Covid-19: Local Restrictions

Baroness Jolly Excerpts

Thursday 3rd September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, we are working extremely hard to create confidence in the Test and Trace system and in the effectiveness of our two-tier system of hands, face and space combined with Test and Trace. We are appealing to the country to take necessary precautions but within those precautions to go about everyday life.

[Baroness Jolly (LD)]

My Lords, in the pandemic, I fear that some sectors of the public are losing confidence in politicians. Scientists, on the other hand, are seen as independent and trusted. Surely, advice for politicians from scientists should be published in the interests of openness and transparency. Does the Minister agree?

[Lord Bethell (Con)]

I completely agree with the noble Baroness. The collapse in confidence in politicians is nothing new, I am afraid. I can only pay tribute to British scientists, who have been extraordinary in terms not only of the integrity of their work but its pioneering nature. In many fields, Britain has led the world in the innovative and brave science that we have pioneered.

Covid-19

Baroness Jolly Excerpts

Thursday 3rd September 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for the Statement and the Covid update that the House will discuss today. We are, of course, all on the same side in fighting this virus. I hope the Minister will understand that when we raise issues it is to urge the Government to improve their response to fighting the virus which, as he said earlier today, remains lethal and leaves many with serious, debilitating sickness. Everything must be done to drive down and eliminate infections and suppress the virus completely.

Given the news today about testing availability and the aspirations of the Secretary of State in that regard, I start by asking the Minister about the current state of testing and tracing. From the news this morning, it would seem that coronavirus testing was being prioritised in high-risk areas, leading to shortages in others. This has led to some people with symptoms being asked to drive significant distances for a swab. The Government say that areas with fewer Covid-19 cases have had their testing capacity reduced to cope with outbreaks elsewhere. Is this within the 300,000 tests which the Secretary of State has mentioned as being his aspiration? As the Minister will be aware, public health experts warn that this could miss the start of new spikes, so I would be very grateful if he could clarify the exact position on the rollout of mass testing.

Saliva testing is being used in Hong Kong, as we know. Would the Minister be able to ensure a quick turnaround of these tests? Has he seen the study from Yale which suggests that saliva testing could be as sensitive as nose and throat swabs? What is his attitude towards pool testing, which surely could increase capacity in areas of low prevalence? Does the Minister have a plan to introduce pool testing? Will we now allow GPs to carry out testing or, at the very least, arrange tests for their patients directly? They currently have to ask patients to log on to the national system, which may be causing huge delays.

A testing problem came to my notice in an email I received from an English family on holiday in Northern Ireland. They went there to have a break and did everything they could to ensure their safe passage—they did not stop for toilet breaks, they packed lunches, they booked the shortest ferry crossing, and they were heading to a house that had not been occupied for a week. However, something went wrong, and the father became ill. He said: “Getting a test should be easy, right? Well, wrong. When we first tried to get a test, the booking system was completely down. It was not working online or by telephone. When it eventually resumed, I was offered a test appointment 460 miles, and a ferry journey, away in Scotland. I was worried about having potentially to drive 20 or 30 minutes with a raging fever, so we ordered the home tests. The kits took 48 hours to arrive. Remarkably, there seems to be no test-kit storage site in Northern Ireland itself, so they have to come from the mainland, even though one of the companies than manufactures tests—Randox—is based in Northern Ireland.”

This person had the usual problems that lots of people have when doing a self-administered test and returning the results. They were in an isolated place, so they chose to use the specially designated postal box, which meant his wife driving 25 minutes. That box was inside a building. It did not seem to cross anybody’s mind that potentially infectious people should not be entering a building full of people. When the wife talked to someone about their concerns, they said that they were not allowed to handle parcels and she should put the results in another post box. It took six days from the husband developing the fever and seeking a test to getting the result. When it came, it was not absolutely conclusive. We know that these tests can sometimes be only 70% accurate. This person is still very ill and still in Northern Ireland. He is an academic who, as it happens, is also a scientist. He is very disappointed with the 111 service, which he called to ask for another test. He was told that he could not have one, that he probably did not have Covid, and that he should go back to work. It seems to me that this system is not working terribly well. What is the Minister’s view of this sorry tale, which raises all sorts of issues about testing and tracing, at least in Northern Ireland?

I move on to the cancer plan and whether a task force will be in operation. The number of new cancer patients presenting is down by one-quarter this year, the number of appointments for specialist cancer treatment is now also falling, and the amount of money available for clinical trials has fallen through the floor. This means that people will die. What are the Government’s plans to move this forward?

We know that a vaccine is our best hope to stop this pandemic. It will save hundreds of millions of lives. We on this side of the House have offered to work with the Minister on a cross-party basis to promote uptake and challenge the poison of anti-vax myths. That offer remains in place. We would work constructively with the Government on any proposals that they bring to the House to deal with those myths.

On Public Health England, the Minister is aware that we on this side of the House think that embarking on a distracting restructuring of Public Health England in the middle of a pandemic is very risky. Conservative MPs seem to like to blame Public Health England and this will sap morale even further. The UK has suffered the highest per capita death rate of any major world economy. To get through this winter safely, our NHS and public health services need resources, staff, protective equipment, fair-pay security and the support of this Government. I hope they will be able to deliver that.

Finally, the Minister said a few minutes ago that the folic acid issue would not be dealt with until after the pandemic. He needs to write to the House about exactly what that means and what the timeline is.

[Baroness Jolly (LD)]

My Lords, yesterday it was raining when I left the house, so I decided to catch a bus. I donned my mask and got on. There were signs to say that only 30 passengers would be allowed, but I was disappointed that not only was that number exceeded, but masks were not universally worn. Some came off when the individual wanted to use their phone or talk to a friend, and there appeared to be no awareness of the reason for wearing one. I was glad to get off. It raised as many questions as it answered.

I appreciate that there is positive movement in some parts of the country. In my own part of the world, the far south-west, despite many visitors from elsewhere—the locals were anxious that they would bring the virus with them—they mainly kept to themselves and only left their footprints in the sand behind. Areas have been locked down in north-west England, Yorkshire and Greater Manchester, as there have been many cases identified. Will the Minister outline how these cases were identified?

Social distancing is difficult when you are young. We all might remember when we felt immortal; many young people catch the virus, are barely unwell but are spreaders among their generation. They then take it home and pass it on to their older family members. Mass testing would avoid this.

What is the Government’s policy on testing key workers? Do they have to book their own tests, or are some professions automatically tested or encouraged to book a test? I was contacted by text quite out of the blue by my local authority to take a test, which I dutifully did. No reason was given; perhaps it was a contact trace. I therefore looked at where the local testing stations were located and no station was nearer than 50 miles, so I ordered a postal test. Easy, excellent directions came with the test and the result came back quickly, so I had a completely different experience from that of the person who wrote to the noble Baroness, Lady Thornton. Could the Minister outline where test and trace is being used and what system is in operation? I know that it is going well in Northern Ireland. Have the Government considered using this in England?

The Government pay-to-isolate scheme also seems a good idea for those who cannot afford to miss work. Will the Minister tell the House what the take-up is and where the department might use it in future?

When do the Government expect to roll out a vaccine? I would like to know how many volunteers are taking part in the programme and how that number compares with the development of any other new vaccine that would be working to the usual timetable. I would expect Public Health England to organise vaccinations when it is ready. Now that Public Health England’s future is uncertain and it is being disbanded, how will this happen? What clinical personnel would the Government consider capable to deliver the vaccine? Presumably, as local pharmacies deliver flu vaccines, they would be capable of delivering coronavirus ones as well. Would this be something paid for by the patient, as with flu, or paid for by the Government? Has the department had conversations with the pharmacy profession about doing this work?

May I ask the Minister a question about numbers? In the Statement, it was mentioned that 84.3% of contacts were reached and asked to self-isolate. Do we have any certainty that they did so? Are local authorities or call centres checking on this?

My final point is about nurse numbers. I am delighted that they are higher, although we will still be far off full complement. Will the Minister comment on care-worker numbers? In the new year, some EU-origin workers might not be able to afford to stay under the new system. The Home Secretary suggested that we could use British care workers. Is the Minister confident that they will exist in sufficient numbers?

Health Protection (Coronavirus, Restrictions) (England) (No. 3) Regulations 2020

Baroness Jolly Excerpts

Thursday 3rd September 2020 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I apologise to the House. I came here from my office in Millbank for the beginning of Questions. I picked up my papers from my desk, and it was not until I was sitting that I realised I do not have my full speech. But we have been through this before—we have just changed the number to three. I welcome the move to local powers in this measure.

In the first of these debates, I asked the Minister about fixed penalty notices. Since we are now up to the third set of regulations, how many fixed penalty notices have been served since the first debate? How many have not been paid? Is the Minister of a view that they are a deterrent? I certainly do not think that the average member of the public would even know that they exist, but I just ask the question.

Medicines and Medical Devices Bill

Baroness Jolly Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Wednesday 2nd September 2020 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I am sorry that my noble friend Lady Brinton is unwell and not able to lead today. I hope that she is better and back in her place soon.

The Bill creates extensive delegated powers in the fields of human medicines, veterinary medicines and medical devices—but, I note, not veterinary devices. They enable the existing regulatory frameworks in those fields to be updated following the UK’s departure from the EU. The Bill creates a delegated power to establish one or more information systems in relation to medical devices, consolidates enforcement provisions for medical devices, introduces sanctions and provides an information gateway to enable the sharing of information held by the Secretary of State about medical devices. Your Lordships’ Delegated Powers and Regulatory Reform Committee published a report on the Bill in July. I was going to have a go at the Government about how poor the Bill was, but the noble Lord, Lord Blencathra, did it so much better.

Medical devices legislation currently relates only to medical devices for the field of human healthcare. Thanks to the health and cost benefits, these devices have also found their way into veterinary medicine. Somewhat surprisingly, however, the regulation of these products is missing altogether, unlike in some other European countries. Veterinary practice makes use of all kinds of medical devices, including products designed for use on humans, regardless of their regulatory status and control. With rapid growth in the animal health monitoring field, there should be opportunities to regulate such devices with regard to their safety and efficacy. Given the complexity and potential hazards of certain veterinary devices, the current unregulated state of affairs may lead to health and safety risks, both for animals and the clinical personnel involved. Perhaps the Minister would like to comment and think again.

Claims of medical relevance of new diagnostic tools should be considered because of the potential impact on animal welfare. Although ultimate responsibility for diagnosis should always rest with vets, reliance on these devices will increase, as will the need for regulation of performance standards. Although I recognise that Part 3 of the Bill, entitled “Medical Devices”, currently relates only to medical devices for the field of human healthcare, remote animal health and welfare services and remote health monitoring is a field of rapid growth. Opportunities to regulate such devices with regard to safety and efficacy, and to set standards for production, should be considered.

I move on to people. The timing of this debate, only two months after the publication of the Cumberlege report, is opportune. Many aspects of the report have not been debated, and I am sure that other noble Lords will have areas from the report that suggest amendments to the Bill. It will give us an opportunity in Committee to debate some of the recommendations.

For as long as I have been actively involved in either health governance or policy—some 20 years—the NHS has said that it wants to put the patient at the centre; there are various ways of framing it, but that is what it has said. The recommendations in the Cumberlege report do just that, absolutely and without any equivocation. We should legislate for a patient safety commissioner, tasked with focus on the patient, and for a redress agency, based on looking at systemic failure, not individual blame; I think there has been quite a lot of agreement in the House this afternoon on that.

The MHRA needs to highlight its public protection roles and ensure that it actively engages with the patient body. This is another theme running through the Cumberlege report. There will be a searchable register of who has had an implant and when; details about its type; the clinician carrying out the procedure; and, I would hope, any financial or other interests of that clinician.

While I recognise the need for the UK to remain competitive, patient and user safety must be paramount. There is a real need for strong regulatory oversight. Recent scandals, such as those concerning DePuy metal-on-metal hips, as well as those already discussed today relating to Primodos, sodium valproate and pelvic mesh, highlight the importance of safety.

The final recommendation of the Cumberlege report is that the Government should set up a task force to implement its recommendations. Public confidence needs to be restored, and with a matter of urgency, so will the Minister tell the House when he expects the task force to start its work and how its members will be selected?

The Bill confers on the Secretary of State an extensive range of powers to make regulations pertaining to medicines, clinical trials and medical devices. This is necessary in the short term to facilitate alignment with those parts of EU law which are to be implemented post transition—notably, the EU clinical trials regulation and the medical devices and in vitro devices regulations. However, the ongoing use of delegated powers in this area should be time-limited. Will the Minister tell the House whether this was debated in the department when the Bill was being drafted and why time-limiting was rejected?

On trade, the UK has a strong industry base in both medicines and devices, but we will not be able to be self-reliant. How does the Minister expect that we will be able to trade with the rest of the world in the future? What conversations has the department had with the EU, and what strategy is in place to work with non-EU countries? Time is against us. Negotiations with the EU are ongoing but if we have to set up treaties with various countries, it will be some time before all this is pulled together.

Our pharmacies not only dispense medicines, and some devices, but act as a local high-street source of information and advice; that is welcome to those who think that they do not need a doctor but want an expert’s opinion. The Bill enables community pharmacy contractors to use innovative new systems to support dispensing and is welcomed by members of the profession.

There is much that I have not had time to outline and I suspect that we all have a long list of points that we were not able to shoehorn into our speeches, but I look forward to the detailed work in Committee. I hope that the Minister will acknowledge that this Bill is important but needs detailed examination.

Health Protection (Coronavirus, Restrictions) (Leicester) Regulations 2020

Baroness Jolly Excerpts

Wednesday 29th July 2020 Lords Chamber

[Baroness Jolly (LD) [V]]

My Lords, I thank the Minister for his update, but again we find ourselves agreeing to regulations after the enforcement date, which was over three weeks ago. They will be in place until January 2021, although today’s news from Hong Kong is a very timely reminder of the gravity of our situation. The Secretary of State must review them every fortnight. Given that 16 July has passed, can the Minister please let us know the outcomes of that first review? Has there been any significant change in the situation? How will this be conveyed to Parliament during the Recess?

We know that there has been a considerable amount of testing in Leicester and the surrounding area, and that there is still a push for more testing. How is this progressing? What proportion of the population has now been tested, and is the sample size large enough to make meaningful decisions on a way forward?

Why is sport singled out for preferential treatment in SIs? We are a nation that loves our sport, but why is a sportsperson deemed more worthy than, for example, a world-class organist? They cannot take their instrument home, but their form goes unless they continue to practise. What is the harm in them trying to maintain their standard, too, if they can practise in a distanced fashion?

Finally, one area of concern that came from press coverage of the Leicester outbreak was employee safety. Employers have a legal responsibility to protect their employees and other people on site, and most are diligent. On the news that evening, we saw garment trade workers in Dickensian conditions, neither wearing masks nor distancing from their colleagues. What penalties does an employer pay for this dereliction of duty? What confidence have the Government that this was the exception and not the rule?

Covid-19: Response

Baroness Jolly Excerpts

Monday 27th July 2020 Lords Chamber

[Lord Bethell [V]]

My Lords, local authorities have had daily Covid-19 containment dashboards, which include 111, 119, online triage information and positive case information at UTLA and LSOA levels, for more than two weeks. Data for directors of public health who have signed the data-sharing agreement requires data-sharing agreements as personally identifiable information, and is mostly for their teams. That data includes much more granular data, including sex, age, postcode, ethnicity, occupation, test date, pillar and test location type. This question of data is one that concerns us enormously. We have moved a phenomenal amount in recent weeks, and it is my genuine belief that those in local authorities, directors of public of health and local infection teams have all the data that they need to do the job.

[Baroness Jolly (LD) [V]]

My Lords, social care has barely been mentioned in the last three Statements. Could the Minister clarify, in the event of a second wave of coronavirus, who in the Department of Health and Social Care is now leading on preparations with the care sector, and who from the care sector is leading in those discussions? How frequently do they meet?

[Lord Bethell [V]]

My Lords, I pay tribute to my colleague Helen Whately, the Minister for Social Care. She has worked incredibly hard and tirelessly on this area, which is her ultimate responsibility. There is a social care team which handles those negotiations, and I thank all those in the social care industry who are engaged. The social care industry is highly fragmented so engaging with the entire industry is a massive challenge. That is why we have put in place new structures, new dialogues, new guidelines and new ways of working to ensure that we are match-fit for the winter.

Health Protection (Coronavirus, Restrictions) (No. 2) (England) Regulations 2020

Baroness Jolly Excerpts

Friday 24th July 2020 Lords Chamber

[Baroness Jolly (LD) [V]]

My Lords, these regulations go some way towards easing the coronavirus restrictions and I am grateful to the Minister for the clarifications. Many people will now be glad of the opportunity to eat out, but I know that some owners feel that the time is not yet right to open, and some diners may be happier staying at home. The regulations include a new power for the Health Secretary to restrict access to a specified public outdoor space. That could include public gardens, open country and access land. Can the Minister confirm whether it could include beaches? How will a repeat of the Bournemouth mass occupation be avoided? Can the Minister also tell the House how the testing of wastewater is being used to identify outbreaks across the country?

We are debating these measures retrospectively as the restrictions were imposed before we could have our debate. We are in strange times, but we do live in a parliamentary democracy, and that should not mean that we have to accept a loss of parliamentary oversight.

Pharmacies

Baroness Jolly Excerpts

Monday 20th July 2020 Lords Chamber

[Lord Bethell [V]]

The noble Baroness is entirely right. Although the vast majority of people live within a 20-minute walk of a pharmacy, many people face issues with location. That is why we will continue to maintain the good level of access that we have through the pharmacy access scheme, which provides additional financial support to pharmacies in areas where there are fewer pharmacies. Our commitment remains fully in place.

[Baroness Jolly (LD) [V]]

My Lords, clinical commissioning groups can commission local pharmacies to carry out tests on their patients, such as for blood pressure or atrial fibrillation. This would relieve local GP practices. How widespread is the adoption of this way of using pharmacies and what is being done to increase its uptake by clinical commissioning groups?

[Lord Bethell [V]]

The noble Baroness is right that pharmacies can play an enhanced role, particularly in providing the kinds of services that mean that people do not have to visit their GP. If we have learned one thing from Covid-19, it is that GP surgeries can be a source of infection and that GPs can sometimes be much more impactful working away from home. That is why we support exactly the kind of initiative that the noble Baroness outlines.

Independent Medicines and Medical Devices Safety Review

Baroness Jolly Excerpts

Wednesday 15th July 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is right: we do not listen to our women clearly enough. The medical health of women is more complicated than the medical health of men, and that point has been overlooked for too long. We are working hard to bring this into the education of young medics and to update the attitudes, procedures and knowledge of those who are already in the profession.

[Baroness Jolly (LD) [V]]

The noble Baroness, Lady Cumberlege, recognised the importance of regulation in her excellent report. Our regulation system is in a transitional stage. Regarding the European Medicines Agency and the Medicines and Healthcare products Regulatory Agency, the text of the political declaration accompanying the withdrawal agreement stated only that the UK and EU will “explore” the possibility of co-operation. Can the Minister confirm what exploratory talks have been made to ensure that the EMA and MHRA remain strong and convergent post Brexit, and that the MHRA is adequately staffed?

[Lord Bethell]

The noble Baroness is right that regulation is important, but so is culture. I emphasise the importance placed by the Cumberlege report on a change in attitude in the healthcare service as much as on a change in regulation. I cannot guarantee that the EMA and the MHRA will be aligned on regulation in all matters, but I can guarantee that the MHRA will be given the resources it needs to do the job properly.

Medical Teaching and Learning: Ethnic Diversity

Baroness Jolly Excerpts

Tuesday 14th July 2020 Lords Chamber

[Lord Bethell]

My Lords, the recruitment of 50,000 new nurses, more GPs and new trainees into our medical colleges is being done in a fresh and, importantly, exciting new way, with a much greater focus in the marketing and advertising on attracting those from BME communities. This recruitment programme will, I hope, present a little bit of an inflection point in our approach to recruitment.

[Baroness Jolly (LD) [V]]

My Lords, the Medical Schools Council is steered by an executive committee of 42, which is elected from its membership. Of these, only four are of an ethnic minority background and 11 are women. Apart from encouragement, can the Minister tell the House what the Government are doing to ensure that, across medical and other health professional training, there is proportional representation of both ethnic and gender minority teachers?

[Lord Bethell]

The noble Baroness is right; the representation of BAME communities at the higher echelons of the medical establishment is not good enough. In too many areas, the representation is not fair and does not reflect the much higher proportion of BME workers at other levels of the health service. We are working hard on a variety of agendas: the People Plan, which I have already mentioned, and the NHS workforce race equality standard. These measures are taken seriously and we are working hard to change the balance of representation.