Health Protection (Coronavirus, Local COVID-19 Alert Level) (Very High) (England) Regulations 2020

Baroness Smith of Newnham Excerpts

Wednesday 14th October 2020 Lords Chamber

[Baroness Smith of Newnham (LD)]

My Lords, I very much regret the statutory instrument that we are debating this afternoon. Like other Members of your Lordships’ House, I am acutely aware of the need to be able to deal effectively with Covid-19.

I declare my interest. I might go by the title of Baroness Smith of Newnham, which is in Cambridge, but I am of Crosby in the county of Merseyside, which I believe Her Majesty’s Government have now renamed Liverpool City Region. I am from Sefton. On Friday, I was planning to travel to visit my father, as well as my optician. That might of course be seen as simply “doing a Dominic Cummings” but I had anticipated doing so. I have talked to my family and asked what they think about the tier system and, in particular, the question of visits by members of the family who no longer live in the city region. Officially, we can visit but we cannot stay—or maybe we can, although it is advised not to.

I have looked at the three statutory instruments that we are dealing with today—unlike the noble Baroness, Lady Noakes, I propose to speak to only one of them—but it is not clear how people are expected to engage between the three tiers. It is not necessarily clear to people in Sefton and others parts of Merseyside why they should be in the “very high” tier, when infection rates are lower than in Manchester, Nottingham or Newcastle-upon-Tyne. If it is because of the capacity of the local hospitals being reached, that needs to be made much clearer.

Given that I am from Crosby, I should be most grateful to be told whether outdoor locations where people are permitted to meet include a beach. To me, that is outdoors and possibly a place where I am allowed to meet my father. However, in terms of trust and understanding the Government, can the Minister explain why this approach is being taken now rather than their having proposed something clearer and more self-explanatory three weeks ago, when SAGE put forward its suggestion for a circuit break?

Covid-19: Response

Baroness Smith of Newnham Excerpts

Monday 27th July 2020 Lords Chamber

[Baroness Smith of Newnham (LD) [V]]

My Lords, the noble Baroness, Lady Falkner of Margravine, raised the issue of the procurement of PPE. Can I press the Minister on the procurement of vaccines? According to the Statement, the Government appear to have secured 190 million doses of vaccine—if they succeed. Could he tell us what procedures have been undertaken to procure the vaccines and reassure the House that the country will not lose money if the vaccines do not, in fact, succeed?

[Lord Bethell [V]]

I am not quite sure of the 190 million number. I think that is possibly an aggregate number of different vaccines. However, the practicalities of vaccine research are extremely expensive, and there are eight, nine or 10 potential runners and riders in the global vaccine market. It is the practice for countries to contribute to those research costs up front in order to have access to the vaccine should it be successful. That is the practice for medical research of many kinds, and these are the practical costs of trying to break the difficult mystery of the disease and providing security for ourselves and for our children.

Covid-19 Update

Baroness Smith of Newnham Excerpts

Monday 16th March 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is entirely right. As a trustee of Sadler’s Wells, I understand completely the implications of what she is saying, her point about insurance, and the confusion there might be about what the current status is. I simply cannot answer the question right now. I am not trying to avoid a difficult question; I simply do not have the information. When I do, I will be very happy to write to her and to others who have asked about this.

[Baroness Smith of Newnham (LD)]

My Lords, the Minister has told us several times that the key government priority is to deal with the health crisis of Covid-19. But what work are the Government doing to ensure that the other issues that have been raised, for the self-employed and for small businesses, do not lead to such severe crises that we see an outbreak of suicide because people simply cannot cope and think they do not have a future? It is not only the virus: there needs to be a whole series of decisions around questions that have been raised this evening, to which we have not yet had any answers.

Hospitals: Listeria

Baroness Smith of Newnham Excerpts

Monday 17th June 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Lord, Lord Tunnicliffe, for his question. The purpose of the review is to build on previous work and to implement standards for higher-quality food for NHS patients. It will take a root-and-branch approach and will follow the evidence where it can make improvements. The terms of reference are to work with the NHS and stakeholders; they are currently under development, but will be shared with Parliament as soon as they are set in place.

I can also reassure the noble Lord on the question he raised about the products. While GFC manufactures a range of products, in the consumption data gathered from case records only sandwiches were identified as having been consumed. It is therefore anticipated that the review targeted at the NHS is the right approach.

[Baroness Smith of Newnham (LD)]

My Lords, like the noble Lord, Lord Tunnicliffe, my thoughts and prayers are with the families of those who died. It is clearly right, as the Secretary of State said in his Statement, that people expect to be safe and looked after in hospitals. Yet the Answer to the Urgent Question seems to spend rather a time talking about healthy food and other wider issues. This is an urgent issue. What will happen urgently to ensure that similar situations cannot happen again? Getting rid of sugar may be important, but ensuring that listeria is not present is vital. What necessary steps will be taken to restore trust urgently? I am sure that we all welcome the Secretary of State back to his full-time job now that he has stopped trying to be leader of his party.

National Living Wage: Social Care

Baroness Smith of Newnham Excerpts

Thursday 5th May 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness is absolutely right. Our whole focus must be on the residents of these homes rather than the owners. There are a number of very highly leveraged providers in this sector, which have high levels of debt—often very expensive debt—for historical reasons. The CQC is keeping a very close watch on them. When there are early-warning signs of difficulties, the CQC and the local authorities will put in place alternative plans.

[Baroness Smith of Newnham (LD)]

My Lords, talking to a charity recently I was told that some care homes have already raised fees by £100 a week since the introduction of the national living wage in April this year. What plans do the Government have to look at the relationship between the cost of care homes and the cost to the individual of the economic viability of care homes, in light of the fact that the target for 2020 is to have a national living wage of £9? We need social care and care homes to be economically affordable.

[Lord Prior of Brampton]

The living wage will go up over this period of time. The better care fund and the social care precept will of course go up, too, over this period. Clearly there will be some fee increases. Local authorities have an obligation under the Care Act to have a sustainable and diverse market in their area. There will be fee increases to private providers but the main squeeze—the main concern which we in this House should have—is over local authority-funded care.

Health: Lymphoedema

Baroness Smith of Newnham Excerpts

Wednesday 9th September 2015 Lords Chamber

[Baroness Smith of Newnham (LD)]

My Lords, I am most grateful to the noble Lord, Lord Hunt, for raising this issue for debate today. Many people have no idea what lymphoedema is. When I saw that this was to be raised as a Question for Short Debate, over the course of the summer I said to various people, including Members of your Lordships’ House, “I am speaking in a debate on lymphoedema”. The reaction of most was, “What is that?”, and in the case of someone I was speaking to last week, “What a waste of time. Has the House of Lords not got anything better to do than talk about medical things? Surely that is a waste of taxpayers’ money”. I might have added the last sentence about taxpayers’ money, but there was a sense of incredulity that noble Lords would talk about a medical issue. Clearly, we cannot spend all our time talking about specific medical issues, and yet as we have heard, particularly from the noble Lord, Lord McColl, lymphoedema is a lifelong condition that needs greater awareness and earlier diagnosis. Sufferers need to be aware of what needs to be done.

I declare an interest as someone who has secondary lymphoedema. I do not have it from having had cancer but from having had an infection in the foot. Last week, when I told my GP, who has been a doctor for 20 years, that I would be speaking in a debate, he said, “Yours is the first case I have seen of someone with lymphoedema following an infection”. That is part of the problem. A cancer sufferer who has their lymph glands removed is immediately told, “There is the potential that you will get lymphoedema. Here are the things you need to look for”. That will include massage, compression and so on. It is not so easy to diagnose a person who suffers from secondary lymphoedema as a result of surgery.

In my case, the diagnosis came almost by chance, as I was perhaps a bit too vain. My foot was puffy, although not particularly sore and there was not any infection, but I kept going back to the doctor. Eventually, a GP said, “It has been puffy for a year. We will send you for further diagnosis”. I was sent to a lymphoedema clinic in Cambridge. From what I have heard today, Cambridge is clearly a beacon because the clinic has several lymphoedema nurses. They all seem to know what they are doing, whether or not they have been taught to a common framework. The clinic went through the diagnosis and eventually said, “You can go and we will try to find out what the problem is”. The answer was that there are no lymph nodes in my foot because somehow they had been killed.

The formal diagnosis is fascinating but not something that most people will have to go through. Obviously, I went online to find out more about lymphoedema and began to realise that it is potentially a hugely dangerous, lifelong condition. It will not immediately kill you, so one may understand to some extent those people who said, “Why is the House of Lords wasting its time talking about this condition?”. For most people, it will not be life-threatening but the complications need to be considered carefully. If it is not managed in the way referred to by the noble Lord, Lord McColl, there is a danger of severely thickened limbs and loss of mobility. There is also the danger of cellulitis, the repeated need for antibiotics and a potential need for intravenous antibiotics. Clearly, the NHS does not want to have to deal with more in-patients with conditions that are preventable, which is an issue. It is almost impossible to prevent lymphoedema in the first place but there are ways to ensure that its aspects associated with further infection can be minimised.

As someone who was diagnosed in my 30s, I particularly would like to make a case for talking about how we raise awareness for younger sufferers. People may say that being in one’s 30 is not very young but, relatively, if you are diagnosed in your 30s and told that you should wear a surgical stocking—please do not look but I am not wearing my surgical stocking—it is not something that you really want to do. If we think about people in their teens or their 20s being told that they have to wear a compression garment for something that does not immediately seem to be a very serious condition, their immediate reaction is, “Yeah, yeah, maybe”. They will not do it unless someone is able to make clear why it is so important.

There should be greater awareness and information that is not only on cancer sites. When one explores where lymphoedema comes from and what it means, much of the information is on cancer sites, which is also true for the information given to us by the Lords Library. Many pages do not come from general sites but from sites associated with breast cancer. You would not think to look there if you had not had breast cancer. The clinic that I went to in Cambridge is collocated in a hospice. Again, you go along and think, “I have a condition that appears to be relatively minor and I’m going along to a hospice”. Again, that was not the best introduction to how to deal with a condition.

The issues that one needs to think about on prevention or ensuring that development does not get worse are ones that most people do not necessarily want to think about on a daily basis. If you have some conditions that you are aware of and you take a tablet every day, that is fine, but to avoid lymphoedema getting worse you need to avoid infection, to ensure that you do not get stung or cut, that you do not do many things that just happen in everyday life. If most people fall over, get a sting or cut themselves, it does not matter: they heal up very quickly. If they have lymphoedema, the potential infection or the sting does not get out of their system. They need to ensure that they minimise the opportunity of that happening. But if you are in your 20s and you want to go off on holiday, you do not want to pack steroid tablets, antihistamines and antibiotics in case you get stung or cut, but those are the sorts of things you need to think about. Something that makes awareness available for young sufferers would be beneficial—that makes GPs think about non-standard sufferers of lymphoedema, not people who have had cancer or cancer surgery.

Would the Minister consider whether manual lymphatic drainage could be part of the strategy? It is an extremely effective way to deal with the symptoms of lymphoedema and to begin to manage the condition. It can go alongside compression. However, it is not always available on the NHS. If you can afford to go to a private practice to have treatment that is fantastic, but ideally it should be available. If there is to be a national strategy, would the Minister consider making manual lymphatic drainage available for those sufferers who would benefit from it?