David Davis debates involving the Department of Health and Social Care during the 2019 Parliament

Tue 14th September 2021
3 interactions (103 words)
Thu 24th June 2021
9 interactions (2,583 words)
Thu 14th January 2021
4 interactions (2,414 words)
Tue 10th November 2020
3 interactions (84 words)
Tue 24th March 2020
3 interactions (131 words)
Mon 23rd March 2020
15 interactions (460 words)

Covid-19 Update

David Davis Excerpts
Tuesday 14th September 2021

(1 month ago)

Commons Chamber

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Department of Health and Social Care
Sajid Javid Portrait Sajid Javid
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I think the hon. Lady would agree that we are as a country in a much better place today with covid than we were even at the start of this year. That is down to many factors, and I referred to a number of those in my statement, but I believe that with the measures we have set out today, we can be confident that our children will not have to go again through the kind of disruption they have seen in the last couple of years.

David Davis Portrait Mr David Davis (Haltemprice and Howden) (Con)
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The distinguishing characteristic of the emergency Coronavirus Act was not so much the new powers, which already existed in the Civil Contingencies Act 2014 and other Acts, but in the fact that Ministers were not required to get them approved by Parliament before implementation, which is one of the reasons for the poor quality of some of the decisions taken in the last year. Will the Secretary of State give an undertaking that any new regulations and indeed any regulations he retains will be put to the House before implementation, including vaccine certification if the Government are unwise enough to pursue that course?

Sajid Javid Portrait Sajid Javid
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I can tell my right hon. Friend that when the Government or any Government make decisions that have such an impact on people’s liberties, even if those decisions are made for all the right reasons—in this case, of course, to deal with this pandemic—they should be working with the House and working with colleagues. On any measures that are significant, of course the Government will come to the House and seek a vote of the House.

Use of Patient Data

David Davis Excerpts
Thursday 24th June 2021

(3 months, 3 weeks ago)

Commons Chamber

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Department of Health and Social Care
David Davis Portrait Mr David Davis (Haltemprice and Howden) (Con)
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In winding up the last debate, the Minister for the Armed Forces referred to volunteering a mucker for the guardroom. I hope that my entire speech does not sound like that to the Secretary of State; it is not intended to.

Every couple of years, Whitehall, like an overexcited teenager expecting a new mobile phone, becomes fixated with data. Most recently, it has been about the power of big data mining, and I am sure that that is not just because of the influence of Mr Dominic Cummings. The Department of Health and Social Care wants to open our GP medical records—55 million datasets or thereabouts—to pharmaceutical companies, universities and researchers.

Managed properly, that data could transform, innovate and help to overcome the great challenges of our time, such as cancer, dementia and diabetes. Those are proper and worthwhile ambitions in the national interest, and I have little doubt that that was the Government’s aim, but that data is incredibly personal, full of facts that might harm or embarrass the patient if they were leaked or misused. Psychiatric conditions, history of drug or alcohol abuse, sexually transmitted infections, pregnancy terminations—the list is extensive. Revealing that data may not be embarrassing for everyone, but it could be life-destroying for someone.

Unfortunately, in keeping with the Department’s long history of IT failures, the roll-out of the programme has been something of a shambles. The Government have failed to explain exactly how they will use the data, have failed to say who will use it and—most importantly—have failed to say how they will safeguard this treasure trove of information. They describe the data as “pseudonymised” because it is impossible to fully anonymise medical records, a fact that is well understood by experts in the field.

Even pseudonymised, anyone can be identified if someone tries hard enough. Take Tony Blair, who was widely known to have developed a heart condition, supraventricular tachycardia, in October 2003. He was first admitted to Stoke Mandeville and then rushed to Hammersmith. One year later, in September 2004, he visited Hammersmith again for a corrective operation. Even the name of the cardiologist is in the public record. A competent researcher would make very short work of finding such individual records in a mass database. That cannot be for the public good. Moreover, the Government seem to intend to keep hold of the keys to unlock the entire system and identify an individual if the state feels the need to do so.

Jim Shannon Portrait Jim Shannon (Strangford) (DUP)
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I congratulate the right hon. Gentleman on securing the debate; I have been inundated with the same concerns from many of my constituents. Does he agree that a system that allows a diversion from the court-appointed warrant to collect information is a dangerous precedent in terms of judicial due process? We must ensure that anyone who opts out is completely opted out, as is promised.

David Davis Portrait Mr Davis
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I take the hon. Gentleman’s point and will elaborate on it as I make progress. As presented, the plan is to collect the data first and think about the problems second, but the information is too important and the Department’s record of failed IT is too great for it to be trusted with carte blanche over our privacy.

There is also the so-called honeypot problem. Data gathered centrally inevitably attracts actors with more nefarious intentions. The bigger the database, the greater the incentive to hack it. If the Pentagon, US Department of Defence and even Microsoft have been hacked by successful cyber-attacks, what chance does our NHS have?

Nigel Evans Portrait Mr Deputy Speaker (Mr Nigel Evans)
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Order. As we are coming towards 5 o’clock, I will just go through the following technical process.

--- Later in debate ---
David Davis Portrait Mr Davis
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Thank you, Mr Deputy Speaker. I take it you do not want me to start from the beginning again. That might test people’s patience a little.

As I was saying, if the giants of data security can be hacked, what chance the NHS? Big databases and big systems are intrinsically vulnerable. In 2017, a ransomware attack brought parts of the NHS to its knees. Trusts were forced to turn away patients, ambulances were diverted and 20,000 operations were cancelled. That highlights significant problems the Government have not yet had time to address. Despite those problems, the Government have been determined to press ahead with their data plans regardless. They undertook no widespread consultation, provided no easy opt-out, and showed no particular willingness to listen as would be proper with such an important move. The public were given little over a month to opt out of a data grab that few knew existed. The plan was described by the British Medical Association as “a complete failure” and “completely inadequate”.

The Government’s riding roughshod over our privacy was halted only when a coalition of organisations, including digital rights campaign group Foxglove, the Doctors’ Association UK, the National Pensioners Convention and myself, challenged the legality of the state’s actions. Our letter before legal action and threat of injunction forced a delay of two months. That is a welcome pause, but it has not resolved the issue.

Earlier this week, the Secretary of State published a data strategy that raised the possibility of using health data to improve care, something I know is close to his heart, but plans for securing and handling our data were consigned to a single paragraph—almost an afterthought. If the Government do not take corrective action to address our concerns, there will inevitably be a full judicial review. I have no doubt that, without clear action to both protect privacy and give patients control of their own data, the Government will find themselves on the losing side of any legal case.

Today, I hope and believe the Government will have the courtesy to listen. Indeed, if I may, I will thank the Secretary of State for being here personally today. It is very unusual for a Secretary of State to take the time to be here—he must be the busiest man in the Government—and address the issue today. That he has done so is, I think, a compliment to him.

A comprehensive health database undoubtedly has the potential to revolutionise patient treatment and save hundreds of thousands of lives. However, this data grab is not the correct approach. There are much better, safer and more effective ways to do this in the national interest. No system is ever going to be 100% safe, but it must be as safe as possible. We must find the proper balance between privacy and progress, research and restrictions, individual rights and academic insights. That also means controlling the companies we allow into our health system. Patient trust is vital to our NHS, so foreign tech companies such as Palantir, with their history of supporting mass surveillance, assisting in drone strikes, immigration raids and predictive policing, must not be placed at the heart of our NHS. We should not be giving away our most sensitive medical information lightly under the guise of research to huge companies whose focus is profits over people.

Of course, this was not Whitehall’s first attempt at a medical data grab. The failed care.data programme was the most notorious attempt to invade our privacy. Launched in 2013, NHS Digital’s project aimed to extract data from GP surgeries into a central database and sell the information to third parties for profit. NHS Digital claimed the data was going to be anonymised, not realising that that was actually impossible. The Cabinet Office described the disaster as having

“major issues with project definition, schedule, budget, quality and/or benefits delivery, which at this stage do not appear to be manageable or resolvable.”

The project was ended in July 2016, wasting £8 million before it was scrapped.

However, care.data was just one example. I am afraid the Department has a long and problematic history with IT. Before care.data the NHS national programme for IT was launched by Labour in 2003. It sought to link more than 30,000 GPs to nearly 300 hospitals with a centralised medical records system for 50 million patients. The initial budget of £2.3 billion—note billion, not million—ballooned to £20 billion, which had to be written off when the programme collapsed in 2011. My old Committee, the Public Accounts Committee described the failed programme as one of the

“worst and most expensive contracting fiascos”

ever.

The possibilities to make research more productive, quicker and more secure are goals worth pursuing. There is no doubt that we all agree on the aims, but the path to progress must be agreed on, and there is clear concern among the public, GPs and professional bodies about this new data system.

Rachael Maskell Portrait Rachael Maskell (York Central) (Lab/Co-op)
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I am very grateful to the right hon. Gentleman not only for giving way, but for leading today’s very important debate. It has been a really difficult year both for clinicians and for the public. The public understand the importance of research and planning, but they need confidence that their data—often about very intimate health needs—is secure. Given the need to maintain the special relationship between the clinician and patient, does he agree that the insufficiency of the current processes will damage that relationship, and therefore that we need a complete rethink about how data is collected and then used appropriately?

David Davis Portrait Mr Davis
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I do absolutely agree. I think there is a common interest, frankly, between everybody in this House, including those on the Front Bench. The worst thing that can happen to this is a failure of trust. The failure of public trust in the care.data system saw some 2 million people opt out, and that is not what we want to see here, but we could easily exceed that figure with this programme now.

A lack of trust will undermine the usefulness of the dataset the Government hope to collect. The Guardian reported this month:

“All 36 doctors’ surgeries in Tower Hamlets…have already agreed to withhold the data”

had the collection gone ahead on 1 July as was planned. Other parts of the country are seeing more than 10% of patients withdraw their data via their GP surgery, and that is with little to no public awareness campaign. Much of this would have been avoided had the Government trusted Parliament and the public with a detailed and carefully thought-through plan. As the BMA noted:

“Rushing through such fundamental changes to confidential healthcare data, losing the confidence of the public and the profession, will severely undermine the programme and threaten any potential benefits it can bring”.

It is entirely correct.

Despite the errors so far, this proposal need not necessarily be consigned to the ash heap of NHS history. There are ways of safely achieving the vast majority of what the Government want. The programme OpenSAFELY is a new analytics platform, principally authored by Dr Ben Goldacre, Liam Smeeth and Seb Bacon, that was created during the pandemic to provide urgent data insights, so I know the Health Secretary will be very familiar with it. Working with 58 million NHS records distributed across a range of databases—not centralised, but on a range of databases—their software maintains health data within the secure systems it was already stored on. It is not transported outside the existing servers and it does not create a central honeypot target.

The programme sees the data, but the researcher does not. Furthermore, all activity involving the data is logged for independent review. The way it works is that the researcher sets up the experiment, and the programme returns the results, such as a hypothesis test, a regression analysis or an associational graph. At no point does the researcher need to see the raw patient data; they simply see the outcome of their own experiment. This is very important because the biggest risk with any new data system is losing control of data dissemination. Once it is out, like Pandora’s box, you cannot close the lid.

OpenSAFELY gets us 80% to 90% of the way to the Government’s objectives. Operated under rigorous access controls, it could give the vast majority of the research benefit with very little risk to the security of the data. Therefore, this is a viable approach providing there is a properly thought-through opt-out system for patients. This approach, so far, has been severely lacking: where are the texts, the emails and the letters to the patients that should have been there at the beginning? On the “Today” programme earlier this week, the Health Secretary indicated that he was now willing to contact every patient. That is very welcome. I hope he is now writing to every single patient involved in this proposed database and informing them properly. That information should be in easy-to-understand English or other community language, not technical jargon. Everything in the letter must be easily verifiable: clear facts for clear choices. The letter should have the approval of the relevant civil organisations that campaign on privacy and medical data issues to give the letter credibility. Unlike the disastrous scenes of only a few weeks ago, this will mean that patients should be able to opt out through their choice of a physical form with a pre-paid return, an easily accessible form online, or a simple notification of their GP. As well as the physical letter, a reminder should be sent to them shortly before their data is accessed, which, again, should give the patient a clear way to change their mind and opt out. The overall aim must be to give patients more control, more security and more trust in the process, and that requires very high levels of transparency.

However, my understanding is that the Government want to go further than the 80% or 90% that we could do absolutely safely. They want to allow, I think, partial downloads of datasets by researchers, albeit under trusted research environment conditions. They may even go further and wish to train AIs in this area, or allow outside third-party companies to do so. In my view, that is a bridge too far. One of the country’s leading professors of software security told me only this week that it is difficult to ensure that some designs of AI will not retain details of individual data. The simple fact is that at the moment AI is, effectively, a digital technology with analogue oversight. Other researchers argue for other reasons that they need to have more direct access to the data. Again, as I understand it, the Government’s response is downloading partial samples of these databases under the control of technology that will track the researcher’s every click, keystroke and action, and take screenshots of what their computer shows at any point in time. I am afraid that I am unpersuaded of the security of that approach. Downloading any of these databases, even partially, strikes me as being a serious risk.

The stark fact is that whether it be data downloads, AI or other concerns that we are not yet aware of, there are significant ethical and risk implications. If the Government want to go beyond what is demonstrably safe and secure, an opt-out system is not sufficient. In this scenario, a database would only be viable as an opt-in system, with volunteers, if you like: people who have decided they are happy that their data is used in a system that is perhaps not perfectly secure. The risk is too great to work on the presumption of consent that an opt-out system has. The Government must make these risks of exposure and privacy absolutely clear to those willing to donate their data. It is obvious that an opt-in system will be significantly constrained by a much smaller data sample, but that is the only way we should countenance such risks. My strong recommendation to the Secretary of State is that the Government pursue the first stage properly with a closed technology like OpenSAFELY that can provide proper security, proper access for researchers, and proper reassurance to the public.

There is no doubt that this is a complex issue. However, it would be a dereliction of our duty if this House did not hold the Government to account on what could have been, and could still be, a colossal failure. Whether it intended it or not, the Department of Health has given us the impression that it did not take the privacy and security of our personal health records sufficiently seriously. This is extremely damaging to the Government’s cause, which I have no doubt is well-meaning. The Department needs to explain to the House how it will address the legitimate concerns and safeguard this most sensitive of personal data. Only by properly respecting the privacy of the citizen, and by obtaining freely given informed consent, can the Department deliver on its prime purpose, which must be enhancing the health of the nation—something that I know is absolutely close to the Secretary of State’s heart.

Matt Hancock Portrait The Secretary of State for Health and Social Care (Matt Hancock)
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I have come to the House today to answer this debate because of the importance of the subject matter and the importance of getting this right. I recognise and acknowledge the chequered history that my right hon. Friend the Member for Haltemprice and Howden (Mr Davis) described, and I see that chequered history as one of the reasons that the NHS does not yet have the modern data architecture that it needs. Previous attempts—both the national programme for IT and care.data—have failed, so people have shied away from tackling this problem in a modern, secure and agile way.

I have come to demonstrate and to argue that there is no contradiction between high-quality security and privacy of the data held in a health system and the use of that data to save lives, because in a well-structured, well thought through system, both are enhanced. I profoundly believe that. I think that my right hon. Friend does too, and I agree with him when he says that we agree on aims; the key is the path. I agree with him, too, that the proper use of data has the potential to save hundreds of thousands of lives if we use it as safely as possible but also allow for the insights in the data to be discovered in order to promote better healthcare, better discoveries and the better operation of the NHS.

If someone did not believe that before, they could not have failed to be persuaded by it if they have looked at the experience of the last 18 months. We discovered that an old, cheap drug, dexamethasone, helped to reduce the likelihood of someone dying if they ended up in hospital with covid, and as a result it has saved around a million lives across the globe. We discovered that in the NHS because of the data that we have and because of a well-structured, high-quality data architecture project to find out which drugs worked.

We know that the NHS will operate better if different parts of it can compare their performance better. We also know that patients want their data to be used better, because the frustration expressed to me so frequently by patients who are asked over and over “Who are you and what’s wrong with you?”, when that data should be available to the clinicians who need to see it, is palpable. And we know that the clinicians in the NHS want high-quality use of data so that they do not waste so much time on outdated IT and can treat the people in their care better. All these things matter, and they will save lives.

The current GP data service, GPES—the general practice extraction service—is over 10 years old, and it needs to be replaced. The project that my right hon. Friend referred to, GP data for planning and research, is there to unlock the intrinsic benefits of this data, but that must be done in a way that maintains the highest possible standards of security. The goals of this, and the outcomes when we get it right—I say when, not if—are that it will reduce the bureaucracy and workload for GPs, it will strengthen privacy and security, and it will replace around 300 separate data collections with one single collection.

If I may take my right hon. Friend back to 2018, I piloted through this House the Data Protection Act 2018, in which we brought the GDPR into UK law and strengthened provisions for data security. You may remember that, Mr Deputy Speaker, because you may have received a few emails about it at the time from companies asking whether you were still happy for them to hold your data. You could have replied, “No.” In fact, I came off quite a few lists I was no longer interested in receiving emails from because I was reminded that I was still on them and that I could opt out. I think the time has come for a similar approach—an update—to the way we think about health data in this country that puts security and privacy at its heart and, in so doing, unlocks the insights in that data and allows us to hold the trust of the citizens we serve.

The way I think about that is this. Current law considers that citizens do not control their health data, but the NHS does. For instance, GP data is controlled by GPs. However, the approach we should take is that citizens are in charge of their data. It is our data. The details of my bunion are a matter for me, and me primarily. I will not have anyone in the NHS tell me whether I can or cannot disclose the details of my bunion—it is going fine, thank you very much for asking. It matters to me, even though it is a completely uncontroversial health condition, but, as my right hon. Friend set out, for many people their health data is incredibly sensitive and it is vital that it is kept safe.

On the question at hand, the programme—GP data for planning and research—will be underpinned by the highest standards of safety and security. Like my right hon. Friend, I am a huge fan of the progress and advances we have seen in trusted research environments. Those are the safe and secure places for bringing together data, where researchers can access the data or, more accurately, the insights in the data while maintaining the highest standards of privacy.

I, too, am an enormous fan of Dr Ben Goldacre and his team. The OpenSAFELY project has shown the benefits that TREs can bring, because they allow us to support urgent research and to find the insights in the data while protecting privacy. During the pandemic, the project was absolutely fundamental to our response. In fact, it existed before the pandemic, but really came into its own during the pandemic. For instance, it was the first project to find underlying risk factors for covid-19. OpenSAFELY was the first project around the world to find statistically and significantly that obesity makes it more likely that someone will die of covid. That was an important fact, discovered through this project and without disclosing anybody’s body mass index in doing so. That is therefore the approach that we will take.

I can tell my right hon. Friend and the House that I have heard people’s concerns about using dissemination of pseudonymised data. We will not use that approach in the new GPDPR. The new system will instead use trusted research environments. All data in the system will only ever be accessible through a TRE. This means that the data will always be protected in the secure environment. Individual data will never be visible to the researcher, and we will know, and will publish, who has run what query or used which bit of data. The question was asked: who has access to what data, and who knows about it? The answer is that we should all know about it and that people should have access in a trusted way, but to be able to find insights in the data, not people’s individual personalised data itself.

I hope that that will help to build trust. It will mean a different way of operating for data researchers, but I disagree with my right hon Friend that it will allow us only to get 80% or 90% of the research benefit. A well structured TRE allows us to find more insight from the data, not least because the data could be better curated, and therefore more people can spend more time finding the insights in the data, rather than curating it over and over again. The dangers that come with the dissemination of pseudonymised data are removed.

It will take some time to move over to the new system, hence I have delayed its introduction, but we have also made that delay to ensure that more people can hear about it. That is the other reason that I came to the House today: I want people to be engaged in the project. People are engaged in their health like never before, and in their health data like never before, in part because of the pandemic. If we think about the NHS app, which is no doubt in everyone’s pocket—it is certainly in mine—if we think about the covid app, which has been downloaded 25 million times, we have never seen people more interested in their health data. We have never seen a greater connection, and we should use that to make sure that consent, when it is given, is given fully and properly.

I can assure the House we have an extremely high benchmark for who can access data. We have put in place a rigorous and independent approvals process, and audits are carried out to make sure the data is only being used for legitimate purposes. We will make sure that the right data can be accessed by the right people at the right time, but only by the right people at the right time. Both sides of that—that it can be accessed by people who need to see it, but only by the people who need to see it—are critical to getting this right.

On the question of the giving of that consent, it is crucial that we ensure that there is enough knowledge and understanding of these changes, that people are brought into the process, and that people know they have an opt-out. The research is clear: the majority of people are keen to allow their data to be used to help to save other people’s lives, but they want to know they have an opt-out and are reassured if they have one, even if they stay opted in, because they know then that it is based on their consent.

This important programme will have an opt-out system. We are strengthening the opt-out system already, and we will take the time to work with those who are enthusiastic about using data properly, with those who ensure that questions of privacy and security are put to the fore, with the public and, of course, with clinicians to make sure that we strengthen this programme further in terms of its security and privacy, yes, but also in terms of the outcomes we can get from the data, so that we can find new treatments to help save lives.

This is an important programme. The use of data in the NHS will have a huge impact on the future of health and care in this country, and we want to take people with us on this mission. We have developed this policy together with doctors, patients and experts in data and privacy, and more than 200 prominent scientific and medical researchers have endorsed a statement of support for this mission, but we have decided to take some extra time to consult further and to be even more ambitious about what we want to deliver, with a new implementation date of 1 September.

One of the central lessons of the pandemic is that data makes a difference, so let us keep working to take this programme forward, learning the lessons of the crisis, so that we can build back better and use data to save lives.

Vitamin D: Covid-19

David Davis Excerpts
Thursday 14th January 2021

(9 months ago)

Commons Chamber

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Department of Health and Social Care
David Davis Portrait Mr David Davis (Haltemprice and Howden) (Con)
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May I start by giving my thanks to the hon. Member for Ealing Central and Acton (Dr Huq) who cannot be with us today, but who is a fantastic ally of mine in this campaign to help protect our public?

Today, the nation is facing the second peak in the worst health crisis in living memory. To date, nearly 85,000 people have died. In November, the death rate was 175 fatalities per million, in December that figure was 222, and it looks as though January will be more than 324. To deal with this catastrophe, the Government are reluctantly instituting tough lockdowns and considering even tougher ones. Whether these measures work is disputed by some, but there is no doubt that they are incredibly costly—in economic damage, in individual freedom, in mental health, and even in lives lost to other causes.

As the death rate per million climbs month by month, from 175 in November to 324 now, the strategy certainly is not working as well as we would hope. Compare that with the province of Andalusia, a Spanish province of more than 8 million people. It started in November with a situation worse than ours—189 deaths per million as against 175—but which cut its death rate by at least two thirds while ours was doubling. That reduction, from between 50 and 70 deaths a day in November to between five and 15 deaths a day currently, started immediately after it initiated a programme of issuing calcifediol, the fast-acting high potency form of vitamin D, to at risk groups including care home residents.

The first thing that I will ask the Minister to do—not today obviously, but afterwards—is to look closely at that policy experiment and see whether vitamin D was the key to what is a spectacular success in cutting death rates by anybody’s measure. I believe that the Government in Madrid are reviewing it. So should we.

For decades, researchers and medical professionals have been warning that there is a pandemic in vitamin D deficiency, with more than 1 billion people worldwide being vitamin D deficient. The warning bells for this ignored pandemic had been ringing long before the World Health Organisation declared the outbreak of covid-19 as an official pandemic on 11 March last year. Those warnings should have been especially loud in the UK, as our vitamin deficiency levels have been described in a recent research study as “alarmingly high.”

Jim Shannon Portrait Jim Shannon (Strangford) (DUP)
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Does the right hon. Gentleman agree that, given that children have been precluded, for very obvious reasons, from taking the vaccine, we need to be proactive in building up their immune system? Will he join me in asking the Minister and the Health and Social Care Department to work with the Education Department to provide free vitamin D to every school-age child? I have asked the Minister in Northern Ireland to do the very same.

David Davis Portrait Mr Davis
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It is an excellent idea and I do join him in that request.

On the question of medical education, it has long been understood that vitamin D plays a critical role in calcium uptake and the prevention of diseases such as rickets and osteoporosis. That was what was thought to be its main effect. Since1983, there has been a large amount of research demonstrating its critical involvement in the body’s immune system. Many of the mechanisms involved are now very well understood. By 2017, it had been clearly shown in a number of randomised clinical trials that vitamin D deficiency was a very significant issue in acute respiratory disorders such as flu, colds, pneumonia—the lot—and correcting the deficiency with supplementation could reduce the severity of symptoms by as much as 70%. This and other research showed that vitamin D had a critical role in the activation of both the innate and the adaptive immune systems and in modulating some of their responses, most notably the now infamous cytokine storms. Deficiency in vitamin D led to compromised immune systems and, as a result, susceptibility to a number of diseases, most particularly respiratory diseases but of course also covid-19. Despite this evidence to suggest that vitamin D has wider health benefits than just bone health, and despite our particularly exposed situation in the UK, our public health bodies have done little to correct this problem.

At the beginning of the covid-19 crisis, several well-respected research teams noticed a high correspondence between low vitamin D levels—deficiency—in the blood and severity of covid-19 symptoms in patients. Early evidence suggested a strong link between the two, with studies showing that 40% of patients who suffered severe covid-19 outcomes were vitamin D deficient compared with 4% of those with sufficient levels of vitamin D. Moreover, mortality rates of vitamin D deficient patients were dramatically higher than for patients who had sufficient levels of vitamin D. These were correlational studies, so they were not proof of causality, but they were massively indicative given the prior evidence of the importance of vitamin D to the immune system. So this was startling evidence.

Therefore, in early May last year, I wrote to the Health Secretary calling on the Government to urgently review the available evidence to assess the role that vitamin D could play in helping us to combat this dreaded virus. The Health Secretary, quite reasonably, handed this work to his health advisers and ordered them to undertake a rapid review of the evidence. The National Institute for Health and Care Excellence attempted to analyse the statistical data and came back unconvinced. The problem is that correlation is not a proof of cause and effect, and a correlation, albeit a strong one, was all that we had at that point. In effect, NICE said that more data was necessary. One would think that at this point it would have initiated a large, well-designed random control trial to pin down the question: is vitamin D a causal factor in bad covid outcomes in terms of morbidity and mortality? After all, it is an incredibly serious disease and this is a very cheap and safe treatment. Not only did it not do this, but two applications for funding to carry out random control trials were turned down. Since then, more general global evidence in many other countries has grown in strength, which makes the inaction all the more questionable. Several studies have been published showing how low vitamin D levels lead to poorer outcomes for covid-19 victims.

In September 2020, the results of the world’s first randomised control trial—the gold standard of medical research—on vitamin D and covid-19 were published. The trial, conducted in the south of Spain at a hospital in Córdoba, involved 76 patients suffering from covid-19 sufficiently badly to have been hospitalised. Fifty of the patients were given vitamin D and the remaining 26 were not. Half of those not given vitamin D became so ill that they needed to be put in intensive care. By comparison, only one person of the 50 given vitamin D required ICU admission—just one. To put it another way, the use of vitamin D seemed to reduce a patient’s risk of needing intensive care twenty-fivefold.

Other studies have shown, at a statistically significant level, large reductions in mortality too. There was an experimental study conducted at a nursing home in France with 66 participants. The outcome of that study was that taking regular vitamin D supplements was associated with less severe covid and a better survival rate. Evidence from the United Memorial Medical Center and Sentara Norfolk General Hospital, both in the US, showed that they could get a more than 75% absolute risk-of-death reduction and reduction in mortality when treating patients with a cocktail of treatments including vitamin D. Researchers at Eastern Virginia Medical School who designed the protocol estimate that if their approach, including vitamin D-to-patient management, had been widely implemented at the start of the pandemic, it could have saved many, many thousands of lives.

The results of these studies are stark and clear-cut, and what was originally dismissed in some quarters is now backed by leading medics around the globe. Richard Carmona, the 17th surgeon-general of the United States, has said:

“The response to the pandemic…should include an effort to aggressively eliminate what is becoming apparent as a morbidity and mortality risk factor in COVID-19—vitamin D deficiency.”

Dr Carmona pointed out that the classical criteria for dealing with correlation evidence was, ironically, drawn up in this country by the great British physicians Sir Austin Bradford Hill and Sir Richard Doll in their study of smoking and lung cancer. They deduced that it was possible to use correlational data to show causality if certain other conditions could be shown: consistency of evidence, specificity of evidence, dose responsiveness and what they called temporality, which basically means that what happens first is the cause and what happens second is the effect—it is fairly obvious when you put it in English.

The simple fact is that we can show that all the Bradford Hill criteria are met for vitamin D and covid-19 if we look at the many separate individually small but collectively persuasive studies. Every single one of the criteria can be seen to be met. That is presumably why Dr Anthony Fauci, famously the head of the US Coronavirus Task Force—a difficult job at the time—has said:

“There is good evidence that if you have a low vitamin D level… you have more of a propensity to get infected”.

These are serious voices that are now backed up by serious evidence.

To give the Government proper credit, they have instigated the provision of a supplement free of charge to the clinically extremely vulnerable in care homes. However, if supplementation is to have any material effect, the dosage has to be sufficient to correct the existing deficiency. Sadly, with the Government’s programme for the clinically extremely vulnerable, the supplementation falls far short of this. The Government are providing supplements of 400 international units, or IU. That is in line with what the national health service currently recommends to tackle issues surrounding bone health. By contrast, the American health authorities recommend 600 IU to 800 IU depending on age. The latest research from the Royal College of Physicians recommends that health authorities should urgently recommend a higher supplementation of 800 IU to 1,000 IU a day, which would more than double the current daily recommended dose of vitamin D.

However, even that dose—based on bone health—is not high enough to provide the additional benefits and protect against respiratory disorders such as covid-19 for those with existing deficiencies; it must be much, much higher. We are not aiming to protect elderly people in care homes from rickets. We are aiming to protect them from a lethal disease, which is a very different issue.

The vitamin is safe in quite high doses. In the summer months, a person could sunbathe for 30 minutes and get the equivalent of 20,000 IU—much more than would be taken in a daily dose. All the modern toxicological evidence indicates that if there are any deleterious effects at all, they do not happen until a much higher dose than 20,000 IU. Even the NHS, which is very cautious on this, accepts that a dosage of 4,000 IU a day is perfectly safe; it says so on its website. What is needed to provide adequate protection against covid-19 is a significantly higher dose of up to 4,000 IU per day, particularly for those vulnerable groups that tend to be deficient in the vitamin—namely, the elderly, ethnic minorities and those suffering from a number of medical conditions.

Providing the supplement to the clinically extremely vulnerable in care homes is a small step in the right direction. However, it is a drop in the ocean compared with the action the Government should be taking overall. There needs to be a wider scheme providing supplements to all at-risk populations, including the elderly, the obese, minority ethnic groups, diabetics and people with high blood pressure. That would be a tiny cost compared with other health initiatives. A year’s supply of a daily dose is likely to cost about £15 a person, so allocating it to the identified risk groups would amount to £45 million. Allocating it to those groups plus every ethnic minority citizen would cost about £200 million, and to every clinically obese person and at-risk people in other categories would cost a little more. However, those figures could be halved if the risk is more severe during the winter months and we just gave the dose then. The benefits would be enormous. That cost is a mere rounding error when we measure it against the cost of not defeating the pandemic or the cost of a lockdown.

It is by no means a coincidence that the United Kingdom has one of the worst mortality rates in the world. After all, we have one of the worst rates of vitamin D deficiency in the world—about 40% of the population—and with that, very high levels of people with compromised immune systems. However, Public Health England continues to refuse to acknowledge the growing evidence linking vitamin D deficiency and poorer covid-19 outcomes, and for this, we are now paying the price.

Vitamin D could be one of the tools that helps turn the tide in the fight against this terrible virus. Vaccines, of course, are now being rolled out, but it will still take some time to reach levels sufficient that lockdowns are no longer needed. The Government are doing a great job on vaccines, but there are limits to what they can do, and unlike the general effect of vitamin D sufficiency on the immune system, vaccines are very specific. If a person has a specific mutation, the vaccine can be rendered obsolete; that is not true of vitamin D. In the meantime, vitamin D supplements could be provided to all at-risk groups more quickly, and at a lower cost.

As I said at the beginning of my speech, the UK has now had nearly 85,000 covid deaths. It is long past the point where we try anything with even a marginal chance of success to prevent those deaths rising even higher. Well, vitamin D has much more than a marginal chance of success: we now have good reason to believe that vitamin D supplementation will help reduce mortality from covid-19 and cut susceptibility to infection. It will save lives, improve population immunity, and help reduce the medical and economic impact as we continue the universal roll-out of vaccines.

There is now no reason not to act. After all, in the Secretary of State’s own words, supplementation has “no downsides”—he was right. The surgeon general whom I quoted earlier said that we should not let covid-19 patients die with vitamin D deficiency while we “wait for perfect evidence”. Vitamin D is cheap; it is safe; it has many other proven health benefits; and, as the Government of Andalucía have shown, it could be a dramatically effective weapon in our fight against covid. There is no more time to waste. The time to act is now, Minister.

Jo Churchill Portrait The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
- Hansard - - - Excerpts

I am extremely grateful to my right hon. Friend the Member for Haltemprice and Howden (Mr Davis) for having secured this debate, as well as to the hon. Member for Strangford (Jim Shannon); it would not be an Adjournment debate if he did not play his part.

As we have always said, the Government consistently review the latest data and information on covid-19 as it emerges. This, of course, includes the progress there has been in treatments for those suffering with the virus, as well as preventive measures. I would like to express my thanks to health and care workers and to the scientific community, whose dedication and hard work has made this possible, and I am sure right hon. and hon. Members from across the House will join me in doing so. Over the past months, there have been reports about vitamin D potentially reducing the risk of coronavirus, and I am aware of colleagues’ interest in the relationship between vitamin D and covid-19. I welcome the opportunity to discuss it today because, as my right hon. Friend says, nothing should be taken off the table, and we should be constantly vigilant when it comes to new science and information.

Several nutrients are involved in the normal functioning of the immune system; however, there is currently insufficient evidence that taking vitamin D will mitigate the effects of covid-19. In collaboration with Public Health England and the scientific advisory community on nutrition, NICE has published a rapid guideline on vitamin D in relation to covid-19, which my right hon. Friend mentioned. That data was reviewed by an expert panel and included the best available scientific advice published so far, including both randomised control trials and observational trials. That expert panel supported current Government advice, and the recommendation for everyone to take a 10 microgram vitamin D supplement throughout autumn and winter. However, it concluded that there is not currently enough evidence to support taking vitamin D in order to help, or treat, covid-19. There are still significant gaps in the current evidence, and studies to date have not reached the high level of data quality required to revise the guidance.

I heard what my right hon. Friend said about not wasting time, but as he mentioned, the Spanish study to which he alluded only included 76 participants. The smaller the sample group, the more challenging it can be to draw conclusions about the effect. We are also dealing with very poorly people, with multiple different factors affecting how they are responding and what they are responding to, so it is important to ensure that we can rely on that data. Indeed, there was a good double-blind trial before Christmas that showed no effect. However, there is a large-scale trial currently at Queen Mary University of London. I hope that it will give us some good clarity when it reports later in the year.

The current evidence base is mixed, and dominated by studies that are not always of great quality, with substantial concerns about bias and confounding. At the moment, they are unable to demonstrate that causal relationship between vitamin D and covid-19, because many risk factors for severe covid-19 outcomes are the same as for low vitamin D status. Due to the lack of reliable evidence, the NICE guideline recommends that more research is conducted. Government guidance continues to stress the use of high-quality randomised controlled trials in future studies. There are 70 trials under way in the UK and internationally, including some very high-quality ones that will answer key questions from NICE, Public Health England and the Scientific Advisory Committee on Nutrition, and they are monitoring this new evidence. My right hon. Friend asked for my assurance that we are doing that, and I can give him that.

The long-standing Government advice is that, between October and early March, everyone should take a supplement containing 10 micrograms, or 400 international units, of vitamin D a day. Vitamin D helps to regulate the amount of calcium and phosphate in the body, and protects bone and muscle health. In April and autumn 2020, PHE reiterated its advice. It also ran a marketing campaign throughout December 2020. This had a specific focus on the communities mentioned by my right hon. Friend, in particular the BAME community, for whom vitamin D supplementation is very important. PHE advice to continue taking vitamin D supplements is important for those who are shielding, care home residents and prisoners, as well as for those who choose to cover most of their skin when outdoors. As he said, BAME individuals have a greater risk of not having high enough levels of vitamin D, and are advised to take a supplement all year round.

We are actively supporting the uptake of PHE’s recommendations to ensure that those who need vitamin D supplementation receive it. The Government are providing a free four-month supply of 10 microgram vitamin D supplements to all adults on the clinically extremely vulnerable list, going far beyond care home residents who have opted in, residents in residential and nursing care homes in England, and the prison population; Her Majesty’s Prison and Probation Service have made supplements available across England and Wales. Through this commitment, this winter we have offered 2.7 million eligible people in England free vitamin D supplements, and to further drive uptake we have extended the registration period to 21 February so that even more people can benefit.

The Government have prioritised groups who were asked to stay indoors more than usual in the spring and summer due to national restrictions. In addition, recipients of the Healthy Start scheme are also offered access to vitamin supplements by the Government, and of course GPs and pharmacists may be approached for general advice on taking vitamin D. However, we do not expect this measure to place any additional burden on either group, as they are under some pressure during the current pandemic. Guidance can be found online and we encourage individuals to buy 10 microgram vitamin D supplements, which are easily available from supermarkets, chemists, and health food shops.

We must keep looking at the evidence, and as research into the impact of vitamin D on covid-19 continues, we will continue to monitor it as it is published in real time. We have committed to keep this under review. PHE, the Scientific Advisory Committee on Nutrition and NICE will update advice if and when necessary. Of course, I welcome any further studies into this emerging area.

I know my right hon. Friend wants us to move at pace. He embarks on everything he does with enthusiasm and vigour. However, I am sure he will agree that we are nudging along and some progress has been made. Future decisions should and must be based on robust evidence.

Question put and agreed to.

Covid-19 Update

David Davis Excerpts
Tuesday 10th November 2020

(11 months, 1 week ago)

Commons Chamber

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Department of Health and Social Care
Matt Hancock Portrait Matt Hancock
- Parliament Live - Hansard - - - Excerpts

That is a matter for the Treasury, as the hon. Lady indicates. The truth is that we have made PPE freely available to health and social care and other public services until the end of this financial year.

David Davis Portrait Mr David Davis (Haltemprice and Howden) (Con)
- Parliament Live - Hansard - -

The weekend press carried briefing of a Government intention to distribute vitamin D to care homes and other vulnerable groups. If that is true, I congratulate the Secretary of State on this decisive, low-cost, zero-risk, potentially highly effective action. If it is true, will he tell us the dosages proposed, how quickly it will happen and whether the target groups include ethnic minorities? Is his Department reviewing and considering the Spanish trials, with a view to the use of calcifediol in a clinical context?

Matt Hancock Portrait Matt Hancock
- Parliament Live - Hansard - - - Excerpts

This is something that we are working hard on in the Department. I am not yet in a position to answer all those questions, except to say that I have looked at the results of the Spanish trial that my right hon. Friend mentions, not least because he sent me those results with some enthusiasm. We are looking at this very closely.

Covid-19 Update

David Davis Excerpts
Tuesday 24th March 2020

(1 year, 6 months ago)

Commons Chamber

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Department of Health and Social Care
Matt Hancock Portrait Matt Hancock
- Hansard - - - Excerpts

On the last point, there was an urgent question about exactly that issue. It really is a matter for the Treasury. The hon. Gentleman is right that contact tracing is incredibly important, and the amount of contact tracing that we have done is one of the reasons why we have managed to be behind other European countries in the curve. At this stage in the epidemic, it is not possible to have contact tracing for everybody, as we can when there is a very small number. We are looking at how we can do that better and enable individuals to contact trace, including by using technology.

The hon. Gentleman asked about refugees. I do not know whether he was in the Chamber yesterday, but that subject was brought up and I said that I would look into it. I will get back on that as soon as I can.

The hon. Gentleman asked about the number of ventilators. We started with around 5,000 and we now have more than 12,000, which we have bought. We have also made the call to arms for manufacturing capability to be turned over to ventilators, and that has been very successful.

I strongly endorse and support the backing of the Scottish Government and the SNP in the UK-wide approach to getting the message out to everybody that the most important thing anybody can do is stay at home.

David Davis Portrait Mr David Davis (Haltemprice and Howden) (Con)
- Hansard - -

I commend the Secretary of State for his heroic efforts in our defence so far. Given that the proscription on travel is now legal and not simply a recommendation, will he give us some clarification on what is meant by the care exemption, and confirm that it does not apply just to professional carers? At the moment, and since special schools have been closed in the last week, a great deal of support has been given from one family to another, for example in providing respite care for special needs children. That is very important and the people doing it are often being very responsible about self-isolation, which they are already applying to their families. Will that continue to be possible, and will my right hon. Friend enable it in future?

Matt Hancock Portrait Matt Hancock
- Hansard - - - Excerpts

I will say three things in response to my right hon. Friend’s questions. On special schools, one of the carve-outs in the closure of schools was keeping open schools for those who are vulnerable, including those with special educational needs. The Bill includes a power to enable us to move from that position, but we do not propose to exercise it unless absolutely necessary. The position therefore is that if someone wishes to send their child to a special school, that is fine. It was one of the specific carve-outs. In the same way, if a key worker needs to send their child to school and cannot look after them at home, schools are available.

My right hon. Friend asked about care. I want to make it clear that for people who are volunteering in response to covid-19 and those who are caring, even if their responsibilities are unpaid or informal, they are okay to do that and should do that. They should stay more than 2 metres away from others wherever possible, but that has to be a practical instruction, because of course we need to care for people. As I said in the statement, travel allows for caring, and I want to make it clear that volunteering in the response to covid-19 is a legitimate reason to travel. For example, the increasing numbers of volunteers in the NHS are important. Although it is not paid work, it is work in the national effort to respond to covid-19.

My third point is that the Patient Safety, Suicide Prevention and Mental Health Minister is sitting next to me and close to me, because she has recovered and all the evidence shows that people cannot catch covid-19 twice, at least not in quick succession. I welcome her back to her place.

Coronavirus Bill

(2nd reading)
David Davis Excerpts
Monday 23rd March 2020

(1 year, 6 months ago)

Commons Chamber

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Department of Health and Social Care
Matt Hancock Portrait Matt Hancock
- Hansard - - - Excerpts

We have other ways to enforce that with care homes, not least contractually through local authorities. I understand the hon. Gentleman’s concern; people in care homes need to be protected, and many of them shielded, from the virus, because many of the most vulnerable people are in care homes. I will take away the point and look at whether more needs to be done, but we do have other powers available to deliver on what he and I—I think—agree is needed.

David Davis Portrait Mr David Davis (Haltemprice and Howden) (Con)
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I commend the Secretary of State for accepting the six-month review that he has just announced, but in the event that the House decides that one element of the Bill is working badly, will we be able to amend or strike out that element, or will we have to take the whole thing or reject it at that six-month point?

Matt Hancock Portrait Matt Hancock
- Hansard - - - Excerpts

As discussed with the Opposition, we are proposing a six-month debate and vote on the continuation of the Bill, and before that debate we will provide evidence and advice from the chief medical officer to inform the debate. There is also a reporting mechanism for a report every eight weeks on the use of the powers in the Bill.

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Jonathan Ashworth Portrait Jonathan Ashworth
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23 Mar 2020, 5:03 p.m.

My hon. Friend makes an excellent point. I represent an inner-city seat, and I appreciate that her seat is on the outskirts of London but, none the less, our seats have similar demographics. I know full well that many, many families are living in cramped, small flats. There are intergenerational families living with elderly mums, elderly grandmothers and so on who have various comorbidities and who need to be shielded.

If we enter a situation in which we force people to stay at home, I hope the Government will look at how to support such families, because it is quite outrageous that, in many parts of the country—especially in London, but also in my constituency—there are flats with families of nine or 10 people sleeping on the floor, and so on, while property developers have flats standing empty. Why cannot we take over some of those empty flats to house some of these very vulnerable families and to help us get through this national crisis?

David Davis Portrait Mr David Davis
- Hansard - -

23 Mar 2020, midnight

I commend the hon. Gentleman for the stance he is taking in this debate. The whole House will respect him for it. The series of interventions that he has just taken demonstrates a wider point: the need for the Government, sadly—and I did not think I would ever say this in this House—to get into intrusive levels of planning that we have never seen before, because every time we have a change in the level of ferocity or intensity of our dictating what the state and society should do, we run into a new set of problems, whether that is crowding on tube trains overwhelming our desire for social distancing, or young mothers with children at home finding it very difficult to get to supermarkets and therefore literally running out of food, which is even more fundamental than running out of money. We need to think forward, and I say that because we have seen in Europe—between Germany, Italy and Spain—very similar policy actions but with completely different outcomes. I suspect that it is because of a different approach taken by the German Government and society from that taken by the Italians or the Spanish, and we have to think about that as we go into the next stage.

Jonathan Ashworth Portrait Jonathan Ashworth
- Hansard - - - Excerpts

The right hon. Gentleman is absolutely right. We are asking people, and are probably on the cusp of probably of forcing people, to radically adjust their behaviour in a way in which we have not been used to for more than 70 years. The last time that we asked people to radically adjust their behaviour was in the second world war. We have generations who are not used to this. We are a society who are used to going where we want, buying what we want, doing what we want and socialising when we want, and clearly, for a lot of people, it is not dawning on them that they will have to change the way they behave. That has huge knock-on effects for how public services will be organised, how the criminal justice system will have to work and how food distribution systems are going to work. It is right that we as parliamentarians continue to ask Government Ministers serious questions about that, but we also have to be aware that we have a responsibility to set an example to the country. We have to socially distance ourselves, so I really hope that the good offices of the Speaker, the Leader of the House and everyone who is involved in House business can quickly find a satisfactory set of procedures for us to continue having our discussions and asking Ministers questions, but not setting the example that we are unfortunately setting today. I am not making any personal criticism of any Member, because it is the situation we are in—we have to debate the Bill today—but we are going to have to hold the Government to account on the far-reaching, extensive powers that they are taking.

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Jonathan Ashworth Portrait Jonathan Ashworth
- Hansard - - - Excerpts

Absolutely. That is why these particular clauses must be scrutinised so carefully by Members across the House.

We have tabled amendments to schedule 11. We recognise that there will be difficulties delivering social care over the coming weeks and months, but it should not be possible for local authorities to immediately drop care packages to a lower level. As long as it is reasonably practicable to do so, they should continue to meet people’s care needs. The presumption should always be that services will be disrupted as little as they can be under the circumstances. Nothing in our amendments would stop a local authority cutting back care hours if it had to, but they would mean that disabled and older people could be reassured that any reductions in their care will be a last resort, and that their independence will not be the first sacrifice to be made.

There are particular concerns about people who live alone or are being held in in-patient units and care homes. We have seen visits to those settings stopped as part of the Government’s shielding approach, and the CQC has halted all inspections, but we know from incidents such as Whorlton Hall that is too easy for abuse to go unnoticed—something the current situation could make worse. How will we ensure that in-patient units and care homes do not become hotbeds of abuse of human rights over the coming months?

David Davis Portrait Mr David Davis
- Hansard - -

That is precisely why I asked the Secretary of State whether, when we get to the six-month review and renewal of this legislation, we will be able to amend it. If there is oppressive behaviour in one part or another of it while the rest is all very important to the survival of our people, what stance will the Labour party take?

Jonathan Ashworth Portrait Jonathan Ashworth
- Hansard - - - Excerpts

23 Mar 2020, 12:01 a.m.

The right hon. Gentleman is right: we cannot just have a take-it-or-leave-it approach to these things. Tonight, the House will give the Government extraordinary powers, like we have never seen before, and it is right that we parliamentarians are given an opportunity, after the appropriate timeframe, to look at how those powers have been used and hold Ministers to account. I agree with the spirit of the point he makes, although I cannot at this stage—I suppose it may emerge later in the debate—give him a commitment one way or the other on a particular amendment. We will see how the discussions proceed throughout the afternoon, but I certainly endorse the spirit of what he says. As I say, these are extraordinary powers that the House will grant the Government this week.

We have tabled a new clause related to schedule 11. We propose that a relevant body, such as the Equality and Human Rights Commission, should be tasked with overseeing the Bill’s impact on the provision of social care. That body would have to report every eight weeks on the operation of these changes and whether they should be amended. It would provide the oversight that is needed to prevent people’s rights from being undermined.

One of the ways the Bill seeks to free up medical staff is by relaxing the requirements of the Mental Health Act 1983. Specifically, only one medical professional will have to agree to someone’s being sectioned, rather than the two it currently takes. The scale of that change should not be underestimated. No longer will a decision to section a person have to be taken in consultation by two doctors. There will be no requirement for anyone involved to have had prior involvement with the patient. Medical professionals are going to be under huge pressure in the coming months, and mistakes may well be made.

The Bill says that a decision should be taken on the basis of one signature if requiring a second signature would be

“impractical or would involve undesirable delay.”

That seems to be too vague and potentially open to misreading. I hope Ministers can tell us what exactly that means and what safeguards will be put in place to prevent the change from being misused. Our amendments to schedule 7 would narrow the provision so that a second signature could be left off only if acquiring it would mean an undesirable delay. If something is impractical, it will by definition create an undesirable delay. By narrowing the wording in the Bill, we can avoid the potential misuse of powers.

We propose changes to ensure that private mental health hospitals cannot detain someone solely on the single recommendation of one of their employees. That could create a conflict of interest whereby a doctor comes under pressure to sign a detention authorisation because doing so will provide their employer with income from the NHS. No medical professional should be put under that kind of pressure, and our amendment would ensure that they cannot be. [Interruption.] Is the hon. Member for Bracknell (James Sunderland) seeing to intervene?

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Ian Blackford Portrait Ian Blackford
- Hansard - - - Excerpts

23 Mar 2020, 12:05 a.m.

That is the height of irresponsibility, and Amazon and anybody else who would behave in that way needs to think again. Of course there are companies that are engaging in best practice. I have had a number of complaints from people in the highlands about those who have not been doing the right thing, but let me thank Highland Experience Tours, which has suspended all its activities and sent its drivers home. The hon. Member for Ilford North (Wes Streeting) mentioned Sykes Cottages, and I have to disagree with what he said, because its behaviour has been absolutely reprehensible. Let me read to Members what Sykes Cottages sent to me on Saturday. It said, “Given concerns surrounding the current outbreak, it is understandable that people want to arrange private accommodation in more remote locations to distance themselves from larger towns and cities. The latest Government advice does not prohibit travel in the UK. We are continuing to provide a service for customers.” That is a service to customers to come from the urban areas; it is deliberately creating the circumstances whereby their customers should come to self-isolate in an area where we have limited public health capabilities. That simply is not good enough.

I am delighted to say that, under pressure, the site has now relented and is stopping new bookings in the highlands and islands over the next few weeks, but it has sent a considerable number of people up to the highlands who are there today. The site should be delivering immediate advice to all those guests that they should return home to their place of origin.

I give the same message to those with holiday homes and second homes in the highlands: “Do not come to the highlands. Do not put additional pressure on our public services. We will welcome tourists back to the highlands once this emergency is over, but do not threaten the health of our constituents.” In my district, like in many rural areas, 35% of the population is aged over 65. We have to think about the needs of those living in such areas.

In addition to the sites I have mentioned, Cottages.com is refusing to allow cottage owners to cancel bookings without a penalty, which is simply not good enough. As this is now in the public domain, I hope all these providers will now think about their responsibilities.

As I have mentioned, some providers are behaving more responsibly. HomeAway has guidance on its booking site for giving refunds to those who cancel, but I will read one last email from somebody living in the Lake district:

“My family and I were due to take up a holiday home rental from the 28th March. We will stay away and remain in the Lake District where we live.

However you might be interested to learn that the owner of this holiday home, let through HomeAway, is refusing (at present) to cancel my booking, refund my payment of £957 or move my reservation to next year. He maintains that Skye is an ideal place to self-isolate…and as the home is available he is refusing to refund the total of my booking fee.”

[Interruption.] I can hear an hon. Member shout, “Shocking.” Skye, or anywhere else in the west highlands, is no place for anyone to self-isolate, and I hope this cottage owner, and others who are behaving in such a reprehensible manner, changes their ways.

Of course, it is not just those who are providing accommodation. Everyone knows about the Harry Potter films and the attractions of the rail line from Fort William to Mallaig. The steam trains, which operate on a regular basis, are due to start on 6 April. What on earth is the Jacobite steam train company thinking? These train trips, along with every other visitor attraction in the west highlands, must close, and they must close today.

This is my message to anyone thinking of coming to the highlands: “You will be made welcome when this is over but, for the time being, stay at home. If you are in the highlands now, please go home. The Scottish Government have already announced that ferry traffic will be prohibited for those on non-essential journeys, but you have the ability to return home today. Please do so.”

This Bill includes badly needed powers to allow more health and social care workers to join the workforce. That includes removing barriers to allow recently retired NHS staff and social workers to return to work, as well as bringing back those on a career break and bringing in social work students to become temporary social workers. It has to be said that the number of doctors, nurses and carers already seeking to re-register to help in this emergency has been one of the most uplifting stories of this crisis. The Bill allows that process to become much easier. Its provisions also allow for the relaxation of regulatory requirements within existing legislation to ease the burden on staff who are on the frontline of our response.

The next few weeks and months need simply to be about saving as many lives as possible. Try as we might to save these lives, unfortunately the truth is that this virus will inevitably end up with many of our people dying before their time. That terrible reality is why it is right that this legislation includes special arrangements and provisions to manage an increase in the number of deceased persons with respect and dignity.

Finally, something my party has raised repeatedly since the early stage of this crisis is the economic interventions required to help our people though this emergency period. I note that the legislation includes provisions to support the economy, including on statutory sick pay, that are aimed at lessening the impact of covid-19 on small businesses. While we have welcomed many of the measures brought forward by the Chancellor, we have put it on record that more needs to be done. The self-employed and the unemployed, whom we talked about earlier, need to be considered. They are under pressure and they need to know that we have got their backs. They need the security of a guaranteed income. We now have an opportunity to overhaul and fix the universal credit system—ending the delays, uprating the level of support and scrapping the bedroom tax. If we are to fight this virus together, we must ensure that everyone is supported equally and that no one—no one—is left behind.

The emergency and extensive powers in this legislation have rightly raised questions and concerns, many of which we have heard this afternoon. The imposition of measures that will significantly alter individual liberties deserves full and frank scrutiny, no matter the context. We know that the Bill sunsets after two years. However, there are serious concerns over the two-year period and the scrutiny of this measure. I know that aspects of the Bill and amendments to it will be discussed at later stages. I hope that the Government will look carefully at the safeguards of regular reporting, review and renewal if it is required.

David Davis Portrait Mr David Davis
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The right hon. Gentleman is making a powerful speech. As he knows, I have an amendment in Committee to change two years to one year. I asked the Health Secretary whether we would be able to amend or delete an element of the legislation at the six-month review; otherwise, we will perhaps be faced with eight good bits of legislation and one or two bits that are doing badly, and we will be forced to vote the whole thing through, rendering it a rubber stamp. Does the right hon. Gentleman agree that either my amendment or a variant of the amendment tabled by the right hon. and learned Member for Camberwell and Peckham (Ms Harman), which would allow us to change the Act, would be a better way forward?

Ian Blackford Portrait Ian Blackford
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23 Mar 2020, 12:08 a.m.

I agree with the right hon. Gentleman that that would be a very good way forward. It is important that we enact the Bill, but the House must have oversight of it in the period ahead. I commend him for his approach.

The Scottish Government have pledged to have appropriate reporting on how and when they will use the powers in the Bill. They will embed such reporting and renewal in law. They have stressed that the creation of these additional powers does not mean we will automatically be required to use them. I hope the UK Government follow that lead and give assurances in the remaining stages this evening.

The emergency powers and the extent of the legislation demonstrate what all of us are faced with. This is not a normal time. Unfortunately, the truth is that none of us will live normally for some time to come. As the First Minister has said, if individuals are continuing to live normally, they need to ask themselves if they are following all the scientific advice. The sheer speed of the spread of this deadly virus has shocked us all. It has naturally made us reflect on the way we live and the vulnerability to which we are all exposed. Equally, it has demonstrated our dependence on one another. We live in an ever smaller world and the major challenges we all face are the same; we can only face them together.

The provisions in this legislation are about saving as many lives as possible during the biggest health emergency this planet has faced in 100 years. If we do not take immediate and unprecedented actions, we will be responsible for putting people at risk. If we act fast, we know that we can save thousands of lives. It is as simple and as clear as that. Never has a more important responsibility been placed upon all of us. Saving these lives must be our sole focus.

Oral Answers to Questions

David Davis Excerpts
Tuesday 10th March 2020

(1 year, 7 months ago)

Commons Chamber

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Department of Health and Social Care
Jo Churchill Portrait Jo Churchill
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We are committed to providing those extra 6,000 GPs across the country. We have also made sure that incentive schemes are in place in areas where it is difficult to recruit, and they have been found to be very effective in driving additional GP numbers into challenging areas such as the hon. Lady’s constituency. We are working on the matter.

David Davis Portrait Mr David Davis (Haltemprice and Howden) (Con)
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3. What assessment his Department has made of the risks to public health of antimicrobial resistance. [901418]

Matt Hancock Portrait The Secretary of State for Health and Social Care (Matt Hancock)
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10 Mar 2020, 11:46 a.m.

The UK is a world leader in tackling the global challenge of antimicrobial resistance. Since 2014, we have invested £615 million in the area, over half of which is in research and development, as part of our vision to contain and control AMR by 2040.

David Davis Portrait Mr Davis
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10 Mar 2020, 11:46 a.m.

Regrettably, the coronavirus outbreak has demonstrated the susceptibility of global society to pandemics and antimicrobial resistant organisms. Lord O’Neill, who chaired the review, estimated that some 10 million people a year could die by 2050 because of AMR. The previous chief medical officer said that we could easily get to a state where fully half of people die from untreatable infectious diseases. Is my right hon. Friend content with the level of work and research being done in his own Department with respect to novel approaches such as genomics, combination drugs and new sorts of vaccinations? Will the importance of those things be reflected in the forthcoming spending review?

Matt Hancock Portrait Matt Hancock
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Yes, absolutely. My right hon. Friend is right to highlight the threat of AMR, because microbial illness and disease is just as much of a threat as viral disease and we must ensure that we retain the tools that we currently have through antibiotics to tackle it. We are investing in that space with more to come.