Covid-19: PPE Procurement

Baroness Brinton Excerpts

Wednesday 30th November 2022 Lords Chamber

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

I thank the noble Baroness, and I commit to write with the precise figures. To put it into context, we should remember that this was at a time when unprecedented action was required. Of the 38 billion PPE items ordered, 98% were delivered and just 3% were unfit for purpose. Within that, clearly there is action that needs to be worked on and action is being taken to pursue those damages. I will put those in writing, so that the noble Baroness can understand them all. As I say, it is good if noble Lords recall that the priority at the time was clearly getting equipment to help protect and save lives, and that was what was done. Were mistakes made? Of course. Are we seeking to address those now by going back to take action against those people? Yes, of course we are, but we need to keep it in the context that the undoubted priority was to buy PPE and protect lives.

[Baroness Brinton (LD)]

My Lords, from these Benches we echo the questions that the noble Baroness the Leader of the Opposition has asked. We note that at least 71 PPE deals were awarded to firms, of which at least 46 were put into the VIP lanes by Conservative Ministers and officials during the Covid pandemic, as well as by some MPs and Peers, before a formal eight- stage due diligence and checking process was put in place. There were also deals made not for PPE during that period, including for testing and some non-health ones.

I think we all agree that the wastage and profiteering should never happen again, but we warned from these Benches, as did other Members across the House, in the early stages of the pandemic that all the right contracting arrangements, protocols and scrutiny needed to continue. The Minister has said that the pandemic posed problems, so will he push for a separate, independent-led inquiry able to examine the whole procurement process, including the VIP lanes, and analyse forensically the bids, profits, wastage and catalogue of links to Ministers, MPs, Peers and others who had influence on them?

[Lord Markham (Con)]

I thank the noble Baroness. My understanding is that there have already been three NAO reports and three PAC reports on this, so it has been covered in depth. I think people have accepted that mistakes were made and that the high-priority lane, so to speak, should not have been on the basis of referrals but more burden of proof should have been put on the applicants, so we could get more information and sift it that way. Again, to put it all into context, there were 19,000 applicants at the time. This was led by officials, and they put the high-priority lane in place to try to sift those. Also, of the 430 that went into the high-priority lane, only 13% actually ended up in contracts. Are there lessons to learn from this? Of course, but the NAO and PAC reports have outlined those lessons.

Care Homes: Severely Disabled People

Baroness Brinton Excerpts

Wednesday 30th November 2022 Lords Chamber

[Baroness Brinton (LD)]

My Lords, the Minister just referred to mental health funding and referred earlier to the increased funding to cover delayed discharges and get more people coming out of hospital into social care. Neither of those affects severely disabled adults; funding for them from central government to local government has not been increased. I repeat the question of the noble Baroness, Lady Pitkeathley: does the Minister think that the provision and arrangements for this particular group of people are broken?

[Lord Markham (Con)]

No—it is for local authorities to decide how best to use the funding we have put in place, as I said. That means looking at the needs of local people and how best they will put this in place. The 22% increase in funding can be channelled to exactly these types of places and people if a local authority believes that that is in the best interest.

Adult Social Care

Baroness Brinton Excerpts

Thursday 24th November 2022 Lords Chamber

[Lord Markham (Con)]

Obviously, the central grant is raised through general taxation and so is distributed and raised in the way we all know. We can all have a question as to what the balance should be between the two. At the same time, I think we all believe in localism and we all believe, as part of that, that local authorities are the best placed to make decisions. That means that they have some of those fundraising abilities, so they can put more funds into the area where it is required. Whether we have the balance right is something we need to keep under control, but right now the most pressing thing is putting in more money for next year and the year after, and I am very glad—and I hope the whole House will welcome—that we have committed to do that. We put our money where our mouth is to create 200,000 new care packages.

[Baroness Brinton (LD)]

My Lords, surely the most pressing thing is the emergency winter fund to help remove and reduce delayed discharges this year. The Secretary of State for Health has said that he wants to reduce the bureaucracy, so why are the rules for accessing the emergency winter fund so complex that the Health Service Journal is full of local authority and senior NHS staff saying that they do not understand why the Government are insisting on this bureaucracy?

[Lord Markham (Con)]

Believe me, I am no fan of complexity. At the same time, I want to make sure, as I am sure we all do, that the funding goes to the places of most need and is really being spent on the areas that it is being spent on. Having said that, I will take away those comments at face value and will look into the complexity because, clearly, that is in no one’s interest.

NHS: Waiting Lists and Increased Spending

Baroness Brinton Excerpts

Tuesday 22nd November 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord. For the record, there are 29,000 extra nurses since 2019-20, so we are well on course for the 50,000 increase. At the same time, we do need to recruit from overseas, and that is very much part of the plan. Again, this will go into the workforce strategy, but I completely agree that we should be looking to recruit from around the world, which we are. I am delighted that we are adding more and more people to the essential workers list, so to speak, to enable us to do that, because we all know that the workforce plan will show that we need to recruit people and retain them.

[Baroness Brinton (LD)]

My Lords, the last time the figure of 92% of patients being seen within 18 weeks was achieved was in 2016. Since then, the numbers who are waiting have doubled: it is now 7.1 million. What does the Minister say to the 16 year-old in Shrewsbury who has just been told that he has to wait nearly three years for a first appointment at his local hospital? The hospital says that it has recruitment problems. When will we see the details of this workforce plan, particularly for rural areas?

[Lord Markham (Con)]

I thank the noble Baroness. As I say, we have committed to that workforce plan, and it will be detailed. We will look at every place in every part of the country because we understand that that is needed, and it is part of the critical plan to get on top of the 7.1 million waiting list. As I think we have accepted, it is not a quick win; it will get higher before it gets lower again. Clearly, however, we need to get on top of it, and we are focused on it. It is very much about the plan and the new spending plans that we put in place to address it.

NHS Waiting Times

Baroness Brinton Excerpts

Tuesday 22nd November 2022 Lords Chamber

[Lord Markham (Con)]

I agree with the noble Lord that cardiovascular is one important area in which, over the last few years, patients have not received the number of check-ups that we want, so it is an area on which we want to focus—not just through checks in GP centres but in the community. We all know that it is very easy to take blood pressure and have blood pressure machines. As a team, we are looking at precisely those kinds of measures to make sure that we can get the preventive screening in up front, so we can identify these people before problems occur.

[Baroness Brinton (LD)]

The Minister referred to the worst-performing hospitals and ambulance trusts, but news from the Health Service Journal today has shown that the longest waiting times are mainly in rural, deprived areas, with an elderly population that is much higher than in the rest of the country. Can the Minister say what special resources will be provided for those areas—rather than just using words like “worst”, which punish them unnecessarily?

[Lord Markham (Con)]

I thank the noble Baroness. If I have used a poor choice of words, I apologise. What we are looking at is identifying the areas where we most need to focus resources to solve wait times. That might be because it is a rural area or it might be, candidly, because it is not performing so well. The point that I was trying to make is that there is targeted support. We spent £150 million on ambulance performance and new facilities last year, and it is something that we will continue to do if those rural areas and other areas need the spend.

Social Care Sector: Staff Shortages

Baroness Brinton Excerpts

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

I agree and have often made the point that solving this part is key to the flow and to getting people through discharge quickly, which has a knock-on impact on A&E and ambulance wait times. That is why I was delighted to hear the Chancellor recognise this specifically and mention £2.8 billion of funding in 2023-24, which will account for 200,000 new care packages in this space, as well as £4.7 billion in 2024-25 to resolve the exact problems that the noble Baroness brings up.

[Baroness Brinton (LD)]

My Lords, the Minister has now referred three times to the money that the Chancellor has said he will invest in social care from April next year. But the crisis is now and the Government’s own plan for patients says this must be resolved and there must be more social care workers immediately to help with the pressure on hospitals. What will the Government do over the next six months to ensure that there are more workers and help to relieve the problems with both discharges and A&E?

[Lord Markham (Con)]

I thank the noble Baroness. In the past few days, local authorities have been notified of the £500 million discharge fund. That funding will go out in December and January, so it is very much going out there. It is very much designed to address the issues of discharge, creating new places and helping to recruit.

Health: Pancreatic Cancer

Baroness Brinton Excerpts

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

We are very clear on the need for speed in cancer treatment; that is one target that will not change, because we know its importance in all this. With pancreatic cancer, we are where we were with prostate cancer about 10 or 15 years ago, and I am glad to see that we have made great strides on that with initiatives such as the Movember campaign and the action on that. Candidly, we are not where we need to be on pancreatic cancer, and we need to adopt those sorts of awareness campaigns, as well as fast action on screening, to improve our performance.

[Baroness Brinton (LD)]

My Lords, 30 years ago cervical screening was developed and introduced; prior to that, cancer of the cervix was as impossible to detect and to find as pancreatic cancer. Will the Minister say whether research will be provided to ensure that screening for pancreatic cancer can be introduced as soon as it is confirmed, because screening was the real game-changer for cervical cancer?

[Lord Markham (Con)]

I agree that screening programmes are, without doubt, the way forward. I mentioned earlier the 73 different pancreatic cancer research studies, of which screening is a very important element, so I totally agree that that should be our top priority.

Long Covid

Baroness Brinton Excerpts

Thursday 17th November 2022 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I declare my interest as a vice-chair of the All-Party Parliamentary Group on Coronavirus. I add my congratulations to the noble Baroness, Lady Thornton, on securing this important debate. She and I have spent most of the last 30 months in the parliamentary trenches of emergency Covid legislation, Statements and Questions, along with the noble Lord, Lord Bethell, and, more recently, the noble Lord, Lord Kamall. The noble Lord, Lord Markham, does not know how lucky he is to have missed those times.

The speech by the noble Baroness, Lady Thornton, eloquently set out the issues. I thank the organisations, including the Library, that have sent briefings. I also thank everyone who has spoken so far in the debate; there have been many powerful contributions from all around the House. Despite the worry of the noble Baroness, Lady Pitkeathley, that there was nothing left to say, she certainly said many things, including different things, and it is a pleasure to follow her.

I start by taking us back 100 years. The excellent book Pale Rider by Laura Spinney—which both the noble Baroness, Lady Thornton, and the noble Lord, Lord Bethell, have heard me quote repeatedly—shows evidence of excess deaths throughout the late-1920s and 1930s, after everyone thought the Spanish flu epidemic was over. But no one made the connection; all they knew was that there was excess death from cardiac and respiratory disease over a decade. Now, we understand more, of course. I have a key question for the Minister. It is already evident to me that parts of the NHS and many parts of government want to put Covid behind them. Will he undertake to make sure that we do not repeat history and stop learning from Covid, because it is not yet over, as others have said?

The authoritative and expert contribution of the noble Lord, Lord Kakkar, was really helpful. The scientific world is now publishing papers that show the consequences of Covid after that initial infection period. One in 22 will have a major cardiac event within 12 months of having caught Covid and one in five will get long Covid—as we have heard, that is over 2 million people to date. Covid damages the brain. A friend of mine in his 70s and his wife thought that he had very bad rapid onset dementia; last week, he discovered after an MRI scan that it was not dementia at all, but many micro clots in his brain, which were definitely affecting his capacity to think, speak and do physical things. That will be with him now for the rest of his life. Covid also damages the vascular system and the immune system. Variants mean that herd immunity and even one course of vaccines are no long-term solution.

Among the studies published recently is one from Washington University in St Louis. One American commentator, a scientist, says:

“We don’t know everything about long COVID yet, but what we do know is downright terrifying. But you’d never know it if you don’t seek out that information yourself … This pandemic is a mass killing AND a mass disabling event. Long COVID is going to be a defining issue of our times.”


The Americans have a reference system. The US veterans’ association provides a longitudinal study for Covid, and an article in Nature, published in May, showed that, after breakthrough SARS-Covid infection, there is considerable evidence of further and long-term problems. And the more you get Covid, the more likely you are to get long Covid or other serious consequences.

The right reverend Prelate referred to health inequalities in rural areas, and the noble Lord, Lord Brooke, referred to health inequalities for people catching Covid. Interestingly, this was also a major problem in the Spanish flu pandemic 100 years ago. We have that long tail—100 years—but have learned nothing.

My noble friend Lady Scott of Needham Market made a strong and impassioned argument for not falling into the trap of assuming that long Covid is about weakness or psychology. There are still no blood tests to identify long Covid or ME. She and the noble Baroness, Lady Meacher, made the vital connection with other post-viral conditions. Researchers this week are seeking volunteers with long Covid to take part in a study that looks at psychological factors, full stop. After all the evidence that we have heard this morning, that is breathtaking.

If noble Lords have not seen it already, Rowland Manthorpe, the excellent technology correspondent of Sky News, has a long article on the Sky website about his two-year journey with long Covid. It is very moving, including people saying that he just needed to start doing things gently and build up—not the answer. The noble Earl, Lord Clancarty, spoke of the difficulties in accessing appropriate support with GPs. At this point, the questions others have asked about definitive research become really important, but it is not just research; it is ensuring that the training for all our front-line healthcare and clinical staff understands that and they do not stick by the old thoughts.

The noble Lord, Lord Brooke of Alverthorpe, spoke about the high number of deaths in the UK. This was thought to be principally due to late lockdown in the first big wave, if we look at excess deaths, and comorbidities were key. It was not just about obesity, but obesity was among them. Significantly, people with high blood pressure, a history of heart problems or asthma also faced high death rates.

Long Covid definitely affects children too. My noble friend Lady Harris of Richmond, who cannot be in her place today, has spoken often in your Lordships House about the devastating effect that long Covid can have on children, from familial experience. The noble Baroness, Lady Taylor, referred to a young girl from the north-east and her two-year experience of long Covid. Yesterday, Hayden from Elvington in Kent, a previously fit and healthy 15 year-old, told the BBC how his life completely changed after he caught Covid in December 2020. He used to swim and play judo, but now has to use a wheelchair and is largely bed-ridden with, among other things, extreme and severe fatigue.

The noble Viscount, Lord Stansgate, referred to ivermectin. That is a longer debate for another day, but I strongly recommend he reads the one-pager that he can find online where a scientist explains why it should not be used in humans at all—in vitro, possibly; possibly even in cows; but not in humans.

The employment issues are vital. The right reverend Prelate referred to employment stats in Devon and the All-Party Group on Coronavirus also found statistics. The big issues that seemed to affect employees were that Covid-19 was often first contracted in the workplace, especially, as we heard, in professions deemed key and essential workers. As the noble Baroness, Lady Neuberger, said, 10% of those are in healthcare, so it is really shocking that the NHS is now sacking staff with long Covid and when those staff say, “But I caught it at work”, the NHS says, “You cannot prove it, end of case”. That happened to a friend of mine who was a senior midwife and it is appalling that she is now lost to the profession.

The all-party group has received many examples of healthcare professionals who were forced to work with Covid-19-positive patients with inadequate PPE. We have also heard of employers forcing them to work in unsafe conditions and offering no support for return to work, and a growing trend that those with long Covid feel physically and mentally unable to challenge dismissals or wrong PIP allocations. That is a real problem, because it means they are not getting benefits to which they are entitled.

The noble Baroness, Lady Thornton, set out the medical problems. I want to raise another issue. A number of Education Secretaries over the last 30 months have continued not to take account of Covid and long Covid in schools. That is why we have so many children with long Covid, so why are we not following the example of America, where all children are eligible for the vaccine? A colleague of mine, Councillor Oliver Patrick in Somerset, has devised a very cheap ventilator for children’s classrooms. You need only one and it costs about £100 to create, but schools are not getting support to do that and the word is certainly not getting around. So, when we have the next wave, expected in January and February, schools will once again act as a vector for Covid, and arising out of that will be long Covid.

I finish by asking the Minister some questions, some of which have already been asked. We need guidelines for employers, in both the private and public sectors, about how to manage employees who have had Covid. Will the Government undertake a compensation scheme, available to all front-line key workers who have Covid? Will the Minister look at the care system, as the noble Baroness, Lady Pitkeathley, outlined? Will the Government look at measuring, reporting and monitoring the number of people, including children, with long Covid in the UK? Finally, as the noble Baronesses, Lady Watkins and Lady Taylor, said, long Covid is a key part of Covid. Until the long Covid tail is over, Covid is not over. Will the Minister undertake to make sure that the Government act by that?

GPs: Anti-depressants and Alcohol

Baroness Brinton Excerpts

Wednesday 16th November 2022 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend and agree. It should always be down to the GP, working closely with the patient, to decide the best form of treatment, whether talking therapies or drugs, and that is why we are quite clear in the guidance that first and foremost it has to be the local clinician who makes the decision.

[Baroness Brinton (LD)]

My Lords, the noble Baroness, Lady Blackwood, made the very important point that there are differing results with different anti-depressants and different reasons for depression. A 2007 study showed that the use of anti-depressants reduced alcohol intake in those who drank a lot while they were very depressed. However, a 2011 study showed that SSRIs and alcohol often produced disinhibition. The one thing those two studies both showed was that where the physician was able to talk to the patient and explain, the patient reduced their alcohol. When will more time be available for GPs to talk these things through properly with patients?

[Lord Markham (Con)]

We all agree that GPs are best placed to do this. I think the House is aware of our commitment to increase the number of GP appointments by 50 million, and we are well on course to meet that target. At the same time, we have the independent review of drugs by Dame Carol Black, which looks at mental health, drugs and drink and how they are closely related, to make sure we have the best advice. First and foremost, I totally agree that the best-placed person is a GP talking to their patient.

Ambulances

Baroness Brinton Excerpts

Thursday 3rd November 2022 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I declare my interest as a vice-president of the Local Government Association. I congratulate the right reverend Prelate the Bishop of London on securing this important debate and thank her for her thoughtful and knowledgeable introduction. I also echo her thanks to the House of Lords Library for its briefing and the Royal College of Nursing. It is important that we start by paying tribute to our ambulance and paramedic staff and, obviously, ambulance call handlers—as well as 111 staff, who may not automatically come into that category but are also fulfilling a very important role. All are doing the absolute best they can, despite the current circumstances. We owe them an enormous debt of gratitude.

We have had regular debates, Questions and Statements on the problems in our ambulance services for over a year now; everyone recognises that they are at breaking point. Record long ambulance waits are leaving vulnerable patients stuck outside hospitals waiting for the treatment they need. This debate rightly focuses on the part of the crisis that is very visible to everyone—ambulances queueing outside hospitals and delays in response times and handovers because A&E is full—and refers to the Government’s plan for patients.

I refer to the plan for patients because we have debated it within the last few weeks in your Lordships’ House, and most people recognise, as the plan does, that delays in the ambulance service are part of a larger problem—a “whole-systems problem” was the phrase I think the right reverend Prelate used. I will return to the detail of the plan later, but I start with some of the problems facing the ambulance service and its staff.

National standards set in 2017 said that calls are triaged into four categories depending on urgency and that all ambulance trusts must respond to 90% of category 3 calls within two hours and category 4 calls within three hours. I raise that because the targets for those categories have changed—they have lengthened.

Nationally, average ambulance wait times have more than doubled in the last two years. The British Heart Foundation, in a report published today, said that in September, average response times for category 2 calls—that is, suspected heart attacks and strokes—was 48 minutes, against the new target, set in spring this year, of 18 minutes. It used to be eight minutes before that.

I want to make a further point on category 1 and category 2 response times, because they also affect handover times and what is happening in A&E. For most levels of injury and illness, both category 1 and 2, there is what is known as the “golden hour” in which treatment must be started, particularly for strokes and suspected heart attacks. Strokes were moved into category 2 after paramedics started to be allowed to administer anti-clotting medication en route to hospital but, even with that extra time, you have to add on the queueing for hospitals. So, despite our talking about the waiting times for responses and the delays to handovers, that golden hour is constantly being eroded.

The Library briefing, to which the right reverend Prelate referred, made it plain that the situation continues to worsen. Ambulance handover delays are almost entirely caused by crowding in A&E, and that is why the plan for patients that the Government produced was discussed so heavily in your Lordships’ House. Part of the problem is that a lot of that is work that will happen in the future, not now. I want to ask the Minister what plans there are to upgrade the plan for patients, given the current crisis, because it is clear that this is unsustainable.

Today, a report in the Times on the British Heart Foundation report said that

“there had been 30,000 ‘excess’ deaths involving heart disease in England since the beginning of the pandemic.”

There is an absolute understanding that some of those are definitely due to ambulance delays. In fact, our papers are absolutely full of those reports and have been for the past six months.

The logjam could be described best in A&E as “beds and backlog”—and then there is care as well. The NHS Confederation helpfully identifies the problems of discharge and lack of capacity in the social care sector and has repeatedly, over the last year, asked the Government to help social care. Social care vacancies increased to 165,000 in July. That is a shocking increase of over 50% on the previous year, and the figure continues to rise.

It is increasingly difficult for disabled people who rely on personal assistants to recruit them. In your Lordships’ House, the noble Baronesses, Lady Campbell of Surbiton and Lady Thomas of Winchester, have repeatedly raised this. The same is true for people who need domiciliary care—that is, care in people’s homes—to keep them at home. It is increasingly difficult to recruit people to do that job. A key plank of the plan for patients is getting people home and keeping them there but that will not work without carers.

The consequences of Brexit are writ large in this sector. We know that the Government are trying to recruit from overseas, but we lost a stable workforce who returned home to Europe from the UK and have not, despite the problems of the pandemic, returned, even though they have been asked. The issue of delayed discharges therefore remains. I ask the Minister: what else on top of what was set out in the plan for patients will the Government introduce as a matter of urgency?

The broader problems in the NHS are also causing problems. From these Benches, we have highlighted for years the shortage of hospital beds compared to other OECD countries, which shows the UK at 2.3 beds per 1,000 of the population, compared to France at 5.7 and Germany at 12.6. It was a mistake to cut so many beds, especially without planning for and investing in primary care—not just GPs but all primary care healthcare professional staff and their support staff.

In August, when we were all on holiday, the Secretary of State announced that the Government would create the equivalent of 7,000 more beds through a mixture of new hospital beds, “virtual ward” spaces and initiatives to improve patient flow over the coming months. I have repeatedly asked Ministers for breakdowns of how many beds are in each of the various categories, but I still have not had an answer. There is a big difference between a bed, a virtual bed in somebody’s home, even with remote monitoring, and initiatives to improve patient flow—I am not quite sure how the latter equates to beds. It has been three months since this announcement, and we are already facing a rise in flu and other winter problems. Can the Minister please tell your Lordships’ House what that breakdown is and how many beds are in place? Specifically—I have asked him this before—can he say how many are virtual beds, because extra support is required in primary care to make those work? Will the Government undertake to fund more extra beds to stop handover delays at A&E and the backlog that goes right the way through the system?

I was very pleased to hear the right reverend Prelate refer to the importance of a workforce plan. We absolutely echo that from these Benches and have asked for one repeatedly, including during the passage of the Health and Care Bill earlier this year. This is not just about doctors and nurses, which the plan for patients relies on; it is also about other vital health care professionals such as physios, occupational therapists and speech and language therapists.

The plan for patients talks about more independent qualified prescribers in community pharmacies. This is essential to help reduce the burden on GPs. Exactly when will there be the promised increase in the number of independent qualified prescribers within community pharmacies? Will any long-term plans for providing finance and support for training and recruitment be brought forward? The plan for patients covers next year, but it is this winter that we have the problem. Above all, we need that workforce strategy.

My honourable friend Daisy Cooper MP said that Ministers should not lay the blame for these scandalous handover delays at the door of the NHS. To stop such delays, the Government need to fund the extra beds in A&E and properly fund social care. Hospitals are now running food banks for staff and staff cannot get to work because they cannot afford petrol for their cars. This is one of the reasons why staff are so concerned. This is not just about NHS staff possibly going on strike; this is an NHS cost of living strike. I hope the Minister can answer my questions.