Victims and Prisoners Bill

Debate between Baroness Thornton and Baroness Brinton

Report stage
Tuesday 21st May 2024 Lords Chamber

[Baroness Brinton (LD)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Royall, and the noble Lord, Lord Russell. I also thank Laura Richards, Claire Waxman—the Victims’ Commissioner for London —and the Suzy Lamplugh Trust for their consistently helpful briefings for us. I am very moved by the powerful examples that the noble Baroness gave us and I agree with everything that she and the noble Lord said.

I just want to reiterate the point that we as a group keep making, which is that the government arrangements often mean that stalkers are missed out. They are often mischarged with other crimes, such as harassment or malicious communication. It is common for the National Stalking Helpline to see high-risk stalking cases managed as low-level nuisance behaviours or even as isolated incidents, and as a result fewer perpetrators are convicted and even fewer sentenced to 12 months or less.

There are also some concerns. The Minister has told us that the Home Office domestic abuse and stalking perpetrator intervention fund for last year was made available for PCCs to commission services covering all forms of stalking, including non-DA. However, there were a disproportionate number of funds apportioned to DA-specific stalking services or even DA services that do not address stalking at all, or claim to address stalking but without any stalking expertise. Some 65% of awards in this grant were solely for domestic abuse interventions, with no stalking provision. The problem is that whatever we say here is not ending up on the front line, so can the Minister tell us how the Government propose to manage a more comprehensive approach for stalking perpetrators?

The Suzy Lamplugh Trust has provided plenty of evidence over the years, and indeed in its super-complaint, about how investing in perpetrator management saves money. It saves money because there is no constant repeat of crimes committed by these obsessed and manipulative stalkers, and it helps the state as well. On that basis, from these Benches we support the noble Baroness, Lady Royall, if she wishes to call a vote on these two amendments.

[Baroness Thornton (Lab)]

My Lords, I shall be brief. My name is on this amendment, and indeed, I spoke to similar amendments in Committee. It was a great pleasure to do so, but I regarded myself, as I said at the time, as a substitute for my noble friend Lady Royall, who indeed has the most tireless record of championing this cause and taking every opportunity to remedy the problem. We are presented with an opportunity here. Guidance is not working. That is the problem. We have to put these modest amendments into the Bill because we know that guidance is not working. It is not good enough, and it means that it is a postcode lottery as to whether action is taken in the way that is necessary, and it makes a hit and miss system for whether or not women’s lives are saved. That is not good enough. It is time. We need to put both these amendments in the Bill. We owe it to the victims of stalking to ensure that the police everywhere will see stalking for what it is: often a stepping stone to something worse. It is time we did that.

Victims and Prisoners Bill

Debate between Baroness Thornton and Baroness Brinton

Report stage
Tuesday 21st May 2024 Lords Chamber

[Baroness Brinton (LD)]

My Lords, from these Benches, and in the absence of the noble Lord, Lord German, I want to say that we have had a fascinating, amusing, witty, but actually very important debate. We on these Benches completely support everyone who has spoken so far. I know that there is no question of moving to a vote, but it is something that we fundamentally believe in.

[Baroness Thornton (Lab)]

My Lords, from these Benches I express irritation that we have these in the Bill at all. We have spent the last two or three months working across the House, improving and building a new framework for victims. It is, let us just say, very puzzling that these are in the Bill.

Victims and Prisoners Bill

Debate between Baroness Thornton and Baroness Brinton

Report stage
Tuesday 30th April 2024 Lords Chamber

[Baroness Brinton (LD)]

My Lords, it was an honour to sign this amendment and to join in some of the meetings with the noble Baroness, Lady Morgan, and colleagues and Stella Creasy. Other colleagues have already explained the progress that has been made. We are hoping to hear from the Minister shortly, but I just want to say that, should the noble Baroness, Lady Morgan, decide to call a vote, we on these Benches will support her. If she does not, we look forward to seeing an amendment at Third Reading.

[Baroness Thornton (Lab)]

My Lords, I am only going to congratulate the noble Baroness, Lady Morgan. I think she has shown huge patience and persistence. I am not surprised, because my honourable friend Stella Creasy has those qualities too. As the noble Baroness, Lady Brinton, said, should the Minister not satisfy the noble Baroness, Lady Morgan, we on these Benches are ready to support her in a Division.

Victims and Prisoners Bill

Debate between Baroness Thornton and Baroness Brinton

Report stage
Tuesday 23rd April 2024 Lords Chamber

[Baroness Brinton (LD)]

My Lords, my honourable friend Layla Moran laid an amendment about the ending of non-disclosure agreements that prevent victims disclosing information to the police or other services, including confidential support services, ensuring that they cannot be legally enforced. She has campaigned on this issue for some considerable time. She and I both thank the Minister for the progress in Amendment 76, which is undoubtedly a step in the right direction. It certainly will help some victims access the support they need, but we on these Benches regret that this is not enough to fully give victims their voice back. We still need a complete ban on the use of non-disclosure agreements in cases of sexual misconduct, harassment and bullying to ensure that no victim is ever silenced. We will campaign on this in future but appreciate the step forward that has been made in this Bill.

I have signed Amendments 87, 88, 89 and 94 from the noble Baroness, Lady Bertin. I also thank the Minister for the meetings, his Amendment 76 and what he said in introduction—I agree with the response by the noble Baroness, Lady Bertin. The noble Baroness, Lady Morgan of Cotes, talked about third-party data requests, and again it was a privilege to be involved in those meetings. I thank her for her comments and her remaining concerns. She is absolutely right that it does not take us further forward enough.

Finally, I signed Amendment 96 from the noble Baroness, Lady Meacher, on the immigration firewall. My noble friend Lady Hamwee was absolutely right: we have been here before. I was just thinking about amendments during the passage of the Illegal Migration Bill, the safety of Rwanda Bill and, I suspect, the Nationality and Borders Bill before that—yet we are not making progress. It is very unfortunate that the Government have gone backwards since the Modern Slavery Act in the protection of these particular victims. I know that across the House we will continue to push for ensuring that the loophole is closed.

[Baroness Thornton (Lab)]

My Lords, it is really a pleasure to respond to this group from these Benches, because there is real progress. It is important to record thanks to everybody who has made this progress happen. I very much welcome the clarification that the Minister has made in Amendment 76. The noble Baroness, Lady Brinton, is quite right, though, that this is a first step. Indeed, today a useful brief was sent to me and possibly other noble Lords from the Bar Council, which makes the point that the issue of non-disclosure agreements is ripe for legislative change. The Bar Council welcomes the Government’s intention to implement legislative reform and recognises that some NDAs are abusive in nature. NDAs cannot cover criminal acts, and under existing common-law protections many are already unenforceable, but those who are asked to sign them are not always aware of the relevant legal principles. When you have the Bar Council and everybody else on your side, you know that this is an important first step.

On the Government’s amendments, I welcome Amendment 85, as the noble Baroness, Lady Newlove, welcomed it. I thank the Minister and his team for listening and for bringing forward this amendment, which was aired in Committee very powerfully indeed by the noble Baronesses, Lady Watkins and Lady Newlove. Then, of course, there is a suite of amendments in the name of the noble Baroness, Lady Bertin. I was very pleased to be able to support these in Committee. These Benches are absolutely in favour of them; they have the support of the whole House. I know from the very long time ago when I was a Minister how much work goes into getting to this place. I congratulate the noble Baroness and say how much we are in favour of these amendments.

The noble Baroness, Lady Morgan, is absolutely right to be disappointed about the Government not accepting Amendments 87A and 88A. It is probably clear that we have not come to the end of this. The noble Baroness is quite right in nodding to say, “We have definitely not come to the end of this discussion about what needs to happen to support victims with requests for dealing with digital and other information, and providing the right kind of safeguards for them”.

The noble Baroness, Lady Meacher, is right, and she has our Benches’ support for her amendment. If there were to be a Division on this then it would be next week. Between now and then we need to look at what the Minister has said to see if we can push him a bit further than he has gone, and then maybe we could avoid that, but the noble Baroness needs to know that she has these Benches’ support, and probably that of the Liberal Democrats, if we need to take the issue further. All in all, we have made great progress.

Victims and Prisoners Bill

Debate between Baroness Thornton and Baroness Brinton

Committee stage
Monday 26th February 2024 Lords Chamber

[Baroness Brinton (LD)]

My Lords, the noble Baroness, Lady Fox, started her speech by talking about sex offenders changing their names frequently, and there is no doubt that this happens. I will come on to explain why I think that there is help in that. However, her amendment seems to be intending to strengthen identification of individuals on licence who have a different gender assignment from that given at birth. It implies a perceived need to know that person’s birth gender, legal gender and legal identity, and that they are relevant to the prevention of a sex crime. This is, as I think the noble Baroness is aware, highly contentious and a sensitive topic, with implications for the equality, dignity and fair treatment of transgender people.

His Majesty’s Prison Service estimates that there are approximately 2.9 transgender prisoners per 1,000 in custody. There were 281 prisoners living or presenting in a gender identity different from their birth sex as of 31 March last year. At the same time, the number of prisoners with a gender recognition certificate was only 13. HMPPS already has robust arrangements in place for identifying individuals who have undergone gender change at the point of entry to custody. That is because there are already rules inside prisons for making sure that there are no risks to the prison population—or indeed to those who have changed their gender, who sometimes are attacked as well.

Nevertheless, even if an individual somehow managed to slip through the net, establishing it would require staff checking the legal gender of every person convicted of a sex event who was released from prison—effectively trying to prove that they do not have a GRC by asking the gender recognition panel. Proposed new subsection 2 of the noble Baroness’s amendment is about the database recording absolutely everybody who has committed a sexual offence in their gender at birth. Data published on 31 December last year shows there were 14,152 people serving a sentence in prison for a sex offence. I wonder whether the Minister cares to hazard a guess at how much time would be spent if HMPPS and the GRC trawled through that lot. HMPPS is required to accurately record a person’s legal gender upon entry to custody, and the policy states that, where legal gender has not been confirmed, efforts to establish legal gender must be recorded separately when different—so both are still recorded.

Furthermore, I remember that during the course of the then Police, Crime, Sentencing and Courts Bill in 2021, the noble Baroness, Lady Williams, on behalf of the Government, said:

“There are no other instances across government where there is a mandatory requirement to record both a person’s sex as registered at birth as well as their acquired gender, if that is applicable. The Office for Statistics Regulation is clear that it is for each department to decide when and how it collects data, including data on both sex and gender.


We have already stated that we do not plan to require biological sex to be recorded across the criminal justice system in our response to a recent petition calling for the biological sex of violent and sexual offenders to be so recorded”.—[Official Report, 22/11/21; col. 724.]


Given that, and given the protections that the Prison Service must follow through with every transgender prisoner, I wonder if there is actually a real reason for the need for this amendment. I appreciate the tale that the noble Baroness, Lady Fox, gave us from the individual, but I am not sure that what she requires in this amendment would actually help the victim in this case.

[Baroness Thornton (Lab)]

My Lords, I echo the worry of the noble Baroness, Lady Brinton, about this, partly exactly because it may not solve the victim’s problem that the noble Baroness, Lady Fox, outlined in proposing this amendment. We have also talked a lot about the unevenness of the criminal justice system’s data collection and everything else; I wonder how on earth it would do this, to solve what is probably a very small problem—but a challenge, absolutely—and whether there may be another way of resolving it. I look forward to the Minister’s remarks.

Victims and Prisoners Bill

Debate between Baroness Thornton and Baroness Brinton

Committee stage
Tuesday 13th February 2024 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, in moving Amendment 122, I shall also speak to Amendment 123. I thank Justice and Inquest for the briefings they have given us about this issue. I hope the noble and learned Lord the Minister will be back with us at some point as the Bill proceeds, although the duo who have taken his place are doing a great job.

These amendments follow on from our debate at the end of the proceedings last week about victims of major incidents and how they should be treated. The amendments are about the fact that bereaved people and survivors in inquests and inquiries will have suffered serious harm but do not receive the same recognition from the Government as victims of crime, so are not entitled to the minimum level of support and services. Instead they are often expected to navigate complex legal processes, with little recognition of the harm they have suffered or the trauma they have faced.

Under Clause 2, the victims’ code in the criminal justice context would reflect the principles that victims

“(a) should be provided with information … (b) should be able to access services which support them … (c) should have the opportunity to make their views heard … (d) should be able to challenge decisions which have a direct impact on them”.

Applying these principles to the victims of major incidents and interested persons at inquests would have a significant, practical and symbolic benefit, consistent with the Government’s pledge to place victims at the heart of their response to public tragedies.

Extending the provisions of the victims’ code could be achieved by introducing a requirement in the Bill for the Secretary of State to issue a separate victims’ code relating specifically to victims in the context of inquests and inquiries. Such a code could be guided by the same principles and have the same weight and legal status as its criminal justice counterpart. Before drafting the code, the Secretary of State should be required to consult the survivors of major incidents and the bereaved. Further consultations should be required before any changes were made to the victims’ code or its provisions relating to victims in the inquests and inquiries context.

The Government could be invited to suggest their own way of achieving the proper support for victims of major incidents. These are probing amendments about the best way forward, and this may not be it. Inquest contends that

“affording victims of major incidents and Interested Persons entitlements under the Victims Code would represent a recognition of their status as victims of significant, and often wrongful, harm who should be treated in a manner that is dignified and promotes participation”.

I beg to move.

[Baroness Brinton (LD)]

My Lords, I thank the noble Baroness, Lady Thornton, for tabling these important amendments creating a code for victims of major incidents and the processes by which it should be laid before Parliament. At Second Reading, a number of noble Lords raised the problem in the Bill that faces victims who are not victims of a type of crime listed in Schedule 1 and relating only to the first part of the Bill. It is self-evident that the victims of major incidents are not all covered by crime, or sometimes criminality may not be evident for a long period after the incident. However, the consequences of these incidents are often life-changing and require the same sort of support that victims of serious crimes do.

It would be iniquitous if the victims of aircraft accidents, flooding disasters, stadium collapses and many others were not able to access the support of the relevant services via an advocate and agencies that they need. That is why amendments debated last week, as well as those today, make strong arguments for provision. The advocates also need to know what rights these victims have in major non-criminal incidents and which services to refer them to.

--- Later in debate ---

[Baroness Thornton (Lab)]

I wonder whether the code would cover the Hillsborough situation. It seems that the definition the noble Lord has just given would not cover that situation—one in which people may think that a crime was committed but nobody has ever been charged with a crime, and there were definitely a very large number of victims.

[Baroness Brinton (LD)]

I am grateful to the noble Lord for allowing me to intervene. The other point he has raised about the type of—if I can call it this— “victimhood” completely ignores the experience of the victim, the journey they have to make, and the services, which are so vital to the victims’ code. How can he explain that victims of major incidents that are not deemed to be a crime at the time would be able access those services in the same way? They are no less victims.

--- Later in debate ---

[Baroness Thornton (Lab)]

My Lords, in moving Amendment 124 I will speak to Amendments 125 and 128 in the name of my noble friend Lord Ponsonby. We are now, of course, continuing our discussion about major incidents and the role of the advocate.

The reason for Amendment 124 is that the press release introducing the standing advocate position states that the role will

“give victims a voice when decisions are made about the type of review or inquiry to be held into a disaster”.

However, there is no requirement in the Bill for the standing advocate to directly consider the views of victims of a major incident when advising the Secretary of State. The Bill provides for an individual other than the standing advocate to be appointed as the advocate in respect of a major incident. In these circumstances in particular, it is not clear from the Bill how and whether the views of victims will be communicated to either the standing advocate or the Secretary of State. That is the situation that Amendment 124 seeks to rectify. It would require the standing advocate to communicate directly to the Secretary of State the views of victims in relation to the type of review or inquiry to be held into the incident and their treatment by public authorities.

I turn now to Amendment 125. The Government have said that the appointment of advocates for individual major incidents will allow for expert insight from, for instance, community leaders who hold the confidence of victims. There is no requirement to consider the views of the community affected by the incident when deciding whether and who to appoint as a specialist advocate in relation to a specific incident. We appreciate that the need for rapid deployment of an advocate following a major incident—which noble Lords have been talking about already—may make it difficult to seek the views of victims before appointing an advocate in respect of that incident. However, once an advocate has been appointed, the Secretary of State should seek the views of victims as to whether to appoint an additional specialist advocate and who to appoint. This is what Amendment 125 in the name of my noble friend seeks to do.

Amendment 128 would require the Secretary of State to consider the views of the victims of an incident before making a decision to terminate the appointment of an advocate appointed in respect of that incident.

This suite of amendments strengthens the role of victims, which is what we are seeking to do in this Bill. I beg to move.

[Baroness Brinton (LD)]

My Lords, I thank the noble Lord, Lord Ponsonby, for laying these amendments and the noble Baroness, Lady Thornton, for introducing them. After the last group, we continue to delve into the role of standing advocates. Once again, the lack of a victims’ code for those major incidents not deemed to be criminal, or not obviously criminal, means that the voice of the victim may not be heard.

One would hope that any standing advocate would seek and relay to the Secretary of State the views of the victims, but it is not evident from the Bill as published exactly how that would happen. These amendments create the golden thread that ensures that a standing advocate must do that, and that the Secretary of State, before they terminate the appointment of an advocate, must consider the views of the victims of a major incident. For example, there might be a conflict of interest with a future Government who are unhappy about the direction in which a standing advocate is going. The standing advocate might think that what the victims are saying goes beyond what the Government had hoped, and there might be a push to remove the standing advocate. Under this amendment, the standing advocate would be able to produce the evidence brought to him or her from the victims to say why the matter should be taken seriously. At the moment, there is no such structure to do that.

Victims and Prisoners Bill

Debate between Baroness Thornton and Baroness Brinton

Committee stage
Monday 5th February 2024 Lords Chamber

[Baroness Brinton (LD)]

With the greatest respect to the noble Baroness, Lady Fox, and the noble Lord, Lord Jackson, who said he felt that the entire House was behind this amendment, it is important for them to know that some people disagree with it. Although I understand where the noble Baroness is coming from, it does not help the issue inside our refuges. The most urgent thing is to help women, regardless of their natal birth, if they have been assaulted and raped and need somewhere safe to go.

[Baroness Thornton (Lab)]

My Lords, I congratulate my noble friend Lord Foulkes on his suite of amendments. I am not surprised that he has tabled them; he is quite right that older people need particular support and help as victims of violence. We can imagine why that might be the case. It feels like we should not really have to say it, but it is the case, and this is an important suite of amendments, which I hope the Minister will invite to be part of the wider discussion that we will have about how different groups can be supported as victims as we move forward. That goes without saying.

I say to the noble Baroness, Lady Fox, that I am confident that the arrangements to be put in place will comply with the Equality Act 2010.

Victims and Prisoners Bill

Debate between Baroness Thornton and Baroness Brinton

Committee stage
Wednesday 31st January 2024 Lords Chamber

[Baroness Brinton (LD)]

My Lords, this is the first group of amendments which really gets into victims’ rights—not just what is expressed in the victims’ code, but ensuring that they can access it. The noble Baroness, Lady Gohir, started the group with the important issue of a victim’s right to challenge decisions, including but not only relating to multiple perpetrators. I thank her for that, because that and some of the cultural issues she raised are important in ensuring that victims’ services are tailored to victims’ needs and are not a tick-box exercise.

I thank Restorative Justice for All for its briefing, and all noble Lords who have spoken in this debate. I will not repeat it all, but we know that restorative justice is a well-established and evidence-based alternative that certainly does not let offenders off the hook; it is as difficult for offenders as it often is for the victims. Restorative Justice for All wrote to us because it is concerned about how long it has been since issues about the right to restorative justice were addressed. It goes back to an EU directive of 2012, yet there is still no absolute right available. That needs to be remedied.

Unfortunately, under this Bill there is no obligation for criminal justice agencies to inform harmed parties about restorative justice systems. When we come to later amendments, we will be fighting hard to ensure that that does become a requirement, because victims deserve no less. The other part of this group also talks about signposting of services. I am grateful to the noble and right reverend Lord, Lord Harris of Pentregarth, who believes that the perpetrators need restorative justice as much. The right reverend Prelate the Bishop of Manchester said that being told there is a code is a start, but much more is needed. I suspect that the Minister will try to say that having such a system would be expensive. However, we know that not having the alternative is even more expensive not just in terms of the consequences for victims’ lives, but for the criminal justice system, parole and stopping recidivism. Without restorative justice, all those costs will continue to pile on.

I do hope that the Minister will bring us some good news. I gently remind him that in the costings for this Bill we were reminded that Part 4, on prisoners, will cost around £0.5 billion, but only a very token amount is allocated for victims’ services. Perhaps that balance is not yet quite right.

[Baroness Thornton (Lab)]

My Lords, I agree with the noble Baroness, Lady Brinton, as I often do, that we are now digging into how this legislation can be improved for victims. I congratulate the noble Baroness, Lady Gohir, on raising the issue of the gap in proceedings whereby, if there are multiple perpetrators, some of whom are not charged and some of whom are, the victim does not have the right to challenge why people are not being charged. That clearly needs to be remedied, and I look forward to hearing the Minister’s suggestion.

Victims and Prisoners Bill

Debate between Baroness Thornton and Baroness Brinton

Committee stage
Wednesday 31st January 2024 Lords Chamber

[Baroness Brinton (LD)]

From these Benches, I will be extremely brief, because I agree with everything that has been said. I signed Amendments 27 and 29 in the name of the noble Baroness, Lady Chakrabarti, and I absolutely support the amendment from the noble Baroness, Lady Thornton, which my noble friend Lady Hamwee has also signed. We cannot have commissioners who are commissioners in name only. They need clear roles, responsibilities and powers, and clear limits to those powers. The problem at the moment is that they do not, so we support the amendments.

[Baroness Thornton (Lab)]

My Lords, the noble Baroness, Lady Newlove, said it right when she said that it is time to give the Victims’ Commissioner the statutory place and rights that are appropriate. That is exactly the point of this suite of amendments. They aim to do two things. One is to give the Victims’ Commissioner the right status to be able to get the right information and have the right relationships to make them most effective, but it is also placing duties on other organisations to co-operate with the Victims’ Commissioner. That is what this suite of amendments is about. That means that they are very important. They also reflect the powers that other commissioners have in this space.

We have a group of amendments which give the Victims’ Commissioner a statutory duty to review the operation of the victims’ code, placing a statutory duty on the Secretary of State to consult the commissioner when making any changes to the victims’ code or issuing any statutory guidance relating to it. The amendment refers to the duty of the Secretary of State to consider any representations in relation to the drafting of the victims’ code in consultation with the Attorney-General. Again, I thought, “Why do you have to say that?” But, actually, I think we have to.

Amendments 27 and 29 alter the procedure for amending the victims’ code to require formal consultation with the Commissioner for Victims and Witnesses—I did not think that was necessary either, but if we need to say that, then we do—and affirmative parliamentary procedures.

Amendment 28 refers to

“the duty on the Secretary of State to consult the Attorney General on any revisions”.

Amendment 35 refers to

“the Secretary of State’s duty to issue regulations on the information to be collected by PCCs at a local level”.

Amendment 43 also places a duty on the Secretary of State to

“issue regulations on the timing and format of the information”.

This is about relationships that the Victims’ Commissioner needs to have to do their job effectively—with the Attorney-General, with PCCs, with the agencies with which the commissioner has to work.

My amendment—again, you would not think it would be necessary, but it clearly is—states that there is a specific public authority duty

“to co-operate with the Commissioner in any way that the Commissioner considers necessary for the purposes of monitoring compliance with the victims’ code”.

If we do not give the Victims’ Commissioner the power to ensure that the code is being complied with, we are not taking victims seriously. If we do not do that, we do not place the right kind of duties on the Secretary of State. We also need to make sure that the way the Victims’ Commissioner works is joined up with all the different agencies that she—it has always been “she” so far—needs to have.

We are very keen on this group of amendments because it does those two things: it gives the Victims’ Commissioner power, and it places a duty on different parts of the state to provide, as the noble Baroness, Lady Newlove, said, formal parts of criminal justice infrastructure. This a powerful suite of amendments that I hope the Minister will agree to, and certainly will discuss with us as we move forward.

Procurement Bill [HL]

Debate between Baroness Thornton and Baroness Brinton

Committee stage
Monday 11th July 2022 Grand Committee

[Baroness Brinton (LD) [V]]

I apologise again to the Committee. I was just quoting the element of Amendment 534 that talks about “procurement rules” as meaning

“the requirements related to procurement set out in this Act or issued under the authority of this Act, and the health procurement rules referred to in section 108.”

While I was very grateful to the Minister for her explanations to my question on the first group of amendments, I am afraid that I do not think she answered the core question about the interface between this Bill and the provisions in Section 79 of the Health and Care Act.

I refer the Minister to his Amendment 528 to Clause 108 of this Bill which, because it was among the government amendments in the second group of amendments, was not moved or debated. It is important, however, because that amendment states

“If the procurement of goods or services by a relevant authority is regulated by health procurement rules, a Minister of the Crown may by regulations make provision for the purpose of disapplying any provision of this Act in relation to such procurement.”


I appreciate that that amendment makes an important link to the Health and Care Act, which both Ministers have pointed out to us that they are trying to do. However, it does not pick up the issues raised by a number of noble Lords, including me, about the problem that provisions in the Health and Care Act do not cover the entire NHS.

I am very grateful to the noble Baroness, Lady Noakes—and I look forward to hearing her introduction to her amendment—for picking up my concerns at the end of the first group. Her Amendment 534 would ensure a review by a Minister, including looking at the procurement provisions in the Health and Care Act. That would at least ensure that any emerging tensions and practical problems could be identified and published.

Having raised this, there are two fundamental questions that were not answered by the Minister’s letter, nor by the Minister earlier. First, why are the rules for NHS public spend—which, in 2018-19, was in excess of £70 billion—to be created by a statutory instrument without the same level of public scrutiny that this Bill is receiving and no guarantee of the same protections that this Bill is affording to public money being spent on public contracts? Secondly, I ask again exactly where is the interface between the Bill and the Act, given the gap in the Health and Care Act legislation that is covered by the Procurement Bill? I ask again whether it might be sensible to have a meeting for noble Lords interested in this particular and perhaps esoteric problem. It is vital that public procurement works across the board.

[Baroness Thornton (Lab)]

My Lords, I find myself being drawn into this Bill in all kinds of ways. I apologise for not speaking at Second Reading, but I was not able to do so. I declare interests as the founding chair and current patron of Social Enterprise UK and as a senior associate of Social Business International, which is an organisation concerned with social enterprises that contract with the public sector. Both of those positions are unpaid.

Over the 20-odd years I have been in your Lordships’ House, I have been involved in putting community interest companies on the statute book and, as a Minister, in the right to request for social enterprises and the Public Services (Social Value) Act. I will speak to Amendment 75B in my name but, because this is the first time I have spoken, I will say that there is a suite of amendments to this Bill that are all about social enterprise. They follow the introduction by the noble Baroness, Lady Neville-Rolfe, very well, because many of the problems are the same, although there are some huge social enterprises providing public services.

This amendment proposes a new clause for the Bill, which addresses market stewardship. The reason is that we are interested in how you give voice to the social value Act in this space; that is at the heart of this amendment. There is a policy background to this that the Government will recognise. The 2015 review of the social value Act carried out by Lord Young of Graffham found that

“where the Act is being used, it has a positive impact and that the variety … of organisations that support the Act is quite striking.”

In 2018, Her Majesty’s Government announced that all central government contracts would be evaluated on the basis of social value. In December 2020, a new social value model was published by the Cabinet Office, which was to cover all procurement by central government departments and bodies under its responsibility. In June 2021, the new national procurement policy statement required contracting authorities to consider how they could maximise social value in creating new businesses jobs and skills, improving supplier diversity and tackling climate change.

Less than seven months ago, in December 2021, in its response to the consultation in the Green Paper Transforming Public Procurement, the Cabinet Office promised that

“A procurement regime that is simple, flexible and takes greater account of social value can play a big role in contributing to the Government’s levelling-up goals.”


Her Majesty’s Government’s flagship levelling-up White Paper calls for greater use of social value yet, despite all this, social value is nowhere to be seen in this Bill. When it was in the Commons, the Minister for Brexit Opportunities and Government Efficiency was directly asked why social value was missing. He refused to even use the phrase “social value”.

That is a considerable disappointment because, over the last decade, a strong cross-party consensus has developed on the need for all public bodies to consider social value when making procurement decisions. Indeed, the social value Act was introduced by a Conservative Member of Parliament, championed in this place by a Liberal Democrat Peer and supported by Labour and the Green Party during its passage.

Health and Care Bill

Debate between Baroness Thornton and Baroness Brinton

Lords Hansard - Part 1 & Report stage
Monday 7th March 2022 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I echo the thanks of my noble friend Lord Sharkey to the Ministers and their officials for the very helpful discussions that we have had with them on reciprocal healthcare agreements. I also thank my noble friend for his persistence in leading on those discussions between Committee and Report on the two points of difference between us—the definition of reciprocal healthcare, with our concerns about the ability to create a privatisation of parts of healthcare, and that an SI under a negative resolution is not strong enough for Parliament to scrutinise properly. My noble friend’s amendments are, as he said, very specifically aimed at removing these concerns, and I look forward to the Minister’s response.

I also particularly thank Ministers for understanding that the House was deeply unhappy with the original proposals for regulations via a negative resolution. I hope to hear that Ministers will now agree to the affirmative resolution proposed in the amendment of my noble friend Lord Sharkey. Scrutiny by Parliament needs to be timely, and Parliament needs to be allowed to effectively challenge proposals about which it has concerns.

[Baroness Thornton (Lab)]

My Lords, it is a great pleasure to speak about reciprocal healthcare, which is not how I felt several years when we dealt with this exact issue in your Lordships’ House, as many noble Lords might remember. It was with some trepidation that I and these Benches looked at this part of the Bill, because we were so concerned and had to do so much work to protect our NHS in the passage of the 2019 Act.

I am very grateful to the Minister and the Bill team for engaging with us so thoroughly to take on the board our concerns, which needed to be built into this part of the Bill. I say particularly how impressed I am by the noble Lord, Lord Sharkey, and how grateful I am to him for his understanding and persistence—and his ability to read long, complex documents, understand them and then translate them so that other people can understand them too. That is a great talent.

From these Benches, with the idea that the affirmative resolution will be agreed, we are very happy indeed.

Covid-19 Update

Debate between Baroness Thornton and Baroness Brinton

Wednesday 8th December 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for reading the Statement tonight. On this side of the House, we have always put public health first at every point during this pandemic, so I repeat the words of my honourable friend Wes Streeting, shadow Secretary of State for Health and Social Care, in the Commons an hour ago, when he said

“I want to be clear with the House and the country that Labour will support these measures in the national interest.”

Of course, we know that this decision is not taken lightly. Restrictions impact on people’s lives, livelihoods and liberties and we do not take those for granted on this side of the House.

Everyone wants to be able to enjoy Christmas safely this year, given the trauma of last winter. But the omicron variant is a clear threat, as the Minister has explained, and clearly swift action is needed to limit its spread. I want to ask the Minister a question I have not asked for some time in your Lordships’ House: what is the R number today and what is it predicted to be in two weeks’ time?

On these Benches, we have said that scrapping the guidance on mask wearing was a mistake and have consistently called for masks to be worn in indoor hospitality settings too. We welcome the Government’s reintroduction of that measure, if that is what the Minister said. I seek some clarification on what is actually going to happen; I am not sure I understand the difference between an attraction and hospitality, so could the Minister go into some detail about what will happen in our pubs and restaurants—or will they continue as they are?

The House may remember that we have said that people should have the flexibility to work from home, so we welcome the updated guidance on that. On vaccine passports, I am glad that the Government have listened and responded following their previously abandoned plans to require vaccination status only, and that presenting a negative test will be an option. Can I ask for clarification about whether vaccine passports will be required for access to essential services?

The Minister is correct to say that the greatest tool against the pandemic remains vaccination. How do the Government plan to speed up the booster rollout, which is certainly not hitting the target of 500,000 vaccines a day and is not on track to get everybody boosted by the end of January?

Public health depends and relies on people’s willingness to comply with rules that affect their lives, livelihoods and liberties, and which, in return, relies on confidence in the people making those rules. The damage the Government have done to public compliance with the rules that have governed our lives during the pandemic is very serious indeed. We had the Cummings eye test—that seems like years ago—the former Health Secretary’s tryst with his special adviser, the former Education Secretary’s private party, the Prime Minister attempting to get out of having to isolate, and now the footage of his staff laughing on camera and joking about breaking the rules at a No. 10 Christmas party.

It is hard to overstate how this makes people feel when they have followed the rules and complied, sometimes at enormous personal cost—the businesses that were forced to close; the family weddings that were postponed; the chance to say goodbye to loved ones at funerals that we missed; and the NHS workers, educators and key workers who risked their own health to get us through the pandemic before vaccines and treatments arrived. The headline we saw today is why the laughter in the video from Downing Street is so stomach-turning; it feels as if they are laughing at us.

It is not just that they clearly feel that there is one rule for them and one for everyone else, infuriating though that is; it is the actions of the Prime Minister, which have undermined public trust and distracted from key public messaging at a critical time. This comes from the very top of our country. The problem is that we have a Prime Minister who does not believe the rules apply to him—his own conduct says that—and who also finds it almost impossible to own up, take responsibility and admit that he might have been wrong. The Minister needs to explain to the House how the Government will overcome that.

I was very pleased to hear the news that three doses of the Pfizer/BioNTech vaccine appear to neutralise the new omicron variant, according to preliminary studies; this is very good news indeed. However, it underlines that we have to get more jabs in arms if we are going to make that at all effective.

How will the Government support the people who cannot work from home and who need to continue to go to their workplace? As we know, millions of people who we depend on every day to keep our nation running have continued to go to work throughout the pandemic.

Will the Government set a deadline by which they expect all children to receive their first dose of the vaccine? Will they be able to get them vaccinated over the Christmas period? What are the Government doing to drive up vaccination in areas where there has been low take-up? Are they offering additional support ahead of the winter?

We have discussed in the Chamber before that many critically ill NHS Covid patients are unvaccinated pregnant women. Why is there only one mention of pregnant women in the Government’s COVID-19 Response: Autumn and Winter Plan 2021? In the Whittington Hospital, of which I am a non-executive director, we have set up a room for pregnant women to deal with the issues they may have about vaccination. The Minister might look at that as one of the ways of dealing with this.

Finally, do the Government accept that, if they have not done enough to drive down infection rates by improving ventilation in public buildings such as schools, they must institute a programme of investment in ventilation in schools? This pandemic is clearly a long way from being over and we need our children to be protected.

[Baroness Brinton (LD) [V]]

My Lords, I thank the Minister for repeating the Statement. The chaos to even get it heard in the Commons and the very late notice on whether we were having this or Monday’s Statement sum up the chaos that the Government find themselves in.

As the noble Baroness, Lady Thornton, outlined, the Government have once again lost the trust of the public. My first question is: how on earth will Ministers persuade people to follow these new, very important restrictions, with the chaos going on at the moment?

We understand that restrictions are disappointing but, from these Benches, we have always said we want people to remain safe. As for these proposals, we have said before and say again that we think the Government are once again late to move to plan B.

I note that the arrangements will remain until 5 January and that there is a sunset clause of 26 January. Please can we debate the regulations before they expire—preferably next week, before we rise for Christmas?

Today, there are 131 new cases of omicron, a rise of a third in one day, taking the UK to nearly 600 cases. This confirms that the doubling rate is between two and three days. Scientists are talking about an R rate of between 2 and 4 and it is also following the same rapid transmission trajectory seen in many other countries. Unfortunately, in the last 48 hours, we have seen that South Africa is now showing increasing hospital and critical care bed admissions, showing that, even if there is less likelihood of serious disease, there is still some serious disease.

Ministers are right to be concerned about superspreader events, which are being reported all over Europe. Assuming that doubling continues at this rate and with a million cases possibly by the end of the year, that is very worrying, as is the news of the lower immunity against omicron from the vaccine compared to delta.

Just this afternoon, Antonio Conte, head coach of Tottenham Hotspur, reported that eight of his first team members and five members of staff have tested positive ahead of a big European game. He said:

“The situation makes me very upset … It’s contagious and there is a big infection.”


He is right.

The Statement does not mention that there is a higher percentage of young children both contracting omicron and going into hospital in South Africa. What arrangements are being made to ensure that parents recognise that and understand the different symptoms that young children have?

From these Benches we have been urging the Government to move ahead with plan B since cases started rising steadily in September. Today, all cases—of whichever variant—still number over 51,000, with a further 161 deaths. It is vital that we make sure that those numbers do not go up.

Face masks are vital, especially with increased transmission. But do I understand the Minister to say that singing, which we already know is high risk for transmission, will be exempt? On what medical grounds is that sound? I understand that hospitality has exemptions too. Is this taking us back to when you could take your mask off if you were sitting at a table and eating, but had to wear one when you were moving around a pub, bar or restaurant?

Ventilation is vital. Can the Minister say how many schools have received the air filters they were promised a year ago?

I notice that we are moving now to lateral flow tests rather than isolation. Can the Minister say what the current percentage of false negatives is for lateral flow tests and how that is going to be managed?

It makes sense to follow both Scotland and Wales in asking people to work from home if they can. How is that likely to affect the working arrangements on the Parliamentary Estate, including your Lordships’ House? In particular, and as a minimum, should the House consider returning to remote voting to avoid noble Lords mixing together in large numbers? We know we have a large number of votes over the next few weeks.

There are also a large number of notable omissions from this Statement. The first is the difficult issue of social care and support for those in homes, or housebound, as well as the staff who look after them. I see that the Statement says that there will be information to follow.

The second is the lack of mention of the Covid app. Given that many people are saying that their third dose or booster dose information is still not being recorded properly, can the Minister say if these difficulties have been resolved? The consequences of having to have Covid certification will affect people from Friday.

Thirdly, there is not one word about the clinically extremely vulnerable: that is 3.7 million people, of whom 800,000 are severely clinically extremely vulnerable. Most of the larger group should have had their booster jabs by now, and should be reasonably protected, but can the Minister say yet if that is true of omicron, especially as no one will have had three doses of Pfizer?

I thank the Minister for arranging our meeting next week to discuss the problems that the severely clinically extremely vulnerable are facing. Doctors are already telling this group that they will have a less good and shorter-lived response—if any—to vaccines. Is there any data on vaccinations for this group and omicron?

Other problems remain, as the Minister will have seen from the responses to my tweet this morning. Many people are still finding that their GPs do not know they should have a third dose, because there is no register and their hospital consultants have not had time to write to every patient’s GP. The NHS app still is not recognising third doses. GPs are not sure if it should be eight weeks or 12 weeks between the third dose and the booster.

While the news about the antivirals and retrovirals is good, most CEV people do not want to catch Covid. So above all, following this Statement, where is the specific guidance to both groups who are alarmed by the high number of delta cases, the growing number of omicron cases, and the marked reluctance of people generally to follow mask guidance. This is not a “nice to have”. This is 5% of the population who risk severe disease or dying from Covid. Please can the Minister agree to advise this group in the same way that there will be advice for the social care sector?

Covid-19 Update

Debate between Baroness Thornton and Baroness Brinton

Monday 29th November 2021 Lords Chamber

[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.

Covid-19 Update

Debate between Baroness Thornton and Baroness Brinton

Wednesday 10th November 2021 Lords Chamber

[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?

Covid-19 Vaccinations

Debate between Baroness Thornton and Baroness Brinton

Monday 8th November 2021 Lords Chamber

[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?

Covid-19

Debate between Baroness Thornton and Baroness Brinton

Wednesday 15th September 2021 Lords Chamber

[Baroness Thornton (Lab)]

Normally, of course, we would have taken these Statements separately but on this occasion, we can take them together. I hope we are working towards taking Statements on the day they are made in the Commons wherever possible.

I looked back at this week in 2020. This time last year, the Prime Minister introduced the rule of six—and really confused the nation. Covid marshals were introduced and the offence of mingling appeared on the statute book. We had infection rates rising, from the young to the middle-aged, and we were very concerned that that meant that they would move into the older cohort of the population. I of course acknowledge that vaccine and testing regimes have made a huge difference, but the lesson we need to learn from last year, and which is signalled in the recent SAGE report, is the need to take action in a timely fashion—which, I am afraid, the Government failed to do from time to time last year.

On Monday, we had confirmation of the vaccine programme for children, and we on these Benches welcome that and support the decision and recommendation of the CMO. Children may not have been the face of this crisis, but they have certainly been among its biggest victims. Yesterday, the Secretary of State also confirmed a booster jab and again, we on these Benches welcome and support that. The obvious question is: how will all this be done? In addition to the issues of our young people, booster jabs and the flu vaccine, we have areas of the country where vaccine take-up remains relatively low. For example, in Bradford, where I am from, second doses are running at 65%; in Wolverhampton, 65%; in Burnley, 69%; and in Leicester, 61%. The first question has to be: what support will be given to those areas and others so that they can boost their vaccine take-up?

Can the Minister explain to the House what the next stage in the children’s vaccination programme will look like and by what date he anticipates that children will be vaccinated? Will it be the responsibility of parents to arrange their children’s vaccination, or will the local NHS arrange it with schools, year by year, or class by class? Will the flu vaccine, which is this year being expanded to secondary schoolchildren, be delivered at the same time as the Covid vaccine or separately? Can the Minister explain what steps will be taken to ensure that parents are informed of the benefits and risks of the vaccination? Can he confirm the Government’s position in rolling out the vaccine and whether the consent of parents will be necessary, because surely the Gillick principle will come into play here? Can the Minister explain why, 470 days since SAGE warned about the importance of ventilation in schools and colleges, it looks as though not a huge amount of action has been taken?

Yesterday, in Grand Committee, I raised the issue of anti-vaxxers demonstrating outside our secondary schools. Given the creation of safety zones around hospitals to prevent harassment and bullying from anti-vaxxers and ensure the safety of our healthcare workers, patients and their caregivers, what will we do about our schools? Can the Minister confirm that the duty of schools, their leaders and the Government is to protect vulnerable children from any form of intimidation or demonstration at their school gates? What is his view of this matter?

Despite the success of the vaccine rollout, the delta variant continues to pose a considerable threat to people. Those who are sick with the delta Covid variant are twice as likely to need hospital care as those who contract the alpha variant. Of course, the UK has not yet experienced delta in the winter. The Government have acknowledged that there is a “plausible” risk of cases rising to an extent that would place the NHS under “unsustainable pressure”. Can the Minister advise the House at what point different measures in the plan will therefore be introduced?

The Government—and, indeed, the scientists—note that

“the epidemic is entering a period of uncertainty … It will take several weeks to be able to fully understand the impact of any such changes.”

In its report, SAGE stressed the “importance of acting early” if cases rise to stop the epidemic growing. It warned:

“Early, ‘low-cost’ interventions may forestall need for more disruptive measures and avoid an unacceptable level of hospitalisations … Late action is likely to require harder measures.”


Given that deaths are currently five times what they were a year ago, with hospitalisations four times as high, why are the Government not already pursuing light-touch measures, such as mandatory masks? The CSA, Patrick Vallance, said that the UK is now at a “pivot point” where, if the situation worsens, it could do so rapidly—so would light-touch measures not be prudent?

The Autumn and Winter Plan states that the Government want

“to sustain the progress made and prepare the country for future challenges … by … Identifying and isolating positive cases to limit transmission”.

Yet the Health Secretary said that no decision has yet been taken as to whether pupils in England will continue to undergo regular testing. Does the Minister share my concern that ending regular testing for pupils is contrary to that key plank in the winter plan?

Although we are still waiting to hear what changes will be made to Covid travel rules, the Health Secretary implied that PCR tests for fully vaccinated travellers will be replaced with lateral flow tests. What will this mean in terms of possible delays in identifying cases involving variants of interest or concern to the UK?

The Health Secretary also confirmed that, although the plans for mandatory vaccine-only Covid-status certification have been shelved for now, the Government may well pursue them in future under the plan B scenario. Can the Minister provide further details about which settings and scenarios will be involved? Can he confirm whether this will require primary legislation?

[Baroness Brinton (LD) [V]]

My Lords, the publication of the 33-page Covid Autumn and Winter Plan, including plans A and B, rightly talks about the need to resume life as normally as is possible while Covid is still around, but to move into restrictions faster if cases surge and the NHS is pressured. The World Health Organization’s special envoy on Covid, Dr David Nabarro, has said that the UK is right to find a way to live with the virus. However, he added:

“Speed is of the essence. We’ve been through this before and we know, as a result of past experience, that acting quickly and acting quite robustly is the way you get on top of this virus, then life can go on. Whereas if you’re a bit slower, then it can build up and become very heavy and hospitals fill up, and then you have to take all sorts of emergency action.”


Why does the Statement talk about the vital importance of mitigations, such as meeting outdoors where possible, ensuring ventilation if inside and wearing face coverings? Why are there no clearer, repeated messages for the general public about all these vital interventions, especially what we can all do now to slow down the increase in cases and hospital admissions?

At the No. 10 press conference on Monday, Professor Chris Whitty said:

“Anybody who believes that the big risk of Covid is all in the past and it’s too late to make a difference has not understood where we are going to head as we go into autumn and winter.”


He is right to be concerned. The seven-day rolling figure for daily hospital admissions is now around 1,000, with an average of 8,400 Covid patients in hospital beds. These numbers are considerably greater than they were this time last year. SAGE is very concerned that, as rules are further relaxed and people start coming back into work, the number of Covid patients going into hospital is set to increase substantially. This would put the NHS under real pressure, with perhaps as many as 7,000 admissions a day in six or so weeks, so it says.

The Statement announces the final decision on the booster scheme for those aged over 50, healthcare staff and the clinically extremely vulnerable, following the third dose for the half a million people who are severely clinically vulnerable. We welcome this. However, the World Health Organization reminded us that we should also be providing doses for low-income countries, but I see that the Government are planning only 100 million doses over the next few months. That is a drop in the ocean given that only 2% of the populations of low-income countries have been vaccinated. Will the Government agree to review and increase this number?

We on these Benches welcome the news on 12 to 15 year-olds getting vaccines. We accept that this was a difficult and complex decision, but we are pleased that there finally is one. There was an excellent slot on the “Today” programme this morning, with a group of 12 year-olds asking a paediatrician some questions; he had to look one answer up on Google. I hope that all parents and children will be able to access this sort of information because we know that it makes all the difference in coming to a decision.

However, as the noble Baroness, Lady Thornton, said, anti-vaxxers are causing serious problems. Good on Chris Whitty for what he said about one celebrity who attacked the idea of 12 to 15 year-olds having vaccines. However, today, yet another celebrity attacked him on social media, saying that he should be hanged. That is disgraceful. What are the Government doing about public servants like Professor Whitty being threatened in this way? As importantly, what will the Government do about the disinformation that people are now spreading at school gates, including leaflets with the NHS logo on them?

Ten days ago, Dr Jenny Harries announced that all clinically extremely vulnerable children in England—even those still on chemotherapy—would be removed from the CEV list and expected to return to school as term was starting, regardless of their underlying condition or the fact that there are no masks, bubbles or even, in many schools, proper ventilation. Although it is really important to have all children back in school, this cohort of children is at particular risk. Their consultants and GPs are as bemused as their parents, so why is Jenny Harries’s letter to the parents of these children, explaining why they are being removed from the CEV list, not on either the NHS or UKHSA website? Will the Minister write to me to explain this decision? We are hearing confusion from parents and medics alike.

Finally, last week, I commented on the continuing farce of Ministers U-turning daily on the use of vaccine passports for clubs. It is confusing to keep up with the U-turns on U-turns; I note that the Statement is trying to have it both ways. I suspect that Ministers could do with some new flip-flops.

NHS Update

Debate between Baroness Thornton and Baroness Brinton

Thursday 22nd July 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I first record from these Benches our thanks for the hard work of the noble Baroness, Lady Penn, who has gone on maternity leave. We wish her and her baby all the very best for the future. Also, adding to the words of the Government Chief Whip, I thank the clerks, the virtual technicians, the managers and all our staff, for keeping the show on the road and for keeping us safe throughout this year. I particularly echo his words about their patience with us. We have continued to do our job and could only have done so with the support of these dedicated teams. I also thank the Lord Speaker, his predecessor, and Members of all those Committees that have been in almost permanent session this year, for guiding us through.

This is the last repeat Statement before the summer—I think this may be number 50; the Minister will know. We have three matters to deal with today: the somewhat puzzling Statement made in the Commons yesterday afternoon, the Written Statement from the Secretary of State which announced the results of the NHS pay review and—I have given the Minister notice—I will also address some of the issues raised in the Covid update given in the Commons this morning.

The Statement made by Helen Whately yesterday was an odd moment. We of course join her and the Minister in thanking Sir Simon Stevens for all his work in the NHS—he has also taken up his place in your Lordships’ House. We also join others in welcoming progress on the autism strategy, which the honourable lady talked about in her speech; although, in due course I will seek the views of the organisations who are experts in this area. However, the honourable lady gave what can only be described as a parliamentary doorstep clap for the NHS and its staff. Welcome though that might be, it does not pay the bills or provide the respect that this Government owe to our NHS staff.

The Statement was followed within hours by a Written Ministerial Statement outlining the NHS pay award. This is not a respectful way to treat Parliament or our NHS staff. As my honourable friend Dr Rosena Allin-Khan said yesterday, once again the Government have had to roll back on a shoddy, ill-thought-through position, with their 1% pay rise—a real-terms pay cut —rejected by the independent pay body. Less than an hour before, there were competing briefings on what the deal was to be and, at that moment, it turned out to be nothing. Our NHS staff deserve better than this. My honourable friend invited the Minister in the other place to shadow her in the A&E department where she has worked shifts throughout the pandemic. I suggest that she takes her up on that offer, and that the Minister here might do the same.

My right honourable friend John Ashworth has said:

“Ministers were dragged kicking & screaming to 3% for NHS staff. But after years of cuts & rising pressures, NHS staff will feel let down & disappointed especially after today’s chaos. And where is the pay rise for junior docs? Where is a fair pay rise for care workers?”


It really was not worthy of a Government. We had chaos and confusion, with the Government once again rowing back on their position. Does the Minister agree that the pay review body has done what Ministers could not and would not do in recognising that our NHS staff absolutely could not be given a pay cut? Does he accept that, after last year, this is not enough?

Does he accept that this is not an NHS-wide pay settlement? It does not cover all the health and care workforce, who do not fall under this pay review body, and it does not cover junior doctors—I declare an interest, as two are nephews of mine, both of whom were redeployed during the pandemic. We know that our junior doctors have been put on the front line, caring for sick patients, and redeployed across an understaffed, pressured NHS, and that their training has been disrupted. Will the junior doctors get a pay rise? Will all health staff employed in public health receive the settlement? Again, when we know absolutely the value of care workers, why do the Government not guarantee a real living wage for those working in social care?

How will this pay settlement be funded? NHS trusts do not even know what their budget is beyond September, and NHS employers pointed out that this settlement will cost the best part of £2 billion, so where is that coming from? Is the Minister expecting trusts to find it from their existing budgets? These Benches keep repeating this question: the Government seem not to appreciate how central this is to stopping the spread of the virus, so when will they address support for low-paid workers who have to self-isolate?

I posed many of the immediate questions yesterday to the Minister. Sometimes I felt enlightened by his answers and sometimes I did not, but the one I wish to go back to concerns the Government’s plans for September. Are they ready to reimpose safeguards? Will our schools get filtration units over the summer so that we can feel that our children will be safer? Will our teenagers be vaccinated so that, next year, this cohort can do a full year of learning without being sent home in their millions?

[Baroness Brinton (LD) [V]]

My Lords, I echo the thanks to all the staff who have made a hybrid Parliament work over the last year especially, from these Benches, to the health team, because of the high workload of health and Covid business. I also repeat the good wishes to the noble Baroness, Lady Penn, as she starts her maternity leave.

Along with colleagues in the Commons, I am unconvinced that the first half of this Statement was planned to be delivered by the Minister yesterday. In the bizarre events of this week, of Covid restrictions being lifted, a rush of announcements—Monday’s, and today’s on vaccine passports—U-turns, and No. 10 contradicting Ministers, this Statement is definitely filed under “Y” for “You couldn’t make it up”.

Yesterday morning, the press were briefed and opposition politicians heard on the parliamentary grapevine that the NHS staff pay rise would be announced in the Statement. Even Sky News and the BBC news channel were saying that there would be an announcement on NHS pay in the Commons yesterday afternoon. Yet, when the Minister stood up, there was not one word about the pay award, just an end-of-term report and a much-deserved paeon of praise about how wonderful our NHS staff are—they are, and they deserve that praise. However, an extraordinary line in the Statement says:

“But I can assure those hardworking nurses: you should feel it soon”.


Well, they did. Four hours after that Statement, a Written Ministerial Statement and a press release were slipped out, bypassing parliamentary scrutiny, presumably in the hope that it would not be spotted. NHS staff, especially junior doctors and nurses, are appalled. I am not sure this is what the Minister meant by

“you should feel it soon”.

However, it gets worse. This morning’s Times says that the 3% NHS staff pay rise will be funded by robbing the expected increase in national insurance contributions reserved for the social care proposals leaked earlier this week by the Government. That is an absolute disgrace, especially given the appalling way that No. 10 has handled the social care reform proposals. After the Queen’s Speech, Ministers told us that it would be this autumn. Last week, they suddenly said that there would be an announcement this week but, this week, they have thrown the proposals back into the long grass, with a promise—again—of later this autumn, two years after the PM promised us, on the steps on No. 10, that this was his absolute priority. His actions are showing otherwise.

I know that the Minister understands that social care needs urgent reform and that it has borne the brunt of the first year of the pandemic. Can he confirm the Times story about the funding of the NHS pay rise and whether this decision was made by the Secretary of State for Health and Social Care or by the Chancellor of the Exchequer? Can he also say when the full proposals for social care will now be published, including the funding arrangements?

Moving to the only substance of this Statement, the autism strategy, we on these Benches also pay our respects to the late Dame Cheryl Gillan MP, who was such an advocate for those with autism. Peter Wharmby, the autistic writer, speaker and tutor, says that the autism strategy sets its targets very low in saying:

“Moreover, we have been able to transform society’s awareness of autism, as … 99.5% of the public have heard of autism … which is so important in autistic people being able to feel included as part of their community.”


Peter Wharmby is right. Much of the strategy talks about continuing as usual, but if you talk to autistic people or parents of autistic children, they all say that much needs to be done in supporting those with autism, especially in education and at work. Knowing that autism exists is not the same as providing the best environment for those with autism to overcome the barriers they face in society and giving them the support that they need to succeed. The Disabled Children’s Partnership points out that the pandemic has exacerbated existing problems around support for those with autism, creating further social isolation and poor health outcomes. It is depressing that the autism strategy is so unambitious.

One particular problem that parents face when trying to get support for their autistic children is an automatic assumption that parent carers are treated as a resource—worse, their parenting capacity is often questioned. There is no mention here of support for their needs. As John Bangs, a special needs expert, points out, this deliberately ignores carers’ legal rights. It is noticeable that this autism strategy makes no real reference to ensuring that parental and familial carers are supported. When will these wider issues relating to positive support for those with autism and their familial carers be addressed?

Finally, briefly on the Covid Statement in the Commons today, page 4 says that

“two doses of a covid vaccine offers protection of around 96% against hospitalisation.”

But the key bit of information we need in the “pingdemic” at the moment is the rate of double-jabbers getting Covid. I understand that it is part of the same study that is quoted, but what is the answer and where can we find it? If the pingdemic is due to the virus spreading —we hear of police and control rooms unable to operate and empty shelves at supermarkets—perhaps it is time we actually understood how many double-jabbers are getting Covid and having to go into self-isolation, and thereby creating a problem. The Minister needs to consider whether lifting all restrictions on Monday was the right thing to do.

Covid-19

Debate between Baroness Thornton and Baroness Brinton

Wednesday 21st July 2021 Lords Chamber

[Baroness Thornton (Lab) [V]]

I thank the Minister for this discussion on the Statement made on Monday in the Commons. In fact, even since Monday the world has moved on. The infection rate continues to rise. There are mixed messages from government Ministers about responses to the ping. For example, does the Minister share my concern that the Investment Minister, the noble Lord, Lord Grimstone, wrote to the car manufacturer Nissan, pointing out that isolating after being pinged by the app was only “advisory” and that there was no “legal duty” to isolate? I recall the noble Lord explaining this to the House some weeks ago at my prompting. Indeed, many noble Lords came to me afterwards and said that they had not realised that there was no legal obligation to isolate after the ping. There is huge confusion now about vaccine passports, and 1 million children are out of school as their term ends. Here in London, we still have some challenges about getting people vaccinated.

So let us start with the issue of the vaccination of teenagers. The MHRA has approved the Pfizer jab for all 12 to 18 year-olds. Indeed, such countries as the United States, Canada, Israel, France, Austria, Spain, Hong Kong and others have started or soon will be vaccinating their 12 to 18 year-olds. Can the Minister tell us when we might start doing the same?

The Prime Minister obviously took fright on Monday, because on Tuesday he made the announcements about vaccine passports in September. I think that even he could see that nightclubs were offering superspreader events, with music and strobe lights attached to them—talk about closing the door after the horse has bolted.

The risk of death to children from Covid is mercifully very low, but they can become very sick and develop long-term conditions and long Covid. Indeed, according to the Office for National Statistics, 14.5% of children aged 12 to 16 have symptoms lasting longer than five weeks. Will the Minister spell out in detail the clinical basis for why the JCVI has made its decision? Will he publish all the analysis and documents in the same way that SAGE has published its analysis, not just its advice? Will he guarantee that this decision was made on medical grounds, not on the grounds of vaccine supply?

The Statement talks about infection among children being disruptive. We know that infection among children is highly disruptive for learning. We have seen hundreds of thousands of children out of school. We are not vaccinating all adolescents. Can the Minister tell the House what the Government’s plan for September is, when children return to school? For example, are the Government considering using this summer to install air filtration units in every classroom in every school?

Testing is already stretched, with turnaround times lengthening, so can the Minister guarantee that through the summer, especially once contacts can be released from isolation on the back of a negative PCR test in August, and into September when schools return, there will be sufficient PCR testing capacity to meet demand? As we move into autumn and winter, we can anticipate more flu and respiratory viruses, so do we need multi-pathogen testing going forward? Is this being developed?

It has been announced that critical workers such as food, health, utility and border staff with two Covid jabs will be able to avoid self-isolation. Many ambulance and acute hospital trusts have found themselves under extreme pressure because of the combination of very high demand and very high levels of staff absence due to self-isolation.

Three weeks ago, the Health Secretary told us that unlocking would make us “healthier” and promised us it would be “irreversible”, but today we have some of the highest infection rates in the world. Can the Minister tell us what the experts say about the risk of reimposing new restrictions in future? Our already exhausted NHS staff face a summer crisis. Covid admissions are already running at about 550 a day, and hospitals are now all cancelling cancer surgery. For example, liver transplant operations were cancelled in Birmingham last week.

It is clear that more infections mean more isolation. The NHS staff released from isolation if double-jabbed will still want to protect themselves and their patients, so will the Minister ensure that the standard of masks worn in NHS settings is upgraded to the FFP3 requirement that NHS staff have called for? What is his plan for keeping the economy and public services functioning through the summer, as more and more people are asked to isolate? Can the Minister confirm reports that SAGE scientists have advised that some measures, such as mandatory masks and working from home, should be reinstated at the beginning of August?

Recent days have seen some of the lowest numbers getting first-time jabs on record, with the daily average now lower than at any point since the start of the programme—although I suspect the Prime Minister is hoping that his threat that you will need a vaccine passport to get into a nightclub might help in that direction. Unused vaccine doses are being sent back by GPs as demand for jabs slows to a fraction of recent levels, yet we still have millions of unvaccinated adults. Does the Minister share my concern that falling demand, combined with emerging evidence of the effectiveness of vaccines beginning to wane over time, may mean that we in this country will be less protected in September?

Finally, I understand that the “hands, face, space” slogan is about to be dropped in favour of a plea to “Keep life moving”, despite the fact that hundreds of thousands of people are still isolating. Can the Minister explain what this actually means?

[Baroness Brinton (LD) [V]]

I thank the noble Lord, Lord Bethell, and the noble Baroness, Lady Penn, their officials and all staff in the Lords, the Whips’ Office and the health team, as well as Members, for their extraordinary work this year on Covid-related business—mostly emergency Statements and statutory instruments. From these Benches, we particularly wish the noble Baroness, Lady Penn, a safe delivery and a happy maternity leave.

The Statement talks about enjoying “new experiences” following the lifting of lockdown and safely slowing the spread of this deadly virus, but 48 hours is a long time in politics, as evidenced by the difficulties of taking this Statement two days after it was delivered. So much has happened, much of it demonstrating that this Government are still struggling to get a grip on keeping people safe from this deadly virus.

The phrase in the Statement:

“We are cautiously easing restrictions”


is the most extraordinary thing to say, given all the rhetoric about freedom day—and it is wrong. All restrictions have been lifted—no mandatory face masks—and young people have understandably taken their lead from Ministers. There are videos of young people deservedly enjoying themselves in nightclubs in the knowledge that the Prime Minister has declared it safe to do so, yet hidden in this Statement is the bizarre announcement that in two months’ time only those who are double-jabbed will be able to go to such crowded venues, thus delivering Covid ID cards by the back door. Once again our young people, who have had to bear much of the brunt of lockdown life, are the ones targeted by this Government.

That little phrase caused chaos on Tuesday morning. Paul Scully was not clear about which other large venues might be included—for example, pubs with performance dance venues, large or small. He thought so. Two hours later, No. 10 contradicted that: no pubs. Can the Minister tell me what is the difference between a pub with a large dance venue of, say, 500, and a nightclub that can have up to 400 people and why one will require everyone to be double-jabbed but the other will not? I am really struggling to understand the difference. Perhaps the Minister can point your Lordships’ House at a safety document that sets out what the risks are for these different venues and why it is appropriate to ignore lateral flow tests and only go on double vaccination when we know that people can still get Covid after they have been double-jabbed.

The Statement is right to praise the progress of the vaccination scheme, although there is some considerable way to go, including awaiting the data on whether the booster jab can be given at the same time as the flu jab in the autumn. What plans are in place to provide support for GPs if the jabs cannot be given at the same time? We all know that the annual flu vaccine date requires a very large amount of administration by medical and admin staff alike.

The Statement says that JCVI has decided not to vaccinate all 12 to 17 year-olds yet but is keeping it under review. I too refer to today’s ONS data that was referred to by the noble Baroness, Lady Thornton, demonstrating underlying illnesses and a greater prevalence of long Covid among the young than among older people. I thank the Minister for the helpful briefing on Monday, but I remain concerned that with up to 1 million children out of school now it has been clear that the alternative to vaccinating secondary-age pupils appears to be allowing Covid to rip through our schools. We all want our children back in school in the autumn, so what are the Government going to do about that? It is good that the Government are finally allowing the children most vulnerable to Covid to receive the vaccine because they deserve protection and that those children with an immunocompromised or immunosuppressed adult in their home will also finally be able to be vaccinated. That is good.

This Statement also refers to the regulations debated in your Lordships’ House last night, and I hope the Minister has taken away the many concerns expressed by all sides of the House. The Statement refers to tradespeople, such as plumbers and hairdressers, who will also have to be doubled-jabbed to gain entry into a care home. I have two questions about these non-staff members. I am happy to receive a reply by correspondence if the Minister does not have immediate answers. First, if the registered person is not on the premises when an outside worker comes in, can another member of staff admit them and make the decision about their vaccination status? What does that do to the registered person’s responsibilities? If a plumber comes out of office hours to, say, mend a burst pipe and the registered person is not there, must they be turned away? Secondly, care homes are already reporting that some contractors are heavily ramping up the rates for care homes for their staff who have been double-jabbed. Did the hurried and inadequate impact statement published on Monday include the cost to homes of this outrageous practice, and will the Government issue guidance that it should be stopped immediately? Can the Minister say when the detail of how this is all going to work in practice will be published?

The Statement refers to the fact that we must be pragmatic about how we manage the risks we face, yet the past two days have been full of contradictions from the Prime Minister and other Ministers about the need to self-isolate when people are pinged. It has taken journalists to reveal that the only legal responsibility to self-isolate is when called by track and trace, but after the embarrassing U-turns on Sunday morning of the Prime Minister and the Chancellor about not self-isolating, the PM is confidently saying “You must self-isolate once pinged”. Apart from the irony of that statement, given his behaviour, once again we have Ministers not seeming to understand the difference between advice to people—moral guidance, perhaps— versus the reality of a chaotic series of SIs that confuse not just the police, the public and Parliament but the very Ministers responsible for them.

With a further 44,000 new cases today, making us world-beating in one league table no one wants to head, a further 73 deaths and millions of people being pinged and everything in chaos, I fear we are in for a long and difficult summer.

Covid-19

Debate between Baroness Thornton and Baroness Brinton

Thursday 15th July 2021 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for taking this Statement, although I have to say—and I know this is not in his gift—that Monday to Thursday is probably too long a gap, but taking the Statement today might in this case prove useful because we have seen the reaction to the nearing of so-called freedom day, nationally and internationally. We have also seen the Government becoming progressively more cautious. That is not surprising because in England 42,000 Covid infections and 49 more deaths were recorded yesterday, hospital admissions have increased to more than 500 a day, up 50% on last week, and we now see routine operations being postponed and cancelled.

The NHS is rightly focused on waiting lists, which are at their highest level over the past decade at 5.3 million, and 336,733 people have been waiting more than a year, more than 76,000 have waited for at least 18 months and more than 7,000 have been waiting for two years. Emergency care is grappling with some of the highest summer demand ever, and this is in the context of NHS staff being exhausted and facing burnout. The NHS is also losing a significant number of staff to self-isolation, which has led to much reduced capacity due to infection control. As infection rates get worse and increase, what is the Government’s plan to deal with this situation?

Since Monday we have seen an increasing number of announcements and questions about how to safeguard against further increases in infection and the impact it is having on our NHS, schools, businesses and communities. Indeed, our own Lord Speaker wrote:

“Members are still expected to wear a face covering both in the Chamber, in indoor crowded spaces and when moving around the Estate, in line with general advice from Public Health England and the Chief Medical Officer. Members are strongly encouraged to use the testing facilities provided.”


On these Benches we intend to follow that advice, and I regret that some Members have already abandoned their masks when moving around the building and in the Chamber. We have staff to look after us who may not yet be fully vaccinated and, anyway, have no choice but to be here and who will continue to wear their masks to protect us. We should afford them the same consideration. Does the Minister agree?

On the “Today” programme a few days ago Professor Graham Medley, the chief modeller for the SAGE committee said: “Wearing face masks is worth it but only if everyone does it, not just 70%. I understand the Government’s reluctance to actually mandate it. On the other hand, if it is not mandated, it probably won’t do any good.” In other words, my understanding is that unless more than 70% wear masks, the protection for those who are still vulnerable will not work.

I fear we have been here before, with the Government back-pedalling and, in doing so, creating confusion and ambiguity—exactly the circumstances for the virus to thrive and mutate. The guidance issued by Ministers yesterday was stronger than businesses expected, many of which feel that they have been led astray, given the Government’s repeated characterisation of 19 July as “freedom day” and the end of most restrictions. The truth is that the guidance is hardly different from the current rules, except that businesses are now “encouraged” to keep many of their Covid adaptations rather than required to do so. Businesses now have just five days to decide how to implement the rules and how to communicate that to their customers. Does the Minister accept that the Government’s mixed messages have left many in legal limbo?

The new guidance gives little clarity to the 3.8 million extremely vulnerable people who are being told to avoid all unvaccinated people. How are they supposed to know whether or not someone is vaccinated? Does the Minister share the concerns raised by charities and patient groups that guidance has effectively told the extremely vulnerable to shield, without backing that up with any formal support from the Government for working or food shopping? Government advice to the clinically extremely vulnerable is to go to the shops at quieter times of the day after 19 July. I am not sure if that can be dignified as “support” for those most at risk of serious illness from Covid-19.

Is it true that the Government have not had anyone in post to deal with the clinically extremely vulnerable for three months, since Dr Jenny Harries was appointed chief executive of the UK Health Security Agency? If that is true, it is deeply concerning and it may explain why the Government have failed to prioritise support for these 3.8 million people.

What are the contingency plans for surging hospital admissions, which may remain high until the end of August, as called for by members of SAGE? The new guidance also says that businesses should encourage customers to check-in using the NHS app or otherwise leave their contact details. Can the Minister confirm reports that plans to reduce the sensitivity of NHS contact tracing have been reduced because of the surge in cases? What assessment have the Government made of the effectiveness of the app as an infection control tool, given reports that more than 20% of adults and a significantly greater proportion of young people have actually now deleted the app and many more are ignoring the advice to self-isolate?

I turn to those working from home. Despite the lifting of guidance to work from home, the Government say they expect and recommend a gradual return to offices. This is very confusing. What protection is proposed for those who are vulnerable, and for whom “freedom day” is not freedom day but a further lockdown day? If their employers demand that they return to work, even if they are immunosuppressed, for example, travel and enclosed places pose a threat to them. Under these circumstances, we need to be grateful for the good sense of the Mayor of London in following the science. Sadiq Khan has said that Transport for London will continue to enforce the wearing of face masks on services in the capital beyond 19 July.

While industry bodies said on Tuesday that no domestic train operators or major bus and coach firms will require customers to wear masks, the city mayors and others are calling for mask wearing on all public transport. Does the Minister agree with them? If Tracy Brabin, Andy Burnham and the other mayors had the power to enforce mask wearing to protect drivers and passengers, they would do so. They are doing the Government’s job for them.

What support are the Government going to give those areas with the lowest vaccination rates? Local authorities in London have, variously, 35%, 36% and 42% of their populations vaccinated. Does the Minister support the leaders of those authorities who say that they wish mask wearing to continue until they have got their populations caught up with vaccination?

[Baroness Brinton (LD) [V]]

My Lords, the Prime Minister told us 10 days ago that we were heading for “freedom day” and that all the data was going in the right direction; all restrictions would be lifted, and now was the time to take personal responsibility for our behaviour and for the Government essentially to step back. The Secretary of State’s Statement on Monday confirmed that, although with a marginally more cautious note about taking care. I echo particularly the comments made just now by the noble Baroness, Lady Thornton, about the mixed messaging in the new guidance for business and on returning to work, which conflicts with what was said both in the Statement and by the Prime Minister.

However, since the Prime Minister’s and Mr Javid’s confident assertions on Monday, there has been an outpouring of disbelief from senior scientists and doctors. Cases are currently doubling every nine days, and yesterday there were 42,000 new daily cases—a level last seen at the beginning of the January total lockdown. If there is no slowing of that doubling rate, we will have hit 100,000 new daily cases by the beginning of August. And that is before the Government’s expected extra cases as a result of “freedom day” on Monday.

Ministers constantly say that there are fewer people in hospital, that fewer people need ventilation and there are fewer deaths, but what they do not mention is that those numbers are a matter of ratios, and that with the current level of cases our hospitals are already reporting A&Es with the equivalent of a winter surge and more wards being turned into Covid wards for patients. A letter published a few days ago in the BMJ, initially signed by 1,000 doctors, is at over 7,000 signatures and still rising. The data is already clear that the surge in new cases from three weeks ago is increasing hospital admissions right now. So what are the Government doing to support and protect our NHS from this sharp increase and pressure on doctors, nurses and hospitals right now?

While many people are being responsible, still following the guidance and using their face masks, sadly there are many who are not. I was talking to a young security guard who told me that, this week, she is finding it impossible to persuade people to put masks on in their local shopping mall, despite the fact that the rules are still in place. Yesterday, my local community pharmacist told me in despair that two people arrived separately asking him for PCR tests as they each had Covid symptoms and thought all the previous rules had just finished. Not for the first time, much of this is about the Prime Minister’s muddled communication style. In the light of the fact that Scotland, Wales and Northern Ireland are going to retain the face mask mandate, and that the metro mayors, including Sadiq Khan and Andy Street, would like to do so, will the Government please reverse the lifting of the face mask mandate immediately, so that it remains in place, especially on public transport?

I turn to the new guidance for the clinically extremely vulnerable. I have to say that I have never read such an inconsistent and contradictory formal guidance note from the Government—and I have read a few. You should stay at home to be safe but if you cannot work from home, go in; you must remain socially distanced from everyone outside your bubble, even if they do not have to; you must not mix with unvaccinated people, outside or inside. I ask the Minister to tell me how on earth you know who is unvaccinated. As one of the CEV, do I stand in the doorway at opening time at my local greengrocer’s—a quiet time—and shout out to any customers and staff, “Anyone not vaccinated in here”? Of course not. The inevitable logic of this is the restart of shielding but without any of the previous support.

Worst of all, on Friday evening Public Health England put out a press release in which it mixed up advice to the clinically vulnerable and the clinically extremely vulnerable by citing vaccine efficiency research relating to the former in advice to the latter. That paragraph has been repeated in the formal guidance published on Monday. It is plain wrong. In a total administrative muddle, no one has gone through the nine pages of this guidance and updated it, so it is littered with references to the need to follow other rules and guidance for the general public in place at 17 May and 21 June, all of which goes next Monday. Please will the Minister ensure that the guidance is reviewed immediately to remove these anomalies?

All this, and the lack of answers to my questions last week about who the clinical lead is on the clinically extremely vulnerable, tells us 3.8 million former shielders that we have been not just forgotten but thrown to the wolves. Please will the Government actually review the guidance to keep the CEV group safe and provide the support that they need?

I also gave the Minister notice of the following two questions, as they both concern urgent and slightly unusual elements of lifting restrictions. First, for a couple of weeks now, Malta has said that it will not accept UK citizens who have received particular batches of the AZ vaccine manufactured in India, about 5 million doses of which have been given in the UK. Earlier this month, the Prime Minister reassured the press, saying:

“I am very confident that it will not prove to be a problem.”


However, holidaymakers are being turned away from Malta right now. When will the Government resolve this problem?

Secondly, those thousands of wonderful people who came forward to take part in the AstraZeneca clinical trials have been told that their vaccine status cannot be put on the NHS app, which means that they cannot go abroad, either to work or on holiday, or do certain jobs in the NHS that require this evidence. In early June, there was a blog on the BMJ website that set out these problems, but three months on from this issue being initially raised, there is still no resolution. It is utterly wrong that these publicly-minded people have now been left in limbo. Can the Minister say when this problem will be resolved and their vaccine details uploaded?

Covid-19 Update

Debate between Baroness Thornton and Baroness Brinton

Thursday 8th July 2021 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for the Statement today, which takes us further into the discussion that we were having on Tuesday and allows him to address some of the questions that perhaps he was not able to on Tuesday.

We all want our economy to open and get back to normal. The question is whether we do it in a controlled way or a chaotic way. The Health Secretary told the Commons on Tuesday that, under the Government’s plan, infections could go to as high as 100,000 a day. There are some huge issues that the Minister and the Government have failed to address with information and clarity about the massive change in policy contained in the announcements on Monday and Tuesday. The first of these is surely the potential 100,000 infections a day in a few weeks’ time. When I asked on Tuesday about the scientific advice, the Minister gave me what can be described only as a pick-and-mix answer, one in which he said SAGE’s advice was “interesting”. I am sure that SAGE’s advice is always interesting, but is it being taken into account in decision-making as it used to be? I specifically refer him to the most recent SAGE papers, which made it clear that with high infection rates there would be a greater chance of new variants emerging and greater pressure on the NHS. More people will get long Covid and test and trace will be less effective. As NHS Providers said today,

“current pressures on the NHS mean that the predicted rising infection rates for COVID-19 will inevitably affect the speed at which trusts can recover care backlogs.”

I quote Chris Hopson:

“Trust leaders can see the strong logic of ‘if not now, when?’ and they recognise that, as a nation, we must learn to live with COVID-19. But they want the Government to be clear about the risks of relaxing restrictions. This includes the inevitability of higher hospitalisations and mortality, albeit at lower levels than previous waves and the risk of new and more dangerous variants emerging. They are also worried about the impact of long COVID. It’s important these trade offs are clearly set out, including the impact on the NHS’s ability to bear down on the backlog.”


Indeed, a letter from 100 experts in the BMJ today raises the same issues. That is why the impact assessment is so crucial. The Prime Minister seemed to find this impossible to address yesterday, so I would like to see if the Minister with his much greater and closer knowledge of these issues could be more enlightening to the House today. Have the Government undertaken an impact assessment of the projected rate of infection? Yes or no would probably suffice. If it is yes, when will it be shared with Parliament and the public? If it is no, the Minister must explain why this has not happened and tell the House when it might. We need to know what is the number of hospitalisations and deaths; what is the number of people with long Covid, which will be the outcome of 100,000 infections a day; and what is the impact on the NHS, will it slow down the catch-up for diagnostics and treatment and by how much? I am very happy if the Minister wants to email the details of the answers to me, if he does not have them to hand–although he ought and they need to be in the public domain.

We know that the link between infection rates and deaths has been weakened, but it has not been broken. All the experts seem to agree on that. Let us be clear why infection rates are so high: it is because the Prime Minister let in the delta variant. I agree with my right honourable friend Keir Starmer that we might now change its name to the “Johnson variant”. Let us be clear why the number of cases will surge so quickly: it is because the Government are taking all protections off in one go. As my right honourable friends Sir Keir Starmer and Jonathan Ashworth have said, this is reckless.

The next obvious question is the one about the dreaded ping and the huge number of people who will be asked to isolate. If there are 100,000 infections a day, that means hundreds of thousands—perhaps millions —of people are going to be pinged to isolate. The Financial Times estimates that it could be 2 million people and the Daily Mail says it could be 3.5 million people. Either way, it is a massive number. How many people do the Government expect will be asked to isolate if infection rates continue to rise at this rate? Again, this question was asked of the Prime Minister yesterday and he clearly did not know the answer or refused to say, so I will repeat it again: how many people are going to be asked to self-isolate if there are 100,000 or more infections a day?

Does the Minister appreciate that those who are immunocompromised or for whom the vaccine is less effective will have their freedoms curtailed by ditching masks on public transport? Blood Cancer UK warned yesterday that people with blood cancer will feel that their freedoms have been taken away from them. It is quite possible that the 19th will not be freedom day. It might be the day when a record number of people will switch off their NHS app, because they will see coming down the track isolating and cancelling holidays. It is already beginning to happen. Has the Minister seen those stories? We on these Benches do not support that course of action, but does he realise that this could seriously undermine the expensive track and trace system, on which so much depends?

I have to repeat again that the biggest barrier to an effective isolation policy has been not the inconvenience but the lack of financial incentive to stay at home. If we are to live with this virus, the days of people soldiering on when unwell are over. Sick pay is vital to infection control. Will the Government please now fix it?

Business leaders are expressing very serious concerns about the loss of staff and customers. There are now 700,000 children off school per week. At my grand- daughter’s school this morning, two classes were sent home due to two teachers being pinged. After-school sports were cancelled and she is very disappointed. It is happening everywhere, as our amazing head teachers and school staff limp towards the end of term doing everything they can to deliver teaching, joy and normality to our children under the most difficult and often underappreciated circumstances.

The question I want to ask for clarity from the Minister is about the ubiquitous ping. Is the ping advisory for self-isolation or mandatory? If you get an email or phone call, does that trigger mandatory self-isolation? Finally, I ask about data in the last 24 hours or so from Israel’s Ministry of Health, which points to the Pfizer vaccine being just 64% effective at stopping symptomatic and asymptomatic transmission of the delta variant. Can the Minister tell the House about this?

[Baroness Brinton (LD) [V]]

My Lords, one year ago when lockdown was lifted, we had around 1,000 new cases a day. Yesterday it was 32,000 new cases. Equally concerning, cases are doubling every nine days; hospitalisations are going up; ventilation bed occupation is going up; NHS Providers, as the noble Baroness, Lady Thornton, has said, is talking about hospitals moving back into created-Covid wards and managing safe areas. GPs and hospitals are all reporting a worrying large increase in young people with long Covid, putting further pressure on their services, let alone the worries of an epidemic of long-term illness in the working population. Anecdotal evidence suggests that some hospitals are now considering cancelling some staff summer leave. Wonderful as yesterday’s England victory was, the sight of 60,000 fans walking down Wembley Way in very close proximity with hardly a mask in sight was concerning. As with the England-Scotland match, we must expect a surge in cases. Yesterday, the BBC asked Dr Mike Ryan of the World Health Organization about the UK proposals to lift all restrictions on 19 July. He replied:

“The logic of more people being infected is better is, I think, logic that has proven its moral emptiness and epidemiological stupidity”.


The letter in today’s Lancet from 100 senior medics and scientists echoes the WHO view. What are the Government doing to explain to the experts why their strategy is safe?

I will return to the substance of the Statement later, but I start by thanking the Minister for the meeting yesterday with other Peers, Blood Cancer UK and the Anthony Nolan trust to discuss the immunocompromised and the clinically extremely vulnerable. There are over 2 million CEV who had to shield—that is 3% of the population. So, arising from questions I have asked the Minister many times before in your Lordships’ House, I will ask the following. The CEV, of whom I am one, are worried at the total silence to them over recent weeks since shielding ended formally but, with stay-at-home advice still in place, with cases rocketing daily and all restrictions easing, can the Minister explain how advice to them is being co-ordinated publicly by government? One blood cancer patient said today to an APPG of parliamentarians that the dissonance of their safety versus everyone else’s freedom was hard to bear, especially with no advice. In particular, who has clinical responsibility for drawing together the different issues of therapies, responses to vaccines and continuing care for underlying diseases, and which Minister has overall responsibility?

Overnight, there have been some suggestions from journalists that shielding might even return. If so, that needs to be communicated very urgently to those at high risk, who have not been told about their low vaccine antibody rate. They may be planning to mix with people, or perhaps even go on holiday. Will benefit support for the CEV who have to stay at home but cannot work from home be reintroduced? If the Government are serious about the irreversibility of the lifting of all restrictions, some of the CEV will not be able to return to work for weeks, or even months.

I turn to testing. There are reports today that the Government plan to charge for the lateral flow tests from the end of this month. As LFTs are supposed to be the great self-regulators that the Government are relying on, how much are people going to be charged? You do not pay the Government for a blood test to see whether you have picked up any other infection. The level of charging for PCR tests for people returning from abroad also remains a big issue. Last week in your Lordships’ House the noble Baroness, Lady Vere, told my noble friend Lady Ludford that PCR tests could be obtained at a price of £85 for two. My noble friend’s local pharmacy is charging £398 for a test on the same day, or £240 for the next day for two tests. I know other members of the public have reported similar problems. Can the Minister say how the pricing of PCR tests is being managed and, perhaps more importantly, where one can find the “£85 for two” tests?

On Tuesday, I set out what we from these Benches seek in a return to normal life. We want people to return to work as soon as possible, to be able to mix with family and friends and for our children to be able to have consistent access to education without interruption. We also agree that now is the time to start to do some of that but—and it is a big “but”—we cannot get rid of all the safeguards that protect people mixing together while the virus is still live. An effective test, trace and isolate system is essential. This Statement makes it clear that that is being dismantled. Can the Minister explain why that makes any sense?

Last night, Sebastian Payne of the Financial Times reported the re-election of Sir Graham Brady MP as chairman of the 1922 committee, and tweeted:

“Brady’s re-election is … a reminder of why Johnson is dropping masks and nearly all other … restrictions on July 19: ministers privately say the government no longer had the … votes to keep the measures in place. Relying on Labour would have been … difficult for the PM.”


Are the Prime Minister and the so-called Covid Recovery Group now putting health and lives at risk for their own principles?

Finally, with the threat of 100,000 cases by the end of the month, with hospitals saying they are already worried about the increase in patients and with the threat of the new lambda variant and new north-east variant under investigation, please will the Minister confirm that these changes are not irreversible and that the protection of the NHS, and the safety of all the people in this country, remain the Government’s priority?

Covid-19 Update

Debate between Baroness Thornton and Baroness Brinton

Tuesday 29th June 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I start by saying how much these Benches identify with the words the Government have issued about the horrifying treatment of Chris Whitty, our Chief Medical Officer. It was completely shocking and disgraceful. For a truly amazing public servant to be treated like this is unacceptable at any level.

I thank the Minister for presenting the Statement and echo the words of my right honourable friend John Ashworth yesterday in welcoming the new Secretary of State to his position. It was pleasing to see the new Secretary of State at St Thomas’ Hospital yesterday; I hope it is the first of many visits to our inspirational and dedicated NHS and social care staff. I hope the Minister’s new boss will be more receptive than the previous one and make arrangements for them to receive a fair pay rise, and not the real-terms pay cut that is currently pencilled in.

Yesterday the Secretary of State let it be known that the 19 July reopening will, in effect, go ahead. He told the news that there is “no going back” and that lifting the restrictions will be “irreversible”. It is probably not an exaggeration to say that many across your Lordships’ House will give a collective and noble eye- roll at these words. Like many here—and unlike the Secretary of State—we have responded to a lot of these Statements in the last 15 months. We heard that there was “nothing in the data” to suggest that 21 June could not go ahead. Noble Lords will remember that children returned to school for one day before the January lockdown and the words “It will all be over by Christmas.” Some time last spring, I think the words “We will send it packing in 12 weeks” were used.

The context this time is that there has been a rise of 84,000 cases in the past week—an increase of 61%. Yesterday saw the highest case rate since January. If these trends continue, we could hit 35,000 to 45,000 cases a day by 19 July. We know that this variant means fewer hospitalisations and fatalities, but it also means that young people will become ill and some will have long Covid. It will again mean disruption to our schools and our youngsters’ learning and socialisation. When will we see a review of the arrangements in schools?

We also all know that this is a race between the vaccine and the infection, but I fear it will not be won by the vaccine in the next three weeks, so if we are looking at possibly 200,000 people infected with Covid on 19 July, the Minister needs to tell us what impact that will have on the road map out of restrictions. Can he confirm whether “irreversible” means the Government are now ruling out restrictions this winter? Have they abandoned the plan that the previous Secretary of State and officials were drawing up for that?

The Secretary of State has promised to give the NHS everything it needs to get through the backlog, so will the hospital discharge and support funding be extended beyond this September, or will trusts have to make cuts instead? We have already had some discussion about the backlog today; for example, when will the NHS again guarantee that 95% of patients will start treatment within 18 weeks of referral? How long is it likely to be until we can reach those sorts of targets again? When will the Government give primary care the resources to meet the challenge of the hidden waiting list of over 7 million patient referrals that we would have expected since March 2020?

Given the pressures on primary care, is it still the Secretary of State’s plan to press ahead with the GP data transfer? Frankly, if this department cannot keep its own CCTV footage secure, how does the Minister expect it to keep our personal data secure? I think that is a legitimate question.

Given the pressures across the whole healthcare system, will the Government now abandon the ill-thought-out top-down reorganisation of the NHS that the previous Secretary of State was about to embark on?

Finally, I have raised with the Minister the importance of the Nolan principles which must guide the ethics and behaviour of us all, particularly those in government. The Good Law Project today published emails which used the noble Lord’s private address. Transparency is the word I am looking for here. The spotlight has been turned on the Minister in recent days, including a formal complaint to the Lords commissioners about the issuing of passes.

The Minister might do well to consider a couple of things: actually referring himself to the commissioners about that matter, if there is a chance he may have acted outside the rules, and—he has had to deal with this question several times and is very robust about it—making his emails and communications transparent and explaining them. He is sure that he has done nothing outside those rules; he would therefore be wise to be transparent about that. It is not the original scandal that gets people in the most trouble—it is the attempted cover-up, or the chance that there might be one. Transparency is the best advice I can give the Minister today.

[Baroness Brinton (LD) [V]]

My Lords, I echo on behalf of these Benches the concerns about the treatment of Professor Chris Whitty. It is totally unacceptable, and it is good news that the police are now investigating this.

Just now, in reply to my question on the Urgent Question, the Minister said that the health and social care Bill has been published. Over the last few minutes I have been searching the web, but I cannot find it— can he help me any further?

Yesterday’s Statement from the new Secretary of State struck an interesting new note. The department is clearly no longer going to be led by data but by dates. Yesterday, 22,868 new cases of Covid were reported. This time last year, when lockdown was finally lifted, daily cases were under 1,000. Even with the high level of vaccinations, this is causing illness and pressures on the NHS—even if it is a different kind of pressure to that of a year ago. On Sunday, Andrew Marr reported on his programme that his own experience of catching Covid had been difficult. He said that, while he had not needed to go to hospital, he was more ill than he had ever imagined possible, and it was not an asymptomatic experience. In the light of this and the reports of growing numbers of people living with long Covid, can the Minister say why data will now clearly not factor into the decisions about 19 July?

On these Benches, we believe that we need to learn to live with this disease, but unlike the Statement from the new Secretary of State, we do not believe that this is just about vaccination, important though that is. This week, Israel has found that, despite early and comprehensive levels of vaccination, the delta variant is ripping through its communities. We have argued since February 2020 that controlling outbreaks is vital. Can I ask the Minister about the provision of test, trace and isolate arrangements moving forward? Specifically, have local directors of public health been given access to emergency funding for the provision of surge testing and tracing and vaccination in their communities? When will the pilots for increased support for those needing to self-isolate be published? We still believe that people should be paid their wages if asked to self-isolate. As that number is considerably fewer than six months ago, it would be not only cheaper for the Treasury but a much more effective way of ensuring that the spread of the virus is reduced.

Usually the Minister agrees with me on the importance of test, trace and isolate, even if we perhaps disagree on how that should be funded and supported. Can he respond to the concerns of the doctors and scientists who are appalled with today’s proposals that company directors will be able to temporarily leave quarantine for business meetings? People are still furious that the Prime Minister delayed adding India to the red list, with the resultant rapid spread of the more transmissible and more serious delta variant. As Professor Christina Pagel says:

“luckily elites don’t get or transmit covid.”


Stephen Reicher, the eminent behavioural scientist, said he was horrified by the

“scandalous misuse of science as a cover for political decisions … which is putting us all at risk.”

When commenting on the DCMS report published on Friday, he said:

“The headlines and the political response isn’t just an exaggeration, they directly contradict what the report says. It warns that the research wasn’t designed to draw any conclusions about the effects of events on transmission and mustn’t be used to do so”.


Yet Ministers and the press are all reporting that these events in the trial had no effect on infections and were safe to reopen.

Yesterday, a No. 10 spokesperson explicitly denied that government Ministers have used private email addresses. They said:

“Both the former health secretary and Lord Bethell understand the rules around personal email usage and only ever conducted government business through their departmental email addresses”.


This is directly contradicted by the Second Permanent Secretary in meeting minutes published by the Sunday Times. Those minutes clearly state that former Health Secretary Matt Hancock

“corresponds only with private office via a gmail account”.

As the Good Law Project has reported, on 19 April 2020, the noble Lord, Lord Feldman, emailed the noble Lord, Lord Bethell, at his private address, about the availability of Covid-19 test kits via a Canadian company, saying:

“Certainly worth contacting … to see if they can help … and the pricing seems competitive.”


Self-evidently, this is government business, and specifically within the portfolio of the noble Lord, Lord Bethell. The noble Lord, Lord Feldman, once co-chair of the Conservative Party, was writing to the Minister at his private email address on government business. In addition, I note that the Minister’s meeting with Abingdon Health on 1 April 2020 was not disclosed on the ministerial meeting schedule.

We note that, unlike the response from the noble Lord, Lord True, on the earlier UQ, it is not possible for the public to access private emails; the Freedom of Information Act specifically excludes it. Not going through the formal government-approved routes, whether for emails or declarations of meetings, gives the impression that perhaps the Minister has something to hide from his dealings with a former chairman of the Conservative Party and the company he was acting for. I note that the company was awarded an £85 million contract after the meeting and the emails.

There has been considerable speculation about the role of Ms Gina Coladangelo as a lobbyist, unpaid adviser to Matt Hancock and then a non-executive director for the Department of Health and Social Care. The press and media have also reported that the Minister gave Ms Coladangelo a parliamentary pass last year. Can he tell the House what personal parliamentary service she provided for him during that period? Does the Minister feel that his position is tenable, given this evidence?

Covid-19 Update

Debate between Baroness Thornton and Baroness Brinton

Tuesday 15th June 2021 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for this Statement. These Benches agree with Mr Speaker; in the statement he made prior to the Secretary of State’s Statement last night, he expressed a deep frustration on behalf of all parliamentarians about the Government’s conduct. The announcement yesterday was both predictable and, sadly, predicted. I sigh, because the Prime Minister is now referring to 19 July as “terminus” day instead of freedom day, which has probably brought eye-rolls everywhere. When will the Prime Minister learn that caution and the use of data means also being cautious about how you express these matters?

The Minister will know that on these Benches we support the Government’s decision to delay the move to the next stage of the road map, but do so with a deep sense of anger, if not despair, that this should be necessary. Since the delta variant of coronavirus, first discovered in India, was detected in the UK in April, cases have surged across the country, with the variant now making up 96% of new infections. Experts confirmed last week that the variant is 60% more transmissible than the alpha variant, first discovered in Kent in 2020. Scientists at the Wellcome Sanger Institute have used genomic sequencing to produce maps which show how rapidly the delta variant has taken over in England, and I commend them to noble Lords. They are alarming in that they show the rapid spread to almost the whole country by the end of last week. It is doubling week by week—still with small numbers now, but that will change if this doubling continues.

There were warnings of a new variant in India on 25 March. It is reported that Ministers first learned that the delta variant was in the UK on 1 April. I must ask the Minister: is that true? The Government red-listed Pakistan and Bangladesh on 9 April, but did not red- list India until 23 April, by which point 20,000 people had arrived from India. As my right honourable friend Jon Ashworth said yesterday in the Commons,

“Our borders were as secure as a sieve, and all because the Prime Minister wanted a photo call with Prime Minister Modi.”—[Official Report, Commons, 14/6/21; col. 77.]


On 20 April I said to the Minister:

“With regard to protecting our borders, this week Hong Kong identified 47 Covid cases on a single flight from Delhi.”


We were closing our borders on 23 April, and I asked him:

“there will be hundreds of people arriving on flights from India. Is this not very risky?”—[Official Report, 20/4/21; col. 1769.]

I now return to that question. How many people arrived from India carrying the virus during the period from when the Government were aware of the variant at the beginning of April to 23 April, when India joined Pakistan and Bangladesh?

It is unforgiveable that Ministers have consistently promised to take control of our borders and conspicuously failed to do so, particularly at the very moment when it mattered most: when we were succeeding in the vaccination rollout and the gradual loosening up. The Prime Minister not only opened the back door to this variant; he failed to take measures to suppress it when he could.

There has been growing prevalence of this variant among school-age children, yet mandatory mask-wearing has been abandoned in secondary schools. I have raised this with the Minister at least once before. He has to explain why this has happened, despite being repeatedly asked in both Houses. We also know that isolation is key to breaking transmission yet, 16 months on, people are still not paid adequate financial compensation to isolate themselves. When asked about this at the Select Committee last week, the Secretary of State claimed that people would game the system. Does the Minister believe that this is true? After all the sacrifices and rule-following of the public, does the Minister have the same low opinion of our fellow citizens as his boss?

Yesterday, the Prime Minister and the Secretary of State supported extending restrictions by pointing to plans to go further on vaccination. But even after extending the doses as outlined in the Statement, large proportions of the population will still be left unprotected —having had one dose or none—and exposed to a variant that, if left unchecked, will accelerate and double every week. That would mean more hospitalisations, more long Covid, more disruption to schools and more opportunities for variants to emerge. What will happen under these circumstances? Will the Prime Minister still lift the restrictions?

My reading of this announcement and the terms in which is it couched is that the science points to us being in a very dangerous position. We could lose the battle that is going on between the vaccine and the virus. Will there be vaccine surges to counter this in areas where the virus is most prevalent? What is the plan to bring down infections and extend vaccination rates in hotspot areas? We have learned that in some places—Leicester, Chorley, Tameside, Salford and Wigan —the dose numbers have gone down. Has vaccination surging been abandoned in those hotspot areas? Will the Government bring forward accelerated second doses, and how are they working further to overcome vaccine hesitancy?

The Chief Medical Officer said last night that we would be lifting restrictions were it not for the delta variant. The Prime Minister should have moved at lightning speed to prevent the delta variant reaching our shores. Instead he dithered, and today he is responsible.

[Baroness Brinton (LD) [V]]

My Lords, we on these Benches echo the support of the noble Baroness, Lady Thornton, for the Commons Speaker’s statement yesterday on the Government’s continued abuse of Parliament.

We repeatedly warned the Government that sending out mixed messages about lifting restrictions on 21 June would cause problems. Even in March, the Prime Minister made it evident that he wanted us out of restrictions “irreversibly”—his word—by next Monday. What is worse is that we are now in a fourth Covid wave because of his desire to visit President Modi in India in mid-April. The resultant dangerous dithering about putting India on the red list contrasted sharply with the TV news. Every evening, we saw that the then delta variant was scything through India. Even then, Indian epidemiologists were talking about a much faster transmission. We on these Benches have repeatedly asked why India was not added to the red list on 2 April.

At yesterday’s press conference we were warned that the current delta variant wave will likely peak in mid-July, as cases, hospital admissions and patients needing ICU increase steadily. Even if vaccines mean that hospitals are not being overwhelmed, there is an increase. The UK now faces continuing restrictions entirely because of the Prime Minister’s delay.

The academic paper Estimating the Failure Risk of Hotel-based Quarantine for Preventing COVID-19 Outbreaks in Australia and New Zealand, published in February this year, calculated the risks and likely seeding of variants in the light of infection control and surveillance used locally. It now provides an essential baseline to assess seeding of cases coming from abroad. Devan Sinha of Oxford University and other UK scientists have used this to look at the seeding of the delta variant in the UK. He noted that 96% of the seeding of the delta variant occurred after 2 April—that is, after Pakistan and Bangladesh were added to the red list but India was not. He estimates that putting India on the red list on 2 April would have delayed the current wave by a further four to seven weeks. That four to seven weeks would have meant that all over-40s had had access to a second dose and, at seven weeks, most over-30s. He said that the wave would have been

“much smaller and mostly neutered”.

What have the Government learned from this delay? Why did it take so long for the delta variant to be moved from a variant of interest to a variant of concern? Despite MPs, Peers and scientists all asking in early April, Matt Hancock told the Commons that it would be listed as a variant of concern on 20 April. In fact, it was not listed until 7 May. Even worse, surge testing did not start until May either. If it was serious enough for India to be added to the red list by 23 May, why was it made a variant of concern only on 7 May? Was the delay with PHE or with Ministers?

The necessary continuation of restrictions at the current level means that a number of support schemes are now out of kilter with the restriction levels. These include lifting the embargo on evictions, the reduction in furlough support while people are still being asked to work from home if possible, and other business support mechanisms. Please can the Minister say whether they will be extended until we know that we are lifting restrictions completely? When, oh when, will any of these Statements or communications make it clear to the clinically extremely vulnerable and their families and friends what they are expected to do?

The Statement lists the areas where restrictions are to be lifted, many of which will be welcome, especially the 30-person limit on attending weddings, receptions and commemorative events, and out-of-school residential visits in bubbles of up to 30. But I ask again about mask wearing in schools, given the continuing increase in delta variant cases among children. Will there be specific guidance for these events, including lateral flow testing before and after, so that any outbreaks at a wedding could be tracked and managed? What level of new Covid cases per day would change the pilots on large events with higher capacities, especially the ones planned at full capacity?

It is good to see the removal of enforced quarantine for care home residents after trips out of homes. I never did understand that one, given that staff and visitors did not have to self-isolate.

It was good to hear the emphasis in the statement from Professor Whitty and Sir Patrick Valance on the importance of the second dose. I repeat my regular plea that all Ministers use this as a reference point. Far too many only ever use the number of people having had the first dose. With the delta variant, it is even clearer now that two doses are essential.

Why on earth did the Prime Minister say yesterday that 19 July is definitely the terminal day for restrictions? We all hope that he is right, but if he and Ministers are led by data, how can he say that?

Finally, the Statement refers to surge testing in areas where the variant is also surging, but maps show such a steady rise in cases across the country. Can the Minister confirm that there are enough test, trace and isolate staff to manage effectively this fourth wave of Covid?

Covid-19 Update

Debate between Baroness Thornton and Baroness Brinton

Tuesday 8th June 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, first, I thank the Minister for this update today and congratulate him on yet another long stint at the Dispatch Box.

We face some uncertainty, as we often have throughout the past 15 months, but we know the delta variant is now the dominant variant in the UK; we know that 73% of delta cases are in unvaccinated people; we know that one dose offers less protection against this variant; and we know that, although hospitalisations are low, an increase in hospitalisations will put significant pressures on the NHS as it tries to deal with the care backlog. We also know, of course, that long Covid is significant and debilitating for so many people. As the Statement makes clear, this is a race between the vaccine and the new variant. I therefore invite the Minister to narrow the timeframe between the first and second dose, given that we know that one dose is not as protective as we would like. We have seen that Wales will be vaccinating everyone who is over 18 from next week. Could the Minister tell us when England will follow?

We all know about the outbreaks among schoolchildren and young people. We know that children can transmit the virus and that children can be at risk of long Covid. In that context, why is mask wearing no longer mandatory in secondary schools? It is good that the JCVI will be looking at vaccination for children. Could we please know the timeframe for when the JCVI will report?

I turn to Nepal. UK Ministers justified the decision to move Portugal from green to amber in the travel list owing to the threat of the new Nepal Covid variant—a mutation of the delta variant—which experts believe may have the potential to make vaccines less effective. Some 23 cases of the Nepal variant have been detected in the UK, up to 3 June. Can the Minister confirm whether these cases are all associated with travel, particularly from Portugal?

In this, Carers Week, from these Benches we join the Minister in paying tribute and are grateful to the 6.5 million people who are carers. Making caring visible and valued is the aim, and this year of all years we need to support them in doing so. Our carers across the country have faced huge challenges during the pandemic; three-quarters of them confess to being exhausted, and a third confess to feeling unable to manage their caring responsibilities.

I am sure the Minister has already read the report produced by the Commons Health and Social Care Committee which addresses the issue of NHS and care staff in England being so burned out that it has become an emergency that risks the future of the health service. This is a highly critical report which said that workers are exhausted and overstretched because of staff shortages. It said that the problems existed before the pandemic, although coronavirus has made the pressures worse. It reports that one of the main problems is that there was no accurate forecast of how many staff the NHS needed for the next five to 10 years—something that we know as “workforce planning.” NHS workers, traumatised and exhausted, need to know there is a solution on its way to fix staff shortages. When will there be an NHS and social care workforce plan? How will the Government respond to the urgent situation that this report reveals? How will the NHS stop the haemorrhaging of its staff, which is already happening?

Combined with all this is the fact that we know that the NHS estate is in urgent need of attention and investment, and so Labour is today calling for a new rescue plan. Data also reveals the scale of the pressure on hospitals before the pandemic and how much worse it is now. Freedom of information requests show that the pressure on A&E was already very serious, with waits in ambulances jumping by 44% in the year preceding the pandemic. We know that the underfunding of the NHS, and the unpreparedness of the UK for a pandemic, has been paid for by people’s lives and by the exhaustion of our NHS. Surely these things call for a long-term NHS rescue plan, with the staff, equipment and modern hospital facilities that we deserve.

I turn briefly to the issue of data again. I record that I welcome the delay in proceeding with this proposal from the Government, but I think the Minister and the Government need to address the transparency that is vital around two things. The first is that somebody should be able to retrieve their data if they want to and pull it back; and the second is that, if their data is being used by a third party, they need to know who that party is, what the data might be used for and who benefits from that. My contention has been, for many years from this side of the House, that NHS data is a gigantic asset that we have that can be used to benefit the world, but we need to make sure that it is the NHS that benefits from the sale of our data—not private sector companies or individuals but our NHS.

Finally, I recently visited the Covid memorial wall myself. I would like to ask the Minister whether he has visited the wall of red hearts that we have opposite Parliament. The Covid memorial wall is immensely moving and a poignant reminder of the scale of loss that we as a country have experienced. Does the Minister believe that the wall should become a permanent memorial? If not, what should be a permanent memorial of the loss that we have sustained?

[Baroness Brinton (LD) [V]]

My Lords, I declare my interest as a vice-president of the Local Government Association. I also want to thank the Minister for his long stint at the Dispatch Box, yet again.

I want to start with the issue about consultation on NHS Digital patient data, which the noble Baroness, Lady Thornton, just alluded to. In 2013, the Government wrote to every household to explain the care.data project. This new scheme has had no such communication with the public. As people hear about it, they are increasingly concerned about the breadth of data that will be captured. Will the Minister agree to use the delay to ensure that every adult in England is written to as a matter of urgency, including an opt-out form they can use if they so choose?

I also want to pay tribute to our health workers and carers—paid carers and especially the unpaid carers—who have gone not just the extra mile over the last 14 months but a whole marathon. Can the Minister say what steps the Government are taking to help the exhausted staff and carers who know that there are many miles still to go before we are through this? Help is needed right now for them in an emergency plan that does not just focus on getting back to work as normal.

The Minister is right to say in the Statement that there is no room yet for complacency. The delta variant will not be the last variant trying to wriggle between those who are protected and those who are not. We are concerned that there is not a focus on communicating to the public about how we need to find a way to live with Covid circulating, as my noble friend Lord Scriven said yesterday. We have moved into Covid being endemic, and the public will want and need to know what they should do over the next few months.

Communication about the vaccine figures is cheering to hear, but still too many Ministers talk about the one-dose level, not the two. The Minister in the Lords, to his credit, usually make that point, but the Prime Minister and many other Cabinet Ministers do not make it clear that we need 90%-plus of adults to have had two doses before we are anywhere near safe, and that social distancing, mask wearing and hand washing will still need to happen.

I thank the Minister for giving more information yesterday on the isolation support pilots. He said:

“In Blackburn and Bolton, this will include trialling broadening eligibility during surge testing, so that all those who are required to self-isolate, who cannot work from home and earn under £26,000, receive a £500 payment.”—[Official Report, 7/6/21; col. GC 202.]


That is still only £50 a day if you are expected to self-isolate. If you are told to isolate on a Monday, and usually work nine to five, this works out at £7.81 per working hour—less than the minimum wage. If the minimum wage is the very minimum that the Government believe an individual can live on, why are they paying less than this to people for doing the great public good of self-isolating? What about people who work in risky occupations and have been told to isolate multiple times over the last year? For them, it is not just one period of 10 days.

From these Benches, we believe that the Government need to pay people’s wages. Now that fewer people should be required to self-isolate, as community cases are lower, we should be diverting resources to really get right what the Government have been getting wrong all along. We must stop Covid in its tracks. Examples from other countries show that paying wages has a strong and demonstrable effect.

On international travel, the red terminal at Heathrow is an improvement, but there are still issues with those arriving from amber countries, who are asked to jump on public transport to get home and need to travel in various ways before they are tested, once in this country.

Given the increase in cases of the delta variant among primary-age pupils, would the Minister outline what measures are being taken to prevent transmission in schools? When will the JCVI report on vaccines for 12 to 17 year-olds? Are any plans beginning to consider whether vaccination should happen for the under 12s? We strongly echo the comments of the noble Baroness, Lady Thornton, about mask wearing in schools. Is this really the right time to stop that happening?

Finally, I note that the consultation on vaccine and testing certificates has closed. Will the Minister say when the Government will publish their plans following that consultation? What type of legislation will be brought in on this, and will Parliament be able to see and comment on any regulation prior to it being enacted?

Covid-19: Update

Debate between Baroness Thornton and Baroness Brinton

Tuesday 20th April 2021 Lords Chamber

[Baroness Thornton (Lab)]

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

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

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

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

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

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

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

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

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


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

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

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

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

[Baroness Brinton (LD) [V]]

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

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

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

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

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


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

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

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

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

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

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

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

Health and Social Care Update

Debate between Baroness Thornton and Baroness Brinton

Monday 22nd March 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for the Statement from last Thursday. We heartily welcome the rollout of the vaccine and place on record huge gratitude to the scientists from everywhere, the NHS staff—all of them—the local government officials, the pharmacists and the volunteers who have worked so hard and seamlessly to produce such a successful outcome so far. I also take this opportunity to support the AstraZeneca vaccine. I am sure we were all very pleased with the news from the USA, which supports all the scientists in the UK and Europe, that the AZ vaccine is both effective and safe.

However, it was not great news to learn that this amazing vaccine effort will have to slow down due to supply problems, and, I have to say, that did come as a surprise. We have one of the worst death rates in the world and our economy has taken a massive hit. Many key workers under the age of 50—such as teachers and police officers—who through the nature of their work have not been at home, are going out and are more exposed to risk. I imagine that many had hoped that vaccination for them was not very far away. An update on the vaccine supply, particularly on the issues around discussions with the European Union, which seem to have become more fractious, would be appreciated.

But, specifically, what has happened to the Moderna vaccine? I understand that it will start in April. Is there any prospect that, if Moderna supplies come on stream, new appointments can be offered in light of that? Can the Minister assure the House about the second vaccine which many of us await? Will there be sufficient supply and will providing the millions of second jabs delay further the first vaccines for the 30 and 40 year-olds? It seems that the vaccination programme will need to ramp up to about 3.5 million doses a week from May to ensure that everyone under 50 is vaccinated by mid-July. Is the Minister confident that these supply issues will be fixed by May?

Adam Finn of the Joint Committee on Vaccination and Immunisation said that infection rates may rise as a result of the delays. Does the Minister anticipate that any of the stages or dates in the road map for easing out of lockdown will be pushed back, given that we are rightly judging the road map by data, not dates?

There are two other issues that we particularly need to address today. May I ask about the impact of the EU-AZ concern on vaccine hesitancy in the UK? It has been reported that there was a jump in no-shows and people questioning or refusing to go ahead with the AZ vaccine in the last week or so here in the UK.

Many poorer areas today still have the highest infection rates relative to elsewhere in the country, and at the same time their vaccination rates are below average. The worry is that places such as Oldham, Leicester or Hartlepool might be facing a double whammy: they still have high infection rates, but they are not getting the vaccination rates up to the levels needed. Not only will the disease continue to circulate there, with the risk of people catching it becoming severely ill, this also raises the question: will these towns and cities be left behind as the rest of the country eases out of lockdown? Some areas such as Leicester have endured the longest coronavirus restrictions of any part of England, remaining in lockdown since last summer. Closer to home here in London, I understand that in Enfield there are 16,000 people who do not have GPs and are in wards with high levels of poverty, high Covid rates and low vaccine rates—some as low as 55%. What are the Government’s plans to support these areas and ensure that they are not left behind?

Secondly, vaccination centres are detecting a rising number of queue jumpers as Britain prepares to face a four-week jab drought. Officials say that people pose as care or health workers to cheat their way to an early jab and fear that fraudulent bookings will soar before next month’s slower rollout. When the cheats are caught, vaccination slots that could have gone to people entitled to a jab are wasted. In addition, according to anecdotal evidence and the Times article of yesterday, it seems that some centres more recently are not being diligent about requiring proof of the eligibility of the person claiming to be a care worker.

Anyone can fraudulently book a jab on the national booking website by ticking a box to say that they work in health or social care or provide “personal care” for people in their homes. The NHS insists that those who do this but do not bring proof of that to their appointment “will not be vaccinated”. But officials say that the loophole means that rising numbers are trying to exploit a system that is “open to abuse”. Some sites are catching 15 queue jumpers a day and fear that more are slipping through. The problem is that those appointments are lost and those vaccinations wasted. The centres therefore face a “difficult balance” between wanting to avoid wasted doses and appointment slots and rigorously checking ID cards. Bhaveen Patel, who runs a Covid-19 vaccination clinic in Brixton, says that he turns away 15 queue jumpers a day.

Finally, children make up about 21% of the population. That is a large segment of the population who will lack immunity. Obviously, research and trials are ongoing, but does the Minister have a timeline for when he hopes to vaccinate children? Does he anticipate, for example, being able to vaccinate children this autumn, as Anthony Fauci in the US has suggested could well happen over there?

[Baroness Brinton (LD) [V]]

My Lords, from these Benches I also thank the noble Lord for the Statement given in the Commons last Thursday and thank and congratulate everyone involved in the creation and delivery of all the vaccines so far, and for their continuing work to protect the world against mutant strains of the virus. It is good news at a time when much else is still worrying.

I also start with the availability of supply. Can the Minister explain to the House what guarantee there is for people on receiving their second doses? He has reassured the House before, but I am hearing from GPs worried that they have not had confirmation that they will receive enough doses or that they are getting any supplies at all at the moment, as well as from people who have had their first dose from their GP but who have been told they cannot book their second dose via the online national system because their first dose was delivered by their GP. There are a lot of confused people around.

Today’s news about the EU-UK war of words on the vaccine supply chain gets more bizarre by the hour. Are Ministers seriously considering holding back exports of the special lipids from the UK to the EU as a proposed retaliatory action if the EU holds back doses in the Netherlands? There should not be a war of words but the best possible collaboration to ensure that the “lumpy supply”, to quote the Prime Minister, is smoothed out.

On the issue of queue jumpers, both the NHS and the care sector have an effective ID system that has been in place for some time, although obviously it was probably easier to do when they were in the first group of people to be vaccinated. What are the Government doing to ensure that every vaccine centre understands what they need to see from people presenting for vaccines from the care sector?

On the hesitancy in uptake, I too have heard of the increase in no-shows. What are the Government doing to encourage especially those from the first six groups who have not yet come forward to do so? The publicity campaign that is beginning on reassurance about the AstraZeneca dose is good, as is the test news, but we need much more than that. We know that hesitancy tends to be reduced when people, especially doctors and nurses, talk directly to their patients.

As we have said from these Benches, it is good that the UK is playing its part in funding vaccines via COVAX. However, there is a lot of discussion at the moment that the UK should support TRIPS and encourage the sharing of intellectual property rights of vaccines. I have some concerns about this approach and agree with Professor Sarah Gilbert, who said:

“If another company tries to take the IP and go it alone, they are manufacturing a different product. The regulators would see it as a different product; it would have to go through all the efficacy trials again, and that would be very wasteful and very slow. I want to get rid of the idea that we should be sharing the IP and letting everybody make their own vaccines. It does not work like that. We have a way of sharing the materials and the expertise, and that is what we have been working very hard to do. That is the correct way to do it, because that is how we get the right vaccines to as many people as possible.”


The work of places such as the Serum Institute of India are examples of how this collaboration can work at its best. Can the Minister say what the Government will do to encourage and support more examples of such collaboration worldwide? Can he also say whether the UK Government plan to donate some of the spare doses that they have ordered to less developed countries and on what timescale this might be enacted?

The Statement refers to the end of shielding on 1 April. As a shielder, I have received another long letter from Matt Hancock and Robert Jenrick which says to shielders:

“Until the social distancing rules are eased more widely, it is important that you continue to keep the number of social interactions that you have low and try to reduce the amount of time you spend in settings where you are unable to maintain social distancing. Everyone is advised to continue to work from home where possible, but if you cannot work from home you should now attend your workplace. Your employer is required to take steps to reduce the risk of exposure to COVID-19 in the workplace and should be able to explain to you the measures they have put in place to keep you safe at work … From 1 April you will no longer be eligible for Statutory Sick Pay … or Employment and Support Allowance … on the basis of being advised to shield. Clinically extremely vulnerable pupils and students should return to their school or other educational settings.”


I said last year when I received an almost identical letter that this feels very strange. You are told that shielding ends but you should continue to do all the things you were doing before shielding—unless you were in receipt of SSP or ESA, because that is no longer available for those who have to go back to work in an unsafe workplace. In response to a question about shielding I asked at a briefing the Minister kindly held for parliamentarians with Chris Whitty, he said that shielders who are immunosuppressed should continue to shield unless the results of the OCTAVE clinical trial for immunosuppressed people was available. But it has not been announced yet. There is total silence from the Government, but there are many immunosuppressed people who will have received this letter and think that they are okay to start moving around more.

The end of the Statement talks about safe discharge, and the £594 million for safe discharge is welcome, but is that to go to the NHS or the better care fund, or will part of it go to local government? Is the £341 million mentioned later in the Statement to support adult social care with the costs of infection prevention part of that same £594 million or is it in addition and completely separate? How will that money get to social care providers?

Once again, why is only adult social care getting this funding? Once again, paid and unpaid carers for young disabled people, who are often extremely vulnerable to any infections, not just Covid, appear to be excluded from this grant. Can the Minister please explain?

Women’s Health Strategy

Debate between Baroness Thornton and Baroness Brinton

Tuesday 9th March 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, we welcome this Statement, made yesterday on International Women’s Day. We believe that the six pillars it outlines are important signals of the need to take women’s health very seriously. It is welcome that the Government want to understand the plight of women throughout the country. However, although the Statement says that this strategy is the first of its kind, that is not the case. For example, when the Government launched the women’s mental health task force in 2017, the Minister responsible for mental health at the time, the honourable Member for Thurrock, Jackie Doyle-Price, said:

“This report is a call to action for all providers, commissioners and practitioners across the health care system to drive forward the ethos of trauma- and gender-informed mental health care.”


That is absolutely right, but we have to ask: why are the Government asking exactly the same questions four years later? The three matters that I want to raise with the Minister are: the questions that arise out of the effect of Covid on women’s health and well-being; the troubling matter of breast cancer and sexual health; and the implementation of the recommendations of the Cumberlege report.

Analysis of Covid-19 data from around the world suggests that men make up a higher share than women of reported hospitalisations, intensive care admissions and deaths, but the impacts of the pandemic extend far beyond health outcomes for people who have been infected with the Covid virus. There have also been significant economic impacts from measures adopted to control the spread of the virus, and those have affected women in specific ways. For example, what support can be offered to a woman who experiences baby loss without her partner by her side?

The Statement is right to highlight the fact that black women are four times more likely to die in pregnancy or childbirth. I welcome the launch of the forum but the Government have known about these inequalities for many years. Now we need to see some actual investment and action.

Covid-19 has worsened the mental health crisis among young women in the UK. Before the pandemic, young women aged 16 to 30 had the worst mental health of any age and gender group in the population. In the last 12 months those in this same group have experienced a bigger fall in their mental health than any other. The mental health of teenage girls and young women is now a very serious health issue. This will need some investment and attention in the call for evidence launched yesterday.

I turn to the issue of working mothers and the increase in the burden of care. The Government were quite rightly criticised for their sexist “Stay at home” advert depicting women doing schooling and housework. I am very glad it was withdrawn at short order. But this is the reality of the lockdown in many households with young children. The pandemic has revealed stubbornly persistent gender stereotyping in the division of domestic labour. It has shown that men and women are not equal when it comes to unpaid childcare and housework.

Before the pandemic, women did more than 60% of home childcare. When schools and childcare closed during the first lockdown, they took on roughly the same share of the massively increased burden of additional care. Evidence from the ONS indicates that women have taken on even more of the burden of home-schooling during the 2021 lockdown. Two-thirds of mothers, compared with half of fathers, report that they have personally home-schooled their children. Half of those who have done home-schooling report that this has negatively affected their mental health and well-being.

Looking at older women, before the pandemic, those aged 70 and above enjoyed a relatively high level of mental health compared to the population as a whole. But they have experienced one of the biggest falls, far greater than that of older men. An important factor is of course that older women are likely to experience a higher level of bereavement, since older men have a higher risk of death from Covid-19. We have seen a higher level of grief following deaths, with the inability to say goodbye to loved ones. The cost of grief has received relatively little attention from economists, with some notable exceptions, but it is a very important factor in the mental health of older women in our society. The cost of grief needs to be factored into this inquiry.

Women are still being misdiagnosed in 2021, with male bodies being seen as the default body. There is a huge historical data gap in understanding women’s health needs. It is shocking that women are 50% more likely to be misdiagnosed following a heart attack, simply because their symptoms differ from those of men. The research of the government commission needs to bridge that divide.

I turn to breast cancer specifically. Almost 11,000 women in the UK could be living with undiagnosed breast cancer because of the Covid-19 pandemic, according to new analysis by Breast Cancer Now. It says that 10,700 fewer people were diagnosed with breast cancer between March and December than one would have expected. That data has to be factored into this commission of inquiry.

I turn now to women’s sexual health. Jo’s Cervical Cancer Trust said that

“600,000 tests failed to go ahead in the UK last April and May … in addition to a backlog of 1.5 million appointments missed annually.”

Thousands of IVF cycles were cancelled or postponed in the early stages of the pandemic, with many clinics then facing a backlog of patients. Again, this needs to be factored into this research.

One of the most potent symbols of how the health service fails women is that identified in the report of the noble Baroness, Lady Cumberlege, First Do No Harm. It shows decades of women being ignored and dismissed by the medical profession and all of those in it. The report talked of the

“disjointed, siloed, unresponsive and defensive”

health service not adequately recognising the needs of women over decades. Surely the best way to mark International Women’s Day would be to commit to implementing all the recommendations in that report, would it not?

[Baroness Brinton (LD) [V]]

My Lords, the warm words in this Statement regarding women’s health inequalities are certainly a start, but there is so much to do. Many of us in your Lordships’ House have been working on the Domestic Abuse Bill, where looking at access to health and mental health support for victims—the vast majority of whom are women—has exposed that there is a major problem.

Mental health has been brought into sharp relief, as the noble Baroness, Lady Thornton, has already said. But we know that it has been underfunded, and services pre- pandemic were already at breaking point. The pandemic has really exposed these shortcomings. What are the Government going to do to provide that parity of mental health services they committed to in 2015, which women in particular are finding difficult to access?

The Statement talks about women’s experiences of specific services. For pregnancy and maternity support, the pandemic exposed that, for far too long, pregnant women have been isolated and their partners not permitted to be with them. My own niece had a baby during lockdown and was not particularly well. When she went in for her weekly tests, not knowing whether she would have to stay in until the birth, her husband was not allowed into the hospital with her until she was actually in the delivery suite. That caused tension for far too long.

We have also seen that the vital role of health visitors and community nurses, which has been curtailed somewhat, is absolutely evident when they are not there. Community services for young mothers are really important, and I hope the Government will look at that.

The Statement talks a lot about endometriosis. I was diagnosed with endometriosis well over 40 years ago. I am pleased to say that treatment in hospitals has advanced considerably since those days. But what seems not to have changed is diagnosis and referral. I ask the Minister this: what support is there to train all GPs, primary care nurses and employers to recognise when women have these problems? They should not be dismissed as “a bit of a bother” because all women have a problem at that time of the month. It is not just an information issue for women themselves to recognise it. We need the professionals and the business community to understand that endometriosis is a very serious illness.

The Statement notes that

“77% of the NHS workforce and 82% of the social care workforce are women”.

They are absolutely on the front line but too often have been let down. Despite that enormous ratio of women in the workforce, there are still pay gaps—certainly at a higher level. It would be interesting to see the publication of the percentage of male and female staff at each level and for all trusts and CCGs to publish their pay gaps on an annual basis, as we ask large companies to.

We also know that a higher percentage of BAME women were at risk of serious Covid and death. This was particularly amplified for our front-line NHS and social care staff.

I echo the points raised by the noble Baroness, Lady Thornton, about caring responsibilities. It is not just about care for children who are home from school. The pandemic has brought into sharp relief the unpaid carers of adult family members. I would like to make a call out, and I hope the Minister will support me: when it is time for every one of us to fill in our census form in 10 days’ time, please will unpaid carers tick the box saying that they are carers? We need to know how many people out there are doing this. We know that the majority of them are women.

The Statement talks about issues facing women with disabilities. Yesterday, it was wonderful to see a series of tweets from disabled women about their lived experiences in our society. Some of it, especially on access to health services, was pretty depressing too.

Women with learning difficulties are also often at the end of the queue for health treatments. Ciara Lawrence, who is a Mencap ambassador, is an absolute shining example of how women with learning difficulties can get access to those services. She went for her cervical smear test a year ago. Since then, she has not only been promoting it among other young women with learning difficulties but is teaching the NHS how to work with women with learning difficulties to encourage and support them to have their tests. Women with learning difficulties also say that access to family planning services can often be harder too. Will the Government make sure that these issues for this group of disabled women are addressed?

The paper refers briefly to LBGT women, who also face particular difficulties in accessing services throughout their adult lives. What will the Government do to reach both these groups? I note that, towards its end, the Statement talks formally about working with women’s organisations, but so much will be missed if women who also have other protected characteristics—and their organisations—are not specifically asked.

Covid-19 Update

Debate between Baroness Thornton and Baroness Brinton

Thursday 4th March 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for this Statement. I agree with the Statement in congratulating the NHS on its rollout of the vaccine, which continues to be a huge cause for optimism and hope, as does the science and research, in which the UK has played a leading role. However, we are still the country that has the third highest number of deaths in the world, at 124,000. Given the success of the vaccine and the strength of our science base, that is dismal. It must at least in part be attributed to decisions that the Government have taken or not taken, the failure of test and trace to do the job that we need it to do and the porous nature of our borders, on which we have again seen decisions taken too little, too late.

The concern about new variants means that, if the UK does not get on top of them, the valiant efforts of our NHS, our scientists and the vaccine could be terribly undermined. In January and February, cases here were running at tens of thousands a day and we were in lockdown, as we still are, because of our home- grown, new infectious variant. Nevertheless, people were allowed to fly in from abroad, bringing the P1 Brazilian mutation with them. Throughout history, epidemic after epidemic has exploited international travel. Surely it is obvious that tougher border controls should have been in place sooner.

The Brazilian variant cases arrived a month ago. They showed the problems of delays as well as the limitations of the pre-travel tests that did not catch those cases. Even now, 99% of the 15,000 daily arrivals are not covered by hotel quarantine. Most people can still travel home from the airport by Tube, train or even plane, mixing with others, as some of these travellers did, without being tested on arrival in the UK. Why are the Government still refusing to introduce additional tests on arrival and still allowing international passengers to travel onward on UK public transport? Does the Minister recognise that those gaps in the system will let more new variant cases spread? Is it also the case that there is a risk of cross-infection at airports where congestion is occurring? I understand that yesterday there were queues that lasted for several hours at Heathrow. What are the Government going to do about this? It is shocking that people are mixing, having arrived from a list of countries at risk, instead of going straight into hotels for isolation.

Of course, I welcome the progress that the Government have made in identifying the batch of tests from which that of the missing infected person came, but how on earth can a test be processed that does not collect contact details? What mechanisms have been put in place to fix that for the future? Some £22 billion have been allocated to this system, but it feels as though someone has vanished into thin air. How is the hunt for this person proceeding? Can the Minister assure us that this will not happen again?

Is there any information suggesting why this variant is spreading? The Minister might recall that John Edmunds from SAGE told the Home Affairs Select Committee in January that for every identified South African variant case, there were probably another 30 that had not been identified. Can the Minister tell the House, therefore, whether he has received any estimates of the number of unidentified cases in the wider community?

We are in a race against the evolution of this virus, so we have a long way to go. To be frank, nowhere is Covid-safe until everywhere is Covid-safe. None of us wants to yo-yo in and out of lockdown, so will the Minister guarantee that the lockdown easing will, as promised, be absolutely based on data, not dates, and that the assessment time between each step will not be compromised?

I welcome the extra surge in testing, but what is the current timeframe for genetic sequencing? How can it be speeded up? What steps will be taken to ensure that areas such as Ashfield, Leicester, Watford, Worthing and Hyndburn are not left behind when the national lockdown restrictions begin to lift, or will those places be put in localised lockdowns? Will the local authorities there be given extra resources to do more door-to-door testing and retrospective tracing? Will workplaces in those areas be inspected by the Health and Safety Executive to ensure that they are Covid-secure? Will people finally be given decent sick pay and isolation support?

On the Budget, it beggars belief that it did not include any detailed plans for the NHS. Indeed, the OBR highlights this, saying:

“The Government’s spending plans make no explicit provision for virus-related costs beyond 2021-22, despite its Roadmap recognising that annual vaccination programmes and continued testing and tracing are likely to be required.”


We know that the last reorganisation of the NHS cost £3 billion and that does not seem to have been put into the Budget either. Can the Minister explain how the NHS will catch up with the enormous backlog that has been created, as well as the ongoing pandemic-related costs? This is an urgent question.

It has also emerged that the Government appear to have delayed social care reforms until 2022, with the Chief Secretary to the Treasury, Stephen Barclay, telling campaigners that plans for sustainable improvement will only come next year. In January, the Prime Minister told Parliament that the Government would bring forward plans later this year, so will the Minister confirm whether it is this year or next year or when they actually intend to launch reforms on social care?

[Baroness Brinton (LD) [V]]

My Lords, from these Benches we, too, congratulate everyone involved in the vaccination process, including our brilliant teams of scientists, both in this country and abroad, who have been working—and continue to work—tirelessly on safe and effective vaccines for the world. We also congratulate the teams who are organising and managing the supply chains and all of those on the front line delivering jabs in arms, or supporting them to make it possible to reach the target of 20 million doses achieved this week. We will also not forget everyone working on Covid at the moment, whether front-line staff in health and social care or back-office staff who may not be visible to us but who are making sure that all these processes are working. We thank them all.

It is reassuring to hear that the second jab supply chain has been factored in, but can the Minister please tell the House if the supply chain and vaccination dose capacity is also protected for the next priority groups due to receive their first dose? This is critical to lifting lockdown.

It is good news that the clinical trials under way since before Christmas are demonstrating that the over-80s are developing good antibodies to resist the coronavirus and that this is now evident in the data. It is fascinating to see the vaccine gap in graphs, showing that there is a much steeper decline in cases in the over- 75s than there is in the under-60s. It is also encouraging to see reports that there have been very few side effects to both the AZ and the Pfizer vaccines. Can the Minister say if this information will be used to encourage those who have so far refused their first dose?

The Octave trial, funded by the Medical Research Council, is now under way, assessing whether those people with compromised immune systems are able to make antibodies. It was reassuring to read the details of this trial from some participating universities and university hospitals and I am grateful that Professor Chris Whitty was able to outline this project in a briefing to parliamentarians recently. I had understood it to be well under way already, although the press release makes it sound as if it is much more recent and still recruiting. Can the Minister say when the Octave trials are likely to publish their results, given that many people currently shielding are anxiously waiting for them?

The Statement refers to the Brazilian P1 variant and to the case of the individual who had not completed their form correctly. There has been silence over the last couple of days, and I wondered whether the Minister could update the House on the search for this individual. As I raised earlier this week, can the Minister help the House to understand why such an issue was able to happen at all? Is it correct that there are no processes in place to ensure that, as people come into the UK, border agency staff check their passports against the online forms completed in advance, so that personal details, such as addresses, are visible? The noble Lord, Lord Balfe, made it plain—as have many others travelling into the UK—that these checks are rarely made, if at all.

Is it correct that local health and resilience forums are not given any details of people quarantining in their areas? This is important to ensure that care support teams would be able to check and provide help for those quarantining if they have any concerns. That might have helped with this particular case: a traveller from Brazil feeling unwell would have had a local contact to talk to about what to do.

Finally, as we wait to see if cases, hospitalisations and deaths have reduced enough to start lifting lockdown carefully in April, can the Minister respond to the report published today showing that test and trace has barely used the check-in app data from visitors to pubs, restaurants and hairdressers, resulting in thousands of people who have been checked in not being warned that they might be at risk of infection? The report states that the Department of Health and Social Care has noted that more than 100 million people have checked into venues since it went live in the autumn, but only 284 alerts have been sent to 274 venues—not 274,000 venues, just 274. Worse, the report says that the lack of guidance for local resilience forum trace teams on how to use the data has left businesses being asked to, or volunteering to, contact customers and visitors, which is technically a breach of GDPR and leaves those businesses and venues open to potential legal challenge.

After spending £40 million on the contact tracing app, encouraging the public to act responsibly, and the department saying today:

“The NHS COVID-19 App is an important tool in our pandemic response”,


can the Minister tell us which of these statements are true? Can he confirm that the guidance given to local authority health departments on how to use the data to notify people from the app is in full compliance with GDPR legislation? Is the figure of only 274 venues receiving alerts correct—yes or no? What steps are the Government taking to remedy this before pubs, restaurants, hairdressers and non-essential retail begin to open again?

Future of Health and Care

Debate between Baroness Thornton and Baroness Brinton

Tuesday 23rd February 2021 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, I thank the Minister and declare my interests as a former member of a CCG and a non-executive director of a foundation trust.

The Lords Labour health team—myself and my noble friends Lady Wheeler and Lord Hunt—are veterans of the infamous Lansley Bill, which became the Health and Social Care Act 2012. Many noble Lords will take part in the new legislation—including, of course, those on the Lib Dem Benches, who supported the Lansley Bill. I hope that they have come to their senses since then.

We cannot sweep under the carpet, as the Secretary of State and the Minister would have us do, the fact that many of us warned that the huge bureaucracies and implementation costs of something like £3 billion would be a terrible waste of public money and time. They resulted in a loss of initiatives and innovations that lies at the Minister’s door. Some indication of lessons learned would be welcome.

We are in the middle of the biggest public health crisis our NHS has ever faced. Staff on the front line are exhausted and underpaid. The Royal College of Nursing says that the NHS is on its knees. Primary care and CCG staff are vaccinating and will be doing so for months ahead. Today, we learn that 224,000 people have been waiting more than 12 months for treatment. The Secretary of State and the Government think that now is the right moment for a structural reorganisation of the NHS. It might be significant that, in the Statement, I cannot find a single explanation of how patients will benefit from this reorganisation. It is all about systems.

Apart from the timing, some very serious matters need to be addressed. This is a Conservative NHS plan, and it shows. Without the money, none of this is worth discussing seriously. Without a workforce plan funded by that money, it will not work. This Bill should not go ahead in its current breadth until the solutions for social care and public health are also set out. Although reform of the Mental Health Act is welcome, it also needs to fit into the wider solution that is missing around social care.

Why does the White Paper not include an option simply to delete Part 3 of the existing Act, thus abolishing the market and competition regimes that created the burdensome bureaucracies and which, it must be said, many CCGs and ICSs have worked hard to get round in recent times? Let us take some time to work out the rest, bring forward the promised social care reforms, let our exhausted NHS recover and have a system co-created with local government.

I suspect that the need to move powers to the centre is a poisoned chalice. Is the Minister proposing simply to dump the Lansley structures and bring back the situation where the Secretary of State has the power of direction over all and any parts of the system? Although I welcome the place-based commitment, it is woefully undefined. This plan ought to be co-owned and co-developed with local government nationally as well as locally, with real parity of esteem. Far more is needed to remove barriers, but the biggest local barrier now is the absence of any solution for social care and public health.

Looking at the NHS’s history, we should be sceptical of structural reform necessarily leading to changes in care delivery that make services more integrated and benefit patients. We know from Wales, Scotland and Northern Ireland that integrated care systems have not brought about integrated care. It is necessary to remove system barriers but not sufficient. The bigger challenges lie around culture and vested interests, which are not even mentioned in this White Paper. It is all far too complicated, with health and well-being boards and HealthWatch still in place as well as the proposed new structures. It needs a clear explanation of who controls the money. Can you have two boards at the same time and call it integrated, and be sure where the accountability sits and whether good governance can be assured?

There is little about how decisions are made on who sits on these boards. Is it proposed to bring back independent appointments commissions to guarantee the diversity required? Will staff representatives and patients have a seat where it matters? Surely there can be only one body with the power to set the local strategy and sign off the plans that bring the money. This proposal seems to have many bodies, meaning that governance and accountability are at risk. Having providers, and even independent providers, with a place in the decision-making about resource allocation is clearly unacceptable. If there are to be some contracts awarded by competition, there must be clear rules about who is entitled to compete. These organisations and companies must pay their taxes, for instance, and must offer fair and comparable terms and conditions to their workforce. For example, we know that social enterprises totally fulfil those conditions, but one must ask why we need competitive tendering when you can hand out contracts to chums from the stables, the golf course, and the pub, as we have seen in the last year.

The White Paper is silent on the future of foundation trusts, silent on the role of governors, silent on a whole range of potentially competing governance issues which will have to be resolved. How much acute and tertiary care can be brought into locality-based structures? Integration of primary, community and social care is clear, but, as everyone knows, the acute side is far more complex and a single solution, as proposed in this White Paper, almost certainly will not work. The big players such as teaching hospitals do not fit into any single locality, or even single ICS, but are vital players. Will there be extra layers of governance above the ICS, which is not defined at all?

We will of course study the legislation carefully when it is published, but the test of reorganisation is whether it benefits patients and communities, brings down waiting lists and times, widens access, especially for mental health care, drives up cancer survival rates and improves the population’s health.

[Baroness Brinton (LD) [V]]

I am grateful to the Minister for the short-notice briefing just as we were rising for recess.

If you had said to most people in the health and social care sector three weeks ago that the Secretary of State for Health and Social Care was announcing a new White Paper, virtually everyone would have assumed that it was the extremely long overdue White Paper on social care, promised by the Prime Minister in his party’s manifesto in the 2019 general election and repeatedly further promised at the Dispatch Box over the last 14 months. This Statement refers to it appearing at some point later in the year.

Instead, we have a comprehensive White Paper that focuses, despite the references to care, on the NHS and health systems, undoing some but not all of the 2012 Lansley reforms. This White Paper talks grandly of integrated systems, but you cannot integrate systems if one of the key parties is on its knees as a result of appalling neglect for many years. We agree that our clinicians, managers and associated health and social care staff have great ambitions for moving our health and care structures into the 21st century, and we compliment them, and Ministers, on their ambition, but we have been here before. A decade ago, the Government announced and legislated for a Dilnot-style cost model for social care, which, unfortunately, was later scrapped. We went from a point where all three main political parties were in agreement, but, sadly, the Conservatives withdraw from that agreement. As with manifesto promises on the care sector over the last three general elections, when will the Government start the long-promised cross-party talks to find a solution for the care sector? We remain ready and waiting.

The Statement makes the point that the pandemic has brought the structural difficulties in the care sector into sharp relief. That much is true. With more than 25,000 care home deaths, 10,000 of which have occurred since the lockdown started in January, what will it take for the Prime Minister to make good on his promise to fix social care? Why did it take weeks longer to arrange for residents and staff in care homes to get testing, whereas the NHS had reliable access as soon as it was available? Worse, the care sector’s experience of the Department of Health and Social Care taking its orders of PPE out of lorries and diverting them to protect the NHS first—which happened—and the NHS discharging Covid patients into care homes, while reassuring care staff that it was not doing that, has undoubtedly damaged trust. I do not deny that there has been a really strong attempt to get people to work cross-department, but this sort of behaviour has really not helped.

The Statement talks about making Ministers accountable again. A good step would be for the Secretary of State to come to Parliament and explain why he did not publish PPE and other contracts within the appropriate timeframe. There are concerns, too, about cronyism and possibly even corruption. So I say to Ministers: beware of what you wish for.

A further problem of the White Paper in front of us is the need to undo some of the perverse bureaucracies and expenses created by the 2012 reforms. The “internal market” was one such. I cannot see the logic of having a CCG of GPs overriding NICE and a hospital team on a medication pathway because it wants to spend the money elsewhere. The Minister told me that there will be changes and that there will be some representation from trusts, but, from what I hear, it is not enough to leave the clinicians who are expert in charge able to follow the advice of NICE.

The Statement also talks about the portrait of Sir Henry Willink, who published the 1944 White Paper from the Dispatch Box. But Sir William Beveridge’s report that led to that White Paper, and then to the post-war Labour Government’s creation of the NHS, had a clear structure. The five great evils that Beveridge, as a Liberal, set out could be tackled only by a cross- departmental approach, of which health was a vital component but not the sole driver.

When my grandfather was dean of St Mary’s Hospital Medical School, he always used to say that it took only 20 years for the NHS to move to a “national illness service”, as demand and costs in hospitals increased exponentially and any budget that was not for hospitals was squeezed. That is why, in the 2012 reforms, we in coalition wanted at least elements of public health moved to local government, where it could more effectively work with the other parts of the system fighting Beveridge’s five great evils and, through the health and well-being boards, be accountable at a local level. The examples of the excellent directors of public health during this pandemic have shown that it can and does work, despite the NHS finding it difficult to delegate to them. It is no surprise that inequality is one of the greatest predictors of serious Covid illness or death. Can the Minister reassure us that, whatever happens to public health, it will have its funding ring- fenced to tackle these inequalities?

Next week, we have the Budget, in which the Chancellor will have to face the highest levels of national debt since the Second World War. After the publication of his report, Beveridge expressed concern, saying that the Government should be bold:

“Now, when the war is abolishing landmarks of every kind, is the opportunity for using experience in a clear field. A revolutionary moment in the world’s history is a time for revolutions, not for patching.”


Now, too, is the time for such revolutions. This pandemic has left us with a health and social care system that needs not just reform but proper funding. Without it, integration and effective joint working will fail. Can the Minister assure us that there will be bold actions to ensure that any changes are fully funded? Without it, Atlee, Beveridge and Willink will be turning in their graves. Worse, these proposed reforms will fail the UK people, whether patients or just those living in their communities—the very people who need it most.

Covid-19 Vaccines Deployment

Debate between Baroness Thornton and Baroness Brinton

Thursday 11th February 2021 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, it is clear that we will live with Covid-19 and its mutations for a long time, so a full vaccination programme seems the best way to get out in front of it. Obviously, everyone was very pleased to hear the study results regarding the Oxford/AstraZeneca vaccine reducing transmission and maintaining protection for over 12 weeks. While the daily cases begin to fall, it is vital that the Government do not repeat previous mistakes and take their foot off the gas just as things look like getting better. Could the Minister update us on whether he expects similar trial data to be published for the Pfizer vaccine?

Would the Minister care to comment on the—how can I put this?—forceful comments of his honourable friend Sir Charles Walker MP on “Channel 4 News” when he accused the Government of robbing people of hope and said:

“We cannot cancel life to preserve every life”—


whatever that means? Apart from the fact that, in my own view, that sounds like a petulant child, it is concerning that these are the pressures being brought to bear on the Government, and it is to be hoped that they will bear up and previous mistakes will not be repeated.

It seems that the Government are on track towards their promise of vaccinating the top four Joint Committee on Vaccination and Immunisation priority groups by the middle of this month. That is to be applauded. Regarding data, though, I think everyone is concerned about the reports of lagging take-up among black, Asian and minority ethnic communities as well as among poorer communities. We know that these groups have been the worst affected by the pandemic and we need to get them to take up the vaccine, but I am conscious that much of what we hear is based on anecdotal stories rather than hard data at community level split by ethnicity. What data does the Minister have on that? When can colleagues get council ward level data so that they can be part of the effort to drive uptake?

As the first phase is coming to an end, can the Minister update us on the number of care home staff who have received their first dose, and perhaps what the plan is to encourage those who have not done so to take up the vaccination?

It appears that one in five over-80s in London has yet to be vaccinated; that is what the latest figures suggest. Some 78% of over-80s in the capital have had a first dose, lower than for other groups, while the figures are 83% for the 75-to-79 age group and 79% for the 70-to-74 group, so we still have some way to go in London.

When we get to the beginning of April, those who have had their first dose will be expecting and needing their second one. Can the Minister give an assurance that there will be enough supply to ensure that everyone who is due their second dose will get it?

Also, we do not want the vaccine rollout across Britain to be undermined by a vaccine-resistant strain entering the country, which the Government’s failure to secure our borders risks jeopardising—but we will be coming on to that in the next Statement.

Will the Minister say what conversations are now taking place with the JCVI and what changes might be made to the priorities of the people who will be due the vaccination? For example, will the JCVI be reviewing key workers? Data has shown that those who work closely with others and are regularly exposed to Covid-19 have higher death rates than the rest of the population. By prioritising those workers alongside the over-50s and over-60s and people with underlying health conditions, surely we can reduce transmission further, protect more people and keep the vital services that they provide running smoothly—which, of course, includes reopening schools.

[Baroness Brinton (LD) [V]]

My Lords, I start by congratulating everyone working in the vaccine sector: the scientists, still working behind the scenes to ensure that there are vaccines that will be effective against the South African and Manaus variants; those involved in the manufacture and supply chain; and all those on the front line, making sure that the vaccines are delivered into arms safely and swiftly by clinicians, with administrators, staff, the military and volunteers helping. A notable reason why the UK has been able to manage this so well has been the expertise of Professor Chris Whitty and our vaccine research community, which has so many years’ experience in epidemics, including the Ebola outbreak in west Africa.

The Joint Committee on Vaccination and Immunisation has also kept our focus on who should be protected first, and the government delivery group, led by Kate Bingham, has also done well. The numbers vaccinated in the top four priority group continues to grow and I, for one, hope that the target for next week will be achieved.

The Statement says:

“We … visited every eligible care home possible with older residents in England and offered vaccinations to all their residents and staff. That means we are currently on track to meet our target of offering a vaccine to the four most vulnerable groups by mid-February.”


However, I still cannot find the actual number and percentage of social care staff vaccinated, whether those working in care homes or domiciliary care staff providing essential support to keep people living in their own homes, so please can the Minister provide the number and percentage of social care staff who have now had their first dose of vaccine? Once again I ask: why are care staff not disaggregated from NHS staff in the published data?

The target of “offering” a vaccine to those in or working in homes is, frankly, no target at all. We know that, after Christmas, an alarming number of cases were diagnosed in care homes, which has resulted in residents and staff being refused vaccine until all cases are over in those homes. With very limited visits by families, the only way that Covid could have come in is, unfortunately, via staff, who probably picked it up from others over the Christmas break. Today, the ONS has said that one-third of all Covid cases in hospital during this pandemic have been over the past month. That is truly shocking.

Was the Prime Minister’s bold statement last year that Christmas should not be cancelled and his encouragement to allow people to mix, against all the expert advice from SAGE and alternative SAGE, worth it? How many deaths will have resulted from those cases, which could have been avoided if that expert advice had been followed earlier?

There are reports of some surgery teams arriving at care homes with enough vaccine only for residents and staff being redirected to large hubs, many miles away. This is unhelpful when staff work shifts and are on low wages, with no access to the transport needed to get to a hub. What is planned to ensure that all care home staff can be vaccinated at their place of work by their local vaccination teams?

Another bit of ONS data this week has shown that there were more than 30,000 Covid-related deaths of disabled people between mid-January and mid-November last year, representing 60% of all Covid-related deaths in that period. I remain concerned that many of those under 70 who are disabled or learning disabled and live in homes are still not on a priority list. We know that those requiring close personal care are at very high risk. The ONS data proves that. When will the Government add them to the top four priority lists?

The opening of large hubs is welcome, but they must not replace very local access to vaccines, whether through GP surgeries or local pharmacies. Worrying reports are emerging of GPs running out of supplies and being told that the large vaccine hubs are being prioritised over them. I thank the Minister for the excellent briefing that MPs and Peers had earlier this week on vaccines and possible treatments for Covid-19. The Statement says:

“This trial will look at whether different vaccines can be safely used for a two-dose regime in the future to support a more flexible programme of immunisation.”


It goes on:

“I want to reinforce that this is a year-long study, and there are no current plans to change our existing vaccination programme, which will continue to use the same doses.”


However, the green book on the vaccination programmes states:

“For individuals who started the schedule and who attend for a vaccination at a site where the same vaccine is not available … it is reasonable … to offer a single dose of the locally available product”


to complete the schedule. If safety has not yet been established, why does the green book say that potentially unsafe dosing regimes can go ahead?

The Minister is correct to say that no one is safe until the whole world is safe, and it is good that the UK has made a commitment of £548 million to COVAX with match funding to provide 1 billion doses of vaccine this year to developing countries. I hope that the Prime Minister will use his chairing of the G7 to encourage other countries to donate their share to make this happen. The examples of the South African and Manaus variants are a wake-up call to all of us that we must work as a global community to protect all people and the world’s economies from Covid-19.

Covid-19

Debate between Baroness Thornton and Baroness Brinton

Thursday 11th February 2021 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, a hotel quarantine policy has been debated for months and was finally announced two weeks ago, yet the legislation underpinning the scheme has not been laid. That means that, yet again, Parliament cannot scrutinise and vote on the regulations until after they have been brought into force. Can the Minister advise the House when they will be published and when we will get the opportunity to debate them? I hope that he will be able to assure me that they will not be laid at the 11th hour, as so many other coronavirus regulations have been, which would mean that people who are impacted by this policy and need to implement it will have to get up to speed very fast indeed to make the necessary arrangements.

The UK’s quarantine policy is due to come into effect on Monday. It is exactly a year to the day since I raised this exact issue in your Lordships’ House in response to a Statement repeated by the Minister’s predecessor, the noble Baroness, Lady Blackwood. Her answer was basically that the Government would be putting the resource into dealing with quarantine immediately. A year later, “immediately” has not really happened, which is a shame. We have possibly borne the burden of deaths as a result of that, too.

It is also clear to see that there are gaping holes in the Government’s new hotel quarantine system. Figures suggest that thousands of people travelling from higher-risk countries will be missed by the scheme every day. Analysis of passenger data suggests that 10,000 passengers will arrive in the UK on Monday from countries where the South African or Brazilian variants of Covid-19 are circulating but which are not yet on the Government’s “red list”. These people—roughly 19 out of 20 passengers —will avoid hotels and ask to quarantine at home. Yet just three in every 100 people are being checked to ensure that they comply with home quarantine. Does the Minister think that that is good enough? Given that we know that the South African and Brazilian variants of the virus involve a key mutation, E484K, which may help the virus evade antibodies and render the Pfizer and Oxford/AstraZeneca vaccines less effective, the Government’s failure to secure our borders risks jeopardising the fight against Covid-19 just at the moment when it looks like we are making significant progress. So I hope that the Government will urgently review the policy and extend quarantine to all travellers arriving in the UK.

I turn to the implementation of the policy. Will the Minister update the House on the number of beds in hotel rooms that have been secured for travel quarantine measures? Can he confirm whether they are seeking to expand capacity in anticipation of extending the policy to further countries? What steps are being taken to ensure that staff in quarantine facilities are given adequate PPE? I would also be grateful if the Minister could outline what support and financial assistance will be in place to help people seeking to return to the UK from “red-listed” countries who cannot afford the up-front £1,750 quarantine cost. This is very important, given that, among the numerous categories of travellers, there are likely to be people who had to go abroad at short notice for family emergencies.

Finally, it has been announced that people found to have omitted to reveal that they have travelled from a “red list” country could possibly face up to 10 years in prison under the Forgery and Counterfeiting Act 1981. While the penalties for non-compliance are a core part of any regime, does the Minister accept that a 10-year prison sentence is really disproportionate? It is more severe even than sentences given out for some violent and sexual offences. Sir Keir Starmer has, quite rightly, pointed out that pretending judges would sentence anyone to that long in prison, in court cases that—given the current backlog—will not be heard for several years, is not going help anyone and probably will not deter anyone.

[Baroness Brinton (LD) [V]]

My Lords, the Minister is right to say that it looks as if the corner has been turned on cases, and even on hospitalisations, in this most recent surge. I too, like the noble Baroness, Lady Thornton, look forward to actually seeing the quarantine regulations being laid in Parliament. We keep asking for sight of them as early as possible. We have known that this quarantine arrangement was coming in—leaks started in December.

The BMA and other medical groups are concerned that those without GPs must have access to the vaccine. Last week, the Government announced that undocumented migrants can register with GPs for a Covid vaccine without fear of being prosecuted by the Home Office. This is good news, as we need everyone possible in the country to be vaccinated, to keep us all safe. However, the law currently requires the NHS to report those without a defined migration status. This amnesty announcement, based on the suspension of so-called immigration data sharing between the health service and the Government, is temporary, only during the pandemic. What safeguards are there that this data will not be shared after the pandemic is over? A temporary amnesty will not encourage people to come forward if their data can later be shared.

According to Ministry of Justice data, 2,400 Covid-positive cases were recorded in prisons in December—a rise of 70% in a single month. Given that the Government have a legal duty to provide equivalent healthcare to those in prison, can the Minister explain why prisoners in priority groups 1 to 4 started to be vaccinated only from 29 January?

Will the Minister answer a question I asked earlier this week without a response? There have been number of reports of Sitel and other call centre contractors having their contracts reduced by government and immediately sacking track and trace staff because, as a Sitel manager said,

“At this point in time as a business we need to reduce the number of agents because we have done our jobs.”


Can the Minister please confirm or deny that the Government have asked for track and trace staff numbers to be reduced? Do the Government still believe that test, trace and isolate remains a vital part of coming out of this pandemic, or are they totally relying on the vaccine? Everything that the scientists and doctors are telling us is that we will have to continue to take all precautions, such as “hands, face, space”, and will also need all the protection tools, such as test, trace and isolate, for some time to come, otherwise we will be hurtling towards yet more cases, hospitalisations and deaths.

That brings me to borders. On 22 January last year, alongside the noble Baroness, Lady Thornton, I asked the Minister’s predecessor what steps were being taken to monitor flights from places where Covid-19 had been confirmed or was suspected. I have repeatedly raised worries that the UK was not following either the World Health Organization advice or the actions of the CDC in America, which has resulted in many cases coming into the UK from China and the Far East and, during February, through those returning from skiing holidays in Italy, France and Austria. Every step of the way, the Government have been too slow in making arrangements to monitor passengers, whether placing them in quarantine at home or, as is now proposed, in quarantine hotels.

Some countries have learned through experience that early action at borders is vital. South Korea, Australia and New Zealand are notable examples. Taiwan should be a role model for us all. It began monitoring passengers arriving as early as 31 December 2019, and shortly afterwards created formal quarantining, both at home and in hotels, with electronic monitoring by health teams. Its Government’s clear communication with its people, providing the carrot of a support package for anyone quarantining, as well as the stick of substantial fines, has meant that a country of 23 million people had, in 2020, fewer than 800 cases, with only seven deaths. One city alone has 3,000 hotel rooms reserved for quarantining; the Government here are proposing 4,000 for the whole of the UK. And the fines in Taiwan are not small, at up to 300,000 New Taiwanese dollars—about £7,500—with one businessman who breached quarantine seven times in three days fined more than £26,000.

Taiwan’s approach is as much about self-isolation as it is about quarantine for those coming from abroad, and the view of the Taiwanese public is that everyone should do their civic duty, helped by the clarity of messaging from the Government and their medical experts. So it is a shame that our Government’s key message is all about the maximum prison sentence. We need as much of the carrot in our approach, rewarding people for self-isolation, preferably by paying their wages and by supporting them with care calls and delivering shopping and medicines, most of which has been notable by its absence to date.

Two things are clear from the worries over the new variants. The UK public want to do their duty. The vast majority of people are complying with lockdown. They also understand that the nature of Covid-19 is changing, and that new variants mean we must change the way we live too. So will the Government please make the changes that we on these Benches have asked for, for over a year, regarding borders? Otherwise, we risk losing all the progress made with vaccinations, we risk children not returning to school, and we risk further and substantial damage to our economy.

Covid-19 Update

Debate between Baroness Thornton and Baroness Brinton

Thursday 4th February 2021 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for this debate on the Statement made in the Commons on Tuesday. I start by joining the Minister and everyone across Parliament and government in sadness at the death and in celebration of the life of Captain Sir Tom Moore. I also join everyone in celebrating the fact that 10 million people, 15% of the population, have now been vaccinated with a first dose. That is a fantastic achievement and I am so grateful to the NHS and all those who have contributed to this amazing national effort. Another Statement about vaccines is being taken in the Commons today, so I think we can see that this is a fast-moving world that requires Parliament to be quick on its feet to make an input and provide both scrutiny and support.

However, we are all aware of some people who are refusing the vaccine, including care workers. Can the Minister advise the House how many people in the priority vaccine groups have refused the vaccine? If he does not yet have these figures to hand, can he say when the figures, broken down by area, age, gender and ethnicity, will be available? This data seems to be crucial to understanding and tackling vaccine hesitancy moving forward. I am sure that the Minister will be aware of the research carried out by Professor Tim Spector and his team at King’s College London into why people are refusing or doubtful about the vaccine. Only yesterday there was a webinar about this. What was quite clear from that is that communication and example setting are important, and I hope that the Minister can share some of the thinking that may be going on about how to tackle this.

I turn now to the vaccination of the most vulnerable. I thank the Minister for his letter today in response to my question last week about how the bedridden and the homebound, and their carers, are being vaccinated. I would appreciate it if we could have some numbers showing how many people are in this vulnerable cohort. Only yesterday on the news we saw the example of an elderly man living alone who is recovering from cancer. He is isolated and his family are very anxious indeed that he has not yet been vaccinated.

According to recently released figures, Covid-19 deaths in care homes in the week ending 22 January represented 46% of all deaths in homes. That was the highest proportion of deaths since the beginning of the pandemic, surpassing even the previous high of 39.2% set last May. During that week, 1,817 care home deaths involved Covid-19, taking the total to more than 25,000. Gavin Terry, head of policy at the Alzheimer’s Society, said that, given the worsening figures

“staff vaccinations must be urgently prioritised along with rapid rollout of second jabs.”

The Government are being optimistic in saying that vaccines have been offered in care homes—but that is not the same as them having been taken up. Time is rolling on for older people who have not been able to see and touch their loved ones for almost a year. We all admit that this is cruel. In many ways, it underlines the dreadful inequalities that Covid has revealed in our society and its care of the most vulnerable.

If the current rate continues, the UK will be on track to have offered a dose to everyone in the top four priority groups by mid-February and to complete the remaining five priority groups in early April, when the need for the second dose begins.

The Minister will be aware of concerns as to whether medical and administrative staff can continue at the current pace for many months at a time, when many are already working seven days a week. What steps are the Government taking to relieve the pressure on staff and ensure that the pace of vaccination remains sustainable in the weeks and months ahead?

The new research from Oxford shows that the AstraZeneca vaccine is 76% effective after one dose and can reduce transmission by 67% over 12 weeks. This is fantastic news. Will the JCVI review this evidence and consider using the AZ vaccine to help prevent spread of the disease—not just serious illness and death—once everyone in the priority groups has received two doses? This would allow public health directors to speed up the vaccine rollout in more deprived communities, including among black and ethnic minority groups, and in hotspots where the disease is threatening to run out of control.

We all agree that children’s health must always be a priority. On current plans, how many teachers will be vaccinated as part of bands 5-9? How many teachers and support staff will have to wait until the period between Easter and summer to be vaccinated? Last September, it was reported that 25,000 teachers had been off sick with Covid-related illness, further disrupting children’s learning. How can the Government ensure that we do not see the same disruption again from March, when it is hoped that the schools will return? I hope that the JCVI will prioritise this as part of its review because, once schools have reopened, we need them to remain that way.

Finally, high infection rates, death rates and the identification of the South African variant in the community and the E484K mutation in the infectious Kent variant are deeply worrying. Although the noble Baroness, Lady Harding, claims that this was

“something that none of us were able to predict”,

the Minister must know that scientists have long warned of new variants as the pandemic unfolds and that the likelihood of mutations increases when there are high rates of transmission. It is more urgent than ever that this hole in our defences is fixed.

Increased testing is always welcome but will ultimately be insufficient unless test and trace is made to work for everyone. This week, the noble Baroness, Lady Harding, advised that at least 20% of people—she reckons approximately 20,000 a day—who should be self-isolating are not abiding by the rules. These figures demonstrate the need for both decent sick pay to break the chain of transmission and for test and trace to work properly.

[Baroness Brinton (LD) [V]]

My Lords, we also express our condolences to the family of Captain Sir Tom Moore. He was an inspiration and an example to so many.

The health Statement reminds us that this is HIV testing week. HIV Prevention England rightly says that the message about early HIV testing must be well publicised. I pay tribute to our Lord Speaker for his key role as Health Secretary in the 1980s in managing urgent and uncompromising messages to the public about HIV and AIDS. This Government could learn much from those campaigns about communicating clear messages.

From these Benches, we also echo the excellent news that 10 million people in the first four priority groups have been vaccinated so far. Last week, I asked the Minister whether the vaccine dashboard could break down vaccine take-up below national level. I note that this Statement says that this is happening at local health and local authority level. However, there is still no breakdown between health and social care staff. On Tuesday, the United Kingdom Homecare Association reported that only 32% of its staff had been vaccinated so far. It said that invitation to vaccinate care staff was a local lottery, with some areas having excellent arrangements, but others not. Live-in carers face even harder access to vaccines, as they are often completely left off local vaccination lists.

Further, we know that some care staff have concerns about taking the vaccine, so dialogue is vital. Recently, there was an excellent radio interview with a GP from the north-east who explained how they had talked to staff who were worried about vaccinations at the care home where they worked. Those staff were reassured and were vaccinated. Too many social care staff are just referred to large vaccination hubs with no opportunity to discuss it with a known and trusted GP. Will the Minister ensure that GP surgeries can still have vaccine doses for everyone in groups 1-4, including social care staff, so that the barriers to vaccination are tackled and removed? Please can we see the NHS and care staff separated out on the vaccine dashboard?

This Statement also raises the emerging problems with the South African variant, with further restrictions in some postcodes. These, as well as the new changes to the UK variant discovered in Bristol and Liverpool, remind us that Covid-19 is still challenging us at every turn. I say well done to the local directors of public health and leaders of councils, working with their local NHS, on their excellent speed of response and the clarity of their local messages to people in the relevant postcodes.

I have a couple of questions for the Minister. First, Ministers have said that the new South African variant problems were discussed and planned for last Thursday. So why was there not an announcement before the weekend, ensuring that affected residents could protect themselves and their neighbours as soon as the risk was apparent? Secondly, the Statement says that everyone in these areas must have a PCR test—good. However, a letter sent from the NHS to hospital staff said that no staff were to go to work until they had had the results of a PCR test. Given that hospitals already have a large number of staff off sick or self-isolating, what help are they getting to deal with further staff absences?

The Minister will remember that I have urged the Government to include unpaid carers in the priority list in order to protect those they care for. The announcement of their inclusion in priority group 6 is welcome. However, they are not in the summary lists in the vaccines delivery plan. Will the Minister commit to clear up any confusion by explicitly including unpaid carers in government communications and by publishing specific guidance on making sure that they are vaccinated as part of group 6?

Finally, we look forward to hearing the Prime Minister speak on 22 February about the route map out of this third lockdown. Progress on vaccination is vital, but test, trace and isolate is also essential if we are to avoid a fourth national lockdown. We on these Benches believe that people who are self-isolating should be paid their wages and have access to a proper care package, as in Germany and Taiwan. We have been asking for this for 11 months. The failure of people to comply with self-isolation rules demonstrates that the current system is not working. Will the Government urgently review the arrangements for isolation and encouragement to comply?

Yesterday, Chris Whitty and the Prime Minister were clear that this third lockdown cannot be lifted until it is safe to do so. Yet already MPs and some Peers are pressuring the PM to open schools immediately. Strong, clear messaging is needed every day—as strong as on the AIDS campaign by the noble Lord, Lord Fowler, 30 years ago. We know from polling data that the vast majority of people want to do the right thing. The Government’s role is to tell us what and why and to provide support for those who need help to do it.

Covid-19: Vaccinations

Debate between Baroness Thornton and Baroness Brinton

Wednesday 13th January 2021 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, I thank the Minister for allowing this Statement to be taken. This is a challenging moment in the handling of the pandemic. We have growing infection rates; we are in lockdown; businesses are shut; schools are closed. Tragically, more than 80,000 people have already lost their lives to this awful virus. However, the vaccine provides us with a light. It is a glimmer of hope; a way to beat the virus, save lives and get us back to normal. I congratulate the Government on investing in multiple vaccine candidates —that has definitely paid off. But a vaccine alone does not make a vaccination programme. Given the Government’s record with test and trace, and the procurement of PPE, it is right that the Minister will face many questions about the delivery and implementation of the vaccine programme.

The plan that has been launched is quite conventional. Aside from big vaccination centres, it uses traditional delivery mechanisms, operating within traditional opening and access times. If the Secretary of State’s target for the number to be vaccinated is to be reached, exceptional circumstances call for an exceptional response. Why did the Government believe that 24/7 access is something that people would not be interested in? What is that view based on? However, I see that, in a characteristic U-turn, Prime Minister Boris Johnson has said today that the coronavirus vaccine programme will operate 24 hours a day, seven days a week, “as soon as we can”. What does this actually mean? When will the details of the plan to provide this service be published? The Secretary of State has said that the only limiting factor on the immunisation programme will be the speed of supply. Can the Minister confirm that this plan will receive the supply which is needed?

I think we can all see that the logistics of vaccinating a nation are huge, and we now hear many anecdotal stories about the reliability of supply, the organisation of vaccination, cancelled appointments and uncertainty of supply. On 17 December, I asked about the inoculation of our NHS staff, as it seemed obvious to me that, if we did not give vaccines to those dealing with the most sick Covid patients, and given the spike we are now experiencing, we would find many of our precious NHS staff becoming ill—as indeed we have. We are now experiencing the consequences. We are currently missing around 46,000 NHS staff for Covid reasons. When will all our NHS staff have been vaccinated?

What consideration has been given to vaccinating patients who are going to be in hospital? I am thinking, for example, about maternity services. Has it been considered that expectant mothers, and those who have just given birth, should also be vaccinated?

London currently has by far the highest rates of Covid in the UK, yet it is receiving fewer doses of the Pfizer and Oxford vaccines per head of population. Will the Minister commit to providing those desperately needed additional supplies urgently?

We are all reassured to see pharmacies included in the plan. They are at the heart of the communities of our country. They are trusted and are all ready to deliver mass vaccination. It is slightly odd that the number being trailed publicly is of 200 participating pharmacies, given that there are in fact 11,500 community pharmacies in England. Can the Minister clarify whether that is right? Why are not more involved, or is that number wrong? Can the Minister share with us what the number is?

On social care, it seems that about 23% of elderly care home residents have been vaccinated compared with 40%—which is brilliant—of the over-80s. Given their top prioritisation, can the Minister tell us when all care home residents will have been vaccinated? Will it be the end of the month, as has been promised?

When is it likely that our school and nursery staff will be vaccinated? I can see that the prioritisation lists are difficult and demanding—there is huge demand on this vaccine—but if we are to return to any semblance of normality, we need to get our children back to school.

[Baroness Brinton (LD) [V]]

My Lords, I welcome this Statement on the on the vaccine strategy and rollout, which we have been asking for from these Benches, in both Houses, since before the first lockdown. The Government have rightly set themselves stretching targets and we agree with them, especially in the light of the new variant’s high levels of transmission. The news this week of the severe problems that our NHS is facing across the country shows how out of control the virus is at the moment. Individuals must comply with the spirit and the rules of lockdown to help to reduce cases as soon as possible.

The Prime Minister has talked repeatedly about a vaccine signalling the end of the pandemic. I fear that lax messaging about the hope that vaccines bring is hampering the message about lockdown. It is a relief to hear in this Statement a more measured tone about this being a staging post in a long journey. Please can somebody tell the Prime Minister? The Minister will know that epidemiologists repeatedly make the point that we are a long way from life returning to normal. I note, for example, that in the debate about the vaccination priority list, the advice to clinically vulnerable people from government is that, even after their vaccine, they must remain shielding until told that it is safe for them not to shield.

On supply, we remain concerned that the Government will struggle to reach 2 million a week by next week—mid-January—given the numbers of vaccines being delivered this week. We are also receiving reports from GP surgeries of fewer doses arriving than ordered or, worse, short-notice cancellation of orders causing administrative chaos for already hard-pressed administrative surgery staff. While the opening of super vaccine hubs is welcome, can the Minister say why the hubs are vaccinating only during the day? If it is truly a priority to vaccinate as many people as possible, arrangements should be made for close to 24/7 delivery. I hear that, in the last hour, the Prime Minister has announced that the Government will try to start a pilot of some 24/7 hubs as soon as supplies permit—but how soon is soon? What are the vaccine supply pinch points? It is clear that targets are already slipping. This week, the target of 2 million a week has moved from mid-January to the end of January, and it is now the end of March instead of the end of February for the top five priority groups. Is this for the supply of all three approved vaccines, or just the AZ vaccine, where there is a much larger order to be rolled out with more substantial delays if there are supply pinch points? Also, it is because of a shortage of glass vials, or vaccine manufacture and regulation checks?

What are the Government doing to ensure that vaccine hubs are not superspreader locations? There have been worrying reports about people being asked to change masks and sit and wait less than two metres away from other people in the vaccine hubs. Given that the first five priority groups are all high-risk people, the last thing the NHS should be doing is encouraging them to go to areas that do not follow the government guidance on “hands, face, space”. Inevitably, there are glitches with any new process. We are still hearing of problems with the Pinnacle IT system that is being used for vaccinations. Some hubs were resorting to pen and paper in despair, and there are further problems reported with patients being asked to give the same detailed answers to a group of questions about Covid symptoms and allergies as they arrived, as they were registered and then as they were being given their jab. Any effective IT system should enter that information once. IT delays are reported as causing major delays, queues outside centres and daily targets missed at hubs. Can the Minister say what is being done to remedy these problems?

Can the Minister also say whether the vaccine dashboard will separate out the number of care home residents vaccinated? I see that care home cases are increasing again, which we deplore. As earlier this year, we strongly object to Covid patients being sent from hospitals into care homes, unless they are specialist Covid-designated units separated from other non-Covid residents. Even better would be to follow the example of Southampton hospital, which is using local hotels as step-down facilities. Will the Government endorse this and ensure that care home patients are kept safe through this surge until they are vaccinated?

The Government have announced that fewer than 1,300 surgeries and pharmacies are approved to deliver vaccines. The large hubs are all in urban areas. What will the Government do in rural areas, where elderly people do not have access to transport and may have to travel considerably further than the 90-minute journey for vaccinations announced this week? Are there plans as yet unannounced to increase substantially truly local-level provision, at a high-street level, in every rural village and small town—whether at a local surgery, pharmacy or visiting mobile vaccination unit—to ensure that vulnerable people who cannot travel or take the risk of infection will get access to the vaccine? It is not good enough for the Government to say that vaccines have been offered if the patients concerned cannot get to the vaccination delivery point.

Covid-19: Response

Debate between Baroness Thornton and Baroness Brinton

Monday 27th July 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I gave the Minister notice on Friday that, because we had not taken a Statement about Covid for three weeks, I will need to address the three Statements that are outstanding.

Parliament entrusted this Government with huge powers to deal with Covid-19 when we put the emergency powers on the statute book in March. Certainly, in this House, at the time of the passage of the emergency legislation we sought and received undertakings from the Minister and the Government about the need for effective scrutiny, timely debate, consultation and trust. So how will accountability be achieved during the Recess and the autumn in this fast-moving world? All three Statements raised vital issues that deserve more time and scrutiny than we were able to give them, and I am grateful for the extra time that the usual channels have found for Back-Bench colleagues.

Before I address these Statements, I want to ask Minister about the sudden announcement this weekend of quarantine measures for those returning from Spain. These Benches have made it clear that we support evidence-based protective measures at the border. We have long called for the scientific evidence to be made public and for track, trace and isolate systems to be in place, to avoid the need for the blunt tool of 14-day quarantine. Does the Minister agree that the latest decision-making process regarding Spain and the short notice for travellers have created a sense of panic and suggest a loss of control? Will he agree that proper contingency plans should be in place to support people coming home where there is no guarantee that their employers will allow them 14 days of work flexibility? Why do the measures apply to the whole of Spain? As my honourable friend Jon Ashworth MP said yesterday, “We’ve got an outbreak here in Leicester, but the whole of Leicestershire is not locked down and the whole of the East Midlands is not locked down, so why are the Balearics and the Canaries included when their infection rate is so low?”

On the announcement on 14 July about face masks and shopping—a month after it became mandatory to wear masks on public transport—why did it take so long and why was the messaging so confusing? We have long known about airborne transmission. The Secretary of State warned long ago about asymptomatic transmission. The Secretary of State’s own advice published on 11 May advised in favour of wearing face masks, so it is a shame that it took two months to make that advice mandatory; it came into force last Friday. How will it be enforced? As a former member of USDAW, I am very concerned for shop workers. USDAW says:

“We are also deeply concerned that enforcing the wearing of face coverings could present a further flashpoint for abuse against our retail members.”


It makes the point that full government guidance was released only hours before the changes came into effect, so how were employers to have adequate time to put the policy in place to support their staff during these changes?

On the Leicester lockdown announced on 16 July, the people of Leicester are now in the 17th week of lockdown. We will discuss that issue on Wednesday, but will the Minister confirm what lessons the Government have learned from what they did and did not do in Leicester, for when they face other local flare-ups? Will the Minister guarantee—I would like a yes or no answer—that local authorities will now get the specific data that can facilitate action, that it will be timely and in the form of person-identifiable data, not just postcodes, and that it will include not just positive but negative results so that they can understand the overall infection prevalence? Will they receive the contact tracing data so that they will know who has been asked to isolate by test and trace and can follow them up? Will they receive the data on a daily basis? Once a week is not good enough. The virus does not wait a week, so why should local directors of public health have to wait a week?

Moving on, the financial Statement said that £10 billion had been allocated to test and trace. It would be helpful if the Minister could itemise what that £10 billion has been spent on and with whom. A letter to me lodged in the Library would probably suffice for that question. On 20 July last week, the Secretary of State made a comprehensive Statement—a sort of end-of-term report; I can pick out only one or two important matters and hope that other noble Lords will cover the rest. The news about vaccine progress was very welcome and exciting, but will the Government ensure that there is equitable access to a vaccine when it is developed? The Minister knows that we stand shoulder to shoulder with the Government in taking on poisonous anti-vax propaganda. However, if a vaccine does not become available, what scenario planning is taking place right now, should we be confronted with that awful prospect? Will the Minister take this opportunity to update the House on R? Are we still below 1? Which parts of the country are not?

On social care, we welcome the fact that families are now able to visit their loved ones in care homes and we also welcome the extra funding for the NHS announced by the Prime Minister. But there was no extra funding for social care. Will social care get any more resources this winter? This is underlined by the Government’s failure to reimburse care homes properly for PPE and testing costs during the pandemic. They will actively have to meet the additional costs of ensuring that care homes stay safe for residents, staff and visitors. It must be cost-effective that they do so. The Local Government Association has today called for a social care reset after reflection on the Prime Minister’s pledge to fix social care a year ago. That representative body has urged the Government to publish their timetable for social care reform prior to Parliament’s return from the Summer Recess in September. Will the Minister tell the House whether that is possible?

[Baroness Brinton (LD) [V]]

My Lords, from these Liberal Democrat Benches, I thank and congratulate all the millions of people, whether paid staff or volunteers, who have worked tirelessly over the last five months to combat this pandemic, serving people and providing support during what is the most extraordinary health crisis in 100 years. As the noble Baroness, Lady Thornton, outlined, it is very disappointing that the Government Whips’ Office has resisted giving your Lordships’ House the opportunity to have a timely discussion on each of the three Covid Statements, on 14, 16 and 20 July. Each covered different, urgent and serious matters for our country that should be scrutinised by your Lordships’ House, so I too will use all three Statements as the basis for my questions to the Minister today.

First, given that the report of 20 July has a strategic and end-of-term report feel, we have an overarching concern about the Government’s repeated mantra in Statements about protecting the NHS at all costs, including the preparations for a second wave. Unfortunately, it appears that lessons have not been learned from the consequences of that single priority, not least those from throwing our care sector to the wolves without adequate testing, PPE or financial support for its massively increased costs. So I ask the Minister again: do all parts of the care sector now have repeat and regular testing, the PPE they need to practise new standards of infection control and continuing financial support for the consequences of both?

As I mentioned on Friday in the debate on the coronavirus regulations, a further group feel they have been left high and dry: people who shield, whether they are disabled, elderly or have serious underlying conditions. So I again ask: will the Minister explain why the letter to shielders dated 22 June insists that shielders lose all the support for shielding from 1 August? The letter instructs recipients to follow strict social distancing at all times and to stay at home where possible but, in complete contradiction to that, also instructs people to return to work if it is Covid-safe and removes access to furlough pay and sick pay, so if it is not safe to return to work and shielders cannot work from home, they are now at high risk of losing their jobs. Blood Cancer UK is extremely concerned about this risk for people who have been shielding as from August they will face an impossible choice between returning to work and risking their health or staying at home and risking unemployment. It asked the Government to extend the furlough scheme for the small number of people involved for up to three months or to provide alternative financial support to protect them from life-threatening ill health, and we agree. Will the Minister undertake to raise this with the Chancellor of the Exchequer as a matter of urgency and write to me?

Lifting the lockdown also brings into sharp relief how much real progress has been made by the Government on testing, tracing and isolating as a key tool to manage outbreaks. To that we must again add quarantine arrangements. On the news today, following the Spain quarantine regulations, we heard the Government say that they will not be monitoring any quarantine arrangements. They are still experimenting with temperature screening at airports and are not routinely testing people as they arrive in the country. If we are serious about having a proper system for people arriving in this country and quarantining safely, when will that be put in place?

We also hear that testing capacity will shortly reach 500,000 a day, which is welcome, but there seems to be no routine to test that capacity to the full. It is still not universal, despite repeated requests, regularly to test NHS and care staff to keep them safe. We hear that many local testing centres are closing down and that the test at home system is to stop. Can the Minister reassure your Lordships’ House that a full test, trace, isolate and quarantine policy is in operation, not least to test the larger-scale, effective system that we will need in the event of a second wave? How many people were tested on Friday?

Finally—the Minister can probably recite my next question as I have asked it so often, but I will be grateful if he could answer my actual question, not repeat the usual mantra because just saying that local authorities are being given more data at postcode level is not enough—when will all local authorities and directors of public health get the full data that they have requested and signed data protection releases for on a daily basis and at a more granular level than postcode, without which they cannot effectively tackle spikes in cases swiftly? The Minister saying that he is giving them more data is not enough. It must be the data that they need and for which they have already signed data protection releases.

Independent Medicines and Medical Devices Safety Review

Debate between Baroness Thornton and Baroness Brinton

Wednesday 15th July 2020 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, I thank the Minister for the Statement. I start with the words of the chair of the review, our colleague, the noble Baroness, Lady Cumberlege, who said when she launched the report last week that she was shocked by the sheer scale and intensity of suffering. She said:

“I have conducted many reviews and inquiries over the years, but I have never encountered anything like this … Much of this suffering was entirely avoidable, caused and compounded by failings in the health system itself.”


I congratulate the noble Baroness on conducting an inquiry over the last two years that has been praised by everyone concerned, particularly the patient groups and those affected.

Some of us have been discussing the problems addressed in this report for many years. We have heard about the hormone pregnancy test Primodos, the anti-epileptic drug sodium valproate and, in recent years, use of vaginal mesh in surgery. It is important to pay tribute to the bravery and persistence of the patients and patient groups, but also to the parliamentarians whose work helped to persuade the Government to establish the inquiry two years ago. The All-Party Groups have been vital, as have Yasmin Qureshi MP, Norman Lamb MP, Owen Smith and Sharon Hodgson MP, to name but a few.

On the surface, the three medical issues are separate. What links the medicines and devices is that they were all taken or used by women—in two cases, by pregnant women. As my honourable friend Alex Norris MP said last week in the Commons,

“these cases reek of misogyny from top to bottom—and ageism and ableism as well.”—[Official Report, Commons, 9/7/20; cols. 1148-49.]

We also have to look at the reaction of the healthcare system, which, according to the report, failed to monitor the use of these medicines and medical devices, then failed to identify and acknowledge the things that had gone wrong, then failed to work to improve. The review sets out the missed opportunities when something could or should have been done to prevent harm. Instead, there was a culture of denial, disjointedness and defensiveness that failed to listen to patients’ concerns.

Our NHS failed to protect these women and their families. It is therefore right and welcome that the Minister’s first reaction has been immediately to offer an unqualified apology, which is the first of the nine recommendations in the report. The Secretary of State said that listening and humility are in order. That is right, but it now needs to be followed by action to make the process worth while and to address the suffering. I hope that in this discussion the Minister will be able to outline what the Government will do to implement the rest of this report and to what time- scale. The most sensible way forward is the ninth recommendation, which is to set up a task force to implement the other recommendations. Will this be done, and by when?

On recommendation 2, I can see that progress has already been made. But can the Minister explain what legislative underpinning would be needed for a patient safety commissioner? Some of us are very puzzled as to where the delightfully named HSSIB is—the patient safety Bill—and whether that would have been a good complementary vehicle.

Recommendation 3 calls for:

“A new independent Redress Agency for those harmed by medicines and medical devices”


to create a new way of delivering redress in future. It suggests that manufacturers and the state should share the costs. Would the Minister care to tell us how that might be achieved?

Recommendation 4 suggests:

“Separate schemes … for each intervention—HPTs, valproate and pelvic mesh—to meet the cost of providing additional care and support to those who have experienced avoidable harm”.


How might that be achieved? I also have one question relating to mesh and all other implants. How will the Government ensure that they are safe to use? A register is obviously a good step forward and is in the Bill that we will discuss in the next few months, but why do the regulations on implants not provide for trials, as with medicines?

On recommendation 6, will the Minister commit to amendments to the Medicines and Medical Devices Bill to strengthen the Medicines and Healthcare products Regulatory Agency’s regulatory regime? On these Benches, we are committed to implementing the nine recommendations in this excellent report. We will seek to use the forthcoming MMD Bill to do so, and we wish to work with the Government to explore how best to achieve that.

[Baroness Brinton (LD) [V]]

My Lords, on behalf of the Liberal Democrat Benches, I too thank the noble Baroness, Lady Cumberlege, and her team for such an outstanding report. It is not only comprehensive but blunt in its language, so that no one can misunderstand the failings of all levels of the healthcare system, whether in our NHS or other health and research settings, over many years. We too pay tribute to those women, and their children and families, for continuing against all the odds for years when too many ears, including the Government’s, were deaf. I also pay tribute to the many parliamentarians, including Norman Lamb, who over the years supported them. They pushed for this review in Parliament and raised it in any way they could.

Ministers have apologised for these failings, including for the system not listening and for not acting soon enough, over the decades since patients first started to raise the problems with these three medical interventions. Last week, when I asked the Minister about the timetable for implementing the recommendations, he said that

“it will take some time for the Government to study these recommendations … and to come back on the timetable”.—[Official Report, 9/7/20; col. 1224.]

The noble Baroness, Lady Cumberlege, says in her letter introducing the report:

“Over the past two years we have found ourselves in the position of recommending, encouraging and urging the system to take action that should have been taken long ago.”


She also said:

“Implementation needs to be approached with a new urgency and determination, founded on the guiding principle that our healthcare system must first do no harm.”


When the interim report was published, leaving this House in no doubt about the direction in which the review group was proceeding, many people expected action at that point.

I am grateful to Epilepsy Action for its briefing, which demonstrates exactly why urgent action must be taken now. Epilepsy Action, the Epilepsy Society and Young Epilepsy jointly surveyed over 500 women and girls who had taken sodium valproate since the pregnancy protection plan was introduced two years ago. One in 10 were unaware of the possible risks of birth defects. Almost half said that they had not discussed the risks of taking medicine with their health professional in the last 12 months, and only four in 10 said they had signed the annual risk acknowledgement form. For patients and families who have suffered as a result of these interventions, urgent action needs to be taken on government departments such as the DWP regarding the way it assessed the damage caused, and on how government as a whole compensates them for this gross injustice.

So I ask the Minister again: when will the Government return to those affected and to Parliament with clear recommendations and a timetable to do honour to the report and to all those affected? And when will the various bodies in our healthcare sector be set a deadline to publish the list of recommended actions that they will take that will not need parliamentary action? Last week, the Minister told your Lordships’ House that the Government had moved ahead on one of the recommendations—the creation of a patient safety commissioner—but their version is not independent, as asked for in the report.

So much of this report is about changing cultures: we still have not learned from Mid Staffordshire, East Kent and Shrewsbury maternity care, all of which Ministers have rightly been appalled by. For all the excellence and commitment of the individuals who, singly and collectively, provide our unique healthcare in the United Kingdom, there remains an unhealthy culture in some parts that does not listen to patients, does not understand conflicts of interest and resists change. That must change, it must change soon and it must be led from the top by the Government.

The report quotes Professor Ted Baker, chief inspector of hospitals for the CQC:

“I have to say 20 years later it is very frustrating how little progress we have made. It’s clear to me we still have not got the leadership and culture around patient safety right. As long as you have that culture of people trying to hide things, then we are not going to win this.”


Armed with this blunt and excellent report, I hope that the Minister can demonstrate the Government’s support with firm actions and dates, and not just with warm words that will drift away. The hopes of patients and their families and the future safety of our healthcare system depend upon it. When, Minister, when?

Covid-19 Update

Debate between Baroness Thornton and Baroness Brinton

Wednesday 1st July 2020 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, I thank the Minister for providing the Statement.

Many in Leicester are wondering why it has taken so long to act, when authorities knew that there was a surge of Covid-19 cases in early June and the Health Secretary called it “an outbreak” a fortnight ago, on 18 June. Why did it take so long for pillar 2 information to be shared with the council and public health leaders in Leicester? Is the Minister aware that published data for Leicester recorded just 80 new positive tests between 13 and 26 June, but the Secretary of State has revealed that the complete figure for that period was 944?

In the last 30 minutes, a leading respiratory doctor and consultant at Glenfield Hospital has confirmed what my right honourable friend Sir Keir Starmer said at Prime Minister’s Questions an hour ago—that the true numbers and demographic data were not shared. Why is the Prime Minister trying to pretend that the information was made available when the truth is that it was late? Given that the Minister is in charge of testing in the UK, he might owe Leicester an apology for this disrespectful and dangerous treatment. Does the Minister agree that areas that see flare-ups will need a faster response?

This is important, because new statistics show that coronavirus cases have increased in 36 parts of England; Bradford, my home city, is number two. I learned from the Public Health England website that many of the places on the list with increased infection rates have large BAME populations, so why are PHE’s recommendations regarding the disproportionate effect of Covid-19 on our BAME populations not in play here? Given the diversity of a city such as Leicester, why have none of the PHE recommendations that have been implemented included the mandatory collection of ethnicity data?

Can the Minister confirm whether the Government anticipate announcing further local lockdowns in the coming days? The Prime Minister has used the rather ridiculous and flippant words, “whack-a-mole” strategy, regarding tackling local outbreaks. If that means moving quickly and firmly, then frankly it is of no use to the people leading the response on the ground, including Public Health England local leaders, if they are not given the most accurate, up-to-date data possible as soon as it is available. Does the Minister agree? Can he ensure that it happens without centralised bureaucracy getting in the way?

Leicester City Council has been waiting to be given pillar 2 data from commercial labs that process at-home and drive-through tests for many days, and the mayor, Sir Peter Soulsby, said that he was only given access last Thursday after he signed a data protection agreement. A data protection agreement? Why have local authorities not routinely been given pillar 2 information about their residents who test positive? Will the Government confirm why a data protection agreement needed to be signed and whether there is a data-sharing exemption for public authorities on public health grounds? Do the issues go beyond the availability of the data and also concern its quality and the speed with which it is disseminated? I note that data flows more quickly in Wales where the Welsh Government publish both pillar 1 testing data from hospitals and pillar 2 data from commercial labs on a daily basis. Will the Government commit to publishing this data for England moving forward?

It was not until after 9 pm on Monday that we and the people of Leicester learned that there would be an increased lockdown with non-essential shops prohibited from opening with immediate effect. In fact, the mayor got an email about the strategy at 1 am on Monday morning. The Health Secretary said that the decision had been taken in the last two hours, which is why people were given such little notice.expand-col2 That is wholly inadequate. Many businesses and communities on the Leicester boundaries are unsure about whether they and their staff are permitted to work. It was not clear until 9.30 am on Tuesday which areas were included in the lockdown, by which point some businesses had just minutes’ notice that they would have to close again. It was not until Tuesday afternoon that the Government confirmed that those workers who had previously been furloughed would have access to the scheme again.

Will the Minister explain why the decision was taken so late in the day, given the mounting evidence of rising cases? Why were key details, including boundaries and furlough eligibility, not confirmed immediately, leading to further confusion and anxiety? Will he confirm whether people are permitted to travel to work in other cities from Leicester because of the lockdown and, if not. whether they will be eligible for support too?

The situation may have been clearer had the regulations been laid immediately alongside the announcement, so will the Minister confirm when the regulations relating to Leicester will be laid? Given that the Government have long been advised to prepare for local spikes and first floated the idea of local lockdowns in May, why are we still waiting for these regulations? We are also waiting for the latest coronavirus regulations to be laid, which concern changes due to come into effect on Saturday 4 July. Is it true that accident and emergency departments have been told to treat Saturday evening as if it were New Year’s Eve? What on earth do we think we are doing? Again, it is very disappointing that the Government have yet to lay these regulations, which were first announced three weeks ago.

The Minister is well aware that the House and the Select Committee on Statutory Instruments have urged the Government to ensure that legislation follows more closely from any announcement that they make and that even a short gap between regulations being laid and their coming into effect would better enable those affected to prepare, having seen the actual detailed requirements rather than just headline announcements.

[Baroness Brinton (LD) [V]]

My Lords, first, on behalf of the Lib Dem Benches, I once again pay tribute to all of those who are helping to curb the coronavirus pandemic, whether in the front line or behind the scenes, and especially in Leicester. We know that there are many unsung heroes who continue to work long hours in stressful and ever-changing environments. Secondly, on behalf of these Benches, and in memory of the outstanding report by William Beveridge, I extend our congratulations to the NHS on its birthday, and note that of the five evil giants, many are still present in those most affected by Covid.

If the Minister is unable to answer all the questions asked, will he write to noble Lords with an answer? I hope that I can speak for other Members of your Lordships’ House when I say that we understand that the nature of a pandemic means that there are many questions to raise, but to repeatedly not have answers from Ministers is disappointing.

On that note, I ask the Minister for the fifth time in just over two weeks what the problem is with ensuring that every local council and director of public health has full test and tracing data as it becomes available. Over the past three weeks, it has become clear that full data has not been provided, and directors of public health, council leaders and mayors have all had to beg for data so that they can intervene early to prevent further cases, hospital admissions and deaths. Information is being dribbled out and it appears that pillar 2 testing lies at the root of the problem.

Stella Creasy MP asked a Written Question in the Commons, which was replied to by Minister Nadine Dorries on 11 June. It states:

“The contract with Deloitte does not require the company to report positive cases to Public Health England and local authorities.”


Does that remain the case, or has the contract now been varied to ensure that that information is made available immediately to key partners? The issue of why any such contract should not require positive cases to be reported is quite extraordinary but for another day; however, with low transmission, tracing pillar 2 cases is absolutely critical. Are all local authorities and directors of public health now getting full data, including pillar 2 data immediately so that they can prepare for small or larger local outbreaks? That is important because there are reports from across England of areas with increasing cases—indeed, as the noble Baroness, Lady Thornton, said, Sky News reported this morning that 35 other local authority areas may face locking down if their cases do not reduce quickly.

That raises an issue about the powers of local lockdown. It was rather strange to hear Matt Hancock saying on Monday evening that he would bring forward legislation for local lockdown, but this morning on Sky News he said that he would rather not do that by legislation but by consent. So I put what I hope is a hypothetical case to the Minister. If this Saturday a number of Leicester residents get in their cars, what powers to the police have to prevent them from going to Loughborough, Derby or Sheffield to be able to go into a pub? Clearly, at the moment, local authorities do not currently have the powers to stop them: their powers relate only to single buildings. But if the Secretary of State believed on Monday that there needed to be legislation, why not today?

This feels very much like policy by press release, and local legislation enforcers, whether they are police or local authorities, need to know what powers they have as a matter of extreme urgency. I also ask again, why will Ministers not give the powers of local lockdown to local authorities and directors of public health, obviously working with Public Health England, the NHS and Ministers? For any final decision to rest with the Secretary of State inevitably slows down processes, as we have seen in the Leicester case over the past three weeks. Above all, we must keep people safe.

Finally, will the Minister inform the House whether there is sufficient supply of PPE in Leicester and other areas where cases are increasing for hospitals, primary care, care homes and care in the community? The Health Service Journal reports today that there is still much panic buying of PPE, with some orders costing 10 times the amount that would have been paid before March.

This Saturday marks the lifting of lockdown for most of England except for those of us shielding and the people of Leicester. Will the Minister ensure that the wider public will remain safe with the increases in cases in at least 35 other local authority areas? Will the Government move much more quickly to ensure that public safety is guaranteed?

Covid-19: Response

Debate between Baroness Thornton and Baroness Brinton

Wednesday 3rd June 2020 Lords Chamber

[Baroness Thornton (Lab)]

Before I ask the questions we need to address, I wish to record the deep sadness felt by me and my colleagues at the death of our friend and comrade, Dr Lord Nic Rea, two days ago. Nic was much loved across the House and gave me unstinting support and health advice over many years.

In March, the medical director for England said that keeping the number of coronavirus deaths below 20,000 would be “a good result” for the UK. Therefore, I start by asking whether the Minister agrees with the Prime Minister when he says that he is proud of our efforts in the UK. They have resulted in an ONS figure of 60,000 excess deaths due to Covid-19, even if at present the Government are admitting to only almost 40,000. The UK has 2% of the world’s population and we have had 13% of the deaths from Covid. I suggest to the noble Lord that some humility is required here. We can be as proud as we all are of our NHS, support staff and all key workers but it seems inappropriate to be proud of leading us to where we are today.

I would like to ask about disparities in the risk and outcomes of Covid-19, as covered in the PHE review, which addressed the unequal nature of the risks of this virus. The review reveals that the virus poses a greater risk to those who are older, male and overweight. The risk is also described as “disproportionate” for those of Asian, Caribbean or black ethnicity. It makes no attempt to explain why the risk to BAME groups might be higher.

Yesterday, the Royal College of Nursing released data that supports PHE’s findings. The survey found that for nursing staff working in high-risk environments, including those working in intensive and critical care units, fewer than half—43%—of respondents from a BAME background said that they had enough eye and face protection equipment. This is in contrast to two-thirds—66%—of white British nursing staff who were content. Has the Minister read this report, and what is his view of its findings?

An earlier draft of the PHE review seems to have included responses from the 1,000-plus organisations and individuals that suggested that discrimination and poorer life chances were playing a part in the increased risk of Covid-19 to those with BAME backgrounds. Why was that section omitted? Why was the report published a week late? Is it true that the omitted part included recommendations like that from the Muslim Council of Britain, which stated:

“With high levels of deaths of BAME healthcare workers, and extensive research showing evidence and feelings of structural racism and discrimination in the NHS, PHE should consider exploring this in more detail, and looking into specific measures to put in place to tackle the culture of discrimination and racism”?


Apparently, these words did not survive contact with Matt Hancock’s office over the weekend. Is that true? Does the Minister agree with the Muslim council that the clear statement about the need to introduce change would surely give greater meaning to the statement by the Secretary of State that “black lives matter”?

Moving on, the Prime Minister assured us that by 1 June we would have a world-class track and trace system. I assume that he was misinformed, as crucial parts of the system do not exist and will be in place only at the end of June, which is what the noble Baroness, Lady Harding, says. Furthermore, the fragmented mess of using private contractors has been a disaster. Some recognition is finally being given to the role of expertise and knowledge at the local level and in local authorities, yet even these local experts were not consulted about the system and seem to be in the dark about just how it is supposed to work—just ask any department of public health how confident they are that we have a world-class system. Surely such a system should have the capacity to turn around tests in 24 hours, and we are nowhere near that point.

Over two weeks ago, I asked the Minister a series of simple questions. Who would call me if I tested positive? If the call is from a call centre, how will I know that it is genuine and to be trusted? The deputy at Public Health England seems to think that we would know through the expert questions that the tracer will ask. Clearly, she has never been on the receiving end of skilled online or telephone fraudsters. This is an important question. If it takes over 24 hours to get the test results and the tracing does not start within 48 hours, surely the system of protection will have broken down by then? Would the information, which is held centrally for some years, go to my GP? It is unclear where that data will be stored and what rules will apply. Can the Minister please explain?

An analysis published by Cancer Research UK has outlined that as many as 2.4 million people in the UK have been affected by a backlog in cancer care, waiting for screening, further tests or treatment. That can change only if the staff doing the cancer care, treatment and testing are being tested very frequently, even those without symptoms.

It is very concerning that the Government are refusing to publish information about the reproduction rate per region, the viability of home test kits, the number of people tested daily, and the number of people contacted under the new contact tracing system, to list a few examples. Furthermore, the data that the Government have published has been decried as highly misleading by the head of the UK Statistics Authority. Will the Minister commit to urgently publishing these figures to ensure openness, transparency and public confidence in the Government’s approach?

Does the Minister share the concerns of scientists, including members of SAGE, and public health leaders that the Government’s NHS Test and Trace system was not yet robust enough to quash any resurgence of the virus and should have been “fully working” before lockdown measures were eased? A final comment on “test, track and trace” is that the Cummings saga was bad enough, but we now have the chairman of the UK Statistics Authority making very robust suggestions that government presentation may not be what it seems. Sir David Norgrove has pulled no punches and makes it abundantly clear that he thinks the presentation of testing numbers in England is unacceptable.

On shielding, it is remarkable that the announcement to lift shielding was made during the night at the weekend. There was no notification to GPs, public health officials or those who most recently had been told to shield until the end of June. Can the Minister please tell us what the scientific justification is for that? Apparently, according to my noble friend Lady Armstrong, department officials met many organisations representing patients with long-term conditions last Thursday. There was no mention then that anything would be lifted on Saturday, even though they discussed experiences of lockdown and talked about the way forward. That suggests to me that it was a politically motivated announcement, without any involvement of the relevant clinicians or patient groups. Can the Minister say which clinical groups had supported the announcement on Saturday evening? What preparations were the NHS able to make before the announcement was made? At the beginning of lockdown, shielded people got daily emails from the NHS about how to behave but, since Saturday, I understand that they have received nothing. I think many may feel abandoned —some are our colleagues in the Commons.

We must not make the same mistakes with our shielded citizens as were made with care homes, ignoring the risks to those most vulnerable. The arguments about discharging patients into care homes without them being tested has not abated. What information does the Minister have about current and regular routine testing of care home staff, and even daily tests? There is emerging evidence of higher death rates among those with learning disabilities—yet another emerging tragedy. Does the Minister think that was avoidable? Was a strong shield wrapped around them from the start? I do not think that it was, but maybe the Minister can give us his view.

Finally, we must start thinking about what kind of NHS will emerge after the pandemic is really under control, whenever that might be. How will the system deal with the huge backlogs, such as those for cancer patients and cancelled surgery? I do not expect an answer from the Minister right now, of course, but we need a debate and a discussion. Can we expect a Statement on these matters? If we truly are now going through the worst, can we start planning for the future?

[Baroness Brinton (LD)]

My Lords, I too thank the Minister for the Statement. From these Benches, we send our condolences to the family of Lord Rea; he will be missed. I also repeat the support from the Liberal Democrat Benches for everyone working hard to help contain and reduce Covid-19, from the magnificent front-line staff in the NHS and the care sector to all key workers, whether visible to us or not: we know that you have given your all. We also send our condolences to all those who have seen the death of families and friends over the last four months.

The World Health Organization has insisted repeatedly that no country should start to lift lockdown until Covid-19 is no longer in the community. With the noble Baroness, Lady Harding, confirming that there are still over 8,000 new cases per day, clearly it is still in the community, and WHO also says that lockdown should not be lifted until a full test, trace and isolate process is in competent operation across the country, which it is not.

Can the Minister explain why Ministers took the decision to start the process of lifting lockdown even though the Chief Medical Officer refused to allow the threat level to reduce from four to three? Unlike other European countries, which started lifting lockdown only when the daily death rates were below 10, today the department reports a total of 359 people died in the UK in the last 24 hours. Why was the shielding advice changed over the weekend, and why was no guidance sent out to GPs, care homes and clinical groups? I can confirm, as someone who is shielding, that I still have had no advice, by text, by letter or by telephone, on what I should be doing now that the advice appears to have changed. What can the Minister do to reassure people who are shielding that this is safe advice?

What steps are the Government taking to prepare for flare-ups of cases in our communities, and, worse, an early second wave? Will the care sector be involved in that preparation, given that they appear to have been left to hang out to dry in order to protect the NHS? I understand that unlike hospitals, the care sector has not been approached at all yet.

In the Statement, the Secretary of State refers to the publication of the Public Health England report on disparities and the risks and outcomes of Covid-19. The Runnymede Trust summarised the problems with the report, saying that there were not

“any recommendations on how to save BAME lives.”

What specific guidance is being provided to the NHS and care sectors to protect BAME staff in high-risk Covid-19 areas? Can the Minister comment on the report from the Western General Hospital that BAME locums were disproportionately placed on rotas in coronavirus-intense wards, and that the hospital has experienced a recent and very large spate of cases?

Yesterday, the Office for National Statistics wrote its second letter in four weeks to the Secretary of State, challenging him in the bluntest terms and accusing him of obfuscation and confusion on the number of daily tests carried out. Can the Minister give the House a date when we will be able to see real and consistent data on testing, approved by the ONS, back- dated and adjusted, so that there is no room for any misunderstanding?

I return to the issue I have raised repeatedly with the Minister: the care sector. At the weekly APPG on Adult Social Care update today, we heard again from across the sector that it still faces a number of problems, some of which the noble Baroness, Lady Thornton, outlined. To be clear—before the Minister responds again, saying that this is just anecdotal evidence—we were told that this is happening in a large number of care homes and settings in wide areas right across England. This is not a one-off.

First, a number of CCGs are still pushing care homes to take block-bookings of patients coming out of hospital without having had Covid tests. The Prime Minister and Secretary of State have repeatedly said that this has never happened. It has happened and is still happening. When will it stop?

Secondly, on PPE, the care sector says that the Clipper system is finally starting to be rolled out across the country—a mere eight weeks after your Lordships’ House was told that it was only a handful of days away. However, care homes report that deliveries are still only a portion of their original orders, meaning homes still have to make decisions about rationing. Can the Minister provide a date by which the care sector will receive all the PPE it orders and needs?

Thirdly, the Minister told us that all care homes would be offered tests by 6 June. I repeat my question from two weeks ago as to why some homes are excluded from the portal so that they cannot access tests. These are homes for learning-disabled adults and disabled people under 65. Given the worrying comments on the inequalities data in the PHE report, when will this change?

Fourthly and finally, I echo the points made by the noble Baroness, Lady Thornton, about it being essential for all health sector staff to be able to access repeat testing to keep people safe. While it is true that it is happening for NHS staff, it is not true that our care homes or staff working in the community are able to access regular testing. Can the Minister please provide a date by which staff in care settings will have regular testing? This is vital because there are so many asymptomatic cases. They need parity with the NHS.

I recognise that I have asked a large number of specific questions and hope that, even if the Minister cannot answer them now, he will be able to write to me and others taking part in the Statement. Perhaps he could also answer any of the questions from the noble Baroness, Lady Thornton, if he cannot answer them now.

Covid-19: Response

Debate between Baroness Thornton and Baroness Brinton

Tuesday 19th May 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for not repeating the Statement, which I have read.

First, I want to ask about these Covid-19 symptoms: lack of taste and smell. The Minister will know that many healthcare specialists and the World Health Organization were making these warnings eight weeks ago, so can he explain why there has been a time lag in updating the definition?

I start by referring back to the question, on testing and tracing and the NHSX app, which I posed to the Minister yesterday and which he did not answer. I asked him whether it was true that in a Downing Street briefing that morning it was announced that the rollout of the app has been delayed until June. Is that true? When can we expect the rollout? Indeed, will we see the rollout of this app at all? If the Government will not use the app any time soon, does that mean that testing, tracking and isolating have to work smoothly and effectively at local level? That raises many questions.

We on the Benches welcome the wider rollout of testing, of course. Can the Minister update the House on whether the screening of all healthcare workers, whether they are symptomatic or not, has been successfully rolled out? What proportion of healthcare workers have been tested so far? Will they be tested every week? If not, how often? This is important, because it has been reported that 20% of hospital patients got Covid-19 while in hospital for another illness or treatment. So if routine NHS work is to be restarted, patients must be confident that they are in a Covid-free environment.

Can the Minister inform the House of the progress on antibody testing? Are these tests now widely available? If so, for whom? If they are not yet available, when will they be available? I gather from a widely available advertisement that I could have what is said to be a PHE-approved antibody test right now for about 100 quid. Would the results of that test be acceptable if I wished to use it to prove to an employer that I could got to work, go to school or teach at school?

On tracing, we on these Benches have long argued that the safe way to transition out of the lockdown is by having a test, trace and isolation strategy in place. Can the Minister tell us the current median time for test results to be received by someone when the test is carried out by Deloitte and other private sector testing facilities? More crucially, how soon do directors of public health and GPs receive the results of those tests?

Is that how it works: that the test is nationally organised and carried out, and the results are fed back locally? Who are they fed back to, and are those people responsible for tracking and tracing? Are they people the experienced local public health tracers or are they some of the 21,000 tracers who, we are informed, have been recruited? To whom are any or all of them accountable for tracking down people who are infected? As the Minister knows, we on these Benches believe that the Government should have made better use of local public health services. Who will inform people who have been in touch with a person with Covid-19 to isolate? Who is responsible for what happens to those people who must isolate, and for whether their families are supported in doing so? Where does the national call centre delivered by Serco fit in to this system? Can the Minister tell us by what date tracing and tracking services will be operational? Will they be operational by 1 June? I have raised with the Minister the issue of isolation. Why is that not mentioned as one of the key elements of the test-and-trace strategy?

Turning to care homes, I note what the Secretary of State said about social care last week: that he had thrown a “protective ring” around care homes. What constitutes a protective ring? The spread of coronavirus in care homes has become a crisis within a crisis. It was reported by the Guardian on 13 May that during the period coronavirus has been spreading in the UK, there have been as many as 19,938 excess deaths in care homes, well above the figure attributed to coronavirus by the ONS, leaving an urgent question about the causes of these deaths. None of this suggests anything remotely protective.

The reality is that there was no early lockdown of care homes, which was needed, and no early testing of people transferring from hospitals to care homes until mid-April. Prior to 15 April, the Government’s care home advice said:

“Negative tests are not required prior to transfers/admissions into the care home”.


That was not rescinded until mid-April, when the Government eventually issued their care homes strategy. Today, the CQC report says that 36% of care homes have Covid-19. That seems to be a greater proportion than that being admitted by the Government. Weeks later, do we yet have full testing of all residents and care home staff? No wonder Age UK say that this is “too little, too late”. When will they all be routinely tested? What is the date for that?

Turning to the R number, can the Minister guarantee that every easing of restrictions—such as asking children to return to school—is accompanied by a government statement on the expected impact on the R number and the underlying prevalence of the infection? If the R number rises to be greater than one in a region or local area, how will the Government deal with that?

Finally, I want to be clear that we on these Benches are desperate for the Government to succeed in beating this virus. We will and have supported the Government. In return, we expect transparency, as everyone does. Let us see the science. Give us clarity about what people are expected to do, truthfulness when things go wrong, as they inevitably will, accurate communication on all occasions and regular accountability to Parliament. We deserve no less.

[Baroness Brinton (LD)]

My Lords, I thank the Minister for the Statement. The ONS statistics this morning showed that over 44,000 people have lost their lives, with the Financial Times estimating that the total figure is now well over 60,000 when a percentage of excess deaths is taken into account. From these Benches, we send our sympathies to all bereaved families and friends, and our thanks and support to the amazing front-line staff in the NHS, social care and community sector, and to others in key roles working to save lives and keep people safe.

The Secretary of State began his Statement by talking about flattening the curve, but yesterday an article in the British Medical Journal said:

“What is clear is that the UK’s response so far has neither been well prepared nor remotely adequate … Above all, the response to covid-19 is not about flattening epidemic curves, modelling, or epidemiology. It is about protecting lives and communities most obviously at risk in our unequal society.”


We agree.

I echo the points made by the noble Baroness, Lady Thornton, about the acceptance, at last, by the Government of a third symptom, anosmia, but many other countries have more symptoms. France says that you should self-isolate if you have any symptom on a list of 10. Why do our Government still refuse to increase that list?

The Secretary of State has repeated his claim that he has prioritised testing in care homes, yet he still repeats that testing for everyone in care homes, whether staff or residents, will be only “offered” by 6 June. The Adult Social Care APPG is still hearing of care homes waiting for that “offer” of tests, and of others that have had tests but results still going astray or taking 10 to 14 days to be returned. On that basis, if Ministers are really prioritising care homes, why does the Statement announce testing for members of the public over the age of five now while people at the heart of the firestorm of Covid in care homes still have to wait up to two weeks before being offered a test?

Still on testing, can the Minister tell us the percentage breakdown of PCR testing results versus antibody testing results? If not, can he tell the House when this information will be publicly available? We need as many PCR tests as possible as part of an effective test, trace and isolate programme. How many of those carrying out testing are paid roles versus volunteers? A couple of weeks ago, the Minister told your Lordships’ House that testing would be extended through, among other things, a deal with Boots. Five days ago, Boots had an advertisement seeking volunteer testers taken down after public outrage that a company that had been given a commercial contract with the Government was relying on volunteers to carry out the work. Was using volunteers part of its tender to government? If so, does the Minister approve of companies using volunteers while pocketing public money in a contract?

On tracing, it is encouraging to hear that more than 21,000 tracers have been recruited, but today there are reports of people recruited receiving multiple emails congratulating them on being successful or attending online training that has completely fallen over and failed technically. Can the Minister say what percentage of those 21,000 have received full training and are now working as tracers? Last week, the Secretary of State said that local tracers would be used, whether local health or environmental health tracers, as well as central ones. Can the Minister say how many local tracers—that is, not Serco call-centre tracers or central NHS tracers—there will be from the 21,000?

The Statement asserts that the Government now have all the elements to roll out their scheme of test, track and trace, but I repeat that there is no focus on isolation for those who have to quarantine. Test, trace and isolate is used not just by the WHO but by many countries. What plans are in place to support people isolating, whether at home or in a quarantine unit, once lockdown is lifted? They will feel much more vulnerable at that point, when everyone else is moving back into their normal lives. Experience from Taiwan, Germany and South Korea shows that community health support for those in quarantine is more likely to make it successful. Again, countries that have been successful in containing the virus all had fully operational test, trace and isolate programmes up and running from day one. Given that each new venture the Government have undertaken during this crisis, as outlined in the BMJ article—from expanding PCR tests from a low base to manufacturing ventilators, supplying PPE and now the tracer app—has had a very problematic start, to put it kindly, are the Government starting to run full contact tracing now, using new staff in an area that has sufficient cases of coronavirus, before lockdown starts to be lifted but particularly by 1 June? It would be inappropriate for schools to return and people further to return to work without such a system in place.

Covid-19

Debate between Baroness Thornton and Baroness Brinton

Thursday 23rd April 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for repeating the Statement. I join him and the Government in saying that our thoughts are also with all those who have lost their lives to this horrible virus. I pay tribute to the NHS and social care staff who have lost their lives. I know the Minister agrees that the number of victims who appear to have come from BAME communities is very concerning. Can he confirm reports that BAME people make up 72% of all NHS and carer deaths with Covid-19?

We welcome the announcement of an inquiry. It would be great if the Minister could provide further information about the scope of the inquiry and when it will report its initial findings.

The Minister said he believes that we are now at the peak, but we are nevertheless heading for one of the worst death rates in Europe. The Government have told the public that their response to the pandemic will always be guided by science but, as the Minister will be aware, there are often different views within the scientific community, so I repeat the call that we have made from these Benches in the past that the Government should publish the evidence underpinning their decision to recommend, for example, a seven-day rule for isolation. This is important for public confidence, given that the Government’s advice appears to contradict the advice by the World Health Organization, which advocates a 14-day rule for isolation based on evidence that people can still transmit the virus after 10 days or more.

Despite many questions, it remains unclear why the UK did not participate in some of the European procurement projects. The Chancellor of the Duchy of Lancaster said this was because we missed an email, whereas a senior civil servant at the Foreign Office said in evidence to a Select Committee that it was a political decision, before retracting that comment several hours later. The lack of transparency is deeply unsatisfactory. It would help if the Government published a background briefing so that we could see exactly what happened. We believe that it is necessary to get to the bottom of this situation now to ensure that the UK takes part in any future EU schemes that may help us deliver PPE to those putting their lives at risk on the front line.

The Government have repeatedly said that they are “ramping up”—this is an expression I do not enjoy, and I certainly intend never to use it myself—testing capacity, but the latest statistics show that only 14,629 NHS tests were carried out in the last 24-hour period, eight days before the Health Secretary’s self-imposed deadline to reach 100,000 tests. This is despite testing centres having a capacity of 39,000 checks a day. Why is more than half the country’s testing capacity still going unused when tens of thousands of NHS and social care staff, along with other critical workers, are being forced to self-isolate because they have not been tested? It is very concerning that the number of tests being undertaken is not increasing. Even if the capacity does reach 100,000, that is not the same as access. The latest statistics reveal that the number of tests performed on Tuesday was two-thirds that of the previous day. The Minister needs to tell the House what on earth is going to happen and when we can see the daily increase of tests.

Earlier this week the Health Secretary pledged to test immediately anyone in the social care sector who needed it. While elderly residents can be tested in the homes they live in, staff still have to travel. I learned earlier from the Minister that there are plans in place to change that, so I would like him to explain how soon those alternatives will come on stream.

Testing and contact tracing are vital to managing the UK’s response and easing lockdown restrictions. The new NHS app mentioned is very welcome. Can the Minister set out the timeline for when that will become available?

Finally, will the Minister confirm that the combination of some spare capacity in the NHS and the Government’s view that we now have reached the peak of the virus means that postponed NHS treatments and procedures will resume imminently? Although we understand why some elective treatments were postponed, the delay for many illnesses, including cancer, involves its own risk. It is therefore important that people receive the necessary treatment as soon as possible when it is safe to do so considering the impact of the virus. What support are the Government giving to trusts to help them manage demand amid the ongoing situation and give patients confidence that they will be treated in a Covid-free hospital?

[Baroness Brinton (LD)]

I thank the Minister for repeating the Statement and for his work on testing. We may have some difficult questions for him, but I hope I have the support of the whole House in saying thank you to him and his team for the work they are doing on this difficult area.

I too thank all the staff and volunteers in the NHS and the wider social care sector and other key areas who have been working during this crisis, whether directly on the front line or in supporting families and our children in schools. We send our condolences to the families of the bereaved, and are pleased that many people are recovering, even though we know that, if they have had it badly, it takes time. From these Benches, we echo the concerns about the high percentage of BME deaths, among workers and non-workers alike.

The Statement says that there are 3,000 spare critical care beds, but ITV reports that care home residents now account for up to half of Covid deaths. However, last week the Daily Mail reported that care home residents were still being asked to sign letters to say that they would not go to hospital in the event that they had Covid-19. Will the Minister confirm that these critical care beds in hospital are not spare? There are plenty of people in care homes who could use those beds but they have been put under pressure, no matter how gently, to sign the letters.

It is good to see the Nightingale hospitals coming on board—even if they are empty, for the right reasons. One of the concerns expressed has been about the staffing and the initial request that any patient had to have staff accompanying them from their previous hospital. Can the Minister say that this has now definitely stopped and that staff with appropriate critical care experience are able to be recruited? I gather that this has also been a problem for increasing the number of beds.

There was a good message in the Statement for people to go to their GPs and to use 999 for emergencies, but today there was a report of somebody who had a severe heart attack not being picked up urgently, as heart attacks are still second-level priorities to Covid. As a result of that 20-minute target rate, sadly the patient died. Is there any rebalancing of priorities for ambulances now that we seem to be over the peak of cases?

On equipment and medicines, it is good to hear that there are now just over 10,000 ventilators. Are they full ventilators, or does that include CPAP and BiPAP machines? How many more are to come? There have been some worrying shortages of medicines for those who need to be sedated, and recently we have heard news that there is a problem with kidney dialysis and kidney medicine for people who have come out of intensive care and require long-term support. Is there a shortage of such medicines, what other medicines are at risk and what proposals are there to remedy that problem?

We have spent many hours today talking about PPE. We are still waiting for supplies for everything outside hospitals. On 6 April, Clipper was heralded as being about to solve this problem, but it is still woeful. Until the social care and community sectors get the support they need, they will continue to be worried about the spread of Covid.

The Turkish ambassador has written to various people in the APPG on Turkey, setting out the actual arrangements—as opposed to those reported by the Government—concerning the delay in the package that appeared to get stuck. Turkey actually donated 250,000 pieces of medical protection equipment to us; the rest came through privately. Can the Minister say when the remainder of the consignment due from a Turkish supplier will arrive?

It is good to hear that formal arrangements for testing, tracking and tracing are now under way, but the WHO always puts in a third word alongside “test” and “trace”: “isolate”. Any mention of isolation in the Statement is notable by its absence. Taiwan, South Korea and Hong Kong have all managed to suppress further bursts of Covid because of the arrangements for not just testing and tracing but isolating. It is good to hear that an app will be available, but the Minister will know that there are people with technical experience concerned about whether it is appropriate to use Bluetooth for it, because of security issues. Can the Minister assure the House that this is not the case and that people’s data will be used only for NHS purposes and will absolutely not be able to be used by any providers of the app or beyond? The 18,000 tracers announced by the Secretary of State just before this Statement are a good start, but we will need more for good national coverage. Worryingly, Mr Hancock said a few days ago that all this will be operated centrally. Is that still the case, or will he use the existing trained tracers that there are in local communities, whether environmental health tracers in councils or in local health teams? It seems rather bizarre to try to cover the country on that level.

On shielding, it is good that there is a request to create more volunteers and to celebrate the volunteers, but notable by their absence in the Statement are the many people who have not yet had their letters on shielding and whether any further groupings may have to consider shielding—which I understand is the case.

I congratulate the Government on their progress on test and trace, but confirm that we are extremely concerned about supplies of equipment and medicine and hope that things will be remedied speedily.

Covid-19 Update

Debate between Baroness Thornton and Baroness Brinton

Monday 16th March 2020 Lords Chamber

[Baroness Thornton (Lab)]

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

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

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

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

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

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

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

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

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

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

[Baroness Brinton (LD)]

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

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

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

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

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

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

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

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

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

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

Coronavirus

Debate between Baroness Thornton and Baroness Brinton

Thursday 12th March 2020 Lords Chamber

[Baroness Thornton (Lab)]

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

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

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

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

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

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

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

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

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

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

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

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

[Baroness Brinton (LD)]

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

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

Health Protection (Coronavirus) Regulations 2020

Debate between Baroness Thornton and Baroness Brinton

Monday 9th March 2020 Grand Committee

[Baroness Thornton (Lab)]

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

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

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

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

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

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

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

[Baroness Brinton (LD)]

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

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

Coronavirus (COVID-19)

Debate between Baroness Thornton and Baroness Brinton

Tuesday 3rd March 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the noble Lord—the government spokesperson—for repeating this Statement. Our thoughts are always with those who have contracted the virus and we pay tribute, again, to the extraordinary efforts of the NHS and our public health staff. We, on these Benches, are clear: the public health interest must, at all times, be the priority. All the Government’s decisions must support this strategic aim and, where they follow the medical and scientific advice, they will have our support.

I start by raising the issue of the EU early warning and response system, of which, of course, until Brexit, the UK was a member. This early warning and response system has played a vital role in pandemic preparations in the past. It is rumoured that No. 10 overruled the Department of Health, which wished, quite rightly, to be part of the European Union’s safeguarding system at this time. The Prime Minister has said that keeping the public safe was the Government’s number one priority but has refused to seek to retain or apply for membership of the EWRS because of the negotiations taking place at the moment. I understand that the Secretary of State agrees with those of us who believe that tackling fast-moving, global outbreaks—including this virus—could become harder if the UK loses access to the EU’s early warning system for cross-border threats, so I urge the Government to urgently review this stance.

The PM says that there is significant risk of the virus becoming widespread, meaning further measures might be necessary, and that emergency legislation may be necessary to give the Government the powers they need to implement the action plan. I would be grateful if the Minister could set out some kind of timetable for emergency legislation. Will it be primary and secondary legislation, and which department will take the lead?

The plan sets out what the Government could do to contain the virus on the basis of scientific evidence. Drastic steps, such as closing schools, would have major social and economic consequences, so can the Minister advise the House on how they plan to seek a balance?

We agree with the Government’s strategy to contain, delay, research and mitigate, and indeed it has our endorsement. However, can the Minister explain why we have not followed other nations by imposing a travel ban to the UK from higher-risk countries such as Italy, Iran, China and South Korea?

Are the Government undertaking workforce planning as a consequence of self-isolation? This has huge implications both for this stage and the peak stage, in which the Government recognise that up to a fifth of workers could be absent from work. The Prime Minister said today that workers who self-isolate will be considered to be on sick leave. Can he confirm that those who need to self-isolate will not need to visit a GP to receive a sick note?

Two million workers on low pay or insecure contracts in the gig economy do not even qualify for statutory sick pay. The GMB trade union points out that NHS trusts have a huge number of outsourced staff and that a large number of companies providing NHS services do not pay sick pay for the first three days. Therefore, we are looking at cleaners, porters and catering staff who might put their own health at risk when we need them to contain the coronavirus, because they will not be paid if they go off sick. Therefore, I ask that NHS trusts, for example, guarantee that all staff are given full sick pay if they have to self-isolate.

Equally, what action will be taken to reduce the requirements placed on those in receipt of benefits who will not physically be able to attend appointments if they need to self-isolate? Can the Minister guarantee that no financial sanctions will be imposed? No one should be faced with having to make a choice between their health and hardship. Therefore, when the Government consider emergency legislation, will they bring forward legislation to remove those barriers to self-isolation so that all workers can get the sick pay that they deserve?

We know that the elderly and those with chronic underlying long-term conditions such as diabetes or cardiovascular conditions are vulnerable. What is the Government’s latest advice to providers of social care for those in residential settings or staff visiting elderly and vulnerable people in their homes?

On the NHS more broadly through the mitigation phase, we know that last week 80% of critical care beds were occupied. Can the Minister clarify how many beds are available should we need them, and how quickly can ICU beds be opened up? Can we be assured about the extra resource that will be made available to health trusts? Every sample for testing will carry a cost, and that will soon build up. As people self-isolate, that will affect the NHS workforce, and trusts will be forced to take on more agency staff. If retired staff are encouraged to return to practice, the wage bill will increase. Can the Minister explain how retired staff returning will be engaged and protected, and what oversight will be put in place to ensure that they deliver safe care if the revalidation process is to be suspended for retired returnees?

Will the Government provide emergency funding to cover the NHS resource budget and support the NHS through this next challenging period? For example, it is possible that thousands of elective surgeries will have to be cancelled.

Directors of public health are preparing a local response to Covid-19, yet they still do not know what their public health allocation for the next financial year, starting next month, will be. It means that they will be cutting the nurse workloads that they are commissioning at a time when we need those nurses to cover these cases.

Finally, on global efforts to contain the virus, I have already mentioned the European Union EWRS. We will not contain the virus internationally, nor will we be able fully to protect ourselves if the outbreak becomes uncontrolled in countries with weaker health systems. What assistance are we offering the World Health Organization with the international response to Covid-19?

We will continue to raise our concerns responsibly when we have them but, on these Benches, we also pledge to work constructively with the Government, because the public health interest must always come first.

[Baroness Brinton (LD)]

My Lords, on behalf of the Liberal Democrat Benches, I thank the Minister for repeating the Statement. We repeat our thanks to the staff of the NHS and the Department of Health and Social Care, as well as to all those working cross-department on preparing for the various possible outcomes in the event that this escalates.

We also echo the points made from the Labour Benches about No. 10’s announcement that we will not take part in the EU early warning system. It was clear from the media yesterday that the NHS and medical experts all say that we must be part of it. To have No. 10 say, “No, we won’t”—presumably because it has the dirty letters “EU” in it—is extremely unhelpful. Will the Government please review this position as a matter of urgency and, as they said in their Statement, take scientific and medical advice on whether we should be involved?

We welcome the two amounts of £20 million that the Government have put forward for research into Covid-19—the first for the Coalition for Epidemic Preparedness Innovations, but particularly the £20 million for Covid research here in the UK, including on epidemiology and treatment in hospital. Far too often we focus only on blue-sky research. This needs to be very practical and it is—these Benches welcome that.

I apologise for being a broken record on this. However, I am sorry to say that the advice for those who are either vulnerable or have underlying medical conditions is still not clear. The Minister and I have had an email exchange on this matter. The WHO and the American CDC still offer clearer advice to members of their public about what to do if you are either elderly or have underlying conditions than we do in this country, whether you are travelling abroad or in a community that may have some cases. Can this be beefed up? There is a statement in the action plan report that this will be strengthened in due course, but that will be once we get to mitigation.

There are already concerns in the medical and disabled communities about whether people should be shaking hands. I was somewhat concerned to hear the Secretary of State affirming confidently on television this morning that shaking hands was still fine. I am sorry: if you have an underlying condition, you do not want to be shaking hands with people. You should be washing, not doing that. Wearing hand splints, I have learned over the years to wave at people. It is much easier. Perhaps we could get a trend going with that.

We know that emergency legislation is coming up. That is heralded in the action plan. There are some concerns from our Benches on the extent of the mobilisation of retired and former staff. There has rightly been an emphasis on clinical staff. There will be questions that our Benches will look to have responses to. If people, particularly doctors, have been deregistered, perhaps because of retirement, will there be an expedited system, a reduced appraisal system, or a system to take people on who perhaps have not been reregistered but could work under supervision? It is important that these things are both clear and done at speed. But we are extremely concerned that there is no mention of people in other core parts of the NHS and social care system who are not clinical staff. The cleaning, catering and admin staff also keep the NHS and our social care system going. What arrangements are being put in place to provide extra support for them?

Once we move into mitigation and discussion about the possible closure of schools, surely it more important to keep schools open, even if there is only a reduced number of pupils in those schools, if the pupils’ parents are key workers—essential workers in the NHS, the police and other key areas. There is no sign that that has been thought about at this stage. It seems to us that this is an important point to cover.

Finally, after a nearly a decade in your Lordships’ House, I should not be too surprised when Ministers, particularly the Prime Minister, use very positive frames for things. The idea that the NHS will move out of a winter crisis into a landscape of delight once we get to the summer is extraordinary. We know that our social care system is at breaking point. The social care system was grateful for the £240 million provided by the last Chancellor in the autumn. However, the Local Government Association and almost every health think tank say that our current social care system is short of £2.5 billion now, without any impact from coronavirus. Of course, our social care system will have the patients most at risk of serious illness should coronavirus move into our communities. So, without heralding anything in the Budget, which I understand the Minister cannot speak about, can the Minister reassure the House that there will be serious support: for ensuring that there are no delayed discharges because there will be adequate support for social care in the system?

Wuhan Coronavirus

Debate between Baroness Thornton and Baroness Brinton

Wednesday 26th February 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the noble Lord for repeating the Statement. The challenge the Government face—as we all do—is that this is a very fast-moving situation. If noble Lords look at their BBC newsfeed, they will find that coronavirus is now spreading faster outside China, according to the World Health Organization—that was reported literally 15 or 20 minutes ago. Our thoughts are with those who have been diagnosed with the virus in the UK, across Europe and elsewhere, and those in quarantine. I place on record our thanks to the NHS and public health service staff.

I understand the approach the that the Government have taken to the quarantine arrangements. There has been a significant spread of the virus across the continent, including cases in Austria, Croatia and Switzerland. As the noble Lord said, a hotel in Tenerife is in lockdown after a guest tested positive. What support is being offered to British nationals in this hotel? Will flights from northern Italy be stopped? Will there be any additional screening of flights from other European cities with confirmed outbreaks? Can the Minister clarify the travel advice for passengers to and from these areas? I know of several people who intended to fly to Italy and have now cancelled their flights.

Several schools in England and Northern Ireland seem to have shut down completely for a week to carry out a “deep clean” after students and teachers returned from skiing trips in northern Italy over the half term. The Minister has given us some information about the advice to schools. How will it be enforced, or are we leaving it to local organisations, councils and school and academy boards to take those decisions?

I am sure that noble Lords will already have noticed that the oil company, Chevron, has asked 300 traders at its Canary Wharf headquarters to stay at home after an unwell employee was tested for the virus, having reported flu-like symptoms. They are awaiting results.

I want to ask a question about capacity. We have just had a debate in which many noble Lords talked about that issue. According to the NHS’s weekly winter statistics, bed occupancy in England is at 94.8%—way above the target considered to be safe. If this virus was to spread rapidly in the UK, how would the Government free up bed space in hospitals, which are currently mostly full?

Public Health England has announced today that tests for the virus are being increased, to include people displaying flu-like symptoms, at 11 hospitals and 100 GP surgeries across the UK. Up to now, people were tested only if they displayed symptoms having recently returned from one of the countries where there has been an outbreak, including China, South Korea and northern Italy. This action seems contrary to previous advice given to patients, which was not to go to GPs or A&Es but to self-isolate. I would like some further clarity on that issue.

On behalf of the Official Opposition, we thank all our NHS staff. We also thank the Government and hope that they will continue to keep us fully informed, as they have done hitherto.

[Baroness Brinton (LD)]

From the Liberal Democrat Benches, I start by echoing the Labour Party’s thanks to the NHS, staff at the Department of Health and Social Care and other public bodies, and all the staff, clinical and non-clinical, working around the clock both in the UK and abroad in the FCO in countries where there are cases and UK citizens. I think that we all accept that this is a major continuing crisis. It is one thing for something to happen for two or three weeks, but we are now two months into this, and it is clearly continuing to increase.

I emailed the noble Lord, Lord Bethel, with some questions on the basis that we were all working here for some hours immediately before the Statement, and I hope that advance notice of them was helpful. Dr David Nabarro from the World Health Organization spoke on the “Today” programme this morning about the WHO’s overnight warning that the world must prepare for a potential coronavirus pandemic and that the WHO is beginning to be concerned that the outbreak could be “Disease X”, for which they have been preparing for many years. I also thank the World Health Organization and its staff, who are doing a brilliant job that is invisible to most countries—I shall return to that in one of my questions.

In previous Statements on coronavirus, I have asked other Ministers to explain why UK health advice always seems to be one step behind that of a couple of other countries—I refer specifically to CDC. I will give a personal illustration. I am due to go to Naples at the tail end of next week. I suffer from a long-term condition for which I take medication that suppresses my immune system. As a result, I come into that category of vulnerable people who need to think carefully, yet when I look at the World Health Organization website, the government website and the NHS website, I can find very little of clarity about what I should do as somebody in that condition. However, the CDC website is very clear.

So I ask again, as I have done repeatedly: what advice are the Government and the NHS giving to people regarded as being in a vulnerable position? My previous comment was about people so described who might live in and around Brighton when the cases surfaced there—what should they do and where would they get their advice from? Perhaps I am “asking for a friend”, but what is the position for people going to a country defined by the CDC at alert level 2? I think the UK is at that level, but we do not call it that. The CDC’s advice, in its key points box at the top, is very clear:

“Older adults and those with chronic medical conditions should consider postponing non-essential travel.”


I have seen it, and that is fine. I am sure that other professional travellers will be looking at it, but many people planning holidays will not know where to turn. They would normally go to the FCO website or the NHS website, and it is just not clear on those. In the Statement, the Minister referred to a public communications plan. Are there plans to set out exactly what people need to do? Will part of this communications plan be to make clearer, as the CDC website does, all the different stages and what ordinary people need to do to think about things?

Picking up the point about the Tenerife hotel, have lessons been learned from the cruise ship in Japan about keeping a lot of people in close quarters? Can we be reassured that UK and other citizens who are going to be in this hotel for two weeks will not end up in the same position as the many hundreds on the cruise ship who have now been diagnosed with coronavirus?

Talking of updates, Ireland has just postponed the Ireland v Italy Six Nations rugby match that was due to be played in Dublin, because of the coronavirus virus outbreak. So the Irish Government are already beginning to think that travel plans ought to be reconsidered.

My final question arose from noticing, when using the toilets in this place, that there are now very helpful posters reminding us about the 12 steps of hand washing. Suddenly, in the last two days, hand sanitisers have appeared. That is great; it is wonderful. But what will the Government’s advice be to the general public about personal hygiene such as hand washing and using alcohol hand sanitisers? The World Health Organization’s frequently asked questions and myth-busters pages are very good. I struggle to find anything as accessible in the UK. Most of the BBC report referred to by the noble Baroness, Lady Thornton, was taken from the WHO pages. So let us not reinvent the wheel but talk to people to ensure that they understand where we are.

I want to end on the same note as the noble Baroness. I thank the many hundreds, if not thousands, of people working to keep our country safe.

Wuhan Coronavirus

Debate between Baroness Thornton and Baroness Brinton

Tuesday 11th February 2020 Lords Chamber

[Baroness Thornton (Lab)]

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

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

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

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

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

[Baroness Brinton (LD)]

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

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

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

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

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

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

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

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

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

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

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

Paterson Inquiry

Debate between Baroness Thornton and Baroness Brinton

Tuesday 4th February 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for repeating the Statement made by the Health Minister in the Commons today. Two hundred and eleven former patients of Paterson, or their relatives, shared their experience with this inquiry. This report makes for harrowing and appalling reading, as the Minister said. Ian Paterson wilfully abused the trust placed in him by patients at their most vulnerable. At his hands, hundreds of women underwent extensive, life-changing operations for no medically justifiable reason. His unregulated cleavage-sparing mastectomies, in which breast tissue was left behind, meant the disease returned in many of his patients. Others had surgery they did not need and needlessly lived under the shadow of cancer for many years. This should never have been able to happen, let alone go on unchecked for so long.

As the Minister has done, I pay tribute to the courage, tenacity and persistence of many of these women and their families in exposing the injustice. I thank the panel, under the leadership of its chair, the right reverend Graham James, for uncovering the extent of Paterson’s malpractice and the systems that allowed it to continue despite repeated warnings.

The victims of Paterson’s malpractice were let down time and again by the NHS trust and an independent healthcare provider, which failed to supervise him appropriately and did not respond correctly to well-evidenced complaints about his practice, and by the wholly inadequate recall procedures in both the NHS and the private sector. The report identifies failures on the part of individuals and institutions, saying that

“a culture of avoidance and denial”

meant that those working closely with Ian Paterson did not spot his behaviour or were unwilling to challenge it. On the contrary, the report concluded that

“Paterson’s behaviour and aberrant clinical practice was excused or even favoured.”

What action does the Minister propose to support a change in the culture of the health service that encourages staff to speak up?

There is a potent example on page 130 of this report:

“The operation and awarding of practising privileges is defined in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 … Practising privileges are based on the ‘scope of practice’—that is, the procedures a consultant is competent to perform in the independent sector are based on what they undertake in the NHS … In Paterson’s case … he did not limit himself to operations he was competent to perform in the independent sector. He was undertaking operations and procedures he did not do in the NHS. Measures to monitor and limit this at Spire were inadequate.”


What has changed? Is this still the practice in the private sector? Indeed, is it still the case that private hospitals incentivise referrals from consultants who have been given shares in their private hospitals? That is what the report suggests.

Can the Minister confirm that the Government will urgently bring forward legislation to give private patients the same protection provided by the NHS, as called for by the lawyers representing hundreds of Paterson’s victims? The Centre for Health and the Public Interest has called for Paterson’s income and earnings, as well as the profits made by Spire Healthcare, to be treated as income from criminal acts, which could mean that they could be reclaimed. Can the Minister advise on whether this aspect has been referred to the CPS?

The Independent Healthcare Providers Network, which represents the sector, has already said that more needs to be done to ensure that information is shared between the NHS and private companies about their doctors. What action are the Government taking to facilitate this information sharing?

We cannot undo the awful harm that Paterson’s criminal action has caused so many, but we must act to ensure that lessons are learned and changes made so that something like this does not happen again. This report must not remain on a shelf to be forgotten, because it is clear: this was not just the act of a rogue, lone surgeon; systemic organisational failures were at fault as well. Fundamentally, it is time we addressed the question of safety in private healthcare providers and the way in which clinicians can operate in private providers with little oversight. I would be grateful if the Minister could share her thinking about this with the House.

The inquiry makes a number of recommendations about transparency and accountability, and I hope the Government mandate health bodies to implement those quickly. As the Minister said, the fight that the patients had to make for compensation was shameful.

Around a third of all private hospital income now comes from NHS procedures such as hip replacements, hernia repairs and cataract procedures, yet safety standards in the private sector often leave much to be desired. How is the NHS addressing patient safety in this regard? Apart from anything else, there are very few critical care facilities available in private hospitals, so patients are transferred to NHS hospitals when things go wrong and complications occur. I would like to know whether private hospitals can be held liable for this use of the NHS. The previous Secretary of State wrote to the private hospital sector in 2018, telling it to get its house in order on patient safety, and he was absolutely right.

If it is decided that the Government wish to legislate on this matter, I urge them to do so swiftly and bring forward proposals. I promise the Minister that she will have constructive co-operation from these Benches, so let us get on with it.

[Baroness Brinton (LD)]

My Lords, I echo the points just made about the speed of the Government’s reporting. It is extremely helpful that the Minister in another place apologised clearly for the failures in the system and paid tribute to the victims. I too pay tribute to them and their families for their tenacity over many years, when it was clear that something was going wrong but the people who were in a position to gather information and do something chose not to.

The Statement says:

“I can promise the House a full response in a few months’ time.”


This public inquiry has rightly taken two years—it was slightly delayed by the general election and purdah—but it was clear in 2017 what many of the issues were. The excellent report from the Centre for Health and the Public Interest published in November 2017 entitled No Safety Without Liability: Reforming Private Hospitals in England after the Ian Paterson Scandal set out in a slightly different format many of the recommendations in front of us. I am sure that the Department of Health, the NHS and the independent hospitals will have looked at those recommendations.

I ask the Minister right up front: how long will it take before recommendations come back to the House from the Government on where they want to take things? After all, we have a Bill that is almost ready to go—or perhaps, as I said yesterday on the Second Reading of the Birmingham Commonwealth Games Bill, Groundhog Day is coming around again for us. Let us use that opportunity, at the very least, to remedy the obvious shortfalls in the system.

One of our major concerns is regulation of indemnity procedures for healthcare. There are serious shortcomings that must be dealt with as soon as possible. I was extremely concerned to read in the recommendations about the arrangements private hospitals have with clinicians to carry out their own activities that are rather like self-employed contractors almost renting an out-patient desk and in-patient beds. That is similar to renting a barber’s seat but without the overseeing regulations you need when people’s lives and health are absolutely at risk. That must be managed immediately.

Independent hospitals must take responsibility for their actions, so it is good that one of the key recommendations tries to focus minds on filling the gap between responsibility and liability. The report from CHPI two years ago said that this was vital and that independent hospitals must employ doctors and healthcare professionals, because without that responsibility on their behalf they will continue to wriggle out of liabilities and choose not to monitor clinical practice, missing either ill-meaning or incompetent surgeons. That cannot happen in the NHS and trusts have to take responsibility, as they do when things come to light. This hole in the current system needs to be remedied swiftly.

The inquiry also makes the important point that boards must apologise meaningfully and as early as possible. The UK health system, whether NHS or independent, has an extremely poor record of apologising, or of even commenting at all. Worse, it often tries to bury problems, denying whistleblowers any access. I am afraid that this is part of the systematic culture exposed in this very important inquiry—one that fears liability above apology and, equally importantly, does not learn well from mistakes, especially if through malpractice.

It is shocking that patients were often not guided to the Parliamentary and Health Service Ombudsman or the Independent Sector Complaints Adjudication Service. Compare that with the Financial Ombudsman Service: financial services companies must signpost access to the ombudsman at every step of the way when people buy financial products. A financial service problem could result in a loss of money, but a medical problem could end up changing lives for ever, as in the Paterson cases, so when will the Government deal with this issue? Will there be compulsory signposting for patients and clarity over whether all independent hospitals have to sign up to an independent complaints adjudicator—preferably just one, but I understood from what the Minister said in another place that they cannot regulate the independent sector completely? Frankly, as far as healthcare is concerned, my party believes we should.

Once again, the Paterson case demonstrates the need for effective whistleblowing processes. Will the Government commit to an office of the whistleblower to, through legislation, give more protection to patients, whether they are in the NHS or the independent sector? Spire Healthcare has said that it has put more measures in place to encourage staff and patients to speak out since the Paterson case, but even the Statement refers to there still being problems in Spire Healthcare. This just demonstrates that this is not working. Paterson’s victims are very clear: we need a system within the NHS that protects patients and staff. That is equally true of the independent sector.

I end by repeating my initial question: can we please have a timetable for the Government to come back to Parliament with proposed changes, given that a Bill is waiting that could easily be amended for both Houses to attend to speedily?