Covid-19 Update

Baroness Finlay of Llandaff Excerpts

Tuesday 18th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, my noble friend refers to humility and he is right: we have all had to develop a stronger sense of humility in the face of this awful virus and this dreadful pandemic. It has taught us that, despite all our 21st-century healthcare systems, we are all vulnerable to its awful effects. His words are absolutely spot on. I repeat the statistic that 69.4% of adults across the UK have had the vaccine, because the overall story of the vaccine rollout has been one of incredible participation by the British public. Not only have I never been involved in anything quite so successful in my life but there are very few national projects anywhere in the world that have been as successful. I really applaud all communities in every part of Britain for the way in which they have stepped up to the vaccine. My noble friend is right that there are some communities in which those levels are not as high as they should be. That has led to higher transmission among younger people, and in a few cases that has led to severe disease among older people who, frankly, should have taken their vaccine. I urge everyone to step up to their opportunity.

[Baroness Finlay of Llandaff (CB)]

As the Minister, who has worked tirelessly during Covid, knows only too well, an outbreak anywhere can become an outbreak everywhere. Can he tell us how the UK plans to increase vaccine distribution globally through COVAX to control the pandemic and decrease the risk of further variants arising in countries with high rates of infection, particularly as the risk of vaccine-resistant variants will remain high for at least a decade?

[Lord Bethell (Con)]

My Lords, the Tedros principle of us being safe only when we are all safe remains the most profound insight. The noble Baroness is entirely right: we must do more to try to help those in the developing world. The frustrating truth is that the world simply does not have enough capacity for the manufacture of these very complex and tricky substances. We are straining every sinew to try to deliver the 9 billion vaccines we need to deliver worldwide vaccination, but the rate of manufacturing is not as high as any of us would like. I take my hat off in particular to AstraZeneca, which has provided licences for the vaccine worldwide on a no-profit basis, but I also pay tribute to the other vaccine companies, which, despite what one might read in the press, are trying all they can to set up manufacturing sites all around the world. Progress is being made.

Alcohol Harm Commission: Report 2020

Baroness Finlay of Llandaff Excerpts

Thursday 22nd April 2021 Grand Committee

Asked by

[Baroness Finlay of Llandaff]

To ask Her Majesty’s Government what assessment they have made of the report by the Commission on Alcohol Harm 2020 ‘It’s everywhere’—alcohol’s public face and private harm, published on 14 September 2020.

[Baroness Finlay of Llandaff (CB)]

My Lords, I had the privilege of leading a group of 16 experts to investigate one of the most pressing issues of the day: the harm caused by alcohol. I extend my sincere thanks to each of those 16, who gave their time and expertise so generously in their dedication to reducing alcohol harm. The findings of the Commission on Alcohol Harm were stark. One cannot overstate the sheer scale of the harm caused by alcohol every day to individuals, those around them and society. Alcohol is linked to 80 deaths every day across the UK and, most worryingly, it kills people when they are young. Alcohol is responsible for more years of working life lost than the 10 most frequent cancers combined.

However, the commission found that alcohol harm extends beyond health. We heard a great deal about the impact on families: 200,000 children are estimated to live with an alcohol-dependent parent, making them five times more likely to develop eating disorders and three times as likely to consider suicide. Some children are harmed even before they are born. Exposure to alcohol in the womb can cause foetal alcohol spectrum disorder, a lifelong developmental condition found in up to 17% of UK children.

The links between alcohol, violent crime and anti-social behaviour are strong. Alcohol fuels almost 40% of violent crimes and half of domestic violence. Drunk-driving causes almost 9,000 casualties and 260 deaths a year. Police Sergeant Mick Urwin told us that

“delivering a death message to a parent, brother, sister, son or daughter to inform them that someone has been killed by a drink driver is not something I ever got used to”.

The burden falls on all society, particularly public services. There are 1.26 million alcohol-related hospital admissions annually and alcohol costs the NHS £3.5 billion. The cost of alcohol-related crime is even higher, at £11.4 billion per annum. That is why sentencing to alcohol abstinence and monitoring is so important, with its high compliance rate allowing people to face and tackle their harmful drinking, and it has been shown to decrease repeat offending.

The extent of these harms is truly shocking but is no surprise, as alcohol is ubiquitous. That is why we titled the commission’s report It’s Everywhere—a quote from a witness. We heard how alcohol is all around us: at social gatherings, on TV, in supermarkets, card shops and the workplace, and at all times of day or night. People told us they could not escape from alcohol; “relentless” was a word we heard repeatedly. Although national consumption has fallen from 2004’s historical high, especially as more young people abstain, the increases in measures of harm and deaths persist.

Alcohol’s harm is often hidden in plain sight, leaving people to deal with it alone, unsupported. The stigma of harmful drinking makes people conceal their problem. Children instinctively understand that they are expected to keep quiet about their parents’ drinking. To quote another witness:

“Families and children like us didn’t and won’t discuss it for fear of being separated, being taken away from parents, being singled out ... feeling embarrassed, scared of repercussions and fear of retribution”.


The alcohol industry’s “personal responsibility” framing blames individuals for their drinking. Stigmatisation makes it harder to seek help. Blame lies within the product itself: alcohol is addictive. It can turn people’s lives upside down, as anyone listening to “The Archers” at the moment will know. It warrants careful regulation, hence the commission’s recommendations.

First, we call for an alcohol strategy. The last was almost 10 years ago. Revision is urgently needed—last year, alcohol deaths reached their highest level since records began. The updated strategy needs to include evidence-based policies to reduce the affordability, availability and marketing of alcohol. These tools, recommended by the World Health Organization, proved effective at tackling tobacco use. Let us look at each in turn.

Alcohol harm and price are directly linked. The alcohol duty system is inconsistent and perverse—white cider at 19p a unit feeds addiction. Affordability has grown significantly in the last four decades, driven by low prices in off-trade settings. Cuts to alcohol duty at the annual Budget have not helped—beer duty is now 21% lower than in 2012-13 according to the Institute of Alcohol Studies. We urgently need minimum unit pricing in England, as already introduced in Scotland and more recently in Wales. Tax should be proportionate to the harm caused.

The commission heard from witnesses how the constant availability of alcohol affects those who drink. One individual told us:

“My dad can’t help drinking. Every day we need bread, milk etc from the shop next to our house. When he goes in, the temptation is too much for him. It’s not his fault when it’s staring him in the face. Maybe if we didn’t live near a shop he wouldn’t be able to get drink as easily.”


Local authorities told us that they struggle to reduce availability under the current licensing regime. The UK Government could follow Scotland to allow local authorities to consider public health as a distinct licensing objective when assessing licensing applications.

Advertising and marketing set the tone for our relationship with alcohol. The alcohol industry spends hundreds of millions of pounds on advertising, much of which can be seen by children and vulnerable individuals, such as those with addiction. Children’s exposure to alcohol marketing makes them more likely to consume alcohol and to start consuming it at an earlier age. Opinion polling carried out for the Alcohol Health Alliance showed that 75% of the public support reducing children’s exposure to alcohol advertising. Many countries, such as France, restrict such marketing to better protect their populations. We should follow suit.

Consumers have a right to know what they are drinking. It is bizarre that currently there are fewer legal requirements for information on a bottle of wine than on a carton of orange juice. Unlike soft drinks, alcoholic drinks do not have to list their calories or sugar content or ingredients. Consumer information is grossly inadequate, as there is no statutory requirement for drinks to carry a health warning, warnings about alcohol in pregnancy, or the weekly guideline for low-risk consumption. Without label information, consumers are unaware of the risks and cannot make informed decisions.

Time does not allow me to cover the toll on the NHS and social care, where the burden of alcohol harm ultimately falls. Suffice it to remind your Lordships that alcohol is the leading risk factor for death, ill health and disability in 15 to 49 year-olds in England. It was causal in almost 12,000 cancers in 2015—that is 33 people a day—particularly cancers of the mouth, pharynx, oesophagus, larynx, breast, bowel and liver. It is also a factor in over 200 other diseases and injuries, including hypertension, heart disease, stroke, gastrointestinal disorders, brain damage and mental illness. Deaths from alcohol liver disease have increased 400% since 1970.

The Government have tackled tobacco harms and shown in their recent obesity strategy a willingness to take bold action to protect the public’s health. With an estimated 1.6 million adults in England having some degree of alcohol dependency, I hope that the Government will show the same boldness and heed our report’s recommendations.

Covid-19: One Year Report

Baroness Finlay of Llandaff Excerpts

Thursday 25th March 2021 Lords Chamber

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, the National Mental Capacity Forum, which I chair, recently ran its eighth fast-track webinar during the pandemic. We called it “The good, the bad and the ugly”. I will focus on those three categories: good things we want to keep, bad things we should change and ugly things we must never see again.

The speed with which medical and public health research has been approved, instigated and reported shows that past bureaucratic systems can be abandoned. The speed of innovation has been impressive. The rapid return to clinical registers of doctors, nurses and other healthcare staff from retirement was commendable, but many were underutilised. Their knowledge and wisdom should be retained to mitigate shortages in NHS manpower by employing them to what they can do well to provide support to patients through availability for remote consultations and hundreds of other roles.

We should commend those who coped with the very difficult task of the terrible catalogue of deaths. Absolutely nobody wanted to see what we have seen. The bereaved will live with those memories for the rest of their lives. One of the greatest failings has been inappropriate rigidity and inflexibility over visiting when people were dying. We must balance risks and ensure that infection control and emotional support are achieved without compounding the anguish that so many have experienced. The inability to be with the person you love and to say goodbye has been awful. We never want to see it again. Blanket policies failed. The term DNAR, or do not resuscitate, is dangerously imprecise. The Care Quality Commission emphasises respect, open discussion and clarity over CPR.

Many of our simplest public health measures have been far too slow to roll out, compounded by mixed messaging. As a Bevan commissioner in Wales, I supervised the Distance Aware project—a simple prompt now adopted wholesale in Northern Ireland. We need to remain distance aware, probably for years to come, using the protective function of face masks and handwashing as basic infection control. Westminster must work better with the devolved Administrations for recovery.

We must also avoid vaccine complacency, maintain infection control and embrace new ways of working through the rapid rollout of technology, with working, voting, consultations and even mental capacity assessments online. But online living risks promoting loneliness, which has become an enormous problem. Safe meeting places, such as the hospitality sector, sports facilities or the myriad voluntary sector support services, are an important part of our infrastructure. In doing all this we must tackle head-on inappropriate use of alcohol and recognise the associated harms with its links to violence. Nutrition policies need to change to recognise the links between malnutrition, obesity and loss of life years.

We will never go back to where we were. In easing restrictions, consistent UK-wide messages based on evidence are essential. We face difficult decisions. We need to tackle social inequities far better, respect local and devolved services, which know their own communities, and build resilience for the next generation.

Folic Acid

Baroness Finlay of Llandaff Excerpts

Tuesday 23rd March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I think my noble friend alludes to the rollout of the vaccine, which has been the consummate preventive medicine programme that the country has ever seen. It is, I hope, an inflection point in the whole country’s approach to its healthcare. We have for too long emphasised late-stage, heavy- duty interventions, and we have not focused enough on preventive early-stage interventions. Folic acid is a really good example, as are the vaccine and fluoridation, and the kinds of population health measures we hope to bring in will address all of those.

[Baroness Finlay of Llandaff (CB) [V]]

I too commend the noble Lord, Lord Rooker, for his tenacity on this important aspect. Do the Government recognise that 90% of women of childbearing age have low folate levels? If these were corrected by the dietary addition of folate to flour, we could see up to a 58% decrease in neural tube defects. These are massive numbers and cannot be ignored. The clock is still ticking and there are women getting pregnant today who have low folate levels.

[Lord Bethell (Con)]

The noble Baroness’s figures are not quite the same as the ones I have in front of me. The mandatory fortification of bread flour with folic acid in Australia resulted in a 14.4% overall decrease in NTDs—although that is still a really important number, and if we are running at 1,000 a year in the UK, 50% of which are due to unplanned pregnancies, there are clearly important grounds for this measure to be considered seriously.

World Health Organization: Pandemics

Baroness Finlay of Llandaff Excerpts

Tuesday 9th March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I share the noble Lord’s passion for international travel. Like him, I cannot wait for global travel to restart. I also see the connection between the promise of a vaccine certificate of some kind and taking up the vaccine itself. Plans for vaccine certificates for global travel are emerging as we speak. We have a Cabinet Office programme which is co-ordinating across government initiatives on vaccine certification, and a review is in progress which will pronounce shortly.

[Baroness Finlay of Llandaff (CB) [V]]

[Inaudible]—excellent record in research, are the Government able to work through the WHO to promote research into recyclable PPE to avoid the environmental hazard of an enormous pile-up of plastics and discarded PPE? Can the Government work on a public education programme of basic hygiene, with clean water and soap available across the world, so that the very basic principles of hygiene can be maintained?

[Lord Bethell (Con)]

My Lords, the environmental consequences of the pandemic are indeed severe, as the noble Baroness rightly points out. We are working with colleagues in Defra to try to figure out answers to this tricky problem of the legacy of all this PPE. With regards to hygiene education around the world, we have a number of programmes in place, through ODA and our various international development plans, and hygiene is very much at the centre of those.

Covid-19 Update

Baroness Finlay of Llandaff Excerpts

Thursday 4th March 2021 Lords Chamber

[Lord Bethell (Con)]

I am grateful to my noble friend for his question and I echo his comments on Kate Bingham. However, my Lords, we are not post-vaccine; we are, at best, mid-vaccine. Vaccinating 20 million people is an enormous achievement but there is a hell of a long way to go. There is still an enormous amount of infection in this country; nearly half a million people, or thereabouts, have the disease. There are variants of concern being generated in this country, such as the Kent virus, and overseas, such as the Manaus virus. Until we are truly through this, we have to show restraint and make uncomfortable decisions, and we must ensure that the NHS is preserved and we save lives. That, I am afraid, remains our priority.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, British science is indeed to be celebrated, as is government support of it, in vaccine development, genome sequencing and disease-specific registries such as UK Biobank. Will the Government use that experience to establish a national Covid registry to bring together the four main groups of data referred to by the Minister in his reply to the noble Lord, Lord Taylor, to inform long-term planning to reveal links between new variants found on sequencing, different long-term complications, including long Covid, the risk factors behind it and other matters such as body-mass index, vaccine history and any associated other contagious diseases? Such a registry could act as a long-term public health research tool.

[Lord Bethell (Con)]

My Lords, I am grateful to the noble Baroness for her insightful question about the obscure but vital question of data architecture. If there is going to be one powerful legacy of this awful disease, it will be the way in which data helped drive medical research, medical insight and the treatment of individuals. I am not sure if we need a new registry, a national Covid registry; what we need is for our existing data to be able to talk to itself. I can tell the Chamber that we are making enormous progress on that. I pay tribute to the unsung heroes, the CTOs who meet weekly at the NHS data architecture meeting, an obscure but vital forum where an enormous amount of good work is done by NHSX, NHSD, test and trace and others in primary and secondary care who are working incredibly hard, so that if one takes a test today, it goes into one’s patient record tomorrow and can be used the day after by a researcher looking at long Covid, dexamethasone, recovery or whatever. This is how modern healthcare should work. We have not done it well enough to date. We are making great progress on it tomorrow and we must not stop.

Covid-19: Brazilian Variant

Baroness Finlay of Llandaff Excerpts

Tuesday 2nd March 2021 Lords Chamber

[Lord Bethell (Con)]

I am grateful to the noble Lord for flagging the Brazilian connection with Ireland, which I did not know about. I reassure him that there is an enormous amount of collaboration between Whitehall and Dublin on this matter. There are strong links on the managed quarantine programme within Ireland in order to close the “Dublin backdoor”, as it is sometimes called. I pay tribute to colleagues in Dublin for their collaborative approach. We do not currently have a five nations unified approach, but it is of interest. We are definitely keen to ensure that there is no backdoor entrance for VOCs through Dublin, or in the other direction.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, given the inevitability of variants and that some will evade antibody responses, what plans do the Government have for unified messaging, across the whole of the UK, that long-term distancing, mask-wearing and other measures are essential, and to tell the public that this is not like flu and we need to live differently?

[Lord Bethell (Con)]

The noble Baroness is entirely right, which is why the Prime Minister struck such a cautious tone when he unveiled the road map. We are not through this yet. A substantial proportion of the country is vaccinated, but we have to protect the vaccine. For those who have not been vaccinated, there are risks, and that is why we still have in force a “do not travel” alert and why we are maintaining marketing and communications at every level on the restrictions that are still in place.

Covid-19 Update

Baroness Finlay of Llandaff Excerpts

Thursday 4th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I pay immense tribute to the test and trace system, which, at 11 am, published remarkable performance figures, as the noble Lord probably knows; 92% of tests were turned around before the next day, and 86% of contacts were traced. This is an incredible performance. On his specific point, the creation of a variant-of-concern tracing group that is targeted at those rare appearances of VOCs in the community is the important development that we have put in place in reaction to the mutant variants. I pay tribute to Steve McManus, who is running that programme, for the impact that he has already made on the problem.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, with the emergence of new variants, questions over vaccine-induced antibody response to these and the risk of children as asymptomatic carriers, will the Government ensure that schools’ policies are flexible, adapted to each child’s needs, so that children shielding a very sick parent or sibling at home will be able to continue with home schooling and not be forced back through punitive threats on parents; while children needing the security of school can continue to access school as at present and when the majority have the benefit of being able to return?

[Lord Bethell (Con)]

I reassure the noble Baroness that we are absolutely putting the arrangements for pupils in the hands of schools themselves, because they know best how to look after their pupils and their teachers. The role of test and trace is to provide testing facilities and the resources to make schools safe, but it is up to the Department for Education, the local authorities and the schools themselves to protect those who need special arrangements, either because they are shielding or because they have other needs.

International Year of Health and Care Workers

Baroness Finlay of Llandaff Excerpts

Monday 1st February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the Minister for Vaccines has been clear on this: the Government are not currently undertaking work on vaccine certification. However, the noble Baroness makes the case well. Certainly, those who have had the vaccine are very anxious to ensure that they have the correct documentation, and we will ensure that that is in place.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, I declare my roles at Cardiff University. Will the Government create a range of funding streams as overseas aid to ensure that UK universities’ successful distance learning programmes in practical health and care specialities and generalist care are affordable and supported in those countries? Will they work with me and others to invest in better provision of public health, infectious disease control, maternity services, dermatology, palliative care and other services around the globe?

[Lord Bethell (Con)]

My Lords, I pay tribute to the work of the noble Baroness in this important area. Her implied insight is exactly correct. We cannot be healthy and safe here in Britain if there are diseases raging around the world. It is both in our pragmatic self-interest and aligned with our values of partnership with other countries that we should indeed invest in the kind of training and support to which the noble Baroness alluded. I will definitely look into how we could do this better.

Social Care Funding (EAC Report)

Baroness Finlay of Llandaff Excerpts

Thursday 28th January 2021 Grand Committee

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, I declare that I chair the National Mental Capacity Forum and am a Bevan Commissioner. This commendable report provides a way forward, recommending that there must be an appropriate national funding formula. That formula must be fair, recognising that areas of high costs are often in areas of less business buoyancy, meaning that the desire to make local authorities more fiscally self-reliant risks widening gaps in provision and worsening the postcode lottery.

The report was prophetic. The pandemic has shown that social care cannot be used as a pressure valve for the NHS. It has also revealed to the nation, as the report points out, that social care sector staff providing direct care are underpaid and undervalued and that their personal well-being has often been overlooked.

Personalised care has two distinct roles. One is providing all the personalised care underpinning and integrated with healthcare interventions, often delivered by health and social care staff working together. Any division based on budgets creates an artificial split, with expensive bureaucratic processes if a person’s care moves from one sector to another, either geographically or by diagnostic category.

The other role of personal social care is to support people—often working-age adults—in their own homes, to allow them to live well and contribute in our society. A key part of this role is in the prevention of healthcare problems arising. Yet this prevention role has been chronically undervalued, even though it saves avoidable expenditure from the health budget. The future of public health in social care needs much greater emphasis.

During the pandemic, some charities have instigated innovative programmes to deliver social care and support, several seeing great results in improving mobility and independence. But current funding difficulties for charities have revealed our overreliance on this sector over years.

The report highlights the workforce—without a workforce any structure will fail and there will certainly be no resilience. Will the Government urgently look again at a proper career structure with parity of esteem and of pay for those in social care? Percentage pay increases simply widen the gap between the lowest paid, who do the work with the most vulnerable, and others. Staff need their travel time between homes recognised and to be able to park on arrival. They need ongoing training and supervision, with support for their own well-being—if they feel cared for, they are better able to care for others. Those receiving social care are potentially very vulnerable, which is why a proper registration and revalidation process of social care staff would set a national standard and could provide a focus—to nurture staff, helping them feel pride in their work and more respected. Their work is highly skilled and low paid, and their indemnity needs sorting out across the sector in the long term as part of an integrated system.

Form must follow function in a fair national funding formula that recognises our duty to each other in society. In this way, we might be able to move forward. To not heed this report will worsen our problems.