Procurement of Evusheld

Daisy Cooper Excerpts

Wednesday 12th October 2022 Westminster Hall

[Sir Gary Streeter (in the Chair)]

There has been a lot of interest in this debate. I will call Daisy Cooper to move the motion and then call the Minister to respond. There will not be an opportunity for the Member in charge to have the final say, as is the convention for a 30-minute debate.

[Daisy Cooper (St Albans) (LD)]

I beg to move,

That this House has considered the procurement of Evusheld.

It is a pleasure to serve under your chairship, Sir Gary. I am pleased to have secured this important debate on behalf of the forgotten half a million immunocompromised and immunosuppressed patients in England, and the 18,617 people who have signed the parliamentary e-petition calling on the Government to fund the preventive covid-19 drug Evusheld. I pay tribute to the extraordinary campaigning work of Evusheld for the UK, Blood Cancer UK, Kidney Care UK and many other charities that have given their members a voice. There is clearly significant interest from colleagues across the House, and I will endeavour to take as many short interventions as possible.

Let me be blunt: the Government have got this badly wrong. Some of our most vulnerable people are now in an impossible position, or, as some of them have said, they have been left to rot. People with blood cancer, vasculitis, kidney transplants, multiple sclerosis, long- term conditions and rare diseases and those on immunosuppressant drugs are crying out for the preventive drug Evusheld. Why? For them, the covid infection is just as deadly—in fact, more so—than when we first went into lockdown two and a half years ago. They do not mount a response to covid through the vaccines like the rest of us. Covid is not just a bad cold or an inconvenience, but a killer disease. In a society where people are allowed to walk around with that killer disease without being required to wear a mask, test or isolate, nowhere is safe for the immunocompromised—not inside or out.

[Andrew Selous (South West Bedfordshire) (Con)]

I share the passion with which the hon. Lady speaks. Does she agree that it is incredibly important that the clinicians and scientists take this decision through the usual rigorous methods, and not us as politicians?

[Daisy Cooper]

I welcome that intervention and I do agree. I will outline all the scientific evidence that backs the decision to procure Evusheld and roll it out right now, this side of Christmas.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

I congratulate the hon. Lady on securing this timely debate. I was contacted by a constituent ahead of it, who reiterated that as autumn and winter approach, we are even more vulnerable and isolated. Given what we face, I am sure the hon. Lady agrees that it is urgent for Ministers to listen to this debate and set out plans to support immunosuppressed patients and people during the difficult winter ahead.

--- Later in debate ---

[Daisy Cooper]

The hon. Lady is right. I will set out not only that the scientific evidence backs up the case for Evusheld, but that there is strong political consensus for it. Of course, the voices of those affected must be heard.

There is nowhere that is safe for these people: not shops, not schools, not supermarkets, not buses, not even the very GP surgeries and hospitals that they need to visit to manage the conditions that make them vulnerable. They are at extreme risk of hospitalisation and death, and they have been left with no choice but to lock themselves away from family and friends for two and a half years. Many now face a third winter of shielding.

[Mark Logan (Bolton North East) (Con)]

I agree with the hon. Lady’s sentiments. I have a constituent who has been shielding for 30 months—a 26-year-old who is the son of Mrs Rehana Patel. Along with the hon. Lady, I plead that the Government continue to give serious consideration to the use of Evusheld to help those thousands of clinically vulnerable people across my constituency and the rest of the UK.

[Daisy Cooper]

I thank the hon. Member for his intervention.

Let us move on to the facts. Is Evusheld safe and effective? Yes, it is. The Medicines and Healthcare products Regulatory Agency approved it in March, seven months ago. Is there enough scientific evidence? Yes, there is ample evidence.

[Sir Mike Penning (Hemel Hempstead) (Con)]

The hon. Lady and I have had conversations about this issue and about my own constituents. What I cannot understand is that the RAPID C-19 committee has looked at this 11 times. These are supposed to be experts that are looking at it. She is quite right to want evidence that proves that the committee is wrong. How come we have got into a situation where Government scientists are saying one thing and the rest of the scientific community is saying something completely different?

[Daisy Cooper]

I thank the right hon. Member for his intervention. That is exactly the question I would like the Minister to answer.

There are two significant problems with the most recent report published last week. First, it effectively says that the RAPID C-19 group looked at the results of a trial run on actual people in December 2021 and concluded that the evidence was so good that they were going to recommend that Evusheld be rolled out to patients. However, in May of this year, they looked at non-clinical data—test tubes, petri dishes and the like—and decided that the results were not good enough. It does not take a rocket scientist to work out that high concentrations of a virus in a petri dish do not translate to tests in real human beings.

[Julian Sturdy (York Outer) (Con)]

I understand that 33 other countries have approved the use of Evusheld, including every G7 member apart from the United Kingdom. What do you think we can learn from the other parts of the world that have approved this important treatment for the immunocompromised?

[Daisy Cooper]

I am grateful for that question. In fact, Evusheld is now so effective that not only has it been rolled out in 33 countries, but a number of countries, including Japan, Italy, Spain and Israel, have actually put in repeat orders for Evusheld, and the Centers for Disease Control and Prevention in the US has even launched a public drive to increase uptake. In private discussions, both the Minister and his predecessor have indicated to me in meetings that there was some evidence that countries had bought the drug but were not using it.

Let us be clear: the failure of any Government to identify clinically vulnerable patients and distribute the medication to them has nothing to do with the effectiveness of that particular drug. Before we throw stones in glass houses, we should remember that of immunocompromised patients in England who caught covid and were referred for treatment, only 17% actually got it. That failure to distribute is more to do with the fracturing of our health systems; it is not about the effectiveness of this drug.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I thank the hon. Lady for bringing forward this vital debate on behalf of the many constituents who have contacted me and in my capacity as chair of the all-party parliamentary health group. Does she agree that when people feel they are being left to rot, it is not only their physical health that is impacted; their mental wellbeing is crippled in the stage of recovery where they need the most support possible?

[Daisy Cooper]

The hon. Member is absolutely right. Many people are clinically vulnerable because they have a health condition, and their physical health is getting worse, as it would when someone is stuck at home for two and a half years, but the mental health impact is also incredibly profound. We know that many of our constituents have experienced suicidal thoughts.

I turn now to the advice of the RAPID C-19 oversight group, which has been mentioned. The Government refused to share this advice for some time, and many of us were asking for it. I was pleased to see that this advice was finally published last Thursday on 6 October. I was pretty shocked for two reasons. First, the report actually says that the group looked at real-world data and the impact on people and that data was very strong. Then it looked at the data in a non-clinical setting and decided not to roll it out. That seems absurd to me.

There is a second problem with the evidence that was published last week. It lists the evidence that the group reviewed, and it leaves out one very critical scientific study by the Francis Crick Institute—a study that I believe the Government commissioned themselves. That study was commissioned to look at the effectiveness of a different drug: sotrovimab. That report concluded that sotrovimab was effective, and the Government are using that report to justify why they continue to use sotrovimab. However, the report also concluded that Evusheld was even more effective. So why not buy Evusheld too? Perhaps the Minister can enlighten us.

On the same day the Government published this RAPID group report, The Lancet—the world’s highest-impact general medical journal—carried an article by 19 experts calling on the World Health Organisation to update its guidance on Evusheld, based on the study the Government commissioned. In the article, those experts say that Evusheld should be used for not only preventative, prophylactic use, but treatment. The UK Government are really trailing behind. Can the Minister tell us why the RAPID study ignores this vital piece of research, which they must have known about?

Many of the people we are talking about have already had five or six vaccine jabs, even though they will mount very little, if any, response. The Government say it is important that these people get those vaccines, because they say some response is better than none. Why does that same test not apply to Evusheld? Why is it being singled out and held to an impossible standard?

Let us look at what the Government are proposing, instead of following the science. Ministers have referred Evusheld to NICE for further clinical and cost-effective assessment; apparently, we might hear back in April 2023. That is another delay—another six months of isolation—even though every other covid treatment and vaccine was urgently procured before being appraised. I ask again, why is the Government’s treatment of Evusheld so inconsistent?

[John Glen (Salisbury) (Con)]

My constituent Helen Nash asked me to be here to support the case that the hon. Lady is making. She makes the key point: while the Government did a lot of great work to accelerate the availability of vaccines for the population at large, this particular cohort seems to be subject to a very different set of criteria. That is the great concern. While we must rely on clinical advice, we must also have the same situation for all people, regardless of their status.

[Daisy Cooper]

I agree with the hon. Gentleman. One of the big concerns that has not been answered by the Government so far is why their approach to this drug is so inconsistent with their approach to others. As I say, Ministers have referred Evusheld to NICE, and it is not at all clear why their treatment of it is so different.

Meanwhile, the Department of Health has proposed that immunocompromised patients have an antibody test, and that those who do not respond well enough could join an Evusheld trial. Let us be clear what that trial would mean in real life. It would require some of the people who have been shielding to stay alive for two and a half years to come out of shielding like the rest of us, but without any protection from covid vaccines, knowing that they might only be given a placebo. It would be like taking lambs to the slaughter. I would be astonished and appalled if that proposal passed anyone’s ethics test. I do not know if the Minister would support one of his loved ones taking part in such a trial, but I certainly would not. Can the Minister therefore tell us why his Department wants to take this dangerous approach instead of the approach suggested by the Drug Safety Research Unit, which has called on the Secretary of State to roll out Evusheld now, for this winter, and to run an observational study of the impact?

Another question that has arisen is whether there are problems with supply. The answer is no. AstraZeneca has dismissed that claim.

[Dan Jarvis (Barnsley Central) (Lab)]

The hon. Lady is presenting a powerful case; I congratulate her on securing this important debate. Max Johnson is a 14-year-old heart transplant recipient. He was the key figure in the organ donation campaign that was supported by Members right across the House. Max and his family are being supported by their local MP, the hon. and learned Member for Eddisbury (Edward Timpson), but we have kept in close touch. Max’s life has been turned upside down since the start of the pandemic, with no light at the end of the tunnel of isolation. Does the hon. Lady agree that Max, along with thousands of other people across the country, has the right to a better life and should be allowed access to Evusheld without any further delay?

[Daisy Cooper]

I completely agree.

I do not know how much a dose of Evusheld costs. I hope that, when the Government enter into negotiations with AstraZeneca, they will get a good price for the taxpayer. However, all Members of this House know what the cost is to our constituents who are affected. They have given up jobs, caring responsibilities and vital moments in their lives—they could not go to weddings, funerals or births. Some of them no longer run vital volunteer-led community services. Some have lost their life, and some are suicidal; they are thinking of taking their life because the psychological torture of prolonged shielding is too much for them to bear.

Those people are getting even more ill, because no one can be locked up for two and a half years without getting problems with their back or knees, or experiencing extreme loneliness and mental ill health. Those are all problems that are piling up for our already overstretched NHS. If those immunocompromised patients get covid, they are far more likely to end up in an intensive care unit, which we know will cost us thousands and thousands of pounds. There is also a risk of variant escape, because several studies show that new variants and virus mutations are more likely in immunocompromised patients. Against that backdrop, Evusheld is the cheap option.

Two years ago, Members stood in this room and begged Health Ministers to change their minds on care home restrictions, which were supposed to protect people but were so tight that some people started dying of neglect. We are at risk of that happening again. The Government changed course after that debate and can do so again today. The people affected by this feel that they do not have a life; it feels like a life sentence. Ministers have it in their gift to give those people their life back, and on behalf of the half a million, I urge the Minister—I beg him—to do it today.

Ambulance Pressures

Daisy Cooper Excerpts

Monday 18th July 2022 Commons Chamber

[Steve Barclay]

My hon. Friend is absolutely right on mental health and where a patient is violent, as I saw for myself on my visit to Bedford, for example, that can be unsettling for A&E. I am happy to have further conversations with him on what measures can be taken. The fact is there is no single intervention in this space; it is a question of looking at the integrated approach. That is what the call for evidence is about. Also key is understanding the data and seeing where it can better target action on areas such as mental health that can have a disproportionate impact.

[Daisy Cooper (St Albans) (LD)]

It is absolutely right that we limit the amount of time that patients must spend in the back of ambulances, and I welcome that measure, but it is putting intolerable pressure on hospitals. This morning, health leaders told me that they simply do not have the space or the staff, and the one thing they need in the next few hours is more staff. Can the Secretary of State commit himself to ensure that in the next few hours there are no financial or other barriers to the NHS being able to access more NHS bank staff, paramedics and ambulance drivers from the fire service, and, if necessary, from the military?

[Steve Barclay]

The principle of subsidiarity is that, as part of the extreme heat plans, local trusts make decisions locally on targeting resource, whether that has an impact on outpatients or other services, to meet the increased pressure. The hon. Lady is absolutely right that there is significant increased pressure, as we see in the call volumes coming in to 999 and 111. Part of the contingency plans that are in place is to surge resource, but it is also partly about being clear where risk best sits. At the heart of the letter from NHS medical director Stephen Powis on Friday was the importance of not pushing risk out into the community where it is an unmet need, or into the ambulance, where it is best that patients are, but having that risk more on the ward, where a patient is known and can receive care. Local contingency plans are in place to allocate resource to meet that.

Ambulance Services and National Heatwave Emergency

Daisy Cooper Excerpts

Wednesday 13th July 2022 Commons Chamber

[Maria Caulfield]

I thank my right hon. Friend, who is absolutely right, because a number of factors are influencing the wait times at A&E. While delayed discharges are not increasing, there are still a significant number of them, which means that the NHS and local authorities have to be working together. That is why we have created the integrated care boards, which Opposition Members voted against, to better co-ordinate care between health and social care so that we can have better systems in place to discharge patients sooner. As I have said, we have 1,200 void beds, which is either due to infection control measures because of covid rates increasing or because patients cannot be discharged. I will be meeting every single ICB in the coming days, because as part of our winter preparation, we need to improve co-ordination in those areas.

[Daisy Cooper (St Albans) (LD)]

Last October, I revealed through a parliamentary written question that every ambulance service in England was at the highest alert level. We are now nine months on, and we are in that situation again. We are facing warnings of extreme weather this weekend. The Government need to reinstate the funding for discharge packages into social care homes. We need primary care to be used to stabilise people in communities, and we must be using first responders from the fire service. Will the Minister agree to convene an urgent meeting of Cobra today to protect patients and paramedics, who are really operating at the brink?

[Maria Caulfield]

I say to the hon. Lady that we have put additional investment this year—over £150 million of extra funding—into ambulance services to help them meet demand, because they do have significant demand. The rates we are seeing at this time of year are the sorts of rates we would normally see in winter, and we are doing exactly as we would then. We have our heatwave plan, which was published earlier this year, and we are confident that we are working with all NHS trusts, and all the ambulance trusts too, to make sure they have the support they need. Can I gently say to her that this is not just about funding? This is about bringing care together to ensure that hospital beds are freed up so that when ambulances arrive at A&E they can unload their patients. As I said to the shadow Secretary of State—I am not sure if he is going to take me up on this—I am happy to work with every single Member across this House to make sure that we support our emergency services.

Draft Mental Health Bill

Daisy Cooper Excerpts

Monday 27th June 2022 Commons Chamber

[Sajid Javid]

We are determined to reduce the number of people with learning disabilities and autism who are in mental health hospitals. As part of those plans, we will shortly publish the cross-Government “Building the right support” plan to drive progress; I will have more to say about that shortly. I listened carefully to my right hon. Friend’s suggestion and would be happy to meet him to discuss it further.

[Daisy Cooper (St Albans) (LD)]

I was incredibly moved to learn of the Secretary of State’s personal experience with this issue. I commend his courage in talking about a deeply personal issue.

In his statement, the Secretary of State outlined that patients will be able

“to choose a nominated person who they believe is best placed to look after their interests.”

Could he outline what rights that nominated person might have? I have a particular issue in my constituency: somebody has been moved from one part of the country to another, but their next of kin was not asked for permission and only found out after the event. I think that it is incredibly important not only that there is a nominated person, but that that person has outlined rights that can be enforced in these situations.

[Sajid Javid]

I am pleased that the hon. Lady welcomes the change that will come about through the Bill. The draft version has only just been published, and I appreciate that she will need time to digest it, but it does explain how the nominated person—who does not have to be a family member, but can be anyone whom the individual chooses and trusts—will be able to co-produce the treatment plan for that individual and work with him or her very closely.

Access to GP Services and NHS Dentistry

Daisy Cooper Excerpts

Tuesday 21st June 2022 Commons Chamber

[Daisy Cooper (St Albans) (LD)]

The Conservatives have been running our health and social care system into the ground for years. Covid has made an already bad situation worse, but it was already bad, and my constituents—patients and healthcare professionals—can really feel it. A constituent who is a professional chauffeur needs to provide regular medical assessment certificates to keep his job, but his GP is not doing them right now, so my team have had to work hard to make sure that his employer will not sack him.

Some of my constituents have managed to see their GPs. One has had a referral for chronic back pain, another for a diagnosis of breast cancer that needs treatment, but having had those appointments they then discovered weeks later that the referral letters were never sent. Another constituent who had a contraceptive implant has had some very severe side effects and wants to have it removed, but she cannot get an appointment. A constituent who contacted her GP to say that she was having suicidal thoughts was asked to fill out a form.

I was so concerned about these reports that I have been to visit our GP surgeries in St Albans. From the other end of the spectrum, it is incredibly shocking. The very second the phone lines open in a GP surgery, there are flashing lights on its big screen. At one minute past the time that its phone lines open, there are hundreds and hundreds of calls on the electronic board. Many of those phone calls are from very distressed callers who are in pain and very concerned. Many of the people at the counter—the receptionists at the other end of the phone—are receiving verbal abuse, and we know that GPs are receiving abuse in their surgery rooms behind closed doors as well. The BMJ suggests that violent incidents in GP surgeries have doubled in the last five years.

One of the GP surgeries in my constituency has now employed somebody on a full- time basis to do one job: to chase the local hospitals to send the letters so that the GPs can get the results that their patients need. We have heard Members across the House talk this afternoon about how fantastic it would be if we could use big data and if our constituents could become expert patients and use all the information collected on their phone, but frankly, at the moment, we are starting from a basis where we cannot even get a letter from a hospital to a GP surgery. It feels as though the entire system is creaking at the seams, and that is even before we get to the postcode lottery of the number of patients each GP has, or the length of appointments.

Members across the House have talked about the planning system and the fact that lots of new homes are often built in areas without the infrastructure to go with them. I wholeheartedly sympathise with the calls for new homes, but it seems crazy in the circumstances that clinical commissioning groups are not even statutory consultees for planning applications, for local plans or even for permitted development. It should be a priority for this Government to change that and make sure that CCGs have the right resources to respond to planning proposals.

Then we have the problems with dentists. Like many other Members use, I have constituents who have raised these problems. I have mothers with MAT-B certificates who cannot get dental treatment. I have parents whose children are developing gum disease, but they cannot get an appointment with their dentist. I have couples who have moved to St Albans and, because they have moved, cannot get an appointment with the dentist. The list goes on and on.

I have challenged the Minister before about the Government’s announcement earlier this year that they were going to give £50 million to dentists to create some emergency catch-up appointments. When the Secretary of State was challenged on this earlier this afternoon, he said that that £50 million had resulted in tens of thousands of new appointments. That was news to me. Earlier this year, I submitted a number of written parliamentary questions. I asked the Government how many dental practices had achieved the quarter 3 targets to make them eligible for this £50 million. The answer was that the Government did not hold that information centrally. I asked the Government how many expressions of interest had been received by the deadline of 3 January. The answer was that the Government did not hold that information centrally. I then asked the Government how many of those who had offered to carry out this urgent dental practice had been accepted. Again, the Government said that they did not hold that information centrally. So what has happened to that £50 million? How much of it has been drawn down?

[Maria Caulfield]

The hon. Lady will know, because she raised this in oral questions, that dentists return that data in quarters. We will have that data from the dental community by the end of June, and we will then be able to answer her questions. She knows that; she is making a political point here.

[Daisy Cooper]

I am genuinely incredibly grateful for that answer, because when I challenged the Minister on this last week I did not receive that answer. I am grateful to receive that response. I submitted a letter to the Minister—I think it was in April—and attempted to come to some drop-in events that were cancelled, so I am pleased to hear that that data will be provided by the end of June. However, my constituents in St Albans have seen absolutely zero appointments created from that money. Every dental practice has said that because of the way the funds have been set up, it has been impossible for them to apply for them. A number of other Members have raised that point.

The truth is that the Government have failed to recruit the GPs that we need. We have a retirement time bomb among our general practitioners, and we know that dentists are leaving NHS work as well. We need to see a serious plan from the Government so that everybody who needs to see a GP or a dentist can actually see one.

--- Later in debate ---

[Daisy Cooper]

Will the Minister give way?

[Maria Caulfield]

No, I will not.

We are also delivering zero tolerance to abuse through the Police, Crime, Sentencing and Courts Act 2022. Labour talk the talk, but it was those of us on the Government Benches who voted to double the maximum sentence for those who abuse our emergency care workers. Labour actually voted against giving the Bill a Third Reading. That tells us all we need to know.

With the time I have left—

Oral Answers to Questions

Daisy Cooper Excerpts

Tuesday 14th June 2022 Commons Chamber

[Maria Caulfield]

I am sure the people of Wakefield are as frustrated as I am that the Labour dental contract, put in place in 2006, is the nub of the problem. If the hon. Lady were to meet with dentists, she would hear loud and clear that the dental contract is causing the problem. [Interruption.] She might not have listened to my previous answers because she is not listening now, but we will be announcing changes before the summer recess.

[Daisy Cooper (St Albans) (LD)]

At the start of this year the Government announced £50 million to create some new dentistry appointments, but that money resulted in exactly zero new appointments in my constituency. I wrote to every single dental practice in my constituency and they said that was because the funding offer was too limited in scope and time and they were given only a week to reply.

On 25 April, I wrote to the Minister asking how many appointments had been created from this money across England and where that money had gone. I have not received an answer. Will we get one today?

[Maria Caulfield]

I am very disappointed: that £50 million of funding was for dentistry to access and be able to afford more appointments, and if local commissioners in an area did not bid for that money or ask dentists to take that money on, that is extremely disappointing—those in other parts of the country certainly did. We are putting £3 billion a year into dentistry. Local MPs have a role to play in this: if there was a problem, I would have expected the hon. Lady to have come and seen me before now to lobby for more funding for her local area.

North East Ambulance Service

Daisy Cooper Excerpts

Monday 23rd May 2022 Commons Chamber

[Maria Caulfield]

I reassure the hon. Gentleman that the police have investigated and that they did not find evidence of that. As I have said at the Dispatch Box, I will look into specific cases to be confident that no stone has been left unturned with respect to the allegations in The Sunday Times. There are measures in the Police, Crime, Sentencing and Courts Act 2022 that increase sentences for assaults on emergency workers, which we take extremely seriously.

[Daisy Cooper (St Albans) (LD)]

As far back as December last year, I wrote to the Secretary of State urging him to commission a CQC investigation of the crisis in our ambulance service, using his powers under the Health and Social Care Act 2008, because the CQC does not have powers to conduct thematic reviews itself. Since I wrote to him, we have seen scandal after scandal. In the north-east, people were told to phone a friend; in the west midlands, a patient waited more than 22 hours; in the south-west, stroke and heart attack victims are having to wait more than an hour; and in my own constituency, a cancer patient nearing the end of life had to wait almost 12 hours in agony for an ambulance to arrive. Surely it is time for the Government to stop sitting on their hands and to commission the CQC to launch a wide-ranging investigation of the crisis facing all our ambulance services.

[Maria Caulfield]

Let me reassure the hon. Lady. The CQC has been heavily involved in this case. I met representatives this morning to hear from them, and will be following that up. Moreover, an extra £55 million has been invested in the ambulance service nationally. We are aware of the pressures that the service is facing, and will do all that we can to support it.

Health and Care Bill

Daisy Cooper Excerpts

Consideration of Lords amendments
Monday 25th April 2022 Commons Chamber

[Sir Iain Duncan Smith (Chingford and Woodford Green) (Con)]

I will speak briefly to Government amendment 48A, which is in lieu of amendment 48B. Essentially, it requires the health service to ensure that it does not use products made under forced or slave labour anywhere in the world. That is a big statement by the Health Department, and one that I think we all welcome—I have certainly campaigned on this issue for some time.

In the great sweep of this health legislation, on which there are agreements and disagreements across the board, that may not seem to be something that will directly affect our lives, but in truth it will resonate beyond our shores. It is already resonating among the Uyghur, who have found themselves under distinct pressure, with husbands often separated from wives and families broken apart for forced labour thousands of miles away from their homes. This measure will speak to them; it is, in a way, a sign that Governments in the free world are taking up this real cause and recognising that it is intolerable for us to turn a blind eye and buy equipment, clothing and so on simply because it is cheaper and helps our cost balance. I do not believe that it will in the end; the trade-off between cost and the human rights of those who have suffered so much under the heel of those totalitarian states is an abysmal one.

Child labour is used in rare-earth mines; when we use those rare-earth materials for the manufacture of our computers, we turn a blind eye to it. When slave labour is used in the Xinjiang region to produce the cotton and the cloth for our personal protective equipment, making it quicker and easier to get, we turn a blind eye to it. It is not just done there; it is done in many countries around the world because it is easier and cheaper, and we tolerate it. I therefore welcome that my right hon. Friend the Secretary of State and the Ministers have tabled the amendment. It will speak volumes to those who are oppressed. It will say to them, “The free world has not forgotten you.” I am certain that in due course the rest of this Government will do the same, and other Governments will then follow suit. I congratulate us for making the right decision.

[Daisy Cooper (St Albans) (LD)]

I will speak to the workforce amendment and the amendment on the social care cap.

The Lords have compromised on the workforce amendment—they have now asked for projections every three years instead of every two, and they no longer require independent verification of the projections—so it is deeply disappointing that the Government have not moved to meet them halfway, especially when outside the Government there is so much cross-party consensus that the amendment is badly needed. I know from my constituency of St Albans, as I am sure many Members know from theirs, that our NHS and care staff are burnt out. They are understaffed and overworked. Those people, who continue to turn up every single day, need to know that the cavalry is coming, and without this workforce amendment, they simply will not.

There have been worrying reports that NHS trusts have been silenced when they have tried to talk about the numbers of staff that they need to recruit, so will the Minister address this question in his response: if the Government will not produce workforce planning numbers, will they at least commit to not interfere with or silence any part of the NHS or care sector that decides that it wants to produce its own workforce projections? I look forward to hearing the Minister’s assurances on that point.

When it comes to the social care cap, Ministers have stated time and again that their changes would save the Treasury £900 million a year by 2027-28, but that saving comes at the expense of people with fewer assets and savings, including those who will have been paying five years of increased national insurance contributions, which were put in place partly to fund these care reforms. The Government continue to say that that improves on the current situation, but they conveniently ignore that it is much worse than their original proposal. The social care cap provision does nothing to generate more care; it does nothing to give protections to unpaid carers, who are often on lower incomes but save the Government millions of pounds; and it does nothing to help the social care workforce. I know from my constituency that hospitality, the NHS and social care are all fighting for the same people, and nothing in the Bill will help to improve that situation.

[Peter Aldous (Waveney) (Con)]

I am grateful to have a few minutes to say a few words on the cap on care costs and on workforce planning.

With regard to the care cap, it is important to congratulate the Government on tackling a problem—or attempting to defuse a ticking time bomb—that all their predecessors shied away from. However, there is concern that the proposals are a rushed tag-on to a Bill that was designed for a different purpose: the integration of health and social care and the setting up of integrated care systems. I accept that there is a clear correlation, but the legislation that addresses the problem of people being forced to sell their homes to pay for their care should have been considered and scrutinised separately and carefully, with the objective of putting in place a system that has political consensus and will stand the test of time. That is what the Dilnot proposals and the Care Act 2014 achieved, and they should be the foundation stone on which we build this new system.

My concerns are twofold. First, clause 140 is extremely unfair to those with limited assets and modest incomes. The changes may save the Government hundreds of millions of pounds, but they do so at the expense of those on low incomes and those who live in parts of the country where house values are lower, such as Lowestoft in my constituency. Secondly, there is a worry that working-age adults with disabilities will be unfairly penalised, hence the introduction by the other place of a provision to address it. I acknowledge the Government’s worries about the cost implication of that additional provision, but that iniquity needs to be addressed.

On workforce planning, there is a staffing crisis both in the NHS, where there are 110,000 full-time equivalent vacancies, and in social care, where there are another 100,000 vacancies, high staff turnover and very limited respite for unpaid and family carers. Those deficiencies cascade through the health and care system, creating bed-blocking in hospitals and impeding the efforts made to reduce waiting lists. There is an urgent need for strategic planning to address this crisis. There is concern that framework 15 is not working because of inadequacies in the collection of data, lack of assessment of workforce numbers, and unresponsiveness to societal shifts.

Since we last considered the issue last month, the other place has sought to address the Government’s concerns and, as we have heard, has made reasonable concessions. There is a crisis that must be addressed, and I hope that at this very late stage the Government will accept this reasonable amendment, so that we can get on with this much-needed work.

Health and Care Bill

Daisy Cooper Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Jeremy Hunt]

It is absolutely the case. We need something like this because, as I know—I will do my self-reflection now—when a Health Secretary negotiates a spending settlement with the Chancellor, the number of doctors they are going to have in 10 or 15 years’ time is quite low down their list of priorities because they are thinking about immediate pressures. So we need something that deals with that market failure. I did set up five new medical schools and was proud to do so, but I do not know whether that was enough. That is why we need something to make sure that we never have to worry, whoever the Government and the Health Secretary are, that this fundamental thing that is vital for the future of the NHS for all of us is always properly looked after.

Let me conclude by remembering what we were discussing this morning in the Ockenden review. We talked about the agonies faced by families. We did not talk enough about the agonies faced by doctors, midwives and nurses who find themselves responsible for the death of a child—it is psychologically incredibly devastating for them. We need to be able to look them in the eye and say, “The No. 1 thing in the Ockenden review that came out was that staffing shortfalls can make a difference. We understand that.” They know and we know that there is no silver bullet; this cannot be solved overnight. It takes seven years to train a doctor, 10 years to train a GP and three or four years to train a nurse or a midwife. No one is expecting a solution tomorrow, but we do at least have a responsibility to look each and every one of those people, who worked so hard for us in the pandemic, in the eye and say, “We do not have a solution right away but we really and truly are training enough for the future.”

[Daisy Cooper (St Albans) (LD)]

The Minister made a valiant effort to dissuade some of us from supporting Lords amendment 29—the workforce amendment—but I suspect he knows he is not kidding anybody.

We have learned today that public satisfaction with the NHS is at its lowest level since 1997. We should not underestimate the blow that that news will deliver to the health and care workers who turn up, do an amazing job, and go above and beyond every single day. To say that that news is dispiriting is an understatement. It is important that those workers know that the public, and every Member of this House, loves our NHS; it is just that we want it to work a bit better. It is hardly surprising that people’s biggest frustrations are waiting times, a lack of proper funding and staff shortages. Those things are the fault not of health and care workers but of this Tory Government, who are driving our health and care services into the ground.

Cancer Research UK says that without the workforce amendment the Bill will fail to address the biggest barrier to the achievement of world-class cancer outcomes in the UK: the staffing shortages and pressures. The King’s Fund has said that the health and care workforce crisis will be the key rate-limiting factor in the reduction of the NHS elective care backlog. The workforce amendment may not be a silver bullet, but it is the closest thing to one, which makes it all the more frustrating that the Government will not accept it. As I suspect the Minister knows, the Government’s objections just do not stand up to scrutiny.

As the right hon. Member for South West Surrey (Jeremy Hunt) said, framework 15 simply sets out the number of staff the Government think they can afford, rather than the number of staff we actually need. I urge the Minister to think about what message that sends to my constituent, who is a newly qualified midwife. She wrote to me just a couple of months ago and said:

“I am extremely concerned about the crisis in maternity care. This isn’t caused by Covid-19—the systemic failings have been crippling the service for a generation—but the pandemic has made a bad situation worse.”

She said:

“I am being harmed, my clients are being harmed. Staff are being harmed. For every 30 newly qualified midwives, 29 are leaving. Parents are reporting bullying and coercion. Threats are being used to ensure compliance. Unnecessary medical interventions are at epidemic levels. Trauma—amongst parents and midwives—is rife.”

She said that “concerns are being missed” and interventions “made too late”, and that the reason was “staffing problems.” If that is not a wake-up call, I do not know what is.

I wish briefly to express my concern about the powers the Bill will give the Secretary of State. At best, the change will create a bureaucratic nightmare; at worst, it will lead to meddling and the politicisation of the day-to-day running of the NHS. The Government have tried to argue that the pandemic showed the need for Ministers to have more powers, but we know that during the pandemic the Secretary of State had powers over PPE and test and trace, both of which issues were handled extremely badly. The NHS’s operational independence is critical, but it will be undone by the introduction of the Henry VIII powers in the Bill, so Liberal Democrats will oppose them.

Finally, I congratulate the right hon. Member for Chingford and Woodford Green (Sir Iain Duncan Smith) on his impassioned speech. I agree with him wholeheartedly that we have a duty as a nation and as a society to ensure that the goods used in our publicly owned NHS are not tainted by modern slavery or linked to the behaviours that may lead to genocide.

[Derek Thomas (St Ives) (Con)]

I rise to speak in support of Lords amendment 29, in the context of those who suffer brain tumours. I wish to take a moment to reflect on the fact that Tom Parker, a member of The Wanted who had done so much work to raise awareness of brain tumours and who worked with the all-party parliamentary group on brain tumours, which I chair, died today of his brain tumour. I wish to take a moment to remember him, his family and the two young ones he has left behind.

As I say, I chair the APPG on brain tumours, so I wish to discuss the need for Lords amendment 29 in that context. As we have heard, there is currently no data on how many healthcare staff the country needs, but we know that staff are overstretched. As we heard from my right hon. Friend the Member for South West Surrey (Jeremy Hunt), £6.2 billion was spent on locums in the financial year 2019-20 to plug the gaps. The NHS and social care will never be able to keep up with demand without regular assessment of the numbers needed. As we know, the Government have so far dismissed this workforce planning amendment on the basis that the Department of Health and Social Care has commissioned a long-term strategic framework. We have heard already this evening why that is not good enough, although I am extremely aware of how much the Minister is engaged in, and concerned about, this workforce subject, and he has been generous with his time in talking to colleagues about what the Government hope to do.

--- Later in debate ---

[Daisy Cooper]

I would like to start by talking about carers and safe discharge. I welcome the Government’s concession on this point. It is a pleasure to follow the hon. Member for Gosport (Dame Caroline Dinenage), who talked so eloquently about the fact that unpaid carers are often, in effect, invisible. She is seeking a number of assurances from the Minister, and I wonder if I might add another.

The Minister will be aware that on Report I tabled an amendment calling for a new NHS duty to recognise and identify unpaid carers who come into contact with the NHS so that their health and wellbeing could be taken into account when decisions are made concerning the health and care of the person or the people for whom they care. The amendment now before us is not as strong as that. In fact, it is not as strong as the Lords amendment. I welcome the Government’s concession on this, but I wonder whether the Minister might provide some assurances that the nub of my amendment at an earlier stage could, for example, be included in some of the ICB guidance. It is important that carers are consulted but also important that their health and wellbeing is taken into account when decisions are made about those for whom they care.

I have a couple of thoughts on the social care cap. First, it is a really terrible way to come up with policy to change a policy halfway through a Bill, because it starves important policies of public debate and parliamentary scrutiny. It is a very bad habit. We have seen it with other Bills, such as the Building Safety Bill—a national scandal that I have spoken about many times. This is a bad way of making law. It is important that the Government do not fall into bad habits.

The other point is on broken promises. The Prime Minister stood on the steps of No. 10 and pledged to

“fix the crisis in social care once and for all”.

He also promised that no one would have to sell their home to pay for care. He has now broken both those promises, because this Bill does not fix the social care crisis and it does continue to see people facing the prospect of losing their home to fund care costs. Quite frankly, it is appalling that the Government are arguing that they cannot afford to accept this amendment when the savings that are going to be generated for the Treasury come off the backs of the poorest people in our society. The Government really should think again.

[Steve Brine]

I have sat through all this debate and taken issue with the Government in some places and supported them in others. I am going to take issue with them on amendment 51. It is always hard to take issue with this Minister, but I seem to have done it twice already today. My hon. Friend the Member for Gosport (Dame Caroline Dinenage) and I did not compare notes but seem to have exactly the same comments, which suggests that this is an important amendment.

I want to make a few points about young carers in Hampshire and nationally who have been in touch with me about amendment 51. The amendment that we are being asked to strike out says at paragraph (5)(b) that

“a ‘carer’ means any person, including any child under the age of 18”.

It does not say that in the Minister’s amendment in lieu, but I have heard what he has said today and I hope that it will be heard clearly, because what is said at the Dispatch Box matters a great deal. The Minister in the Lords said on Report that there will be statutory guidance that hospitals “must have regard to” and that that is a sufficient measure for carers. Again, I hear that, but what is said at the Dispatch Box in the Lords matters as well. As young carers have said to me, ahead of today, this is not the same as primary legislative rights and it can be withdrawn or changed at the stroke of a Minister’s pen, intentionally or unintentionally. It does not mean the same for carers and young carers in the daily operation of the system. I would suggest that very few carers, especially young carers, have the energy, the means or the knowledge to go to judicial review if their rights are not followed.

When the Minister winds up, I beg him once again to make it absolutely crystal clear that his amendment in lieu does the same as the Lords amendment that he is asking us to strike out, because young carers, in particular, want and need that reassurance. Other than that, it is a good amendment that is worthy of our support, but I just want to hear a little bit more from my excellent Minister—and now that I have flattered him he cannot deny me.

Civil Proceedings

Daisy Cooper Excerpts

Tuesday 29th March 2022 Commons Chamber

[Daisy Cooper (St Albans) (LD)]

I, too, put on record my enormous thanks to all the health and social care workers as well as the many unpaid carers—who have demonstrated extraordinary public service over the last couple of years, and also on a daily basis, day in day out—for the instances of love, care and medical attention for the thousands of people who have recovered, but also the 165,000 who did not.

Two years ago, in March 2020, the Liberal Democrats recognised the seriousness of the emergency. We worked constructively with the Government, along with other Opposition parties, to introduce this emergency legislation. In the course of time it became clear that some of the provisions were indeed necessary to tackle the impact of the pandemic, such as enabling the emergency registration of nurses and other healthcare workers, and allowing people to receive statutory sick pay. However, many of the powers in the 2020 Act have serious implications for people’s wellbeing and for their rights and freedoms, such as the relaxation of duties on local authorities to assess and meet people’s care needs, the extra powers for police and immigration officers to detain people, and the powers to restrict or ban events and gatherings.

This is the third time that the Act has come up for renewal. We are glad that the Government have retired many of the most controversial provisions. However, I ask the Minister whether the Department of Health and Social Care will work with the Cabinet Office to review the use of emergency legislation over the last couple of years, because we must not end up in this situation again. It is vital that we as a House ensure that there are safeguards in place to guard against the assumption that this or any future Government may use emergency legislation outside of an emergency.

Although the emergency legislation is effectively being retired bit by bit—we have just six months left—I share the concerns of a number of colleagues about the creeping complacency that has shown its face in the Department of Health and Social Care, particularly towards some of our most vulnerable residents, the immunocompromised. Other colleagues have talked about the importance of free covid tests, clear guidance and sick pay. The Government have talked very much about taking a vaccine-led approach, yet they are falling down in that approach when it comes to the immunocompromised.

There is a life-saving drug, Evusheld, the trials for which have shown that it can reduce the chances of developing symptomatic covid-19 among immunocompromised patients by 77% after three months and 83% after six months. I ask every Member of the House to take a second to put themselves in the shoes of immuno-compromised people. Two years ago, the Prime Minister wrote to every person in this country and asked them to stay at home. Those who are immunocompromised or immunosuppressed have never left. Many of them are still in lockdown. They cannot benefit from the vaccines that the rest of us have enjoyed. For them, the decision of whether to go back to work or just to the shops is a life or death decision. It is a huge health inequality in our country that all of us can benefit from vaccines but those who cannot are not being given access to this life-saving drug.

I therefore ask the Minister not only to respond to the point about how we deal with emergency legislation in future, but to confirm on record today that the Government intend to place an order for this drug, and to do so within days not weeks, because, now that it has approval from the European Medicines Agency, the window within which there is still manufacturing capacity and the UK can place an order is shrinking fast. Although it is vital that the legislation that we have used during the pandemic comes to an end slowly—in six months hopefully it will all be retired—many people are still living in lockdown because of covid, so I would ask the Minister to respond to those points.