Covid-19 Update

Baroness Brinton Excerpts

Wednesday 10th November 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for the Statement, which largely concerns the matter which we discussed on Monday—making vaccination mandatory for patient-facing NHS staff. I need here to declare an interest as a non-executive director of a local trust.

We know that vaccination saves lives and that it is the best protection against this deadly disease. It helps to cut transmission. We, of course, want to see NHS staff vaccinated. But have the Government considered and taken account of the fact that the NHS is already under the most intense pressure this winter? Waiting lists are close to 6 million, there are already more than 90,000 vacancies across the NHS, and in his Budget the Chancellor failed to allocate funding for training budgets to train the medics we need for the future.

There will be anxiety at local trust level. However laudable the principle, it could exacerbate some of these chronic understaffing problems. We simply cannot afford to lose thousands of NHS staff overnight. Indeed, I spent this morning, as a non-executive of my local trust, discussing risk and its mitigation. Without doubt, the highest risk facing the whole of the NHS is staff shortage.

It was clear that the mandatory vaccine for care home workers covered all staff. These are predominantly in the private sector. Does this new mandate for vaccination apply also to all patient-facing staff, whether they work in the NHS or for private providers?

It is important that the Government have listened to representations from organisations such as NHS Providers, the NHS Confederation and others about delaying the implementation of this until after the winter. We welcome that. I urge the Secretary of State and the Minister to resist the blandishments of the former Secretary of State to bring forward any deadlines. However, have the Government consulted the British Medical Association, relevant trade unions and the royal colleges, which have raised concerns about the practicalities of implementing this policy? It seems to me that there needs to be a push right across the piece.

Will the Minister outline to the House what success looks like for this policy? Some of the 10% of NHS staff who are not vaccinated include those with medical exemptions, those who are on long-term sick and those who could not get the vaccine first time round because they were ill with Covid. Can the Minister tell the House the actual number of NHS staff who should be vaccinated but have not had the vaccine? In other words, when does he consider there to be success? Does full vaccination across the NHS look like 94%, 95% or 96%? What are we aiming for here? What is the target?

The aim of this policy is presumably to limit those with Covid coming into contact with patients, but one can still catch and transmit Covid post vaccine, so will the testing regime that is already in place for NHS staff—I think it is about twice a week at the moment— increase in frequency? Furthermore, will the thousands of visitors who go on to the NHS estate every week be asked whether they have had a vaccine or have proof of a negative test?

What analysis have the Government done of those who are vaccine hesitant in the NHS workforce? What targeted support has been put in place to persuade take-up among those groups? We know that in trusts where take-up is around 80%, specific support has been put in place—I know it has been in my own trust. But we know from society more generally that there has been hesitancy, for example, among women who are pregnant and those who want to have a baby. That means, sadly, that a significant proportion of those in hospital with Covid are unvaccinated pregnant women and, indeed, some of them have died. So, for example, will there be a dedicated phone line to give clear advice to women and their partners who might have concerns?

Today on the BBC “Today” programme, the Secretary of State spoke about the impact assessment for the mandatory vaccination of care home staff. We have been asking the Minister for this information to be brought to the House. We have done that many times. When will the impact information be available to Parliament?

Finally, on vaccination more generally, Leicester has a vaccination rate of 61%, Bradford—where I come from —63%, Bolton 69%, and Bury 71%. Generally, on children’s vaccinations, we seem to be stuck at 28%. On boosters, there are still around 6 million people eligible for a booster who have not yet had one. The Government’s own analysis shows that people over 70 who are dying from Covid or hospitalised should have had a booster, but many have had only two jabs.

With Christmas coming, which will mean more mixing indoors at a time when infection rates are high—with one in 50 having Covid—we are facing six crucial weeks. What more support will the Government offer now to local communities, such as those I have named, to drive up vaccination rates? Nobody wants to see either local or national lockdowns again.

[Baroness Brinton (LD) [V]]

My Lords, I declare my interest as a vice-president of the Local Government Association. I also thank the Minister for repeating this Statement. Covid-19 Statements are now taking on the role of London buses—large gaps for a while and then suddenly two in one week on vaccines. It feels as though arguments were going on behind the scenes for such a quick second vaccine Statement to be repeated in less than two or three working days.

Like the noble Baroness, Lady Thornton, my honourable friend Daisy Cooper MP asked yesterday about the publication of the long-awaited impact statement —Making Vaccination a Condition of Deployment in Health and the Wider Social Care Sector—that this Statement refers to. It would have been helpful for MPs to have had sight of it at the same time as the Statement. As the noble Baroness, Lady Thornton, said, frankly we needed to see it a long time ago, given that the social care deadline starts tomorrow. It was finally published overnight, and I have some questions on it for the Minister.

The Statement announces that all NHS and social care staff will have to have to be fully vaccinated by 1 April 2022. The deadline for care home staff remains tomorrow. The predicted numbers on page 4 of the impact statement are pretty staggering—up to 126,000 staff, of whom 73,000 are expected to be NHS staff. Page 6 of the impact statement also says that the modelling cost of replacing unvaccinated workers is between £162 million and £379 million. That is also staggering, given the financial pressures and backlog of cases across a health and social care sector that at the moment is still struggling with the pandemic.

From these Benches we really want to see staff vaccinated but would prefer that it is voluntary and remain concerned about the consequences of tomorrow’s care homes deadline. Page 6 of the impact statement published overnight talks about the disruption to health and care services. But for social care that disruption has already started. Many care home staff have already left or this week are being fired, with a good number moving to the NHS and to retail and hospitality roles.

Large homes are reporting closing down wings of beds due to lack of staff and some smaller homes are handing back state-funded patients to local authorities. Both the Statement and the impact statement are silent on how patients will be looked after before we even get to the consequences of social care homes without beds.

So can I ask the Minister what emergency plans there are to help areas? By the way, answers that say “It’s down to local authorities” are not helpful. This is a crisis created, at least in part, by mandatory vaccines, and there are no staff or beds that can just magically appear. Or is what Sajid Javid said at the Conservative Party conference the reality: namely, that families will be expected to step up to the plate to look after their loved ones in the absence of care home beds? If so, it would be good to see Ministers’ planning for that and the consequent problems for the workforce.

The Statement says that other parts of the social care system—for example, domiciliary care—that were excluded from the original care decision will now be included, but neither the Statement nor the impact statement is clear about the deadline for those in the social care system now being drawn into mandatory vaccination. Can the Minister say what the deadline is for these new groupings? It surely cannot be that the deadline for domiciliary workers is this week. Is this just for full-time staff employed by the care sector, or will others offering regular services such as activities in care homes or subcontractors working in hospitals now be included? There are staff working as sub- contractors for the NHS who have front-line access to patients; for example, delivering meals. Are they included or excluded?

The table on page 4 of the impact statement lists the total number of staff in each sector exempt from vaccination. I cannot find anywhere the criteria for exemption. Can the Minister please tell the House what those criteria are?

I have now asked the Minister at least twice in the past fortnight about the online vaccination form which sits behind the GP records and the app. How many of those who were vaccinated overseas and those who took part in clinical trials are now on the records system? Has it increased from the 53 people that he talked about last week, and are the arrangements for logging third doses for the severely clinically extremely vulnerable, as distinct from the booster doses for everyone over 50 and health staff, now sorted out? I am still getting reports that they are not.

Finally, there has been considerable concern that the Prime Minister was not wearing a face mask at Hexham hospital yesterday, against all NHS advice. This morning, Dr David Nabarro, the World Health Organization’s special envoy for Covid-19, said on Sky News:

“I’m not sitting on the fence on this one … Where you’ve got large amounts of virus being transmitted, everybody should do everything to avoid … getting the virus or inadvertently passing it on. We know that wearing a face mask reduces the risk. We know that maintaining physical distance reduces the risk. We know that hygiene by regular hand washing and coughing into your elbow reduces the risk. We should do it all, and we should not rely on any one intervention like vaccination on its own. So … please, would every leader be wearing face masks, particularly when in indoor settings? … This virus is unforgiving, and we need to do everything possible to prevent it getting in between us and infecting us.”


Can the Minister explain why the Prime Minister was not wearing a face mask, in breach of Hexham hospital’s rules, and will he pass on those words from Dr Nabarro to No. 10 Downing Street?

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

I thank both noble Baronesses for their questions and the important points they made. It is important that we are clear about many of the issues that they have brought up.

Let us be clear that the best mitigation against this is to encourage those who are vaccine hesitant to take up the offer of vaccination. In both health and social care, we have worked extensively with key stakeholders and arm’s-length bodies to encourage vaccine take-up. This has involved a number of different measures: bespoke communications materials, paid advertising, stakeholder toolkits, positive messaging using influencers and leaders, content in different languages, briefings with different faith groups, webinars with clinical experts, vaccine champions and practical support including vaccination at places of work, flexible access to vaccine hubs, digital booking support and monitoring and support from NHS England. We will continue to encourage uptake in the run-up to the requirements coming into force.

The NHS has also focused in recent months on a targeted approach to improve uptake in hesitant groups by undertaking specific, targeted campaigns directed towards, for example, midwifery staff, ethnic minority groups in certain areas that have been hesitant and students, as well as using the booster campaign as an opportunity to re-engage staff. I thank noble Lords across the House for the advice that they have given me on how we can address hesitancy in some communities and for their very useful suggestions. I have discussed this with a number of other people, and we are looking at potential pilot projects, one working, for example, with faith communities in inner-city areas and mapping the data from Public Health England and the relevant offices.

It is interesting to see how many absences are due now to the unvaccinated. The seven-day average to 6 October 2021 shows an average of 74,863—nearly 75,000—absences in NHS trusts per day, of which more than 15,500 were for Covid-19-related reasons, including the need to isolate. This benefit would be reduced if we relied only on testing, although that remains part of our armoury.

I was asked a number of questions about scope and who this extends to. It applies to all providers, both public and private, of a CQC-regulated activity. This obviously covers a wide range of services, including hospitals, GP and dental practices, and social care providers. Further support on implementation for the sector will be provided through continuous guidance. The policy does not apply to those services and activities which are not regulated by the CQC. Children’s and social care services which are CQC regulated will be in scope of the requirement, but it will not apply to services that are provided as part of shared-living arrangements. Many of these reasons are of course as a result of the extensive consultation that has been undertaken.

I was asked for the number of uptakes. The vaccination uptake figures for NHS staff show that nearly 93% have had at least one dose. Uptakes still vary, from 84% to 97% for the first dose, among NHS trusts. Among primary care workers, this ranges from 94% in the south-west to 76% in the east of England—so we would welcome the advice of any noble Lords who have experience of the east of England. In adult social care, nearly 84% of domiciliary care staff have received one dose of the vaccine, and nearly 75% have had a full course of a Covid-19 vaccine, as of 14 October, which we believe represents the best proxy for the workforce in scope of the policy in other settings, too. So, despite our best efforts, there is still much more that we can do. I personally feel very uncomfortable about compulsion, but I also understand the arguments on both sides when I meet many patient groups and others who tell me that, if they were in hospital or a care home or had relatives there, they would feel much better if the staff were vaccinated and were protected.

What more can we do? The Covid-19 vaccines have been approved by the MHRA as safe and effective, and we continue to send that message out. Analysis suggests that the Covid-19 vaccination programme prevented more than 100,000 deaths in England as of 20 August. We continue to have targeted engagement. The NHS plan also includes one-to-one conversations for all unvaccinated NHS staff with their line manager, with clear guidance on how to do this. We have found that such one-to-one conversations are working in some cases. We want to make sure that we listen as well, hearing concerns that are seen to be legitimate as well as concerns that are not medical reasons but other reasons that staff may have for being so hesitant. It is really important that we understand, and that was all part of the extensive consultation.

We are trying to increase the number and diversity of opportunities. We are using the booster campaign, walk-ins and pop-ups for not only the public but staff as well.

A question was asked about pregnant women. Short-term exemptions from requirements are available to those with short-term medical conditions, but also including pregnancy. For pregnant women, the exemption expires 16 weeks after childbirth. This will allow them to become fully vaccinated after the birth. We will set out these arrangements, as has been called for by noble Lords, in the guidance on exemptions.

As noble Lords acknowledged, we set out yesterday an assessment of the impacts alongside the laying of the regulations. We also published a full impact assessment yesterday for the original care home regulations, and I thank the noble Baroness for acknowledging that. As committed to by my right honourable friend the Secretary of State in the other House yesterday, we will publish a full impact assessment for the regulations as soon as possible, and before Members vote on the proposed legislation. I recognise that Peers will be keen to understand the impacts of the policy as soon as possible and as part of consideration of the regulations. However, I hope that noble Lords will appreciate the necessity of trying to move as quickly as possible to ensure that patients are protected and that workers are given as much notice as possible. We will set out the statement of impact, which noble Lords will be able to consider, and it will be published before Members cast a vote.

We have done a number of things on vaccine hesitancy, and I have laid them out already. We want to encourage as many people as possible to take up the vaccine ahead of the regulations, which is one reason why we have the grace period until 1 April next year. The individual worker maintains a choice as to whether they decide to have the vaccine. Even if they choose not to have the vaccine, the registered person may redeploy them to a non-patient-facing role. When that is not possible, the worker cannot be employed or otherwise engaged by the registered person. This is incredibly important when it comes to patient-facing staff, especially for the families of those patients who are deeply concerned that their loved ones may be infected by unvaccinated staff.

I was asked how the measure will be enforced. On the approach to vaccination requirements, it is the CQC’s role to monitor and take enforcement action. At the time of registration and when inspected, health and care providers would need to demonstrate that they have effective systems in place. There are a number of measures in place to support care home workers. The majority of care home staff are now fully vaccinated, but there are a number of different programmes. Given the time, I shall not go into them but, if noble Baronesses would like more details on those encouragement programmes, I should be happy to write.

David Fuller Case

Baroness Brinton Excerpts

Tuesday 9th November 2021 Lords Chamber

[Baroness Wheeler (Lab)]

I thank the Minister for the Statement and its contents, and I fully welcome the Government’s announcement of an independent inquiry into this unspeakably vile and horrific crime. Across the House, our thoughts and hearts go out to the families of Wendy Knell and Caroline Pierce and those with deceased loved ones. These 100 victims—we are talking about the corpses of 100 women—were, as has been reported in the press, violated in the most monstrous, vile and sickening way.

Will the Secretary of State confirm that all the families impacted will have immediate access to the psychological counselling and support that they need? Will NHS staff at the hospital, many of whom will themselves be devastated, also have access to appropriate counselling and support? What steps are being taken to identify the 19 victims yet to be identified?

I also pay tribute to local Members of Parliament across Kent and Sussex who have spoken up on behalf of their communities in recent days. ln particular, the MP for Tunbridge Wells, Greg Clark, said over the weekend that authorities and politicians must

“ask serious questions as to how this could have happened and … establish that it can never happen again.”

This is why the inquiry is so crucial. Can the Minister set out its timetable and say when the terms of reference will be published? Can he confirm that its remit will allow it to make recommendations for the whole NHS, as well as for the local NHS trust?

Fuller was caught because of a murder investigation, which in itself prompts a number of questions about the regulation of mortuaries. The Human Tissue Authority, which regulates hospital mortuaries, reviewed one of the mortuaries in question as part of its regulatory procedures. It raised no security concerns, but found a lack of full audits, examples of lone working and issues with CCTV coverage in another hospital in the trust. Will the inquiry look at the way in which the HTA reviews hospital mortuaries, as well as its standards and how they are enforced? Will it be asked to recommend new processes that the Secretary of State will put in place if it is found that a mortuary fails to meet the necessary high standards for lone workers, security and care? If the HTA’s role is not to be included in the inquiry, how will this work be undertaken by the Government and within what timescales?

The requirement for NHS trusts to review their procedures and ensure that they are following current HTA rules and guidance is very welcome. This procedure must include the requirement for all mortuaries to document and record the access of all staff and visitors entering a mortuary, ensure that CCTV is in place comprehensively across all mortuaries, and that CCTV standards on usage and access records are fully enforced. Can the Minister confirm this? What is the timeframe for hospitals to adopt the extra rules that have been announced on CCTV coverage, swipe access and DBS checks in every single hospital and mortuary? Can the Minister confirm whether this will be guidance or a statutory requirement? There are, of course, other premises where dead bodies are stored, such as funeral directors, that do not fall under the regulatory remit of the Human Tissue Authority, so will the authority’s remit be extended? Will the inquiry look at regulations for other premises where bodies are stored?

The Minister will agree that the conduct of the inquiry itself will be very important for victims’ families. Will they be allowed to give evidence on the devastating impact that the crimes have had on them? When our loved ones are admitted into the hands of medical care, that is done on the basis of a bond of trust that they will be cared for when sick and accorded dignity in death. That bond of trust was callously ripped apart here. I repeat the offer from our shadow Secretary of State, Jonathan Ashworth, to work with the Secretary of State to ensure that something so sickening never happens again.

[Baroness Brinton (LD) [V]]

[Inaudible]—but that such a prolonged period of abuse was able to take place without it being noticed. We echo the sincere condolences to the families and friends of Wendy Knell and Caroline Pierce, as well as the many families and friends of those whose bodies David Fuller so foully desecrated.

The Statement says that the families and friends will have access to mental health support and counselling. That is good, but can the Minister confirm that it will be available for as long as they need it and will not be time limited? Will the staff at the mortuaries and hospitals, as well as the police and the over 150 family liaison officers involved in this case, also have access to counselling? They too have had to deal with this very distressing series of events.

We must obviously be very careful in our discussions today pending the sentencing of David Fuller, but we welcome the Secretary of State’s announcement for the upgrading of the trust’s independent review to an independent inquiry, to be chaired by Sir Jonathan Michael.

In August 2018, the Health Service Journal reported that 58 mortuaries that had been inspected in 2017-18 revealed that more than 500 “shortfalls” were exposed during that period. Worryingly, that included eight critical failings. At that time, the Human Tissue Authority as regulator and the various other regulated bodies undertook to look at the large increase in failings that year and to review practice. What actions were taken following those 2017-18 reports and were measures on access by staff to mortuaries among them? I ask this because, looking at the Human Tissue Authority’s codes of practice online, almost the entire focus seems to be on those whose role is to be involved with bodies. In Code A: Guiding Principles and the Fundamental Principle of Consent, the only reference I can find that does not relate to those with direct responsibilities for bodies is in paragraph 14 on page 7, which begins:

“Quality should underpin the management of human tissue and bodies.”


It goes on to say that this means that:

“practitioners’ work should be subject to a system of governance that ensures the appropriate and safe storage and use of human tissue and which safeguards the dignity of the living or deceased”,

and that

“premises, facilities and equipment should be clean, secure and subject to regular maintenance”.

One of the concerning issues relating to this case is that Mr Fuller ceased to be an employee of the Tunbridge Wells health authority in 2011 when the maintenance contract was subcontracted out. Will the inquiry look at not just whether employees of subcontractors working in sensitive areas are subject to DBS checks but whether there is a duty on their employer to report any findings to the hospital, or in this case the mortuary? Mr Fuller had a previous criminal record, but it is reported that the hospital did not know this.

There is another issue which I have not heard referred to either here or in the Statement in another place yesterday, and that is our criminal justice system’s approach to the desecration of bodies. The respected criminologist Professor Jason Roach from Huddersfield University has analysed the policing of and law in Britain towards necrophilia. He found an almost complete absence of case studies, which is not true in the rest of the world. Indeed, it was not until the Sexual Offences Act 2003 that necrophilia became a criminal offence in its own right, but he says there is no evidence that anyone has ever been prosecuted. He reports that, as part of his research in 2016, he was told by one senior police officer that it was very unlikely that the police would ever urge the Crown Prosecution Service to charge an offender.

One hypothesis that Professor Roach explores in his 2016 work “No Necrophilia Please, We’re British” is that

“the attitude of the British criminal justice system towards necrophilia echoes that of the British public, i.e. one of embarrassment, whereby those caught are either not charged with a criminal offence or, perhaps for the sake of the deceased’s family, are charged with a less degrading offence such as grave robbing. Both routes will produce less attention-grabbing stories”.

Can the Minister say if the review will look at police and criminal justice system attitudes towards necrophilia or other forms of desecration of bodies? One of the deeply unsatisfactory legacies of Jimmy Savile’s extended abuse is the suspicion of his undertaking such activities. However, perhaps through embarrassment, there has been no real examination of that case and the cultures of the places where he was able to have access to the dead.

Can the Minister say if any lessons learned so far will be reported and implemented straightaway, before the full independent inquiry reports, to give the public confidence that hospital mortuaries are safe and secured? As ever, if the Minister does not have any of the answers to my questions to hand, please will he write to me with them?

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

My Lords, this is one of the most difficult issues that we have had to address and discuss in my short career at the Dispatch Box. It is one of those crimes that are beyond imagination. Who could think that an act of such depravity would occur? David Fuller has pleaded guilty to the murder of Wendy Knell and Caroline Pierce, and all our thoughts are with Wendy and Caroline’s families and friends.

In recent days the courts have heard about a series of David Fuller’s shocking and depraved offences. He is yet to be sentenced, so I am sure noble Lords will understand that it would not be appropriate for me to comment on the details of the case while the legal process is still in progress. However, I will try to address as many of the questions about the response as possible.

This is a profoundly upsetting case that has involved distressing offences within the health service. I apologise to the friends and families of all the victims for the crimes that were perpetrated in the care of the NHS, and for the hurt and suffering that they are feeling. It has taken months of painstaking work to uncover the extent of this man’s offending. The fact that these offences took place in a hospital, somewhere all of us would hope to feel safe and free from harm, makes it all the more harrowing. This has been an immensely distressing investigation, and I thank the police for the diligent and sensitive way in which they have approached it. I also thank Maidstone and Tunbridge Wells NHS Trust for co-operating so closely with the police.

I am sure that in the inquiry all matters will be considered and that it will be as full and comprehensive as possible, but it is critical that we investigate this case thoroughly to ensure that lessons are learned. My right honourable friend the Health and Social Care Secretary is replacing the trust investigation with an independent non-statutory inquiry, which will look into the circumstances surrounding the offences committed in the hospital as well as their national implications. That will help us to understand how these offences were allowed to take place without detection in the trust and then to consider the wider national issues, including for the National Health Service. My right honourable friend has also asked the Human Tissue Authority to advise on whether changes are required to the existing legislation.

What will the independent inquiry do? We thank the NHS trust and its leadership for its quick initial work in setting up the investigation, but we have a duty to look at what happened in detail and to make sure that it never happens again. The Secretary of State has appointed Sir Jonathan Michael to chair the inquiry. Sir Jonathan is an experienced NHS chief executive, a fellow of the Royal College of Physicians and a former chief executive of three NHS hospital trusts. He has been leading the trust investigation and will be able to build on some of the work that he has already done. The inquiry will be independent and will report to the Secretary of State.

The noble Baronesses asked about the timeframe. Sir Jonathan will split his time into two parts. The first report will be an interim one, which has been asked for early in the new year. The second and final report will look at the broader national picture and the wider lessons for the NHS and other settings. We will publish the terms of reference in due course. Sir Jonathan has been asked to discuss with families and others to ensure that their feelings are fully considered and that they input into the process. Sir Jonathan’s findings will be public and will be published.

We all know that this is a shocking case. None of us ever thought that we would have to take part in a discussion such as this. Specialist police officers have contacted the families of the victims directly and privately. We want to, and we must, respect the families’ privacy at this difficult time. There is a comprehensive package of support for the families affected. This includes dedicated caseworker support, a 24/7 telephone support line and specialist support, such as mental health support and counselling, as needed and as appropriate. The trust is also talking to family members who wish to be contacted.

Kent Police has set up a major incident public portal and contact centre to manage calls, collect any relevant additional information and direct people to other sources of support. If people are interested in looking at that, they can search online for the major incident public portal and select Kent Police and Operation Sandpiper. We know that this is distressing for many people, both the families and more widely.

Wider support can also be accessed through the Ministry of Justice Victim and Witness Information page, which provides links to local support according to postcode, the 24/7 Victim Support helpline and My Support Space, a platform providing many guides and tools and access to a 24/7 live chat function. The trust has worked closely with the police to put in place a comprehensive package, and we thank the NHS trust for the measures it has put in place. We also recognise that, as the noble Baroness said, all those working in the trust and wider health service are profoundly shaken by the nature of these offences. The trust has put support in place for affected staff.

The trust and NHS Resolution are considering the right approach to compensation, but that involves getting further legal advice. The trust will provide support to the families concerned. As we have said, it is also important that we understand what is happening.

The police have so far found evidence of 100 victims of the offences committed in the hospital mortuary and have been able to formally identify 81 victims. They are seeking to identify all the victims, as is appropriate. Specially trained family liaison officers have spoken to all the families of those identified to date.

It is important to make sure that this is investigated thoroughly, and I want to be careful not to pre-empt the inquiry’s findings. Under the current regulations, the Human Tissue Authority regulates licences and inspects organisations that run mortuaries where post-mortems are carried out. Mortuaries that do not carry out post-mortems may not need to have a licence from the Human Tissue Authority. It is the responsibility of the organisation running a mortuary licensed by the HTA to ensure that the HTA’s licensing standards are met, including those relating to security. It is also for the organisation running the mortuary to ensure that safety procedures are in place.

I was asked about the DBS regime. In July the Home Office announced an independent review of the disclosure and barring regime. The review will consider the adequacy of current arrangements for criminal record checks for jobs that entail contact with the deceased. Ministers are finalising arrangements for the review, and further details will be announced as soon as possible.

I apologise to noble Lords if I have not answered their questions. I hope I will be able to follow up with answers.

Public Health England (Dissolution) (Consequential Amendments) Regulations 2021

Baroness Brinton Excerpts

Tuesday 9th November 2021 Lords Chamber

[Lord Lansley (Con)]

My Lords, it was not my intention to speak in this debate—I wanted to come and listen to it—but I am prompted by a number of contributions just to say one or two things in response to the debate and before my noble friend has a chance to reply. I share with my noble friend Lord Cormack his support for my noble friend in taking on these responsibilities, and nothing I have to say reflects on his role in this. Indeed, I think it has been handed on to the Secretary of State as well, so in a sense we have a new team and I hope they will think about things sometimes in new ways.

I want to make a few, very simple points. The noble Lord, Lord Hunt of Kings Heath, is absolutely right: Public Health England was an executive agency. It worked for the department. In so far as it had operational autonomy, that was not in the legislation; it was a choice made by Ministers. At any stage, as was the case during the Covid crisis, Ministers had all the powers they required in relation both to Public Health England and to the NHS under the emergency legislation.

Let us remember that this House went through the 2012 Act in scrupulous—I might almost say excruciating —detail. It arrived at a conclusion that NHS England should be independent and Public Health England an executive agency. Notwithstanding certain measures put into the legislation to make sure that Public Health England would be more transparent and accountable, that balance was struck not least because I and my colleagues on behalf of the Government said, “We want the NHS to be seen to be independent. We want Ministers to take personal responsibility for public health.”

The noble Lord, Lord Howarth of Newport, referred to one or two things that happened afterwards. I want to share in thanking Duncan Selbie for what he achieved. I want to make it absolutely clear that I understand that Ministers subsequent to the establishment of Public Health England did not give to public health the resources, either for PHE itself or for local government with its responsibilities, that were intended back in 2010-12 under the coalition Government. That did not happen.

Let us remember that, at the beginning of 2020, the King’s Fund produced a report saying that it thought that the public health reforms had worked but they had not been sufficiently funded. Internationally, Public Health England was regarded as being as prepared for a pandemic as virtually any other country in the world. That things fell down needs to be thoroughly examined by an inquiry. An inquiry has not even begun, yet we are already at the point where people have made judgments, reached conclusions and found scapegoats. Heads and deputy heads have rolled.

We are not going about this in the right way. I want Ministers in due course to think again in the light of the report of that inquiry about what constitutes the right mechanism for managing their public health responsibilities. They need an organisation that understands public health in its entirety. How many of us think that the pandemic was unrelated to the extent of non-communicable diseases in this country, to the extent of disparities in this country and to extent of the obesity epidemic that we suffered?

We have so many interconnections between inequalities and public health problems, and our resilience against communicable diseases, that we should never think of managing public health in separate, siloed organisations again, but that is exactly what the Government are doing, without, frankly, having thoroughly understood what happened in in 2020 and 2021. I hope that they will go back and say, “Prevention is not the job of the NHS. Prevention is the job of the Government.” Public Health England was the organisation whose job it was to do that. If it was not strong enough in 2020 to do it, Ministers might look at what they did in the preceding years that might have undermined that role and think carefully about how they should take on the responsibility of building an integrated and fully functioning public health organisation for this country in the future, certainly not simply fragment it.

[Baroness Brinton (LD) [V]]

My Lords, I declare my interest as a vice-president of the Local Government Association.

From the Liberal Democrat Benches, we support the Motion of Regret in the name of the noble Baroness, Lady Merron, and the noble Lord, Lord Cormack and the noble Viscount, Lord Stansgate, are absolutely correct that this House does not like the fact that once again the Government have chosen to use secondary legislation to make major changes to the way the Government manage their business—in this case, public health.

The noble Baroness, Lady Merron, has set out the chaos of a series of announcements from August last year, followed by a variety of procedures and changes when the Government kept getting things wrong. I absolutely support her concerns, and, as have many other speakers, I start from the position that major reorganisations during a global pandemic are unsound and unhelpful, not just to dealing with the pandemic but to the performance of any successor bodies, including the UK Health Security Agency and the Office for Health Promotion and Disparities, with disparity work continuing in NHS England. I echo the comments of the noble Lord, Lord Howarth, and others on the work of all the PHE staff, and Duncan Selbie in particular.

Cancer Drugs: Licensing and Approval

Baroness Brinton Excerpts

Monday 8th November 2021 Lords Chamber

[Lord Kamall (Con)]

I think noble Lords will agree with that frustration at the speed of approval and licensing, but in most cases it does happen speedily. One of the central issues is making sure that there is confidence in the ability to purchase. We are looking at a number of different ways to accelerate the process, including through ILAP—the accelerated partnership—while also making sure that MHRA and NICE can speak where they are allowed to, given some of the legal restrictions on their discussions. For example, I went a couple of weeks ago to a board-to-board meeting between MHRA and NICE at which they discussed issues of common concern.

[Baroness Brinton (LD) [V]]

My Lords, picking up on the point of the noble Lord, Lord Hunt, there is a particular problem in the United Kingdom with NICE and MHRA appearing not to talk together as much as they should to help streamline the process, where that is appropriate. An academic paper in March demonstrated that the CDC in America has a much stronger, streamlined system that works, with far fewer drugs being delayed. How can NICE and MHRA learn from what is happening abroad?

[Lord Kamall (Con)]

It is important that we learn the best lessons from abroad on incredibly important issues such as this. Where NICE and MHRA are allowed to talk to each other and co-operate—there are some restrictions, as I am sure many noble Lords are aware—both clearly recognise that there are great concerns and distress on the part of the many patients who want access to these drugs, and they are trying to work out how they can speed up the process as much as possible.

Covid-19 Vaccinations

Baroness Brinton Excerpts

Monday 8th November 2021 Lords Chamber

[Baroness Thornton (Lab)]

I start by thanking the Minister for taking the Statement. I very much welcome the new antiviral, molnupiravir—another name we all have to learn—as a significant drug in our armoury in the fight against Covid. I think this might be my and the Minister’s first Covid Statement since he was appointed, though we have done several Questions. I thought it might be useful to remember the last 18 months for a moment, when his predecessor and the House dealt with, on average, two Statements and several Questions about Covid a week.

Let us be quite clear: the NHS and social care services have saved the country, and they continue to do so as we move into winter. I again place on record my gratitude from these Benches to the NHS, social care services and all the staff from the top to the bottom of our health service who have worked so hard to save lives, protect the vulnerable and roll out vaccines. But we should remind ourselves that 142,000 people have died from Covid in the UK so far, and 1,173 died last week. We have the highest, or one of the highest, infection rates in Europe. This is not over by a long way, and we are now moving into the winter. Frankly, one has to question whether the Government have a handle on Covid going into the busiest season for our NHS.

The Government must get a grip on the stalling vaccination programme. The Health Secretary, Sajid Javid, is calling on younger relatives to help their eligible parents and grandparents take up the offer of the booster and the flu vaccine. Older and vulnerable people have been urged to get their Covid-19 booster jabs as part of a “national mission” to help avoid a return to Covid restrictions over Christmas. The Health Secretary said:

“If we all come together and play our part”,


the country can

“avoid a return to restrictions, and enjoy Christmas.”

That is a bit late, and it is absolutely in line with this Government’s handling of the pandemic—about two to three weeks later than they need to be. It is a bit rich for the Secretary of State to line up who is to blame if we do need further restrictions at Christmas because the Government have failed to get everyone vaccinated who needs to be.

I ask the Minister specifically about immuno- compromised patients. In September, the JCVI recommended that severely immunosuppressed patients have a third primary dose prior to having their booster jab to maximise their protection. There has been a lack of clarity about whether and when this would happen, which has caused huge confusion among a very vulnerable group in our communities. It is estimated that between 400,000 and 500,000 people fall into this category and are entitled to both a third primary jab and a booster. These two things are not interchangeable. Can the Minister tell the House how many of this group have received a third primary jab, and how many are going on to have a booster? How many are missing out on potentially life-saving doses of Covid vaccines after confusion about who is eligible for a third dose followed by an additional booster jab?

The blood cancer charity Myeloma UK said its helpline has been inundated with hundreds of inquiries in recent months from patients who are struggling to book their third and fourth doses. To compound this challenge, patients like this cannot turn up at a walk-in or mass vaccination centre. What plans are there to ensure that the immunosuppressed receive the vaccinations they need?

More generally, local residents are contacting their MPs to say that they cannot get the boosters they so desperately want. One lady in her 70s with an underlying health condition went to her pharmacy and called 119, just to be told that she was not eligible for her booster—but she knew she was. She finally has one booked in December, but she had to rely on her daughter to book the appointment because she does not use the internet. The system simply is not working for many of those who need it most, because they do not have access to the internet or the new technology the Government want them to use to get their boosters.

Turning to care home residents and booster vaccinations, 1 November was the Government’s target for getting care home residents their booster jab. Could the Minister tell the House what proportion of care home residents have been vaccinated so far? My honourable friend Dr Allin-Khan said in the Commons on Thursday that only about a quarter of care home residents in Leicester have had their booster. The former Secretary of State is now calling for all NHS staff to be compulsorily vaccinated. Is this government policy? If so, what is the timetable? Is it wise to force this through right now when the NHS has a vacancy rate of 100,000?

Finally, plan B, which contains measures that we on these Benches already support, such as mask wearing and allowing working from home, is simply not enough on its own. Yes, we support it, but we must turbocharge vaccine boosters, fix sick pay, and improve ventilation. Does the Minister agree?

[Baroness Brinton (LD) [V]]

My Lords, from these Benches, we add our thanks to all those involved in the current delivery of vaccinations, whether they are GPs, nurses, healthcare assistants or volunteers at vaccination centres, and we thank more broadly our NHS and care-sector staff who are still working extremely hard to reduce the backlog of cases while coping with over 9,000 patients currently in hospital with Covid.

The Minister knows that the Delta variant and its subvariant, which is thought to be behind the growth of cases in the west country and Wales, remains highly transmissible. Doctors are reporting daily that double-jabbed patients are catching Covid and passing it on. Why have none of the mitigations in plan B been carried out? Many scientists, including some members of SAGE and Independent SAGE, believe that we should be operating them now to reduce the high numbers of cases and not be faced with a second Christmas being cancelled by the Prime Minister at short notice.

From these Benches, we have asked time and again for the wearing of facemasks inside and on public transport, as well as room ventilation in schools and other public venues, to be mandated, and for social distancing to remain. There are now, on average, 35,000 new cases daily, a shockingly high number. Professor Peter Openshaw, the chair of NERVTAG, said today that it was clear that immunity from the vaccines is waning. Yes, and vaccination is vital, but with cases at this level why are the Government not making mask mandates and social distancing formal?

Today, the Prime Minister once again reminded people to get their jab, whether first, second, third or booster, the ONS data showing that the risk of dying from Covid is 32 times greater in unvaccinated people. Can the Minister tell us why last week it was announced that vaccination centres are now closing at 6pm? Surely it should be easy for people to get vaccinated at a time that works for them, when they leave for work or get home from work?

The last time we spoke about Covid, I asked the Minister what the Government were doing to prevent some of the very unpleasant anti-vaxxer interventions at school gates and outside some vaccine centres. Has any action been taken on their disgraceful leaflets, which deliberately look like an NHS document but are full of direct lies and mistruths? It is important, because, by the Minister’s own numbers in this Statement, only 22% of 12 to 15-year olds have had their vaccination so far. I think Ministers now recognise that cases in this age group are driving cases in the older age groups, which is probably why hospital numbers are going up.

The noble Baroness, Lady Thornton, referred to the muddle between booster and third doses. The pandemic is far from over for immunocompromised and immunosuppressed people. I declare my interest as one of the clinically extremely vulnerable, as I have said before. I discovered by chance, reading something online, that I am now in the third-dose category. My GP did not know it and I certainly did not know it either. That is the problem. GPs and vaccination centres have not been told about the distinction. I have read the NHS guidance on the third dose, but many other clinically extremely vulnerable people are saying that their surgery or vaccination centre does not understand which category they fall into.

This is not helped by the problems with the online form which I asked the Minister about last week. Does the online form now specify the third dose, which is for around 800,000 people, according to current estimates, not for 400,000 people, as the noble Baroness, Lady Thornton, said, as distinct from the booster, which is for around 20 million? It is important, because the third-dose patients must have a booster in a further few months. If the system is not even recording the third dose, how will it know to call them back?

With the end of the shielding programme on 17 September, Sajid Javid wrote to all those on the patients’ list to inform them that it had finished, that the Government would no longer be offering specific advice and that we should go to our hospital clinicians. But many of us do not have an appointment in the diary, and there is not likely to be one because our clinicians are catching up with the backlog of cases, and those who are specialists in immune diseases are working on the Covid wards as well. So can the Minister say how on earth the clinically extremely vulnerable are meant to know what to do in the meantime?

Will the Minister ensure that the Government will work with patient organisations, clinicians and employer to produce clear and meaningful guidance that promotes safe working practices for this group and, in particular, let employers know that they have to help employees either to work from home or, if they have to go in, to make sure they do not have to go in by train or bus at peak hours? Please will the Government appoint a dedicated national lead to co-ordinate the support and guidance available to people in this group?

The news in the Statement of the approval of the Merck and Ridgeback antiviral Molnupiravir is also good news. I see that just under half a million courses of doses have been ordered. It was good to hear on Saturday of the success of the Pfizer clinical trials elsewhere, but I gather we are some way off from that being approved, because further trials of people who are clinically vulnerable are needed. Can the Minister tell the House the likely timescales of the actual delivery of both these different antivirals?

Finally, I am aware that I have asked some technical questions. If the Minister cannot answer them today, please will he write to me with the answers?

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

I thank the noble Baronesses for their questions and for raising some very important points, on which I and others have been in discussion not only with health professionals but with departments and other advisers. I will try to answer their questions in detail. The ones that I do not answer because of their technical nature—as the noble Baroness, Lady Brinton, acknowledges—I will try to answer later if I am unable to answer now.

First, I join the noble Baronesses, Lady Thornton and Lady Brinton, in praising our wonderful doctors, nurses and other healthcare staff. Also, we should not forget all the wonderful people who have supported them: the delivery staff who brought stuff to their homes and delivered food, and the local civil society projects. We saw a massive upsurge in voluntary work and volunteerism. Whatever our politics, whatever part of the spectrum we are on—whether we call it co-operative socialism, local libertarianism, community conservatism, or just humanity and people helping each other—I thought it was a wonderful expression of what we can do when we all pull together.

We also have to remember, as the noble Baronesses, Lady Thornton and Lady Brinton, reminded us, that this is not over. That is one of the reasons why the Secretary of State felt it was important to make this Statement and this point. There has been a level of complacency in encouraging people to come forward. We have not been strong enough, which is why we are pushing now and emphasising the fact that we want as many people as possible to come forward and get the booster. It was announced over the weekend that it is not necessary to wait for six months after the second dose; people can book from five months. In fact, today I tested the system and took advantage of it and was able to book my booster. I hope many others will be able to do so to.

I would ask noble Lords across the House that if anyone comes to them with experiences of not being able to use the service—we have had a couple of reports of a few technical hitches—please let me know so that I can pass them on to NHSX, so that we make sure that we are aware of problems as soon as possible. So far—I want to try to touch some wood somewhere—it seems to be working.

Let me now turn to some of the detailed questions that I was asked by the noble Baronesses. The JCVI has advised that people with severe immunosuppression at or around the time of their first or second vaccination receive a third primary dose as a precautionary measure. Some individuals who are severely immunosuppressed due to underlying health conditions or medical treatment may not achieve the same full immune response to the initial two-dose Covid-19 vaccine course. The third dose aims to bring them up to nearer the level of immunity. As with the vaccination of other at-risk individuals, eligible individuals will be identified and invited by the hospital where they receive care under a consultant and/or GPs.

If either of the noble Baronesses or any noble Lord here today is aware of that not happening, please let me know so that I can make sure that we push on this. I am told that the NHS is writing to all patients who may be eligible so that they can talk through their options with their GP or consultant if they have not done so already. Any patients who have not yet been contacted but think they may be eligible, for example because they have previously been advised to shield, can contact their consultant for an update. If noble Lords know of any problems or are aware of any issues, I hope that they will let me know as soon as possible so that I can chase on them.

On the booster, while there are many stories saying that we have not done that well, we have 12% booster vaccination. When we look at booster vaccination in other European countries, the highest is Israel with 45%, but Spain is at 2%, Italy is at 3%, France is at 4% and Germany is at 2%. This is why we are emphasising the importance of booster vaccinations. My right honourable friend the Secretary of State and others are keen to push people to make sure that they have their booster as soon as possible. It is the best defence against Covid and it is important, especially as protection wanes, that people are getting their boosters.

On plan B, I repeat what has been said previously: there is no set threshold. We consider a range of evidence and data, as we have done throughout the pandemic, to avoid the risk of placing unsustainable pressure on the NHS. For example, while the number of Covid-19 patients in hospitals is an important factor, the interaction with other indicators, such as the rate of increase of hospitalisations and the ratio of cases to hospitalisations, will also be vital.

The Government monitor and consider a wide range of Covid-19 health data. I shall go into some of them in a bit of detail. We look at cases, immunity, the ratio of cases to hospitalisations, the proportion of admissions due to infections, the rate of growth in cases and hospital admissions in the over-65s, vaccine efficacy and the global distribution and characteristics of variants of concern. We also look at the risk to the NHS. One of the issues, as many noble Lords will know, is about making sure that the NHS is not overwhelmed. In assessing the risks to the NHS, the key metrics include hospital occupancy for Covid-19 and non-Covid-19 patients, intensive care unit capacity, admissions in vaccinated individuals and the rate of growth in admissions. The Government also track the economic and societal impact of the virus to ensure that any response takes into account those wider effects.

On some of the measures that are being proposed in the potential plan B, clearly a number of people with other health conditions, including mental health conditions, would be incredibly concerned were we to go to some of the more severe measures under plan B. We always have to balance them up. As noble Lords will be aware, questions have been asked about those awaiting elective surgery and the unintended consequences of focusing on Covid-19, for example whether it has led to a disproportionate number of deaths from other diseases or conditions.

Covid booster jabs have been delivered or booked in almost nine in 10 care homes as the NHS vaccination programme accelerates ahead of winter. Around 6,000 care homes have already been visited, while a further 3,700 homes have visits scheduled in the coming days and weeks. The new figures also show that residents in more than half of care homes have received their booster jab. When I asked about the discrepancies in the small proportion that have not yet been booked or vaccinated, I was told that there may well be cases of Covid in those care homes and they are waiting for the delay after the positive test to ensure that it is safe to go there.

I was asked about the breakdown of different types of care home. Based on the latest CQC annual report on care, we can say that the CQC inspects a number of these care homes.

To answer some of the other questions, as I said, the NHS is writing to all patients who may be eligible so that they can talk through their options. On the issue of whether to make NHS staff take their vaccinations, we have consulted on vaccination as a condition of employment in wider health and social care; I am told that my right honourable friend the Secretary of State will set out the position very shortly. The important thing to remember is that we want people to take the booster, and we want to make sure that we reach those communities and demographics who have not had even their first or second vaccine yet.

I have had a number of conversations with noble Lords from across the House—I thank them for their advice and suggestions—about how to reach out to some of these communities. For example, I was in conversation with one right reverend Prelate about how we could work in conjunction with interfaith communities in local communities, for example in certain parts of London where there is a low uptake. Sometimes people may not be of faith, but they respect faith leaders—vicars, imams, priests et cetera. We are looking at how we can work on this, and I very much hope that we will be able to roll that programme out further. If any noble Lords are interested in or have any suggestions on that area, I would welcome them.

I apologise if there are technical questions that I have not answered; I will make sure that I write to noble Lords.

People with Learning Difficulties and Autism: Detention in Secure Settings

Baroness Brinton Excerpts

Thursday 28th October 2021 Grand Committee

[Baroness Brinton (LD) [V]]

My Lords, I congratulate the noble Baroness, Lady Hollins, on securing this important debate, especially with her expertise following the excellent review that she led two years ago. I declare my interest as a vice-president of the Local Government Association.

The Health and Social Care Select Committee’s report published on 13 July this year makes it absolutely plain that, 10 years on from Winterbourne View, the provision for autistic people and those with learning difficulties sees far too many placed in residential settings, which is unacceptable.

Jeremy Hunt MP, the chair of the Select Committee, said:

“Despite commitments by governments over the years, the totally inadequate level of community provision means that autistic people and people with learning disabilities are wrongfully admitted to inpatient facilities and detained for a shocking average of six years … it is time to recognise that a voluntary approach to reducing the numbers has failed and long-term admissions should now be banned with alternative community provision set up in their place.”


The Select Committee report follows on from the oversight panel review of the noble Baroness, Lady Hollins, saying once again that this is an emergency and needs dealing with immediately. I start by asking what is probably also my final question: can the noble Lord the Minister say when the Government will announce not another plan, but the recommendations and how they will be delivered?

I welcome the comments from the noble Lord, Lord Crisp, about what happened 35 years ago; 25 years ago, when I was chair of education in Cambridgeshire, it really felt as if this country was beginning to become progressive in its approach to ensuring that those with learning disabilities and autistic children should, wherever possible, be living with their families or in their communities with support and going to their local schools. We believed that we had changed things. The evidence is—as the noble Lord, Lord Crisp, said—that too many people are being warehoused in unacceptable settings.

For some people, specialist residential provision has been developed over the years, but there are now complex commissioning rules with health and local government again fighting over the costs—as we heard about in our previous debate. Additionally, the lack of funding from central government to local government for this specialist provision, as well as the general funding crisis that local authorities are facing following cuts of about 30% to their overall budgets, means that there is a real problem and it appears that short cuts have been taken.

Noble Lords have also spoken about the further worry of restrictive practices. The horrors of the Winterbourne View covert videos, showing staff treating in-patients badly, were seared on the public’s soul. Everyone said that this must never happen again. But the evidence is that it continues. Indeed, there was a video of a staff member dragging a young autistic person by his hair only last month in a school. As both the noble Baroness, Lady Hollins, and my noble friend Lord Addington have said, this speaks to the lack of supervision and a lack of training of staff in these institutions. As the Select Committee report said:

“None of this is worthy of a 21st century healthcare system”.


I am grateful to the noble Baroness, Lady Hollins, for giving a successful outcome for one patient, now living successfully and happily in the community. The problem is the inertia and structural problems with commissioners and funding, meaning that 2,000 are still in inappropriate settings at best, and at worst living their lives with their human rights ignored. Immediate action is needed now.

Social Care

Baroness Brinton Excerpts

Thursday 28th October 2021 Grand Committee

[Baroness Brinton (LD) [V]]

My Lords, I declare an interest as one of the vice-presidents of the Local Government Association. I congratulate the noble Lord, Lord Lipsey, on securing this important and timely debate, and for his interesting opening statement about a Labour Peer setting out how the private sector can help individuals to pay for social care. These Benches do not have a problem with that principle; if people wish to make provision for such costs, they should be able to. The big issue from these Benches is whether they understand the social care system for which they are planning to cover costs and whether it will be able to deliver when they need to use it.

I also thank the Association of British Insurers for its helpful briefing, which has wide applicability for the general population, as this issue is not just about financial products. The problem is that, for decades, reform and funding of social care has left us with this current mess—or, perhaps I should say, without the reform and changes to the funding of social care, we have been left with this current mess. It was extraordinary that both your Lordships’ House and the House of Commons each had to pass the Health and Social Care Levy Bill in one day, before Parliament could even see the detail of how the levy and new financial structures will work for social care. This is even before we see the Government’s White Paper on social care, which is still due to be published a few short months away—a line the Conservative Government have been running pretty much since 2015, when they refused to implement the Dilnot commission recommendations. This is very odd, given the Prime Minister’s insistence on the steps of No. 10, two years ago, that it was an absolute priority to

“fix the crisis in social care once and for all”.

For the past 30 years, social care has been funded in this peculiar dual way. Those below the income and asset cap get their care paid for, with the further problem of that being divided into the NHS paying for nursing care and local authorities paying for the personal care element and some, or all, of their accommodation and food costs—misnamed as the hotel costs.

All that the new levy announcement does is raise the cap on the savings element—the noble Lords, Lord Lipsey and Lord Balfe, set out the problems here. The cap should be viewed as a solution to avoid catastrophic care costs for individuals and is not a way to enable a private market. A cap in itself will not necessarily prompt a market for financial products to develop. In particular, a product that would dovetail with the cap would be almost impossible to create. As the noble Lord, Lord Lipsey, said, care needs and costs are unpredictable, both for individuals and therefore for insurers. That, frankly, is why there has been some reticence on the part of the insurers over the years to provide a specific tailored product for care needs, as medical progress over time will determine how many people need care and for how long they need it.

Some of the existing products have been mentioned already, but there are care fee plans or intermediate needs annuities; life assurance policies with care cover included; pensions, investment and retirement income products; and equity release and lifetime mortgages. It was fascinating to hear the noble Lord, Lord Balfe, talk about being plagued by people trying to sell him equity release after he had completed a form online. Equity release is already proving to be something of a problem, as such products are being sold to people every day on their television sets and radios for other uses, including their passing on to their children large amounts of money to provide deposits for homes. Some local authorities are now finding that people who started off as being privately funded move into a position of needing public pay once the residual equity has been sorted out with a prior demand from the bank which has offered the equity release. To a local authority’s frustration, when the property is sold after the death of the resident, someone who was thought to be a private payer suddenly becomes a bill that the local authorities has to pay and had no control over commissioning.

What of the future? The noble Lord, Lord Desai, with his usual expertise, set out the wider economic issues facing the public. The first and most fundamental of them returns to the point I started with. Because of the current muddle, we must have a clear state offer from the Government about the boundaries of who will pay what. I add to that a question for the Minister. Is it planned to run an extensive publicity campaign—not just the odd, occasional advertisement, but perhaps a leaflet to every house to raise awareness in advance of the levy being implemented and to explain to people what will be different? I believe that a large number of people think that, by paying the increase in national insurance to fund the levy, they will be exempt in future. As I have said to the Minister on more than one occasion since he took up his post, most people currently think that they do not qualify to have to pay for any element of their social care costs. Even more, virtually everyone is shocked to discover that there are different systems for the nursing element of their care and personal care. It is clear that we will now have to add to that the accommodation and food costs, which are certainly not included in the cap arrangements under the levy.

Any state offer absolutely must be easy to understand, with preferably just one system. The ridiculous system of having clinical commissioning groups and local authorities arguing about whether a patient’s need is caused by a health issue or is a personal care issue, and the divisive and shameful treatment of dementia as a social care issue, must stop. My brother and I are not alone in having to be present at meetings, in our case about our mother, where the NHS and local council argue about the percentage of nursing care versus personal care on the basis of whether it is needed as a result of her stroke or as a result of dementia. We witness this to a ridiculous degree. All sense of the treatment of the whole person is totally lost when different parts of the system spend enormous amounts of time and energy trying to deflect costs to other parts of the care system.

There is undoubtedly a role for the private sector in helping people to pay for social care, but there are two major stumbling blocks to making it happen. The first is that the public and the financial sector need an absolutely straightforward system that the population understands, especially regarding whether they will be covered by state provision or will need to pay for it from their own resources and may want to plan for that, say, from the age of 40. We need state provision that is not used by different parts to deflect responsibilities in payment, calling crises at the moment that people need to use the system. That means a streamlined system. For those who wish to use financial products to fund their care, the Chancellor must also make it plain what people can do and whether they will get some tax breaks for this careful planning. After all, it is prudent planning that will cover costs in future.

The second issue is much more fundamental. As many Members outlined in the debate of the noble Baroness, Lady Pitkeathley last week, we need comprehensive reform, not just structural reform to the care system. We need to think about this as part of the public health of our nation. Housing, health, working life and activity in later life are all also vital to reducing the need for people going into care homes, let alone having extended stays there.

Social Care

Baroness Brinton Excerpts

Wednesday 27th October 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness makes a very important point: we have to see reforms in the social care sector. The spending of £5.4 billion includes £1.7 billion for wider system reforms, including at least £500 million to support the adult social care workforce in professionalisation and well-being. We are also working closely with providers of care, local government charities, the unions, professional bodies, and users of care and their representatives, and will respond to their views in the forthcoming adult social care system reform White Paper, later this year.

[Baroness Brinton (LD) [V]]

My Lords, so far the Minister has responded only on the issue of adult social care. Freedom of information requests from every local authority in England by the Disabled Children’s Partnership reveal that 40% of authorities cut the respite care for parent carers during the pandemic. This comes as eight in 10 parent carers are experiencing some form of anxiety—a rate much higher than among the general population. Can the Minister outline specifically how the health and social care levy will help restore short breaks and respite care for families with disabled children?

[Lord Kamall (Con)]

The noble Baroness makes an important point that we should address. In looking at the wider picture, we recognise that unpaid carers play a vital role in our care system and make a considerable contribution to society, alongside the paid social care workforce. The Care Act encourages local authorities to support unpaid carers and provide preventive care to stop people’s early care needs escalating. The announcement of the £5.4 billion funding marks the next step in our transformational plans for the sector.

Covid-19: Vaccinations Administered Abroad

Baroness Brinton Excerpts

Wednesday 27th October 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness raises a very important issue about the devolved Administrations. As the noble Baroness will know, health is a devolved matter; we are keeping the devolved Administrations informed of progress on the overseas vaccination solution and they are looking to set up similar processes within their own jurisdictions. A Northern Ireland service has just launched. Bidirectional data flows have also been set up by NHS Digital for those who have been vaccinated cross-border between England, Scotland, Wales and the Isle of Man. Bidirectional data flows between England and Northern Ireland will be live soon.

[Baroness Brinton (LD) [V]]

My Lords, in July, the Minister’s predecessor, the noble Lord, Lord Bethell, told your Lordships’ House that the problem with registering Covid vaccines—whether it was UK residents jabbed abroad or those who had taken part in clinical trials—would be resolved by August, in time for the holidays. A further problem is that the app still cannot tell the difference between a third dose and a booster dose. That is important because third-dose people need a further booster dose. To hear that only 53 people have now got their records on an app is appalling. What are the Government going to do about this mess?

[Lord Kamall (Con)]

One of the reasons for the delay has been the wide range of vaccinations that have been administered worldwide. MHRA is working to make sure that it is confident about recognising them in a Covid pass. There is also a range of issues relating to anti-fraud measures that have to be put in place to maintain the integrity of a Covid pass service. The multi-organisation approach that has been adopted has ensured a high-quality service. NHS England has engaged vaccination centres, provided training and enhanced the vaccine data resolution service capability. NHS Digital has updated the API to allow overseas vaccinations to flow from the vaccine database—the so-called national immunisation management system—to the Covid pass. Also, NHSX has built the certification rules to enable overseas vaccinations in the Covid pass.

Health Care and Adult Social Care

Baroness Brinton Excerpts

Wednesday 27th October 2021 Lords Chamber

[Lord Kamall (Con)]

The Government recognise the valuable role that paid and unpaid carers play in social care. We are looking at how we can make sure that we recruit and retain staff. We understand the challenges that many care homes, quite often those in the private sector, face when trying to recruit and retain staff, given the competitive pressures around the jobs market. The Government certainly take seriously the role of unpaid and paid carers.

[Baroness Brinton (LD) [V]]

My Lords, in addition to the winter’s and next year’s workforce plan, the CQC reports that providers of residential care showed the vacancy rate rising month on month from 6% in April to 10.2% in September. Some care homes whose attempts at recruitment have failed are now having to cancel their registration to provide nursing care, leaving residents looking for new homes in local areas that already are at, or close to, capacity. In recent weeks, two homes in York have announced that they are closing. I appreciate the discussion about planning for the workforce but this is a current crisis. What is the Minister going to do as councils are overwhelmed trying to find beds for patients when there are none?

[Lord Kamall (Con)]

I am grateful to the noble Baroness for the specific examples that she gave. The department is constantly monitoring the workforce capacity pressures. We are continuing to gather a range of qualitative and quantitative intelligence in order to have a strong and live picture of how the risk is developing and emerging. In more detail, this includes drawing on evidence gathered by a regional assurance team and regular engagement with key stakeholders, including the Association of Directors of Adult Social Services in England, local authorities and care provider representatives. We are also monitoring data from the capacity tracker, Skills for Care’s monthly workforce reporting and wider market data. To ensure that we are aware of any emerging workforce capacity pressures, we are strongly encouraging providers to continue sharing available capacity and completing the capacity tracker.