Health Protection (Coronavirus, Restrictions) (England) (No. 3) Regulations 2020

Baroness Barker Excerpts

Thursday 3rd September 2020 Lords Chamber

[Baroness Barker (LD)]

My Lords, I hope the Minister managed to get a small break over the summer. I did, and I visited Salisbury Cathedral and its most famous exhibit from 1215. The entrance to the exhibition has a copy of the emergency Coronavirus Act 2020. The display says, “Do you know that the Government has taken unto itself the following powers and taken away the following rights from citizens?”, and lists them. Looking at these regulations today, it is tempting to repeat the most famous question of all: “Magna Carta: did she die in vain?” Six months ago, when we were looking at that Act, we said to the Government that it was predicated on some wrong assumptions. One of the key assumptions that was wrong was that it did not take into account the role of locally elected officials and their accountable rule in public health.

I want to draw attention to four problems that underlie all the regulations that we are having to deal with. The first is the mistaken belief that Department of Health Ministers, their spads and their friends in tech companies know better than local government and public agencies how to handle the pandemic. With every passing week, it is more evident that what my noble friend Lord Scriven said in March, which was ignored, was absolutely right: the key to managing a pandemic is to give local authorities a general power of competence, and that is becoming more and more urgent. I ask the Minister when the Government will remedy that.

I checked throughout the summer with colleagues throughout local government and found that the same issue has arisen time and again: they are ordered by central government to take action to close down establishments and to install barriers for physical distancing, but they have no power of enforcement. They are managing at the moment on the power of their own authority negotiated with local populations, but they need the Government to understand that what is being achieved is done so despite the orders from central government, not because of them.

The second problem is the failure to understand that, while central government and the NHS can focus solely on Covid if they have to, and they have done so, others cannot. The police have to deal with the consequences of the virus at the same time as carrying out routine crime policing. Local authorities have had to reorganise social care completely, maintain sanitation services, try to support local businesses to keep open and, in one case, try to decide what the consequences were of Zippos Circus not being able to open on common land. That may seem trivial, but that is what people in local government are having to deal with as yet more “helpful” advice and guidance comes from the Government. So my next point to the Minister is this: will the Government ban officials from issuing yet more advice to local government that gets changed day by day and gets in the way of implementing things properly?

The third and most important problem is the one that we have alluded to and which we knew was coming: the failure to have an effective track and trace system. The Government have thrown millions at companies that did not have to tender or even show any competence in the area at all. Directors of public health still do not have timely household data about infections so that they can use their local intelligence to work out what the transmission patterns are and take precise precautionary action. Ministers can stand there and bluster and blame all they like, but until such time as they own up to that and work with people in local government to rectify the systems and build on local intelligence, we are not going to be able to make any of this work.

The fourth problem is that immunity from parliamentary scrutiny has clearly enabled the Government to do something that has been quite counterproductive: to pay no attention whatever to the communications strategy for what they want to do. Time and again they have announced at the last minute to professionals what they are expected to do within hours rather than days. I can tell the Minister that in Oldham, hours before the beginning of Eid, it was announced that two families from separate households could not meet in a garden but it was still all right to go to the pub. That went down very badly with everyone in Oldham because they understood entirely what its effect would be. I have to say, looking at some of the other public announcements since, it is clear that people in central government have yet to understand what people in the streets understand: that they are making this up as they go along.

The noble Baroness, Lady Jones, rightly pointed us to the really important matter: the Act has to be reviewed by the end of this month. We have a backlog of regulations that are every bit as ineffective as these are. I do not think that in all conscience this Parliament can let the Government hide as they did behind the emergency nature of the virus outbreak six months ago. The Government have to start telling us now how they intend to revise the legislation, who they intend to involve in consultation and, above all, how they will be led by local professionals who understand what is happening in their communities, so that not only do we get something that is effective but we get ourselves back on the right side of human rights and public responsibilities.

Medicines and Medical Devices Bill

Baroness Barker Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Wednesday 2nd September 2020 Lords Chamber

[Baroness Barker (LD)]

My Lords, Brexit poses many threats to the economy and well-being of UK citizens. Perhaps the greatest is the threat to our life sciences and pharmaceutical industries which, based on our scientific resources in universities and companies that have easy access to international talent and resources, have been truly world-leading. The impact of moving away from the existing collaborative approach between the UK and the EU will be substantial. The European market accounts for 25% of all world sales of medicines and has timely access to new medicines and devices. The UK, in comparison, accounts for only 3% of the total world market. It is against that backdrop that we have to consider this legislation, which is intended to mitigate threats to our industry.

We all agree that we need legislation, but not this thoroughly unsatisfactory Bill. It is a Bill that should not be accepted unless it is thoroughly revised, for three main reasons. The first is that alluded to by the Minister: it is built on the flawed assumption that the Secretary of State or an “appropriate authority” must take equal account of the safety of human medicines and medical devices, the availability of human medicines and medical devices, and the “attractiveness” of the relevant part of the UK as a place in which to conduct clinical trials, supply human medicines or develop medical devices.

The last two considerations depend on the paramountcy of the first. If we do not accept that in legislation, none of the rest will apply; we will simply be signalling to the world a willingness to move away from international standards. One of the most interesting and detailed points made in the briefings that we were given came from the Association of the British Pharmaceutical Industry, which pointed out that it wanted to encourage the UK to apply for full membership of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use and the International Organization for Standardization. They are global organisations that produce harmonised regulatory guidance across nations. It was pointed out that previously the UK had represented the EU at meetings of those bodies and contributed to committees and regulatory thinking. Since 1 February 2020, we have had no direct recognised status as either a member or an observer. If we are willing to move away so swiftly from the international standard-setting bodies, we cannot do so on the basis of this unsatisfactory legislation.

The second reason for rejecting this Bill is that it is a Toom Tabard Bill, as we would say in Scotland; it is an empty cloak. The Minister put the best gloss possible on the reports from the Delegated Powers Committee and the Constitution Committee, whose comments were detailed, comprehensive and scathing—I have rarely seen reports of that nature.

On the delegated powers, Clauses 1, 8 and 12 allow Ministers by regulations to amend or supplement the whole regulatory regime for human medicines and clinical trials under important legislation such as the Human Medicines Regulations 2012. Those regulations alone contain 350 criminal offences which a Secretary of State could unilaterally or without any scrutiny change completely. It is something when the Constitution Committee says, as it has done:

“The delegated powers to create and adjust criminal offences in this Bill are constitutionally unacceptable.”


That is a very powerful reason.

Both the Delegated Powers Committee and the Constitution Committee were deeply critical of the way in which the Government have used this legislation, coming as it does at the time of the current pandemic, to confer emergency powers on Ministers to disapply existing health medicines regulations. They point out that there are no formal requirements to set out the form, publication or dissemination of protocols; Ministers can do that simply by publishing a document on a website. That is not taking back control; it is taking the mickey. It is time for us as a Parliament to stand up and say that this is not an acceptable way forward.

The third reason for rejecting this Bill is its potential to do harm. Many professionals in the pharmaceutical and medical devices industries have expressed the fear that by slightly and incrementally moving away from existing regulation from the EU we could very quickly put ourselves into sudden isolation. We should be fearful of that, not just because it could harm our ability to market into the European Union but because many other countries—African countries, for example— use EU approval as a short-cut mechanism for approving medicines which they do not have the capacity to trial themselves.

The report of the noble Baroness, Lady Cumberlege, is sobering. If we were to take just one thing from it, it would be the need for us to set up as soon as possible and as a matter of urgency not just databases but registries of medical devices. Those of your Lordships who have read the report will understand the difference that makes to traceability.

The Government are in trouble with the timescale that they have set for Brexit. This Bill demands detailed and lengthy scrutiny. For the health not just of our fellow citizens but of future generations, some forensic surgery needs to be done on it. It should not pass without receiving detailed attention from your Lordships’ House.

Health Protection (Coronavirus, Restrictions) (Leicester) Regulations 2020

Baroness Barker Excerpts

Wednesday 29th July 2020 Lords Chamber

[Baroness Barker (LD) [V]]

My Lords, why did Public Health England take until 20 July to start supplying test data to local authorities on a daily, rather than weekly, basis? Why were local authorities told only then which households contained people who had tested positive?

On track and trace, when will the Government stop wasting resources on national call centres and—as we on the Liberal Democrat Benches have been advocating since March—put resources into local resilience forums working with directors of public health, health and safety officers and local police?

Matt Hancock stated in mid-May that he had

“tried to throw a protective ring around our care homes”

right from the start of the outbreak. Today, the Public Accounts Committee stated that discharging 25,000 patients in order to free up beds was an example of

“the Government’s slow, inconsistent and, at times, negligent approach”

to social care. The committee also said that advising hospitals to discharge thousands of patients into care homes without knowing if they had coronavirus was a “reckless” and “appalling” policy error. Will the Minister tell the House who was responsible for that decision?

There was no protection from central government. Will directors of social services now be empowered to challenge any similar decisions by NHS Providers and central government which jeopardise social care? Will local authorities currently in lockdown, such as Leicester, be resourced to share their experience and good practice with colleagues in areas at risk, such as Oldham? As the demographic profile of areas most likely to experience second waves becomes clearer, will local authorities be identified and given additional resources now to put prevention plans in place?

Health Protection (Coronavirus, Restrictions) (No. 2) (England) Regulations 2020

Baroness Barker Excerpts

Friday 24th July 2020 Lords Chamber

[Baroness Barker (LD) [V]]

My Lords, had these regulations been provided in April with proper consultation, they might have been credible, but today, with our “world-beating” track and trace system, which fails to notify 20% of contacts of people who have tested positive, and with Public Health England releasing data to local authorities only once a week and without patient identification, they are highly questionable. When will local authorities be given real-time data and the powers that they really need—for example, to instruct the opening of facilities such as toilets? When will the Government release the scientific basis for treating different businesses in inconsistent ways? Will they monitor the differential impact of these regulations on black and minority communities, and will they act swiftly to end such discrimination?

Pharmacies

Baroness Barker Excerpts

Monday 20th July 2020 Lords Chamber

[Lord Bethell [V]]

As the father of four small children, I completely endorse the noble Baroness’s point. Many a night have I been outside a hard-working pharmacist’s shop looking for advice, support and essential medicines. I pay tribute to the hard-working community pharmacy sector, whose pharmacists are often up until midnight helping their local communities and hard-hit fathers like me.

[Baroness Barker (LD) [V]]

What advice has the department had from local directors of public health about the resources that are necessary to ensure continuity for community pharmacies during local lockdowns?

[Lord Bethell [V]]

We are fully engaged with the sector. The National Pharmacy Association and the other stakeholder groups are in close communication with the department to ensure that they have the PPE, medicines and finances to keep going during the epidemic. The voice of the DPHs is involved in that stakeholder engagement.

Covid-19: Mental Health Services

Baroness Barker Excerpts

Thursday 2nd July 2020 Lords Chamber

Asked by

[Baroness Barker]

To ask Her Majesty’s Government what steps they are taking to ensure that mental health services are available in (1) acute, and (2) community, care settings (a) during, and (b) after, the COVID-19 pandemic.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]]

My Lords, the mental health challenge of Covid is a serious matter, and I pay tribute to NHS mental health services in both acute and community care settings, which have remained opened for business throughout this time, including delivering support digitally, over the phone and, where possible, face to face. There are no plans to stand down that support after the peak of the pandemic and we remain committed to our NHS long-term plan ambitions for increasing mental health services in acute and community care settings.

[Baroness Barker (LD) [V]]

In July 2019, the Government committed £2.3 billion for services for 370,000 people with severe mental illness. Will the Minister give an undertaking that if, as expected, Covid-19 causes greater demand for mental health services, that money will be increased?

[Lord Bethell [V]]

My Lords, we are investigating the long-term implications on our services from Covid-19. We are engaging with counterparts across Whitehall and, if necessary, we will invest further money. However, the mental health impact of Covid is not clear yet, and we await the final implications of that.

Covid-19: Masks

Baroness Barker Excerpts

Thursday 11th June 2020 Lords Chamber

[Baroness Barker (LD) [V]]

My Lords, on 4 March, the government advice on face masks was that they do nothing, so do not wear them. On 17 April, the advice was that they do more harm than good, and on 11 May, it was that wearing one is an added precaution. As of 4 June, wearing them is to be compulsory. In that time, the science did not change but the death toll rose. Why have the Government failed to distinguish between PPE standards necessary in acute treatment settings and masks which are suitable for people using public transport? Why, given this record, should the public trust them during a second spike?

National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2020

Baroness Barker Excerpts

Monday 8th June 2020 Lords Chamber

[Baroness Barker (LD) [V]]

My Lords, these fees are a perfect encapsulation of the disparity between health and social care. Prior to the emergence of Covid, the social care sector was in crisis. Since 2010, local government finance has reduced by 50%, but statutory responsibilities have not. Local authorities have had staff reductions, to the point where there are senior directors, front-line staff and very few people in between.

On 25 February, the Department of Health and Social Care guidance told local authorities:

“It remains very unlikely that people receiving care in a care home or the community will become infected … There is no need to do anything differently in any care setting at present.”


On 14 May, the Health Secretary, Matt Hancock, stated that

“right from the start we have tried to throw a protective ring around our care homes.”

The public response was incredulity, because by that time there had been 10,000 deaths in care homes in England and Wales, according to the ONS—a quarter of all deaths. I repeat the statement from Martin Green, chief executive of Care England, who asked to

“see the evidence of what exactly the protective ring consists… and when exactly they instituted this protective ring”,

asked why

“we had our PPE distribution networks disrupted to send things to the NHS”

and

“why we had our primary care support withdrawn from many care homes?”

Why are they still waiting for it?

On 18 May, in their Covid recovery strategy, Our Plan to Rebuild, the Government pulled another fast trick. On clinical support, the strategy states that

“the Government is accelerating the introduction of a new service of enhanced health support in care homes from GPs and community health services, including making sure every care home has a named clinician to support the clinical needs of their residents by 15 May.”

But that should have been happening already under various pieces of legislation. In truth, the NHS abandoned care homes at their point of greatest need. Nevertheless, I ask the Minister: what progress has there been towards that 15 May deadline?

It is time for the Government to stop announcing new responsibilities for local government and start listening to local authorities about what they need central government and the NHS to do, so that there can be a joint strategy to manage Covid and its lasting impact on communities. Inadequate testing, little tracking and no isolation means that care homes will not be ready to withstand a second spike. They simply will not be able to provide what these older people desperately need.

Hospitals: Patient Safety

Baroness Barker Excerpts

Thursday 21st May 2020 Lords Chamber

[Lord Bethell]

My Lords, there was some interruption in hearing my noble friend’s question but, if I understood him correctly, the answer is that all patients are now tested on entry to hospital. Until their test result has arrived, they are treated as though they have Covid-19 and isolated wherever possible.

[Baroness Barker (LD)]

How will the Government enable hospitals to work on a regional basis, co-operatively, to optimise the use of surgical and radiological resources?

[Lord Bethell]

I am afraid that at the moment, I cannot give a precise and thorough answer to the perceptive and very detailed question asked by the noble Baroness, but I will be glad to.

Mental Health Services

Baroness Barker Excerpts

Tuesday 19th May 2020 Lords Chamber

[Lord Bethell]

I recognise the insight of my noble friend Lady Newlove, who speaks from experience of these matters. I reassure her that the funding in place from the long-term plan for mental health has been substantial and will support a dramatic change in mental health services. We will be supporting mental health workers who, as my noble friend says, have delivered under difficult circumstances. Their creativity is demonstrated by the introduction of video and other technical facilities to keep mental health services going during the lockdown. I pay tribute to their inventiveness and creativity at this time.

[Baroness Barker (LD)]

My Lords, is data on mental health support, A&E presentations, referrals to community mental health services, crisis resolution callouts and detentions under the Mental Health Act being collected during this period—yes or no?

[Lord Bethell]

My Lords, I understand that it is a firm “yes”, but I will check that answer and revert to the noble Baroness if there is any different information.