Covid-19 Update
Debate between Lord Winston and Lord Bethell(3 years, 5 months ago)
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Lord Bethell (Con)
My Lords, the noble Baroness is entirely right to make the connection between Covid and flu. We regard the winter as presenting two pandemics, and we will treat them with equal energy. Flu and Covid have the same net effect on the healthcare system, which is to be a huge drain on resources. So we are putting a huge amount of effort into the vaccine and boosters for Covid and the vaccination against flu. They can be taken together, and the advertising and promotion distribution to identify priority groups will be extremely energetic. That is the most important thing we can do to protect the NHS. Our second priority, though, is getting the beds to which the noble Baroness referred used for elective surgery. We do not want to see the NHS heaving under the pressure of Covid and flu. We want to see it addressing the backlog.
Lord Winston (Lab) [V]
My Lords, to return to my noble friend Lady Thornton’s first question, given the continued rise of the variant mutations and increasing infections, can the Minister report on a simple biological issue? What rapid mathematical calculations are in the Government’s possession to assess and predict the increasing risk of further new variants evolving that may escape the current vaccines or are more virulent? If he is unable to answer this question now, perhaps he will be kind enough to write to me.
Lord Bethell (Con)
My Lords, I cannot promise to have a simple algorithm to make the calculation that the noble Lord refers to. I will ask the system if such a thing exists, but I have never come across such a thing. The challenge he alludes to is entirely right: the vaccine pressure on the virus will create the circumstances in which variants are possible. That is why we are investing heavily in sequencing, not only here in the UK where everyone positive is now sequenced thoroughly and studied, but also offering that around the world through NVAP—the new variant assessment platform—to try to understand what is going on in markets around the world. To date, we think that we have tracked down all the current routes that the virus is taking, and we are satisfied that they are met by the vaccine, but we keep our eyes peeled.
Covid-19 Update
Debate between Lord Winston and Lord Bethell(3 years, 9 months ago)
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Lord Bethell (Con)
My Lords, I have nothing but good news on both those important issues. The number of people who have mild or profound sickness, need hospitalisation or die after having the vaccine is extremely small indeed. There is some differential when we come to the variants of concern. Certainly, mild disease has been observed with the South African variant by sources in South Africa and we are working to understand that. However, severe hospitalisation and death are massively reduced by all the vaccines. The side-effects from all the vaccines on all age groups and on people with almost all comorbidities are extremely small. The yellow list information published by the MHRA is extremely reassuring and so far it has been nothing but good news about the vaccines.
Lord Winston (Lab) [V]
My Lords, the House should be very grateful to the noble Lord, Lord Bethell, who is constantly being bombarded with our questions. However, I point out that within six hours of entering a cell this virus will have replicated, leading to millions of copies. Some copies will be imperfect, the so-called variants. Time is of the essence. The risk of dangerous new variants to which we have no defence is eventually likely to be inevitable. Will the Government now answer the question that has been repeatedly asked both in this House and in the other place since Christmas: as the red list of presumed points of embarkation is ludicrous and ineffectual, why do the Government not ensure that all those tens of thousands we have heard about entering the UK daily are effectively separated, screened, tracked, traced and isolated where necessary before they are lost within minutes somewhere in a British city?
Lord Bethell (Con)
My Lords, I thank the noble Lord for his grim prognosis and I agree with his analysis. If there is one place in the world where a mutant variation is likely to happen, it will be in an area where you have high infection rates and a large amount of suppression of the virus by either a lockdown or a vaccine programme. If you look around the world, that country is most likely to be Britain. We must be on the balls of our feet to be prepared for unhelpful news on that front.
Can I reassure the noble Lord on the borders? The number of people travelling in and out of the UK has reduced dramatically and the traffic through our airports and seaports is down tremendously. The application of the red list programme is extremely effective and the use of quarantine hotels has been extremely rigorously enforced. The isolation, along with amber routes, has also had enormous resources and is much more effective than it once was. We are prepared to go further. We review the red list constantly and, should the threats mount up to being serious enough, we will extend the red list as far as necessary.
Covid-19: Brazilian Variant
Debate between Lord Winston and Lord Bethell(3 years, 9 months ago)
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Lord Bethell (Con)
The noble Lord is entirely right. Our commitment to genomic sequencing, which has lasted for years, has put Britain in great shape to be able to do the sequencing necessary to track these variants. We are doing more sequencing than any other country. But as the noble Lord knows, this is detective work, and it is extremely complex. While the 484K mutation might be the significant change in both the Brazil and South African variants, it might be one of a great many other mutations in its genomic characteristics. This is the detective work we are doing. I am afraid that it will take some time to get to the bottom of it, and it needs to be complemented by field studies into how the mutation reacts in real life, as well as with antibodies. The combination of immunology, virology, biology and real-world clinical study will give us the insight that we need.
Lord Winston (Lab) [V]
My Lords, with due respect to the Minister, I wonder if a pinch of salt is quite the right treatment for some of these variants of the Covid virus. It is not just the Brazilian and other different variants. For example, in addition to Siqueira’s paper, which has just been published from Brazil in the last couple of weeks, the paper from Bogota shows numerous variants which are not quite the same. Some of these may be rather more virulent, and it is possible that they may even cause reinfection—it is certainly not very clear. The point is this: surely we need to be very cautious indeed about our airports and whether the list we have is sufficient. At what stage do we decide that we need to take much firmer action with all incoming passengers to the United Kingdom, making certain that they are properly tracked and traced?
Lord Bethell (Con)
The noble Lord is entirely right. Things are happening around the world which are causing a great deal of anxiety. Stories of possible reinfection in South Africa are extremely concerning and the huge spike in infections in South America has not been properly explained. It is possible that there are a number of mutations, and mutations of mutations, there. The truth is that we do not have the genomic or immunological data that we need to fully understand what is going on. That is why we have taken a precautionary approach, as the noble Lord recommends. We have instituted both managed quarantine and a red list which we keep under review. If we feel it necessary to extend that list, we will do so.
Covid-19
Debate between Lord Winston and Lord Bethell(3 years, 10 months ago)
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Lord Bethell (Con)
My Lords, I am grateful for the question but my information is slightly different from that articulated by my noble friend. Passengers overseas have heard the message loud and clear, and there has not been, as far as I understand, the kind of rush that he describes. In fact, there has been a lot of sensible behaviour by passengers. We are grateful to London Heathrow, London Gatwick, London City, Birmingham and Farnborough, which to date are the authorised red list airports and have put in place exactly the kind of social distancing measures around transit from the aircraft to the PCP, from the PCP to the baggage hall, and from the baggage hall to the transport to the hotel. A huge amount of thought has been put into the personnel, signage and arrangements to ensure that that is done in a way that applies the best possible hygiene measures.
Lord Winston (Lab) [V]
My Lords, the Minister knows that I have great respect for him, but I want to put a slightly colder note into this debate, which also reflects on the debate about the previous Statement. We have heard a lot of hugely optimistic and very confident statements from Members of the House and the Secretary of State. It strikes me that we must be a bit more cautious. As the Minister knows, the one country that has conducted more vaccinations than us, proportionate to the population, is Israel. It has also had a complete lockdown of airports, so that there is no ingress at all into the country. Yet puzzlingly, and not even the Israelis can explain this, the infection rate has not gone nearly as well as predicted or expected. Can he comment on that?
Furthermore, what does the Minister intend that the Government should do with regard to poor students returning, as they need to, for their exams? These students are deeply needed by the country and, if they have a good experience here, they were support us in the future when they are adults and working. I would be very grateful for his answer.
Lord Bethell (Con)
The noble Lord is right to cite the example of Israel. It is indeed extremely worrying. I touched upon this point when replying to my noble friend Lord Hamilton on the previous Statement. Undoubtedly the fear is that you vaccinate a large proportion of your most vulnerable population but those who have not been vaccinated—mainly the young—feel a licence to go out and socialise and create an enormous problem by spreading the disease on a large scale among the wider population. As I alluded to in my earlier answer, we currently have an infection rate of between 1% and 2%, It is not impossible that it could rise to 10% or 20%. Should that happen with the kind of proportions of people who then end up being hospitalised whatever their age, or suffering from long-term impacts of the disease, we would have a very big problem on our hands. That is why the Government are moving cautiously. I strike an optimistic tone in my answers, but I am extremely cautious and considered in my approach to policy, as are the Government.
Covid-19 Update
Debate between Lord Winston and Lord Bethell(3 years, 10 months ago)
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Lord Bethell (Con)
My noble friend hits the nail on the head. Nothing could be a greater priority to the Government than the opening of all schools, and primary schools are at the top of the list. I pay tribute to all those parents and, if I may be so bold, particularly the mums, who have taken on the bulk of the work in dealing with young children at home while juggling other commitments to care and work. This is one aspect of one of the greatest emotional tolls on the British public. My noble friend is entirely right that the opening of schools is a massive priority. It hits hard those communities that depend on schools for care, and those that do not have the resources for at-home teaching. I completely agree with his assessment and assure him that it is a primary priority of the Government.
Lord Winston (Lab) [V]
My Lords, the Minister also hits the nail on the head when he talks about a highly infectious new variant that is resistant to the vaccine. As he knows, the scientists have been pointing out that we will be living with this virus for a very long time, and other viruses like it will emerge in due course. I refer to an answer he gave me last week when I asked about antivirals. There are a number of antivirals in development at the moment in this country that look very promising, an interferon beta-based compound by Synairgen and ACTIV-2, which could be used for ambulant patients in the early stages of the disease. If we got people as soon as they had symptoms and tested positive, we could do a great deal of good and reduce the risk of mutation in the population. Have the Government any plans to do what they did excellently with vaccines: pre-order antivirals as they come through phase 3?
Lord Bethell (Con)
The noble Lord is entirely right to raise this issue. There is the awful possibility that the mutant vaccine escape virus could get around the vaccine altogether. We need a plan B, which might be dependent on antivirals as an alternative way of managing the disease. That is what happened with HIV, as we discussed last week. The therapeutic taskforce is looking at antivirals and putting together a plan to upscale our investment in that area. I am aware of Synairgen and ACTIV-2, but he is entirely right that this should now be a greater priority. I will take the matter back for the department to look into further.
Covid-19: Vaccines
Debate between Lord Winston and Lord Bethell(3 years, 10 months ago)
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Lord Winston (Lab) [V]
My Lords, we welcome the efficiency with which the UK is providing vaccines, but vaccines affect only part of the problem. As my noble friend Lady Thornton and the Minister said, this is indeed a global issue. Prompt diagnosis and early treatment with antivirals will become vital. Time is limited. Can the Minister inform the House what measures the Government are taking to stimulate investment and make urgent research into effective antiviral drugs specifically designed against SARS-CoV-2, which are likely to be easier to distribute in many countries?
Lord Bethell (Con)
The noble Lord is entirely right: the vaccines are a hugely important development, but so is investment in all therapeutic drugs. We are extremely blessed to have had a contribution towards dexamethasone, tocilizumab and other therapeutic drugs which have greatly improved outcomes for patients in hospitals. He is right that antivirals also present an opportunity. The reason we have supported research into antivirals through the urgent regime in our clinical trials is to ensure that there is sufficient commitment in hospitals and primary care on antivirals. We are tasking the Therapeutics Taskforce with a specific mandate to look at antivirals and whether we should give greater resources to this avenue of therapeutic development.
Health: Eating Disorders
Debate between Lord Winston and Lord Bethell(3 years, 11 months ago)
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Lord Bethell (Con)
My Lords, the noble Baroness is right: the statistics on eating disorders are shocking. The Mental Health of Children and Young People in England Survey identified 0.4% of 5 to 19-year-olds and 1.6% of girls aged 17 to 19. The NHS Digital Adult Psychiatric Morbidity Survey showed 6.4% of adults displaying signs of an eating disorder. There is the survey by Beat, and I could go on. I do not think it is an issue of surveys; we have to address the underlying statistics with measures that make a difference.
Lord Winston (Lab) [V]
It is very helpful that the Minister recognises the seriousness of anorexia nervosa and other conditions. It remains puzzling, and the causes are not fully understood, but the long-term risks—for example, infertility or the loss of a child during pregnancy or childbirth—are very serious. Given that some of these patients require almost forced admission to hospital, is there any scope for reviewing this issue when we come to consider the mental health provisions that are due next year?
Lord Bethell (Con)
The noble Lord puts it extremely well. Instances of those in pregnancy who have eating disorders are particularly heartrending and disturbing. He is right: sometimes, the condition is so extreme that it needs virtual full admission. We have put six new beds in the south-east, five in the Midlands, five in the east of England and 10 in the north-east. We are putting a massive amount into mental health budgets and this provision covers exactly this kind of disorder because we recognise that more resources are needed. I look forward to further announcements of spending in this area.
Mental Health Act Reform
Debate between Lord Winston and Lord Bethell(3 years, 11 months ago)
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Lord Bethell (Con)
The right reverend Prelate is right to allude to the importance of culture. No amount of bureaucracy or guideline-writing can ultimately address the basic attitudes, backgrounds and mental starting point of those involved in these decisions. I reassure the House that at the moment we are processing the people plan, which addresses at a fundamental level the hierarchy, racism, homophobia and misogyny sometimes found in some parts of the NHS. We are acutely aware that culture is fundamental to the safe provision of services to patients. The framework itself is not wholly directed at culture, but it will be supplemented by these kinds of reforms.
Lord Winston (Lab) [V]
I congratulate the Government on getting Sir Simon Wessely to help them bring about this much-needed reform and will welcome seeing how it progresses in the next year. I want to draw attention to one of the problems about sectioning patients. Two members of my team at different times have been sectioned; both were psychotic and severely depressed at the time. One phoned me at 5 am to say that people had come for her; it was clear that this was highly scary and very damaging. The other patient was left in a police station after being found on a moor for many hours before eventually a bed could be found, miles from where she lived or where anybody could visit her. Also, the premises available for such patients when they have been sectioned seem quite inadequate. The Minister has mentioned the dormitory system, but when I visited both those women, I felt that I would be very depressed myself if I were in those circumstances. We need to do much more to make premises more homely if we are to be more successful in encouraging a return to normal health.
Lord Bethell (Con)
The noble Lord is entirely right: when people experience a mental health crisis, they should be treated with consideration. Unfortunately, the police are sometimes at the front line of dealing with those with mental health difficulties. It is a stretch for them, and they should have the right training to be able to deal with a situation sensitively and they should have the right premises to be able to give people safe and secure environments. It is at the outer limits of their professional responsibilities, but we are doing as much as we can to put the training in place.
I remember from my own personal experience, when my father and my mother were sectioned, the consideration and thoughtfulness of those involved in both those processes. It is not all bad, but I take the noble Lord’s point.
Covid-19: Vaccinations
Debate between Lord Winston and Lord Bethell(3 years, 11 months ago)
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Lord Bethell (Con)
I am grateful to the noble Lord for flagging this important issue. He is entirely right that those who are sometimes overlooked by society and fall between the cracks are often those who either suffer from the disease or are vectors of infection. It is a public health priority to ensure that people such as those excluded from schools are not overlooked or in any way left behind. I would be very grateful if he could write to me with the details.
Lord Winston (Lab) [V]
My Lords, speaking from these Benches, I think it would be appropriate to thank the noble Lord, Lord Bethell, very much for the amazing amount of work he has been doing on this very difficult issue. I hope he will continue to take our concerns back to the Department of Health and the Government in general, because that seems very important. I join my noble friend Lady Thornton in congratulating the Government on getting vaccines out, but, with all due respect, Israel has already vaccinated over one-fifth of its population with a massive vaccine campaign. On the important issue of dividing the time of the Pfizer vaccine, many of us have given informed consent for a period of three weeks between the two injections; by extending that period, we now risk not obeying the consent issue, and therefore there is an ethical problem. Could the noble Lord address that issue, because it is of considerable importance, certainly increasing the risk of suspicion of the vaccine, already very prevalent in parts of the population?
Lord Bethell (Con)
I am extremely grateful for the noble Lord’s kind words. I know lawyers looked at the question he raises on informed consent; I am afraid I do not have the precise answer at the Dispatch Box right now, but I will be glad to write to him with a clarification.
Covid-19: Variant
Debate between Lord Winston and Lord Bethell(3 years, 11 months ago)
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Lord Bethell (Con)
My Lords, I am afraid that I just do not recognise the noble Lord’s proposition. Hundreds, if not thousands, of new variants are appearing all the time. Many of them have passed through the process, but identifying those that are threatening, have more transmissibility and are significantly different is extremely complex. As I said very clearly, it was on 8 December that, after analysing all the genomes available in Kent, we showed that an important new variant was circulating.
Lord Winston (Lab) [V]
My Lords, clearly these variants are extremely—[Inaudible]—for all sorts of reasons. Regrettably, the Minister did not answer the question put by my noble friend Lady Thornton yesterday, when she questioned incomplete vaccination. Can the Minister give us clear figures on the risk of mutant varieties of the virus with a longer period between the two injections of the Pfizer vaccine?
Covid-19 Update
Debate between Lord Winston and Lord Bethell(4 years ago)
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Lord Bethell (Con) [V]
My Lords, I feel the point that my noble friend makes extremely personally. I am currently isolating with a 14 year-old; like many 14 year-olds, he and his friends never demonstrate any symptoms of Covid whatever and yet it would seem that they are carriers and vectors of the infection. The recent explosion in transmission in London and the south-east was led and probably caused by the 14 to 18-year-old age group, even though almost all of them are completely asymptomatic. We have worked with celebrities and opinion leaders in the youth groups to try to get this message across, but I point my noble friend to the announcement today of a very large increase in the use of asymptomatic testing in schools in the new year, as an indication of our commitment to ensuring that transmission among asymptomatic young people is contained.
Lord Winston (Lab) [V]
I thank the noble Lord for repeating the Statement. I concur with what the noble Baroness, Lady Thornton, said from the Front Bench. We know from the history of plagues that they occur through travel. This happened in the 1340s and again in the 1660s with the plague of London. Now we are seeing people travelling to London, which is a massive hub of travel; they come to the airport, they do not leave a phone number or address—they are not required to do so—and tests at the airport are voluntary. Many people go missing and are not followed up by a proper track. When they get tested, they pay for it, so it is entirely voluntary. Does the noble Lord feel that these arrangements are sufficient, given that so many people travel to London and that there is a risk of this plague continuing just as they have done historically?
Lord Bethell (Con) [V]
I am grateful for the noble Lord’s insight. He is right that travel is the friend of the virus. Many of the growths in transmission have been associated with it; one thinks of the ski resort holidays at the beginning, the spring break migrations in America and other examples. I reassure him that, while he is right to question the arrangements around our airports and transport hubs, we have brought in a much more strenuous test to release programme which is much more realistic than the previous isolation programme. The procedures around the passenger location ports have been tightened up and the enforcement and tracking arrangements for passengers have been supplemented. There is now a very strong body of evidence to suggest that passengers are abiding by the testing programme. As he may know, private tests were launched yesterday, and their uptake has been incredibly impressive.
NHS: Doctor Retention
Debate between Lord Winston and Lord Bethell
Lord Bethell
My noble friend makes a good and fair point on return to service agreements. Service time for doctors was tested in 2017; the results were mixed and had a negative impact on the number of applications. However, on his point on female attendance for education, I do not recognise his numbers and I completely reject the idea that there might be too many women working in the NHS.
Lord Winston (Lab)
My Lords, I regret to say that one of the key issues is not being addressed by the Government. Increasingly, inevitably, medicine is becoming a very academic subject; academics at the highest level are now going into medicine. There is a major problem with those academics being attracted to research in the NHS. So many doctors are now looking for alternatives because they cannot do research within the NHS. That is a loss to the NHS and, I am afraid, a loss to medicine. We must do something about research in parallel with clinical treatment.
Coronavirus (COVID-19)
Debate between Lord Winston and Lord Bethell
Lord Winston
I do not mean that in a way that might concern my wife, who might be listening to this debate. We also have to realise that we should not be touching our nose, mouth or eyes, all of which are likely to be contaminated. That is very important in not spreading the infection if you happen to be infected.
Perhaps I may raise one issue, because there are so many. It is the question of screening and diagnosis. News is coming through that people in New York are already finding it difficult to get screened for the virus when they have symptoms. That seems a bit of a problem with a virus that presents in a variable way, not a standard pattern. Sometimes you might be almost sub-clinical but then develop a much more serious, raging infection. One concern that we in this House must have—we have drawn attention repeatedly to this—is the massive difficulty of having properly managed pathology labs. We have excellent pathologists in this country but our pathology is always really stretched, without this virus. Is the Minister clear that we may need more staff to ensure that we can diagnose as accurately and rapidly as possible, as making a diagnosis is clearly one way of controlling the infection?
Lord Bethell
My Lords, the noble Lord is absolutely right about kissing. Kissing is wonderful but potentially dangerous. I share with the Chamber that we have had detailed conversations about kissing, shaking hands, fist-bumping and all manner of social intercourse. The analysis and guidance from the CMO is clear: it is the touching of your own nose that is the real problem. The average person touches their own nose between 70 and 100 times a day. That is why we focus on the message about washing hands. If your hands are clean, it does not matter how many times you touch your nose; but if they are dirty, whether that is through shaking hands, touching a door handle or whatever, the germs are there and can be conveyed. That is why we focus on that.
Health: Sexually Transmitted Infections
Debate between Lord Winston and Lord Bethell
Lord Bethell
The noble Baroness makes a very important point. Engagement with groups from BAME organisations has highlighted that question. There is undoubtedly a change in behaviours around sexual conduct that it is extremely difficult to address. Advertising and engagement with groups play a part, but clearly the problem is more complicated and sophisticated than that. That is why we will put innovation at the centre of our strategy. The HIV Prevention Innovation Fund was an interesting precedent and may be one way in which we can address the kinds of problems that she rightly highlights.
Lord Winston (Lab)
My Lords, the Minister mentions the issue of chlamydia with grave concern. He can write to me if he does not have the figures, but how often is chlamydia clearly implicated in damage in the female pelvis—in other words, in damage to fertility? It is greatly overexaggerated, and it is important to know that, because it causes a great deal of concern and guilt among a lot of women.
Lord Bethell
The noble Lord’s interest in this area is well known and he makes his point very well. The chlamydia screening programme is reviewing the way in which it looks at chlamydia and the possible implications of chlamydia, and I would be glad to chase down the numbers that he requested.
Hymen Surgery
Debate between Lord Winston and Lord Bethell(4 years, 11 months ago)
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Lord Bethell
The noble Baroness is quite right. It is extremely distressing to hear of these stories. The Government are absolutely determined to catch up and review exactly these kinds of procedures. The full scope of the review is under analysis at the moment, but the suggestion of including such examinations is a good one, and we will look at it carefully.
Lord Winston (Lab)
My Lords, while totally supporting the Question asked by my noble friend, does the Minister not agree that one of the problems here is that a number of women have had genital mutilation, for whom repair of the whole vulva is quite often important, as it is, for example, after obstructed labour? Inevitably, there is likely to be a confusion about hymenial repair. Therefore, a total ban might lead to more legal problems than are immediately obvious.
Lord Bethell
The noble Lord touches on the key dilemma of this issue. Cosmetic surgery is appropriate in many circumstances. There are many women who wish to repair damage, for instance from childbirth. A blanket ban would not help them. The key issue here is consent. Are those undergoing this procedure truly consenting to it and what is the ethical climate in which that decision has been made? Important questions have been asked about that climate, and the Government are determined to look at it closely.