Commonwealth Fund Report: NHS Ranking
Baroness Brinton Excerpts(2 years, 7 months ago)
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The Lord Speaker (Lord McFall of Alcluith)
My Lords, we will now have a virtual contribution from the noble Baroness, Lady Brinton.
Baroness Brinton (LD) [V]
My Lords, the report points out that, although the UK is fourth overall in the rankings, we are ninth out of 11 on health outcomes. As the noble Baroness, Lady Thornton, outlined, the top three countries are particularly good at investment in preventive services and primary care, but the report also talks about wider social care, including housing, nutrition, transportation and early years services. All these investments tackle inequity and deprivation, as covered in both the Leadsom report and the Marmot report. Given the Chancellor of the Exchequer’s statement that there is no money for anything other than the NHS and social care, what are the Government proposing to do to address investment in these vital areas?
Lord Bethell (Con)
My Lords, we are investing a tremendous amount in preventive care, and I agree with the noble Baroness that this is key to the future—to better and longer lives and, on my noble friend’s point, to increasing the productivity of our healthcare system. I have already mentioned the key components of our preventive agenda and I add to that list the £325 million that we have allocated to the diagnostic fund precisely to catch disease earlier, to give people the treatments they need earlier, and to bring down the cost of our healthcare service.
Social Care: Family Carers
Baroness Brinton Excerpts(2 years, 7 months ago)
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The Deputy Speaker (Lord Haskel) (Lab)
My Lords, we will now have a virtual contribution from the noble Baroness, Lady Brinton.
Baroness Brinton (LD) [V]
My Lords, the Disabled Children’s Partnership reports that parents of disabled children say that two-thirds were not able to access care at home during the pandemic. In the two years prior to the pandemic, large numbers of respite care beds for disabled children had already been shut down. Given that none of the new social care levy is targeted towards disabled children and young people, can the Minister say whether urgent funding will be provided for this vulnerable and too-often forgotten group, where unpaid carers are often on duty 24/7?
Lord Bethell (Con)
My Lords, I do recognise the problem: 23% of carers—1.3 million—provide care for 50 hours or more a week. That is an absolutely astonishing figure, and I pay tribute to the contribution they make. The overall contribution by carers is around £56 billion a year. We cannot undervalue that contribution in either emotional, care or financial terms. The precise allocation of funding for this new financial package is not yet confirmed. When it is, I will make sure that the reasonable points the noble Baroness made are heard clearly in the department.
Covid-19 Update
Baroness Brinton Excerpts(2 years, 7 months ago)
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The Deputy Speaker (Baroness McIntosh of Hudnall) (Lab)
My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness now to speak.
Baroness Brinton (LD) [V]
My Lords, yesterday 38,486 new daily cases were reported. That is equal to daily cases in mid-January and there are now just under 8,000 people in hospital, with 1,000 on ventilators—and yesterday 191 deaths were also reported, equal to the daily numbers at the beginning of March. The consequence of removing all mitigations and life returning to the new normal means Covid is still very much with us, especially the delta variant. Members of SAGE appear, according to the press, to be advising that preparations for an October lockdown should now be made.
It appears that Ministers are reliant on vaccination as the main mitigation, until the NHS is overwhelmed again. But we are already hearing of hospitals having to dedicate more wards just to Covid, with the complexities of double staffing for hot and not-hot wards. These numbers also make it much harder for the NHS to catch up on the long waiting lists, which have been talked about a great deal during the week, with the health and social care announcements.
The Statement talks about test and trace being another pillar. That is right, but the advice to the public is complex and there is evidence that many are not taking tests even when they have symptoms or have been in touch with a positive case. For example, you have to hunt quite hard online if you have had a negative PCR test but still have some residual symptoms to find out whether you should release yourself from self-isolation. Are there plans to make it clearer exactly what people should do, because we all know that sometimes the first PCR test is a little early and a second one is necessary?
Are the news reports true that there is about to be an announcement that anybody double vaccinated will not need to take a PCR test if they come into contact with a Covid-positive person? The delta variant can and is being caught by double-vaccinated people, and—importantly—they can transmit it too. That can have difficult consequences for those not vaccinated, or those who are clinically extremely vulnerable. The noble Baroness, Lady Thornton, referred to the mu variant. If it is true that the Pfizer vaccination is ineffective in holding it back, that is serious and we may need to think about mitigations again sooner rather than later.
The Statement explains the partial changes on policy for vaccinating 12 to 15 year- olds with underlying conditions. It is good to see that those with blood cancers, sickle cell, type 1 diabetes, congenital heart disease and poorly controlled asthma are now added to the list. Actually, it is vital, given Gavin Williamson’s removal of all mitigations in schools. But other children are omitted from this list, who may be on immuno-suppressants or immunocompromised, and who are now expected back in school. The Statement refers to
“no more home schooling, no more bubbles, teachers vaccinated, and all 16 and 17 year-olds offered a first dose”.
But the removal of bubbles and facemasks, and the Government’s shameful lack of movement on providing proper ventilation interventions in classrooms, means that Covid can and will spread, and not just among the children—they may well take it home. While most children will not have a problem, some—those with underlying conditions—will.
Can the Minister explain why all children with serious underlying conditions have been removed from the clinically extremely vulnerable list of shielders? Parents are already getting threatening letters from schools, yet their questions about why their at-risk child has been taken off the list have not yet been properly answered. The evidence in America is that these children are occupying more paediatric hospital beds and more intensive care beds.
Turning to clinically extremely vulnerable adults, it is good that the 500,000 severely clinically extremely vulnerable are to get a third dose as soon as possible. But delaying the decision on a booster jab for the remaining clinically extremely vulnerable, who number just over 3 million, is worrying. Guidance online for them is still 10 pages long, muddled in with advice to the general population, but the key parts are still not to go into any environment with people who are not yet double jabbed or might breach social distancing, and if they come inside your home they should have had a lateral flow test first. As I have said, that amounts to a stay-at-home order but without the support that government provided before. When will the booster decision be made for this particular group of people?
Care home providers are warning that they are already losing staff ahead of the 11 November deadline for all staff to be double vaccinated. This is in addition to the staff shortages that they are already trying to manage, which include the perfect storm of losing staff through Brexit and increased pay in retail and agriculture. Losing more staff who are unvaccinated will be catastrophic. They have asked for a delay to the start of the scheme, particularly now that a new consultation has started for NHS staff on a scheme which would start at a later date. What plans are there to delay this implementation date?
Finally, the Minister for Vaccines came a real cropper in the House of Commons yesterday when trying to justify Covid vaccine passports, when he was on record in the past as not supporting them. Can the noble Lord update the House on the Government’s plans regarding vaccine passports in light of yesterday’s debate, which demonstrated that the relevant Minister could not even explain his own policy credibly?
NHS: Nursing Workforce
Baroness Brinton Excerpts(2 years, 7 months ago)
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Lord Bethell (Con)
I pay tribute to the noble Lord’s great experience and expertise in this matter. He will be aware that we have a social partnership forum, where we work extremely closely with the professions on how to improve retention. But I think that the motivation of those in public service and, in particular, in healthcare is much more complex than he describes. We have come to a 3% pay agreement with the nurses, and they have demonstrated huge support for the healthcare service during the pandemic, which suggests that it is more complex than he describes.
Baroness Brinton (LD) [V]
My Lords, current NHS nursing vacancies in England are now thought to be over 40,000. Nurses have recently reported concerns that a number of nursing posts at a standard that require a registered nurse or midwife are now being advertised to those not registered with the Nursing and Midwifery Council, presumably because of the shortage of nurses. What steps will the Government take to ensure that only properly qualified nurses and midwives are recruited to these posts that require registration?
Lord Bethell (Con)
My Lords, there are vacancies in nursing, as there always are. The vacancies at present are not hugely higher than they are normally and, in fact, we have more nurses today than we did two years ago. What I can report to the noble Baroness is that UCAS data shows 27,720 acceptances to nursing and midwifery courses in England as of 7 September. That is extremely good news; it shows the commitment of our graduates to the nursing profession and our commitment to making sure that more nurses are trained.
Residential Social Care: Staff
Baroness Brinton Excerpts(2 years, 7 months ago)
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Lord Bethell (Con)
My Lords, I am enormously grateful for the insight of the noble Lord in this matter, in which I know that he is a great expert. However, he should of course remember that social care is provided through independent providers and local authorities. Social care workers are free to organise themselves as they wish, but that is not the arrangement that we have in this country.
Baroness Brinton (LD) [V]
Last week, three-quarters of providers in the United Kingdom Homecare Association said that recruiting social care workers is the hardest that it has ever been. In July, they warned that they faced a perfect storm of losing staff through Brexit and increased pay in retail and agriculture making their wages uncompetitive. They are at breaking point. One-third said that they are handing back some or all of their care contracts to local authorities because they cannot fulfil their contracts now—this is before they lose any unvaccinated staff—so what steps are the Government taking to urgently help the elderly in our care homes, the care homes and their staff going through this crisis?
Lord Bethell (Con)
My Lords, I am aware of the anecdotes that the noble Baroness alludes to, but they have not been seen through the figures that we have in the department. However, we are providing support to providers: we have a national recruitment campaign that is running in the autumn; we have put in free and fast-track DBS checks for staff recruited in response to the pandemic; and we have the promotion of adult social care careers in our jobcentres.
Calorie Labelling (Out of Home Sector) (England) Regulations 2021
Baroness Brinton Excerpts(2 years, 9 months ago)
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Baroness Brinton (LD) [V]
My Lords, today’s debate on calorie labelling regulations has demonstrated how complex and sensitive this subject is. At face value, the idea of labelling calories on the menus of large chains of food outlets may appear sensible and easy. On behalf of these Benches, I thank all those organisations that have sent us briefings, including Diabetes UK and Beat Diabetes, which have helped our thinking on what is not at all an easy subject. This is a complex issue with competing demands from vulnerable people on both sides who need help and support. Helping one group may cause serious problems for another.
We know that there are many people who have or who are at risk of developing type 2 diabetes and obesity. As a number of noble Lords have mentioned, more than a quarter of adults are obese and 66% are overweight. These two conditions provide the basis for a high risk of developing other serious disease, requiring much treatment and possibly leading to early death. This is a serious crisis for our country. The noble Lord, Lord Brooke of Alverthorpe, and the noble Baroness, Lady Jenkin, set that out well in their contributions.
Obese people need support and information to change their lives. Calorie labelling could be a tool in that. Can the Minister answer the noble Lord, Lord Brooke, and the noble Baroness, Lady Finlay, as to why the Government have decided not to put calorie labelling on alcohol? These are rightly described as empty, hidden calories. Is the noble Lord, Lord Brooke, correct that this is because of the alcohol lobby? Doing this would seem more obvious than putting calories on menus.
The amendment in the name of the noble Baroness, Lady Bull, sets out the equally serious problems that well over 1 million, mainly young, patients with eating disorders face and how calorie labelling could exacerbate their illness, whether in withholding food or binge-eating. Even though eating disorders are primarily classified as a mental illness, the reality is that a patient’s reaction to controlling their food intake is at the heart of it. Some will always choose the least calorific option; for others, it is the opposite. Labelling for this group acts as a signpost, supporting their control of their intake. As my noble friend Lady Parminter said, calories on menus could bring young people with eating disorders to a “place of fear”. She spoke movingly and eloquently from family experience, a reality that most of us just cannot understand. But we need to listen, as we also need to hear the testimony from the daughter of the noble Baroness, Lady Wheatcroft.
My noble friend Lady Walmsley made a thoughtful contribution highlighting the need for an integrated public health approach to food that takes account of these wider issues relating to diet and well-being, rather than just focusing on calorie labelling. We believe that public policy should always be evidence-based and we are struggling with the Government’s lack of any compelling evidence on or an impact assessment of mandatory calorie labelling on menus at some restaurants and take-aways. As worryingly, there is little evidence of serious effort to consult experts and stakeholders on all sides of this debate. There has been no formal review of similar initiatives and no attempt by Ministers to trial a pilot scheme or to draw from the evidence from those restaurants that choose already to list calories on their menus, which would have been a useful resource.
As outlined by others, there is limited evidence to suggest that this legislation would even have its intended outcome. A Cochrane review found that there is only a small body of low-quality evidence supporting the idea that calorie counts on menus lead to a reduction in calories purchased. A more recent study found that calorie labelling in American fast-food restaurants was associated with a 4% reduction in calories per order but that this reduction diminished after a year, suggesting that any small differences that may occur are not maintained.
The Minister mentioned reformulation of supermarket products. The 2020 sugar reduction report said that supermarkets had indeed started reformulation and that there were some reductions but that there was still a long way to go before the food industry meets the targets in 2024. That means that evidence is being assembled, but it is not there yet.
Both eating disorders and obesity are extremely important illnesses, which are severely damaging the health and well-being of millions in the UK. On these Benches, we remain committed to tackling both issues. We have long argued, also, that mental health should be considered in every government policy and that it should be treated with the same urgency as physical health.
I agree with the noble Baroness, Lady Bull, and my noble friends Lady Walmsley and Lady Parminter: given the concerns expressed from a large number of speakers during the debate, please will the Government commit to reviewing the regulations’ impact, both beneficial and adverse in 12 months’ time to ensure that they are fit for purpose and not wait the proposed three years?
NHS Update
Baroness Brinton Excerpts(2 years, 9 months ago)
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Baroness Thornton (Lab)
My Lords, I first record from these Benches our thanks for the hard work of the noble Baroness, Lady Penn, who has gone on maternity leave. We wish her and her baby all the very best for the future. Also, adding to the words of the Government Chief Whip, I thank the clerks, the virtual technicians, the managers and all our staff, for keeping the show on the road and for keeping us safe throughout this year. I particularly echo his words about their patience with us. We have continued to do our job and could only have done so with the support of these dedicated teams. I also thank the Lord Speaker, his predecessor, and Members of all those Committees that have been in almost permanent session this year, for guiding us through.
This is the last repeat Statement before the summer—I think this may be number 50; the Minister will know. We have three matters to deal with today: the somewhat puzzling Statement made in the Commons yesterday afternoon, the Written Statement from the Secretary of State which announced the results of the NHS pay review and—I have given the Minister notice—I will also address some of the issues raised in the Covid update given in the Commons this morning.
The Statement made by Helen Whately yesterday was an odd moment. We of course join her and the Minister in thanking Sir Simon Stevens for all his work in the NHS—he has also taken up his place in your Lordships’ House. We also join others in welcoming progress on the autism strategy, which the honourable lady talked about in her speech; although, in due course I will seek the views of the organisations who are experts in this area. However, the honourable lady gave what can only be described as a parliamentary doorstep clap for the NHS and its staff. Welcome though that might be, it does not pay the bills or provide the respect that this Government owe to our NHS staff.
The Statement was followed within hours by a Written Ministerial Statement outlining the NHS pay award. This is not a respectful way to treat Parliament or our NHS staff. As my honourable friend Dr Rosena Allin-Khan said yesterday, once again the Government have had to roll back on a shoddy, ill-thought-through position, with their 1% pay rise—a real-terms pay cut —rejected by the independent pay body. Less than an hour before, there were competing briefings on what the deal was to be and, at that moment, it turned out to be nothing. Our NHS staff deserve better than this. My honourable friend invited the Minister in the other place to shadow her in the A&E department where she has worked shifts throughout the pandemic. I suggest that she takes her up on that offer, and that the Minister here might do the same.
My right honourable friend John Ashworth has said:
“Ministers were dragged kicking & screaming to 3% for NHS staff. But after years of cuts & rising pressures, NHS staff will feel let down & disappointed especially after today’s chaos. And where is the pay rise for junior docs? Where is a fair pay rise for care workers?”
It really was not worthy of a Government. We had chaos and confusion, with the Government once again rowing back on their position. Does the Minister agree that the pay review body has done what Ministers could not and would not do in recognising that our NHS staff absolutely could not be given a pay cut? Does he accept that, after last year, this is not enough?
Does he accept that this is not an NHS-wide pay settlement? It does not cover all the health and care workforce, who do not fall under this pay review body, and it does not cover junior doctors—I declare an interest, as two are nephews of mine, both of whom were redeployed during the pandemic. We know that our junior doctors have been put on the front line, caring for sick patients, and redeployed across an understaffed, pressured NHS, and that their training has been disrupted. Will the junior doctors get a pay rise? Will all health staff employed in public health receive the settlement? Again, when we know absolutely the value of care workers, why do the Government not guarantee a real living wage for those working in social care?
How will this pay settlement be funded? NHS trusts do not even know what their budget is beyond September, and NHS employers pointed out that this settlement will cost the best part of £2 billion, so where is that coming from? Is the Minister expecting trusts to find it from their existing budgets? These Benches keep repeating this question: the Government seem not to appreciate how central this is to stopping the spread of the virus, so when will they address support for low-paid workers who have to self-isolate?
I posed many of the immediate questions yesterday to the Minister. Sometimes I felt enlightened by his answers and sometimes I did not, but the one I wish to go back to concerns the Government’s plans for September. Are they ready to reimpose safeguards? Will our schools get filtration units over the summer so that we can feel that our children will be safer? Will our teenagers be vaccinated so that, next year, this cohort can do a full year of learning without being sent home in their millions?
Baroness Brinton (LD) [V]
My Lords, I echo the thanks to all the staff who have made a hybrid Parliament work over the last year especially, from these Benches, to the health team, because of the high workload of health and Covid business. I also repeat the good wishes to the noble Baroness, Lady Penn, as she starts her maternity leave.
Along with colleagues in the Commons, I am unconvinced that the first half of this Statement was planned to be delivered by the Minister yesterday. In the bizarre events of this week, of Covid restrictions being lifted, a rush of announcements—Monday’s, and today’s on vaccine passports—U-turns, and No. 10 contradicting Ministers, this Statement is definitely filed under “Y” for “You couldn’t make it up”.
Yesterday morning, the press were briefed and opposition politicians heard on the parliamentary grapevine that the NHS staff pay rise would be announced in the Statement. Even Sky News and the BBC news channel were saying that there would be an announcement on NHS pay in the Commons yesterday afternoon. Yet, when the Minister stood up, there was not one word about the pay award, just an end-of-term report and a much-deserved paeon of praise about how wonderful our NHS staff are—they are, and they deserve that praise. However, an extraordinary line in the Statement says:
“But I can assure those hardworking nurses: you should feel it soon”.
Well, they did. Four hours after that Statement, a Written Ministerial Statement and a press release were slipped out, bypassing parliamentary scrutiny, presumably in the hope that it would not be spotted. NHS staff, especially junior doctors and nurses, are appalled. I am not sure this is what the Minister meant by
“you should feel it soon”.
However, it gets worse. This morning’s Times says that the 3% NHS staff pay rise will be funded by robbing the expected increase in national insurance contributions reserved for the social care proposals leaked earlier this week by the Government. That is an absolute disgrace, especially given the appalling way that No. 10 has handled the social care reform proposals. After the Queen’s Speech, Ministers told us that it would be this autumn. Last week, they suddenly said that there would be an announcement this week but, this week, they have thrown the proposals back into the long grass, with a promise—again—of later this autumn, two years after the PM promised us, on the steps on No. 10, that this was his absolute priority. His actions are showing otherwise.
I know that the Minister understands that social care needs urgent reform and that it has borne the brunt of the first year of the pandemic. Can he confirm the Times story about the funding of the NHS pay rise and whether this decision was made by the Secretary of State for Health and Social Care or by the Chancellor of the Exchequer? Can he also say when the full proposals for social care will now be published, including the funding arrangements?
Moving to the only substance of this Statement, the autism strategy, we on these Benches also pay our respects to the late Dame Cheryl Gillan MP, who was such an advocate for those with autism. Peter Wharmby, the autistic writer, speaker and tutor, says that the autism strategy sets its targets very low in saying:
“Moreover, we have been able to transform society’s awareness of autism, as … 99.5% of the public have heard of autism … which is so important in autistic people being able to feel included as part of their community.”
Peter Wharmby is right. Much of the strategy talks about continuing as usual, but if you talk to autistic people or parents of autistic children, they all say that much needs to be done in supporting those with autism, especially in education and at work. Knowing that autism exists is not the same as providing the best environment for those with autism to overcome the barriers they face in society and giving them the support that they need to succeed. The Disabled Children’s Partnership points out that the pandemic has exacerbated existing problems around support for those with autism, creating further social isolation and poor health outcomes. It is depressing that the autism strategy is so unambitious.
One particular problem that parents face when trying to get support for their autistic children is an automatic assumption that parent carers are treated as a resource—worse, their parenting capacity is often questioned. There is no mention here of support for their needs. As John Bangs, a special needs expert, points out, this deliberately ignores carers’ legal rights. It is noticeable that this autism strategy makes no real reference to ensuring that parental and familial carers are supported. When will these wider issues relating to positive support for those with autism and their familial carers be addressed?
Finally, briefly on the Covid Statement in the Commons today, page 4 says that
“two doses of a covid vaccine offers protection of around 96% against hospitalisation.”
But the key bit of information we need in the “pingdemic” at the moment is the rate of double-jabbers getting Covid. I understand that it is part of the same study that is quoted, but what is the answer and where can we find it? If the pingdemic is due to the virus spreading —we hear of police and control rooms unable to operate and empty shelves at supermarkets—perhaps it is time we actually understood how many double-jabbers are getting Covid and having to go into self-isolation, and thereby creating a problem. The Minister needs to consider whether lifting all restrictions on Monday was the right thing to do.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
My Lords, I join the noble Baronesses, Lady Thornton and Lady Brinton, in thanking my noble friend Lady Penn for her hard work over the last 18 months and wishing her well in her pregnancy. She looked absolutely fantastic as she left, and our hopes and good wishes are with her.
I also thank the usual channels, the House of Lords staff and the Speaker’s office for all their contributions to the virtual House and for keeping the business of the House going during this awful pandemic. There has been an enormous amount of traffic from the Department of Health—more than 50 Statements, 2 Acts and hundreds of regulations. I thank all noble Lords for their challenge, their scrutiny and their patience during this difficult time.
The pay review body has given us its recommendations, and we have accepted them. I thank it for its work and insight. I reassure the noble Baroness, Lady Thornton, that the Office of Manpower Economics will publish its analysis online shortly. We are extremely pleased that we can follow the guidance of the pay review body. Junior doctors have their own separate framework, worth 8.2% over four years. They are working from that framework today.
On the funding of the pay review, as noble Lords know, we gave the NHS a historic £33.9 billion settlement in 2018 and have provided £92 billion to support front-line health services throughout the pandemic. The pay uplift will be funded from within that budget, but we are very clear that this will not impact funding already earmarked for the NHS front line. We will continue to make sure that the NHS has everything it needs to continue to support its staff and provide excellent care, throughout the pandemic and beyond. That is why we accepted the PRB’s recommendations in full and provided NHS workers in scope with the pay rise.
On the question from the noble Baroness, Lady Brinton, on safeguards in September, I cannot make any guarantees but I definitely hope not. We very much hope that we are in the final stages of this pandemic, as the impact of the vaccine is being felt, bringing down the R number and saving those who are infected from hospitalisation, severe disease and worse.
The noble Baroness, Lady Thornton, talked about filtration for schools, and I noted her question on this yesterday. I said that we had been looking at it. I am not aware that the results of that analysis have come through yet. To be honest, I am wary of investing too much in unproven technologies. The two things that have been proven to work are isolation and vaccination; we are backing those two measures most of all. However, I accept her point about the importance of ventilation and will continue to look at it.
Likewise, the JCVI is looking very carefully at vaccination for children. We are working with international partners to get to the bottom of it. At the moment, we have a clear read-out—we will move—but our priority is providing either third shots or variant booster shots in the autumn to the most vulnerable. That is where our priorities are at the moment.
The noble Baroness, Lady Brinton, asked about social care. I note the Government’s statement on that; we will bring reform recommendations in the autumn. On her point about the autism strategy, I also pay tribute to the contribution of Cheryl Gillan, who worked so hard in this area and whose impact is still being felt.
I think the noble Baroness, Lady Brinton, overlooks some of the really good work in this strategy. There is £74 million of funding for a number of high-priority projects, which have been designed in collaboration with stakeholders from the community. I guide her to the implementation plan that accompanies the strategy, which has detailed recommendations on a six-point implementation matrix that has grit and traction. I would be very grateful for her feedback on that.
I pay tribute to parent supporters; the noble Baroness, Lady Brinton, is entirely right that they often bear the brunt of care and are often best placed to care for and support those with autism. I remind her that we have provided £31 million through the mental health and well-being recovery action plan specifically for the parents of those with autism, recognising how the pandemic was hitting that group in particular.
Covid-19
Baroness Brinton Excerpts(2 years, 9 months ago)
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Baroness Thornton (Lab) [V]
I thank the Minister for this discussion on the Statement made on Monday in the Commons. In fact, even since Monday the world has moved on. The infection rate continues to rise. There are mixed messages from government Ministers about responses to the ping. For example, does the Minister share my concern that the Investment Minister, the noble Lord, Lord Grimstone, wrote to the car manufacturer Nissan, pointing out that isolating after being pinged by the app was only “advisory” and that there was no “legal duty” to isolate? I recall the noble Lord explaining this to the House some weeks ago at my prompting. Indeed, many noble Lords came to me afterwards and said that they had not realised that there was no legal obligation to isolate after the ping. There is huge confusion now about vaccine passports, and 1 million children are out of school as their term ends. Here in London, we still have some challenges about getting people vaccinated.
So let us start with the issue of the vaccination of teenagers. The MHRA has approved the Pfizer jab for all 12 to 18 year-olds. Indeed, such countries as the United States, Canada, Israel, France, Austria, Spain, Hong Kong and others have started or soon will be vaccinating their 12 to 18 year-olds. Can the Minister tell us when we might start doing the same?
The Prime Minister obviously took fright on Monday, because on Tuesday he made the announcements about vaccine passports in September. I think that even he could see that nightclubs were offering superspreader events, with music and strobe lights attached to them—talk about closing the door after the horse has bolted.
The risk of death to children from Covid is mercifully very low, but they can become very sick and develop long-term conditions and long Covid. Indeed, according to the Office for National Statistics, 14.5% of children aged 12 to 16 have symptoms lasting longer than five weeks. Will the Minister spell out in detail the clinical basis for why the JCVI has made its decision? Will he publish all the analysis and documents in the same way that SAGE has published its analysis, not just its advice? Will he guarantee that this decision was made on medical grounds, not on the grounds of vaccine supply?
The Statement talks about infection among children being disruptive. We know that infection among children is highly disruptive for learning. We have seen hundreds of thousands of children out of school. We are not vaccinating all adolescents. Can the Minister tell the House what the Government’s plan for September is, when children return to school? For example, are the Government considering using this summer to install air filtration units in every classroom in every school?
Testing is already stretched, with turnaround times lengthening, so can the Minister guarantee that through the summer, especially once contacts can be released from isolation on the back of a negative PCR test in August, and into September when schools return, there will be sufficient PCR testing capacity to meet demand? As we move into autumn and winter, we can anticipate more flu and respiratory viruses, so do we need multi-pathogen testing going forward? Is this being developed?
It has been announced that critical workers such as food, health, utility and border staff with two Covid jabs will be able to avoid self-isolation. Many ambulance and acute hospital trusts have found themselves under extreme pressure because of the combination of very high demand and very high levels of staff absence due to self-isolation.
Three weeks ago, the Health Secretary told us that unlocking would make us “healthier” and promised us it would be “irreversible”, but today we have some of the highest infection rates in the world. Can the Minister tell us what the experts say about the risk of reimposing new restrictions in future? Our already exhausted NHS staff face a summer crisis. Covid admissions are already running at about 550 a day, and hospitals are now all cancelling cancer surgery. For example, liver transplant operations were cancelled in Birmingham last week.
It is clear that more infections mean more isolation. The NHS staff released from isolation if double-jabbed will still want to protect themselves and their patients, so will the Minister ensure that the standard of masks worn in NHS settings is upgraded to the FFP3 requirement that NHS staff have called for? What is his plan for keeping the economy and public services functioning through the summer, as more and more people are asked to isolate? Can the Minister confirm reports that SAGE scientists have advised that some measures, such as mandatory masks and working from home, should be reinstated at the beginning of August?
Recent days have seen some of the lowest numbers getting first-time jabs on record, with the daily average now lower than at any point since the start of the programme—although I suspect the Prime Minister is hoping that his threat that you will need a vaccine passport to get into a nightclub might help in that direction. Unused vaccine doses are being sent back by GPs as demand for jabs slows to a fraction of recent levels, yet we still have millions of unvaccinated adults. Does the Minister share my concern that falling demand, combined with emerging evidence of the effectiveness of vaccines beginning to wane over time, may mean that we in this country will be less protected in September?
Finally, I understand that the “hands, face, space” slogan is about to be dropped in favour of a plea to “Keep life moving”, despite the fact that hundreds of thousands of people are still isolating. Can the Minister explain what this actually means?
Baroness Brinton (LD) [V]
I thank the noble Lord, Lord Bethell, and the noble Baroness, Lady Penn, their officials and all staff in the Lords, the Whips’ Office and the health team, as well as Members, for their extraordinary work this year on Covid-related business—mostly emergency Statements and statutory instruments. From these Benches, we particularly wish the noble Baroness, Lady Penn, a safe delivery and a happy maternity leave.
The Statement talks about enjoying “new experiences” following the lifting of lockdown and safely slowing the spread of this deadly virus, but 48 hours is a long time in politics, as evidenced by the difficulties of taking this Statement two days after it was delivered. So much has happened, much of it demonstrating that this Government are still struggling to get a grip on keeping people safe from this deadly virus.
The phrase in the Statement:
“We are cautiously easing restrictions”
is the most extraordinary thing to say, given all the rhetoric about freedom day—and it is wrong. All restrictions have been lifted—no mandatory face masks—and young people have understandably taken their lead from Ministers. There are videos of young people deservedly enjoying themselves in nightclubs in the knowledge that the Prime Minister has declared it safe to do so, yet hidden in this Statement is the bizarre announcement that in two months’ time only those who are double-jabbed will be able to go to such crowded venues, thus delivering Covid ID cards by the back door. Once again our young people, who have had to bear much of the brunt of lockdown life, are the ones targeted by this Government.
That little phrase caused chaos on Tuesday morning. Paul Scully was not clear about which other large venues might be included—for example, pubs with performance dance venues, large or small. He thought so. Two hours later, No. 10 contradicted that: no pubs. Can the Minister tell me what is the difference between a pub with a large dance venue of, say, 500, and a nightclub that can have up to 400 people and why one will require everyone to be double-jabbed but the other will not? I am really struggling to understand the difference. Perhaps the Minister can point your Lordships’ House at a safety document that sets out what the risks are for these different venues and why it is appropriate to ignore lateral flow tests and only go on double vaccination when we know that people can still get Covid after they have been double-jabbed.
The Statement is right to praise the progress of the vaccination scheme, although there is some considerable way to go, including awaiting the data on whether the booster jab can be given at the same time as the flu jab in the autumn. What plans are in place to provide support for GPs if the jabs cannot be given at the same time? We all know that the annual flu vaccine date requires a very large amount of administration by medical and admin staff alike.
The Statement says that JCVI has decided not to vaccinate all 12 to 17 year-olds yet but is keeping it under review. I too refer to today’s ONS data that was referred to by the noble Baroness, Lady Thornton, demonstrating underlying illnesses and a greater prevalence of long Covid among the young than among older people. I thank the Minister for the helpful briefing on Monday, but I remain concerned that with up to 1 million children out of school now it has been clear that the alternative to vaccinating secondary-age pupils appears to be allowing Covid to rip through our schools. We all want our children back in school in the autumn, so what are the Government going to do about that? It is good that the Government are finally allowing the children most vulnerable to Covid to receive the vaccine because they deserve protection and that those children with an immunocompromised or immunosuppressed adult in their home will also finally be able to be vaccinated. That is good.
This Statement also refers to the regulations debated in your Lordships’ House last night, and I hope the Minister has taken away the many concerns expressed by all sides of the House. The Statement refers to tradespeople, such as plumbers and hairdressers, who will also have to be doubled-jabbed to gain entry into a care home. I have two questions about these non-staff members. I am happy to receive a reply by correspondence if the Minister does not have immediate answers. First, if the registered person is not on the premises when an outside worker comes in, can another member of staff admit them and make the decision about their vaccination status? What does that do to the registered person’s responsibilities? If a plumber comes out of office hours to, say, mend a burst pipe and the registered person is not there, must they be turned away? Secondly, care homes are already reporting that some contractors are heavily ramping up the rates for care homes for their staff who have been double-jabbed. Did the hurried and inadequate impact statement published on Monday include the cost to homes of this outrageous practice, and will the Government issue guidance that it should be stopped immediately? Can the Minister say when the detail of how this is all going to work in practice will be published?
The Statement refers to the fact that we must be pragmatic about how we manage the risks we face, yet the past two days have been full of contradictions from the Prime Minister and other Ministers about the need to self-isolate when people are pinged. It has taken journalists to reveal that the only legal responsibility to self-isolate is when called by track and trace, but after the embarrassing U-turns on Sunday morning of the Prime Minister and the Chancellor about not self-isolating, the PM is confidently saying “You must self-isolate once pinged”. Apart from the irony of that statement, given his behaviour, once again we have Ministers not seeming to understand the difference between advice to people—moral guidance, perhaps— versus the reality of a chaotic series of SIs that confuse not just the police, the public and Parliament but the very Ministers responsible for them.
With a further 44,000 new cases today, making us world-beating in one league table no one wants to head, a further 73 deaths and millions of people being pinged and everything in chaos, I fear we are in for a long and difficult summer.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
My Lords, I am enormously grateful for the thoughtful and challenging questions from the noble Baronesses, Lady Thornton and Lady Brinton. I will start by using a couple of their specific questions to illustrate, as clearly as I can, the strategy behind our approach and the challenges and limitations in what government can and cannot do.
When it comes to the app, this situation illustrates the difficulties of leaving an epidemic. I remember well the CMO talking about what happens to a country when it enters an epidemic; at the beginning of last year, he gave us an introduction and said how difficult it was when you are trying to make that transition. The challenge is of having a partially vaccinated population that has huge pressures to get on with life, while at the same this infection leaves many largely untouched by the virus—in fact, the largest proportion of people. That is exactly the kind of dilemma we are wrestling with.
With the app and the Government’s position on whether you have to isolate when you get pinged, isolation remains the most important action that people can take to stop the spread of the virus. It breaks the chain of transmission. There is no single better measure for breaking the spread of the virus than isolation, so it is argued that it is crucial for people to isolate when told to do so, either by test and trace or by the app. I can confirm that the Government’s advice is to isolate if you are pinged by the app although, as I have said previously, this is not captured in law.
Both noble Baronesses asked about policy on schools and why we emphasise Covid vaccination over LFDs for entry into venues. Those questions give me an opportunity, I hope, to be really clear about the strategy. It is to vaccinate a sufficient proportion of the country that the virus cannot spread so easily, and that R is brought below 1. When we have that moment, we can be more confident that the impact of the virus on hospitalisations, severe illness and worse will be brought under control. At the rates at which we are vaccinating, we are hopeful that we can reach that stage relatively soon.
There is no other plan; there is no way of beating the virus other than ensuring that the vaccination deployment is as effective as possible. That is why we are looking at ways to bring young people and those who are reluctant onside, by engaging them in dialogue, answering their questions and emphasising through our measures the critical importance of vaccination, particularly when sharing space with others in your community.
On vaccinating children, healthy children are at a very low risk from Covid-19, with their risk of death being around one in 2.5 million. No previously healthy child in the UK under the age of 15 has died from the pandemic in the UK, and admissions to hospitals or intensive care are very rare. That is why we are taking a cautious approach in this area. The JCVI will keep this advice under review as more safety and effectiveness information becomes available on the use of vaccines in children; for example, regarding reports of myocarditis as an adverse event following vaccination with Pfizer. However, we will be extremely energetic in looking at all avenues in this area.
We are also looking at booster shots. Following the publication of interim advice by the JCVI, the Government are preparing for a potential booster vaccination programme from September. The noble Baroness, Lady Brinton, asked what the state of the country will be in the autumn. That will in large part depend on the flu vaccine and on the Covid vaccine, which can be taken at the same time. We are working closely with GPs to ensure that that rollout is as effective as possible, because the resilience of the NHS depends enormously on the success of our dual vaccine rollout.
Lastly, the noble Baroness, Lady Thornton, spoke about the importance of keeping life moving. I do not know that phrase but I know that there is a huge backlog in the NHS. There are other profound impacts of our social restrictions and our lockdown measures on the health of the nation, the economy and our society. We cannot continue in this way for ever. There is value in trying to open up our economy and giving individuals the information to be able to make decisions for themselves. That is the inflection point we are at now. I have enormous sympathy for those looking for information on the best approach but I hope the direction of travel is crystal clear.
Animal Diseases: Future Pandemics
Baroness Brinton Excerpts(2 years, 9 months ago)
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Lord Bethell (Con) [V]
My Lords, the noble Baroness is right that we need to massively increase international capacity for vaccine production. The Government are working on a vaccine strategy that will include ideas for doing that. A TRIPS waiver is something we have looked carefully at. It is our strong view that this Government support intellectual property, because it is only through our commitment to intellectual property that we can encourage the kind of massive investment by the private sector necessary to develop vaccines in the first place. For that reason, we remain hesitant about supporting a TRIPS waiver policy.
Baroness Brinton (LD) [V]
My Lords, Professor Sir Jeremy Farrar says in his new book that viruses do not change how they transmit between humans and animals, but humanity has become much more mobile. He deplores the pandemic nationalism evident over the last year, saying:
“Only the virus benefits from a pivot towards myopic nationalism because that will keep it circulating for longer. A divided world is a diseased world.”
I thank the Minister for saying what the Government plan to do through their chairmanship of the G7, but can he please confirm the timetable for the delivery of the “one health” approach, including its funding?
Lord Bethell (Con) [V]
My Lords, the “one health” approach is moving through the G7 process at the moment. I am not sure whether a precise timetable exists. I am happy to check to see whether dates are available, and I will write to the noble Baroness accordingly.
Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021
Baroness Brinton Excerpts(2 years, 9 months ago)
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Baroness Brinton (LD) [V]
My Lords, I declare my interests as a vice-chair of the All-Party Group on Adult Social Care. Many have spoken from the heart, including my noble friend Lady Tyler, about the principles of ensuring that those who need to be cared for by the care sector are kept safe. From these Benches we unequivocally support that principle but we argue that this SI itself is flawed, as demonstrated by the eighth and 10th reports of the Secondary Legislation Scrutiny Committee. These echo the concerns of cross-party MPs in their debate on this SI last week.
First, it is important to say that a year ago the shockingly high death toll in care homes was because neither residents nor staff were protected by our Government. In the early days, patients with Covid were discharged from hospital into homes. Worse, staff could not get access to proper PPE. I do not take the view of our Prime Minister—as reported by Dominic Cummings—that anyone over 80 is going to die soon anyway. For too many, Covid is a very nasty disease, as he well knows. Shame on him for dismissing the lives of anyone over 80.
I turn to the regulation itself. There is still no impact assessment. The statement of impact, hurriedly published yesterday, does not answer the questions raised in the Commons debate last week and does not provide the evidence for its assertions. Further, it is not clear exactly where the boundaries of the Minister’s powers lie in the regulation and what ability there is, therefore, for mission creep and Henry VIII powers.
One example is the nature of the evidence required for vaccination status. It might be an app. It might be an NHS letter. There is no evidence yet for your Lordships’ House to understand how secure this process would be. Nor are the duties under law of the registered person in a care home or a care company stated. The Secondary Legislation Scrutiny Committee pointed out that it was not certain
“whether that would provide a sufficient defence to a registered person if they needed to contest a sanction for non-compliance.”
The real concern from the evidence given by Ministers and their officials is the actual size of the problem they are trying to solve. SAGE has said that the target for staff vaccinations should be around 80% and, in his opening speech, the Minister said that we are so nearly there with the vaccinations and then quoted the data to confirm that, despite localised variations. The 10th secondary legislation report says:
“It became evident that the DHSC are trying to target this legislation on particular groups of people”.
It is not explained in the Explanatory Memorandum, perhaps because it is those people in deprived areas, younger staff and ethnic minorities.
I reassure the noble Lord, Lord Wei, the noble Baroness, Lady Fox, and others that, for months, the care sector and unions have been working with vaccine-hesitant staff. Back in January, a GP in Newcastle was reported as saying that the single most effective tool to overcome vaccine hesitancy was getting local doctors who staff know to listen to their concerns and answer them. Care providers confirm that this technique is highly effective and, frankly, it is probably why the SAGE targets and more are achievable. Why are the Government not backing this route, which would appear to overturn staff hesitancy more than any other technique, and certainly more than coercion?
There is a long litany on the lack of legislative compliance, commented on by many noble Lords, in addition to the lack of the vital impact assessment. The sector has faced a perfect workforce storm in the last 18 months. Brexit has resulted in large numbers of EU staff leaving the UK. Now, as restrictions are lifted, staff are being wooed by those able to pay premium salaries in hospitality and, in rural areas, agriculture. Social care providers say that there are already over 120,000 vacancies. They know that they will have to sack those who refuse vaccinations and will find it even harder to recruit from an ever decreasing pool. All the Government say is that it will cost the sector £100 million—much better to work with the sector to do this voluntarily.
To workforce issues, we must add the lack of detail in the Explanatory Memorandum about how this proposed system would work. Nor do the SI or the EM have key definitions, again leaving your Lordships’ House in the dark. I add to the comments of others about the inconsistencies of targeting just this sector and not others in the NHS. So, care assistants, plumbers and hairdressers must be vaccinated if they are going into care homes, but not GPs and other doctors—that is extraordinary.
I end by returning to the fundamental issue of whether there is a need for this SI. One of the largest care organisations, Four Seasons Health Care, challenges the Minister’s assertions that care homes are not safe at the moment. In its evidence, it said:
“Since March 5th 2021 we have had 2 covid deaths, during which time 955 residents have passed away. Covid therefore accounts for 0.2% of all our deaths in the past 18 weeks.”
Can the Minister provide the nationwide data on deaths in care homes over the last four months? I believe it matches these figures, so is this SI necessary? The Government admit that SAGE’s target was met, but have said there should be even more vaccinations. Other than the Minister, every speaker tonight has raised problems with these regulations, from all sides of the House. From these Benches, we say that the litany of minor and major issues means that the instrument should not be brought into effect, so we will support the amendment of the noble Baroness, Lady Wheeler.