My Lords, I thank the Minister for taking this Statement today, and I hope her noble friend is fully recovered from the bug that he acquired—goodness knows where. I declare an interest as a maternity safeguarding champion at a London trust hospital.
We must welcome this rather late and delayed strategy. For too long, women’s health has been an afterthought and the voices of women have been at best ignored and at worst silenced. I welcome the appointment of Professor Dame Lesley Regan as the first ever women’s health ambassador for England.
If this strategy is properly funded and actually delivered, it may not solve the crisis in women’s healthcare after 12 years of Conservative mismanagement but it would certainly help shift the policy and delivery of services. Four out of five women who responded to the Government’s survey could remember a time when they did not feel listened to by a healthcare professional.
The context for this strategy is that, in recent years, we have seen a string of healthcare scandals primarily affecting women: maternity services at Shrewsbury and Telford; more than 1,000 women operated on by rogue surgeon Ian Paterson; thousands given faulty PIP breast implants; many left with traumatic complications after vaginal mesh surgery; and the use of medication such as Valprol during pregnancy, as highlighted by the noble Baroness, Lady Cumberlege, in her report, First Do No Harm, which has helped to transform issues in this space
There is one issue I wish to raise with the Minister immediately, and of which I have given prior notice, which calls into question the Government’s commitment to sexual health rights for women. In the past few days, it has emerged that a statement on freedom of religion or belief and gender equality was issued by the UK as part of the intergovernmental conference it hosted in London on 5 and 6 July. Commitments to abortion and sexual health rights have been quietly removed. Is that true, and, if so, why has that happened?
I return to the Statement. The context of the strategy is that every woman who needs to use the NHS today faces record waiting times. The NHS is losing midwives faster than it can recruit them. Gynaecology waiting lists have grown faster than any other medical speciality. The number of women having cervical screening is falling, and black women are 40% more likely to experience a miscarriage than white women. We need to look at what is being proposed in this strategy.
The strategy promises new research, which is absolutely vital and very welcome. I draw the Minister’s attention to the report from the University of Birmingham commission into safe and effective, accessible medicines for use in pregnancy, Healthy Mum, Healthy Baby, Healthy Future. Chaired by the noble Baroness, Lady Manningham-Buller, it addresses the terrible lack of research into conception and pregnancy. The starting point is that virtually no drugs have been developed or trialled for pregnant women in the many decades since Thalidomide. This leaves women at the mercy of general diseases, the diseases of pregnancy and drugs that are usually unlicensed.
Pregnant women and babies throughout the world continue to get sick and die from largely preventable and treatable causes. Even in the UK, the way in which medicines are developed currently risks preventing pregnant women accessing the benefits of safe and effective medicines. Most recently, the exclusion of pregnant women from Covid vaccine trials has probably led to needless deaths among pregnant women and babies, which highlights this issue. The commission provides a blueprint for action. Will the Government make use of it?
Studies suggest that the gender bias in clinical trials is contributing to worse health outcomes for women. There is evidence that the impacts of female-specific health conditions, such as heavy menstrual bleeding, endometriosis, pregnancy-related issues and the menopause, are overlooked. Can the Minister set out how exactly the Government intend to make use of the new research to improve outcomes for women? How will they address widespread bad practice across clinical trials where women are not selected because their hormones might distort the results—which really means that they might reveal the side effects that treatments will have on them?
Moving on, we welcome improving the education and training of health professionals as absolutely vital. Almost one in 10 women have to see their GP 10 times before they get proper help and advice about the menopause. Why is it that almost half of medical schools do not teach doctors about the menopause, given that it affects every single woman? Those are two small consequences of not addressing gender in the training of our medical professionals.
I want to ask a question about what my honourable friend Carolyn Harris said in the Commons yesterday:
“I am delighted that my private Member’s Bill that I negotiated with the Government last October now appears as part of the strategy, but I am bitterly disappointed that the timeframe for that once annual charge is delayed until April 2023—18 months after it was promised”.—[Official Report, Commons, 20/7/22; col. 980-81.]
My honourable friend needs an answer on that. Why have the HRT costs been delayed until April 2023?
We can only welcome the extra £10 million for the breast screening programme. This screening can prevent avoidable deaths by identifying breast cancer early, but we must note that fewer women in the most deprived areas receive regular breast screening. Even before the pandemic, too many women with suspected breast cancer were waiting more than the recommended two weeks. Can the Minister tell the House how the programme announced today will make a difference to outcomes for patients if, once diagnosed, they end up on a waiting list that is far too long?
There are plans in the strategy to remove barriers to IVF for lesbian couples, which we welcome. For too long, they have faced unnecessary obstacles to accessing IVF for no other reason than the fact that they love another woman. It is encouraging to see the Government take action to set this right.
As well as the appalling figures on black maternity deaths, a quarter of black women surveyed by Five X More felt that they received a poor or very poor standard of care during pregnancy, labour and post-natally. Women who live in deprived areas are more likely to suffer a still-birth than their richer counterparts. Labour has pledged a new race equality Act to tackle the structural inequalities in our society, including in healthcare. Does the Minister acknowledge that those inequalities exist?
There is one final issue that I would particularly like to draw to the attention of the House. Support counselling for women victims of rape is absolutely vital but End Violence Against Women estimates that the Government need to provide a minimum of £195 million each year to rape crisis services to properly respond to that need, with a significant proportion ring-fenced for specialist BAME services. The problem, as a recent survey revealed, is that 60% of people believe that access to free counselling is readily available for rape survivors. That is not the case. The waiting lists are growing. Do the Government accept that this is not an acceptable situation?
My Lords, I agree with much of what the noble Baroness, Lady Thornton, has said. It is always interesting to see what is included and what is excluded in documents such as this. Like the noble Baroness, Lady Thornton, I would like straightaway to query the omission of rights to abortion and sexual healthcare. Is that now the policy of the Government and the Department of Health? If it is, that is a very significant change that will have a huge, detrimental effect on the health of women.
It is notable that this document lists its ambitions at the beginning, talking about the availability of RSHE in schools so that young people know and understand what good health is and what their rights to it are. Unfortunately, there is still a dearth of appropriate material getting to schools and there is equally no commitment to training staff in schools to deliver appropriate training. I therefore ask the Minister when that situation is going to be rectified.
Organisations such as the Faculty of Sexual and Reproductive Healthcare and RCOG have been telling the Government for years that there is an absolute crisis in reproductive health services. We have a completely fragmented system for access to basic contraception, which is having a huge impact. We now know that approximately 50% of pregnancies in this country are unplanned. That statistic in itself tells us how far reproductive health has slid backwards.
I am glad to see the appointment of Professor Dame Lesley Regan. Some of the work that she has done in this report says that investment in contraceptive and fully inclusive reproductive and sexual health services is a public health investment which has a massive return on investment. Every £1 spent on contraception is a saving of £9 in public health services. If you invest that £1 in maternity services, the return on investment increases to £33. It is a no-brainer, yet at the moment we fracture access to services so that women who want access to proper reproductive health services end up going multiple times to multiple places. Why? It is because funding streams are fractured. Can the Minister say when that is going to be rectified? The sooner it is, the swifter we get a proper impact on women’s health.
One of the things that I have noticed, having read the review, is that for the first time it tries to be inclusive in its definitions. I also welcome the statements made about access for lesbians to assisted reproduction. The review includes Roma women. It notes the disparities in the appalling health inequalities for black women and women of colour. It also completely ignores trans people. I have a simple question for the noble Baroness. Is that the policy of the Government and the Department of Health? Are these people going to be excluded from our health policy in future?
The final thing I wish to say is that one of the big things that has been noted all the way through our reviews of continuity of care and the great work by the noble Baroness, Lady Cumberlege, is that continuity of care is key to outcomes, in particular, continuity of care in primary care, which is where most women want to get their health services. Will the Minister say what will be done to do that?
One other thing we certainly know is that we have an impending crisis in the workforce. The skilled women and men—largely women—who have been delivering women’s health services for the past 30 to 40 years are, by and large, about to retire now. Young male and female doctors and nurses, particularly in primary care, have not been given access to training. What will be done to make sure that the looming skills deficit is dealt with? Unless we address that, this is just a load of pipe dreams that will never come to pass.
(3 years, 2 months ago)
Grand CommitteeI thank the Minister for introducing the regulations as he did, but it does not alter the fact that the current rules around self-isolation and PCR and lateral flow testing are confusing. People who are not stupid and who genuinely want to know what to do and what they should be doing for the best find them difficult. I heard about someone who had contact with a positive case last week trying to work out from GOV.UK if it was okay that they had had a negative PCR test and had no symptoms—what were they then supposed to do? It is imperative that we continue to have very clear and sustained messaging around testing and isolating.
Ministers have made great play of the fact that the front line of defence is double vaccination. Okay, but that is only as strong as it is if you continue to have the second-line defences of testing and isolating in behind it; if you do not, that places a much greater strain on the vaccination process. We know that from other countries. I know that the Minister said that there were other mitigations, and he talked about investment in therapeutic treatments, but they are not yet with us. Therefore, we need to concentrate yet again, albeit with fewer restrictions than there were before, on who is being tested and who is having to isolate.
I go back to one point on which I have asked the Minister questions for more than 12 months. What about people who are not registered with GPs? There are still such people in the country, perhaps people whose first language is not English and who—surprisingly, perhaps—do not know about what to do about going to get vaccinated. I have come across a couple of examples recently. I do not think that there are vast numbers of such people, but there is a significant cohort in some communities who are hesitant not because they have any great ideological disposition against vaccination—they just simply do not know what to do, or they may have language problems, which means that they are concerned about going to vaccination centres.
I want to talk again about schools, because we have the data that has come through from Scotland. I point out to noble Lords that mask-wearing in schools in Scotland is still in place. From talking to epidemiologists, as we did earlier this year, about the whole process of the country coming out of tight restrictions, one thing that they said to my noble friend Lady Brinton and our team is that with enclosed spaces it is not just ventilation that you have to look at—you have to look at air purification as well. The big health risk is when you have stagnant air into which people who are positive are exhaling droplets of the virus. What has been done to enable schools to look at things like carbon dioxide monitors, as a proxy for measuring stagnant air? Again, I do not think that many schools have had the resources to enable them to deal with that.
I want to make one point that my noble friend Lady Brinton would have made had she been here. We are still talking about 1,000 deaths a week and 50,000 deaths per annum. By the Prime Minister’s reckoning, that is an acceptable but very high number of deaths. The reason why these regulations are not helping is that they seem to be part of a high-level message that says, “It’s over.” A lot of people think it is over, but it is not; it will not be for a considerable time and it will continue to be very dangerous if we chip away at the side mitigations that go beyond the vaccine.
Finally, we have always said that local authorities have a key role to play in identifying those people who are in the communities that are most vulnerable, and they are the communities that need the most help to self-isolate. When will the Government produce a comprehensive report on the funding of local authorities for local self-isolation schemes and their effectiveness?
My Lords, my noble friend Lord Hunt made the most pertinent point, which is that, as we have acknowledged, Covid has pointed to the gross inequalities in our society. That can be seen absolutely when we look at the self-isolation regulatory regime and the impossibility of those on low incomes self-isolating because they then have to choose between feeding or not feeding their children; they cannot afford to self-isolate. We still have not solved that problem sufficiently well.
As we move into the winter, as the noble Baroness, Lady Barker, said, this pandemic is not over. If you have 150 to 200 people a day dying, it is not over. If you have half the ICU beds in our hospitals still occupied by people with Covid, it is still not over and we will never catch up with all the NHS waiting lists that have fallen so abysmally behind in the past 18 months. So it is not over.
Self-isolation is part of the toolbox, to use the Prime Minister’s and Secretary of State’s word, that will help to control the spread of this virus. What the old regulations did—do—is amend the self-isolation regulations. With effect from 19 July, they allow a person to leave self-isolation and put an antibody test in the post, and from 16 August certain people were no longer required to self-isolate if they had come into contact with a person who had tested positive for Covid. The Minister listed who those different groups are, including children under 18. I completely agree with my noble friend about the need to include children under 18, but we have to address the issue of what that means for schools.
The Minister said before the summer, when we were hearing Statements about the easing of these regulations, that people were going to have to behave “in a responsible fashion”. I had a particular issue with that last week, when a friend I was supposed to be meeting called me to say that her husband had caught Covid. Both were double vaccinated, he was not very ill—I am pleased to say. They had been at a wedding, and there was a family there who were anti-vaxxers; they did not know and he caught it. She tested negative for the next four or five days.
I was personally quite torn about what to do: should we meet or not? The idea shocked me that somebody who is living with somebody who has Covid did not have to self-isolate. I worked my way through it; I read the regulations, which I must say are complex and not completely clear. She did not say, “I am allowed to go out”; she was being very responsible, but I thought that millions of people must be facing those issues all the time. Just saying that people have to behave “in a responsible fashion” may not be quite the point.
(4 years ago)
Grand CommitteeI thank my noble friend Lady Sheehan for her introduction to this amendment and the noble Lord, Lord Alton, for the detail that he added to that.
My interest in this matter stems back to 2013, when I was part of the All-Party Parliamentary Group on HIV and AIDS, which produced a report called Access Denied. It was about barriers to access to antiretroviral drugs for HIV and AIDS in low and middle-income countries. In the course of our research work for that report, we held a number of hearings with all sorts of representatives from a number of international research groups based in the United Kingdom but which worked across Africa and Asia. We met user and patient groups and also included representatives from the pharmaceutical companies.
I vividly remember sitting in a room in Portcullis House during one of our question and answer sessions and putting a question to a representative of a pharmaceutical company that has cropped up in our discussions in the last couple of days. I asked him a simple question—whether there was a direct correlation between the R&D costs of a drug and the price. With disarming candour, he said, “No”. Once people’s jaws had ceased to drop, we had the revelation that actually there is no transparency about pricing in the pharmaceutical industry or about the extent to which public and private funding goes into the development of new medicines—and, in effect, an admission that the overstatement by pharmaceutical companies of the need to charge excessive prices in some markets to maintain their viability is not substantiated.
I am not an anti-pharma campaigner. I believe that human and animal welfare rests very much on the development of pharmaceutical knowledge and science, and I am all in favour of extension of research and development of new drugs. However, for far too long Governments of all sorts have been held over a barrel by pharmaceutical companies, and that should stop.
I say this as someone who has had a long-standing interest in HIV. To see some patient groups in some parts of the world continue to become infected and, perhaps, have threats to their lives that would not occur if they had simply been born in another country is devastating. For example, in the world of HIV, very little work is being done on development of antiretroviral drugs for paediatrics because there is very little call for that in western developed nations, whereas there is a very big need for it in sub-Saharan Africa. Our involvement in these matters has a direct bearing on the lives of people across the world and on our standing not only as one of the major governmental funders through the different international funds but as a country in which research into new and emerging transmissible diseases is second to none because of our long-standing history.
For all those reasons, I very much support my noble friend Lady Sheehan, and I await with interest the answer to the question that my noble friend Lord Stunell put, which was the one I was going to ask, about proposed new paragraph (d) in my noble friend’s amendment.
The Committee owes the noble Baroness, Lady Sheehan, a debt of gratitude for bringing forward this amendment. I very much enjoyed her opening speech—and, indeed, those of the noble Lords, Lord Alton and Lord Crisp, both of whom are so well qualified to speak about international health responsibilities.
What this debate does is to remind us of how privileged we are to live in a country with free access to new medicines and innovations. However, we are now entering choppier international waters. We have been sheltered, as it were, over 40-odd years or so by the European Union’s heft and regulatory framework. So we need to take notice of the need for greater co-operation, as has been outlined by the noble Lord, Lord Patel.
I was very struck by the mention of things like price gouging by the noble Baroness, Lady Sheehan, and their dangers for those less fortunate than ourselves. On the immediate responsibilities and dangers around the Covid vaccination, which we so desperately need, the World Health Organization says that it is working on a plan to ensure equitable distribution of vaccines, but how that would be enforced in practice is not clear. Professor Mariana Mazzucato, who heads the University College London’s Institute for Innovation and Public Purpose, says:
“In a pandemic, the last thing we want is for vaccines to be exclusively accessed by countries that make them and not be universally available.”
That is absolutely right.
However, as the noble Lord, Lord Crisp, said, we need to pay attention to what is happening in the UK and what the effect of Brexit might be—and, goodness me, we are all on tenterhooks as to whether we get a deal or not. Rick Greville, the director with responsibility for supply chain at the Association of the British Pharmaceutical Industry said, in the run-up to a no-deal Brexit—the last time this happened—that there could be currency fluctuations, including a fall in the value of the pound. He said:
“You can imagine in that situation that exporting medicines into Europe would become even more profitable. It may be that”
drugs
“that currently aren’t being exported suddenly become attractive to export, driven entirely by profit”.
The UK is not invulnerable to what might happen next, and I would like the Minister’s observations on that.
Launched earlier this year, COVAX wants wealthy nations to pool funds that together can be used to develop and scale up vaccine production. In return, rich countries would have a guaranteed supply for about 10% and 15% of their population. I would also like the Minister’s answer to that, because several noble Lords have raised that question.
This is one of those debates in which one feels that so many people are better qualified to speak than oneself. I finish by quoting the noble Lord, Lord Crisp, and what he said on Monday. He said:
“This amendment is absolutely right in asserting that the UK should reaffirm its position and its rights to protect the health of its population. We should adopt it. The future will be difficult, as will the negotiations on this issue, but no one should be in any doubt about the UK’s firm position. We should support not just the UK’s position for the population of the UK directly but a global effort to deal with these important matters.”—[Official Report, 26/10/2020; col. GC 71.]
I could not have put it better myself.
(4 years, 1 month ago)
Grand CommitteeMy Lords, I just want to add to what my noble friend Lord Sharkey said. This is a matter of principle; from the two reports by the two committees that have been cited and from the Second Reading debate, the Government can be in no doubt about the strength of feeling on it. In the light of those, the Government’s response in the government amendments in this group is, frankly, rather pathetic and not at all acceptable.
The Bill represents an enormous upheaval for one of the critical areas of our industry. The pharmaceutical industry is of immense importance to this country. Apart from anything else, to add criminal offences created through delegated powers by means of a Bill that is so spare and lacking in detail does a huge disservice to people who want to continue to pursue not just high-quality but ethical production of badly needed medicines in this country and within international frameworks. If the best the Government can do is to table the amendments in this group, they do the industry a great disservice.
I do not think that I need to say much in response to the remarks that were, I think, unanimous in their support for my amendment and the other amendments in the group. The cap on the sentence is not a good enough response by the Government. Earlier in our debates, I made a remark about amendments designed to circumvent; I am afraid that the government amendments before us are exactly that kind of amendment. They will not serve, I am afraid.
Unless the Government are prepared, as I hope they are, to table amendments that actually solve the problems and address the issues raised by the Constitution Committee and the Delegated Powers and Regulatory Reform Committee—they could not have been clearer on this issue: in this country, we do not set up criminal offences and their sentences by delegated legislation—there is nothing more for me to say, other than that I hope the Government will think again.
(4 years, 1 month ago)
Lords ChamberI thank the Minister for this Statement, which was made yesterday in the Commons, and for the one made on Thursday in the Commons. It seems like a good idea to take them both together, since the news about the unreported and untracked positive tests needs urgent scrutiny, and the Minister does not have to suffer double the pain of explaining the very real problems we face with the winter and the second spike.
For example, today, we see another increase in positive tests—14,522 cases reported, with two-thirds of those in the north and north-west. To summarise, we have had people being told to travel hundreds of miles for a test; hundreds of children out of school unable to get a test; tracers sitting idle, watching Netflix; care home tests taking days to be processed; the Minister’s hyperbole, saying this could be a moment of national pride, like the Olympics; and a Prime Minister in a complete muddle over the rules. The Prime Minister seems to be able to learn large chunks of Greek by heart, so why, when he does regional media, could he not at least learn which lockdown rules apply where? It is not much to ask.
The questions from my honourable friends Jonathan Ashworth and Stella Creasy in the Commons yesterday were very pertinent. The reason why they needed to ask what the contractual teams were for the contracts supplying test and trace is that they are not working well and a large amount of public money is being spent on them. Is it not sensible to ask if there is a break clause if goods being purchased with public money are faulty or not working properly, given that they have been sold to us as world-class and planet-beating? What did the Secretary of State say to these questions? Unfortunately, he reverted to the government line of blaming Public Health England. Can we see the terms and conditions and profit margins on all these contracts? Is it true that there is no break clause addressing whether these contracts do what they are supposed to? As the former chair for a few years of the procurement committee of a local CCG, at a very lowly level in the NHS, I can tell the Minister that these are vital questions which have to be asked—questions for which I would expect to be held to account.
Does the Minister agree that transparency would ensure proper governance and accountability for those charged with the stewardship and responsibility of spending public money? Let us examine this for a moment. Is it true that Public Health England’s older version of Excel has a 65,536-row limit, meaning that, in the data transfer from the big CSV file, rows were chopped off? Can the Minister confirm that the data could not be handed over to Public Health England due to the size of the Excel spreadsheet files? Why are critical databases in a national pandemic being hosted on Excel spreadsheets? Is it true that the upgrade to a later version of Excel, which copes with just over 1,000,000 rows, costs about £100? Is this an issue with one particular lighthouse lab or across all the lighthouse labs? Public Health England’s sources say that they report the data when they get it from NHS Test and Trace, so if the information is coming in incomplete, they cannot do their job.
We know that the budget for test and trace is in the region of £10 billion to £12 billion, and it seems to me that an IT audit might have been a good place to start. Was there one? What did it say? We know it is true—so, presumably, does the Secretary of State, who is ultimately responsible for Public Health England—that Public Health England’s budgets were cut by 40%. So, is it the case that Public Health England had no IT upgrades of any kind recently? Given what we know, is it legitimate to ask where all that money has gone?
Why in October, after all the promises of the Prime Minister, the Secretary of State and the noble Baroness, Lady Harding, are we now facing the possibility of 60,000 people unknowingly spreading Covid in their homes and communities, which might account for some of the sudden increases seen today? Have all those people been contacted, traced and isolated?
These are not irrelevant, disloyal or silly questions: they are vital if these matters are to be remedied. They are vital if the Government are to dispel what communities are feeling, described on Sunday by the leader of the Labour Party, Keir Starmer, as
“This deep sense of despondence, anxiety. And actually, what they want is hope.”
We on these Benches want the Government to do that: to give hope. Assuring us that they have everything under control will, however, not work anymore, because it is clearly not true.
Surely, what is needed is transparency and a strategy, expressed with clarity, that everybody understands and supports. It is, furthermore, urgent. Tonight, a group of leaders of the largest councils in the north—Manchester, Leeds, Newcastle and Liverpool—has written to the Prime Minister asking for, among other things, significant local control and support. I beg the Minister not to chant the mantra that test and trace are working closely at local level, because clearly they do not believe that it is. Again, it does not seem to be true. I hope that the Government will respond positively to these councillors.
Yesterday, Jeremy Hunt asked whether responsibility for NHS and care home staff testing should be moved to hospitals and laboratories, and that idea was repeated by the Nobel laureate Paul Nurse, of the Crick Institute, on the radio this morning. The fundamental problem is that there is no strategy: there is a vacuum. That is because there is division in the Cabinet over which strategy should be followed. This needs to be remedied and a clear way forward explained.
Finally, with regard to the part of the Statement concerning treatment: will the Minister clarify whether the establishment of Orbis will be in co-operation and collaboration with EU medicine protocols or in competition with them? Will Parliament scrutinise Orbis, and when?
I thank the Minister for yet again turning up at the crease to defend what is becoming increasingly indefensible: the poor performance of the NHS Track and Trace system.
The noble Baroness, Lady Thornton, was right to note the admission in this Statement that 16,000 positive results had not been uploaded, and that by yesterday only 51% of those people had been contacted, despite the injection of resources into NHS Track and Trace over the weekend to try to make up the deficit. Given that we know that each person who tests positive is likely to report between four and five contacts, that is potentially 60,000 people who last week were walking around, not self-isolating and possibly infecting others. It is not their fault—they did not know. It is a really significant breach of trust.
In the part of the Statement that I find most curious, the Secretary of State said that the Chief Medical Officer’s analysis of the Government’s assessment of the disease as a result of the new data was that
“its impact has not substantially changed.”
Can the Minister give us further detail about that? The omission of 60,000 people not having any impact does not add up at all. The Secretary of State went on to say that the Joint Biosecurity Centre had confirmed that
“it has not impacted the basis on which decisions about local action were taken last week”.—[Official Report, Commons, 5/10/20; cols. 625-6.]
When will that data come through and when will we be able to see the impact on local areas? As these statements make clear, the virus is beginning to have different impacts in different places. Can the Minister say at what point directors of public health were informed about this breach? Six months in, it is clear that, when local authorities are properly resourced and given correct and timely information, the virus is managed and contained. The major problems come about when decisions are made centrally, poorly communicated and badly executed.
Time and again, it comes back to track and trace, whether it is about a lack of skills and capacity or a lack of foresight. Who could not have foreseen the impact that hundreds of housefuls of students moving around the country in September would have on transmission?
Yesterday when this Statement was debated in another place, speaker after speaker, mostly from the Conservative Benches, got up to complain about the effect of the 10 pm arbitrary cut-off. They explained how well-run businesses, especially in the hospitality sector, will be going to the wall because of continued use of blunt instruments designed nationally and applied over wide geographical areas. How long will it be before the Government realise that local people—local professionals, directors of public health and environmental health officers—have detailed knowledge about businesses in their area, their hygiene ratings, their previous breaches of licensing conditions and where crowds congregate? When we can get decision making to a more local and granular level, we will be better able to protect good businesses without jeopardising public health.
I welcome the announcement of hospital funding for upgrades to A&E departments. We need a greater capacity for A&E. However, could the Minister give the House the definition currently used by this Government of what constitutes a new hospital?
On the Orbis project, we go into this having left a safe and highly effective system of medicines regulation, one where patient safety is paramount. How does the Government propose to withstand the commercial imperatives of American pharmaceutical companies in these circumstances?
The public are getting very worried about the extent to which the Government continue to wing it. It is time for them to bear down on the fundamental flaw in their strategy—thinking that they know best in the centre, above people who are professionals at a local level.
(4 years, 2 months ago)
Lords ChamberI thank the Minister for taking questions on this Statement today. It was noticeable yesterday, and on Monday, that at no point was there any attempt to reveal any scientific basis or evidence for the impact on the spread of the virus of either a 10 pm curfew or going back to working from home if you can. A few weeks ago, we were all being urged to go to the office or workplace if we could. We have certainly not been told what SAGE’s modelling shows as the impact a ban on mixing households indoors would have.
The Government are lacking a clear Covid-management approach. We recognise that the pandemic, and its impact, are complex. The response can be no better than the best compromise, and that should be admitted. Timely policies to rejuvenate the economy will fail if policies to contain the infection fail; we recognise that. In the absence of a vaccine, testing, tracing and isolation is the only response that matters now. Covid infection data should be published, to make it clear to the public where the risks are. The Prime Minister said that more information would be made available. I would like to know that it will and when that might happen.
This leads back to testing, tracing and, importantly, isolating, as every conversation about the containment of Covid-19 does at the moment. Looking back over the last few weeks of growing disquiet, and then serious concern, about not being able to get tests, does the Minister agree that part of the problem—leaving aside the seeming failure of the noble Baroness, Lady Harding, and her operation—is the clear lack of communication about testing? I plead with the Minister not to treat the House to the mantra about the record number of tests and so on. It is completely clear, from MP’s postbags and the media, that “them out there” were under the impression that tests were more widely accessible than they in fact are. Lecturing us on how simple all this is both misses the point and is dangerous.
As far as schools are concerned, I asked a headmaster how things were going. He said: “If they ran a school the way they are running the country, what Ofsted grade would they put on their self-evaluation form?” I thought that was quite a good question. The tone of the Secretary of State and the Prime Minister in their Statements rather gave the impression that the Government were blaming people for breaking the rules and allowing the virus to grow. The reality is that people have done everything that they were asked to do. They have missed birthday celebrations, weddings and funerals; they have, quite rightly, sent their children back to school; they have gone back to their workplace. They have done what they were asked to do. In return, Ministers were supposed to fix test, trace and isolate so that we could return to something like normality.
The mayor of Tower Hamlets, John Biggs, said:
“With cases rising the government is right to bring in stricter restrictions to prevent the transmission of COVID-19. In Tower Hamlets we need to keep each other safe by following these new rules”.
He added:
“Government also needs to ensure adequate testing is available and that there’s continued support for those losing out financially due to these restrictions. The next few months will continue to be challenging—as a community we’ll remain resilient and together can get through this”.
He puts the case extremely well.
The Cabinet Office Minister, Michael Gove, said the 10 pm curfew on pubs in England has been brought in after evidence from places such as Bolton, where the curfew has already been in place for two weeks, suggested it will drive down coronavirus infection rates. However, according to the latest figures released by Public Health England, the infection rate in Bolton has risen again. Does the Minister share my concern that the new regulations may be based on poor evidence? Will the Government review this decision and immediately publish the evidence to allow it to be scrutinised in peer review?
Why is that 10 pm curfew not on all sales of alcohol? For example, you get thrown out of the pub at 10 pm with five of your mates; you go to the off-licence, buy whatever you want and go to somebody’s home. I cannot see the evidence that this will make any difference. I would really like to know.
Returning to tests, can the Minister confirm that only half of all tests have been received in less than 24 hours and will he publish the Pillar 2 data which breaks down how many people asking for those tests were symptomatic and how many were asymptomatic? Many parents report going to walk-in centres with their sick children, when they had no symptoms, and being given a test. Was that a national policy? Has it been abandoned? This is further evidence of confusion.
I welcome what the Minister said about prioritising NHS staff, care workers and teachers, but can he clarify why he has issued guidance to hospital trusts placing restrictions on the number of tests they can carry out? Also, how he will protect care homes? In a previous exchange this afternoon between the Leader of the House and the Leader of the Opposition, my noble friend asked the noble Baroness about domiciliary care. I think she maybe did not understand what was being said—it might have been after a question from the Back Benches. Will people in domiciliary care, going from one home to another doing social care, be given PPE and will the tests available in care homes be available to them? I am trying to put it as simply as I can because it is a very important question.
Will the Minister ensure that no one is discharged into a care home without a Covid test? Given where the virus is, what is his advice to the shielding community? What protections is he putting in place for those from black, Asian and minority-ethnic communities, given that there are disproportionate numbers from those communities in intensive care units even today?
None of us wants to see another lockdown or circuit-break. We will understand if one becomes necessary, but test, trace and isolate should be fixed. The failure of that has left us vulnerable and exposed. It seems to me we must now act with speed to save lives and minimise harm.
My Lords, three months ago the Secretary of State said that test and trace was the single most important thing that had to be done to conquer the virus. Yesterday the Prime Minister said it had “little or nothing” to do with the transmission of the virus. These two things cannot both be right. For six months, the problem has been that we have had confused messages, careless use of statistics and a persistent refusal to work with and listen to people who run local public services and know what needs to be communicated to whom and how.
All those are the fundamental reasons we find ourselves in this situation. We still lack an effective and timely track, test and isolate system. In its place and without any evidence base behind them, we have come up with messages which, quite frankly, do not make sense to the general public. The rule of six does not make any practical sense at all, as was very well evidenced today by my noble friend Lord Newby in an earlier interaction with the Leader of the House.
Yesterday, the Prime Minister said the Government now had granular data that enabled them to understand the transmission of the virus. When will that evidence be released? And when will it be released to Members of this House and the other place, who, next week, are going to be asked to renew emergency powers the like of which have never been seen before to this Government? If the Government cannot come up with that evidence—and, I have to say, over the last six months, they have persistently failed to answer any kind of detailed question from Opposition Benches in this House—why on earth should they be trusted to have those powers renewed? When are we going to get the evidence base?
It is helpful, looking at the Secretary of State’s Statement, to see that finally, after repeated questions from these Benches and the Labour Benches, we have got a clearer statement on who is being prioritised for testing and in which area. But, as the noble Baroness, Lady Thornton, said, it is remarkable that there is nothing about black and minority ethnic communities, which we know are at greater risk, and nothing about the important people who work, for example, in domiciliary care, or who work in hospitals but are not medics.
I would like to ask one final question. When will they start listening to local authorities, who are persistently asking, in helpful ways, what they can do to expand the capacity for testing and to make sure that testing is better tied into the rest of the services? We are about to have an app launched, and local authorities are already telling us that there is soft intelligence that people who think they have symptoms but are unable to get a test just give up, and that people whose children are ill give up. It is all well and good for the noble Lord to say, as he did the other day, that they are going to completely redo NHS 111 to make it a more streamlined portal into the NHS, but if people have given up looking for tests long before they should, we are never going to get the data we need to get on top of this.
So I ask, as I did the other day: when they are revamping NHS 111, will they talk to the Royal College of Paediatrics and Child Health about the NHS 111 protocols? I agree with the noble Baroness, Lady Thornton; I think the public are desperate to do the right thing. They have been extraordinarily patient and have listened throughout, giving the Government the benefit of the doubt. But they will not go on doing that indefinitely while the Government continually fail to come up with a decent evidence base for their actions.
(4 years, 2 months ago)
Lords ChamberLike everyone here, I watched the briefing by the Chief Scientific Officer and the Chief Medical Officer today, and very sobering it was too. It was followed by a very informed discussion on the BBC. It feels that we are playing catch-up again, although I realise that that is almost inevitable. Today we have had another Statement since this one and I gather that the Prime Minister will make a further Statement tomorrow.
Last week, when we discussed the then Statement which was already three days old, I said that I thought that we had come to a critical moment when some very serious decisions would need to be taken, and clearly that was correct. The words “tipping point” and “perilous moment” were used in the Commons today during the debate on the Statement. As we have said all along, clarity of messaging is totally vital. The country has become increasingly confused about what people should do to protect themselves and those around them, so perhaps this break point is really important.
A few weeks ago, the Prime Minister was setting out his stall to review the outstanding restrictions and allow a more significant return to normality, possibly in time for Christmas. Now the Prime Minister has admitted that we face a further six months of very difficult lockdown restrictions while the CSO, Sir Patrick Vallance, said that the UK faces 50,000 Covid cases a day by mid-October if the current infection rate is not halted. My first question for the Minister is: are we now at level 4? I ask because the Joint Biosecurity Centre has recommended that the Covid-19 alert level for the UK should be increased to level 4, meaning that transmission of the virus is high or rising exponentially. It has been at level 3, meaning that the Covid-19 epidemic is in general circulation, for several months, but the Chief Medical Officers of England, Wales, Scotland and Northern Ireland said in a joint statement this evening:
“After a period of lower Covid cases and deaths, the numbers of cases are now rising rapidly and probably exponentially in significant parts of all four nations.”
Given that, are we going to move to level 4?
Can the Minister confirm that the Government intend to bring forward further restrictions in London? What are the next steps nationally? This morning, Chris Whitty, the CMO, said that people should
“break unnecessary links between households to stop coronavirus spreading out of control.”
Has the advice about return to work changed? Can the Minister confirm whether the reported two-week circuit-breaker lockdown is indeed going to happen?
It is deeply concerning that the Statement last Thursday contained scant reference to testing. As my right honourable friend the shadow health Secretary said, under this Government test and trace is actually trace a test. When will that be resolved? Giving evidence to the Science and Technology Committee on Thursday, the noble Baroness, Lady Harding, told MPs:
“I do not think anybody expected to see the really sizeable increase in demand that we have seen over the course of the last few weeks.”
This is simply not true. Can the Minister confirm that SAGE warned the Government that the UK faced an inevitable increase in community transmission and cases after the summer and needed a fully functional and trusted test and trace system put in place?
I feel that I need to talk about the “moonshot”, because it is an emerging story on the i that the moonshot test for Covid-19 that will allow people to resume normal life will not be available on the NHS—as the Government’s testing tsar, the noble Baroness, Lady Harding, suggested. She said that individuals and companies would have to pay to access the proposed test and that it would not be part of the normal NHS test and tracing scheme that she heads, which will continue to concentrate on swab tests. So the question I need to ask the Minister is: are we now looking at an A and a B test and trace system or an A and B test system where people who can afford to pay for a test can get one immediately and those who cannot—the majority of us—will not?
Given these issues, tests now seem to be rationed, with health and social care prioritised. Could the Minister reflect on reports that care homes worst hit in the first wave could be tested for coronavirus less often, as the Government believe there will be higher levels of immunity and that they are less likely to pass on the virus? This is deeply worrying, given the high percentage of staff turnover and the vulnerability of residents.
Can the Minister confirm reports that evidence shows that 20% of people who have been told to self-isolate are still leaving their homes, and will that information be published? That is presumably what is leading to the much more aggressive fines. The Government say that the £10,000 maximum fine will act as a deterrent to testing positive and not self-isolating. Does the Minister share my concern that this actually may deter people with symptoms from getting a test at all? For many people, ignorance may also be the only legitimate option, as they are unable to get a test and self-isolation is financially non-viable.
The Minister will be aware that the Joint Committee on Human Rights said it was unacceptable that many thousands of people were receiving fixed-penalty notices despite evidence that the police do not fully understand their powers. They highlight enforcement as having a disproportionate impact on young men from black, Asian and minority ethnic backgrounds. Currently there is no way for people to challenge the fixed-penalty notices easily, so does the Minister share my concern that this will invariably lead to injustice, as members of the public who have been unfairly treated with a fixed-penalty notice have no means of redress?
It ought to be straightforward for a member of the public to find out what the current law is, nationally and in their local area, without having to trawl—as the rest of us are doing—through countless confusingly named regulations. Will the Government publish a website where people can enter their postcode and be told in plain English what restrictions currently apply where they live?
My Lords, I thank the Minister for dealing with this Statement, which comes hot on the news that we are at level 4 as regards the pandemic. Therefore, I want to touch on two or three points in this Statement. The first is the Government’s intention to invest £24 million in increasing call-handling capacity through NHS 111, to make it into a gateway to emergency care, providing the first port of call for patients. I must say to the Minister that it is a bit late to be doing that, and most of us should be somewhat alarmed at the news in the Statement that the Government intend to conduct pilots and will roll out NHS 111 First to all trusts from December. I understand the need to run pilots, but does he not think that time is against us?
On 17 September, six council leaders, cross-party, from across Yorkshire and Humber, wrote to the Minister. It is worth paying attention to what they said in their letter. They said: “It would be worth exploring the protocols and policies that might increase demand for what might be considered lower-value testing in a time of capacity constraint. This would include working with NHS 111 and reviewing their protocols. It seems that any childhood illness may result in a Covid test—that is what GPs are constantly telling us—while the Royal College of Paediatrics and Child Health have produced helpful guidance around that.” I ask the Minister if his department has seen that guidance and whether it will pay any attention to it.
Secondly, back to care homes and the ring of steel that never was. It is very welcome that there is going to be further investment in PPE and coverage for staff who have to take time off. However, there is a real danger in this, and there always has been, because social care is much more than care homes. Only 15% of people aged 85 or over are in a care home—most people who receive care are not. It is not uncommon for domiciliary care workers to visit 10 to 15 different homes in a shift. This Statement is silent on this matter which, given that the advisers are telling us they now know more about the transmission rate, is somewhat surprising. I wonder whether the Minister could talk about that.
The big issue in the last few days is the increasing confusion among members of the public as to who should be tested. Even in areas that are on the watchlist, people do not know whether they should be tested only if they are symptomatic or if they are asymptomatic. Some authorities have been given the power to do asymptomatic testing. Going back to that letter of 17 September, I note that the local authority says that it would be happy to have discussions locally but accepts the need for a co-ordinated approach with the Government. There needs to be a public discussion that provides urgently needed clarification from the department on how long these capacity issues are going to be around and what contingencies are going to be in place to manage them, particularly in high-risk areas.
This is not endless carping but a genuine concern for public health, and I therefore look forward to some detailed answers from the Minister.
(4 years, 2 months ago)
Lords ChamberFirst, I place on record our thanks to the teachers, head teachers, school staff, university and FE college staff and others making it possible for our children and young people to return to their education. I hope this will remain a top priority for the Government as we move through and, we hope, out of this pandemic. It has been wonderful to see my great-nieces and nephews and granddaughter joyfully going back to school in the last week. As a non-executive director of one London’s hospitals, which is in my record, I can testify to the huge amount of work going on preparing for the winter stresses.
But here we go again. We need to start by reflecting on why we do not have before us the incredibly important new Covid restrictions announced yesterday by the Secretary of State and the Prime Minister, which aim to deal with the new surge in coronavirus infections. In fact, the Statement has been made in the Commons in the last hour or so, and I suspect we will see it in due course at the beginning of next week. I accept that the hybrid nature of the House means that we will not be able to take it today, which might have helped us all enormously. It is not the Minister’s fault; it is just one of the casualties of the situation we find ourselves in. Perhaps, the noble Lord could confirm when the new regulations will be laid.
Yesterday, Mr Speaker said quite rightly in the Commons:
“It is really not good enough for the Government to make decisions of this kind in a way that shows insufficient regard to the importance of major policy announcements being made first to this House and to Members of this House wherever possible.”—[Official Report, Commons, 9/9/20; col. 619.]
The Secretary of State made a Statement about current Covid-19 issues on Tuesday and failed to mention major policy proposals of which he must have had prior knowledge and which were already being discussed on social media. Thus, he did not allow a discussion of the current proposals, which the Prime Minister then announced in a Downing Street press conference and a letter which noble Lords will have received overnight. This suggests that the omission was deliberate and reveals yet again the disregard with which the Minister and his colleagues hold their duty to be accountable to Parliament, which is undermining our democracy. If Mr Speaker follows through on his threat to allow Covid-19 UQs at the beginning of every day to ensure that the Secretary of State can and will report new policy and be accountable to Parliament, I assure the House I will be arguing to take every single one in this House every day, so that the Minister can do his bit for accountability, too.
We have a Statement before us, press announcements made and a new law of six, but I need to return to the question I asked yesterday about what has gone wrong with the testing system. I would be grateful if the noble Lord would engage with what look like widespread problems some people are having accessing tests, rather than repeating the mantra about the high proportion of successful tests close to home, which is accurate, I am sure, but not the way to solve a clearly growing number of problems. I know the Minister will not shout at me, as his right honourable friend did to Keir Starmer yesterday, or accuse me of undermining the whole test and trace system when legitimate, evidenced problems are being articulated by many Members of Parliament and reasonable questions are being asked. The Minister needs to address the problem of the availability of tests.
Yesterday, I mentioned schools, where inevitably children will become ill. Parents are advised to keep them at home and get a test, and some are finding this impossible. Unsurprisingly, parents turn to teachers and head teachers for advice, placing even greater stress on our schools, which are working so hard to keep our children safe and educated. A reliable, rapid testing regime is vital, as we have said from the outset.
As for moonshot, which the Prime Minister mentioned in his letter, with his fondness for hyperbole, if the Government cannot even deliver testing for those ill with symptoms, how on earth are they going to deliver 10 million tests a day? I want to correct a statement the Secretary of State made in the Commons an hour or so ago, when he said to my honourable friend Jonathan Ashworth that the Labour Party was opposed to mass testing. That is absolutely not true. What we are against is incompetence. We are saying: how on earth will moonshots be delivered if basic testing is not working well?
The new regulations are meant to make it easier for people to understand. But does the noble Lord agree part of the confusion stems from the fact that some of these rules may be inconsistent with government messaging that people should return to work. Does he accept that, even where employers are taking necessary steps to facilitate social distancing, busy commuter trains, tubes and buses are not Covid-secure? On these Benches, we have said from the outset that one of the biggest barriers to self-quarantining would not be Covid fatigue but personal finances. Does the Minister accept that the Government need to go much further in helping people who need financial and housing support to self-isolate? Otherwise, how will we get on top of infections in areas characterised by low pay, child poverty and overcrowded housing?
Finally, to contact tracing: in Bolton, contacts were reached in only 57% of non-complex cases; in Oldham, 50%; in Blackburn 47%; and in Bradford, only 43%. Nationally, only 69.4% of contacts are reached and asked to self-isolate. These are Government’s latest statistics, and they make me wonder whether “world-beating” is yet another piece of hyperbole. On the effectiveness of testing, my colleague, the shadow Health Secretary, highlighted that only 69% of contacts were identified by the test and trace system, and I am afraid the noble Lord’s colleague Matt Hancock said he was wrong. He was right. I yet again have to ask the noble Lord—privately, if he wishes—to correct his boss’s record. More importantly, how can we improve on that record of testing and tracing?
My Lords, this is a Statement made two days ago in the other place, but it has been largely overshadowed by yesterday’s deluge of hyperbole and hokum. The Prime Minister said yesterday:
“We know, thanks to NHS Test and Trace, in granular detail, in a way that we did not earlier this year, about what is happening with this pandemic. We know the groups that are suffering, the extent of the infection rates, and we have been able, thanks to NHS Test and Trace, to do the local lockdowns that have been working.”—[Official Report, Commons, 9/9/20; col. 609.]
If that is true—and given the record of the Prime Minister and Health Secretary, one is always entitled to ask whether it is—how come local authorities and directors of public health are given only limited access to the test and trace case management system and not given full access to the contact system? Why are the Government sitting on data or passing it to companies run by their mates, instead of passing it to local authorities, which, for weeks, have been trying to predict and manage the inevitable spike in infections that follows people starting to travel and going to school and university. Why are they not getting that data in a timely manner?
From the start of this pandemic, experts advised the Secretary of State to invest in public health teams and NHS labs that are numerous and easily reached by many communities, including in rural areas. Instead, he gave the money to outsourcing firms such as Serco and G4S, which have no expertise and have not had to compete for the contracts. He could have invested in local public services; instead he has built a system on a foundation not fit for purpose. On Tuesday, in the Statement, the Secretary of State for Health said of care homes that
“we have met our target to provide testing kits to all the care homes for older people and people with dementia that have registered to get tests.”—[Official Report, Commons, 8/9/20; col. 517.]
But on Monday, the Government were forced to apologise for continuing delays to Covid-19 testing for care home bosses and GPs, who are threatening that these will lead to more infections among vulnerable people.
The Secretary of State’s own department, the Department of Health, admitted to breaking its promise to provide test outcomes within 72 hours. Care managers have described the Government’s centralised testing service as “chaotic” and “not coping”, amid reports that whole batches of tests are coming back not only late but also void. Testing officials told care homes by email on Monday morning that
“immediate action has been taken at the highest levels of the programme to bring results times back”
within 24 hours.
“We apologise unreservedly to … you … and your staff.”
The ring of steel that the Secretary of State claimed to have put around care homes never was. With upwards of 40,000 deaths, when will the Government sit down with care home providers, local authorities and CCGs to develop a comprehensive system of testing and supply of PPE? It does not have to be world beating; it just has to work.
The Prime Minister’s Statement yesterday would have been risible were the consequences not so serious. Most ludicrous of all was the announcement of a team of Covid-secure marshals to enforce the new laws on public gatherings. The Government could have done any number of things. They could have announced resources to enable the rehiring of retired public and environmental health professionals, since there is a shortage. They could have given funding to local community and voluntary groups to communicate ongoing health risks and the law to communities. They could have given additional funding for trained police officers to work with health officials and businesses to improve adherence to infection control. But, no, instead we got another vacuous attempt to steal the headlines. Maybe these marshals, with no training, no resources, no local management and no authority could join up with the 750,000 volunteers for the NHS and the trackers, and like them they could sit and twiddle their thumbs, waiting for the phone to ring.
One thing we can be sure of is that this is another stunt which will be an utter waste of time, money and resources. Local authorities, police forces, health authorities and schools are using their professional expertise and local knowledge to plan effective public health interventions. They are not only following the science but also using it to actively protect people in their authorities. In stark contrast, this Government ignore advice, misrepresent the science and carry on winging it, but the data on infections and the lack of reliable testing are evidence that the Prime Minister’s bumbling bombast and the Health Secretary’s growing litany of half-truths are indicators of world-beating incompetence and, sadly, people in black and minority ethnic communities and poor communities will suffer the consequences. It is time for the Government to change.
(4 years, 8 months ago)
Lords ChamberMy Lords, on behalf of these Benches, I thank the Minister for the way he has conducted the Bill. It has been a perfect exercise in consultation and work across the House. I thank not just the parties but other noble Lords who have taken part in this Bill for co-operating and working together in a way that has allowed us to scrutinise it as best we possibly could. I think we raised every issue that we could during its passage. It is important to have those things on the record because, as we move forward, we will need to know that we have asked those questions, and the Government will need to address them.
I thank my team, particularly my noble and learned friend Lord Falconer, who got drawn into this about a week ago, and my noble friend Lady Wheeler. I also thank the people in the office, who of course do all the work. In our case, that is Rhian Copple, who has done a brilliant job in keeping us informed and on the go.
I thank all my noble friends and noble Lords who are not here, but who gave us their views and have been patient. I know that they would have wanted to be here.
My Lords, from these Benches I too thank the Minister, the Bill team and all the civil servants who have worked with them for the collaborative and inclusive way that they have conducted the Bill through this House. I thank Members on other Benches for their immense understanding and patience as at times we have had to rattle through some very difficult issues that normally, in other circumstances, we would not have dealt with in that way.