Social Distancing: Two-metre Rule
Baroness Finlay of Llandaff Excerpts(3 years, 11 months ago)
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Lord Bethell [V]
No, I do not accept my noble friend’s analysis. In fact, social distancing, which is central to our strategy, has had an incredible impact on saving lives and protecting the NHS. You have only to look at the spike that is occurring in places such as Texas, Florida and, according to today’s news, Beijing to see what happens if you do not tackle the underlying prevalence of the disease and you allow the lockdown to end too early.
Baroness Finlay of Llandaff (CB) [V]
My Lords, do the Government recognise that if the blanket rule is relaxed for some, such as most primary school children, who appear to have a lower rate of infecting others, people who are shielding someone will be terrified that reducing the distance will endanger the life of the person they are protecting? Their need to maintain a greater physical distance will need to be clearly signalled—for example, through an officially issued lapel badge or lanyard, as I suggested yesterday—and they will need to have antibody testing.
Lord Bethell [V]
The noble Baroness is entirely right. The kind of differential shielding that she suggests may well play an important role in what we do going ahead. We must do our utmost to protect those who are shielded. However, we are also aware of the challenge of having confusing regulations. That is why we are currently holding the line. We are aware of the effects on the economy, and that is why a review is on the horizon, but until then we are focused on reducing the prevalence rate and protecting those who are most vulnerable.
Health Protection (Coronavirus, Restrictions) (England) (Amendment) (No. 2) Regulations 2020
Baroness Finlay of Llandaff Excerpts(3 years, 11 months ago)
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Baroness Finlay of Llandaff (CB) [V]
As regulations change rapidly, I want to focus on PPE, particularly the supply of FFP3 high-level protection masks for clinical staff. The Royal College of Physicians—I declare my interest as a fellow—has conducted four surveys of members about their continuing experiences, and the latest, on 3-4 June, has shown welcome improvements, but problems persist. Just 10% feel ready for services to return to normal, while 31% think it would take a year to 18 months for the NHS to get back on an even keel. Access to PPE and testing have improved but 16% of doctors still report being unable to access the PPE they need for managing patients with Covid-19, and almost a third report not having been properly fit-tested. Shortages continue: 11% found themselves in the last two weeks unable on occasion to access the PPE that Public Health England advises. Only 26% have had access to antibody testing, and of those, 30% report the results as positive.
As Test and Trace gets established, the requirement for contacts to self-isolate for two weeks risks returning to the pressures of staff absences. Current guidance about PPE is that staff should always wear a mask, which decreases the risk of asymptomatic spreaders and protects the patients. But staff are not adequately protected. An FFP3 mask is only allowed in high-risk areas and for certain procedures. Patients on ordinary wards, waiting for admission and on whom results of tests are not yet back, often cough, splutter or vomit and it is inevitable that clinical staff are showered with droplets. Can the Minister say how secure are supplies of FFP3 masks, are we now producing them in the UK, and will they be issued to all front-line clinicians to try to ensure that a second peak does not pull down staffing numbers to critical levels as the lockdown eases? As people move around more, the risks to those shielding or with visual difficulties will make them more anxious. Will the Minister explore with me the idea of Dr Iliff, an anaesthetics Bevan Health Technology Exemplar trainee in Wales, for a lapel badge that those who need more protection can wear to make them visible to others when in public places, and which could go on a lanyard?
The Deputy Speaker (Baroness Garden of Frognal) (LD)
I understand that the noble Baroness, Lady Hussein-Ece, has scratched, so I call the noble Lord, Lord Holmes of Richmond.
Covid-19: Cancelled Medical Operations
Baroness Finlay of Llandaff Excerpts(3 years, 11 months ago)
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Lord Bethell [V]
The noble Baroness is entirely right to focus on those who are the most vulnerable. Data for March 2020 shows that cancer referrals began to drop although treatment levels did remain high, with 15,363 patients starting treatment following an urgent referral. That is the highest figure on record in a single month. So, although some treatments may have been cancelled, as she rightly describes, what I would like to convey is that a large number of treatments did continue, and we will be working hard to address any backlog.
Baroness Finlay of Llandaff (CB) [V]
My Lords, following on from a previous question about bed capacity, I declare an interest in that my son was involved in setting up the Nightingale Hospital Excel. What assessment has been made of bed requirements to keep non-surgical care completely separate from surgical care that needs to happen in Covid-light or Covid-free areas, and to ensure the frequent testing of staff, in particular highly skilled trauma surgical staff who may be moving between these two zones, so that they do not themselves become a cause of transmitting infection?
Exercise Cygnus
Baroness Finlay of Llandaff Excerpts(3 years, 11 months ago)
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Baroness Finlay of Llandaff (CB) [V]
My Lords, after operation Cygnus were estimates of the requirements for PPE checked against the 2006 influenza pandemic stockpile, given that this store was found to contain no gowns or visors, and 21 million protective FFP3 masks were missing when the store was opened for the current pandemic?
Lord Bethell [V]
The noble Baroness is right—if I understand her correctly—that the needs of PPE for a flu pandemic were quite different from those for Covid. It is also true that the planning did not anticipate a breakdown in global trade and a failure of the business-as-usual supply of PPE. No one could have imagined that flights would be grounded and factories shut and that the global supply chains for these key and vital products would have ground to a halt in the way that they did.
Covid-19: Care Homes
Baroness Finlay of Llandaff Excerpts(3 years, 11 months ago)
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Lord Bethell
The noble Lord makes a comparison that history will have to judge on, I am afraid to say. I think that I am making a fair point when I say that Britain can really only benchmark itself against its close neighbours. The experience of Asian countries taught them an enormous amount, but it is not one that has seemed proximate or relevant to us in recent times. I am afraid that I can only leave it to history to judge whether we made mistakes. It would be wrong for me to prejudge that at this moment.
The Deputy Speaker (Baroness Finlay of Llandaff) (CB)
My Lords, I must apologise because I allowed everybody to come in. I had mistaken the timing and had allowed this to run for 15 minutes instead of 10. I must make it clear that this does not set any precedent. It was my error.
The Virtual Proceedings will now adjourn until a convenient point after 7 pm for the second Urgent Question repeat.
Covid-19: BAME NHS Staff
Baroness Finlay of Llandaff Excerpts(3 years, 11 months ago)
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Baroness Finlay of Llandaff (CB)
Given the association that there seems to be between a wide range of factors, are these being centrally collated? Are the Government producing guidance on, for example, vitamin D supplementation in the event of deficiency being detected, so that the national results are rapidly rolled out, and those cases where risk is discovered can be managed and supported?
Lord Bethell
I reassure the noble Baroness that the data is being centrally aggregated. ONS has published figures on ethnicity and the CMO and PHE are both scrutinising them. On their list of issues to consider is the role of vitamin D, where the evidence is interesting but unproven.
Covid-19: Testing
Baroness Finlay of Llandaff Excerpts(3 years, 12 months ago)
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Lord Bethell
My Lords, workplace testing for not just Peers but all workers is an important part of our return-to-work strategy. We need to work with employers of all kinds and the diagnostics industry to put in solutions so that people can go back to work with confidence that they are not infectious and that the person sitting next to them is not infected.
Baroness Finlay of Llandaff (CB)
My Lords, what national policy control mechanisms will be used to monitor and report on false negatives and false positives as testing is rolled out to complement a contact tracing app?
Lord Bethell
I did not hear all the question, but I think I understand what the noble Baroness is asking. The truth is that, however strong the sensitivity of the machines, false negatives and false positives are an inevitable part of the testing process. However, PHE conducts extremely thorough validation processes so that these are kept to a minimum and we will use algorithms to ensure that rogue test results are picked up as soon as possible.
Health Protection (Coronavirus, Restrictions) (England) Regulations 2020
Baroness Finlay of Llandaff Excerpts(4 years ago)
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Baroness Finlay of Llandaff (CB)
My Lords, I declare an interest as chair of the National Mental Capacity Forum. I want to highlight the tension between public health measures and protection of an individual’s rights, as defined through the Mental Capacity Act.
Those with learning difficulties, dementia and brain injury through disease or trauma often also have conditions that make them vulnerable to Covid, yet society has come to realise that the vulnerable are valuable—they enrich our lives. It has been difficult to explain to them why, and which, restrictions were needed, and it is now even less clear which parts of the guidance are statutory requirements. Is there now a need for a personalised app that tailors legally-apt guidance to the risk factors of a person and those in their household?
Going forward, people with capacity impairments will need more support to adapt to the lessening of the restrictions that were imposed for public health measures. The lockdown routines, creatively structured to keep people mentally and physically well, will change again as “isolation” becomes a nuanced word. Simply saying “use common sense” will not be enough. It will be hard work supporting those who are vulnerable as they adapt to widening and changing physical freedoms. Tasks such as keeping a 2-metre distance must be learned, using bank cards instead of cash makes people more vulnerable to fraud and exploitation, keeping a face mask on is difficult, and some have lost physical strength through decreased activity. The very vulnerable, and those with physical care needs, have carers coming and going. The plan of test, trace and isolate will keep them safe only if testing is rapidly and easily available, for both the person and those who care.
Will public health plans require that all testing facilities are local to the person and get results out rapidly? Which national external quality assurance systems are commissioned labs required to adhere to? Are false positives from RNA contamination, and false negatives from specimen decay in transit or from error-prone gene tests, being detected through audits? Unless those supporting the vulnerable are maintained virus-free, our second wave may be worse than the first.
Covid-19: Vulnerable Populations
Baroness Finlay of Llandaff Excerpts(4 years ago)
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Lord Bethell
My Lords, mental health advice is very clearly available, most of all from GOV.UK/coronavirus, where there is a huge amount of practical and pastoral advice, and access to resources.
Baroness Finlay of Llandaff (CB)
My Lords, I declare that I am an honorary fellow of the Royal College of Emergency Medicine. How will the Government ensure that emergency departments never again become the crowded places that they were, which act as a source of nosocomial infection—hospital-acquired infection—for the vulnerable and those caring for them, especially child carers, who might present with acute injuries, particularly once they are out and undertaking more activities?
Lord Bethell
My Lords, a strange and peculiar feature of the epidemic has been that accident and emergency wards are, surprisingly, below normal capacity since people have sought to avoid them because of the obvious threat of the disease. That said, nosocomial infection is of grave concern. It is an inevitable and frequent feature of any epidemic, but we are applying new ways of working and seeking to section off those with the disease to ensure that the infection does not spread in our hospitals and from there into the community.
Covid-19
Baroness Finlay of Llandaff Excerpts(4 years ago)
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Lord Bethell
I entirely agree with the sentiments and intent of my noble friend’s point. It occurs to me that we should perhaps set up some kind of advertising or promotion of this. I will take that point back to the department.
Lord Balfe (Con)
In the Statement, the Minister referred to the need for people who have other medical needs to still contact their GP. In Cambridge, where I live, the opticians, chiropodists, dentists and surgeries are all closed, with different fierce notices on their doors. When the isolation requirements are lifted, could the Government make it a priority to get these vital medical services open again and get doctors back into surgeries, not at the end of the telephone? Perhaps we could at least teach them that Zoom exists.
Lord Bethell
I reassure my noble friend Lord Balfe that the amount of video treatment being given by doctors has gone through the roof. During this epidemic, we have seen the medical trade and patients embrace a huge amount of digital technology. We are working with the colleges to try to get all the services of the medical profession open at this time and the response has been largely positive.
Lord Dobbs (Con)
Minister, are prisoners in our prison system participating in the manufacture of PPE? Does the crisis not represent an opportunity for many prisoners to not only contribute but move towards some rehabilitation?
Lord Sheikh (Con)
My Lords, my noble friend the Minister referred to the fact that the number of deaths that have occurred as a result of coronavirus stand at 18,738. The BAME community represents about 14% of the UK population, but unfortunately accounts for about 35% of all coronavirus patients in intensive care. The number of people in the BAME community who have contracted coronavirus and died as result is disproportionately high.
My noble friend might perhaps recall that I talked about the burial of Muslims when the Coronavirus Bill was discussed in your Lordships’ House. The Muslim community has got together, and burials are taking place in very difficult circumstances. However, I have been told by leaders of the community that the availability of land for burials should be kept under review and that a system should be provided if the land issue becomes a major problem and burials cannot take place. Secondly, the Government should consider providing additional funds to local authorities, which are dealing with very difficult circumstances. They are stretched to the limit and need additional resources for burials and cremations. Will the Minister comment on those two points?
The Deputy Speaker
Minister, if you could be very brief, we might be able to fit in the noble and learned Lord, Lord Woolf.
Lord Bethell
I am very grateful for my noble friend’s helpful update, but I remind him that these arrangements are conducted by local authorities. The question that he asks is best answered by those local authorities.
Lord Bethell
I thank the noble and learned Lord. Will he please express my and the Government’s profound thanks to his secretary for their contribution? I hope it is proving to be rewarding to him or her personally and impactful to the causes in which he or she serves.
The Deputy Speaker
My Lords, the time allotted for the Statement is now up. I thank all noble Lords for being concise, in particular the Minister for his very concise answers.