous amount of progress is being made in an area that is now very much our focus. Local authorities, public health directors and infection control teams have worked hard in the past few weeks knuckling down on those lockdowns that did not get away, on the local outbursts that were well managed and that have not hit the headlines and that are now falling lines on the epidemiological graph.
The noble Baroness, Lady Brinton, asked about the legal aspect. I reassure her that the lockdown in Leicester is being carried out under the Public Health (Control of Disease) Act 1984 at the request of the local authority as the provisions of that Act require. Therefore, regulations will not be brought to this House. The Secretary of State and the Government have sought to manage the epidemic through the consent of the people, not through making things mandatory. That has been our consistent approach because trust and collaboration are at the heart of this country’s response and we do not believe that making things mandatory through regulation will be as effective. However, if regulations are necessary, we will bring them to bear in order to protect lives and save the NHS.
I pay tribute to the British people for their enormous collaboration and the huge sacrifice that many have made in order to put in social distancing and other necessary measures. I pay tribute to the shops, pubs, churches and other venues that are working so hard in order to apply the necessary regulations for reopening on 4 July, which will be an incredibly important but worrying experiment in opening up our society.
On further lockdowns around the country, none is currently planned. Our profound hope is that none will be necessary. Our severe fear is that they will be, because epidemiological experience suggests that a virus that has a doubling rate of two or three days very quickly spirals out of control in geographical focal points. But we remain incredibly vigilant, and the focus of our effort is to use the necessary data to identify outbreaks when they happen and to move epidemiological resources into place in order to deal with those outbreaks.
On further data, we hope to make announcements shortly in order to get the most local data open to the dashboards available to local authorities and public health officials in the very near future.
The noble Baroness, Lady Thornton, asked about the involvement of the Mayor of Leicester in decision-making in Leicester. I reassure the noble Baroness that he was very much at the heart of all the analysis, the meetings with PHE, the gold meetings of the JBC and the process of agreeing the lockdown arrangements. That is entirely right and proper for such a situation.
The noble Baroness, Lady Brinton, asked about PPE in social care. I reassure both noble Baronesses that the measures in place to manage imports and the manufacture of the necessary domestic PPE have proved to have a huge yield and at the moment our RAG rating is extremely positive on PPE for all aspects of the healthcare system.
Health Protection (Coronavirus, Restrictions) (England) (Amendment) (No. 3) Regulations 2020
Baroness Brinton Excerpts(4 years, 4 months ago)
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Baroness Brinton (LD) [V]
My Lords, from the Liberal Democrat Benches, I start by paying our respects to the families and friends of the bereaved. I give our thanks to all those who continue to fight coronavirus on the front line and behind the scenes. The publicity may be reducing, but we know that the battle goes on.
The two regulations in front of us set the scene for the continuing slow lifting of the lockdown. I echo the points made by my noble friends Lord Scriven and Lord Purvis: having sight of regulations in advance and debating them—with clearer, smarter guidance that does not confuse—should be possible now. I want to ask the Minister two questions as we prepare for recess at the end of July. First, some regulations will expire after 28 days. What plans are there to cover such renewals, should they be necessary after we rise on 29 July?
Secondly, these regulations were designed for the short term. What arrangements will be made should there need to be a major change to regulations—for example, a second national lockdown? I hope that in those circumstances, Parliament would be recalled to debate such a serious matter. I see that Israel is already in the middle of a second wave after lifting lockdown too early. The most effective way to manage and stop any second wave, whether local or national, is to have in place a full and effective “test, trace and isolate” programme to keep people safe, as well as transparent communications with the public. Their co-operation is vital to reducing transmission.
The Minister and the noble Baroness, Lady Harding, have both said repeatedly that a full “test and trace” system will not be in place until autumn and that the app will possibly not be ready until winter. The weekly Test and Trace figures released this morning demonstrate that nationally, the Government failed to contact one in three of those who tested positive with Covid-19, down from 75% last week. For the noble Lord, Lord Naseby, who is concerned about leaving names in restaurants, only 81% of contacts were actually reached, down from 90% last week.
The BBC’s dramatisation last week of the Salisbury poisonings made clear to everyone how important local tracing is. Experienced tracers long before the pandemic, our directors of public health and their teams are our unsung heroes. There are currently some outbreaks in England, in Kirklees and Leicester, that they are dealing with. However, local authorities are still reporting that they are not being given the full data from Public Health England to do their job on the ground. I have asked the Minister on three occasions when local authorities and directors of public health will get the full data they need at a local level. I ask again: when will they get that full data? If there is no answer today, can he please write to me and other Peers taking part to explain exactly what the data issue is?
There also remains the issue of the powers of a local authority to lock down. They are currently very limited—usually up to one building or one organisation only—and the Secretary of State’s answer a few days ago at a national press conference was that he would be the person to make every single decision. If we have hundreds of localised outbreaks, which would not be unusual, surely the local team, led by the director of public health and the local authority, should have the power to make that decision—after consulting Public Health England and Ministers in the Department of Health and Social Care, obviously.
Effective lifting of lockdown remains important for our care sector. It is good that cases in care homes and among those cared for at home have now reduced but, unlike the NHS, care sector staff are still not entitled to routine weekly testing. Every time I ask the Minister this question, I am told that they can have a test if they are symptomatic—but this is not the rule for NHS staff. If the Government truly believe they have put a ring of protection around our care sector, they need to act now. When will regular testing for front-line care sector staff be made available to keep them and their patients as safe as those in hospitals?
Extra care staff, defined as those who work in patients’ homes and the non-elderly sector, are still not able to access testing through the testing portal. Can the Minister please have this error—I hope it is an error—remedied as soon as possible? Yesterday, care homes had still not received specific guidance on how they should manage the change in shielding guidance. When will that arrive?
The Chancellor of the Exchequer granted a VAT exemption on PPE to the care sector until the end of July. It is common knowledge that care homes and care companies are struggling with many extra costs. PPE is still around four times more expensive, and they have reduced income as a result of the pandemic. With many of their residents shielding, they must continue to take special care. Can the Minister ask the Chancellor for an urgent extension of this exemption for a further three months?
I recognise that I have asked a lot of questions. Will the Minister please write to me with answers to any questions he cannot answer today? I support the regulations.