NHS Digital: Primary Care Medical Records

Baroness Brinton Excerpts

Tuesday 8th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am grateful to the noble Baroness for her kind remarks. As she knows, there is an incredibly rigorous system for ensuring the safe curation of this data, and I pay tribute to the Caldicott Guardians, the ICO and the IGARD board, which has put in place a very tough and rigorous surveillance system to ensure that all the data sharing that goes on within the NHS complies with the legal requirements and the guidelines laid down by law and by the NHS. These are tough conditions and they are applied very rigorously.

[Baroness Brinton (LD) [V]]

My Lords, it is a relief to hear that there will be a delay, but I am astonished that the Government have left it this late. When will the data protection impact assessment for this be published, and will the Minister place a copy of the DPIA in the House Library, so that Members can read NHS Digital’s own statements about the privacy risks and the impact of the programme? It might help the ICO in its deliberations about whether the system proposed is safe.

[Lord Bethell (Con)]

I am grateful for the question. I will look into that date and share whatever materials are available.

Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) Regulations 2021

Baroness Brinton Excerpts

Monday 7th June 2021 Grand Committee

[Baroness Brinton (LD) [V]]

My Lords, I declare my interest as a vice-president of the Local Government Association. As my noble friends Lord Scriven and Lady Tyler have said, once again we are reviewing and considering these regulations weeks after they have been implemented and published, in that order. It appears that even the routine renewal of SIs is a total surprise to the Government—or they may be treating our democracy with contempt.

The Secondary Legislation Scrutiny Committee noted:

“These national provisions came into effect on 17 May. However the Government published guidance on 21 May which said that to combat ‘the Indian variant’ people … should meet outside wherever possible and travel in and out of those areas should be avoided. This change was not publicised by the Government and caused considerable confusion … It appears that this situation was in part caused by continuing confusion over the status of government guidance and in part by failures in how the advice was communicated.”


The committee says:

“Recent events have illustrated why this is a significant problem: Guidance associated with both the travel regulations and the changes to restrictions in certain areas … have this week caused confusion for the public and have given rise to questions about enforcement, both of which undermine the effectiveness of the advice given.”


The blurring of lines between guidance and regulation, combined with poor communications, is a serious error that made the regulations unworkable, as the Government discovered to their cost.

These SIs will expire on 20 June, as other noble Lords have said—when Ministers, members of SAGE and scientists are all saying to us on a daily basis that the complete ending of restrictions is now very finely in the balance because of the steady increase in Covid delta variant cases over the last month, with cases back up to over 5,000 a day. Is this the right time to lift the ban on pupils wearing masks, when we are now seeing evidence of high spread in schools, including in Cherry Tree Primary School in my home town of Watford?

We agree with the Government that data, not dates, must rule the next set of decisions. What additional resources are being given to local authorities and local resilience forums to help them handle surges in variants of concern? Our local directors of public health are doing an excellent job but, in the areas of high surge, there are requirements for substantial intervention, which costs money. Can the Minister say whether those areas of high surge are receiving extra resources over and above the planned allocation for this year?

The Minister knows that on these Benches we believe in the importance of test, trace and isolate to keep people safe. I was slightly surprised this morning to hear the noble Baroness, Lady Harding, say on “Woman’s Hour” that she was dismissive of its key importance. We believe that it is clearly a vital tool to manage new variants and outbreaks.

The noble Baroness, Lady Harding, like Matt Hancock, talked a great deal about the progress of vaccination, and we applaud that progress. However, over the weekend the Secretary of State said that vaccination had “severed” the Covid link but “not broken” it. Pardon? The dictionary definition of “sever” is “break off”. Can the Minister explain what “severed but not broken” means?

The regulations are silent on advice for those people who, despite shielding being formally ended by the Government, are still under strict advice in letters from the Secretary of State to stay at home wherever possible, to get others to shop for them and not to go into any environment where social distancing is likely to be breached. The Government have been totally silent, but the charities Blood Cancer UK and Anthony Nolan have repeatedly asked for clear guidance for those who are immunocompromised and who have been told that, despite having two jabs, they are unlikely to have the antibodies for long. Will the Minister agree to meet me, them and other noble Lords interested in this issue? What provision is being made for this group of people, their families and friends to guide them through the next stage of learning to live with Covid? Total silence from the Government puts them in an impossible position, and possibly in unsafe surroundings.

We note that the regulations bring back international travel for leisure. We have repeatedly asked for clearer, broader rules, but today all we see is chaos at airports in Portugal as people rush back to avoid having to quarantine. Is this really the best way to do things? Can the Minister say whether the previously ineffective border measures—leading to queues at airports, people jumping on public transport to get home and people having to leave quarantine to get their tests done—have all now been resolved? In particular, are there improved checking arrangements to find forged test results?

The Minister has mentioned the pilots on isolation. Can he give us more details on those? What are “considerable payments”, and who is eligible? On the problem of people coming forward to self-isolate, the noble Baroness, Lady Harding, said this morning that the problem was getting them to come forward to say that they had had a lateral flow test in order to be able to go on working because they needed to earn money. Surely now is the time to reassure people by paying them their wages for self-isolation rather than asking them to go through a ridiculously complex means-tested application procedure.

If the Minister cannot answer all my questions now, please will he write to me with details?

Covid-19: Variant B.1.617.2

Baroness Brinton Excerpts

Wednesday 26th May 2021 Lords Chamber

[Lord Bethell (Con)]

I share the noble Baroness’s concern, but I can reassure her on a couple of things. It is, I think, a real tribute to the hard work of parents, teachers and the pupils themselves that the infection rates in schools have been relatively contained, and certainly have not shown the same kinds of behaviours that they did in September of last year. But we remain extremely vigilant, for exactly the reasons the noble Baroness explained. On the question of face coverings, it is a very difficult balance to strike—they are intrusive and disruptive but, on the other hand, they are an effective way of minimising infection. It is an area that we keep a very close watch on.

[Baroness Brinton (LD) [V]]

My Lords, the delayed publication of official Public Health England Covid variant data, which was slipped out during the Eurovision Song Contest results, is bad enough, but can the Minister say whether the Secretary of State for Education has the power to remove official PHE data on cases in schools? If so, what were his grounds for that removal?

[Lord Bethell (Con)]

I really bridle at the suggestion that we run our data publication programme on the basis of the Eurovision Song Contest schedule. That really is not a credible suggestion. There is an issue with positivity rates for some of this data because not every test is registered, and, as a result, it is difficult to draw conclusions about exactly what proportion of tests have become positive. It is for that reason that we are careful about how we present some of the data, and that is behind some of the decisions that have been made about which tables to publish.

COVID-19 Variant: Travel Guidance for Local Authorities

Baroness Brinton Excerpts

Wednesday 26th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the characterisation presented by the noble Baroness is unfair. We are trusting people to be responsible and to act with caution and common sense, as they have done throughout this pandemic, and to make decisions on how best to protect themselves and their loved ones. We are seeking to avoid bringing these measures into law and instead are using guidance. The communication of that guidance could have been done better but we are working extremely hard with regional partnership teams, Public Health England, local authorities, JBC colleagues and the incident management teams to ensure that these communications are done in the most effective way possible.

[Baroness Brinton (LD) [V]]

I declare my interest as a vice-president of the Local Government Association. Earlier, on the “Today” programme, Grant Shapps said that it was down to local authorities to disseminate the new travel guidance to their citizens, but local authorities reported that they had not been told about it. Do the Government expect them to develop telepathic skills? What does that say for the way government truly operates as a partner with our councils, directors of public health and local resilience forums, which are dealing brilliantly with this new, rapidly transmissible Covid variant? Are they getting extra resources to cope with the extra burdens on them?

[Lord Bethell (Con)]

No, the noble Baroness will be relieved to know that we are not relying on telepathy. Instead we have regional partnership teams, which include Public Health England regional directors, and Contain and JBC colleagues, working together with local authorities, and these meet on a three-times-a-week basis at the regional team updates. Attendees can include government departments, including the MHCLG, the DfE, particularly REACT, and the No. 10 Cabinet Office task force. It is through this kind of extremely regular and intense collaboration between all the different parties working on this extremely complex pandemic response that we share data, provide guidance and ensure that the communications are done to the best of our ability.

Covid-19

Baroness Brinton Excerpts

Wednesday 26th May 2021 Lords Chamber

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

My Lords, the noble Baroness asks two very pertinent questions which slightly answer themselves, in a way—but let me try to update the House on our plans in that area. She is right that we have powers on local lockdowns, but that is not the focus of our thinking at the moment. Local lockdowns are an important tool, but not one that we think is a priority right at this moment. We are focused on the vaccines. It is beyond doubt that this Indian 2 variant particularly hits those who are not properly vaccinated—and by “properly” I mean “have had two doses and two weeks”. Those who have forgone either their first or second dose are particularly vulnerable, and you have only to look at the infection data and, particularly, the hospitalisation data to understand that.

That is why we have rolled out surge vaccination in those areas. What that means is a huge amount of communication, a huge amount of engagement with the communities and the presence of various mobile vaccination units sent directly into the heart of the communities to provide different channels and mediums by which people can step up for their vaccine. The response has been extremely strong and I am touched, as I have said, by the videos of people in some of those communities, particularly in Bolton, where people have queued up for their vaccines. I pay tribute to the DPHs and local authorities that have facilitated that programme.

[Baroness Brinton (LD) [V]]

I echo the gratitude of the noble Baroness, Lady Thornton, to the Minister for his stamina this morning. Can he say whether each of the 121 local authority areas reporting cases of Covid variant B16172 are being given specific extra resources for mass surge test, trace and isolate and arrangements for surge vaccination on top of their planned allocation for this financial year? Can he say when the pilots for extra help with self-isolation will conclude? When would any likely rollout of a proper approach to supporting those who have to self-isolate, including paying their wages, start?

[Lord Bethell (Con)]

My Lords, the noble Baroness alludes to a dilemma that we face. It is not possible to organise surge testing and have pinpoint outbreak management in 120 different areas. That is just too many and our resources do not stretch to that. Many of the outbreaks are substantial clusters. Sorry—let me phrase that better. There is a small number of very substantial clusters in the towns and cities of which noble Lords will be aware. That is where we are focusing the surge testing and surge vaccination. In the other areas, we are working with DPHs to ensure that they know the best way to target the particular behaviours of the India 2. That means that it has very high transmissibility, which requires an extremely quick reaction to school and workplace outbreaks, and within specific communities. That kind of briefing and guidance has been channelled through the Chief Medical Officer’s department and the kinds of infrastructure that I described in my answers to previous questions. The response has been extremely strong and I hope we are making some impact on the spread of the India virus, but we remain extremely vigilant.

Heathrow Airport: Border Control Passenger Safety

Baroness Brinton Excerpts

Tuesday 25th May 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, how many of the passengers who flew in from India between 2 April and 23 April have now tested positive for Covid? If the Minister does not have the data to hand, please could he write to me with it? Given the guidance—slipped out by Ministers last week—for Hounslow residents to stay at home because of the Indian variant, what advice are the Government giving to all workers at Heathrow, whether they are from Hounslow or not, to keep them safe from Covid?

[Lord Bethell (Con)]

I do not have the statistic that the noble Baroness asked for, but I would be glad to write to her with it. The surge testing and vaccination in areas of VOC outbreak are now in many communities up and down the country that are not correlated with the presence of airports. They are distinct and specific to each of those communities: we work with the local DPH to ensure that the local outbreak plan is tailored to the needs of that community.

Health Protection (Coronavirus, Restrictions) (Steps and Local Authority Enforcement Powers) (England) (Amendment) Regulations 2021

Baroness Brinton Excerpts

Monday 17th May 2021 Grand Committee

[Baroness Brinton (LD) [V]]

My Lords, once again we meet to approve a statutory instrument that has already come into effect. As others have said, it relates to the easing of lockdown by moving from step 1 to step 2 on 12 April, but is being discussed in your Lordships’ House on the day England moves to step 3. Irony is not dead.

Can the Minister explain why the travel regulations, a 92-page document, were replaced and published last Friday evening to come into force today? We also had the amendment to shift us into step 3 published only on Saturday morning. Why was this done so last minute? The Prime Minister confirmed the move days before, and the amendment could have been ready to go. We say again: this is not a way to make the law or for Parliament to scrutinise it. On these Benches we have been asking for more than a year why there is not more planning about the publication and presentation to Parliament of these SIs.

I also note that the steps legislation is due to expire on 30 June. I ask the Minister now: what arrangements will be put in place in the event that the Government have to extend these regulations in light of the Indian variant beyond the end of June? With all the Minister’s rightful warnings about having to take action if needed, surely this is a clear case of being able to plan, publish and debate it earlier. I also ask the Minister about the following comments from the JSCI:

“The preamble to these Regulations contains a statutory proportionality statement in respect of the Steps Regulations but not in respect of the Enforcement Regulations.”


The department responded

“that no statement is required for the amendment of the Enforcement Regulations made by regulation 3, because it does not impose a restriction or requirement under section 45C(3)(c). The Committee believes there are arguments either way … the Committee notes the Department’s approach and accordingly reports regulation 3 for requiring elucidation, provided in the Department’s memorandum.”

Can the Minister comment and tell us when that elucidation will be available?

My noble friends Lady Tyler of Enfield, Lady Walmsley and Lord Scriven all asked why the Government have been so slow to add India to the red list. On these Benches we have raised the importance of controlling our borders effectively, first in January and February 2020, in relation to why the UK did not follow World Health Organization advice and enforce quarantine from countries with Covid. We saw the consequences of that with Covid coming in and spreading fast in our communities, causing the first lockdown. So, with a year’s experience, why did the Government not add India to the red list on 2 April when Pakistan and Bangladesh were added? Was it anything to do with the Prime Minister hoping to go to India and then having to cancel his trip at the very last minute? And why do we hear today on Radio 4’s “The World at One” that there is still no guidance for airports on passenger separation once landed and while queuing to go through the checks?

Tim Hawkins from the Manchester Airports Group said that it was still awaiting government guidance. He said that it would expect to put red-list countries into a separate process but there is an element of mixing at certain points at the moment. Last week we heard that Border Force was instructing people to get used to long queues as there would not be extra staff at the passport and Covid check desks. This is intolerable; because of government inertia, there is no guidance, no extra border staff, and people arriving from red list countries are still mixing with those from amber and green countries. That includes up to four flights a day from India into the UK. If the Indian variant is 50% more transmissible than the Kent variant, we risk rapid spread beyond those coming in from those red-list countries. Quarantining and self-isolation are vital to effective management of transmission and what the Prime Minister has called whack-a-mole.

Directors of public health and scientists from SAGE and alternative SAGE continue to ask for better support for people having to self-isolate. In particular, we on these Benches ask the Government to pay the earnings of those self-isolating, as happens in a number of other countries that achieve a much higher success rate of self-isolation. Local authorities report that the administration of the £500 grant has been so rule-bound it is almost impossible for people to claim it. That is not good enough, especially when the vast majority of people who really need it—who need to pay the rent and put food on the table—cannot manage 10 days without their regular pay cheque.

Finally, while it is encouraging to hear that tracing is now primarily in the hands of the experts in local resilience forums, can the Minister assure the Committee that they are being given explicit extra funding to be able to carry this out? Their roles are vital in controlling Covid because without effective test and trace, isolation and quarantining, this Government’s actions will not keep people safe.

Northern Ireland: Flight Passengers and Covid-19

Baroness Brinton Excerpts

Wednesday 28th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am enormously grateful to the Irish Government for the very large amount of informal clinical data-sharing that goes on. CMOs of both countries exchange data on such matters as VOCs the whole time, and that kind of day-to-day clinical exchange of on-the-ground information works extremely well. The specific question of travel information is a lacuna that needs to be closed, I recognise that it needs to be shut, a lot of work is going on to shut it and I am grateful to those involved.

[Baroness Brinton (LD) [V]]

My Lords, I think noble Lords understand that there have to be special arrangements, and the common travel area seems to work well for most things. The Minister knows that I have asked him repeatedly about the joining up of data of international travellers between whichever border they arrive at, the NHS and the testing system, especially the private testing system, otherwise any self-isolation system will fail. Can the Minister say whether this gap that there was before has now been remedied, so that every part of the NHS can pick up data information from borders, and how it works across all four UK countries? Will he explain a bit more about the CTA arrangements between Westminster, Stormont and the Republic?

[Lord Bethell (Con)]

I reassure the noble Baroness that the data flows between borders, Test and Trace, NHS and JBC work extremely well. I was in the Covid Gold meeting earlier today and we had presentations that captured all the data flows from all those places, and we have extremely good see-through on VOCs, infection rates and bed occupancy. The progress we have made on that area is astounding. Where we have a lacuna is on the transfer of data from Irish travellers to Northern Ireland, and that is something we are working to close.

National Health Service (Charges and Pharmaceutical and Local Pharmaceutical Services) (Coronavirus) (Amendment) Regulations 2021

Baroness Brinton Excerpts

Monday 26th April 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I thank the noble Lord, Lord Hunt, for tabling this regret Motion. I echo his opening remarks about supporting the principles set out in the regulations, but proper resources are needed.

We on these Benches thank the All-Party Pharmacy Group, the Company Chemists’ Association, the Pharmaceutical Services Negotiating Committee and the Library for their excellent briefings. I personally want to thank my local community pharmacy for the wise advice that it provides for my community and its ability to provide excellent services over the last 14 months, since the start of the pandemic.

A bit of housekeeping first: I note with regret that this instrument breaches the 21-day rule and its provisions came into force on 1 March 2021. The noble Baroness, Lady Thornton, and I often say to the Minister: when will this urgency rule change? I understand that there are some issues about really urgent statutory instruments coming in on time, but this one should have been advertised in advance and ready for us to debate before it came into effect. Is it so inconceivable to think that, a year into the pandemic, we might have wanted to plan for a place to redistribute new medicines urgently? The Government are far too reactive, and they really need to plan. So how have the Government been working with pharmacies throughout the last year on this issue?

It is interesting to note that the Explanatory Memorandum says that the 2021 regulations also make changes to existing legislation on the obligations of different types of pharmacy. As a result, certain types of providers of community pharmacy services will be required to provide a home delivery option for patients with specific prescription items in a pandemic situation free of charge. We have heard from a lot of community pharmacies that are struggling financially, and they may not have the ability or finances to set up a delivery system of that kind. So how are the Government working with pharmacies to ensure that they have the proper resources to deliver medicines to vulnerable patients?

I believe we all recognise that community pharmacies play a vital role in their local areas—often extremely local—which gives them the ability to reach right into the communities, something that is much harder for many other healthcare providers to do. Whether they are in a town centre, a member of a large pharmacy chain or a family-owned pharmacy at the heart of their village or ward community, our pharmacies are an essential tool in reaching everyone. However, we need to note that since 2016 we have lost 400 pharmacies —perhaps not surprisingly, disproportionately from the poorest communities with the largest health inequalities, as my noble friend Lady Barker so movingly described. Thinking about the Government’s focus on health inequalities, community pharmacies in those areas absolutely need the right resources.

The All-Party Pharmacy Group ran an inquiry last November that included a survey of just over 1,600 pharmacy professionals in England and called for written and oral evidence. It found that the cost of staying open throughout the pandemic and offering services when other NHS services were reduced or halted resulted in staff burnout and rising debts. We hear a lot about nurses, doctors and front-line hospital staff but we need to recognise that other healthcare professionals have faced that same burnout.

Nearly half of pharmacy contractors think that their pharmacy is at risk of closing within the year. More than nine out of 10 feel that their place of work is under financial pressure, and over nine out of 10 feel that the Government do not appreciate the role of pharmacies in front-line healthcare. Pharmacies dispense 1 billion prescriptions a year and gave more than 2 million flu vaccinations last winter. Pharmacists are highly trained healthcare professionals, and their pharmacies are the front door of the NHS for many people who may be too scared or just do not know where to take their health issue.

Pharmacists deliver advice via 48 million consultations a year, taking vital pressure off our GP surgeries, urgent care centres and accident and emergency services, as outlined by the noble Baroness, Lady Wheatcroft. They have also moved with the digital times with a confidence and ease that some other parts of the NHS might perhaps envy—for example, with electronic prescriptions sent from surgery to pharmacy and digital notifications letting the patient know when they can collect their prescriptions. During lockdown, they have worked with volunteers to deliver prescriptions to people who cannot leave home, whether they are shielding, self-isolating or quarantining. More importantly, their Pinnacle database was used by the NHS to record Covid vaccines delivered, and then linked back to NHS records. It is very welcome that our pharmacists had an effective system, and that the Government, for once, recognised that it would be faster and more effective to use an existing system. I hope that joint working is symbolic of the esteem in which the Government and the NHS hold our pharmacies.

They have done all this without complaining, repeatedly finding ways to make things happen, especially in the last year, and we know that they are trusted by their customers. However, overwhelming financial pressures are causing them serious concern. As we have heard, many pharmacies are being pushed to the brink of closure. An EY report published last September made it absolutely plain that the community pharmacy network is unsustainable under the current financial framework, predicting that, without any change, 72% of pharmacies will be in deficit by 2024, with a network-wide deficit of just under £500 million.

These financial projections were based on figures that predated the pandemic, which has undoubtedly put further pressure on pharmacies. This extra pressure means that nearly half our community pharmacists believe that their pharmacy is at risk of closing within the year. The problem is that the regulations take no account of these circumstances. Can the Minister tell us when the Government and the NHS will consult with pharmacists so that they have a clear picture of what is happening? When will the Government and the NHS turn that into urgent recommendations for structural financial change? Enhanced resources would make sure that pharmacies are able to be at the heart of any health reforms that the Government wish to announce following their White Paper. Will the Government look specifically at providing resources for training pharmacists to deliver the new community health services that Ministers refer to so frequently?

At this difficult time, pharmacies are also being asked to pay back the advanced funding provided by the Government to help deal with the extra demands relating to Covid-19, but we know that much of this funding did not even cover the extra costs that pharmacies have had to bear. With their other financial problems, as already outlined, plus extra costs not supported by government, many pharmacists will not even be able to make these repayments. If the Government do not relax the repayment timing—or, better still, turn these loans into grants—forcing repayments now may force pharmacies into closure. That would be catastrophic, and a heavy burden for any Government to bear, especially one that has dished out billions of non-repayable grants to many other small businesses, which is what most of our community pharmacies are.

The pharmacy sector is willing and able to step up and help transform health services. The Company Chemists’ Association said on publication today of the Government’s White Paper:

“We hope the proposed changes in this White Paper will create an environment that allows the community pharmacy sector to do more to help relieve pressure within the rest of the NHS. With waiting times for hospital treatment at their highest for ten years, community pharmacies are needed now more than ever to provide patients with clinical care, close to home.”


It went on:

“However, to deliver on this, pharmacies need fair funding for both the services they currently provide and for any additional workload they are ready and willing to deliver.”


Along with the noble Lord, Lord Hunt, I welcome the principles behind these regulations but, without appropriate support and resources, the Government are setting our pharmacies up to fail—something no one in Parliament or government wants to happen. I look forward to the Minister’s response.

Covid-19: Update

Baroness Brinton Excerpts

Tuesday 20th April 2021 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for the Statement made in the Commons yesterday. I pay tribute again from these Benches for the amazing work of all the NHS staff and volunteers in delivering the vaccine to so many millions of people. However, as the chief medical and scientific advisers have repeated many times in recent weeks, the virus is still among us, creating new strains and threatening our recovery in the UK. It is therefore vital that the Government continue as we emerge from this lockdown to be led by data, not dates.

It is clearly right to add India to the red list. In the UK we have deep ties and bonds with India of course, but it was the correct thing to do in the circumstances and it is also right that the Prime Minister should postpone his visit. Pakistan and Bangladesh, both of which have lower rates than India, have been on the list since 9 April so I wonder why it took so long to add India.

Can the Minister update the House on the presence of all three new variants identified—the Indian, Brazilian and South African—and their presence and spread in the UK? Indeed, can he update the House about the global co-ordination of surveillance of the new variants?

With regard to protecting our borders, this week Hong Kong identified 47 Covid cases on a single flight from Delhi. Before the Friday deadline there will be hundreds of people arriving on flights from India. Is this not very risky?

Even with high levels of vaccination across the population, there will be significant groups who are not vaccinated—children, for example—so the virus will be endemic. As the Chief Medical Officer has recently confirmed, papers from SAGE model a third wave this summer. How do we avoid that?

The poorest and lowest paid in the most insecure jobs do not isolate as they should because they cannot afford to do so. From these Benches we have pointed out time and again that one way to ensure self-isolation—and therefore help the Government tackle this—would be to pay higher sick pay and expand its scope. Will this happen?

There is no mention in the Statement of vaccine passports. Does the Minister anticipate that they will soon be needed for football games and concerts?

I regret that we need to turn to the media stories about lobbying and the revelations in the Sunday Times regarding the former Prime Minister acting on behalf of Greensill and the payday financing scheme. As my right honourable friend Jon Ashworth said in the Commons yesterday:

“This was not an act of altruism to staff in a pandemic but an investment plan to package up loans to sell to investors, with the former Prime Minister, not nurses, in line for a payday windfall. Cameron wrote in one of his emails: ‘As you can imagine, Matt Hancock’ is ‘extremely positive about this innovative offer.’”—[Official Report, Commons, 19/4/21; col. 659.]


What was being sought was a partnership with NHS Shared Business Services, which is jointly owned by the department, to access the personal and financial data of thousands of NHS staff for their electronic records for commercial gain. I expect the move would next be to the social care sector. We know that at least 30 trusts may have spent valuable time considering the adoption of this untested payday lending scheme as a result of the lobbying by Mr Cameron. Can the Minister ensure that publication of all the text messages, emails and correspondence with David Cameron will happen? Can the Minister tell the House how many NHS leaders and officials Mr Cameron and Mr Greensill lobbied and met? How many NHS trusts in total were approached about this expensive—and, indeed, unneeded —scheme? Even today, we see further allegations of contracts being granted without proper scrutiny and governance, following the Secretary of State’s own links with Topwood. Questions about conflicts of interest are inevitable.

Apart from the issue about pay levels in the NHS which might necessitate such a scheme, can the Minister accept that NHS staff deserve a pay rise and support, not payday loan apps forced on the NHS by speculators trying to make money out of the pandemic? What is his view of this? Does he appreciate that honesty, probity and transparency are directly linked to people’s acceptance of and adherence to the rules we have all obeyed for many months to beat this pandemic?

Last year, a former Conservative chairman, the noble Lord, Lord Feldman—who was running a lobbying firm with healthcare clients—acted as an unpaid adviser to the Minister himself. When I was a Minister I was told that one must not only be scrupulous and transparent in one’s dealings but that one should not do anything that could be misunderstood or misinterpreted.

I hope the Minister will not just get angry as he has in the past and say it is all not true and how hard everyone is working to get the pandemic under control—everyone knows how hard he and the public servants are working—as he will be missing the point. The point is about the reputation and standing of government, democracy and accountability. Does he believe it would be a good thing for the Government to reflect on the Nolan principles of public life, particularly with regard to recent procurement processes, and the lessons that might be learnt?

[Baroness Brinton (LD) [V]]

My Lords, I add my tributes from these Benches to all those who continue to work well above and beyond the call of duty in all areas to do with managing the Covid pandemic. This includes the vaccination teams, the invisible workers—the scientists working in labs and all those who we do not see on a daily basis—as well as our overtired doctors, nurses and other clinical healthcare workers, and those in social care who are still taking remarkable precautions.

It is worth noting despite the reduction in cases, hospital cases and deaths that daily cases are still double the level that they were at the lifting of lockdown 1, so it is good that the Government are not speeding things up. We need to continue to move carefully and steadily, as later parts of the Statement talking about the India and South African variants give cause for some concern. It is also reassuring to see that uptake of the vaccine is excellent. However, the Statement is silent on when all adults will have been offered the second vaccine. That is important because, as scientists constantly remind us, two doses are needed. Focusing only on the first vaccine is giving the vast majority of the public overconfidence about protection. If people want to go on holiday, one dose of the vaccine will not be enough, whether that holiday is in the UK or abroad.

That leads also to those who are immune-suppressed and to those under 18, because until all are safe, none are safe. Can the Minister say if there is any news on the OCTAVE clinical trials on the ability of those who are immune-suppressed to make and retain antibodies? Those formerly shielding—including me—still need to avoid mixing with people. They are still waiting for news to see if they can relax, even after two doses of the vaccine.

What is the news for children? I understood that the trials on over-12s had been halted following the blood clot issue with the AstraZeneca vaccine. Is that still the case? What are the long-term plans to ensure that our under-12s and, indeed, our under-18s are safe? The Statement says that:

“The vaccine is our way out of this pandemic”.


Not on its own, it is not. We must continue to test, trace and isolate to keep people safe. The Government are to be applauded for the large number of lateral flow tests because they are useful, but they are not as effective as PCR tests for really tracking the virus.

Had I not been unable to do so, I would have loved to have been at Wembley on Sunday supporting my team, which, sadly, lost to Leicester. I would have been delighted to have been part of a testing arrangement to see what happens, but other fans have said that they were only asked to be tested in advance and that there is no testing afterwards. Is that correct? In other words, how detailed is this testing for moving back into normal life going to be?

I am a member of the All-Party Group on Coronavirus, and this morning we heard from scientists who are bemused that immediate contacts of those who test positive are still not routinely PCR tested, which all the countries with a truly effective test and trace system operate. That is vital with the high percentage of people with Covid still having no symptoms, so they would believe that there is no reason for them to be tested, and it is particularly important with the information about the spread of the variants from South Africa and India.

I have family who live in Wandsworth. This time last week, as the announcement about mass testing across Lambeth and Wandsworth was made, we were told that everyone in those areas would be publicly informed. Three days later, not only had my son heard nothing, but he walked past a newly set up testing site a few hundred metres from his house, went in, and discovered that he did need to be tested. So, he and my daughter-in-law had their tests. It transpires that the only notification from Wandsworth Council before the weekend was a tweet, with none of the mechanisms used elsewhere such as texts via GPs, posters up in the street, word of mouth, or even leaflets. How on earth can that be real surge testing if only a small percentage of the population see a handful of tweets?

On the India variant, scientists also told the APPG this morning that the estimated figure of 103 cases was considerably lower than the likely number of cases circulating because only 10% to 15% of positive lateral-flow swabs are sent on to laboratories where they are scanned for variants. This might mean that the actual number is 10 to 20 times the official estimate. This brings us full circle, back to test, trace and isolate. Even with vaccines, it is vital to have an effective test, trace and isolate system to keep people safe. As the noble Baroness, Lady Thornton, outlined, adding India to the red list but giving people three-and-a-half days’ notice before implementing it, means that a large number of cases are likely to slip into the country. Even if they are caught through positive testing, we are unlikely to have a real sense of the actual number of cases.

This follows on from the concern that we from these Benches have had about successful self-isolation and quarantining for a year. The APPG heard evidence this morning that demonstrated that arrangements at our borders, particularly in airports, are not Covid safe, either for travellers or staff, and they risk becoming breeding grounds. This now needs to include effectively separately passengers who arrive from red-list countries from those who arrive from others, and ensuring that all quarantine rules are observed. We heard evidence that people were leaving their quarantine hotels early, and that others, quarantining at home because they did not come from red-list countries, were being forced to use public transport to get to testing centres for their day eight tests. Worse, border staff are discovering around 100 fake Covid test certificates daily, and there are probably many more. If that does not signify a real worrying standard for the possibility of vaccine passports, I do not know what does. When will a proper test, trace and isolate system be put in place that includes immediate contacts and more lateral-flow tests being tested for variants, along with vital, proper, paid arrangements for self-isolation, including quarantining and proper separation in the transport arrangements for those coming from abroad?

Finally, I will spend just one minute on Greensill. It is not just Greensill: we need desperately to see full publication of all meetings and correspondence—informal and formal—that Ministers have had regarding all contracts, whether it is payday loans, PPE or testing arrangements. This also includes the new quarantining partners; the Health Secretary said on Monday that two have already been sacked, having been in place only for a short time. It is vital that the smell-test on all these contracts is evident and sure.

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

My Lords, I am enormously grateful to both the noble Baronesses, Lady Brinton and Lady Thornton, for such thoughtful questions. I totally and utterly endorse both with regard to their massive thanks to NHS staff, to the vaccinators and, in particular, I echo the words of the noble Baroness, Lady Brinton, who thanked the invisible workers. I am acutely and particularly aware of the lab technicians, many of whom have worked unbelievably hard in difficult circumstances, often located far from their homes, supporting our laboratories up and down the country. There are many other categories of invisible workers in our healthcare system and they deserve our huge thanks.

I am as concerned as the noble Baronesses about the threat of variants of concern. It is an absolutely frustrating and anxiety-making fact, that we simply do not know a huge amount about what the impact of these variants will be on transmissibility, severity and escapology. We are throwing absolutely everything we have got at this to try to understand the features of this disease. However, it is true that while we can study them in a mathematical or computer-generated model, we get only so far with that. We can study them on the workbench and get a little bit further, we can stick them in a tube with some serum from someone who has had a vaccine, and maybe figure out a bit more, but it is only when we have the real-world data of how the vaccines have worked in real life when put up against the virus that we can accurately conclude what the impact will be. Therefore, only the passage of time will give us the critical data we need to go forward.

In the meantime, we are standing up a huge international effort to try to understand the variants that are emerging around the world. The noble Baroness, Lady Thornton, asked me about global co-ordination. Britain is absolutely playing its role; it is using its chairmanship of the G7 to full effect. As noble Lords are, I am sure, fully aware, we have a world-leading facility in genomic sequencing. We have made a massive, open-hearted offer to the world to sequence the genomes of any variants of concern, from any country in the world, through the newly launched New Variant Assessment Platform. We are working to set up hubs to develop expertise in that capacity around the world. We are working extremely closely with multi-laterals such as the WHO, with the relevant major trusts such as the Gates and Rockefeller foundations and the Wellcome Trust, and with individual countries, to provide the insight, the fast-turnaround analysis and the assessment of new variants as they turn up.

Within our own country, it is concerning that variants have made landfall, but I reassure noble Lords that we have put in place remarkably diligent efforts to close down any spread of variants of concern when they have occurred, whether they are from India, Brazil or South Africa. It is a fact that the Operation Eagle process, which is supported by local authorities, DPHs, test and trace and by the JBC, has so far—touch wood—proved to be extremely effective at closing down community spread. We have numbers of the variants in the UK but a very large proportion of them are known to be related to travel and they have not yet created clusters of infection of the kind that might cause concern. The MQS—Managed Quarantine Service—has played an absolutely critical role. I pay tribute to the MQS team, who are at this very moment putting in place arrangements for managed quarantine for flights with travellers from India. They have put in place the necessary pre-testing, the hotels and the assessment.

While I hear, loud and clear, the concerns raised by the noble Baroness, Lady Brinton, about that process, I reassure her that her list of concerns is quite different from the operational notes that I am given every day. The truth is that it has kept a lid on any spread of VOCs in the UK to date. On Wandsworth, I pay tribute to the enormous civic response to our concerns around the cluster there. I recognise the concerns of the relative of the noble Baroness, Lady Brinton, in that area, but there has been an absolutely massive news and community-marketing promotion of the home testing, pharmacy testing, MTUs and ATSs in Wandsworth. Very few people indeed cannot have heard of the arrangements that are in place.

With regard to the OCTAVE clinical trials, that is of grave concern to all those who have immunosuppressed circumstances. We are working extremely hard with Birmingham University, with Professor Paul Moss, to understand more about the response of those with immunity issues. It is a frustrating fact that those with pre-existing immunity issues are likely to be the ones who have the lowest and least response to the vaccine. We are trying to understand as best we can how that can be supplemented. As noble Lords may know, we have already invested considerably in new arrangements for therapeutics and antivirals that we believe will support those with immunosuppressed conditions. I would be glad to write to the noble Baroness about our arrangement for vaccines for the under-12s.

If there are any other questions that I have not had time to answer, I would be glad to write to the noble Baronesses with full answers.