Care Homes: Guidance

Baroness Ludford Excerpts

Wednesday 21st April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, there are two points of difference. One is that we can take certain measures to guide the behaviours of care home workers but we cannot mandate for every aspect of their lives. Secondly, care home workers wear PPE and that significantly reduces their infectiousness. We do not ask care home residents to wear PPE. Were we to do so, I think it would provoke suitable concern among residents and their families. As a result, we have to have these isolation protocols in place to avoid the spread of the virus.

[Baroness Ludford (LD) [V]]

My Lords, I am a member of the Joint Committee on Human Rights, which has been concerned about the treatment of care home residents over the past year. It is continuing its inquiry with an evidence session this afternoon. As colleagues have asked, are not the Government sabotaging the chance for care home residents to have a trip outside, especially given that staff are coming and going without quarantine? The Government’s guidance says that they “recognise how important” outside trips are

“for residents’ health and well-being”.

At the same time, and as the Minister has affirmed in his answers today, they recognise that their requirement for a 14-day isolation period

“is likely to mean that many residents will not wish to make a visit out of the home.”

This is insulting and treats care home residents and their families like children, not as responsible adults.

[Lord Bethell (Con)]

I completely sympathise with the noble Baroness’s point. She is right: this puts huge pressure on residents and their families. I am heartfelt when I say that I completely agree with her that this has an impact on the mental health and well-being of residents. However, their health, their safety and their actual lives take priority, I am afraid. We are at a moment where, even with the rollout of the vaccine, there is still a high infection rate in the country. If the virus gets into a home it has a potentially devasting effect, spreading very quickly within the confined spaces of the home among people who, typically, are highly vulnerable. That is why we have to put in place these serious protocols. This is done with huge regret and we review it constantly. It is my sincere hope that we can lift these protocols as soon as we possibly can, but until the day when the evidence is conclusive, we have to have them in place in order to protect lives.

Reciprocal and Cross-Border Healthcare (Amendment etc.) (EU Exit) Regulations 2020

Baroness Ludford Excerpts

Monday 16th November 2020 Lords Chamber

[Baroness Ludford (LD)]

My Lords, I thank the Minister for his introduction. The removal of free movement rights in the recent Immigration Act is a matter of great regret to millions of British people, who knew their value. It will also become a matter of regret to many more Brits once they realise that their dreams of working in Germany or retiring to Spain without hassle or paperwork have been torn from them. The triumphant tweet from the Home Secretary celebrating the end of freedom of movement was a tasteless mistake.

The loss of the European health insurance card will be understood and felt immediately by any British person wanting to travel within the EEA next year. If the promise of the vaccines is borne out and travel opportunities open up, people will want to spread their wings. But they will get a nasty shock from the travel insurers, as the price of a policy will be whacked up to account for the loss of free emergency healthcare under the EHIC. In the other place, it was mentioned that some 30,000 people on dialysis can currently travel throughout Europe and receive their dialysis free of charge thanks to the EHIC. This is not covered by commercial travel insurers and in future it will cost them up to £1,000 a week. The Minister in the other place talked about a recently launched directory of specialist insurers covering serious medical conditions. Well, maybe—but the premiums are likely to be eye-watering.

Brits are also losing the ability to go to another EEA country for, say, an operation when the NHS waiting list is too long. Can the Minister tell me how many procedures have been done under the cross-border healthcare directive since it was implemented in 2013? It is perhaps appropriate that the amendment to domestic legislation entails deletion of references to “EU rights” because, very sadly, rights are being torn from British people in the healthcare sector as in so many others.

The only brighter news is that, thanks to the withdrawal agreement, some people will retain rights after the end of the transition period. First, UK nationals living and working in the EEA on 31 December 2020 will continue to be entitled to healthcare funded by their member state of residence and get an EHIC issued by that state. Can the Minster clarify whether that EHIC will grant that UK national free emergency healthcare wherever they travel in the EEA or only in their member state of residence? Will those British nationals get free NHS care when they visit here?

Secondly, British pensioners resident in the EEA on 31 December 2020 who hold a so-called S1 form will continue to be entitled to UK-funded healthcare, including a UK-issued EHIC. Will that EHIC be usable throughout the EEA, and will the S1 form mean they will get free NHS care in this country? EEA nationals resident in the UK on 31 December 2020 will continue to be entitled to access the NHS, which I assume means free of charge. They will also get a UK-issued EHIC, which will surely make their British friends very jealous indeed.

Lastly, a British national who has previously worked in an EEA country can get a UK-issued EHIC plus planned treatment in an EEA country under the S2 scheme. They can also apply for an S1 form—this debate has a horrible amount of jargon—issued by the UK once they reach state pension age, on the same terms as now. Is there a specified minimum length of time that they would need to have worked in an EEA country, or could it be for as little as, say, a week? Again, there will be some jealousy from their British friends that a British national, by virtue of having worked for I do not know how long in an EEA country, will be able to get a new EHIC.

I welcome the agreement with Ireland that the Minister referred to. I was not sure whether the agreement had been finalised, but it is of course good news.

As the clock ticks down to 31 December, we know that even if a deal is reached with the EU, it will be a skinny one. How confident is the Minister that it will include any provision to continue reciprocal healthcare, including the EHIC? Discussion about rules of origin or customs arrangements might seem arcane to many people, but losing access to free healthcare if ill on holiday will hit home to most Brits. The Minister said that no impact assessment has been done because the instrument makes only “technical” amendments. British holidaymakers might disagree when they get their bill from their travel insurer. A Government celebrating “getting Brexit done” through gleeful tweets about the loss of rights might find themselves not so popular if they tweeted about the EHIC. They might think that the loss of free movement is popular, as many people have yet to discover that free movement is a two-way benefit, but the loss of the EHIC card will not go down well at all. I hope the Minister will be able to give us good news about continued arrangements.

Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 2) Regulations 2020

Baroness Ludford Excerpts

Friday 18th September 2020 Lords Chamber

[Baroness Ludford (LD)]

My Lords, getting the (Amendment) (No. 2) and (Amendment) (No. 3) regulations is somewhat academic, since the (Amendment) (No. 4) regulations came into force at one minute past midnight last Monday morning. There are various illogicalities and serious constraints on human rights in all these regulations and I look forward to the fairly imminent report from the Joint Committee on Human Rights, of which I am a member.

Our Secondary Legislation Scrutiny Committee commented in its 19th and 24th reports on the problems caused by regulations being laid less than 12 hours before they came into effect. In the case of the (Amendment) (No. 4) regulations, they were published only about 12 minutes before they came into effect—at, as I say, one minute past midnight. Can the Minister confirm my understanding that they were laid only after they came into effect?

I welcome the fact that, finally, the guidance and the law coincide. I believe that the Government’s language in the last six months has created a lot of confusion, including for the police. They have used the term “must” about both law and advice. I imagine this was because Mr Johnson was coy about the “nanny state”, but the obfuscation was very unhelpful. It would have been much better to say, “This is what you must do, because it is enforceable law, and this is what you should do, because it is your civic responsibility to show respect and care for your fellow citizens.”

It is my belief that the overwhelming majority of people would respond to such clarity by following both law and guidance if they diverge. Better, though, to bring the two together, which I believe the (Amendment) (No. 4) regulations finally do. Why has it taken six months for the Government to do that?

Lastly, I observe that, on the Tube in the last couple of weeks, I have observed almost 100% observance of the requirement for a face covering. I attribute this to the clarity of the requirement and to the fact that Londoners are law-abiding and care about their city. As internationalists and majority remainers, they were once labelled “citizens of nowhere” by a former Prime Minister. I am glad to say that Londoners have demonstrated that they are very much citizens of somewhere.

Covid-19: Response

Baroness Ludford Excerpts

Tuesday 19th May 2020 Lords Chamber

[Baroness Ludford (LD)]

When the Health Secretary told the other place yesterday that he was preparing to roll out his contact-tracing app, he rejected the plea from my colleague, Daisy Cooper MP, for a law providing for specific, rigorous safeguards. When does the Minister expect to get the response from the Information Commissioner on the data protection impact assessment for the app, which has been judged by privacy experts to be confusing and misleading?

[Lord Bethell]

The noble Baroness raised the data protection impact statement, which I have read. I did not find it confusing; I thought it was extremely straightforward and it has been welcomed by a large number of the privacy groups I have spoken to.

Coronavirus Bill

Baroness Ludford Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Tuesday 24th March 2020 Lords Chamber

[Baroness Ludford (LD)]

My Lords, the only bright spot in this crisis is that experts are being listened to; long may that continue.

Obviously, the overarching concern is that the powers in the Bill should last no longer than is strictly necessary, should not overreach and should not set unwelcome precedents—one thinks, for example, of the reduction to one doctor for the exercise of Mental Health Act powers and the problems around care assessments. Moreover, the powers should not impact unfairly on disadvantaged minorities or marginalised groups, and should not go further than can be truly justified. It is not entirely clear why the Civil Contingencies Act or the Public Health Acts were insufficient in various areas.

In Schedule 21, there is a test of necessity and proportionality which is strangely absent from Schedule 20—the one that affects directions to people. From these Benches, we will therefore table an amendment to require that all the powers in the Bill should be exercised in accordance with the principle of necessity, proportionality and non-discrimination, respecting the European Convention on Human Rights and other human rights instruments. We also want the Government to keep the powers under frequent review and to publish reasons and explanations for any measures introduced under the Bill.

Although the right to life—Article 2 of the ECHR—underpins the response to this pandemic, human rights issues under several articles of the convention are engaged: Article 5 on the right to liberty; Article 8 on the right to family life, as relating to isolation, quarantining and restriction of family visits; Article 11 on freedom of assembly and association, relating to the prohibition of public meetings and gatherings. These are just some of the examples. I am glad that the Joint Committee on Human Rights, chaired by the right honourable Harriet Harman—I declare an interest as a member—is conducting an inquiry into the human rights implications of the response to Covid-19.

There have been shocking cases of victimisation and blaming of certain people due to their perceived ethnic or national origin, particularly those of Chinese and other east Asian appearance. The power for local authorities not to meet some assessed care needs and to avoid the duty to conduct a care needs assessment will impact on the vulnerable. The Government should, at a minimum, notify the Council of Europe and the United Nations, as stewards of the ECHR and international human rights instruments respectively, that the UK is enduring a national emergency, and of the measures being taken. Do they in fact need to formally derogate? Perhaps the Minister could tell us.

People need to be able to assess, scrutinise and, if necessary, question and challenge the Government. It is not helpful to have a Minister on Twitter call someone by a rather vulgar term because they had the temerity to raise questions about the Government’s approach, as happened yesterday. Apparently, there have been no advertisements on social media. I am on only Twitter so I do not see Facebook, Instagram or any of the others but, considering that a lot of money was spent on Brexit no-deal ads on social media, this omission seems anomalous.

Assessing Schedules 20 and 21 is a bit difficult, as we do not yet know how the Government will give effect to the measures heralded in the Prime Minister’s announcement last night. I imagine that is still being worked through. Schedule 20 does raise a lot of concerns. Where are people to be directed or detained? Is a police station envisaged or just home? What screening is to take place, especially given the lack of current testing capacity? Will there be any judicial authorisation of detention or any provision for appeals? What about people who, for one reason or another, do not have a home to go to—the street homeless, sofa surfers, victims of domestic abuse, some immigrants and refugees, who get little or no support? Surely imposing isolation and quarantining restrictions on people living in abusive or dangerous environments would place them in an impossible situation. As concerns Schedule 21, are the closure of premises regulations issued just last Saturday under the public health Act—they were mentioned by my noble friend Lord Newby—to be revoked in the same way as the February regulations on direction and detention of persons are repealed by this Act in Schedule 20?

I want briefly to mention one or two other things. I entirely agree with the noble Lord, Lord Falconer, and the right reverend Prelate the Bishop of Rochester, who raised issues about funerals and religious beliefs as concerns the need for burial and not cremation. As someone who organised my late husband’s funeral just five months ago, and a memorial service four months ago, this is very important to me. I will perhaps have more chance tomorrow to raise concerns about immigration powers as they affect people in immigration detention as well as in prison. Also, the fear of data sharing with the Home Office could deter people from seeking health treatment. Will the Home Office undertake to suspend that data sharing?

There are also some concerns about video hearings in court. Much as one accepts that they are necessary in the circumstances, various safeguards would be required. There are also concerns about changes to the Investigatory Powers Act and the extension to 12 days for a warrant. From experience, we know that there is a ratchet effect of expansion of state powers, as terrorism legislation has shown. We will need to be vigilant to prevent spillover.

Covid-19 Update

Baroness Ludford Excerpts

Monday 16th March 2020 Lords Chamber

[Lord Bethell]

On government priorities I will be really simple and clear. The Government’s priorities are to save lives and to support the NHS. That is our objective and that is what we are throwing our energies into. In terms of sick pay and support for the self-employed, provisions for those have yet to be published, but when they are I look forward to them being discussed.

[Baroness Ludford (LD)]

My noble friends Lady Brinton and Lady Hamwee have tried to get an answer from the Minister on this question of enabling businesses to claim on their insurance. If they are just advised to close, as I understand it, most of them would not be able to do so, but now we hear from my noble friend Lady Hamwee that DCMS has actually instructed theatres to close—but only theatres. What about restaurants, bars, clubs and everybody else? It does not seem to be a very coherent situation and for the Minister just to say that it is not within his purview to answer this question is frankly not good enough. Could he please give a clear answer as to whether not only theatres but other businesses will be instructed by the Government to close, so as to enable them to claim on their insurance policies?

[Lord Bethell]

As the noble Baroness will be aware, this is a fast-changing situation. I cannot come to this House, in all honesty, and give an account for every single element of the strategy since we have turned around some of these decisions in very quick time. Our focus is on health and on our clinical decisions. When I am able to deliver an answer to that question, I will do it. As soon as I can, I will be glad to write to the noble Baroness.

Brexit: Food Standards Regulations

Baroness Ludford Excerpts

Tuesday 4th September 2018 Lords Chamber

[Lord O'Shaughnessy]

My understanding is that they will be laid, subject to clearance, before the end of the year.

[Baroness Ludford (LD)]

My Lords, the Government are refusing to agree with Brussels on maintenance of the system of geographical indications which protects the name and quality of local and regional products. Are the Government throwing Cornish pasties and West Country cheddar to the wolves in proposing to accept fake American versions of these products?

[Lord O'Shaughnessy]

I do not know whether wolves like cheddar, but that is more a question for my colleagues in Defra which I would not seek to answer. What I can say is that we want to provide protection for everything that the UK produces that is internationally recognised and special.

Long-term Plan for the NHS

Baroness Ludford Excerpts

Tuesday 19th June 2018 Lords Chamber

[Lord McColl of Dulwich (Con)]

My Lords—

[Baroness Ludford (LD)]

My Lords—

[Baroness Manzoor]

My Lords, we have plenty of time. It is the turn of the Lib Dem Benches.

[Baroness Ludford]

My Lords, further to the question from the noble Lord, Lord Davies, is it not true that the OBR forecast budget deficit is twice our net EU contribution? We will also be making continuing payments for participation in EU programmes and agencies, let alone the £39 billion divorce Bill. Is not the Brexit dividend claim on the No. 10 website—which is a government website, not a Tory Party website—a breach of the Government’s duty to ethics, truth and accuracy?

[Lord O'Shaughnessy]

No.

Health: Sepsis

Baroness Ludford Excerpts

Thursday 14th September 2017 Lords Chamber

[Lord O’Shaughnessy]

I am grateful to my noble friend for raising this important issue and I should like to pay tribute both to the UK Sepsis Trust and to the campaigner, the parent Melissa Mead. I do not know if noble Lords saw the moving “Panorama” programme broadcast earlier this week about the work that she has done to raise awareness of this issue. She is truly inspiring given that she lost her child.

A major campaign was launched at the end of last year to raise public awareness. It was fronted by the Secretary of State, and, indeed, Public Health England is building messages about sepsis into its Start4Life campaign. I believe that the particular proposal is that there should be a campaign of advertising on the sides of ambulances. The Secretary of State is sympathetic to the idea and is raising the issue with the chief executives of ambulance trusts to see whether this is something that we can take forward.

[Baroness Ludford (LD)]

My Lords, I am grateful to the noble Lord, Lord Grade, for raising this extremely important topic, which coincides appropriately with World Sepsis Day this week. My husband is a fortunate survivor of sepsis, albeit at the cost of an amputated leg. He is not one of the 44,000 annual fatalities only because of the speed and skill of the medical professionals at the Whittington Health NHS Trust. I should declare an interest in that he is the chairman of the trust, which I believe has the best record on treating sepsis in London. Clinical awareness is rising in the NHS but it is patchy, so more must be done. Public awareness is very low, and I am grateful to the Minister for announcing those plans. However, they must be reinforced so that friends and family and members of the public know how to spot the possible symptoms.

[Lord O’Shaughnessy]

I am sorry to hear that sepsis has affected the noble Baroness’s husband in that way and I am glad to learn that he is not one of the more than 40,000 people who die from the condition every year. Public awareness is critical and, as I say, we are looking at new ideas for how to get the message across using a range of routes. The point about clinical awareness is also very important. Until a couple of years ago, there was no widespread clinical awareness of the symptoms of sepsis and how to assess and then treat people, but we have seen quite a big improvement. I can give one example. For those presenting with symptoms in emergency departments, previously only around half were assessed for sepsis; the figure is now up to nearly 90%. I see that as good progress, but clearly there is much more to do.

Brexit: Risks to NHS Sustainability

Baroness Ludford Excerpts

Wednesday 12th July 2017 Lords Chamber

[Baroness Ludford (LD)]

My Lords, I warmly thank the noble Lord, Lord Warner, for initiating this important debate. As he said, we are very reliant on EU workers in the NHS and social care, which includes around 10% of doctors and 7% of nurses. Sadly, there is already evidence that they are leaving or not coming to the UK. As well as the alarming drop in nurses cited by the noble Lord, more than half of the 10,000 European doctors working in the NHS are now considering leaving, according to a survey conducted by the General Medical Council.

In social care, 7% of staff, or 90,000 people, are from elsewhere in the EU, but numbers are already dropping. The Brexit squeeze on social care workers is likely to hit the elderly hardest, as it is predicted that there will be almost 3.5 million more over-65s by 2030. That figure could be supplemented by many UK pensioners returning from places like Spain if their rights to residence, public services and especially to healthcare are not safeguarded. We could be losing fit, younger skilled workers just as the pressure of more older people needing the NHS and social care builds ever higher. The exodus of EU staff exacerbates the shortage of doctors, nurses and care staff, which puts a heavy workload on current staff, causing many to leave the service. So we absolutely need to attract EU workers into the NHS and social care rather than deterring them in order to fill the vacancies.

The Liberal Democrats regard the Government’s proposals on EU citizens’ rights as inadequate, and in particular are calling on the Government to guarantee an immediate “NHS passport” for the 60,000 EU nationals who work directly for the NHS. In the future under Conservative plans, the NHS faces an “immigration skills charge” of £2,000 a year for each doctor, nurse and health worker that it brings in from the continent. Will the Government exempt the NHS from this charge?

Then there are all the teachers and academic staff in universities helping to train the next generation of medical professionals. We are already short of STEM specialists and Brexit is going to make this even worse. We will also be outside the EU systems for mutual recognition of qualifications, which will make it more difficult to recruit as well as more difficult for our UK citizens to get experience in other EU countries. As was said by the noble Lord, Lord Warner, both the NHS and social care are already underfunded and they both need immediate injections of cash as well as long-term sustainable funding. Brexit puts this at risk because of the threat to the British economy and the tax take. You cannot have a hard Brexit and a strong NHS.

Some 190,000 pensioners live in other EU countries and can use local health systems thanks only to reciprocal EU arrangements. If those arrangements fall away, UK citizens will have to pay for their treatment abroad, and many may choose to return to the UK. The cost to the NHS of the return of all UK citizens of pension age would be nearly half a billion pounds a year.

As soon as the result of the referendum was announced, there was an immediate effect on international collaborative research projects involving UK researchers. Our scientists were asked to withdraw from funding applications, as it was seen that their presence in a team could put an application at risk. The UK has done extremely well from EU funding for life sciences research, receiving almost €9 billion between 2007 and 2013. How do the Government plan to replace all this money in the future? Apart from the money, the medical, scientific and industry benefits from international collaboration are enormous and I do not know one single scientist who is other than deeply unhappy about Brexit.

I am associated with the Juvenile Diabetes Research Foundation, which has told me that:

“Without EU funding a number of vital research programmes would not exist, as comparable funding, especially to support consortia, is not available elsewhere”.


The foundation participated in a €6 million award for immunotherapy to treat type 1 diabetes, which involved small and medium-sized firms as well as research institutes. It also said that researchers,

“depend on personal funding from the EU, including Fellowships, to enable them to pursue a career in research and start-up their labs”.

I understand that the European Research Infrastructure Consortium, which facilitates cross-border research partnerships, requires that all signatories have to accept the jurisdiction of the European Court of Justice for arbitration. How will our researchers continue to participate in this consortium post Brexit? How will British researchers and those coming here from the rest of the EU be able to move seamlessly across borders in an era without free movement? The then Minister, the noble Viscount, Lord Younger of Leckie, told us in March about a high-level stakeholder working group for universities, research and innovation that the Minister, Jo Johnson, had established to look at the risks and opportunities of Brexit—although no one has actually suggested any opportunities to me. What are the conclusions so far of that working group?

There is great concern that Brexit will mean increased cost, reduced access for UK patients to new medicines and medical devices, reduced patient safety and damage to business prospects. Leaving the customs union will cause delays and extra costs in medical devices and access to medicines. Most of these products cross country borders several times during the process of development, clinical trials, licensing and regulation. The single market has built up a complex and detailed web of protection.

The coalition Government carried out reviews on the balance of EU competences. The review on health noted how collaborative action at European level on medicines and medical devices can be more effective and thus beneficial for patient safety because the EU can,

“effectively tackle … counterfeit medicines, which involve complex global supply chains; share safety information on medicines once they are on the market and quickly detect”,

risks to safety. Far from wanting to pull out of this system, industry welcomed it, stressing,

“the advantages of the common regulatory framework for ensuring a high level of patient safety and secure supply”.

Not only are we losing 2,000 jobs through the loss of the European Medicines Agency, but, as the Association of British Pharmaceutical Industry told that review in 2012:

“The introduction of the centralised procedure, along with the creation of the EMA, not only greatly simplified”,


the processes,

“but also resulted in a system where medicines information such as the patient information leaflet are consistent across all EU Member States, which is good for public health protection”.

How do the Government plan to recreate the regulations that will allow us to buy and sell medicines in the EU? What system will be put in place to ensure that UK regulations keep up with those in Europe? Can the Minister explain more fully what the Secretaries of State for Health and for Business had in mind in their wish expressed in a letter to the Financial Times last week for,

“deep, broad and dynamic cooperation”?

The MHRA chairman, Professor Sir Michael Rawlins, has warned that withdrawing from the EMA could put the UK behind Japan, the US and EU nations in the queue when new drugs are introduced.

Brexit will mean that dangerous or defective drugs that pose a threat to patient safety may be available to British consumers for longer than on the continent. Leaving the EU medicine safety system means the UK will be slower to respond to safety issues, putting patients at risk. Relevant to research and clinical trials is the framework for data protection. How will the Government ensure that UK law keeps up with the future development of EU regulation and ECJ case law, without which we could be excluded from collaboration?

I will not mention Euratom as other noble Lords have done so and we are fortunately going to have a debate, initiated by my noble friend Lord Teverson, next week, but I will mention the business opportunities for our pharmaceutical and life sciences industries, which not only EU research collaboration but EU common regulation open up. They have been very vocal in insisting on those opportunities in improving competitiveness and exports. What will the effect be of the UK losing the life sciences section of the EU patent court if we can no longer participate?

How will all these benefits of being part of the single market in health be replicated if we are outside the EU? No free trade agreement will cover the myriad networks and systems that 45 years of EU membership has created. Finally, the Brexit Secretary, David Davis, says it is an aspiration to keep the benefits for individual travellers of the European health insurance card. A lot of people will realise just how useful European red tape is if they lose the EHIC.