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.

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.

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.

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.

NHS England Funding: Announcement to Media

Baroness Brinton Excerpts

Tuesday 26th October 2021 Lords Chamber

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

I thank the noble Baroness for her question. Since 2010, we have increased the clinical radiology workforce by 48%, from 3,239 to 4,797 full-time equivalent posts. Numbers of diagnostics radiographers are up by 33% since 2010 and therapeutic radiographers are up by 44%. We are offering those who want to join the radiographic workforce at least £5,000 as a non-repayable grant for each year of their training to be a radiographer. Since 2016, we have seen a 26% increase in those studying diagnostic radiography and a 10% increase in those studying therapeutic radiography.

[Baroness Brinton (LD) [V]]

My Lords, the £5.9 billion in the Chancellor’s early announcement is to pay for physical infrastructure and equipment, not for current services. The NHS Confederation says that next year’s NHS funding allocations are nowhere near enough either. Last week, the Royal Cornwall Hospital declared a critical incident in its A&E department when it had 100 patients in the 40-bed department and 25 ambulances queuing. Its ambulance service is also under intense pressure, reporting that 50 ambulances have queued at times—again, that is much larger than the actual department. This is echoed across the country. How will Ministers help A&E departments and ambulance services in crisis right now?

Coronavirus Act 2020

Baroness Brinton Excerpts

Tuesday 26th October 2021 Grand Committee

[Baroness Brinton (LD) [V]]

I declare my interest as a vice-president of the Local Government Association. I start by echoing the comments of my noble friend Lord Scriven and many other noble Lords. Regardless of where your Lordships stand on wearing masks, for example, we are all agreed that the way this Government have brought forward far too much Covid legislation as emergency items—

[The Deputy Speaker (Lord Lexden) (Con)]

My Lords, there is a Division in the Chamber. The Committee stands adjourned until all Members have cast their votes.

[The Deputy Chairman of Committees (Lord Lexden) (Con)]

My Lords, the Committee will resume. I invite the noble Baroness, Lady Brinton, to continue her speech.

[Baroness Brinton (LD) [V]]

My Lords, regardless of where your Lordships stand on mask wearing, I believe that we are all agreed that this Government have brought forward far too much emergency Covid legislation, much of which has not even been presented to Parliament before being brought into use. Why, once again, are regulations coming to the Lords for which the expiry date was well known in advance and is not an emergency at all? The Minister’s predecessor heard time after time over the last 20 months many noble Lords complaining that too many statutory instruments were being brought to us as emergency procedures, making a mockery of the scrutiny of your Lordships’ House.

The regulations talk about self-isolation. It remains vital for those who have Covid-19, but can the Minister confirm the rumours that many people are not taking lateral flow tests, even if they are symptomatic, in order not to have to report the results and to avoid self-isolation? I am also hearing that there has been a resurgence of the old problem we had last year of late pinging, presumably because of delays in a struggling test and trace system as case numbers rise dramatically.

The noble Lord, Lord Balfe, raised concerns about whether lateral flow tests are necessary and should be paid for from the public purse. Lateral flow tests are now proving extremely reliable. Actually, we are advised as Members of Parliament to have two lateral flow tests during any week in which we are present in Parliament. Many other workplaces demand even more tests per week than that. It is one of the safest ways we can catch Covid early in people, particularly if they are not yet symptomatic. If we are asking many people to have two, three or five lateral flow tests a week—as I know happens in some places—while the pandemic is still around, it should be paid for from the public purse.

I echo the Minister’s thanks to directors of public health, our local resilience forums and local authorities. Can he confirm that the funding for their work on Covid, including test and trace, is guaranteed for the next financial year and will not end, as is currently planned, in March 2022?

Once again, I ask why the messages from government Ministers repeatedly encourage us to believe that face masks are totally a matter of personal choice. Many noble Lords have expressed their concern about them and said why they do not want to wear them. Even the Secretary of State for Health, when pressed over the weekend, reluctantly said that he would use a mask. However, he refused to say that he would recommend it to his colleagues on the green Benches—although he thought that they should perhaps consider it—whereas the Leader of the House of Commons, Jacob Rees-Mogg MP, has completely eschewed the scientific advice and said that Tory MPs do not need to wear masks because they all know each other and get along so well. The new Minister for Vaccines was of a similar mind on the radio yesterday.

However, as my noble friend Lord Scriven said, vaccination on its own is not the sole answer to Covid. A third of cases at the moment are among people who have already had their vaccinations. With a seven-day rolling average of around 1,000 admissions to hospital per day and with more than 8,000 beds occupied—and with those numbers increasing—I asked the Minister just now, in the Urgent Question in the Chamber, about accident and emergency departments and ambulance services. Conversations with GPs show that they, too, are hard-pressed at the moment in dealing with the increased number of Covid patients calling them for help.

One of the advantages of vaccination is that many people do not get Covid so seriously, but anyone who listened to the “Today” programme from Lancashire this morning will have heard many people say that, even though they had Covid mildly, it was the most unpleasant thing they had had to deal with and that catching their breath all the time was very difficult. GPs are much in demand in offering advice, hopefully to turn people away from hospital and give them the help they need.

Case rates in unvaccinated children remain very high, and despite being told many times in 2020 that children do not get Covid, they clearly do.

On 17 September, Sajid Javid wrote to the 3.7 million people who are clinically extremely vulnerable; that is 5% of our population, though not as large as the 22 million of the over-50s, the clinically extremely vulnerable and NHS staff having booster shots. This group comprises those who have serious problems making antibodies and are at high risk of getting very strong Covid. I declare my interest as being within the severely clinically extremely vulnerable group. Its numbers have expanded from 500,000 to 800,000 over the last two to three months following the publication of a number of clinical trials which were able to show that more categories of people were taking immunosuppressants, which moved them into this group. The news of the antivirals is vital for the clinically extremely vulnerable, and I welcome that. However, as my consultant said to me, “We don’t want you in hospital at all; we absolutely do not want you to end up on many of the drugs coming through yet. You need to keep safe.”

For those of us who have low or no antibodies and were told on 17 September by the Secretary of State that our doctors would now tell us what we needed to do, the outside world is a worrying place. The letter from Sajid Javid said that I should ensure that I did not go into any environment where there were people who were not double vaccinated. I have joked before whether, before entering my local greengrocers, I should stand at the door and shout, “Everyone double vaccinated in here?” I do say that.

The noble Lord, Lord Robathan, can make his own decision about wearing a face mask, but 5% of the population, a mere 3.7 million people, remain at high risk even if they have had their booster jabs. They do not have the choice. I ask him please to reconsider; even when you think you are safe, you may be protecting someone as you may not know that you have Covid and are likely to pass it on.

The noble Lord, Lord Robathan, quoted our scientists in March and April 2020 as saying they did not see the evidence for face masks being helpful. He clearly missed the screeching U-turn in the summer of 2020 after our experts, both in the UK and at the World Health Organization, realised that Covid was much more airborne than they had understood. The noble Lord asked for evidence. This is from the World Health Organization in December 2020, and it is still current advice:

“Masks should be used as part of a comprehensive strategy of measures to suppress transmission and save lives; the use of a mask alone is not sufficient to provide an adequate level of protection against COVID-19.


If COVID-19 is spreading in your community, stay safe by taking some simple precautions, such as physical distancing, wearing a mask, keeping rooms well ventilated, avoiding crowds, cleaning your hands, and coughing into a bent elbow or tissue. Check local advice where you live and work. Do it all!


Make wearing a mask a normal part of being around other people. The appropriate use, storage and cleaning or disposal of masks are essential to make them as effective as possible.”


SAGE told Ministers in May that schoolchildren should wear masks. SAGE did not get rid of masks on freedom day; it was the Government. They decided against the advice. Frankly, it has not been a freedom day for the many people who have caught Covid since mid-July and been in hospital, or for the many who have died.

Sky News reported on 6 July on a report in the Lancet that showed why masks were effective. If noble Lords doubt me, they should just put “Sky News” and

“COVID-19: Do face masks work? Here is what scientific studies say”


into their browser. The evidence is there for the noble Lord, Lord Robathan. It includes that the American CDC reported an incident where two hairstylists with minor Covid symptoms

“were found to have interacted with 139 people during an eight-day period. The stylists and the clients all wore masks”

and a not a single one became infected. Sky News said that, on the USS “Theodore Roosevelt”,

“where living quarters and working environments leave little room for social distancing, a study found there was a 70% reduced risk of infection among those who used a face covering.”

The article also said:

“In Thailand, a retrospective case-control study found that among 1,000 people interviewed as part of contact tracing investigations”—


real people and real cases—

“those who reported always having worn a mask during high-risk exposures again experienced a 70% reduced risk of becoming infected compared with others.”

A quick search of the internet will produce many other examples.

The noble Viscount, Lord Ridley, said that many masks do not contain the aerosol droplets as well as the hospital-grade masks do. That is right, but too many people wear their masks insecurely—not pinching the nose frame or pulling back the ties properly. That is the point the World Health Organization was making. Worse, I am sorry to say that too many think they are protected when they wear their masks under their chins. That does not provide for any protection at all.

As before, the problem of recording third doses versus boosters remains. This is vital. The Minister’s predecessor said that this would be dealt with by the end of July. Because third-dose people need a booster in a few months, it has to be listed separately from ordinary boosters. When will the online system be able to record third doses? Those who took part in vaccine clinical trials or have had their vaccines abroad still cannot get them logged on to the systems. Again, the noble Lord, Lord Bethell, promised that this would be sorted before the summer break.

Since 19 July, when we released all mitigation measures here in the UK, why is it that France, Portugal, Spain and other countries have seen a rapid drop in case rates, while the UK has seen a rapid increase: from 320 cases per 100,000 to 488.5 per 100,000? It is very simple. Our plan B is, in fact, those countries’ plan A across western Europe. Those countries have mandates for masks, social distancing and ventilation. These are not studies but real-life examples.

The noble Baroness, Lady Foster, cited Denmark in her contribution. In Denmark, a country that has been particularly successful, there is not even a mandate but the public choose to wear masks and socially distance. They have accepted this because of the strong messaging right from the start by their Government and local government about taking personal responsibility for their friends, neighbours and community. By comparison, the UK stands alone in saying that a daily case rate of up to 100,000 and, from the Prime Minister’s own mouth, 50,000 deaths a year are acceptable. We are creeping towards those numbers right now. The noble Lord, Lord Hunt, referred to Ministers appearing to believe in UK exceptionalism. Perhaps this is exceptionalism of exactly the wrong kind.

I ask the Minister: why has SAGE been meeting only monthly since July? Who calls those meetings and, if SAGE members feel that they need to advise Ministers, do they have to wait for Ministers to seek that advice? That would be helpful to know.

I believe that every single noble Lord who has taken part in this debate would not want to see plan C having to be enacted, especially if it means that the Prime Minister will have to cancel another Christmas. Experts across our country, and even in the World Health Organization, have expressed real concern that if we do not take at least some of the mitigating measures in plan B right now, the Government will have to move to plan C. We do not want that, so please can the Ministers listen to SAGE and put in the mitigations that most of our neighbouring countries accept as normal and good behaviour, to prevent us ever having to retreat into draconian shutdowns again?

GPs: In-person Appointments

Baroness Brinton Excerpts

Tuesday 19th October 2021 Lords Chamber

[Lord Kamall (Con)]

What is important here is that we leave it to the relationship between the GP and the patient to decide the best form of consultation. Sometimes that will be face to face and, if the patient wants a face-to-face consultation but the GP is unable to provide one, they have to give a good medical reason why not. However, we can balance that with online and telephone appointments.

[Baroness Brinton (LD) [V]]

Many GPs are feeling as if they have been completely thrown to the wolves by Ministers, and even Jeremy Hunt has said that the proposed plan and the £250 million winter access fund to support GPs and reduce the pressures they face is little more than a sticking plaster and will not help, given that the real problem is the shortage of qualified GPs. There are not even locums in many places and no longer applicants for many GP jobs. Has the Minister talked to GPs about their current extensive workload, and will he reconsider the assistance needed to support our exhausted GPs?

[Lord Kamall (Con)]

It is important that we listen to GPs and understand their needs and how we can support them. We have committed to growing and diversifying the workforce and boosting GP recruitment. We have also committed to recruiting an additional 26,000 primary care staff to be embedded in multidisciplinary teams. The details of the training will be left to the trainers themselves.

Drugs: Black Review

Baroness Brinton Excerpts

Tuesday 19th October 2021 Lords Chamber

[Lord Kamall (Con)]

In September 2020, Kit Malthouse and Jo Churchill, the then Minister for Prevention, Public Health and Primary Care, co-chaired a UK ministerial meeting focusing on UK-wide approaches to drugs misuse. The second UK drugs ministerial took place at Hillsborough Castle in Belfast on 11 October. The Government maintain a commitment to consulting the devolved Administrations—or devolved Governments in many cases—as well as a number of expert speakers.

[Baroness Brinton (LD) [V]]

My Lords, the Government’s initial response welcoming Dame Carol Black’s recommendation to create a cross-departmental approach to tackling drugs misuse and related harm is welcome. However, they have not responded to many of the key recommendations, of which the most important is the introduction of multi-year ring-fenced funding for treatment services, distributed by local need, with at least £552 million invested in the treatment system annually by the end of year 5. When will the Government’s full response be published? Will Dame Carol’s recommendations be fully funded?

[Lord Kamall (Con)]

The Government have committed to giving a full response to Dame Carol Black’s review by the end of the year and have already taken action. Since part 1 of her review, the Government have announced £148 million of investment to tackle drugs misuse, supply and county-lines activity. That also includes £80 million for drug treatment and recovery services.