Eating Disorder Services: Referrals

Baroness Thornton Excerpts

Monday 17th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, undoubtedly, the increase in referrals is something of concern. It is something we are monitoring closely, with the round table and the ministerial group dedicated to looking at this. That shows the seriousness with which we regard it. The reduction in the impact of community services, which is the best way of addressing these kinds of issues, has undoubtedly had an effect on urgent needs. During this period, there has also been a large increase in the number of young people who have started treatment, which is encouraging. If the noble Baroness has evidence that measures such as nutrition information on packaging has an effect on anorexia, I would welcome correspondence from her.

[Baroness Thornton (Lab)]

My Lords, as the noble Baroness has said, we know that eating disorders among children and young people have increased during the pandemic. There is a very welcome increase in the grant of £11 million from the grant in 2018-19. Despite this, total spending by CCGs on children and young people’s community eating disorder services increased by just £1.1 million, from around £54 million in 2018-19 to £55 million in 2019-20. This increase is cancelled out if you adjust for inflation, and this means that total spend flatlined in real terms. What are the Government going to do to ensure that this money is spent on what is growing into an epidemic of eating disorders and the suffering they cause?

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right that community eating disorder services are critical. They are the backbone of our measures to address these difficult cases. But money for the treatment of eating disorders comes from many different pots. During 2021, a total of 10,695 children and young people started treatment, which is up from 8,034 children in the year before. So, clearly, resources are getting through to cope with a large number of people, and that is an encouraging sign.

Health Protection (Coronavirus, Restrictions) (Steps and Local Authority Enforcement Powers) (England) (Amendment) Regulations 2021

Baroness Thornton Excerpts

Monday 17th May 2021 Grand Committee

[Baroness Thornton (Lab)]

It is regrettable, as my noble friend Lord Rooker said with a certain amount of robustness, that yet again the House is being asked to retrospectively approve significant legislation that impacts on individual liberty, well-being and livelihoods, five whole weeks after it came into effect and after it was further amended, on the day when a new lifting of restrictions is taking place—I suppose we will get to discuss that some time in the next month.

The regulations state that

“the Secretary of State is of the opinion that, by reason of urgency, it is necessary to make this instrument without a draft having been laid before, and approved by a resolution of, each House”.

Nothing in the regulations or in what has been said by the Minister today justifies using the emergency procedure to introduce previously announced policy changes at the 11th hour. We are now well over a year into the pandemic and, while we encourage the Government to be proactive and driven by data, that does not prevent or exempt them from following parliamentary procedures. The Minister will be familiar with this repeated complaint.

The countrywide road map for lockdown lifting announced on 22 February advised that England would enter stage 2 on or after 12 April. This date was confirmed at a government press conference on 5 April, yet these regulations were not laid before Parliament until 9 April, coming into force three days later. While that is definitely an improvement on the three hours’ notice that we have had for some regulations in the past, there is simply no excuse for the Government’s continuing indifference to the importance of parliamentary scrutiny.

We have so many errors in the regulations given to us; that is another reason why they need to be subject to proper scrutiny before they become law. According to the Explanatory Memorandum, alongside the stage 2 easements the instrument also makes

“minor drafting changes to remove superfluous wording and to amend references”

in the original steps regulation. I am not sure that these are minor. The Minister will be aware that the JCSI report raised a number of serious concerns about these regulations: first, because of their unusual or unexpected use of enabling powers; secondly, because of defective drafting; thirdly, because they required elucidation; and, fourthly, because they failed to comply with proper legislative practice. Frankly, you would have thought that after a year the Government would have got used to all this, that they would be experts and certainly that they would not be making mistakes in the drafting of legislation.

That is quite a sad list of failures for one statutory instrument whose purpose is to see us safely opening society following lockdown. In one instance, the regulations are so unclear that the Joint Committee said that the law being laid down was unsatisfactory in terms of the rule of law. If a committee of legislative experts is unsure what is or is not meant by certain regulations and does not believe that they give sufficient certainty and clarity, how will the rest of us fare, and how can an average person expect to understand them? This is deeply unfair on those required to enforce the rules and on the businesses grappling to comply so that they can safely resume trading. I fully expect the Government’s use—or misuse—of the emergency procedure and the impact of defective drafting to be covered by the inquiry, but I sincerely hope that the Government will get a grip on this now, especially given the continued threat posed by new variants and the risk of a third wave, which many noble Lords mentioned.

Noble Lords will be well aware that the steps regulations have been further amended, with provisions to move England into stage 3 coming into force today. It is therefore important that the Minister addresses those changes, especially given the growing concern about the B16172 Indian variant in the UK and calls from leading experts to postpone the planned easements. I will not repeat the information given by other noble Lords, because that has been very well covered. However, can the Minister confirm how many people to date have been hospitalised with the Indian variant of concern and how many of those had been partially or fully vaccinated? Over the weekend, the Health Secretary suggested that many coronavirus in-patients in Bolton had not been vaccinated, despite being eligible. I would like the Minister to address how that is being tackled. He has already mentioned that, and I know that my honourable friend Yasmin Qureshi, the MP in Bolton, has been very active on this. Surge vaccinations have been introduced in many hot-spot areas, with some bringing forward second doses and others extending eligibility to younger age groups. Can the Minister confirm whether that is happening and what is the JCVI’s position on this?

It is clear that it was a mistake to delay adding India to the travel list and not to implement a comprehensive hotel quarantine policy. This morning, the Health Secretary, Mr Hancock, said that people should not travel to amber countries except for essential reasons and “certainly not” for a holiday, because of the risk of coronavirus. This is not what the regulations state. The Minister needs to confirm whether the regulations will be updated to reflect the Health Secretary’s comments or whether this is yet another case of the Government’s mixed messaging.

Office for Health Promotion

Baroness Thornton Excerpts

Thursday 29th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, there is already considerable co-ordination between the department, DCMS and DfE on exactly that. I highlight the money that has gone from the tax on soft drinks to contribute to funding outdoor activity in schools, which has had an enormous impact. My noble friend is entirely right that physical activity is linked to better health outcomes; that is why it will form part of the agenda for the Office for Health Promotion.

[Baroness Thornton (Lab)]

My Lords, the policy paper does not reference the measures proposed in the childhood obesity plan and the recent Tackling Obesity strategy released last July. I hope that omission is not significant. Can the Minister confirm—I was slightly concerned by his response to the noble Baroness, Lady Jenkin—that the ban on online adverts for foods high in fat, sugar and salt has been watered down? In awaiting the consultation from the advertising industry, is that a “whether” or a “how”?

[Lord Bethell (Con)]

My Lords, consultations are there to have an honest conversation. It would be wrong for me to try to pre-empt the outcome of that consultation from the Dispatch Box.

Northern Ireland: Flight Passengers and Covid-19

Baroness Thornton Excerpts

Wednesday 28th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I recognise the challenge to which the noble Lord refers. It is, of course, a fact that coronavirus restrictions in Northern Ireland are determined by the Northern Ireland Executive as part of the devolution settlement, as I am sure he would recognise. The Secretary of State for Northern Ireland has raised the issue with the Irish Foreign Minister on a number of occasions to press for a resolution, and while the UK Government continue to work closely with the Executive to drive this virus down, we respect that healthcare is a devolved matter. This is a complex issue to resolve, but we are extremely grateful to all parties who are working hard to resolve it.

[Baroness Thornton (Lab)]

My Lords, the truth is that the Northern Ireland Health Minister, Robin Swann, found out that there were cases of the Indian variant of the virus in the Republic of Ireland only from media reports. This is deeply concerning, as was raised by the noble Lord, Lord Dodds. Northern Ireland is part of the UK, so we have the same responsibilities to our fellow citizens in Northern Ireland and therefore it is very concerning. Is the Minister confident that, going forward, mutually beneficial data-sharing processes are in place to ensure that new variants are controlled and do not become seeded and spread in any of our communities?

[Lord Bethell (Con)]

My Lords, I am enormously grateful to the Irish Government for the very large amount of informal clinical data-sharing that goes on. CMOs of both countries exchange data on such matters as VOCs the whole time, and that kind of day-to-day clinical exchange of on-the-ground information works extremely well. The specific question of travel information is a lacuna that needs to be closed, I recognise that it needs to be shut, a lot of work is going on to shut it and I am grateful to those involved.

Folic Acid

Baroness Thornton Excerpts

Monday 26th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I would be glad to take the noble Lord’s recommendation back to the department; he puts it extremely persuasively. As I said, we have looked at the substantial point closely and it is extremely persuasive, as the noble Lord rightly put it. We hope to come forward with recommendations as soon as the elections are over.

[Baroness Thornton (Lab)]

I reinforce what my noble friend Lord Rooker said. I may be addressing this with my third or fourth Minister. I am not certain whether the noble Earl, Lord Howe, dealt with it when I was opposite, but he may have done, which would make the noble Lord my fourth Minister on this issue. It is even more irritating that it was research in the UK that led the United States and other parts of the world to adopt this policy. I think The Minister has run out of road on this one, and I would like to hear what the timetable to implement this policy is.

[Lord Bethell (Con)]

I completely endorse the tribute of the noble Baroness to those who have worked on this policy. She is right: the science that has gone into this has been persuasive around the world. I thank those in industry who worked with us on our pilot, which proved extremely successful. We are in good shape when it comes to thinking through the implementation of such a policy. My hands are tied at the moment, because of purdah, but I hope to return and fulfil the noble Baroness’s wishes.

National Health Service (Charges and Pharmaceutical and Local Pharmaceutical Services) (Coronavirus) (Amendment) Regulations 2021

Baroness Thornton Excerpts

Monday 26th April 2021 Lords Chamber

[Baroness Thornton (Lab)]

Like my noble friend Lord Hunt, I welcome the purpose of the 2021 regulations, as community pharmacies are contracted and commissioned in England under the national community pharmacy contractual framework, which sets out the services that need to be provided, how quality is assured and other expectations, such as safety.

As has been said, the CPCF is negotiated nationally between NHS England and NHS Improvement, the Department of Health and Social Care, and the Pharmaceutical Services Negotiating Committee. As has also been said, the latest CPCF runs from 2019-20 to 2023-24, but it has not been able to be reviewed, due to Covid. It makes it easier for pharmacies to dispense certain medicines under specific circumstances. If those medications to help treat coronavirus outside hospitals are found, the regulations aim to allow them to be dispensed in such a way as to maximise take-up—this must be the right thing to do.

Community pharmacies makes up one of the four pillars of our primary care system in England, along with general practice, optical services and dentistry. They must often feel that they are the poor relation—the wonky leg on this particular table, perhaps. I will not list all the contributions that they make to our primary healthcare system because that has been adequately covered by many speakers—in fact, all of them, in different ways—in this debate. They are an important feature and fixture on our high streets, in our rural communities and, often, in our supermarkets.

When Covid struck, community pharmacies did not close; they stayed open and served their communities. They continued to deliver medication to people who could not leave their homes. They have been a huge asset to our NHS throughout this whole period; they have been vital. We depend on them at a local level, in both rural and inner-city communities; as people have said, their expertise saves hundreds of thousands of GP and hospital visits. Indeed, the Government have encouraged people to go to their pharmacy before they do anything else—quite rightly.

I support the housekeeping point made by the noble Baroness, Lady Brinton, about the instrument breaching the 21-day rule, with its provisions coming into place before that. The noble Lord knows that a bit of forward planning would be appreciated, but I do not deny it is clear that, because of the rollout of the vaccine, it was necessary to ensure that no one paid for their vaccine, or any treatment in another pandemic situation, to support the maximum take-up of treatment.

However, why would the Government underfund and behave in such a fashion as to undermine and put at risk these businesses? That is the basis for my noble friend’s regret Motion. I have a further question about the uncertainty over the hub and spoke proposals that were in the recent MMD Act: does the Minister have an update on how implementation work is progressing and when we can expect the consultation process to commence?

I finish by asking three questions. Can the Minister advise the House when community pharmacies can expect a final decision on the reimbursement of their extra Covid costs? Like the noble Baroness, Lady Wheatcroft, I agree that the likes of Greensill are not an answer to this. Can the Minister explain why the NHS is refusing to increase investment in community pharmacies to support the NHS? Given the vital role they play, as everybody has acknowledged in this debate, they need certainty about their ability to play their full part in tackling the Covid healthcare backlog, for example. Finally, would the Minister willing to meet me, my noble friend Lord Hunt, other noble Lords, and representatives of pharmacy associations, for instance the Company Chemists’ Association, to discuss long-term funding for this sector?

Alcohol Harm Commission: Report 2020

Baroness Thornton Excerpts

Thursday 22nd April 2021 Grand Committee

[Baroness Thornton (Lab)]

My Lords, I thought I would read out all the recommendations very quickly. They are:

“1. A new comprehensive strategy… 2. Alcohol harm should be a specific part of the remit of the new Domestic Abuse Commissioner … 3. All professionals who have regular contact with children and families must have a core competency to intervene and provide support in cases where alcohol harm is evident … 4. Action to prevent, identify and support Foetal Alcohol Spectrum Disorder … 5. Reduced price promotion of cheap alcohol through increased alcohol duty and minimum prices with regular reviews of prices in relation to inflation and income … 6. Restrictions on availability of retail alcohol through reduced hours of sale and reduced density of retail outlets … 7. Comprehensive restrictions on alcohol advertising across multiple media, including restrictions on sponsorships and activities targeting young people … 8. Alcohol labelling to provide consumers with information about alcohol harm … 9. Treatment and care for alcohol use disorders and co-occurring conditions … 10. Brief psychosocial interventions for people with hazardous and harmful alcohol use, with appropriate training for providers at all levels of healthcare … 11. Action to reduce drink driving”.


Almost every one of those has been mentioned in some way or other during this brief debate, so I hand them all over to the Minister, asking whether the Government agree with them. Will they enact them, and in what timeframe?

Body Mass Index

Baroness Thornton Excerpts

Thursday 22nd April 2021 Grand Committee

[Baroness Thornton (Lab)]

My Lords, I congratulate the noble Lord, Lord Addington, on this debate, which has already raised many interesting issues. Indeed, the report of the Women and Equalities Committee into body image is not new. Over 40 years ago, Susie Orbach wrote Fat is a Feminist Issue; she challenged body mass index as a measure of—as she said—“nothing useful” and pointed out how it affected women’s self-image. On the 40th anniversary of FIFI, as many of us know it, she said:

“When you grow up absorbing the idea that food is quasi-dangerous, it is hard to know how to handle it. There are no end of experts selling their wares whose books and products end up generating enormous profits … So, too, with other food and diet fads. The desperation that exists to be at peace and dwell in our bodies clashes with the knowledge that such schemas promote or reinforce confusion about appetite and desire.”


The fact is that, 40 years on, it is still pretty grim:

“It’s a story of … destabilising the eating of many western women and exporting body hatred all over the world as a sign of modernity”,


as a way of medicalising and pathologising

“people’s relationship to food and bodies so successfully that vast industries would grow up to treat problems that these industries had themselves instigated.”

What is clear from this short debate is that it should come as no surprise that BMI as a single measure would not be expected to identify cardiovascular health or illness; the same is true for cholesterol, blood sugar and blood pressure. As a single measure, BMI is clearly not a perfect measure of health, but it is probably a useful starting point for important conditions when a person is overweight or obese.

The Select Committee said that it was

“not satisfied with the use of BMI as a measurement to evaluate individual health.”

On the other hand, as other noble Lords have said, Diabetes UK says that it provides

“valuable information for care focused on individuals that doesn’t discriminate against anyone.”

I dispute that, but it also goes on to say that it has been an important tool for monitoring the population’s health and informing policy decisions and has been fundamental in the rollout of the Covid population risk assessment, which identified 1.7 million people at increased risk of hospitalisation and death from coronavirus. Without that use of BMI, a population-based intervention would not have been possible.

The challenge for the Minister is how to reconcile these issues. I look forward to hearing his answer.

Covid-19: Obesity

Baroness Thornton Excerpts

Wednesday 21st April 2021 Lords Chamber

[Lord Bethell (Con)]

As the noble Lord rightly points out, the cost is enormous: £27 billion is the estimated cost to society, and 64% of people are classified as overweight. The challenge is enormous. We have to strike the right balance between government action and personal agency. The noble Lord is right that the return on investment is huge, but the Government cannot lose weight for people on their behalf. No amount of government initiative will shed the pounds. We have to get people to change their behaviours. We are trying to understand what the right measures are to give people the inspiration and information they need to take the right steps.

[Baroness Thornton (Lab)]

My Lords, this Government’s proposal is the 14th government obesity strategy since 1992. Despite 689 policies having been introduced in the past 29 years, obesity rates have increased. Another major indicator is deprivation. Children from deprived areas are twice as likely to be obese as children from the richest areas, as acknowledged by the Government’s strategy. However, the strategy was criticised for not going far enough on poverty. Healthy foods are three times more expensive per calorie than less healthy foods. Can the Minister address this grave and vital matter of people from lower socioeconomic backgrounds not having access to, and being unable to afford, healthy and nutritious food?

[Lord Bethell (Con)]

My Lords, I agree with the correlation pointed out by the noble Baroness. We must acknowledge and address the fact that areas of deprivation undoubtedly have higher levels of obesity. However, we have to be careful about taking away people’s sense of agency. It is possible to buy affordable healthy foods at any price point. Food has never been cheaper than it is today. We must put into people’s hands the knowledge and inspiration to take the steps necessary to shed the pounds that need to be shed.

Covid-19: Update

Baroness Thornton Excerpts

Tuesday 20th April 2021 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for the Statement made in the Commons yesterday. I pay tribute again from these Benches for the amazing work of all the NHS staff and volunteers in delivering the vaccine to so many millions of people. However, as the chief medical and scientific advisers have repeated many times in recent weeks, the virus is still among us, creating new strains and threatening our recovery in the UK. It is therefore vital that the Government continue as we emerge from this lockdown to be led by data, not dates.

It is clearly right to add India to the red list. In the UK we have deep ties and bonds with India of course, but it was the correct thing to do in the circumstances and it is also right that the Prime Minister should postpone his visit. Pakistan and Bangladesh, both of which have lower rates than India, have been on the list since 9 April so I wonder why it took so long to add India.

Can the Minister update the House on the presence of all three new variants identified—the Indian, Brazilian and South African—and their presence and spread in the UK? Indeed, can he update the House about the global co-ordination of surveillance of the new variants?

With regard to protecting our borders, this week Hong Kong identified 47 Covid cases on a single flight from Delhi. Before the Friday deadline there will be hundreds of people arriving on flights from India. Is this not very risky?

Even with high levels of vaccination across the population, there will be significant groups who are not vaccinated—children, for example—so the virus will be endemic. As the Chief Medical Officer has recently confirmed, papers from SAGE model a third wave this summer. How do we avoid that?

The poorest and lowest paid in the most insecure jobs do not isolate as they should because they cannot afford to do so. From these Benches we have pointed out time and again that one way to ensure self-isolation—and therefore help the Government tackle this—would be to pay higher sick pay and expand its scope. Will this happen?

There is no mention in the Statement of vaccine passports. Does the Minister anticipate that they will soon be needed for football games and concerts?

I regret that we need to turn to the media stories about lobbying and the revelations in the Sunday Times regarding the former Prime Minister acting on behalf of Greensill and the payday financing scheme. As my right honourable friend Jon Ashworth said in the Commons yesterday:

“This was not an act of altruism to staff in a pandemic but an investment plan to package up loans to sell to investors, with the former Prime Minister, not nurses, in line for a payday windfall. Cameron wrote in one of his emails: ‘As you can imagine, Matt Hancock’ is ‘extremely positive about this innovative offer.’”—[Official Report, Commons, 19/4/21; col. 659.]


What was being sought was a partnership with NHS Shared Business Services, which is jointly owned by the department, to access the personal and financial data of thousands of NHS staff for their electronic records for commercial gain. I expect the move would next be to the social care sector. We know that at least 30 trusts may have spent valuable time considering the adoption of this untested payday lending scheme as a result of the lobbying by Mr Cameron. Can the Minister ensure that publication of all the text messages, emails and correspondence with David Cameron will happen? Can the Minister tell the House how many NHS leaders and officials Mr Cameron and Mr Greensill lobbied and met? How many NHS trusts in total were approached about this expensive—and, indeed, unneeded —scheme? Even today, we see further allegations of contracts being granted without proper scrutiny and governance, following the Secretary of State’s own links with Topwood. Questions about conflicts of interest are inevitable.

Apart from the issue about pay levels in the NHS which might necessitate such a scheme, can the Minister accept that NHS staff deserve a pay rise and support, not payday loan apps forced on the NHS by speculators trying to make money out of the pandemic? What is his view of this? Does he appreciate that honesty, probity and transparency are directly linked to people’s acceptance of and adherence to the rules we have all obeyed for many months to beat this pandemic?

Last year, a former Conservative chairman, the noble Lord, Lord Feldman—who was running a lobbying firm with healthcare clients—acted as an unpaid adviser to the Minister himself. When I was a Minister I was told that one must not only be scrupulous and transparent in one’s dealings but that one should not do anything that could be misunderstood or misinterpreted.

I hope the Minister will not just get angry as he has in the past and say it is all not true and how hard everyone is working to get the pandemic under control—everyone knows how hard he and the public servants are working—as he will be missing the point. The point is about the reputation and standing of government, democracy and accountability. Does he believe it would be a good thing for the Government to reflect on the Nolan principles of public life, particularly with regard to recent procurement processes, and the lessons that might be learnt?

[Baroness Brinton (LD) [V]]

My Lords, I add my tributes from these Benches to all those who continue to work well above and beyond the call of duty in all areas to do with managing the Covid pandemic. This includes the vaccination teams, the invisible workers—the scientists working in labs and all those who we do not see on a daily basis—as well as our overtired doctors, nurses and other clinical healthcare workers, and those in social care who are still taking remarkable precautions.

It is worth noting despite the reduction in cases, hospital cases and deaths that daily cases are still double the level that they were at the lifting of lockdown 1, so it is good that the Government are not speeding things up. We need to continue to move carefully and steadily, as later parts of the Statement talking about the India and South African variants give cause for some concern. It is also reassuring to see that uptake of the vaccine is excellent. However, the Statement is silent on when all adults will have been offered the second vaccine. That is important because, as scientists constantly remind us, two doses are needed. Focusing only on the first vaccine is giving the vast majority of the public overconfidence about protection. If people want to go on holiday, one dose of the vaccine will not be enough, whether that holiday is in the UK or abroad.

That leads also to those who are immune-suppressed and to those under 18, because until all are safe, none are safe. Can the Minister say if there is any news on the OCTAVE clinical trials on the ability of those who are immune-suppressed to make and retain antibodies? Those formerly shielding—including me—still need to avoid mixing with people. They are still waiting for news to see if they can relax, even after two doses of the vaccine.

What is the news for children? I understood that the trials on over-12s had been halted following the blood clot issue with the AstraZeneca vaccine. Is that still the case? What are the long-term plans to ensure that our under-12s and, indeed, our under-18s are safe? The Statement says that:

“The vaccine is our way out of this pandemic”.


Not on its own, it is not. We must continue to test, trace and isolate to keep people safe. The Government are to be applauded for the large number of lateral flow tests because they are useful, but they are not as effective as PCR tests for really tracking the virus.

Had I not been unable to do so, I would have loved to have been at Wembley on Sunday supporting my team, which, sadly, lost to Leicester. I would have been delighted to have been part of a testing arrangement to see what happens, but other fans have said that they were only asked to be tested in advance and that there is no testing afterwards. Is that correct? In other words, how detailed is this testing for moving back into normal life going to be?

I am a member of the All-Party Group on Coronavirus, and this morning we heard from scientists who are bemused that immediate contacts of those who test positive are still not routinely PCR tested, which all the countries with a truly effective test and trace system operate. That is vital with the high percentage of people with Covid still having no symptoms, so they would believe that there is no reason for them to be tested, and it is particularly important with the information about the spread of the variants from South Africa and India.

I have family who live in Wandsworth. This time last week, as the announcement about mass testing across Lambeth and Wandsworth was made, we were told that everyone in those areas would be publicly informed. Three days later, not only had my son heard nothing, but he walked past a newly set up testing site a few hundred metres from his house, went in, and discovered that he did need to be tested. So, he and my daughter-in-law had their tests. It transpires that the only notification from Wandsworth Council before the weekend was a tweet, with none of the mechanisms used elsewhere such as texts via GPs, posters up in the street, word of mouth, or even leaflets. How on earth can that be real surge testing if only a small percentage of the population see a handful of tweets?

On the India variant, scientists also told the APPG this morning that the estimated figure of 103 cases was considerably lower than the likely number of cases circulating because only 10% to 15% of positive lateral-flow swabs are sent on to laboratories where they are scanned for variants. This might mean that the actual number is 10 to 20 times the official estimate. This brings us full circle, back to test, trace and isolate. Even with vaccines, it is vital to have an effective test, trace and isolate system to keep people safe. As the noble Baroness, Lady Thornton, outlined, adding India to the red list but giving people three-and-a-half days’ notice before implementing it, means that a large number of cases are likely to slip into the country. Even if they are caught through positive testing, we are unlikely to have a real sense of the actual number of cases.

This follows on from the concern that we from these Benches have had about successful self-isolation and quarantining for a year. The APPG heard evidence this morning that demonstrated that arrangements at our borders, particularly in airports, are not Covid safe, either for travellers or staff, and they risk becoming breeding grounds. This now needs to include effectively separately passengers who arrive from red-list countries from those who arrive from others, and ensuring that all quarantine rules are observed. We heard evidence that people were leaving their quarantine hotels early, and that others, quarantining at home because they did not come from red-list countries, were being forced to use public transport to get to testing centres for their day eight tests. Worse, border staff are discovering around 100 fake Covid test certificates daily, and there are probably many more. If that does not signify a real worrying standard for the possibility of vaccine passports, I do not know what does. When will a proper test, trace and isolate system be put in place that includes immediate contacts and more lateral-flow tests being tested for variants, along with vital, proper, paid arrangements for self-isolation, including quarantining and proper separation in the transport arrangements for those coming from abroad?

Finally, I will spend just one minute on Greensill. It is not just Greensill: we need desperately to see full publication of all meetings and correspondence—informal and formal—that Ministers have had regarding all contracts, whether it is payday loans, PPE or testing arrangements. This also includes the new quarantining partners; the Health Secretary said on Monday that two have already been sacked, having been in place only for a short time. It is vital that the smell-test on all these contracts is evident and sure.