Invasive Group A Streptococcus and Scarlet Fever

Baroness Ritchie of Downpatrick Excerpts

Monday 5th December 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness for bringing this important issue before us today. To give context and answer the point, there were about 850 cases in the latest week, compared with about 186 in previous years. Generally, in peak years such as 2018, we had as many as 2,000 cases per week. We are not at those levels at the moment, but we seem to be seeing an earlier season: we normally expect levels to be higher in spring. At the same time, it is essential that we are alert. We have given instructions to doctors that they should proactively prescribe penicillin where necessary, as it is the best line of defence, and that they should be working with local health protection teams to look at whether to sometimes use antibiotics on a prophylactic basis where there is a spread in primary schools, which we know are the primary vector.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, the UK Health Security Agency is to work in collaboration with the public health agencies in Scotland, Wales and Northern Ireland. What level of collaboration has taken place on issues around strep A and scarlet fever, and what have been the results and outcomes? I am aware that there have been some cases in Northern Ireland.

[Lord Markham (Con)]

I know that the health agencies in each country work very closely together. I do not yet have the specific details, so I will happily follow up on this. I know that they are working very closely because it is clearly an area of concern. Right now, we have not seen any evidence of a new strain, so we think that we are looking at existing strains. We are seeing this number of cases because of a general situation where there is less immunity in the population because of the isolation related to Covid.

Coronavirus: New Cases

Baroness Ritchie of Downpatrick Excerpts

Monday 11th July 2022 Lords Chamber

[Lord Kamall (Con)]

Undoubtedly there will be an inquiry; in fact, the Government announced that there would be one. There will also be lots of independent inquiries and academics writing about what different countries got right and got wrong. When speaking to my friends who are Health Ministers in other countries, we all say that, looking back, there are things that we could have done differently, in various ways, if we had had that knowledge. But we also have to be very careful about the fallacy of hindsight, and of saying that we would have acted differently had we been in that situation. We can learn from hindsight, and we need to make sure that we do so for future pandemics.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, will the Minister take up the offer made by the noble Lord, Lord Foulkes, of a meeting of the four chief medical officers of the regions and nations of the UK to explore further possibilities and solutions in relation to Covid? Only last week in Northern Ireland I heard two separate virologists indicating that to reduce the advisory limit for self-isolation to five days was a dangerous precedent because many people in that group would remain positive, thereby spreading Covid in their local area. In view of that and the rising levels of Covid and other respiratory viruses, will the Minister immediately talk to his ministerial colleagues and set up such a meeting?

[Lord Kamall (Con)]

One of the things we do in the Department of Health and Social Care is to have regular meetings with our counterparts in the devolved Administrations—all the Ministers do. The noble Lord, Lord Foulkes, shakes his head, but I can tell him that we regularly have meetings with the devolved Administrations. I commit to go back to the department and see who is next due to have a meeting with their devolved counterparts, and ask whether we can put Covid on the agenda.

NHS: Respiratory Syncytial Virus Infections

Baroness Ritchie of Downpatrick Excerpts

Thursday 9th June 2022 Grand Committee

Asked by

[Baroness Ritchie of Downpatrick]

To ask Her Majesty’s Government what assessment they have made of the cost to the NHS associated with managing Respiratory Syncytial Virus infections.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I thank the Minister and the Front-Bench speakers in this important debate, particularly as we emerge from Covid-19 and given the other respiratory viruses that are live in the community. I declare a personal interest: as an infant, I had pneumonia, which was one of these deep-seated respiratory viruses. I am talking about 64 years ago, but the viruses were all put in the family of pneumonia. Out of that emerged bronchiolitis.

Several questions are raised about this issue. The first is: what is respiratory syncytial virus infection? It is a leading cause of severe lower respiratory tract infections among young children and infants. An RSV infection usually causes mild and self-limiting symptoms in children and adults, which resolve within a couple of weeks. Symptoms can include a runny nose, fever and persistent cough—something that most of us can identify with. However, modelling suggests that the virus is responsible for 50% to 90% of hospitalisations among young children due to bronchiolitis, which is a common lower respiratory tract infection predominantly affecting babies and children under two years old. Up to 40% of hospitalisations are due to pneumonia.

So why the concern about RSV now? In late 2021 and early 2022, modelling predicted that RSV levels may double compared to a normal year, with a 100% increase in cases in young infants and a 40% increase in overall infections expected. As a result of the Covid-19 pandemic, the 2021-22 RSV season may be longer, with spikes in infection expected sooner than usual. There was a significant reduction in respiratory viruses during Covid-19 lockdowns, which limited infant exposure to RSV and thus impacted overall immunity. As the restrictions eased, it became apparent that there had been a significant rise in RSV cases and admissions.

Most hospital admissions for RSV in the UK occur in babies who are otherwise healthy. Despite the risk to all infants, studies suggest that 88% of pregnant women and 66% of midwives have no or little awareness of RSV. There are now widespread concerns in the medical community around the impact of RSV on an already stretched health service in the coming months and the cost to the health service of managing RSV infections—hence the subject of this debate.

In an average season in the UK, RSV is estimated to be responsible for more than 450,000 GP visits in children and adolescents, 125,000 cases of ear infection and 416,000 prescriptions of antibiotics. On secondary care, the Academy of Medical Sciences said:

“A lethal triple mix of COVID-19, influenza, and the respiratory virus Respiratory Syncytial Virus (RSV), could push an already depleted NHS to breaking point this winter unless we act now”.


With RSV, there is a cost to the health system, including £48.2 million for secondary care and hospitalisations. There is a direct cost of £65 million, with £15.7 million being spent in primary care on GP consultations. There is also a socioeconomic cost from the direct financial losses of the family and carers of children diagnosed with RSV. These estimated costs are just over £14 million in productivity losses every year. In addition, RSV in children under the age of five is estimated to cost an accumulated total of almost £1.5 million from the out-of-pocket costs incurred to families.

We have to ask what should be done to alleviate the burden on the NHS and to provide relief to infants and young families. In the wake of the Covid-19 pandemic and the nature of RSV infections, what consideration have the Minister and the Department of Health given to this matter? What assessment have the Minister and the department, working with the NHS, undertaken on those costs, bed blocking and the impacts on primary and secondary care? What is the impact on hospital and workforce capacity and waiting lists? What consideration have the Minister and the department given to ensuring that RSV infections could be treated in the community and in homes?

There are other questions to which I would like answers. What steps is the Department of Health and Social Care taking or planning to take to reduce the costs of managing RSV for the NHS, families and the economy, particularly with the overprescription of antibiotics leading to problems with resistance? What is the proper treatment? What discussions have taken place with medical professionals and clinicians to ensure that infants and young children receive the best treatment for full recovery? What learnings from the Covid-19 pandemic is the Department of Health and Social Care considering implementing for other respiratory viruses, such as RSV?

In conclusion, the bottom line is to ask what plans are being made and what funding has been set aside to ensure that protection against respiratory viruses remains a health priority for the upcoming season this autumn and into the winter and that there is better management to deal with them. What new policies are being forged to address RSV infections and to cope with the demands on the NHS? We must not forget that not only the infected child feels the burden of RSV; their families, carers and the health service are also impacted. The seasonal and contagious nature of this infectious disease has raised wider concerns over the possible impact on healthcare capacity, which has been re-emphasised during the Covid-19 pandemic, particularly when the NHS has been overburdened and overstretched.

I look forward to the developing debate and the answers that the Minister can provide. I like to think that this will be the first stage of an opportunity to give this subject a greater level of debate in your Lordships’ House, as it will become much more acute and apparent as we emerge from the Covid-19 pandemic and approach this autumn’s influenza and RSV season.

International Healthcare Outcomes

Baroness Ritchie of Downpatrick Excerpts

Thursday 19th May 2022 Lords Chamber

[Lord Kamall (Con)]

I had a meeting only a few days ago with the person responsible for primary care—a doctor herself. One of the issues we discussed is how we make more effective use of different levels of primary care. What is interesting here is that primary care has, over time, taken on some of the services that used to be provided by secondary care. At the same time, some of those primary care services are now being contracted out or delegated out to, say, pharmacists or physiotherapists, et cetera. We are looking at a solution-focused way of tackling these issues, rather than focusing on who provides the care.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, as part of a solution-focused diagnosis, NICE has recently made a recommendation to reduce the waiting list for breast cancer diagnosis by suggesting the use of magnetic diagnosis. What acceptance will the department give to this proposal from NICE?

[Lord Kamall (Con)]

I regularly read recommendations from NICE, as do the relevant policy officials. Yesterday, for example, I was asked to the review the NICE business plan for the next few years, so the department will review the NICE recommendations. However, if the noble Baroness will allow me, I will have to write to her on the exact details.

Respiratory Viruses

Baroness Ritchie of Downpatrick Excerpts

Tuesday 11th January 2022 Lords Chamber

Asked by

[Baroness Ritchie of Downpatrick]

To ask Her Majesty’s Government what assessment they have made of the risks posed by respiratory viruses this winter to (1) children, (2) young people, and (3) the elderly; and what further medical protection measures they will put in place to tackle (a) respiratory syncytial virus, and (b) influenza.

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

Influenza remains a health threat, which is why the Government are offering flu vaccinations to more people this winter, including older people and, for the first time, all schoolchildren up to year 11. Reduced transmission of respiratory syncytial virus, or RSV, last winter led to a summer surge, particularly in child cases—there were few among elderly adults—which is now diminishing. Seasonal RSV preventive monoclonal antibodies for highly vulnerable children were authorised from June 2021.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, measures taken to combat Covid-19 over the last year have resulted in the epidemiology of seasonal viruses being out of sync with usual patterns. Last year, Public Health England reported concerns about rising rates of RSV infections in infants following the Covid-19 lockdowns, and reduced immunity levels combined with an already stretched health service. Given the continued pressures on the NHS, can the Minister outline what evaluation the Government have made of the NHS’s capacity to handle a potentially extended RSV season, and will they work with the devolved Administrations in that regard?

[Lord Kamall (Con)]

There was an unseasonal surge in RSV activity during the summer of 2021, which peaked in late July at about 15.7% swab positivity and a hospital admission rate of 2.5%. But, following the summer surge, RSV activity declined and positivity currently sits below seasonally expected levels. As a consequence, the RSV hospitalisation rate has declined since the summer surge.

Public Health: Night-time Working

Baroness Ritchie of Downpatrick Excerpts

Thursday 6th January 2022 Lords Chamber

[Lord Kamall (Con)]

This is why I was so looking forward to coming back here today. The noble Lord makes an incredibly important point about the effects of night-time working on noble Lords. It is really important that we push the Government to understand the impact it is having on our health.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, many of those who work at night are nurses, doctors and care workers because their jobs demand and require it. Their situation has been exacerbated during the Covid pandemic. Can the Minister indicate what work the Government are doing to look into ways of ameliorating and mitigating their situation, so that they can continue to carry out their work unhindered and unencumbered, as they are exposed daily and nightly to the ravages of Covid and other diseases?

[Lord Kamall (Con)]

I think all your Lordships would agree on the incredible dedication of our medical and health and social care staff, before and particularly during the pandemic. We have to remember that a lot of these conditions are governed by the Health and Safety Executive guidance on managing health and safety risks, which includes guidance on shift work and fatigue, to make sure employees are treated with as much dignity and respect as possible.

Breast Screening

Baroness Ritchie of Downpatrick Excerpts

Tuesday 14th December 2021 Lords Chamber

[Lord Kamall (Con)]

The plan will be published in due course. When we look at the backlog for the breast screening programme, we see that all 77 NHS breast screening providers are now operational and screening women. Some have caught up, and others are not predicted to recover by the end of March 2022. That is why NHS England and NHS Improvement have comprehensive plans, including spending and investment.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, as I can testify, breast cancer screening is vital. Allied to this is the need for funding for secondary breast cancer. I know that an audit has been launched here in England, but there are no such audits for secondary breast cancer in Northern Ireland and Scotland. Will the Minister use his good offices with those appropriate Ministers to ensure that such audits are established and that this House can be furnished with ongoing reports of the audit here in England, and the results thereof, to ensure that funding can be deployed into oncology, nursing and care support?

[Lord Kamall (Con)]

I thank the noble Baroness for raising the importance of co-ordination and sharing information across the devolved Administrations. I have meetings scheduled with health Ministers from the devolved Administrations, and I will make sure that my office puts this on the agenda.

Medical Schools: Training Places

Baroness Ritchie of Downpatrick Excerpts

Monday 13th December 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for that suggestion. I will look into it and get back to him.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, will the Minister indicate what research has been carried out into the training opportunities for specialist doctors post-graduation who wish to pursue careers as consultant orthopaedic surgeons? At the moment, because of Covid investment resources, there are no training opportunities for them in Northern Ireland. Will the Minister raise this issue and indicate what efforts will be made to address it?

[Lord Kamall (Con)]

I thank the noble Baroness for sharing the experience of Northern Ireland. It is really important that we ensure that we have more training places and that we address the types of training that we do. As the noble Baroness will be aware, it is no longer a simple question of nurses and doctors: we are training a number of physicians’ assistants and specialists, and we will continue to do so.

Covid-19 Update

Baroness Ritchie of Downpatrick Excerpts

Monday 29th November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for giving me notice of the question; I appreciate it. The answer that I have been given in response is that we have built a thriving private diagnostic market to meet the demand of the international travellers and day 2 PCR testing for travellers is provided by these private providers. Based on forecast modelling, we are confident that the market has sufficient capacity to meet the rise in demand that omicron may pose.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I thank the Minister for his Statement, in which he indicated that he was chairing a meeting of G7 members to deal with this specific issue. Will that meeting deal with the rollout of excess vaccines to the rest of the world, particularly those countries in southern Africa? I can only think of what my right honourable friend the former Prime Minister Gordon Brown said at the weekend, which was also reaffirmed in the leader column in yesterday’s Sunday Times: that nobody is safe in this world until everybody is safe. So is there a strategic plan to deal with excess vaccines to ensure that they are all used up, and particularly that they are used in those countries in the developing world that need them most?

[Lord Kamall (Con)]

I believe all noble Lords will agree with the points made by the noble Baroness on making sure that as many people in the world as possible have access to the vaccines. Someone said to me today that we are talking about third and fourth doses in the UK, but there are people in many parts of the world who have not yet had their first dose. I am sure noble Lords are aware of that. There is an analogy with when you are on an aircraft and the oxygen masks fall; do you protect yourself before you protect others? There is clearly a debate on this.

The UK remains committed to donating 100 million doses by the middle of 2022. We will have donated more than 30 million vaccines by the end of 2021 and have announced plans for 70 million doses in total so far. We will continue to ensure that any vaccines that the UK does not need are reallocated to other nations which require them wherever possible. Having sat in one of those G7 meetings with Health Ministers and joint G7 meetings with Health and Transports Ministers, I can assure noble Lords that one of the issues that comes up constantly is how we can help the rest of the world, particularly those countries which have not had access to even first doses of the vaccine.

Covid-19: UK Arrivals

Baroness Ritchie of Downpatrick Excerpts

Tuesday 16th November 2021 Lords Chamber

[Lord Kamall (Con)]

I assure the noble Baroness that when I was pressing this issue yesterday with officials in preparation for this Question, I stressed the importance of flexibility and creativity. We need to think outside the box on many issues. One issue we are looking at is: if passenger locator forms can do this, why can the NHS Test and Trace system not? I am told that is because it is based on self-certification. I am pushing the NHS to address and analyse the different options as soon as possible. It is really important we send a message to the rest of the world that we are open to the brightest and the best from across the world.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, in Queen’s University Belfast, the current position is determined by the Public Health Agency in Northern Ireland and is based on your vaccination status and age, rather than on whether you have home or overseas status. Would the Minister engage with the devolved Administrations, particularly the Northern Ireland Executive, who seem to have best practice in relation to this issue?

[Lord Kamall (Con)]

One of the advantages of having devolved Administrations and different practices is that we can learn from best practice, so I will take the noble Baroness’s advice.