Covid-19: Helplines

Baroness Thornton Excerpts

Thursday 19th March 2020 Lords Chamber

[Lord Bethell]

The noble Lord, Lord Alderdice, is entirely right: one of the features of this virus is its extremely unpredictable nature. The way in which it reacts in different people at different times is extraordinarily diverse. Some people appear to be completely knocked out by it; some have the lightest possible symptoms. There seems to be an alignment with age. We are all enormously thankful that the young and very young seem to be blessed by having the light symptoms. We are all extremely concerned about the old, but it is not even as simple or as linear as that. A huge investment is being put into understanding the virus better. I am pleased to report to the Chamber that international co-operation on that is extensive and positive, and that British researchers are at the leading edge of pulling together that data.

[Baroness Thornton (Lab)]

My Lords, this is a question on co-ordination. Yesterday, I saw the script that 111 is using right now; it was perfectly intelligible and sensible. However, it was out of step with what was on Public Health England’s website. I am sure that is a timing issue but it is rather important, because it will increase anxiety. Moreover, the digital exclusion of the elderly and vulnerable is a really serious problem because suggesting to people that they should go online in the first instance is entirely inappropriate for people who can manage a phone, but that is about it. Many of us are probably related to people in that position, so having plans to deal with that—as suggested by the noble Baroness, Lady Watkins—is very important.

[Lord Bethell]

The noble Baroness, Lady Thornton, is right that the Government have moved incredibly quickly, particularly in the last two weeks. The pace of the virus has been faster than initially expected. The response by some of our international partners has in part conditioned our response, and we are working extremely hard to ensure that all parts of the machine keep up with each other. There will inevitably be occasional glitches, but I pay tribute to the NHS, Public Health England and, in fact, the entire Whitehall machine for moving incredibly quickly and, under the circumstances, demonstrating a relatively high level of consistency in the advice as policy has changed.

Contraceptives and Hormone Replacement Therapy Drugs

Baroness Thornton Excerpts

Wednesday 18th March 2020 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government what assessment they have made of the shortage of supply of (1) contraceptives, and (2) hormone replacement therapy drugs, in the United Kingdom, and when they expect that the normal supply of these products will resume.

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

My Lords, we are aware of ongoing supply issues with some HRT drugs and a limited number of contraceptives. We are sympathetic to those affected. I am pleased to say that the supply situation for HRT started to improve at the end of February and continues to improve during this time. However, we will work closely with all suppliers and share relevant information on availability to the NHS on a regular basis to ensure that patients can access the medicines they need.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. I am very happy that things are improving, because a number of HRT medications and contraceptives remain unavailable until the end of this year, some patients have been told, or until they do not know when. I understand that some of the shortages are triggered by supply problems in China, with some of the components of the popular HRT patches being increasingly in demand for other types of treatment that, in their turn, have become scarce. Of course, one guesses that further disruption in China in the wake of the coronavirus will affect the production and supply of prescription drugs. Does the Minister share my concern that online pharmacies are exploiting desperate women by charging up to four times NHS prices for HRT and contraception?

[Lord Bethell]

The noble Baroness, Lady Thornton, is entirely right that supply problems persist. The NHS looks after 11,000 drugs and at any one time around 100 or 150 have supply problems. It is a great frustration to those concerned and we are cognisant that HRT has been a persistent problem for more than a year. However, the outlook is positive. I reassure the House that Covid-19 has not had an impact on the supply of HRT. We do not envisage there being a connection or a problem. I share the noble Baroness’s concerns that online pharmacies might take advantage of the situation, but it is a marketplace: it provides choice and is regulated.

Covid-19 Update

Baroness Thornton Excerpts

Monday 16th March 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I am very grateful to the Minister for repeating the Statement made by the Secretary of State in another place today. Our thoughts are of course with those affected by coronavirus and the families of the 35 people who have died in the UK and the British citizens who have died overseas.

We understand that the Government’s commitment to ensure the UK’s response to the Covid-19 pandemic is driven by evidence and science, but the Minister must have realised that the public are confused and concerned about the advice that has been given, especially when Governments around the world appear to be receiving and giving their citizens different advice. Surely the answer to this lies with the Government publishing the scientific advice and modelling behind their coronavirus action plan, which would enable experts to analyse, peer review and stress test it.

The Covid-19 pandemic is a global problem that requires Governments to work together. Can the Minister confirm that the UK has access to the evidence and data collected by other affected countries? Does he agree that a global response would give more public confidence? I am not suggesting that the UK is not doing the right thing from our point of view, but it is very important that the public understand why we are doing the things we are doing.

We welcome the update that the Government have already increased the number of tests to 5,000 a day and hope to double this to 10,000. Experts have advised that the most effective way to prevent infections and save lives is breaking the chain of transmission. To do that, you have to test and isolate. The head of the World Health Organization has implored Governments to “test, test, test” and check every suspected case, warning that Governments cannot fight the pandemic blindfolded. Therefore, we are concerned by the Government’s decision that only patients who require hospital admission will be tested for coronavirus. This will mean that only a subset of cases, the most severe, will be identified and we will not know how widespread the infection really is. If our approach is to be science-led, surely data is the key.

The Minister will be aware that NHS workers have also expressed concern about this policy, given that it could lead to staff who do not have coronavirus needlessly self-isolating for seven or 14 days, which would put a further strain on NHS staffing. It could also lead to asymptomatic staff with coronavirus treating frail and vulnerable patients, putting them at further risk. Indeed, there is a petition calling for the prioritisation of testing for NHS staff which currently has over 15,000 signatures. Does the Minister agree that mass testing will allow for valuable insights into the behaviour of this virus? Once testing capacity is increased, will the Government reinstate testing for those suspected of having the virus, prioritising NHS workers, including the cleaners, porters and other essential staff who are needed to keep a hospital running and who play a vital role in infection control? If the Government want to keep key workers at work, they have to make testing available to them. That applies to not only nurses and doctors but teachers and head teachers. It is a nonsense not to do so. Will the Government make tests available to key workers?

Public anxiety has been heightened by Britain seeming to take weaker measures than other countries, confusion over things such as herd immunity and anonymous speculative briefing to the media from government sources. It is unimpressive for the Secretary of State to publish a newspaper article updating us on Covid-19 behind a paywall. It does not smack of a firm communication strategy led by the need for clarity, honesty and reassurance. The Government must provide clear and transparent communication to the public about the steps they are taking to mitigate the impact of this outbreak. This is especially important as the coronavirus curve enters a steeper trajectory, with advice changing rapidly. Just today, the advice has changed for those displaying symptoms to stay at home for 14 days rather that seven. Can the Minister advise us on why the length of time has increased?

We certainly welcome the decision to introduce daily briefings to keep the public informed about what action is being taken to fight the spread of this virus, when certain protocols will be implemented and, perhaps most importantly, why. Will the Government commit to providing clearer guidance for people, including specifying the conditions that may indicate that someone is more susceptible to the effects of Covid-19? The phrase “underlying health conditions” is far too vague and misleading to be helpful, and may cause unnecessary panic and confusion. The NHS website is providing information but I am concerned about how those who are digitally excluded will access it, especially now that they are being advised to socially distance themselves. Will the Government launch a dedicated coronavirus telephone advice line for people? This would be an important source of up-to-date information for many people and would help to alleviate pressure on the 111 service.

Many low and middle-income families will be severely hit by a reduction in income if workplaces shut and they have to take time off sick or need money to respond to the crisis. This morning, Virgin Atlantic asked staff to take eight weeks of unpaid leave over the next three months to help the airline to cope during the pandemic, but that means that those staff will not be eligible for sick pay.

The Prime Minister has now advised everyone to stop non-essential contact with other people by working from home where possible and avoiding pubs, clubs and theatres. Experts have warned that this could push 14 million people who live in poverty into hunger and homelessness, which is why we on these Benches call on the Government to bring forward a package of emergency financial security measures to give people the security and confidence that they need to follow public health advice as part of our collective national endeavour.

The Government have confirmed that the NHS has insufficient ventilators to cope with the number of people who may be admitted to hospital. We certainly welcome the announcement that car makers and defence contractors will be asked to switch production to make medical equipment a national priority. Can the Minister confirm whether it is true that the European Union has passed a regulation so that medical equipment can be exported outside the EU only with special regulatory authority? If true, that would cut us off from a huge number of ventilator manufacturers. What action are the Government taking to increase the number of medical staff who will be trained to deal with respiratory care?

[Baroness Brinton (LD)]

I too thank the Secretary of State and the Minister for the Statement. I also thank the Prime Minister, the Chief Medical Officer and the Chief Scientific Adviser for the press conference earlier, which laid out the new advice that we will have to take into account. I will come to this at the end of my comments, but I note in particular the advice to people over 70 and with underlying health conditions; I have been asking in your Lordships’ House for specific advice for about six weeks now—at last, it is here. A couple of points of clarification would be useful but it is extremely helpful.

I also thank all NHS and social care staff, public health officials in our local communities and other public servants who are all now working above and beyond even the emergency duty. We on these Benches recognise them across the country in everything they do. Our thoughts are with those who are currently ill and the families of those who have died.

I will not repeat much of what the noble Baroness, Lady Thornton, said, but I want to make the point that the past week has seen a big sea change in attitude among not just the public but many experts who may not be epidemiologists but certainly have an understanding of modelling. It is important to keep them onside by making sure that the modelling is published; I echo the concerns that that has not happened yet, although I note that Chris Whitty said that it would become available in due course.

I share the horror at the Daily Telegraph article being behind a paywall. Notably, some of the largest American newspapers are making every single article on coronavirus free so that the public can access it; I wonder whether we could encourage our newspapers to do the same.

On testing, which seems to be the big issue of the day, I had an email from a friend who has been in a hospital in London with a severe case of coronavirus. That person is recovering now, but it was noticeable that there was an astonishing lack of knowledge on the part of paramedics, NHS 111 and others that breathing difficulties were a symptom. It was assumed that she was having a panic attack, although she had never had one in her life before. It was clear that A&E was completely overwhelmed. There was not enough protective equipment, and the doctor who saw her said that when doctors themselves became sick at their hospitals they were told to self-isolate for seven days but were not being tested, so they did not know whether they were immune or infectious.

The doctor concerned was desperate, and said that testing seemed to be happening only in care homes and in hospital outbreaks. The whole system had been overwhelmed. According to the Health Service Journal, the Department of Health and Social Care has said that the regime is set up to provide testing, but at the moment it is unclear how it will be applied. More and more of the people we are asking to go on to the front line are feeling very exposed.

Moving on to some workforce issues, various airline companies have announced that they are in real trouble; I think everybody understands why. And they are not alone. From these Benches, I express real concern about the Prime Minister’s announcement today, in which he encouraged people not to go to clubs, cinemas, restaurants and theatres. That is likely to mean that many of those businesses will not be able to claim on their insurance, as they could if this was an instruction, as opposed to a guide. Can the Minister tell us why the Prime Minister used that framing? It will cause serious problems for many small businesses.

As for other money issues, it is reported that there is a very large drop in donations to food banks. What will the Government do to ensure that the many thousands of people who rely on food banks will continue to get the support they need, when most people are no longer dropping two or three items into the boxes as they leave the supermarket?

There was some debate recently, involving the House of Commons Library, about sanctions for those attending jobcentres. According to the Library report, Will Quince MP had said that there would be discretion, and that people would not be sanctioned as long as they let the jobcentre know before the appointment. There are two problems there. First, if someone is sick they may not be able to call in and spend the hours it takes on the phone to do that. Secondly, if staff at the DWP are ill, there may not be enough people available to take those messages. Surely during this crisis—the Prime Minister has made it plain how severe it is—sanctions should be stopped for everybody.

Finally, on the advice to the over-70s, I am grateful that Chris Whitty said this afternoon that anybody, adult or child, with an underlying condition, including anybody who had had to have a flu jab, should consider taking action, especially if they have respiratory problems. Can the Minister confirm that and make it clear? I understand that the message about flu jabs has just come down from the website, so I am concerned that there will be confusion. There is no doubt about people who are immunosuppressed, but will he please reassure people who use inhalers—that is certainly one of the categories on the Department of Health and Social Care website—that they will be included?

Coronavirus

Baroness Thornton Excerpts

Thursday 12th March 2020 Lords Chamber

[Baroness Thornton (Lab)]

I am grateful to the Minister for repeating the Commons Statement and updating the House this morning. I repeat my noble friend Lady Wheeler’s congratulations to him on his—slightly overdue —promotion to Minister.

Our thoughts and condolences are with the loved ones of the eight people who have, sadly, lost their lives because of this virus. Of course we also join the noble Lord in giving our best wishes to the Parliamentary Under-Secretary of State and to her staff in her department, private office and parliamentary offices, who I am sure will be worried as well. We are now learning that there may be another Health Minister and a couple of MPs self-isolating right now. I also thank the Lord Speaker for keeping us so well informed throughout.

I declare my interest as a member of a local CCG and a health and well-being committee, as in the register. Can the Minister explain what the advice is for those who work on this estate, feel ill and present symptoms, but have not, as far as they are aware, been in contact with the Parliamentary Under-Secretary, for example, or one of the MPs? Should they be tested as a matter of routine?

I also thank the Minister for the advice he has provided on the operation of Parliament. It is quite right that we continue to raise issues on behalf of the public, hold our Government to account, and send a message that we are here to both support and question. We welcome the opportunity to discuss emergency legislation, and I look forward to the Minister inviting a cross-party group of us, as we would normally have in this house, to participate in those discussions in due course.

The Minister knows that we support the actions of the Chief Medical Officer and strongly agree that we must be guided by the science. However, I press the Minister further on the epidemiology and latest medical advice about whether we should move from the containment to the delay stage and adopt further social distancing strategies. What is his response to those who suggest—the editor-in-chief of the Lancet, for example, and others in the global science community—that we are not following the epidemiology in the way we might and are placing too much emphasis on behavioural science?

There are countries taking different approaches across the world. Last night, Atlético Madrid fans arrived—and, as it turned out, celebrated—in Liverpool at a game which would not have been held in Madrid due to social distancing procedures. Can the noble Lord please explain the thinking about why we are not taking more stringent social distancing measures? I have gathered from social media, literally just now, that the Republic of Ireland has decided to close its schools.

We welcome the extra funding for the NHS and social care announced as part of the Covid-19 response fund in the Budget. It is, of course, what we all expected to happen. Are representatives of the Local Government Association and the social care organisations at the table when emergency measures and expenditure are discussed? How will this money be allocated and what will happen when it is depleted? The NHS is seeking to scale up the number of intensive care beds sevenfold. At some point, the fund will need topping up and I hope we will not have to wait until the spending review process in the summer.

The Minister knows that on these Benches we are keen to be supportive, but it is hugely disappointing and astonishing that we still have no clarity on public health funding. I spoke to a director of public health yesterday, and asked if they have their funding agreement, which starts in April. They do not. This is a matter of extreme urgency, so I ask yet again: when will the directors of public health responsible for the coronavirus multi-agency responses know what their allocations will be for the financial year starting in April?

We need to do all we can to support NHS and social care staff, so may I specifically ask about care homes? The NHS Confederation has called for the suspension of Care Quality Commission inspections. Care homes face huge challenges protecting their frail, elderly residents, and chronic staff shortages will be exacerbated by absences if staff contract the virus or need self-isolation. Does the Minister agree, given the circumstances, that the NHS Confederation’s request to suspend those inspections and scale them back is sensible?

I want to ask the Government two more questions. First, do they recognise the burden and risk that the pandemic poses to our charitable and voluntary sectors? Not only will they be expected to deliver support and care during the next few months, but many will see a massive reduction in their income. At the local level, community organisations that care and cater for many different groups, or run cultural, art and community events are all at risk. They will not be able to undertake normal fundraising events, runs, collections and so on. Has any consideration been given to the effect on this important part of our civic infrastructure and how best it can be helped to survive this too?

Secondly, in my work as a member of a CCG, I have picked up reports that communications at the moment may not be working as well as they might be. They seem to be working from the centre down but, at the local level in boroughs and towns, it is the GPs and people working at the front line who need to be absolutely clear about what is expected of them. There are numerous and growing reports that the 111 service is struggling, with delays in responding to emails and organising testing, as well as very long delays in answering the phone. I therefore raise again with the Minister that we need more clarity, more communication and greater accuracy, which I hope is going to happen very soon.

Covid-19 is now an official pandemic as designated by the World Health Organization, and we all have to do as much as we can to help to contain this virus and stop its spread. The Government have our continued co-operation because public health, well-being and safety must come first.

[Baroness Brinton (LD)]

My Lords, I echo the thanks of the Official Opposition to the team for the briefings with Chris Whitty, and indeed for the communications from the Lord Speaker and other staff in the House to keep not only Peers aware of what is going on but the wider staff in Parliament. That is absolutely vital and reassuring.

I want to pick up on the point that has been raised about whether we are in delay or not and the difficulties over the past three or four days, where both Chris Whitty and his deputy CMO have said publicly that effectively we are in delay. We know that this is a transition, not a drop-dead moment—

Coronavirus

Baroness Thornton Excerpts

Monday 9th March 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for repeating the Statement. I shall ask three questions as quickly as I can so that as many people as possible can get in to speak.

My first question concerns vulnerable people in residential homes and the learning disabled who may be being supported, either by charities or at home by their parents. We need to include these people in the planning. I do not expect the Minister to respond to the point, but I will put it on the table. There are lots of people who have not been mentioned but need to be taken into account.

The 111 service is clearly under incredible pressure, given that it apparently took 120,000 calls in the first week of March. I want to ask the noble Lord about the training that 111 staff are receiving. If 700 new people have been taken on, how is their training being accelerated and is it being properly funded?

Finally, when the Select Committee saw Professor Whitty last week, he explained that half of all coronavirus cases in the UK are most likely to occur in just a three-week period. Based on recent trends, have the Government estimated when that peak might begin, and is the noble Lord sure that hospitals have enough bed spaces so that they are able to cope?

[Lord Bethell]

My Lords, the noble Baroness has expressed concerns about those in residential homes and people with learning difficulties. The needs of all the most vulnerable in society are paramount. There is no doubt that intense pressure will be put on social services, social care and clinical care. We are doing all we can to ensure that support is in place, which will include the mobilisation of civil society, charities and volunteers to take up some of the pressure being put on those services.

On training provision, modern call centres have very flexible working arrangements whereby staff are brought on and off contracts. Those who have already received 111 training are being brought back on to the front line. The funds for that are properly in place.

On the timing of the peak, it is impossible to say with certainty when that will be, but the CMO is crystal clear: we will do everything we can to spread it out over the summer and we will keep this House and the public up to date.

Health Protection (Coronavirus) Regulations 2020

Baroness Thornton Excerpts

Monday 9th March 2020 Grand Committee

As a final and important reminder, all of us—including noble Lords—can take actions to support the Government’s response that are simple but effective, such as washing hands and catching coughs and sneezes in a tissue. These and other precautions, including these regulations, are a necessary and proportionate response to protect public health. I commend these regulations to the House and beg to move.

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for that comprehensive explanation of the order. When I started to read the policy background, it all came flooding back to me, having sat in his position in 2008 dealing with amendments put forward to modernise the legal framework for health protection and considering what powers were needed. My first question, therefore, is, why is the 2008 Act not sufficient to cover the eventuality of this virus, when these regulations relate to the 1984 Act? It is just a technical, anorak-type question and I am interested to know the answer.

I have given the Minister notice of my other questions, the first being about the differing legal structures in the United Kingdom, particularly between England and Scotland. Where are the regulations being considered? Are they being considered? Have they already been adopted by the devolved Administrations?

Echoing the brief discussion we just had in the Chamber, a further question relates to when this becomes a serious and imminent threat. In our scrutiny, we need always to focus on whether the orders and the Bill about to come before us give too much power or just enough power to a Secretary of State.

The statutory instrument refers throughout to detention or isolation. Can the Minister explain the difference between them? Is detention where somebody is arrested and detained, and isolation where they stay in their home? What would compel them to do that? I would like that to be unpicked.

Will the measure add significantly to the workload of magistrates’ courts? Has some estimate been made of that, and will it be properly funded?

My next question is about police involvement if people will not take the precautions required of them by law. Can we be assured that the police will be protected appropriately if they have to be involved in arresting or detaining people? That goes for other people involved in incarceration of any sort, because prisons and so on are contained environments that pose their own questions and dangers.

Finally, given that we do not know how long the coronavirus outbreak will last and what will happen, is two years too long a time for these regulations? Would not one year be more sensible?

[Baroness Brinton (LD)]

My Lords, I thank the Minister for his detailed explanation of the regulations. I too have warned him in advance of an area on which I want to focus.

In general, we are content with the principles and are reassured that the Government have made it plain that the measures are a last resort when people will not co-operate and public health is seriously at risk. The points that we are raising are more about the detail of how things will work.

--- Later in debate ---

[Lord Bethell]

The noble Lord, Lord Campbell-Savours, is entirely right to press me on this. I should be honest: obviously, I am not a doctor. However, we have arranged for another briefing from the Chief Medical Officer in Room G at 4 pm tomorrow. He is the epidemiologist who can convey to the noble Lord both the extent and limits of current understanding of the virus. I have sat with him sufficiently long to have the impression that a lot of speculation, guidelines and history are associated with such viruses that we might reasonably apply to this one. However, its behaviours are not fully understood. Although the genome is broken, we do not fully understand its genetic makeup. The advice from the CMO generally is to hold back on pretending to understand things that are not yet fully explored.

[Baroness Thornton]

I say to my noble friend that I would not use the internet as my source of information on any of these issues. I would use the BBC, which has been running extra programmes—in fact, I have just received an email from the head of the World Service listing all the extra programmes that the BBC is producing which will give us lots of advice. Its website is useful. I want to put it on the record to my noble friend that I would steer clear of those sorts of discussions on the internet and look at the BBC’s websites.

[Lord Campbell-Savours]

The great majority of the British population will not go into some of the technical areas that my noble friend would go into. That is why I am trying to find a single source of information for people to be able to go to which is authoritative and gives answers, with the latest information and knowledge available, on each of the questions I have asked. I persist in believing that the Government should arrange for this information to be made part of the public debate, because it would be helpful to everyone concerned.

Health: Maternity Care Provisions in East Kent

Baroness Thornton Excerpts

Thursday 13th February 2020 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for that detailed Statement, which this issue definitely warrants. Given the measures that have been taken by NHS England and all the parties concerned, why has this trust not yet been put into special measures and at what point will it be? I agree with the Minister about the issue of leadership and culture in this hospital trust. I was horrified, as I am sure other noble Lords would have been, by the chief executive of this trust saying on the BBC that there had been “only” six or seven avoidable deaths since 2011. Actually, that is not true, and I think she said it because she had not read the report produced in 2015. What worries me is that there has clearly been a serious failure of leadership and culture across the whole of this trust, and that statement from the chief executive seems to symbolise that failure. How will the measures that the Government and NHS England are taking address the very serious leadership issues in this trust?

[Baroness Blackwood of North Oxford]

As I said, there has been an unannounced CQC inspection; there is also further engagement with the CQC and we await the findings of its report, which will come forward in due course. In addition, specialist teams have been sent in to ensure that there is robust leadership so that ongoing care is assured and patients can be reassured on that point. NHS England has announced that it will commission an independent review into East Kent so that there is a belt-and-braces approach to ensure the highest possible standards of care there. We can be reassured that the issues raised by the noble Baroness will be addressed and that no stone will be left unturned.

Wuhan Coronavirus

Baroness Thornton Excerpts

Tuesday 11th February 2020 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for repeating the Statement. Of course, our thoughts are with those who have been diagnosed with coronavirus and are in quarantine. I place on record these Benches’ thanks to our NHS and public health staff.

On the specific issues of quarantine arrangements, we understand the approach the Government have taken, particularly to deal with anyone who seeks to break the quarantine. We understand why the Secretary of State has invoked the regulations; he is entitled to do so under the Public Health Act, and we offer our support for that. Quarantine arrangements must be seen to be necessary, proportionate and in accordance with the law. Their enforcement, including with powers of restraint where necessary, must be fully transparent. The rights and freedoms of the quarantined evacuees must be fully understood to ensure that they are treated with dignity and respect. The media coverage so far certainly suggests that that is exactly the case.

To maintain public confidence in these arrangements, the framework must be understood and scrutinised by Parliament. With that in mind, I ask the Minister when we in this Chamber will deal with the regulations laid. The progress of this virus is rapid; there seems to be rapid change from day to day. We are due to break next week and it seems that 24 February may be too late, because it is moving so quickly. What arrangements are the Government making for us to deal with the regulations in this Chamber?

I feel that I need to declare an interest in the register: I am a member of a local clinical commissioning group. Perhaps the Minister could tell the House what clinical commissioning groups and trusts are being asked to do in terms of making plans in the coming months if this turns into a pandemic. Can she assure the House that local plans are robust and fully resourced? Are we confident that the 111 helpline has sufficient capacity to deal with increased calls? Will the community health trusts that are tasked with visiting suspected patients, and will have to visit people’s homes to carry out swab tests, be given extra resources to build up the capacity to be able to carry that out properly?

Finally, will the Minister update the House on international efforts to share research intelligence and attempts to find a vaccine, as well as the likely timescale? I understand that there is a summit of the World Health Organization today. On behalf of the Official Opposition, I thank all our NHS staff and reiterate our hope that the Secretary of State will continue to keep the House fully informed.

[Baroness Brinton (LD)]

My Lords, I begin my remarks from the Liberal Democrat Benches by echoing those thanks to all staff who are involved, not just on the front line but in the large amount of planning that is going on. We would also like to thank the patients who have self-isolated in calmness, accepting what has happened and moving a long way from home, and those who after flying back from abroad have quite contentedly gone on elsewhere. The advantage of social media, television and radio is that we can hear how they are managing.

I note that the Secretary of State has declared that transmission of coronavirus is a serious and imminent threat to public health, despite the fact that the current situation remains moderate. The regulations for England only—to isolate and hold those at risk of spreading the virus—is, I hope, a last resort. So far, that has not been necessary, but we on these Benches understand that there may be occasions when it is. Will the Minister confirm that the devolved states will follow suit? We would not want Gretna Green suddenly to have a reputation for the wrong reasons, with people trying to remove themselves to somewhere that the regulations do not apply. It seems sensible in the United Kingdom to make sure that there is consistency among the four states.

What safeguards are in place for those conducting the quarantines and isolation to ensure that they are kept safe, along with the patients, and to prevent them contracting the virus?

I note also the regulation that came into force at the end of January, ensuring that no charge is to be made or recovered from overseas visitors who may have to be diagnosed with, or treated for, coronavirus. We believe that that is right, but how is this information being disseminated to healthcare bodies? I see nothing at all about it on the department’s website. The regulation appears for parliamentarians via Hansard, but I can see nothing else anywhere that might help inform hospitals and other bodies.

Today’s Statement from the Secretary of State, the department’s daily 2 pm statement, and the report from the Chief Medical Officer all talk only about those travelling from a number of Asian countries—which the Minister read out in her repeat of the Statement—and who have come from those countries in the last 14 days. This is echoed in the department’s advice to healthcare professionals. So, despite being updated daily—and the number of patients was up to date as at 2 pm today—these Statements do not reflect the fact that some of the eight UK-based cases contracted coronavirus in France, or possibly even in the UK.

Today on radio and television, we have heard a number of experts from China, from John Hopkins University and from UK universities all talking about the possibility of substantial transmission. Indeed, the department has confirmed that this is a high-consequence infectious disease, with all the concerns and constraints that go with it, which include being

“often difficult to recognise and detect rapidly … ability to spread in the community and within healthcare settings … requires an enhanced individual, population and system response to ensure it is managed effectively, efficiently and safely”.

We now have cases in York, in Brighton and its area, and in the specialist receiving hospitals in London and Newcastle, in addition to two GP surgeries in Brighton that have been closed for cleaning. There are local concerns in Brighton about a community centre, and some schools appear to be making the decision to allow children not to come in, after two people were told to self-isolate. But there does not appear to be any formal advice being offered to councils, councillors, schools, prisons and other public bodies. Can the Minister explain why the Statement seems to take no account of what is happening in the UK at the moment? What advice is being given to local councillors, schools and other bodies about early planning for their area, what they should do if a person may have coronavirus, and what happens once they are diagnosed, so that they are ready in the event that there are cases in their area?

I specifically want to mention the role of councillors here. Elected members are often at the heart of their communities, and an informed councillor can calm worries, particularly at the school gate, if they can say that they have been briefed. These days, briefings do not have to happen face to face; there are mechanisms through technology for people to be brought up to date.

Finally, in Brighton, it has been reported in the local media that a number of people with cancer and other long-term conditions are understandably worried about what they should do. They are asked to make sure that they have their annual flu jab, but at the moment there seems to be no specific advice for people regarded as vulnerable patients. Public Health England’s very helpful flow chart on the management of a suspected case runs through very sensibly what to do with the patient, but nowhere does it suggest to ask the patient whether they have any vulnerable people in their family or their contact, nor can I find any advice, anywhere at all, about what primary care doctors should be saying to vulnerable patients in their area—I am thinking particularly of Brighton, at the moment—to make sure that they feel comfortable about this.

These are concerns that could, I suspect, be resolved with effective planning. However, it seems that, at the moment, there is a bit of a lacuna, and I hope that the Minister will be able to help fill the space.

Health: Learning Disability and Autism Training

Baroness Thornton Excerpts

Monday 10th February 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I declare an interest as a lay member of a CCG, and as someone who is therefore involved in the monitoring of LeDeR and other issues related to this debate.

It is a pleasure and an honour to participate in this debate initiated by the noble Baroness, Lady Hollins, who has probably done more than anyone I know to shift opinion and public policy in this area. I pay tribute to her for that. I hope she will not mind me saying that she is a great example of how expertise and persistence are such an effective combination in your Lordships’ House. This welcome debate should be seen as yet another step on that journey.

All the expert contributions tonight are important, but the theme of all of them is how to combat ignorance and ensure that there is expertise and learning on this from top to bottom of the NHS and our social care system. Like the noble Baroness, I welcome the Government’s commitment and specific inclusion of learning disability and autism as one of the clinical priorities in the long-term plan. However, I echo her questions about the introduction of mandatory training. I am grateful for the briefing we received on this, and I particularly appreciated the briefing from the Royal College of Psychiatrists, which pointed out something that we all know:

“The existence of significant co-morbidities and health inequalities for people with learning disability and autism demonstrates the need for better training across all of health and social care, including psychiatry, to improve patient outcomes and patient experience.”


I am also pleased to learn that the Royal College of Psychiatrists will soon publish its own report,

“on the psychiatric management of autism and Asperger’s syndrome in adults, which include specific recommendations for autism learning objectives within all sub-specialities of psychiatry.”

I think those are the expert’s words for what the noble Lord, Lord Addington, said: if you have met one person with autism, you have met one person with autism.

We know that last year the Government launched

“a consultation on proposals for introducing mandatory learning disability and autism training for health and social care staff”

and received a significant number of responses, including from lots of the organisations that have briefed us all prior to this debate. However, the challenge, as other noble Lords said, is significant indeed:

“There are over 1.2 million NHS staff and nearly 1.5 million adult social care staff in England”


and, as we learned, we have also to consider staff who work in Wales.

My first question is about the progress of developing and testing the learning disability and autism training pack, as well as developing guidance to employers to support them in assessing what level of training staff require. When are we likely to see that?

The noble Baroness, Lady Hollins, posed many of the questions that I thought were relevant here. Does consolidating autism training and learning disability training run the risk of not appropriately reflecting those differences? I am sure that the Minister will have an answer to that question. I echo what has already been said on e-learning, which I do not believe would be sufficient for training and learning in this area. Having been involved as a lay member of a CCG, even at that very low level one is required to undertake a lot of e-learning. We have to learn about safeguarding and conflicts of interest—it is all e-learning. I have done it all, and it is fine, but I am not sure that a huge amount of it stuck in my head. I got through, passing pretty much everything that I was asked to do, but I am not sure that that was the point. In this area, the lived experience of and learning from people who are experiencing these conditions will stick and will be much more relevant. Therefore, just e-learning and training packages will not be sufficient, as expert as the NHS is at producing these online packages for people to experience.

We have heard about powerful lived experiences, and I have been moved by some of the contributions this evening. I was also struck by the briefing from Mencap. I know that the House does not need to be reminded about life expectancy, but I was struck when Dan Scorer from Mencap said that this makes “grim reading”, and by his article in the Guardian last November about the scandalous detention of learning-disabled people.

In other words, there are some serious issues here. I echo what the noble Lord, Lord Sterling, said: we do not need more reviews; we need some action and investment.

Access to Palliative Care and Treatment of Children Bill [HL]

Baroness Thornton Excerpts

2nd reading & 2nd reading (Hansard): House of Lords & 2nd reading (Hansard)
Friday 7th February 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I congratulate the noble Baroness, Lady Finlay, on getting her Bill here and being persistent, which counts for a great deal in this House. I welcome all the contributions today, particularly that of the noble Lord, Lord Brownlow. I echo other noble Lords in saying I am certain that he will make a great and valuable contribution to your Lordships’ House. I also thank organisations for their briefings. Like many speakers today, I have had experience of dealing with and accessing palliative care for loved ones, in my case at least twice in the last 10 years.

It is important to focus, as this Bill does, on addressing shortcomings in end-of-life care provision by ensuring that all NHS commissioners make arrangements for general and specialist palliative care services to be available to all those who need them. At this point I probably need to draw the House’s attention to my entry in the register of interests as a member of a clinical commissioning group. We all know that there are examples of excellent end-of-life care being provided throughout the UK, but as other noble Lords have said, particularly my noble friend Lord Hunt, there is considerable and unacceptable variation between locations relating to whether people are being cared for in hospital or in the community and their medical condition. The Bill would help in addressing those variations and ensure that high-quality generalist and specialist palliative care is available to all who needed it, as it should be.

We on these Benches welcome the Bill’s ambition to place hospice provision on an equitable footing with all other healthcare services provided in a local area. We are pleased to see the Bill specifically mention hospice access to pharmaceutical services. Pain and other uncontrolled symptoms are frequently cited as the main concern about death and dying. We support the Bill’s provisions that would ensure that clinicians providing general palliative care had access to specialist palliative care advice at all times.

I am grateful for the briefing that I received from Together for Short Lives. I commend it for its wonderful and hard work in this area. I draw particular attention to the fact that it says the growing shortage of skilled children’s palliative care doctors and nurses across England has now reached crisis point so that even the good services are in jeopardy, which is leading to seriously ill children and their families missing out on crucial out-of-hours care and vital short respite breaks. It says that there are too few skilled children’s nurses to fill vacant posts in children’s hospices, with more than half of children’s hospices citing an overall lack of children’s nurses as a significant factor in the vacancy rates they are experiencing. I feel bound to ask the Minister why this clearly-needed service that should be available across the country is not being driven by the NHS and the plans outlined in the long-term plan—or is it going to be? Is it possible to take urgent action to address both adult and children’s palliative care workforce issues in the NHS people plan?

It is of course Clause 2 that raises the most concern for us, as it did for many noble Lords. I was very struck by the briefings that I received from both the BMA and Together for Short Lives expressing their concerns. I will say that everyone will welcome the Bill’s important ambition to support the resolution of differences of opinion through mediation as a non-adversarial approach, although I think the remarks by the noble Lord, Lord Balfe, were pertinent. We would welcome an accompanying commitment from the Government to properly resource mediation and ensure that it is readily accessible across the NHS, because no one wants to end up in court.

The concerns centre on the proposal in Clause 2(4) to change the way that courts consider cases when there are differences of opinion as to what treatment is in a child’s best interests. I absolutely understand how painful and difficult these issues are. The BMA says about Clause 2(4):

“We believe the current approach is preferable and does not need changing. The current approach ensures the court’s starting point and focus is on a child or young person’s best interests, taking into account all relevant factors, including the views of parents.”


Following the remarks of the noble Baroness, Lady Brinton, I think that simply has to be right.

If the current approach is to be changed, we will need to take account of a number of issues. The courts would surely have to consider the views of all those who have a parental responsibility for a child. What happens when people who hold parental responsibilities disagree on what is in the child’s best interests? How would the situation of foster carers holding parental responsibility alongside birth parents be dealt with? That may be fraught. I can see that there might be increased conflict if one person’s parental responsibility is deemed to hold more weight than others. The way the Bill is drafted could lead to one parent’s views being discounted in favour of those of another. The noble Baroness, Lady Brinton, also mentioned the Gillick competence of a 16 or 17 year-old, who may very well wish to cease medical treatment when their parents want to continue it.

Finally, what weighed heavily with me is what Together for Short Lives had to say about this:

“We have concerns that the level of proof required by this Bill to ‘clearly establish’ that ‘any medical treatment proposals put forward by any person holding parental responsibility for the child’ are not actually in a child or young person’s best interests would be too high. Parents’ views and wishes about the treatment of their children are extremely important and, where possible, should always be sought and discussed.


Where disagreements cannot be resolved and the court is approached for a view, courts frequently support parental decisions that are within the range of what could be considered in the best interests of a child. Where disagreements reach the courts, parents need to be able to access support to ensure their views and wishes are adequately represented. Whilst it is entirely understandable for parents to want to prolong their child’s life for as long as possible, we believe the court has a responsibility to ensure that children with life-limiting illnesses are not exposed to unacceptable, painful, unproven, or suboptimal treatments.


We believe that there is a greater risk of children and young people being exposed to these kinds of treatments if this new approach is adopted.”


That is very serious and has to be weighed in the balance when considering this clause.

We on these Benches offer our support to this Bill. We hope that the problems in Clause 2(4) can be resolved and look forward to the Minister’s remarks.