Maternity and Neonatal Services

Baroness Andrews Excerpts

Tuesday 25th October 2022 Lords Chamber

[Lord Markham (Con)]

As I mentioned before, we have already put this in place with the maternity quality surveillance framework. At the same time, if we feel that more needs to be done, it will be included in my review of the recommendations and report back to the House in four to six months.

[Baroness Andrews (Lab)]

My Lords, one of the significant things about this devastating report is that it does not deal with a list of one-off recommendations, as previous reports have. It deals with systemic issues that mean that the whole service is challenged. One of those, as we have already heard, is the difficulty in identifying risks. The other is why we do not hear what families are saying, which is clearly an issue in preventable deaths. One of the specific recommendations is that the Government should now bring forward a Bill that would place a duty on public bodies not to deny or deflect or conceal information from families. That should be a priority. Will the noble Lord take that back to his senior Ministers and get them to acknowledge it?

[Lord Markham (Con)]

We all acknowledge a duty of candour. That should be fundamental to the leadership and to everyone in every trust. In this case, I was pleased to see the trust completely accept the findings and its failings and apologise unreservedly. That is something we need to make sure that all trusts do. We have the framework in place to do that but, if we do not, we will not hesitate to act further to ensure that it is.

International Healthcare Outcomes

Baroness Andrews Excerpts

Thursday 19th May 2022 Lords Chamber

[Lord Kamall (Con)]

I should refer Members to my interests. When I thought I had retired from politics a couple of years ago, I took up two posts: one as a professor of politics and international relations and the second as an academic research director of a think tank. That meant engaging with a number of think tanks across the spectrum, including Civitas—phew, I have got that off my chest.

I have always admired the noble Baroness for her diligence, particularly during the passage of the Health and Social Care Bill. Given that, I was puzzled by the premise behind the Question. It refers to the UK being ranked 18th out of 19 overall. I found no such ranking in that Civitas report when I was reading it for my homework last night.

[Baroness Andrews (Lab)]

My Lords, my noble friend asked a very specific question about workforce. We are 100,000 short of NHS staff. The last NHS workforce plan was 19 years ago in 2003 under a Labour Government. When will we have the next one?

[Lord Kamall (Con)]

As the noble Baroness will be aware, during the debates on the Health and Social Care Bill, we made quite clear the different approaches to the workforce strategy. Indeed, Health Education England has been asked to compile a strategy. The NHS has the people recovery task force, which involves health and well-being and is not only for retention. Also, in our recruitment, we are on track to meet our manifesto commitment of 50,000 nurses. We had over 30,000 more nurses by February 2022. We are looking at different areas, not only from the department but from the ground, bottom up.

Ockenden Report

Baroness Andrews Excerpts

Wednesday 30th March 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness, Lady Watkins, for sharing a very personal story. It must have taken quite a bit of courage to share that with us so publicly.

The noble Baroness talked about the “significant other”. Sometimes we consider ourselves the insignificant other. I remember when I became a father about 20 years ago for the first time. When you watched the TV programmes, they quite often told the father, “Go and have a smoke and come back. We’ll let you know.” Clearly, nowadays, you would not advise anyone to go and have a smoke. I remember how involved I was allowed to be. I was in the room for 22 hours for the first birth. Pre-natal care was fantastic, but once the baby was born, my wife was ushered into a bathroom, and I was sent away somewhere else. I could hear her voice. She called me. When I went in, she was sinking into the bath; she was just too exhausted. She was terrified and did not have the strength, and I pulled her out. It might have been a tragedy—I do not know—but it shows that even little things like that could have made a huge difference.

We are all grateful when a wonderful new life comes into this world. Let us think about the preparation that families go through—they prepare a separate room; families buy baby clothes and toys for everyone, expecting that bundle of joy to come home. When that is cruelly snatched away from them due to incompetence, we have to make sure that it happens as little as possible in the future. We know that incidents will occur. It brings a lump to the throat.

Noble Lords will recognise that there has been a debate on workforce. There is a debate in government on it. We shall just have to see how that resolves itself. I have heard loud and clear from noble Lords that it is not only about the maternity workforce; it is also about the wider NHS workforce, as well as making sure that we learn from incidents like this and build in that culture of prevention but also openness when things go wrong.

[Baroness Andrews (Lab)]

My Lords, this has been a rather unusual Statement in many ways, not just because it raises such extraordinarily profound questions but because it calls up such deep experiences for everybody around the House and for everyone who has a child or grandchild who survived this still-dangerous procedure. We are indeed indebted to the Minister, to Donna Ockenden and to the parents. It must have taken huge courage to relive all that, because the trauma never fades when one has had that sort of experience. One lives with it.

It is an unusual Statement because of the quality of the experiences around the House. I cannot add to them, but I want to follow up the concern of my noble friend on the Front Bench about monitoring. It is extremely important that we have a clear idea of the trajectory of the implementation of the recommendations and the speed at which they are implemented, because “promptly” is used in the report and the Statement. It is important that we have an idea also of their impact on the ground in terms of the experience of the staff and the patients in that very hospital. That is the only way in which we will know whether these recommendations and the relationship between them are having an impact.

For example, I do want to lower the tone by talking about money, but the Statement makes reference to £127 million. Over what period are we talking about that as an investment? How will it be distributed? Where will the emphasis be placed? Some of things identified are fundamentally important but elusive. How will that be reflected in changes to the quality and quantity of leadership training available? We all know that this is a failure of leadership in so many ways. For a long time, the NHS has been struggling with ways of coming to terms with developing creative leadership which will not condone blame, evasion and avoidance but embrace the need for change and improvement, and transmit and cascade that. These are specific questions. This is such a serious point of inflection in maternity services that we need to know how this is going to come back to us from the department and the Minister, so that we will be able to understand and keep tabs on what is happening. I would be grateful if the Minister could address that.

[Lord Kamall (Con)]

The noble Baroness raises some important issues. Looking at the big picture, as I say, we have accepted the actions made in the report, and I have asked for a timeline for the implementation from the NHS. However, I commit to updating the House when I can. I will also go back to the department and ask some more questions and make sure that I will write to noble Lords who took part in the debate in order to fill in the gaps.

A number of different issues were raised with regard to the £127 million for next year. That is for next year and it is in addition to £95 million in 2021 to try to recruit 1,200 midwives and 100 consultant obstetricians. Work is also under way as part of the largest nursing, midwifery and allied professional recruitment drive in decades. Since September 2020, there are other initiatives, such as the new non-repayable training grant of at least £5,000 per academic year for eligible students. There is extra funding of up to £3,000 per academic year to eligible students for child dependents, and £2,000 per academic year for those studying specialist subjects. There is also a new grant of at least £5,000 in addition to maintenance and tuition fees provided by the Student Loans Company.

An extensive NHS England and Improvement support package is also being developed to allow NHS trusts to establish and expand ethical international midwifery recruitment—I know that noble Lords have raised many issues about that. Health Education England has also pledged money to fund additional clinical placements, including for nursing, midwifery and allied health professionals and healthcare science, and the Government have provided almost £450,000 to the Royal College of Obstetricians and Gynaecologists to develop a new workforce planning tool. It is very easy to talk about large sums, but these are specific examples of what we are doing. However, I will write to noble Lords with more details.

Covid-19 Vaccinations

Baroness Andrews Excerpts

Monday 8th November 2021 Lords Chamber

[Lord Kamall (Con)]

The NHS is writing to all patients who may be eligible so that they can talk through their options with their GP or a consultant if they have not done so already. I understand that that includes the option to be vaccinated at home, but I will double-check and write to the noble Baroness.

[Baroness Andrews (Lab)]

My Lords, two questions were put to the noble Lord that he has not had time to answer. First, I should say that, like him, I have received my booster invitation for Thursday and I am absolutely delighted. Two questions, which I do not think were technical, were asked by the noble Baroness, Lady Brinton. One was about why centres are closing. Clearly, with this big push now, spearheaded by the Government, we need to keep as many open as possible. The second relates to something the Minister said that surprised me: he talked about a level of complacency. It is indeed possible, I think, to see the failure to make masks mandatory as an indication of complacency. Will he say a little more about what he meant by the level of complacency and how making masks mandatory might help to meet that?

Covid-19

Baroness Andrews Excerpts

Wednesday 15th September 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I absolutely applaud the sentiments that the noble Baroness articulated: her sense of responsibility and commitment to the community are generally exactly what we are trying to inculcate in a lot of people. But I just do not agree with her or with the noble Lord, Lord Faulkner, that having a state-mandated direction—accompanied, presumably, by fines and, therefore, court appearances for some—could possibly be described as light touch. It is the most intrusive and intimate of measures. If the circumstances require it, we are prepared to do it. We have done it, and, if necessary, we will do it again. But noble Lords really are missing the mood of the nation if they think that the vast majority of the country is in the same place.

I am afraid to say that this is a question of personal choice at the end of the day. The public health judgment—these decisions were made in participation with public health officials—does not support mandatory mask-wearing for the entire country. I agree that visiting Scotland is a completely different experience; there, policymakers have made a different decision, as they have in some other countries. But when we lifted mandatory mask-wearing on 19 July we saw a very large change in the public’s habit. Why? Because some people find it extremely intrusive and not comfortable at all, and they do not like it or are not prepared to do it. Therefore, at this stage of the pandemic it feels proportionate and right to rely on guidance and inspiration and on the leadership of both our national and civic leaders. If necessary, in plan B we will come back to the mandating of those kinds of measures. At this stage it really does not feel proportionate.

[Baroness Andrews (Lab)]

My Lords, if I may pursue this with the noble Lord, he has used the term “proportionate” on several occasions and has now said that the Government will be prepared to come back to this if they feel that the circumstances require it. It is worth reminding the House that the term “light touch” was not used by my noble friend Lady Thornton but by Sir Patrick Vallance.

I have several questions for the Minister. First, when will the circumstances be such that the Government will agree that “proportionate” is no longer the key and that action will need to be taken to require masks to be mandatory and people to stay at home? That is what the SAGE advice is suggesting. Secondly, exactly why have the Government not taken the advice of their own advisers in this respect, given the circumstances, which have been well described across the Chamber, of increases in the number of hospitalisations and the number of infections? Thirdly, what does the Minister think is likely to be the worst-case scenario this winter and the key risks, given that the Government have, on two or three occasions over the last 18 months, not followed the advice to act swiftly and urgently and according to the advice that they have been given? Why is it so difficult to take that advice and act on it now? It appears that we have not learned the lessons about the necessity for early intervention to stop things getting worse.

Covid-19 Internal Review

Baroness Andrews Excerpts

Thursday 20th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the Prime Minister promised on 12 May that there will be a statutory inquiry beginning in spring 2022, as my noble friend alluded to. Its chair and terms of reference will be announced before spring 2022, and it will be for the terms of reference and the chair to determine exactly what subjects are looked at.

[Baroness Andrews (Lab) [V]]

My Lords, I ask the Minister to return to the first Question asked by my noble friend—she asked two—which he overlooked. Does the Minister agree that publishing the internal review could strengthen the strategic plan to contain new variants? Does he agree with me that it would certainly raise public trust and that, because of the inordinate delay until next year in starting the public inquiry, it surely makes sense? Even if this is not a public-facing review, it is of such public interest that he should publish the internal review.

[Lord Bethell (Con)]

My Lords, as I said before, there was an internal ways-of-working review into the department’s early response to the pandemic, way before the threat of variants was on the horizon. None the less, it is our commitment to focus on the pandemic and the threat presented to us by its future evolution. That is why we are focused on today’s measures. We will leave reflection on the past to the inquiry.

Covid-19: One Year Report

Baroness Andrews Excerpts

Thursday 25th March 2021 Lords Chamber

[Baroness Andrews (Lab) [V]]

My Lords, I support these regulations but I am also glad to have the opportunity to support the regret Motion in the name of my noble friend. A year ago, we were shocked to hear that 20,000 deaths would be considered a good outcome. What, we asked, would be a bad outcome? Sadly, we know that now: 126,000 deaths, which is a dreadful figure, with so many of those deaths being avoidable. I remember vividly our first meeting with Chris Whitty in early March last year. He told a packed meeting of this House—packed into Committee Room G—that some people would have to go into isolation for three months. A year later, we are counting the costs which had not been identified at that point—in terms of mental health, domestic abuse, jobs, loss of learning and loss of life.

Vaccination is an act of solidarity as well as one of personal protection. The Motion identifies the urgent need to support those groups which are still fearful and will bring further risk to their communities. It would be fatal if Covid were to become a residual disease of poor communities. My first question to the Minister is: can he give us an update on how effective the latest campaigns have been in reaching those who are still reluctant and what other plans does he have in mind?

The Motion also recognises the challenges facing the NHS going forward: increases in waiting times and staggering waiting lists. Can the Minister tell us what the modelling shows about the relationship between bringing waiting times down within the next year and the funding that has been made available? In simple terms, how long will it take someone who has now been waiting for over a year for a hip operation, previously done in three months, to get that done?

Beyond the Motion and the many detailed and specific questions which have already been put to the Minister, I want to raise a few longer-term issues. This is indeed a moment of reflection. As we move into a cautious freedom, the exam questions include: how can we ensure that the progress that has been made is sustained and that we can mobilise quickly against dangerous variants? Here I share the anxieties of the noble Lord, Lord Lansley. Perhaps the Minister can answer the question that the Minister in the other place failed to address at all. Why is it that, according to the Explanatory Memorandum:

“Our assessment of the risks is not fundamentally changed by new Variants of Concern”?


This is particularly perplexing. This morning another scientist, Sir Jeremy Farrar, emphasised that the greatest risk currently is from imported variants. Given our vulnerability to variants, does the Minister agree that it is absolutely essential that we maintain the agility of our research base so that our amazing scientists and medics can anticipate and respond? This is a global task.

Is the Minister also aware that one of the reasons, in all probability, that we were so unprepared for Covid was because after an initial spike in funding in response to SARS and MERS in 2005 and 2015, research funding, especially in public health, dropped like a stone? I argue that if that funding had been maintained, we might have had a better understanding of Covid-19 and have had a vaccine closer to hand. Does the Minister agree that the planned cuts to the science budget of more than £1 billion—equivalent to the research and innovation budgets for the MRC and the Science and Technology Facilities Council combined —is madness? How will this help the country prepare for the next pandemic? Can he also say how the planned cuts of £120 million to the UKRI ODA funding will help the world fight further pandemics? So much for being a global science superpower and so much for being prepared for the next pandemic.

The Government did not plan for the Covid pandemic because they were too busy with Brexit, so I would like to have some confidence that they will plan for the next. That is precisely why we need a public inquiry as soon as possible, not least to clear up some of the confusions that the Prime Minister in particular seems so gifted at creating.

The Prime Minister has been saying for some time—indeed, as far back as July last year—that one of the reasons the pandemic got out of control was because the one thing nobody knew early on during the pandemic was that the virus was being passed asymptomatically from person to person. This is simply not true. The issue of asymptomatic transfer was known to SAGE in February and mentioned in the Chris Whitty meeting with us in early March. The Prime Minister was challenged on this in July. No retraction was made and he repeated it again this week at his press conference. Will the Minister correct this and put the record right in this House?

It is to expose the truth behind some of these assertions, which seem to be the Government building a case for exoneration, that we need a public inquiry as soon as possible. We need answers about how the Government intend to plan for the health security of this country, not just for the rest of this year but for the next decade at least.

Health and Social Care Update

Baroness Andrews Excerpts

Monday 22nd March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am grateful to the noble Lord for his tribute to the NHS, both the front-line staff and those who have organised the vaccine rollout. He is right to say that this has been a huge national achievement. However, I do not accept the characterisation he has made of other aspects of our pandemic response, including the provision of PPE, which, by the way, involved a huge global competition for extremely rare materials and led to a massive increase in domestic production. I also do not agree with his characterisation of the test and trace programme, which has developed into becoming one of the largest testing programmes in the world. It is now extremely effective, with tracing completion rates above 90%.

[Baroness Andrews (Lab) [V]]

My Lords, further to Minister’s exchange with the noble Lord, Lord Forsyth, can he update the House on plans to increase the manufacture of vaccine in the UK and when and where that might happen?

[Lord Bethell (Con)]

My Lords, I am not sure that I have at my fingertips the precise rollout plan for domestic manufacturing. All I can do is reassure the noble Baroness that we are exploring all options equally hard and are working 110% on every opportunity we have for delivering vaccines into the UK. I reassure the noble Baroness and all noble Lords in the Chamber that we are doing all we can and that at this stage we are hopeful and confident that the supply chain will deliver the vaccines we need in order to vaccinate all adults by the end of July.

Women’s Health Strategy

Baroness Andrews Excerpts

Tuesday 9th March 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Lord makes a really good point. I am not sure whether we have considered the gender aspect of the clinical trials work programme in our G7 agenda. It has been very much about pandemic-preparedness and ensuring that next time we are able to share clinical trial information. Of course, we pat ourselves on the back for our own vaccine clinical trials in the UK, which, I think, have met a new standard for gender representation. He makes a good point, however, about making that case in our G7 work programme, and I will take it back to the department for further consideration.

[Baroness Andrews (Lab) [V]]

My Lords, I welcome the consultation and hearing women speak for themselves. It is very encouraging that there has been such an immediate and very positive reaction. We have known for a very long time that health inequalities affect women specifically and disproportionately, and we can take action without necessarily waiting for the consultation—for example, the 2018 BMA report on women’s health showed that even women’s life expectancy had deteriorated, and it recommended changes in medical training and education. As the Minister says, getting this consultation right is a big challenge, but can he assure me that, however challenging it is, the findings will be heard, followed up, acted on and invested in?

Covid-19 Update

Baroness Andrews Excerpts

Thursday 4th March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am grateful to the noble Baroness for her insightful question about the obscure but vital question of data architecture. If there is going to be one powerful legacy of this awful disease, it will be the way in which data helped drive medical research, medical insight and the treatment of individuals. I am not sure if we need a new registry, a national Covid registry; what we need is for our existing data to be able to talk to itself. I can tell the Chamber that we are making enormous progress on that. I pay tribute to the unsung heroes, the CTOs who meet weekly at the NHS data architecture meeting, an obscure but vital forum where an enormous amount of good work is done by NHSX, NHSD, test and trace and others in primary and secondary care who are working incredibly hard, so that if one takes a test today, it goes into one’s patient record tomorrow and can be used the day after by a researcher looking at long Covid, dexamethasone, recovery or whatever. This is how modern healthcare should work. We have not done it well enough to date. We are making great progress on it tomorrow and we must not stop.

[Baroness Andrews (Lab) [V]]

My Lords, like everyone else, I could not agree more that the NHS rollout has been absolutely brilliant. I should also say that the Minister has been resilient, and we all appreciate that. However, I return to what is a more uncomfortable subject, I suspect, and follow up the question on airport testing. The Minister said that far fewer people are travelling and that the pursuit of quarantine conditions is more effective than it was. Given that fewer people are travelling, is it not possible to do what my noble friend Lord Winston suggested and pursue those people through test and trace and airport testing, as many other countries are doing successfully? How can the Minister say that quarantine testing of people in self-isolation is more effective? Can he give us more details on that?

[Lord Bethell (Con)]

My Lords, I thank the noble Baroness, Lady Andrews, for her questions. Perhaps I may tackle the specific question of airport testing, which has been raised a couple of times. The honest truth is that the arrival of families in south Gloucestershire and Aberdeen who had done a pre-flight test and subsequently developed symptoms demonstrates, I am afraid, that pre-flight and airport testing is not as effective as one would hope. If it were, we would not have to impose a 10-day testing regime with tests on the second and eighth days. That is the only rigorous way in which one can do it. It is estimated that airport testing catches perhaps between 10% and 20% of infection, and that is why managed quarantine is so important. The infection rate among those who arrive in the UK is high enough for us to be seriously concerned and to impose the kind of isolation that we have done. Until that infection rate is reduced, I am afraid that we have to look forward to managed quarantine and isolation being a part of the travel experience for some time.