Covid-19 Update
Baroness Thornton Excerpts(2 years, 12 months ago)
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Baroness Thornton (Lab)
My Lords, I thank the Minister for repeating the Statement from today and for the Statement from Friday. I add my thanks to the scientists in South Africa for their prompt sharing of this information, as unwelcome as it may be.
We understand that scientists believe that it will take two to three weeks before they can establish whether the omicron Covid variant is more transmissible, causes more severe disease or can make vaccines less effective than was the case with delta, or all three. We support the Government’s strategy of tougher travel restrictions and mandatory face masks, as far as it goes. It seems that there is already real-world evidence from South Africa and Hong Kong that omicron is highly infectious, which begs the first question: why are the Government limiting the mandating of mask wearing to travel and to shops, and not extending it to indoor meetings and social events? Mask wearing is the single most effective public health measure in tackling Covid according to the first global study of its kind, which found that the measure was linked to a 53% fall in the incidence of the disease. As Dr David Nabarro said recently:
“We know that wearing a face mask reduces the risk. We know that maintaining physical distance reduces the risk. We know that hygiene by regular hand washing and coughing into your elbow reduces the risk. We should do it all, and we should not rely on any one intervention like vaccination on its own.”
On these Benches, we support taking swift action and the inclusion of new countries on the red list. We do not want a repeat of the inertia that saw the delta variant run rampant through the country and, as the Minister said, we must protect the progress that we have made. We welcome an increase in the availability of the booster jabs. The only question that I would ask him is about the capacity of the NHS to deliver the massive increase that the Government have reported today.
We support the move to PCR testing, but there are still holes in the testing programme. Ministers have not introduced pre-departure testing and there is little, if any, follow-up on PCR test results, so we need action on this if we are to take it seriously.
The Government could, of course, go further to keep people safe. Fixing sick pay, improving ventilation and properly utilising antivirals remain crucial to ensuring that we reduce the spread of this deadly disease. Do any of these feature in the Government’s plans?
I agreed with my right honourable friend the former Prime Minister Gordon Brown when he said:
“Whatever happens to this particular variant, we’ve got to realise our failure to vaccinate the rest of world … is going to come back to haunt us.”
He said that the new variant was a “wake up call” for rich nations with surplus vaccines. There seem to be surplus vaccines which will expire within the next month. How many vaccines in the UK will pass their use-by dates before Christmas, and will these be destroyed? I am afraid that Ministers have not met the commitments made at this summer’s G7 to roll out the vaccine to other parts of the globe. There is now sufficient vaccine to reach almost every adult in the world. I agree with the Minister that we need to play our part in ensuring that everyone around the globe has access to vaccines to stop the emergence of new variants.
This variant is indeed a wake-up call. The pandemic is not over. We need to act with speed to bolster our defences to keep the virus at bay. In that context, I ask the Minister about preparedness for new Covid variants in general. Both Clive Dix and Kate Bingham, former chairs of the Vaccine Taskforce, have expressed worries about our preparedness for dealing with new variants. Mr Dix has said of a paper that he sent to No. 10 in May:
“I wrote a very specific proposal on what we should put in place right now for the emergence of any new virus that escaped the vaccine.”
It seems that, thus far, No. 10 has not responded, so perhaps I can ask on Mr Dix’s behalf what the Government’s plan is for an escape variant? What is the plan for resistance for the future? The country needs to know. He suggested that a strategy should involve a co-ordinating team to seek out new vaccines and give the company involved a fast track to a swift trial, access to the data and regulatory approval in return for early access to vaccines. If that sounds familiar, it is exactly what the Government did at the start of the pandemic, and it needs to be repeated. Is this in the Government’s plan?
Reports from South Africa and other places indicate that the new infection seems to manifest itself with nausea, headaches, fatigue and a high pulse rate, but not the original and distinguishing features of loss of taste or smell, nor the headaches, sore throat, runny nose, fever and persistent cough which have been the most common in the delta variant. Will the NHS stick to the old symptom guide or will it update it to allow those running test and trace to recognise that they are not necessarily looking for things like loss of taste and smell but for other symptoms?
If the Government intend to report again in three weeks’ time, if not before, it takes us into the Recess, so I would like the Minister to ensure that colleagues will be briefed appropriately. On Saturday evening, the Secretary of State held a Zoom call to brief MPs about the new world that we now entering. I hope that the Minister will do the same for all Members of your Lordships’ House.
We must all be concerned that any spike in serious cases from this new variant could coincide with the NHS’s peak winter period, particularly given that the service is already at full stretch. We all want to enjoy Christmas but, most of all, we all want to stay safe.
Baroness Brinton (LD) [V]
My Lords, I thank the Minister for repeating today’s Statement. The World Health Organization and many globally respected scientists and doctors have been warning us that variants of Covid-19 might pose a serious risk, especially when a Government think that we are winning the war against the virus and that we can all afford to relax. Omicron reminds us that the battle is not won until it is won across the world. From these Benches, we also thank the South African scientists for their genome sequencing that has alerted the world, and I hope that the UK and the other G7 countries will offer them not just gratitude but countries in southern Africa more practical support.
I echo the comments of the noble Baroness, Lady Thornton, about arrangements for international travel and test and trace. I also support her request for a briefing for Peers. For some bizarre reason, the Liberal Democrat MPs were not included in the MPs’ briefing. Please could the Minister make sure that we are included in any such meeting in the Lords.
In April, before the Minister was appointed, we warned Ministers that the Government were responding far too late to the reports of the delta variant in India. So we warn again. While the face mask mandate in shops and on public transport is welcome and well overdue, we are absolutely bemused that it excludes hospitality and that the advice to schools excludes classrooms. Professor Chris Whitty said in Saturday’s No. 10 press conference that when there is a risk we should go in hard, so can the Minister explain how the virus will be kept at bay in those indoor settings where masks are not required? Why is there no encouragement for people to work from home where possible? Trains and buses are crowded and unventilated. Risks will remain there too, even if lessened with masks.
I have said before that I am in the clinically extremely vulnerable group. I have had my third dose of the vaccine and now look forward to my fourth, or booster, dose. But many of those who should be getting the third dose still face a series of problems in the NHS about who should get it, as opposed to a booster, and how it is recorded. Indeed, today, in response to a Written Question to my honourable friend Daisy Cooper about the recording of a third dose, the Minister, Maggie Throup MP, replied:
“Work to assess the need to include boosters in the NHS COVID Pass is ongoing and we will provide a further update in due course”,
so even the records cannot distinguish. Can the Minister say when “in due course” is? I am afraid this is symptomatic of the way the clinically extremely vulnerable have been ignored and left to fend for themselves.
I will ask a question that I have asked the Minister’s predecessor repeatedly since June of this year. In May 2021, Jenny Harries left Public Health England to set up the UKHSA. For the preceding 12 months she had specific responsibility for co-ordinating all the different elements of Covid issues for the CEV and for shielding. When she left, no one was given that responsibility, and it was noticeable that all communications with CEV people and the different parts of the NHS on Covid just stopped when shielding stopped. Can the Minister tell us which senior person in the NHS has that managerial responsibility? It has been five months since I first asked and there are 3.7 million worried people still waiting for answers. It would be good to know which Minister has the responsibility to co-ordinate all Covid matters for the CEV or former shielders. This is important, because the last letter from the Secretary of State tells the CEV not to go into any environment where people have not been double-jabbed. There is no mention of boosters, and obviously no mention yet of omicron.
Is there a confirmed register that distinguishes between the CEV and the severely CEV? Unlike in Scotland, hospital consultants in England do not have access to individual patient records that GPs use or even to the Covid app data. Can the Minister say how NHS England will be able to communicate directly with eligible people if they do not have a register? Is there a specific communications plan to ensure that primary care, secondary care and the 119 vaccine helpline are fully aware of plans and processes for this group? Reports are coming back of blood cancer patients being told at vaccine centres that they do only boosters—there is no knowledge or understanding of the third dose.
I recognise that I am asking the Minister a large number of questions on the immunocompromised. I really do not expect answers to them today—written answers are always very welcome—but please will he agree to meet with me, Blood Cancer UK and the Anthony Nolan Trust to discuss these key questions, not least because we are now in a different situation, with the 3.7 million, which is 5% of the country, left in limbo?
As the noble Baroness, Lady Thornton, said, it is too early to say whether omicron is more dangerous than delta or beta, or whether treatments such as Ronapreve and the current vaccines might not be as effective. The Government are right to be cautious. I echo her comments about Clive Dix, the former head of the Government’s Vaccine Taskforce. What plans are in place for vaccine development for an escape variant?
At a time when manufacturing is one of the key issues slowing down the delivery of vaccines worldwide, why is the Vaccine Manufacturing and Innovation Centre at Harwell, which has received in excess of £200 million of public funding via UK research and development, now up for sale, long before the pandemic is over? We still need its expertise. Selling off a publicly funded, not-for-profit organisation during the pandemic, if at all, seems, frankly, bizarre.
Finally, the Statement has a passing reference to test and trace domestically. It says:
“We have a much greater capacity for testing, enhanced ability for sequencing”.
Genome sequencing in the UK has been a real strength of UK science and has undoubtedly helped us considerably in this pandemic. But, in recent weeks, with the Government’s determination to open up and return to normality, test and trace has been scaled back, with reduced centres and reduced hours for those that remain open. Can the Minister say what plans there are to increase these back as needed? Are directors of public health and their local resilience forums receiving funding for the current omicron problem? It also appears that there is no Covid funding for them next year at the moment. If omicron is a viable variant, we must plan to fund them to keep these safety nets of test and trace in place, because without an effective test, trace and isolate system, including proper payments to those who need to isolate, we will not manage, let alone control, this virus. Defences are not defences when there are large holes in them.
NHS: Primary Care Surgeries
Baroness Thornton Excerpts(3 years ago)
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Lord Kamall (Con)
I am sure that we all want to pay tribute to the work of GPs, who are at the front line and, quite often, are the gateway to many services across the NHS and the wider healthcare system. It is important that we recognise some of the pressures they are under, but also work out how to help them and, indeed, patients. As I have said in the past, I will be a champion of patients and it is important that patients have access to their GPs, as a gateway to further services.
Baroness Thornton (Lab)
Notwithstanding the fact that the Minister says that the NHS is not up for sale, would he care to speculate what would motivate an American health insurance company to buy into a UK primary care GP market? Was this procurement carried out under the Covid relaxation that allowed contracts to be awarded without competition, or the usual procurement regime?
Lord Kamall (Con)
I wish I could read the minds of those who bid to run these services, but I am afraid I will have to admit that I cannot. The contracts are awarded at the local level by CCGs. It is their decision and it would be inappropriate for the Government to intervene.
New Hospitals
Baroness Thornton Excerpts(3 years ago)
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Lord Kamall (Con)
Each of the building projects will be a new hospital that will deliver brand-new, state-of-the-art facilities. One thing that we must be careful of is that if we say, “Well, you can’t call that a new hospital, even though it is a new facility, because it’s on an existing site”, we do not create perverse incentives, where the local NHS or the local ICS says, “We mustn’t build it there, because we will be accused of not having a new hospital”. Surely what we should be focusing on is outcomes, not inputs, and the fact that we are delivering modern, digital hospitals for the future.
Baroness Thornton (Lab)
My Lords, leaving aside the dubious and overinflated claims of 40 new hospitals, many of which are, in reality, upgrades—as welcome as they are—I and others in the House raised with the Minister’s predecessor but one in 2019 that there was an alarming repairs and infrastructure crisis, which was then in the region of £3 billion. Could the Minister explain to the House which part and how much of the new hospitals programme will address the immediate and urgent matter of crumbling wards, sewer leaks in wards and old and dodgy kit?
Lord Kamall (Con)
The noble Baroness will recognise that we need not only to build new hospitals but to upgrade existing infrastructure and this is all part of the capital programme. The decisions on individual hospitals and upgrades will be taken in local communities in consultation with clinicians and local ICSs.
NHS England: Waiting Lists
Baroness Thornton Excerpts(3 years ago)
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Baroness Thornton
To ask Her Majesty’s Government what steps they are taking to reduce NHS England waiting lists.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
I thank the noble Baroness for raising this. It is a top priority for the Government and for the NHS. This year we are providing a record amount of funding to the NHS, with an extra £34 billion. This includes £2 billion this year plus £8 billion over the next three years to step up activity to tackle long waiting lists for elective care and to transform elective services. This funding could deliver around 9 million more checks, scans and procedures.
Baroness Thornton (Lab)
I thank the noble Lord for that Answer. I figured that that was what he would say. It is not about how much the Government intend to put in but how it is being spent. That is particularly important in the absence of any workforce strategy. If the billions were directed immediately at investing in social care and care workers, for example, both domiciliary and care homes, how many beds does the Minister believe could be freed up in the next eight weeks? What effect would that have on the throughput for elective surgery and accident and emergency departments?
Lord Kamall (Con)
When you look at the data on the waiting lists, what is interesting is that 75% of patients on the list do not require surgical treatment. Most actually require diagnostics. Some 80% of patients requiring surgical treatment could be treated without an overnight stay in hospital, and 20% of patients are waiting for either ophthalmology or orthopaedic services. That shows where you can target the spending to cut the waiting lists.
Dementia: Fuelling the Moonshot
Baroness Thornton Excerpts(3 years ago)
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Baroness Thornton (Lab)
My Lords, I first thank the noble Baroness, Lady Greengross, for this short but very important debate today. It is some time since we addressed the issue of dementia in your Lordships’ Chamber, and it is something which noble Lords have had an interest in for many years. I also thank her for her very comprehensive introduction to the debate.
If the Minister has not worked it out by now, he is being asked to pick up the dementia moonshot and champion it in Government and with his colleagues because, at the moment, as other noble Lords have said, the Government have not brought forward the promised funding or set out a timetable for when it will be met.
We all have had experience of dealing with this awful condition and losing the people that we love to its ravages—or at least losing the essence of them, long before they die. In my case, it was an aunt and also a brother-in-law, who was the same age as me and who I had known since we were both involved in student politics. He sadly spent the last few years of his life in a nursing home and died during lockdown, but he had not known any of us in the family for quite some time.
I congratulate the APPG on the Fuelling the Moonshot report, following its inquiry into dementia research and the potential impact of the Government’s manifesto commitment to double funding for dementia research. The primary recommendation in the report is, of course, that the Government deliver on their manifesto commitment and double funding for dementia research. I think we all strongly support this recommendation.
How do the Government plan to address the three main areas that Alzheimer’s Research UK believes this additional funding should be channelled towards if we are to accelerate progress in dementia research? The first of these three areas is to help dementia research recover from the impact of the pandemic. Dementia research lacks capacity compared with other disease areas, as other noble Lords have said. It is vital we do not let the financial impact of Covid-19 reduce funding opportunities, leaving researchers with no choice but to leave the field. Indeed, a survey by Alzheimer’s Research UK found that more than one-third of dementia researchers were considering leaving, or had left, academic research due to the financial uncertainty created by the pandemic.
The second area is transforming early detection and diagnosis. An early and accurate diagnosis of dementia can empower people to access the support they need at an earlier stage, as well as to ensure that they can enrol into clinical trials for new treatments. At the moment, people living with dementia are often diagnosed at a stage when the disease that caused the condition has progressed too far for potential future treatments to be effective. Patients in many parts of the country do not have access to the latest diagnostics that provide the most accurate results and often experience long delays before receiving a diagnosis, even today. Alzheimer’s Research UK’s dementia attitudes monitor found that there was an appetite for earlier diagnosis, with 73% of the public saying they would want to know if they had Alzheimer’s disease before the onset of clinical symptoms.
Thirdly, I am sure the Minister would absolutely want to see the UK be the world leader in dementia clinical research. Given the world-leading institutions and researchers in the UK, this country has the potential to be a leading location for dementia clinical trials, which would allow patients here to be among the first to benefit from potential new treatments. The UK Government should invest in the development of a network of high-performing dementia clinical trial sites. They should look to emulate the success of the Covid-19 trials, for example, using lessons learned to speed up the approval process and generate a cohesive network of sites with a single point of entry for trial organisers. Given the Minister’s brief in the Government, I would have said that this absolutely played to his strengths.
It is a great shame that the comprehensive spending review was a missed opportunity for the Government to deliver on the moonshot commitment and harness the power of research to tackle one of the world’s major health challenges. The CSR announced £95 million for the delivery of the Government’s life sciences vision and £2.3 billion to transform NHS diagnostic services, but we need to see more detail on how that funding will benefit those living with dementia and the dementia research community.
On 7 September the Prime Minister was asked in the Commons whether the Government would fulfil the commitment in the Conservative manifesto to a dementia research moonshot. He replied:
“I can certainly confirm that the moonshot programme that was begun by my right honourable friend the former Secretary of State for Health—one of his many moonshots—continues.”—[Official Report, Commons, 7/9/21; col. 166.]
That is slightly ambiguous and certainly flippant. I hope the Minister will rectify that flippancy.
The Autumn Budget and the spending review published on 27 October did not include a reference to a dementia moonshot funding pledge. Reacting to the Government’s spending commitments, the director of UK DRI, Professor Bart De Strooper, said that the omission was a setback to those working to deliver cures for dementia. The absence of a dementia moonshot today is a major blow to UK neuroscientists racing to find cures for this devastating disease, not to mention the 885,000 people living with dementia in the UK and their friends, families and carers. I look forward to the Minister’s response.
Covid-19: UK Arrivals
Baroness Thornton Excerpts(3 years ago)
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Lord Kamall (Con)
Last night I took part in a debate that involved the issue of the Covid pass, particularly with the boosters. I was frustrated because I thought I had a date I could announce. That was pulled at the last moment, but we are very close to a solution. The technical point on test and trace is that, at the moment, it is unable to validate the vaccination status of people whose vaccines are not registered on the database. We are looking at whether that can be done on trust, or whether that would open a loophole for getting around the system. I have been assured when pushing the NHS on this that it is looking at an answer.
Baroness Thornton (Lab)
The Minister must accept that this a very confusing area for everybody. Perhaps he would like to clarify the Prime Minister’s comments yesterday on what impact tougher overseas travel rules and self-isolation for those without a jab might have. He mentioned those yesterday in the press conference. I think they are linked to the Question my noble friend asked. It is very important that the NHS app shows the booster as soon as possible, because it is going to cause a lot of trouble for Christmas travel.
Lord Kamall (Con)
I welcome questions from noble Lords, particularly on getting the booster on the app, because when I am talking to officials in the department and the NHS it shows how important it is that we do this as quickly as possible. One of the tasks is to be accountable and to push the NHS and others to make sure that we are doing this. Sadly, when I ask what the problem is on test and trace, I am told that it is unable to validate the vaccination status of people whose vaccines are not recorded on a national immunisation management system. I have asked about passenger locator forms and whether we could use a similar technology. At the moment that is done on trust, but you face a very high fine if you are misleading; maybe that could be a solution. I assure noble Lords that I really am pushing.
Covid-19
Baroness Thornton Excerpts(3 years ago)
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Baroness Thornton (Lab)
My Lords, I thank the Minister for actually reading the Statement today and for updating the House on the latest JCVI recommendations. I have to question the last statement that the Minister made. When you have nearly 40,000 infections, as we have today, I wonder if we are one step ahead of the infection or not.
We still see people who are keen to come forward to receive their booster dose but who are still experiencing difficulties in getting it. Does the Minister have an age breakdown by region? I repeat a question that I asked last week. What are the Government doing to fix the ongoing problems with the stalling of the vaccination programme? It is obviously exactly right to accept the JCVI recommendations about extending the programme, but my questions are about how effective we are being in delivering that. Not only is there some confusion about the booster vaccinations, we have also seen some stalling in giving the second dose. There are areas of the country where the second dose vaccine rates are as low as 52%—which is what they are in Westminster.
While we welcome the JCVI decisions to extend Covid booster vaccinations to those aged between 40 and 49, and second doses to 16 and 17 year-olds, there is still a large challenge. As I say, infection rates remain high. Today’s figures show 39,705 cases. Can the Minister give the demography of those being hospitalised and whether this is changing? Can he inform the House, either tonight or by letter, the demography of patients admitted to hospital with Covid—their age, vaccination status and the gravity of their illness? Do we yet know the incidence of genome sequences of the new cases and what has been learned about this?
The Government’s commitment was for all children to be offered a jab by half-term, yet only a third of children have been vaccinated. That means we are quite a long way behind. When does the Minister believe we might catch up? When will all the children who should be vaccinated at least have had their first jab, if not their second?
Last week, the Secretary of State said that he could not rule out the policy of over-65s being banned from all public places if they have not had their third jab, as they have been in France. He said, “We’re not looking at it yet but I can’t rule it out.” Can the Minister confirm whether the Government are considering locking down pensioners who cannot show proof of a booster on an iPhone?
The Minister would expect me to raise the issue of the terrible pressure on our NHS. Today we heard from ambulance chiefs about 160,000 patients coming to harm every year because ambulances are backed up outside hospitals. Thousands of patients will suffer terrible harm. All 10 ambulance trusts are on high alert. We know that NHS staff are stretched and tired, and that there are not enough of them. We know that one in five beds is occupied by an older person who should be discharged and who needs care, but because of the crisis in social care, both domiciliary and in care homes, there is nowhere for many of them to go and no one to look after them.
I am sure the Minister will tell the House about the extra expenditure and the tax rise, but the truth is that the Secretary of State failed to secure a new funding settlement for long-term recruitment and training in the Budget, so how will we recruit the extra staff the NHS needs? The noble Lord’s boss failed to secure the investment needed to fix social care in the Budget. Public health failed to get serious attention in the Budget. We are at the beginning of the winter period and it looks bleak, so what is the plan to get the NHS through this winter without compromising patient care?
I have another few matters to raise. Why does the NHS app still not recognise booster jabs? Apparently, the Prime Minister said at a press conference earlier that this would happen, but he did not say when. Does the Minister have any further information about that?
Indeed, on border controls, Ministers insist that vaccinations are the UK’s main line of defence, but the Conservative Party chair, Oliver Dowden, said this morning that the situation was being kept under review, with alarm over a spike in cases on the continent. As we have seen, Austria has imposed a draconian new lockdown on unvaccinated people after a dramatic increase in infections, and Germany, France and Italy are seeing a significant uptick in outbreaks. Do the Government have a contingency plan for travel restrictions given the fears of a rising fourth wave in Europe?
Finally, and shockingly, we learned today that Covid rates in Parliament were four times the London average in October. Does the Minister believe that this relates to the time when many Conservative Members, particularly in the Commons, were shunning wearing masks and presumably allowing their staff to do the same? I understand that a team from his own department turned up at a Standing Committee without masks a few weeks ago and had to be supplied with them by the clerk of that committee. This smacks of arrogant leadership, led by the Prime Minister last week on his hospital visit. Unfortunately, it is not only unattractive arrogance but dangerous, because it will cost lives.
Baroness Tyler of Enfield (LD)
My Lords, I thank the Minister for repeating the Statement. At this afternoon’s No. 10 press conference, Professor Chris Whitty made it very clear that doctors and scientists are increasingly concerned about the average of 37,500 cases over the last week and the high number of Covid cases in hospitals. Professor Whitty said that it would be a tough winter and added that, in addition to the nearly 9,000 Covid patients in hospital, all other areas of the NHS are under growing and intense pressure. He recommended that, in addition to getting their vaccinations, everyone should use face masks and ventilation to help reduce the number of cases.
This morning, Oliver Dowden, who was just referred to, said “It is in our hands” whether further restrictions in plan B are put in place this winter, but clearly the Government’s current communications on just encouraging using face masks and ventilation indoors and on transport are simply not cutting through. It certainly was not on my Tube journey in today, where distressingly few people were wearing a mask. Even if the Government do not want to implement the whole of their plan B, why will they not at least mandate face masks and improving ventilation on public transport and indoors when so many people across the spectrum are crying out for this to happen?
Leaving it to individual choice and personal responsibility is far too weak and inconsistent a message. It is crystal clear that the Prime Minister does not want to implement plan B, but is the reality not that he is far more likely to have to do so—or, indeed, move straight to plan C, a total lockdown—if mask-wearing is not made mandatory immediately? Does the Minister agree with me, and the point just made by the noble Baroness, Lady Thornton, that all parliamentarians and most particularly Ministers have a duty to set a clear example of mask wearing inside and on public transport?
Professor Whitty highlighted the stark figure that 98% of pregnant women admitted to hospital had not been vaccinated, and that same ratio applied to those in intensive care. What specific steps are the Government and the NHS taking to talk directly to pregnant women to encourage them to have their vaccinations?
It was worrying this afternoon when the Prime Minister said that he “hoped” that booster and third jabs could be logged on the online system “soon”. We have been asking questions about this system for weeks now. Can the Minister look into Pinnacle, one of the systems that logs people’s Covid status, to find out why practitioners are not yet able to record a third jab for the clinically extremely vulnerable, as well as a separate listing for booster jabs for everyone else over 40? As the Prime Minister said this afternoon, evidence of booster jabs will be required for travel this Christmas, but because third vaccinations and booster doses are still not appearing separately on the NHS Covid app, there is a great deal of anxiety and frustration among people who will need not only to have had the jabs but to be able to provide the evidence. Can the Minister say—I underline the point made by the noble Baroness, Lady Thornton—when all third doses and boosters will be on the online system?
Finally, although I welcome the announcement that it is safe for 16 and 17 year-olds to receive a second dose, can the Minister explain where 16 and 17 year-olds will be able to get that second dose? Too often, young people wishing to have their initial jab were put off because they had to travel to a centre some way away, often by bus, train or car, often involving parents providing the transport. Will the Minister undertake to look into ensuring that there are centres in town centres and other easily accessible places so that young people can more easily access their second dose?
Covid-19 Update
Baroness Thornton Excerpts(3 years ago)
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Baroness Thornton (Lab)
My Lords, I thank the Minister for the Statement, which largely concerns the matter which we discussed on Monday—making vaccination mandatory for patient-facing NHS staff. I need here to declare an interest as a non-executive director of a local trust.
We know that vaccination saves lives and that it is the best protection against this deadly disease. It helps to cut transmission. We, of course, want to see NHS staff vaccinated. But have the Government considered and taken account of the fact that the NHS is already under the most intense pressure this winter? Waiting lists are close to 6 million, there are already more than 90,000 vacancies across the NHS, and in his Budget the Chancellor failed to allocate funding for training budgets to train the medics we need for the future.
There will be anxiety at local trust level. However laudable the principle, it could exacerbate some of these chronic understaffing problems. We simply cannot afford to lose thousands of NHS staff overnight. Indeed, I spent this morning, as a non-executive of my local trust, discussing risk and its mitigation. Without doubt, the highest risk facing the whole of the NHS is staff shortage.
It was clear that the mandatory vaccine for care home workers covered all staff. These are predominantly in the private sector. Does this new mandate for vaccination apply also to all patient-facing staff, whether they work in the NHS or for private providers?
It is important that the Government have listened to representations from organisations such as NHS Providers, the NHS Confederation and others about delaying the implementation of this until after the winter. We welcome that. I urge the Secretary of State and the Minister to resist the blandishments of the former Secretary of State to bring forward any deadlines. However, have the Government consulted the British Medical Association, relevant trade unions and the royal colleges, which have raised concerns about the practicalities of implementing this policy? It seems to me that there needs to be a push right across the piece.
Will the Minister outline to the House what success looks like for this policy? Some of the 10% of NHS staff who are not vaccinated include those with medical exemptions, those who are on long-term sick and those who could not get the vaccine first time round because they were ill with Covid. Can the Minister tell the House the actual number of NHS staff who should be vaccinated but have not had the vaccine? In other words, when does he consider there to be success? Does full vaccination across the NHS look like 94%, 95% or 96%? What are we aiming for here? What is the target?
The aim of this policy is presumably to limit those with Covid coming into contact with patients, but one can still catch and transmit Covid post vaccine, so will the testing regime that is already in place for NHS staff—I think it is about twice a week at the moment— increase in frequency? Furthermore, will the thousands of visitors who go on to the NHS estate every week be asked whether they have had a vaccine or have proof of a negative test?
What analysis have the Government done of those who are vaccine hesitant in the NHS workforce? What targeted support has been put in place to persuade take-up among those groups? We know that in trusts where take-up is around 80%, specific support has been put in place—I know it has been in my own trust. But we know from society more generally that there has been hesitancy, for example, among women who are pregnant and those who want to have a baby. That means, sadly, that a significant proportion of those in hospital with Covid are unvaccinated pregnant women and, indeed, some of them have died. So, for example, will there be a dedicated phone line to give clear advice to women and their partners who might have concerns?
Today on the BBC “Today” programme, the Secretary of State spoke about the impact assessment for the mandatory vaccination of care home staff. We have been asking the Minister for this information to be brought to the House. We have done that many times. When will the impact information be available to Parliament?
Finally, on vaccination more generally, Leicester has a vaccination rate of 61%, Bradford—where I come from —63%, Bolton 69%, and Bury 71%. Generally, on children’s vaccinations, we seem to be stuck at 28%. On boosters, there are still around 6 million people eligible for a booster who have not yet had one. The Government’s own analysis shows that people over 70 who are dying from Covid or hospitalised should have had a booster, but many have had only two jabs.
With Christmas coming, which will mean more mixing indoors at a time when infection rates are high—with one in 50 having Covid—we are facing six crucial weeks. What more support will the Government offer now to local communities, such as those I have named, to drive up vaccination rates? Nobody wants to see either local or national lockdowns again.
Baroness Brinton (LD) [V]
My Lords, I declare my interest as a vice-president of the Local Government Association. I also thank the Minister for repeating this Statement. Covid-19 Statements are now taking on the role of London buses—large gaps for a while and then suddenly two in one week on vaccines. It feels as though arguments were going on behind the scenes for such a quick second vaccine Statement to be repeated in less than two or three working days.
Like the noble Baroness, Lady Thornton, my honourable friend Daisy Cooper MP asked yesterday about the publication of the long-awaited impact statement —Making Vaccination a Condition of Deployment in Health and the Wider Social Care Sector—that this Statement refers to. It would have been helpful for MPs to have had sight of it at the same time as the Statement. As the noble Baroness, Lady Thornton, said, frankly we needed to see it a long time ago, given that the social care deadline starts tomorrow. It was finally published overnight, and I have some questions on it for the Minister.
The Statement announces that all NHS and social care staff will have to have to be fully vaccinated by 1 April 2022. The deadline for care home staff remains tomorrow. The predicted numbers on page 4 of the impact statement are pretty staggering—up to 126,000 staff, of whom 73,000 are expected to be NHS staff. Page 6 of the impact statement also says that the modelling cost of replacing unvaccinated workers is between £162 million and £379 million. That is also staggering, given the financial pressures and backlog of cases across a health and social care sector that at the moment is still struggling with the pandemic.
From these Benches we really want to see staff vaccinated but would prefer that it is voluntary and remain concerned about the consequences of tomorrow’s care homes deadline. Page 6 of the impact statement published overnight talks about the disruption to health and care services. But for social care that disruption has already started. Many care home staff have already left or this week are being fired, with a good number moving to the NHS and to retail and hospitality roles.
Large homes are reporting closing down wings of beds due to lack of staff and some smaller homes are handing back state-funded patients to local authorities. Both the Statement and the impact statement are silent on how patients will be looked after before we even get to the consequences of social care homes without beds.
So can I ask the Minister what emergency plans there are to help areas? By the way, answers that say “It’s down to local authorities” are not helpful. This is a crisis created, at least in part, by mandatory vaccines, and there are no staff or beds that can just magically appear. Or is what Sajid Javid said at the Conservative Party conference the reality: namely, that families will be expected to step up to the plate to look after their loved ones in the absence of care home beds? If so, it would be good to see Ministers’ planning for that and the consequent problems for the workforce.
The Statement says that other parts of the social care system—for example, domiciliary care—that were excluded from the original care decision will now be included, but neither the Statement nor the impact statement is clear about the deadline for those in the social care system now being drawn into mandatory vaccination. Can the Minister say what the deadline is for these new groupings? It surely cannot be that the deadline for domiciliary workers is this week. Is this just for full-time staff employed by the care sector, or will others offering regular services such as activities in care homes or subcontractors working in hospitals now be included? There are staff working as sub- contractors for the NHS who have front-line access to patients; for example, delivering meals. Are they included or excluded?
The table on page 4 of the impact statement lists the total number of staff in each sector exempt from vaccination. I cannot find anywhere the criteria for exemption. Can the Minister please tell the House what those criteria are?
I have now asked the Minister at least twice in the past fortnight about the online vaccination form which sits behind the GP records and the app. How many of those who were vaccinated overseas and those who took part in clinical trials are now on the records system? Has it increased from the 53 people that he talked about last week, and are the arrangements for logging third doses for the severely clinically extremely vulnerable, as distinct from the booster doses for everyone over 50 and health staff, now sorted out? I am still getting reports that they are not.
Finally, there has been considerable concern that the Prime Minister was not wearing a face mask at Hexham hospital yesterday, against all NHS advice. This morning, Dr David Nabarro, the World Health Organization’s special envoy for Covid-19, said on Sky News:
“I’m not sitting on the fence on this one … Where you’ve got large amounts of virus being transmitted, everybody should do everything to avoid … getting the virus or inadvertently passing it on. We know that wearing a face mask reduces the risk. We know that maintaining physical distance reduces the risk. We know that hygiene by regular hand washing and coughing into your elbow reduces the risk. We should do it all, and we should not rely on any one intervention like vaccination on its own. So … please, would every leader be wearing face masks, particularly when in indoor settings? … This virus is unforgiving, and we need to do everything possible to prevent it getting in between us and infecting us.”
Can the Minister explain why the Prime Minister was not wearing a face mask, in breach of Hexham hospital’s rules, and will he pass on those words from Dr Nabarro to No. 10 Downing Street?
Gametes and Embryos: Storage Limit
Baroness Thornton Excerpts(3 years ago)
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Lord Kamall (Con)
I thank my noble friend for his work on the subject when he was the responsible Minister to help change the policy so that all people, regardless of medical need, may benefit from greater choice about when to start their family. The 10-year renewal periods will be put in place to give people the opportunity to decide whether they wish to continue with their storage of gametes or embryos. The department is currently working with the Human Fertilisation and Embryology Authority to set out the plans for detailed implementation, including on how the renewal periods should be handled by fertility clinics to ensure that they work.
Fertility clinics will be expected to contact people storing their gametes or embryos a year before a renewal period has ended, so there would be 12 months’ notice. In addition, people will have a six-month grace period following the expiry of any renewal period, in which they can get in touch with clinics to re-engage storage if they wish. I am sorry that I am going on longer than usual, but this is an important issue. It is our view that we would provide an appropriate amount of time for clinics to contact their patients, and for patients to decide what they wish to do with their gametes or embryos in storage.
Baroness Thornton (Lab)
My Lords, I return to the question of the noble Baroness, Lady Deech, because we need some clarity here. For some people, months count. They will be having their eggs destroyed now, in the next few months. Therefore, while I congratulate the Government on the regulations that added two years to the 10-year period in recognition of the need to provide an extension during the pandemic, the Minister needs to be absolutely clear because time is fast running out. Are the Government going to provide interim transitional arrangements before the legislation is before the House? From these Benches, we are very keen and across the House there is an enormous amount of support for this to happen. Frankly, if the Minister brings forward the regulations tomorrow, they will go through.
Lord Kamall (Con)
I thank the noble Baroness for that very kind offer, but we have already stated that it is the Government’s intention that no one misses out on the opportunity to extend the storage of their eggs, sperm or embryos. As she will be aware, in 2020 in light of the Covid pandemic, we took steps to extend the storage. We are currently considering options to make sure that no one misses out on the benefits of the new policy. Given the detailed consultation we have just been through, we hope to announce details in due course. Of course, if an amendment is laid to the forthcoming Health and Care Bill, we will consider it.
Covid-19 Vaccinations
Baroness Thornton Excerpts(3 years ago)
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Baroness Thornton (Lab)
I start by thanking the Minister for taking the Statement. I very much welcome the new antiviral, molnupiravir—another name we all have to learn—as a significant drug in our armoury in the fight against Covid. I think this might be my and the Minister’s first Covid Statement since he was appointed, though we have done several Questions. I thought it might be useful to remember the last 18 months for a moment, when his predecessor and the House dealt with, on average, two Statements and several Questions about Covid a week.
Let us be quite clear: the NHS and social care services have saved the country, and they continue to do so as we move into winter. I again place on record my gratitude from these Benches to the NHS, social care services and all the staff from the top to the bottom of our health service who have worked so hard to save lives, protect the vulnerable and roll out vaccines. But we should remind ourselves that 142,000 people have died from Covid in the UK so far, and 1,173 died last week. We have the highest, or one of the highest, infection rates in Europe. This is not over by a long way, and we are now moving into the winter. Frankly, one has to question whether the Government have a handle on Covid going into the busiest season for our NHS.
The Government must get a grip on the stalling vaccination programme. The Health Secretary, Sajid Javid, is calling on younger relatives to help their eligible parents and grandparents take up the offer of the booster and the flu vaccine. Older and vulnerable people have been urged to get their Covid-19 booster jabs as part of a “national mission” to help avoid a return to Covid restrictions over Christmas. The Health Secretary said:
“If we all come together and play our part”,
the country can
“avoid a return to restrictions, and enjoy Christmas.”
That is a bit late, and it is absolutely in line with this Government’s handling of the pandemic—about two to three weeks later than they need to be. It is a bit rich for the Secretary of State to line up who is to blame if we do need further restrictions at Christmas because the Government have failed to get everyone vaccinated who needs to be.
I ask the Minister specifically about immuno- compromised patients. In September, the JCVI recommended that severely immunosuppressed patients have a third primary dose prior to having their booster jab to maximise their protection. There has been a lack of clarity about whether and when this would happen, which has caused huge confusion among a very vulnerable group in our communities. It is estimated that between 400,000 and 500,000 people fall into this category and are entitled to both a third primary jab and a booster. These two things are not interchangeable. Can the Minister tell the House how many of this group have received a third primary jab, and how many are going on to have a booster? How many are missing out on potentially life-saving doses of Covid vaccines after confusion about who is eligible for a third dose followed by an additional booster jab?
The blood cancer charity Myeloma UK said its helpline has been inundated with hundreds of inquiries in recent months from patients who are struggling to book their third and fourth doses. To compound this challenge, patients like this cannot turn up at a walk-in or mass vaccination centre. What plans are there to ensure that the immunosuppressed receive the vaccinations they need?
More generally, local residents are contacting their MPs to say that they cannot get the boosters they so desperately want. One lady in her 70s with an underlying health condition went to her pharmacy and called 119, just to be told that she was not eligible for her booster—but she knew she was. She finally has one booked in December, but she had to rely on her daughter to book the appointment because she does not use the internet. The system simply is not working for many of those who need it most, because they do not have access to the internet or the new technology the Government want them to use to get their boosters.
Turning to care home residents and booster vaccinations, 1 November was the Government’s target for getting care home residents their booster jab. Could the Minister tell the House what proportion of care home residents have been vaccinated so far? My honourable friend Dr Allin-Khan said in the Commons on Thursday that only about a quarter of care home residents in Leicester have had their booster. The former Secretary of State is now calling for all NHS staff to be compulsorily vaccinated. Is this government policy? If so, what is the timetable? Is it wise to force this through right now when the NHS has a vacancy rate of 100,000?
Finally, plan B, which contains measures that we on these Benches already support, such as mask wearing and allowing working from home, is simply not enough on its own. Yes, we support it, but we must turbocharge vaccine boosters, fix sick pay, and improve ventilation. Does the Minister agree?
Baroness Brinton (LD) [V]
My Lords, from these Benches, we add our thanks to all those involved in the current delivery of vaccinations, whether they are GPs, nurses, healthcare assistants or volunteers at vaccination centres, and we thank more broadly our NHS and care-sector staff who are still working extremely hard to reduce the backlog of cases while coping with over 9,000 patients currently in hospital with Covid.
The Minister knows that the Delta variant and its subvariant, which is thought to be behind the growth of cases in the west country and Wales, remains highly transmissible. Doctors are reporting daily that double-jabbed patients are catching Covid and passing it on. Why have none of the mitigations in plan B been carried out? Many scientists, including some members of SAGE and Independent SAGE, believe that we should be operating them now to reduce the high numbers of cases and not be faced with a second Christmas being cancelled by the Prime Minister at short notice.
From these Benches, we have asked time and again for the wearing of facemasks inside and on public transport, as well as room ventilation in schools and other public venues, to be mandated, and for social distancing to remain. There are now, on average, 35,000 new cases daily, a shockingly high number. Professor Peter Openshaw, the chair of NERVTAG, said today that it was clear that immunity from the vaccines is waning. Yes, and vaccination is vital, but with cases at this level why are the Government not making mask mandates and social distancing formal?
Today, the Prime Minister once again reminded people to get their jab, whether first, second, third or booster, the ONS data showing that the risk of dying from Covid is 32 times greater in unvaccinated people. Can the Minister tell us why last week it was announced that vaccination centres are now closing at 6pm? Surely it should be easy for people to get vaccinated at a time that works for them, when they leave for work or get home from work?
The last time we spoke about Covid, I asked the Minister what the Government were doing to prevent some of the very unpleasant anti-vaxxer interventions at school gates and outside some vaccine centres. Has any action been taken on their disgraceful leaflets, which deliberately look like an NHS document but are full of direct lies and mistruths? It is important, because, by the Minister’s own numbers in this Statement, only 22% of 12 to 15-year olds have had their vaccination so far. I think Ministers now recognise that cases in this age group are driving cases in the older age groups, which is probably why hospital numbers are going up.
The noble Baroness, Lady Thornton, referred to the muddle between booster and third doses. The pandemic is far from over for immunocompromised and immunosuppressed people. I declare my interest as one of the clinically extremely vulnerable, as I have said before. I discovered by chance, reading something online, that I am now in the third-dose category. My GP did not know it and I certainly did not know it either. That is the problem. GPs and vaccination centres have not been told about the distinction. I have read the NHS guidance on the third dose, but many other clinically extremely vulnerable people are saying that their surgery or vaccination centre does not understand which category they fall into.
This is not helped by the problems with the online form which I asked the Minister about last week. Does the online form now specify the third dose, which is for around 800,000 people, according to current estimates, not for 400,000 people, as the noble Baroness, Lady Thornton, said, as distinct from the booster, which is for around 20 million? It is important, because the third-dose patients must have a booster in a further few months. If the system is not even recording the third dose, how will it know to call them back?
With the end of the shielding programme on 17 September, Sajid Javid wrote to all those on the patients’ list to inform them that it had finished, that the Government would no longer be offering specific advice and that we should go to our hospital clinicians. But many of us do not have an appointment in the diary, and there is not likely to be one because our clinicians are catching up with the backlog of cases, and those who are specialists in immune diseases are working on the Covid wards as well. So can the Minister say how on earth the clinically extremely vulnerable are meant to know what to do in the meantime?
Will the Minister ensure that the Government will work with patient organisations, clinicians and employer to produce clear and meaningful guidance that promotes safe working practices for this group and, in particular, let employers know that they have to help employees either to work from home or, if they have to go in, to make sure they do not have to go in by train or bus at peak hours? Please will the Government appoint a dedicated national lead to co-ordinate the support and guidance available to people in this group?
The news in the Statement of the approval of the Merck and Ridgeback antiviral Molnupiravir is also good news. I see that just under half a million courses of doses have been ordered. It was good to hear on Saturday of the success of the Pfizer clinical trials elsewhere, but I gather we are some way off from that being approved, because further trials of people who are clinically vulnerable are needed. Can the Minister tell the House the likely timescales of the actual delivery of both these different antivirals?
Finally, I am aware that I have asked some technical questions. If the Minister cannot answer them today, please will he write to me with the answers?