Covid-19: Forecasting and Modelling

Fleur Anderson Excerpts

Tuesday 18th January 2022 Westminster Hall

[Fleur Anderson (Putney) (Lab)]

Thank you, Sir Edward; it is a pleasure to serve under your chairship. I congratulate—I think—the hon. Member for Isle of Wight (Bob Seely) on securing the debate, because I welcome impartial and honest interrogation of the science, as well as decisions made over the last two years that have been important for our country. I also welcome extreme scepticism about some of the decisions made by the Government. This debate has not been an honest and independent inquiry into the science, however. It clearly comes with an ideological bent, so it has to be taken in that light.

I also begin by paying tribute to our public servants and Government scientists.

[Mr Baker]

Will the hon. Lady give way?

[Fleur Anderson]

I think I will make some progress first.

[Mr Baker]

I am not being rude; I just want to ask a question about what the hon. Lady has said.

[Fleur Anderson]

The hon. Gentleman has not even heard what I have to say yet.

[Mr Baker]

The hon. Lady said that we have made points that require an ideological bent. I invite her to look at what I said and identify at least three points that required any kind of ideological justification. Contrary to the point made by the hon. Member for Argyll and Bute (Brendan O'Hara), nothing that I said required libertarian political philosophy.

[Fleur Anderson]

That was another speech. I have never been in a room with so many software engineers who are also MPs. I begin by paying tribute to our public servants, our Government scientists, epidemiologists, and the scientific community who have worked tirelessly and put everything on the line to keep the public safe. That is what they have been trying to do over the past two years: keep people safe and save lives—and they have. They have shouldered the fear, anguish and hope of an entire nation that was experiencing deep trauma. They have, magnificently, been prepared to put their head on the block, if needs be. I hope the Minister will agree with me that it is very disappointing to hear them come under attack today from certain colleagues, despite everything that they have done.

I would remind those who seek to attack SAGE and our Government scientists that, while they were looking forward, planning and working hard on the evidence of what the virus might throw at us next, it was freshers week in Downing Street. They are not the enemy here. In fact, had a bit more attention been paid to their models, had there been more modelling before the start of the pandemic and had more action been taken in February and March 2020, thousands of lives could have been saved. It is not modelling that is the intrinsic problem here—it is decision making.

Modelling is a hugely important tool for managing epidemics that is tried and tested, with constant efforts to improve it. I agree with earlier comments that there should be more models; there should be models about the impact on mental health, education, poverty and models to learn from other countries in order to inform our decisions. As Graham Medley, one member of SAGE, explains very clearly, models are not predictions and are not meant to be seen as such; they are the “what ifs” that can be used by Governments to inform decisions and guide them as to what they might need to prepare for, which should include the worst-case scenarios—that is a crucial distinction. Accurate predictions cannot be made with such an unpredictable virus, when individual behaviour is also unpredictable, so models and scenarios are the best tools to give us the parameters for the decisions that will be made. As Graham Medley said, SPI-M—the Scientific Pandemic Influenza Group on Modelling—the sub-committee of SAGE that he chairs, produced

“scenarios to inform government decisions, not to inform public understanding directly. They are not meant to be predictions of what will actually happen and a range of scenarios are presented to policymakers with numerous caveats and uncertainties emphasised.”

Who would want it any other way?

My question to the sceptical Members present here today is: what is the alternative? We need to have those parameters. The alternative is guessing without parameters and knowledge.

[Mr Baker]

I am very happy to answer that question.

[Fleur Anderson]

I am going to move on. I do not want another speech from the hon. Member, given the time constraints. I am waiting for the Minister to answer my questions.

The Public Administration and Constitutional Affairs Committee also had problems with the communication of the modelling. It is there that I might have some common ground with the hon. Members who have spoken earlier. The Committee said in its report last March that communication has not always been transparent enough, and accountabilities have been unclear. I agree with this. If the time is not taken carefully to explain what modelling actually is to the public and media, and instead room is allowed for scenarios to be interpreted as predictions, inevitably the practice of modelling and forecasting will be rubbished and scoffed at and Government scientists blamed as doom-mongers. Not communicating the data and models properly creates more uncertainty and misery for small businesses, who have been asked enough as it is, as we saw over the Christmas period.

[Greg Smith]

Will the hon. Member give way?

[Fleur Anderson]

No. The PACAC report makes it clear that no one in Government has taken responsibility for communicating the data. The report states:

“Ministerial accountability for ensuring decisions are underpinned by data has not been clear. Ministers have passed responsibility between the Cabinet Office and Department of Health and Social Care,”.

That is why, as a member of the shadow Cabinet, I am responding to this debate. There are questions about the use and communication of the data.

I want to come to why we needed to rely on modelling and forecasting. Significant mistakes made throughout the last 10 years of Conservative government are the problem. There could have been much better information, and we could have been much better informed, if there had been better pandemic and emergency preparedness.

[Bob Seely]

Will the hon. Member give way?

[Greg Smith]

Will the hon. Member give way?

[Fleur Anderson]

I will give way—

[Sir Edward Leigh (in the Chair)]

Order. I think we need to move on.

[Fleur Anderson]

I agree, Sir Edward. Labour invested in pandemic planning in the Civil Contingencies Act 2004, but the Tory Government did not continue that investment. Operation Winter Willow in 2007 involved 5,000 people from all walks of life simulating a pandemic. The need for PPE, PPE training and wide-ranging social and economic disruption was identified. The Labour Government, then led by Gordon Brown, made heavy investments in pandemic planning.

Cut to 2016, Operation Cygnus made 26 key recommendations about PPE, urgent and drastic improvements to the NHS, and the likely impact on care homes. Most of that was ignored. PPE training stopped, stocks were run down—much of it left to go out of date—and there were no gowns, visors, swabs or body bags at all. The UK pandemic plan was mothballed and we were unready for the pandemic. No wonder we had to rely so much on modelling and forecasting.

We could have been much more ready. The Cabinet Office should have stepped up to enable cross-departmental organisation, and organisation with the devolved authorities based on plans, informed by the results of exercises and earlier modelling, but it did not. I hope that the Minister will echo that, distance herself from some of the earlier comments and criticism of our scientific community and respond to the points about pandemic planning and what we can learn.

Finally, I know that the hon. Member for Isle of Wight (Bob Seely) has asked for an inquiry into modelling. I welcome the inclusion of that in the covid inquiry. I hope that the Government will launch that inquiry. They have appointed a chair, but that chair is waiting for the powers she needs to begin getting evidence from scientists, software engineers and everyone she needs to hear from.

[Sir Edward Leigh (in the Chair)]

Will the Minister allow a short time for closing remarks?

Public Health

Fleur Anderson Excerpts

Tuesday 14th December 2021 Commons Chamber

[Fleur Anderson (Putney) (Lab)]

I thank everyone across the country who has had their booster—everyone who has been lining up at centres across the country and taking the time to ensure that they have done the right thing by getting their booster. I thank all those NHS staff who are enabling that and who are putting in a mighty push to change all their ways of working to get the booster into as many people as possible.

I thank all those who have written to me about the issues being debated today. There are those who say that we should have more measures and that they will feel safe to go out into public spaces or to take up NHS appointments only if more measures are put in place. There are also those who have written to me about their concerns about more measures being put in place and more restrictions on our lives.

It is clear that omicron is a threat. It is highly contagious with cases doubling every two days. Most cases in London are now omicron cases and the numbers are increasing all the time. Two vaccines do not reduce the rate of transmission as much as they did for delta, so it is clear that action must be taken. We know that it is more contagious, but although we do not yet know its severity, we cannot wait. Last year, at the beginning of the coronavirus pandemic, the Government waited too long. They delayed, sometimes for weeks, and we saw the effects. We have to act now.

This is a measured and proportionate set of actions. On masks, I do not think we should have dropped that measure in the first place. We should never have stopped wearing masks on public transport and in shops to keep shop workers safe, so I welcome that.

On vaccine passes, which are not vaccine passports, I am glad that the Government have listened to the Opposition saying that there need to be options. It is absolutely proportionate for people to show proof of double vaccination or a negative lateral flow test to enable big venues and our hospitality venues to stay open, which is so important after last year and the loss of so much income.

Those venues need to stay open, so this is a freedom to go out and to enjoy events and be out with people while staying as safe as possible. We know that there will be a peak in the number of cases in a couple of weeks, and that a couple of weeks after that, in the new year when we return to this place, there will be a peak—or not—in hospitalisations. It is right that we take these measures now to stop hospitalisations later. I welcome the change on the red list of countries, which the Minister announced earlier. If it is not having any effect, there is absolutely no reason for so many of my constituents to be unable to visit their families in South Africa, but also to pay huge amounts of money to be quarantined. I also welcome the Minister saying that he will look into the quarantine costs of those who were unfairly stuck in the middle of a couple of weeks when they needed to pay. Some of my constituents who have written to me are NHS workers who have had to pay thousands of pounds they cannot afford.

I will welcome the engagement with the Elections Bill of all those on the Conservative Benches who are now so worried about civil liberties. It certainly will be a “Papers, please” society when we are asked to show our ID to vote. That is far more of an infringement of our civil liberties. Voting is such a fundamental thing compared to going to clubs or large events.

We absolutely need the schools programme to ramp up. School transmission rates are very high in primary schools in my constituency, but all those facing exams this year must be able to do them. This is not a slippery slope to covid passports, and I am grateful for the assurance on that. We need to ramp up communication and engagement with health staff who face measures later on in the year if they do not get the vaccine. We must see an increase in statutory sick pay. That is only fair.

In conclusion, the Chief Medical Officer gave a chilling briefing to MPs earlier today, saying that when it comes to the omicron variant the brakes are off. We have to put the brakes on. Too many people have died, and we mourn every single one. Now is the time to take action, and I encourage everyone to get their booster jab.

Reducing Baby Loss

Fleur Anderson Excerpts

Tuesday 20th July 2021 Westminster Hall

[Fleur Anderson (Putney) (Lab)]

It is a pleasure to serve under your chairship, Mr Gray, and to follow my hon. Friend the Member for Nottingham South (Lilian Greenwood). I congratulate and thank the hon. Member for Truro and Falmouth (Cherilyn Mackrory) for securing this incredibly important debate. I am so sorry for her loss but I thank her for her bravery in sharing it and for her ongoing campaigning in this area.

I also thank campaigning organisations, including the Stillbirth and Neonatal Death Society, Tommy’s and the Lullaby Trust, and all the members of the Pregnancy and Baby Charities Network, as well as bereavement organisations such as the Good Grief Trust for all they do to support parents and families and for their continued campaigns for change.

I thank all my constituents who have recently written to me about this important debate, underlining the reason for having this debate now and why we need to look again at the plan for the national ambition to reduce baby loss and at progress towards that. I am certain that all Members present share my ambition that the UK should be the safest place in the world to have a baby. However, as broken-hearted mothers and fathers across the UK can testify, it is not, and that is the reason for the debate today.

There are stark inequalities: background makes a difference, as well as where mothers have their babies. That should not be case—the highest standards should be equally available across our country. Recent reports from the Health and Social Care Committee, the Ockenden review of maternity services at Shrewsbury and Telford Hospital NHS Trust, the ongoing investigation at East Kent Hospitals University NHS Foundation Trust, and the devastating revelations from Nottingham University Hospitals NHS Trust—which have been outlined by my hon. Friend the Member for Nottingham South—plainly demonstrate just how much more there is to do.

Although huge strides have been made over the past two decades, that progress has now plateaued and we need to know why and address this. In 2019, the neonatal mortality rate in England and Wales was 2.8 deaths per 1,000 live births, the same as it was in 2017—the third consecutive year of no change. The latest statistics for neonatal mortality published by the World Bank rate the UK as the 37th country globally, making us one of the worst-performing countries in the developed world in this area. As the hon. Member for Truro and Falmouth highlighted, the recent report into progress on maternal mortality said that

“No discernible progress has been made towards reducing the 2010 rate of maternal deaths by 50% by 2025.”

There are huge inequalities in the experience of maternal mortality and baby loss that have gone unaddressed for too long. Babies from minority ethnic and socioeconomically deprived backgrounds remain at an increased risk of death: if a woman is black or poor, it is more likely that she will die or that her baby will die, which is absolutely unacceptable. In 2017, babies born to black or black British parents had a 67% increased risk of neonatal death compared with babies of white ethnicity, and babies born to Asian parents had a 72% increased risk of neonatal death compared with babies of white ethnicity. The 2020 MBRRACE-UK “Saving Lives, Improving Mothers’ Care” report shows that the risk of maternal death in 2016 to 2018 continued to be four times higher among women from black ethnic minority backgrounds than among white women, and that that risk is twice as high for women from Asian backgrounds as it is for white women.

The Office for National Statistics’ latest “Births and infant mortality by ethnicity in England and Wales” report, published in May this year, highlighted substantial inequalities in infant mortality rates among black and other ethnic minority groups. Some of this variation may be explained by other areas of inequality, including deprivation, but the association between social deprivation and child mortality is clear, and there are modifiable factors that can make a difference. This can be addressed—it can be changed. I have raised this issue with NHS South West London Clinical Commissioning Group, and it must be addressed in partnership with those who have relevant lived experience and build on the knowledge of specialist agencies in each area.

Two further issues that need action have been raised with me by constituents. The first is miscarriage: a constituent has raised with me the issue of access to information and support following a miscarriage, and Tommy’s is campaigning on this issue as well. I met with a constituent yesterday who told me that women in the UK have to endure three consecutive miscarriages before they are referred for full investigation. She feels very angry about this situation and how it has affected her and women across the country. It is simply unacceptable for a couple to go through that much suffering and uncertainty and for it not to be addressed until there have been three miscarriages.

Another issue is that of culture. We are talking a lot today about funding: there is a need for increased funding, for staffing in particular, but there is also the issue of culture, which was raised by my hon. Friend the Member for Nottingham South. One constituent wrote to me to say that there had been a lack of investment over a long period of time and that that had played a big part in why the services are what they are today, but she also wanted to highlight behavioural issues within maternity—with bullying and hostile attitudes among members of staff. She said that trainees in obstetrics and gynaecology report a high rate of being undermined, higher than other medical specialities.

It is also well known that, in some services, hostility between midwives and obstetricians contributes to services being unsafe. These issues, not only about resources but about culture, need to be addressed and understood: there needs to be a cultural shift. Reporting should be welcomed within NHS trusts, and change should result from such reporting.

I have some requests for the Minister today. First, I underline the calls from Members earlier in the debate about the need for enhanced data collection and sharing. What gets counted counts, and the first thing anyone sitting down and looking at this area sees is that there are big gaps. Secondly, there should be a review of the impact of covid on our neonatal services.

Thirdly, there should be a plan to increase staffing levels; as has been outlined, we need to increase those. How much will they be increased by next year, the year after and the year after that, so we can achieve those 2025 levels? There needs to be action on ethnic disparity and much more focus within every clinical commissioning group on why those differences exist, learning from each other and from best practice and building on that, with a change in culture where needed.

What additional measures is the Minister taking to achieve the national ambition to halve stillbirths, neonatal deaths, maternal deaths and brain injuries by 2025? As we have seen in the debate and from the recent reports and statistics, business as usual is not going to achieve those aims at all. Will the Government commit to publishing specific national targets before the end of 2022—earlier, ideally—that reflect a bold commitment to action on inequalities due to ethnicity and deprivation, underpinned by specialist pathways and workstreams in every local maternity system?

I pay tribute to all the midwives working so hard across our country for all that they have had to change and go through in the last year, and to all the families affected by the issue. Ambition is all well and good, but it needs to be matched by action and boldness. A lack of both is currently letting down parents and babies across the country and it has to change, starting today.

Covid-19: Contracts and Public Inquiry

Fleur Anderson Excerpts

Wednesday 7th July 2021 Commons Chamber

[Fleur Anderson (Putney) (Lab)]

I apologise, Madam Deputy Speaker, for missing the first couple of minutes of the debate. I did, however, hear the excellent contribution by the leader of the SNP, the right hon. Member for Ross, Skye and Lochaber (Ian Blackford). It is no reflection on my feeling about the importance of this debate not just for us as Opposition parties, but for the people of the whole of Britain who are listening to these questions and who want more answers than those we have just heard. Maybe we will have them at the end of this debate.

On the Opposition Benches, we share the conclusion that the right hon. Gentleman came to in his remarks, which is that Government procurement over the past 16 months has been marred by huge waste to the taxpayer and brazen cronyism. That is not to say that the vaccine roll-out has not been an enormous success, but if that is all we going to hear from Conservative Members we will not get to the heart of the debate. At the same time as we were rolling out the vaccine, these crony covid contracts were being made and there are questions that must be answered for contracts being given now and for the future, as well as those given last year.

[Joanna Cherry]

The hon. Lady will have heard the Minister suggest that the same processes have been followed in Scotland and Wales as were followed by the British Government; but does she agree with me that it is only the British Government who have been found, twice, to have acted unlawfully?

[Fleur Anderson]

I agree with the hon. and learned Lady. This is not about the processes and whether they have been followed, but about what undue weight was given to the resulting contracts that came out of those processes. Some of them have been taken up in court, so there are questions to be answered.

For over 12 months now, my colleagues and I in the shadow Cabinet Office team have been asking some very simple questions again and again of the Chancellor of the Duchy of Lancaster and Minister for the Cabinet Office, the right hon. Member for Surrey Heath (Michael Gove), and his team over their procurement policy during the pandemic. Every time, we have been met with deflection and non-answers. Those questions have not been getting an answer, so I will try again today. That is not very impressive for the Department responsible for increasing transparency across Whitehall, and it is transparency that we are talking about today. But it is not only about transparency. Were those contracts given to the right companies to save lives at the right time? Without question, we needed speed. Without question, we needed the best companies to be chosen. The question is, when it comes to another emergency, pandemic or crisis, do the Government throw due transparency out of the window and just start talking to their friends?

[Alec Shelbrooke]

The hon. Lady said that shadow Cabinet Office Ministers have been asking the Chancellor of the Duchy of Lancaster questions about the things going on. However, I warn the hon. Lady—I say this to draw us back to where we were 12 or 15 months ago —that the then shadow Chancellor of the Duchy of Lancaster, the hon. Member for Leeds West (Rachel Reeves), wrote to the Chancellor of the Duchy of Lancaster saying that he was not awarding PPE contracts quickly enough, and that he should be bypassing the system to get them out there. She then gave a list of companies in my city of Leeds that had offered support, and they included a football agent, an historical clothing company, an events company in Surrey and a private legal practice in Birmingham. All I say to the hon. Lady is that there are lessons to be learned, but in terms of what she is trying to say, please do not think that Opposition Members were all innocent and that the Government were guilty and need to follow some lesson, because the reality is that the then shadow Chancellor of the Duchy of Lancaster put it in writing.

[Fleur Anderson]

Of course there are questions to be asked, and that is what we are doing—we are asking these questions. I hope that there is a real-time review going on right now, and I hope that all the questions we are asking will be in the public inquiry to come. All these questions need to be looked into.

I have 15 questions for the Minister today, which I hope she will be able to answer. Question 1: what assessment has she made of the accuracy of the Prime Minister’s official spokesperson’s statement on 28 June 2021 on the conduct of ministerial Government business through departmental email addresses? The Parliamentary Secretary, Cabinet Office, the hon. Member for Hornchurch and Upminster (Julia Lopez), said, only two hours after the statement that day, that

“a huge volume of correspondence was coming to Ministers via their personal email addresses”.—[Official Report, 28 June 2021; Vol. 698, c. 33.]

The Minister will have seen the leaked minutes from the Department of Health and Social Care meeting on 9 December, confirming that. So was the Prime Minister’s spokesperson not telling the truth, or just wrong, and will the Prime Minister be correcting the record? The use of private email addresses, how it all came to be and the murky times around that time need to be opened up to transparency.

It is hugely welcome news that the Information Commissioner’s Office will be investigating that point. The Government must co-operate fully. It is not just about freedom of information law and data protection law, important as that is; it is about taxpayers’ money being dished out secretly on private emails. Labour expects the Government to ensure that they come clean on private email use in other Departments, and that anyone found to have acted unlawfully or inappropriately in ministerial office faces the consequences.

Question 2: in her response to last week’s urgent question, the Parliamentary Secretary said that 47 offers of PPE supplies were processed through the Government’s priority mailbox. The Government have said that the details of all contracts will be published, but have refused to name the 47 companies. Who are those 47 companies, why are they not being named, and will those names be published now?

Question 3: can the Minister tell us which Ministers formally approved contracts awarded under the emergency procurement process during the covid pandemic? The Minister will have no doubt read the Public Administration and Constitutional Affairs Committee’s recent report on decision making during the pandemic, and it has a whole slew of other questions. It concluded:

“Ministers have passed responsibility between the Cabinet Office and Department of Health and Social Care”.

So who was responsible for actually signing off those contracts?

That leads me to question 4: which Minister made the decision to award a contract to Public First for contact focus group testing in March 2020? The Cabinet Office has stated that the Chancellor of the Duchy of Lancaster did not personally sign off the decision, so if he did not, who did?

Question 5, which was raised earlier in this debate: what role do the army of non-executive directors currently employed across Whitehall have in influencing the award of contracts? Did they have a say in the process or the decisions behind the award of those contracts? For instance, how can the Minister explain the fact that Kate Lampard, the lead non-executive director on the Department of Health and Social Care board, is also a senior associate at the consultancy firm Verita, which in May was awarded a contract by the same Department, worth £35,000, to assist Public Health England? It is not just about how people vote when they are awarded these positions. It is not about their voting tendency. It is their closeness to Ministers and others, and their closeness to some of the contracts being given out, that the public need to know more about.

This brings me nicely on to question 6. What steps were taken by the Department to identify and address conflicts of interest in relation to the contracts awarded through the VIP lane? Is the Minister confident that all meetings between Ministers and companies that were awarded contracts have been fully disclosed and added to the transparency data? Can we be assured of that today?

Question 7: I mentioned the leaked minutes of the December meeting of the Department of Health and Social Care. In that meeting the second permanent secretary used the term “sub-approval”. Can the Minister enlighten us on the sub-approval process? What does it mean in relation to Government covid contracts? The public have so many questions about what was going on in the contracting last year.

Question 8: the Parliamentary Secretary, Cabinet Office, the hon. Member for Hornchurch and Upminster, spoke in a Westminster Hall debate on Monday 21 June, which I attended, about the market conditions facing suppliers in China. There have been questions about links with China. In that same debate, I referenced evidence uncovered by the Good Law Project that showed officials in the Department of Health and Social Care were aware that an agent working for PestFix, the pest company that got a covid contract, may have been bribing officials in China. The point was not addressed by the Parliamentary Secretary, Cabinet Office, in that debate, so I ask the Minister to comment on it today. Is she aware of this allegation? Does she agree that, no matter how difficult market conditions were at the time, it warrants urgent investigation?

Question 9: I also asked in that debate whether the Cabinet Office would commit to auditing in detail all the contracts identified by Transparency International as raising red flags for possible corruption, and to commit to publishing the outcome of that audit. This would go a long way to restoring public trust. If it cannot be done, why not? What do the Government have to hide? I am afraid this is a question to which I did not receive an answer in that debate, so I hope to receive an answer this afternoon.

Question 10: the Parliamentary Secretary, Cabinet Office, said she believes there are cases where clawback is taking place, and other Ministers have mentioned it, too, but we do not know when it has happened and what was in the contracts for those that failed, by millions of pounds in some cases. Is the Minister in a position to provide more detail?

In the past 12 months, the Government have awarded £280 million of contracts for masks that did not meet the required standards, at a time when we were crying out for PPE that would save lives. I presume those masks had to be mothballed. I do not know where they are.

The Government spent £100 million on gowns without carrying out technical checks, so they could not be used. It is incredibly important that as much of this taxpayers’ money as possible is retrieved as soon as possible. Perhaps the Minister can explain to the nurses facing a pay cut, and to the 3 million who have been excluded from any help, that the money has gone to boost the profits of the firms that received these contracts, rather than coming back to the public purse.

Similarly, my eleventh question is about how much money the Government have spent defending themselves in court against the unlawful decisions that have been made.

[James Cartlidge]

How much does the hon. Lady think the investigation into the former Mayor of Liverpool will cost?

[Fleur Anderson]

I do not know how much further investigations will cost, but that does not preclude from needing to investigate this point. We cannot deflect by looking at other investigations; we need to have an investigation into this point.

Hundreds of millions of pounds have been spent on masks that have been mothballed and on gowns that could not be used because the contracts were not good enough. At a time of public emergency, we need the Government to be excellent in their competence in contracting, and not to throw the rules out of the window and end up with these failed contracts.

Question 12: why, despite all the evidence uncovered this year, will the Government still not commit to ensuring these contracts are in the public inquiry? I hope to hear confirmation that this will happen.

[Liz Saville Roberts (Dwyfor Meirionnydd) (PC)]

The hon. Lady is asking a series of highly pertinent questions, and I wonder whether we will receive the answers with any haste. Does she agree that we also need an urgent inquiry in Wales, where it has become apparent that almost 2,000 deaths occurred from infections that probably, or definitely, took place in hospitals and were therefore the responsibility of the Welsh Government, and that we need that inquiry urgently?

[Fleur Anderson]

Inquiries need to happen in real time, as we are learning, because we are making decisions all the time that affect our lives. There also need to be major Government inquiries, and I hope that all of this will be included in the Government inquiry to come.

The Minister made much of the Boardman review, saying, “There has been an inquiry. Don’t worry. The Boardman review has done it,” but this is my thirteenth question. It is, again, a question that I have asked before and received no answer to: does she seriously believe that the Boardman review is an independent and unbiased review, and good enough? How can she think that when Mr Boardman’s law firm has been the recipient of Government contracts in the past year, and given that Mr Boardman once ran to be a Conservative councillor—far more than just voting for one party or another? It looks more and more as if the Conservatives are set on glossing over the cronyism in their ranks, so that they can carry on as if nothing has happened.

I have two more questions, and then I will close. Question 14: when will we see a return of all public sector procurement to open competitive contracting as a default? The Minister said that emergency procurement procedures are still continuing, but they do not need to anymore. We need a way of having a contract in good time but with all the open competitiveness that the public need to see. There is no justification for the continuation of emergency procedures. They should be wound down immediately, and ways found to make contracting work without being secretive.

Finally, my fifteenth question: where is the Chancellor of the Duchy of Lancaster to answer these questions? The Cabinet Office is responsible for overseeing transparency across Government, and these are the fundamental questions that we have today. Why has he once again dodged an opportunity to explain the decisions made by his Department? Will he ever take responsibility and stop getting other Ministers to do his explaining for him, as has happened in many previous debates on this issue? The public will not stop asking these questions. We on the Opposition Benches will not stop asking these questions. We need some answers.

I have a lot of sympathy for the Minister, who will have to field some incredibly difficult questions about serious allegations. When such debates come up I can imagine that the conversation that Ministers have about who will reply is not a pleasant one. There are some very serious allegations, and I hope to hear the answers this afternoon.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I hope that we can manage the debate without a time limit. We will do so if everyone takes around six minutes. That will mean plenty of time for interventions and real debate.

Oral Health and Dentistry: England

Fleur Anderson Excerpts

Tuesday 25th May 2021 Westminster Hall

[Fleur Anderson (Putney) (Lab)]

It is a pleasure to serve under your chairship, Ms Bardell, and I congratulate my hon. Friend the Member for Bedford (Mohammad Yasin) on securing this hugely important and timely debate. It is certainly very important for my constituents in Putney, Roehampton and Southfields.

I sponsored a Back-Bench debate on this topic back in January, and here we are again. In that debate, there was real agreement from Members from different parties that there was an impending crisis facing UK dentistry, and that the actions that needed to be taken to avoid it were clear, yet the crisis remains. Patients in my constituency and across the country still have huge concerns about accessing dentistry and getting the care that they need.

Not enough action is being taken, so the Government should not have been surprised to wake up and find this morning’s front pages covered in reports of a three-year waiting list for some patients to see an NHS dentist. According to a new survey of dentists in England, nearly half indicate that they are now likely to seek a change of career or early retirement in the next 12 months should the covid restrictions stay in place. The same proportion say they are likely to reduce their NHS commitment. That is very important, because we particularly need to save NHS dentistry.

In the five years before the start of the pandemic, the number of practices providing NHS dentistry fell by 1,253. Some 85% of dental practices are now closed to new NHS patients, and 60% are closed to child patients. I can see this in my constituency in London and across the country. It is no exaggeration to say that the future of NHS dentistry hangs in the balance right now, and it is people who are on lower incomes who are the most affected. The Government have been warned time and again by MPs, the British Dental Association, mydentist, patients and dental practitioners, yet we feel that their warnings are falling on deaf ears. I hope we hear differently from the Minister.

As colleagues know, and as has been said, 20 million appointments were lost between March and November, which has created a huge backlog that will take years to clear unless it is addressed now. In my own borough of Wandsworth, nearly 6,000 fewer courses of treatment took place in the final quarter of 2020. One child is hospitalised for a tooth extraction every 10 minutes. I am a mother who took my child to hospital for a tooth extraction. I have seen many other children there and I know how devastating it is at the time. It can have long-term implications for the child’s health as well, but that can be prevented, so I will go through some of the preventive measures.

I welcome the Government’s renewed commitment to dental contract reform, which is essential. The new contract must break with units of dental activity. It must prioritise prevention and ensure that NHS dentistry is available to all who need it. After a decade spent developing new systems, it is crucial that the Government deliver on their commitment to roll out new contractual arrangements by April 2022. It is also important to make it clear that the roots of the crisis we face go back to well before the pandemic. This is not just about covid prevention measures. It has been a long time coming and the pandemic has only lit the touchpaper.

There is a huge disparity in funding across the UK. The Labour Government in Wales spend approximately £47 per year on primary care dentistry per head of population compared with only £34 in England. As capacity across the service continues to be severely limited by infection control measures, access problems have now reached an unprecedented scale in every community, with the existing deep inequalities of both access and outcomes set to widen even further. When the Minister responds, I would like to hear reassurances about action on prevention, about current practices and ventilation, and about dentist retention, especially recruitment, which I will focus on.

First, prevention. There has been a lack of face-to-face health visiting, especially for early years. In early years settings, supervised brushing and encouraging parents and teaching them about supervised brushing has been limited. There needs to be a real upgrade and fast tracking of check-ups in the early years settings so that we do not have a huge backlog of issues in later years. There needs to be dedicated funding for new water fluoridisation schemes, as many other Members have said—I am fully in favour of those—and further measures to reduce sugar consumption.

On recruitment, my dentist is the main provider of NHS dental care, and they consider this a priority issue for now. There are not enough places to train UK dentists in the UK, and the intake is dropping, not increasing as we need it to. Even if the numbers were to increase, it would take six years to have an effect because it takes six years to train a dentist, so there needs to be secondary legislation to change the overseas registration process. That would not cost anything, which I am sure the Minister would welcome. It has a huge amount of support from dental associations and practices, and it could be relatively simple and quick to see an effect with more dentists coming from overseas to this country. A simple change in the way that dental qualifications are recognised would make a difference.

The overseas registration process has to be carried out in the UK. It costs £4,000 and takes 12 months. If the overseas registration exam process could be equivalent for dentists and medics, including part 1 to be carried out overseas and increasing spaces on that exam, it would make a huge difference. Such small changes could transform dental care in this country.

Prior to 2001, the General Dental Council pre-approved certain dental qualifications outside of the European economic area. That was due to our membership of the European Union, but it changed because of Brexit. Now—I do not say this very often—we could take advantage of Brexit and return to the pre-2001 system of prioritising Commonwealth dental schools by recognising select qualifications.

We must support all practices to enable them to increase the number of patients. As the hon. Member for Mole Valley (Sir Paul Beresford) and others have said, they must have capital expenditure for new ventilation equipment and also a road map out of the use of heavy-duty PPE, which is bringing down morale and will not be needed in future. Also, the fallow times need to be brought down. We need to prioritise dentistry in the upcoming reforms of the healthcare system, particularly in the health and social care Bill, and we need an urgent review of the whole system, especially new targets—not for dental activity but for increased retention of NHS dentists.

It is time to stop the slide into the privatisation of dentistry. It is time to stop treating dental health as a kind of luxury instead of there being free oral health at the point of need. We are sleepwalking into the biggest oral health crisis since the creation of the NHS. It is time the Government took responsibility and rescued UK dentistry before it is too late.

A Plan for the NHS and Social Care

Fleur Anderson Excerpts

Wednesday 19th May 2021 Commons Chamber

[Fleur Anderson (Putney) (Lab)]

Once again, despite big promises, we have a Queen’s Speech that just tinkers around the edges. It falls short of what we need for the country and what is needed for my constituents in Putney.

You may be surprised to know, Madam Deputy Speaker, that the volunteers at Putney Scrub Hub are still working flat out to provided much-needed scrubs for hospitals across London and beyond. Covid exposed the urgent need for a national uniform to save millions of pounds and provide our healthcare workers with the uniform they need at the right place and the right time. Instead, there is a fragmented system—a fragmented bureaucracy —that could not scale up at the speed needed. We do not pay our healthcare and care workers enough—clapping is not enough—and the very least that we can give them is the right uniform. Ministers did not step up at any stage to recognise the problem, take it on and solve it. That has still not happened. I welcome the consultation on a national uniform, such as they have in Wales. I hope that the measure will go through in the next year.

One of the biggest issues for my constituents in Putney is social care. On his first day in Downing Street, the Prime Minister promised to fix social care “once and for all”. Twenty-two months later, we have seen nothing. It has not been kicked into the long grass—it never left the long grass. This morning, the Prime Minister again said that there was a plan, but where is it? This afternoon, the Secretary of State made a passing comment in his speech at the beginning of the debate, saying that it would be brought forward this year—but, again, no plan.

Since the Prime Minister’s first day in office, dementia victims and their families have paid a staggering £14 billion for social care. The Prime Minister and the Government have let down every single one of those families, including many families in Putney. Even before the pandemic, there were 1,628 older people in Putney with unmet social care needs. That translates to 1.5 million people across the country. Adult social-care council budgets have been cut, and it is no surprise that 69% of the public believe that fixing adult social care should be a top priority as we recover from the pandemic.

We need a national social care system that is joined up with the NHS, and we need the much-promised dementia moonshot. Without life-changing treatments, the number of people with dementia is set to grow to 1 million in the next five years. No more empty promises; no more leaving families struggling and despairing. We need a clear, budgeted plan for social care reform, complete with milestones, with reform this year, 2021—not next year, not on the never-never. The reforms must improve access to care and quality of care, and provide better working conditions for care workers, with services joined up between the NHS, social care providers and community providers. I urge the Government to listen to the public and come good on their promises to fix adult social care at last so that we can all recover from the pandemic.

Covid-19 Vaccine: Take-up Rates in London

Fleur Anderson Excerpts

Tuesday 9th March 2021 Westminster Hall

[Fleur Anderson (Putney) (Lab) [V]]

It is a pleasure to serve under your chairmanship, Sir Christopher. I congratulate my hon. Friend the Member for Hammersmith (Andy Slaughter) on securing this very important debate, to enable us, as London MPs, to speak about the situation now, which can be rectified. I add my thanks to all the scientists, NHS managers and fixers, vaccinators and volunteers who have made the roll-out of the vaccine programme so far so swift and such a success.

To defeat this pandemic in the UK, we have to defeat it in London—there is no getting away from that—but the vaccination rate is lower here, as colleagues have said. In my area of south-west London, the CCG has provided the first dose to 389,000 people, which is 26% of the population, but some local authorities around England have a rate of over 50%. Areas such as Rother, West Devon and North Norfolk have much higher vaccination rates, so it is not just an issue of supply, although supply is an issue in my area. We have two vaccination centres and they are not open today. We do hope to see that surge.

In January, a promise was made to open a vaccination centre in Queen Mary’s hospital in Roehampton. It will not surprise the Minister that I am going to talk about Roehampton today, as I have raised the subject many times. The vaccination centre there has been built but not opened. There is no vaccination centre in Roehampton, but there have been spikes of covid infection there. It is an area of high deprivation; as my hon. Friend the Member for Hornsey and Wood Green (Catherine West) said, this is a tale of two cities.

There are not good transport links from Roehampton. The primary care network is keen to support vaccination but there is no vaccination centre. The rates at the moment are because a huge amount of transport has been organised, relying on voluntary organisations, to make minibus trips to Putney. That cannot go on for the long term; we need a long-term solution for Roehampton, which is an area of highest need.

The Minister knows Roehampton well because he was a Putney councillor for many years. I know that last week he met Dr Hasan from the Alton Practice, who is a shining example of someone passionate about the health inequalities in Roehampton and the need to address them. She is very concerned about vaccine hesitancy in young people. As the vaccine roll-out goes on, the vaccine hesitancy we see will only increase.

In Roehampton there are higher levels of black and ethnic minority populations, isolation and overcrowding. All those mean that having a trusted vaccination centre nearby that can be attended around shifts—for a care worker, for example—is so important. Otherwise, we risk baking in those existing health inequalities for the long term, which will go alongside all the other inequalities felt by the population in Roehampton. They are throwing up their arms and saying, “We don’t get other things, so we are not getting a vaccination centre.” That is not acceptable.

We are not arguing for more in London; we are arguing for our fair share. We are not arguing for more in particular areas; we are just arguing for every area to have its fair share. We must anticipate, see the problems that are already developing and nip them in the bud right now and address them. I hope I will hear from the Minister that we will have a vaccination centre in Roehampton and that those areas being left behind will be identified and addressed.

Covid-19: Dental Services

Fleur Anderson Excerpts

Thursday 14th January 2021 Commons Chamber

[Fleur Anderson (Putney) (Lab)]

I beg to move,

That this House has considered the effect of the covid-19 outbreak on dental services.

I thank my hon. Friend the Member for Brent North (Barry Gardiner) who co-sponsored the application for this debate, and the Backbench Business Committee for granting it. I also thank many MPs from across the House for their support for this important and timely debate.

I am speaking on behalf of everyone who has suffered toothache under lockdown, or who will suffer it this year, for all the children whose orthodontal treatment has been delayed or is in disarray—that includes two children in my own house—and for all those whose more serious dental problems would have been spotted in routine check-ups, but who have not yet had them spotted. I speak also on behalf of dental practitioners and laboratories in my constituency and across the country who have felt ignored during the pandemic, and not treated as the frontline health workers they are.

During the pandemic, one constituent told me that he had to pull out his own tooth, and a local dentist told me of an elderly lady whose dental pain meant that she could not eat solid food throughout the lockdown, and had lost weight as a result. There are serious consequences to the implications of covid-19 on dental practices. I would like to thank the dentists in my constituency and across the country, who have kept going in very difficult and stressful times, and often against all the odds.

My message today is simple: we are sleepwalking into the biggest oral health crisis since the creation of the NHS. Unless the Government begin to recognise that dentistry is an essential health service, the sector will collapse. For now, the current activity targets are unattainable and need to be scrapped—I am sure other Members will be talking about them today. In the longer term, we also need better targeted financial support to save the sector. Overall, we need a national dentistry recovery plan to provide safety for dentists and patients, funding to stop closures, and ways to address the huge backlog of dental appointments. There is an NHS England phased recovery plan, but it does not address the whole dental sector. Dental care is not a middle-class luxury, but it is moving that way. It is a fundamental aspect of good health and a key indicator of health equality. We neglect it at our peril.

From March to June last year, all routine dental care in England was paused and according to the British Dental Association over 20 million appointments were lost between March and November. That has created a huge backlog that will take years to clear unless it is addressed now. In my own borough of Wandsworth, nearly 6,000 fewer courses of treatment took place in the final quarter of 2020. It did not have to be this way. For example, in Germany, personal protective equipment and guidance was put in place straightaway and dentists were not shut. Funding of PPE and ventilators remains a major issue for enabling dentists to function and see patients even during the pandemic.

Dentists have faced acute financial problems. They are both frontline health services and important high street businesses in all our communities, yet they did not receive the same funding as other frontline health services or high street businesses. Financial support remains either absent or uneven. As many as 53% of dental practices estimate that they can only maintain their financial stability for 12 months or less in the face of lower patient numbers and higher overheads. Beyond access to the furlough scheme and Government credit, support for private practice has been close to non-existent. There has been a failure to recognise the mixed economy on which dentistry is based. Dentists are among the only businesses on the high street that continue to pay business rates. That is totally unfair. Many of my local practices have not received any financial support, such as business grants, and this must be renewed.

Now, on top of that, there are targets. In December, NHS dental practices were instructed by the Government to deliver 45% of all their targets, based on pre-covid levels, to earn their contract value from January to April. This was a hasty, not negotiated and widely discredited target-based dental contract, and it is incompatible with providing safe and sustainable services for patients during the pandemic. I understand that the targets were set before lockdown, but now is the time for the Minister to tell us that they will be reconsidered, they are not achievable and there will be a change of policy. The targets need to be scrapped.

Most dental practices are small high street buildings and they cannot expand to meet the guidelines on social distancing and fallow time as well as meeting the targets. The British Dental Association found in a recent practice poll that 40% of practices in London alone have seen more than half their capacity wiped out by cancellations, staff sickness, self-isolation and difficulties accessing childcare. If there was ever an excuse not to visit the dentist, we have one now. We have told everyone to stay at home, so they are staying at home and they are not going to the dentist, but that is just building up huge problems for us in the future. Dentists cannot be financially penalised because of that.

The latest UK data show high levels of cancellation and non-attendance during lockdown. One local dentist told me that at absolutely full stretch before Christmas he was able to meet 30% of pre-covid activity levels. He cannot meet them now, and he is worried about being penalised and losing money retrospectively, because he is obviously having to pay out for those contracts during these months. We would all like more people to be able to see dentists. We would like them to reach 100% of the targets and to clear the backlog, but the targets are simply unachievable at the moment and will put the future of dental practices at risk. By implementing this target, the Government are effectively removing the safety net from NHS dentistry at a time when covid-19 rates are surging. It is important to note as well that the target is set not by the chief dental officer, but by the Government. The wider implications of these issues extend beyond just bad oral health or a bit of toothache. It is predicted that it will increase emergency attendances at hospital A&E, increase antibiotic prescribing, increase admission to hospitals and longer stays, and increase missed oral cancer diagnoses, which is really worrying. The Oral Health Foundation found that mouth cancer referrals fell by 56% during the lockdown.

In my constituency, the waiting list for tooth extractions by children’s tertiary care is now two years and growing —that is an almost emergency treatment. I met with dentists in my own constituency in the lead-up to this debate, and they made it clear that the 45% target is just unacceptable. One said to me:

“How can the dental profession be expected to transition to this flawed quota system? Practices that fail to reach targets, through no fault of their own, will face penalties and clawbacks which will result in mass closure of dental practices as the funding to provide dental care will not make it viable to stay open. This is a reckless and unsafe decision”.

Today, the Faculty of General Dental Practice UK, the College of General Dentistry and the Royal College of Surgeons Of England issued a joint statement saying that

“safety must take a clear priority over dental activity levels during the…lockdown.”

There is a universal call to scrap the targets, and I hope that we will hear about that from the Minister later.

To wrap up, I have five demands of the Minister. First, we need a national plan for dentistry following the pandemic and a way that the backlog of appointments will be addressed, created in full consultation with the national professional dental bodies. Secondly, the activity levels for January to April must be scrapped. The 45% target will undermine patient care and safety. Thirdly, we must provide urgent support to practices to enable them to increase the number of patients that they can see. That means supplies of PPE and ventilation equipment to keep fallow time down. Fourthly, we need to be clear that all dental teams, including receptionists, must be given priority access to covid vaccines alongside other healthcare professionals. Fifthly, we need to maintain and expand the business rates holiday to dental practices and backdate it to late March.

In conclusion, many parts of the country already had poor access to dental care before the pandemic. Current levels of capacity across the service mean that, unless something is done now, problems are likely to reach an unprecedented scale in every community up and down the country, and we will see a whole generation growing up with poor dental health. Let us recognise the dental sector as the essential frontline health care service that it is and do everything in our power to support it through this crisis and for our future.

[Several hon. Members rose—]

--- Later in debate ---

[Fleur Anderson]

I thank all the MPs who have spoken in this debate from across the country, showing a lot of cross-party agreement on what we are asking for today. The message from all those people who contacted their MPs about this debate—dentists and patients—is loud and clear: dentists cannot reach their targets at the moment. That will mean financial insecurity and the destabilisation of dental provision that already has problems, which will impact patients. I say respectfully to the Minister that she has not heard the patients’ voice, and that actually, patients really want their dentist to be there in the future. That is the risk that we face at the moment.

I welcome what the Minister said about free PPE—I hope that includes ventilators—and the commitment to vaccinating dental staff, but I respectfully say that I do not think she has provided reassurance. The exceptions process has been demanded by dentists contacting all the MPs we have heard from today. So it is going to be a massive application with a huge amount of red tape. It does not allow for the space constraints of dentists, the sickness being faced by dental staff during lockdown, and the message to stay at home, which is stopping people going to the dentist. I ask her to reflect on the whole debate, to rethink the decision, to get around the table with the British Dental Association, to look again at those targets and to meet me, if possible, to talk about this further.

Question put and agreed to.

Resolved,

That this House has considered the effect of covid-19 on dental services.

Public Health

Fleur Anderson Excerpts

Wednesday 6th January 2021 Commons Chamber

[Fleur Anderson (Putney) (Lab) [V]]

Thank you, Mr Deputy Speaker. I am glad to be speaking in such an important debate. First, I thank all the staff at St George’s Hospital and Queen Mary’s Hospital in Roehampton, who are working so hard at the moment to deliver much of the life-saving care that we are talking about in today’s debate. I also offer my condolences to the families of the over 1,000 people who have died in the last 24 hours, which really brings home why we need these measures, hard though they are. As such, I will be voting for them and supporting them. Our hospitals are under stress; we need to have these measures to save lives and protect the NHS.

I am highly disappointed about the failure of the track and trace system up to now, which I think is part of the reason why we are having to see these continuing lockdowns. We are not overcoming this disease, as they have done in other countries, so we have to get to grips with real tracking and real tracing, getting back to 100 contacts each. I welcome the roll-out of vaccines, and look forward to a “community first” way of rolling these out, in which local GPs—those who are trusted to provide and administer the vaccine—will be leading the way. I especially hope to see a vaccination centre in Roehampton in my constituency. I am disappointed that many people are still left out of economic support: a business rate holiday would make all the difference to my constituents and businesses.

Finally, there is still a failure to contract for scrubs. There are still volunteers making scrubs for our NHS providers, and this needs to be sorted out. I would really welcome hearing from the Minister whether I can meet with those who are involved with contracting on scrubs, along with experts in my community, who are still doing this on a voluntary basis when it should be done nationally. Thank you very much.

[Mr Deputy Speaker (Mr Nigel Evans)]

Thank you for being concise as well, Fleur. I call Alex Norris to start the wind-ups.

Coronavirus Vaccine

Fleur Anderson Excerpts

Wednesday 2nd December 2020 Commons Chamber

[Matt Hancock]

Yes. I have good news for the people of Workington and the whole country, which is that suppressing the virus using these restrictions until a vaccine came along has been the strategy all along, and we can just start to see the light at the end of the tunnel getting much brighter because we know we now have a vaccine.

[Fleur Anderson (Putney) (Lab)]

I also welcome this news and thank all the scientists involved in this great breakthrough. When it is my turn to have the vaccine, I will have absolutely no hesitation in doing so. When it comes to turns, can the Secretary of State confirm that community workers—care workers who work in the community going from home to home—will be part of the first assessment of clinical need? Then, after clinical need, will educational need be a factor in keeping our schools open? A school in Southfields has been closed for the last two weeks for lack of teachers being able to teach, so as a next phase, will educational need be a consideration for the roll-out of the vaccine?

[Matt Hancock]

Once we have got through the clinical priority, of course there is a debate to be had about the order of priority after that. Between now and then, if we can get the repeat testing of contacts up and running and working across the board, I hope that that will be effective in ensuring that fewer teachers have to isolate because they are contacts as opposed to positive cases.