Medical Devices (Coronavirus Test Device Approvals) (Amendment) Regulations 2021

Baroness Thornton Excerpts

Monday 12th July 2021 Grand Committee

[Baroness Thornton (Lab)]

My Lords, the importance of this SI is underlined by the decision of the Secondary Legislation Scrutiny Committee to draw the regulations to

“the special attention of the House on the grounds that they are politically or legally important and give rise to issues of public policy likely to be of interest to the House.”

The noble Lord, Lord Scriven is quite right: this is not emergency legislation. Here we are, more than a year in. It is not an emergency. However, this is a very important statutory instrument. My noble friend Lord Rooker and the noble Lord, Lord Lansley, have outlined many of the questions that need to be addressed, but I need to put the Minister on notice that, depending on his answer to this debate, I may oppose it here in the Grand Committee and take it to the Floor of the House.

I am very concerned listening to this debate. I was concerned when I made my own notes, and I am even more concerned now listening to other noble Lords. This is not just about the quality of testing; it is about the market of testing, and that is quite different. That is why the Secondary Legislation Scrutiny Committee was concerned about a major change in public policy. Putting a major change in public policy through in Grand Committee under these circumstances is probably not a good idea and does not make for good legislation.

We absolutely support a quality approval process for all Covid-19 tests in the UK. It is important that the new process is rigorous to ensure that all tests, including those for sale, meet the relevant quality standards, especially if such tests are to play a greater role in the long-term management of Covid-19. In the meantime, it is essential that free NHS tests continue to be available. This is all the more important given the rising case numbers and the Government’s insistence on going ahead with the removal of all restrictions, including the legal requirement to wear face coverings on public transport, in a week’s time.

Given the importance of reliable high-quality testing devices for the effective management of Covid-19 in the long term, can the Minister explain why the new validation process was not introduced earlier? Given that the DHSC says that as part of managing Covid in the long term the Government will want to support

“a thriving private sector market for COVID-19 detection tests to supplement and support testing led by NHS Test and Trace”

and to

“encourage the private sector to bring a number of testing products and services to market to meet the differing needs of businesses and individuals”

and provide consumer choice, how will we ensure that all the tests available will meet the minimum performance standards? According to the department, the new quality requirements introduced by this instrument

“will make the UK private testing market more competitive, as manufacturers will need to improve the accuracy and speed of their tests in order to outcompete competitors”.

Can the Minister confirm the timeframe for shifting to a private testing model? How much will these tests cost and who will bear the brunt, employers or employees? Will there be waivers or business support for vulnerable workplaces, including hospitals, care homes and schools, as well as other key workers where frequent testing is key to protecting the vulnerable and often to things such as keeping a school open? Does he agree that it is essential that free NHS tests continue to be available, given the rise in case numbers and the Government’s insistence on going ahead with opening, as I have already said?

I would like to have some more information about the August cut-off point. During the procurement of lateral flow device tests for the NHS, only 25% passed through all stages of validation including the assessment for performance and quality standards under the current regime. The 75% of the LFD tests assessed as not meeting performance or quality standards of the NHS still qualify as fit for market. The DHSC says that rapid intervention is therefore required to address this. Does rapid mean now or a year ago?

Department of Health and Social Care data showed that six out of 10 positive rapid test results at schools between 4 March and 17 March turned out to be wrong. It is therefore legitimate to ask whether the real reason that we are backing away from them is because they do not work for self-testing and do not represent value for money. What is going to happen next? The Minister needs to set out the timescale. Can he confirm that if the third-party approach is to be considered, these contracts will go out for public tender?

Does the Minister share my concern that the department’s explanation appears to suggest that less accurate tests can be of diagnostic value for the NHS if such tests are used by clinicians who are able to consider other factors and information and therefore put any tests into a wider clinical context? Finally, what extra resources will be available to local authority trading standards teams for testing enforcement activities?

Medical Devices (Northern Ireland Protocol) Regulations 2021

Baroness Thornton Excerpts

Monday 12th July 2021 Grand Committee

[Baroness Thornton (Lab)]

I thank the Minister for introducing these regulations and for the opportunity to debate them. This debate takes place in the context of the Northern Ireland protocol, a protocol signed by this Government and now readily disowned by the very people who agreed to it. When the noble Lord, Lord Frost, says that it is not right to view the protocol as a definitive text, that does not reflect well on our country, its Government and the people who signed it at the time, said that it was excellent and denied that it would create a border in the Irish Sea. It is a bit rich of the noble Baroness, Lady Hoey, to protest, given her role in getting us to where we are.

However, I agree with the noble Baroness, Lady Brinton, that this is an attempt to find a way through on the important matter of medical devices. The SI addresses the fact that, although under the Northern Ireland protocol medical devices regulations are fully applied in Northern Ireland, the MHRA remains the Province’s regulator; there therefore needs to be provisions for enforcement, fees et cetera so that those elements of MDR that allow for national decision—such as on the reprocessing of single-use devices, custom-made devices and so on—are consistent across the UK.

What does this mean for people in Northern Ireland? What impact will there be if the EMA and MHRA depart markedly from each other’s regulatory regimes, and what would that mean for businesses? At the moment, you need a CE mark to go to market, as least as long as the Northern Ireland protocol holds. That is potentially advantageous for NI patients versus GB ones, as the vast majority of products will be CE marked and will continue to be so. However, as the ABPI has said, there are 600,000 medical devices approved in the EU and, at the moment, they are all available in Great Britain. Surely the test of the new UK regulations will be how many of them are still available in three, five or 10 years’ time. I hope that the Minister will be able to address those issues.

I seems to me that the final decision concerning the availability of a product would ultimately be a matter for the EU. Is it the case that, for those products authorised under the decentralised procedure by one member state acting as a reference for another member state, the MHRA would be able to suspend the use of a product only if one of the 27 member states had triggered a review of that product?

I have a couple of other points. I could see no mention of in vitro diagnostic medical devices. Will they come as another statutory instrument? I would be grateful if the Minister could clarify that. Can he tell the Committee what plans he has to update the House on a regular basis on the supply and regulation of medicines and medical devices in Northern Ireland to ensure that regulatory alignment and mitigation against adverse consequences are undertaken?

Finally, on enforcement, the instrument will also give the MHRA powers to serve enforcement notices for breaches of the EU MDR. How many people are these enforcement measures expected to affect? Manufacturers will need to take a number of steps to ensure that their goods can still be sold after the 2023 deadline, as noble Lords mentioned. What discussions have the Government had with the sector? Can the Minister confirm that the threshold to obtain the UKCA certification mark will largely be the same as that for the CE mark?

Women’s Health Outcomes

Baroness Thornton Excerpts

Thursday 8th July 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I declare my interest as the maternity champion for Whittington Health, of which I am a non-executive director. I congratulate the noble Baroness, Lady Jenkin, on bringing forward this debate, which has been of very high quality. Her introduction was both comprehensive and—although I am not sure that I would say Shakespearean —encompassed the whole of life.

I am particularly proud of my nine or 10 noble friends who took part in this debate. My noble friend Lady Massey talked about young women; my noble friend Lord Rooker talked about health inequalities and Marmot; my noble friend Lady Chakrabarti talked about our international responsibilities; my noble friend Lord Hunt talked about heart attacks and discrimination —I will come back to that later—my noble friend Lord Boateng talked about the higher rates of mortality for black people and racial disparities within healthcare; my noble friend Lord Brooke talked about learning the lessons of domestic violence; my noble friends Lord Sikka and Lady Bryan talked about the misdiagnosis of symptoms and inequalities in health; and my noble friend Lord Young talked about single-sex wards. But contributions have come from all sides of the House. I welcome the women’s health strategy consultation: I very much look forward to seeing what comes out of that.

As did the noble Baroness, Lady Jenkin, I want to address the systematic discrimination against women and the gender data gap. She and several other noble Baronesses mentioned Caroline Criado Perez and her work in this area. She said that medical research has traditionally been based around the male body. Indeed, my noble friend Lord Hunt pointed out that women were 50% more likely to be misdiagnosed following a heart attack, but they make up only 25% of the participants across the landmark trials for congestive heart failure. Given that we have a Minister in this House who is very enthusiastic and keen about data and its use and all those things, this issue is very important.

Most medical trials are done on male cells; even female cells react differently. For millennia, medicine has functioned on the assumption that male bodies represent humanity as a whole. As a result, we have a huge historical data gap when it comes to female bodies. That means that women will be dying when they do not need to. The medical world is complicit in this and that needs to change. I am pleased that this was referred to in the women’s health strategy. I hope that it is going to be followed up when the strategy comes to fruition after the consultation process.

It is interesting; I learned, for example, that the first production of the Fitbits that we are all so keen on did not include menstrual cycles in their data, so over 50% of the world was not properly recognised. I am assured that that is absolutely no longer the case. The tech world, of course, is designing the future, so we have to acknowledge the need for diversity in that. If tech is designed by white, middle-class men from America, the future might look very nice to them but not for everybody else. Diversity in the teams and ideas is vital. Artificial intelligence that helps doctors with diagnoses and scans, and with conducting job interviews and so on, is vital, but it all depends on the datasets. If those datasets are designed by those white males in America, then we are all—or at least half of us are—in serious trouble. If you tell an algorithm what a heart attack is based on male symptoms, how are we going to make sure that it recognises female symptoms? These are the issues on which I am particularly interested to know the Minister’s thinking.

I turn briefly to women and Covid. We know that Covid-19 did not strike the sexes equally. Globally, for every 10 Covid-19 intensive care unit admissions for women, there were 18 for men. While men over 50 tended to suffer the most acute symptoms of Covid, there is evidence that women seem to be disproportionately affected by long Covid; one study suggested that women outnumber men by as much as four to one. A study led by the University of Glasgow concluded that

“women under 50 are seven times more likely to be breathless and twice as likely to report fatigue than men, seven months after seeking medical assistance for Covid-19.”

Some academics have linked this to the fact that women have a higher lifetime risk of inflammatory immune conditions such as chronic pain, chronic fatigue and autoimmune diseases. Can the Minister assure us that these issues are a standard part of the ongoing research on the effects of Covid?

A key point that came out when the strategy was first announced by the Government was the need to listen to women’s voices. That is absolutely vital. The House has been active in expressing the need for this, particularly in support of the report by the noble Baroness, Lady Cumberlege. We have made significant progress in implementing some of her report and I hope that we will see more of it included and embedded in the forthcoming legislative programme on health and social care.

To conclude, I thank all speakers who have taken part in this debate, and I look forward to the Minister’s speech. We live in a patriarchal and deeply unequal society. Covid has highlighted those inequalities, particularly health inequalities, and it must be said that, since 2010, the noble Baroness’s Government have been guilty of cuts and underfunding across the whole of our health system, which has disproportionately affected the poor—and that means it has disproportionately affected women. I hope that the noble Baroness, Lady Jenkin, and the Minister will agree that having the best possible women’s health strategy in the world will, as it were, butter no parsnips if it is not properly resourced and funded.

Covid-19 Update

Baroness Thornton Excerpts

Thursday 8th July 2021 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for the Statement today, which takes us further into the discussion that we were having on Tuesday and allows him to address some of the questions that perhaps he was not able to on Tuesday.

We all want our economy to open and get back to normal. The question is whether we do it in a controlled way or a chaotic way. The Health Secretary told the Commons on Tuesday that, under the Government’s plan, infections could go to as high as 100,000 a day. There are some huge issues that the Minister and the Government have failed to address with information and clarity about the massive change in policy contained in the announcements on Monday and Tuesday. The first of these is surely the potential 100,000 infections a day in a few weeks’ time. When I asked on Tuesday about the scientific advice, the Minister gave me what can be described only as a pick-and-mix answer, one in which he said SAGE’s advice was “interesting”. I am sure that SAGE’s advice is always interesting, but is it being taken into account in decision-making as it used to be? I specifically refer him to the most recent SAGE papers, which made it clear that with high infection rates there would be a greater chance of new variants emerging and greater pressure on the NHS. More people will get long Covid and test and trace will be less effective. As NHS Providers said today,

“current pressures on the NHS mean that the predicted rising infection rates for COVID-19 will inevitably affect the speed at which trusts can recover care backlogs.”

I quote Chris Hopson:

“Trust leaders can see the strong logic of ‘if not now, when?’ and they recognise that, as a nation, we must learn to live with COVID-19. But they want the Government to be clear about the risks of relaxing restrictions. This includes the inevitability of higher hospitalisations and mortality, albeit at lower levels than previous waves and the risk of new and more dangerous variants emerging. They are also worried about the impact of long COVID. It’s important these trade offs are clearly set out, including the impact on the NHS’s ability to bear down on the backlog.”


Indeed, a letter from 100 experts in the BMJ today raises the same issues. That is why the impact assessment is so crucial. The Prime Minister seemed to find this impossible to address yesterday, so I would like to see if the Minister with his much greater and closer knowledge of these issues could be more enlightening to the House today. Have the Government undertaken an impact assessment of the projected rate of infection? Yes or no would probably suffice. If it is yes, when will it be shared with Parliament and the public? If it is no, the Minister must explain why this has not happened and tell the House when it might. We need to know what is the number of hospitalisations and deaths; what is the number of people with long Covid, which will be the outcome of 100,000 infections a day; and what is the impact on the NHS, will it slow down the catch-up for diagnostics and treatment and by how much? I am very happy if the Minister wants to email the details of the answers to me, if he does not have them to hand–although he ought and they need to be in the public domain.

We know that the link between infection rates and deaths has been weakened, but it has not been broken. All the experts seem to agree on that. Let us be clear why infection rates are so high: it is because the Prime Minister let in the delta variant. I agree with my right honourable friend Keir Starmer that we might now change its name to the “Johnson variant”. Let us be clear why the number of cases will surge so quickly: it is because the Government are taking all protections off in one go. As my right honourable friends Sir Keir Starmer and Jonathan Ashworth have said, this is reckless.

The next obvious question is the one about the dreaded ping and the huge number of people who will be asked to isolate. If there are 100,000 infections a day, that means hundreds of thousands—perhaps millions —of people are going to be pinged to isolate. The Financial Times estimates that it could be 2 million people and the Daily Mail says it could be 3.5 million people. Either way, it is a massive number. How many people do the Government expect will be asked to isolate if infection rates continue to rise at this rate? Again, this question was asked of the Prime Minister yesterday and he clearly did not know the answer or refused to say, so I will repeat it again: how many people are going to be asked to self-isolate if there are 100,000 or more infections a day?

Does the Minister appreciate that those who are immunocompromised or for whom the vaccine is less effective will have their freedoms curtailed by ditching masks on public transport? Blood Cancer UK warned yesterday that people with blood cancer will feel that their freedoms have been taken away from them. It is quite possible that the 19th will not be freedom day. It might be the day when a record number of people will switch off their NHS app, because they will see coming down the track isolating and cancelling holidays. It is already beginning to happen. Has the Minister seen those stories? We on these Benches do not support that course of action, but does he realise that this could seriously undermine the expensive track and trace system, on which so much depends?

I have to repeat again that the biggest barrier to an effective isolation policy has been not the inconvenience but the lack of financial incentive to stay at home. If we are to live with this virus, the days of people soldiering on when unwell are over. Sick pay is vital to infection control. Will the Government please now fix it?

Business leaders are expressing very serious concerns about the loss of staff and customers. There are now 700,000 children off school per week. At my grand- daughter’s school this morning, two classes were sent home due to two teachers being pinged. After-school sports were cancelled and she is very disappointed. It is happening everywhere, as our amazing head teachers and school staff limp towards the end of term doing everything they can to deliver teaching, joy and normality to our children under the most difficult and often underappreciated circumstances.

The question I want to ask for clarity from the Minister is about the ubiquitous ping. Is the ping advisory for self-isolation or mandatory? If you get an email or phone call, does that trigger mandatory self-isolation? Finally, I ask about data in the last 24 hours or so from Israel’s Ministry of Health, which points to the Pfizer vaccine being just 64% effective at stopping symptomatic and asymptomatic transmission of the delta variant. Can the Minister tell the House about this?

[Baroness Brinton (LD) [V]]

My Lords, one year ago when lockdown was lifted, we had around 1,000 new cases a day. Yesterday it was 32,000 new cases. Equally concerning, cases are doubling every nine days; hospitalisations are going up; ventilation bed occupation is going up; NHS Providers, as the noble Baroness, Lady Thornton, has said, is talking about hospitals moving back into created-Covid wards and managing safe areas. GPs and hospitals are all reporting a worrying large increase in young people with long Covid, putting further pressure on their services, let alone the worries of an epidemic of long-term illness in the working population. Anecdotal evidence suggests that some hospitals are now considering cancelling some staff summer leave. Wonderful as yesterday’s England victory was, the sight of 60,000 fans walking down Wembley Way in very close proximity with hardly a mask in sight was concerning. As with the England-Scotland match, we must expect a surge in cases. Yesterday, the BBC asked Dr Mike Ryan of the World Health Organization about the UK proposals to lift all restrictions on 19 July. He replied:

“The logic of more people being infected is better is, I think, logic that has proven its moral emptiness and epidemiological stupidity”.


The letter in today’s Lancet from 100 senior medics and scientists echoes the WHO view. What are the Government doing to explain to the experts why their strategy is safe?

I will return to the substance of the Statement later, but I start by thanking the Minister for the meeting yesterday with other Peers, Blood Cancer UK and the Anthony Nolan trust to discuss the immunocompromised and the clinically extremely vulnerable. There are over 2 million CEV who had to shield—that is 3% of the population. So, arising from questions I have asked the Minister many times before in your Lordships’ House, I will ask the following. The CEV, of whom I am one, are worried at the total silence to them over recent weeks since shielding ended formally but, with stay-at-home advice still in place, with cases rocketing daily and all restrictions easing, can the Minister explain how advice to them is being co-ordinated publicly by government? One blood cancer patient said today to an APPG of parliamentarians that the dissonance of their safety versus everyone else’s freedom was hard to bear, especially with no advice. In particular, who has clinical responsibility for drawing together the different issues of therapies, responses to vaccines and continuing care for underlying diseases, and which Minister has overall responsibility?

Overnight, there have been some suggestions from journalists that shielding might even return. If so, that needs to be communicated very urgently to those at high risk, who have not been told about their low vaccine antibody rate. They may be planning to mix with people, or perhaps even go on holiday. Will benefit support for the CEV who have to stay at home but cannot work from home be reintroduced? If the Government are serious about the irreversibility of the lifting of all restrictions, some of the CEV will not be able to return to work for weeks, or even months.

I turn to testing. There are reports today that the Government plan to charge for the lateral flow tests from the end of this month. As LFTs are supposed to be the great self-regulators that the Government are relying on, how much are people going to be charged? You do not pay the Government for a blood test to see whether you have picked up any other infection. The level of charging for PCR tests for people returning from abroad also remains a big issue. Last week in your Lordships’ House the noble Baroness, Lady Vere, told my noble friend Lady Ludford that PCR tests could be obtained at a price of £85 for two. My noble friend’s local pharmacy is charging £398 for a test on the same day, or £240 for the next day for two tests. I know other members of the public have reported similar problems. Can the Minister say how the pricing of PCR tests is being managed and, perhaps more importantly, where one can find the “£85 for two” tests?

On Tuesday, I set out what we from these Benches seek in a return to normal life. We want people to return to work as soon as possible, to be able to mix with family and friends and for our children to be able to have consistent access to education without interruption. We also agree that now is the time to start to do some of that but—and it is a big “but”—we cannot get rid of all the safeguards that protect people mixing together while the virus is still live. An effective test, trace and isolate system is essential. This Statement makes it clear that that is being dismantled. Can the Minister explain why that makes any sense?

Last night, Sebastian Payne of the Financial Times reported the re-election of Sir Graham Brady MP as chairman of the 1922 committee, and tweeted:

“Brady’s re-election is … a reminder of why Johnson is dropping masks and nearly all other … restrictions on July 19: ministers privately say the government no longer had the … votes to keep the measures in place. Relying on Labour would have been … difficult for the PM.”


Are the Prime Minister and the so-called Covid Recovery Group now putting health and lives at risk for their own principles?

Finally, with the threat of 100,000 cases by the end of the month, with hospitals saying they are already worried about the increase in patients and with the threat of the new lambda variant and new north-east variant under investigation, please will the Minister confirm that these changes are not irreversible and that the protection of the NHS, and the safety of all the people in this country, remain the Government’s priority?

Covid-19 Update

Baroness Thornton Excerpts

Tuesday 6th July 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for bringing the Statement today and for the debate that we are about to have.

The past 15 months have been so hard on all of us. We all want to find the light at the end of the Covid tunnel and take a step closer to a life of normality. However, caution, care and clarity are needed as we step forward into new freedoms. We all want to see the restrictions end, but what the Secretary of State said yesterday was not a guarantee that restrictions will end; it only described what the end of restrictions will look like.

Can the Minister confirm that the ending about to be announced will be based on SAGE advice and data? Yesterday, the Secretary of State said that he believes the best way to protect the nation’s health is to lift all restrictions. Is that the Secretary of State’s own view or SAGE’s advice? If the latter, where does SAGE say that? The advice that I read yesterday about the spread of the virus was much more cautious, saying:

“There is significant risk in allowing prevalence to rise, even if hospitalisations and deaths are kept low by vaccination.”


It went on to say that, depending on what happens and whether the variant morphs—my word—restrictions might need to be introduced. Is that the Minister’s understanding?

Where I come from, in West Yorkshire, the mayor Tracy Brabin said yesterday:

“Here in West Yorkshire, Covid cases have risen by 62% in the last week. So, we really do need a clear message from the government that puts people’s safety first, based on the science and live data.”


Surely she is correct. If only 50% of people across the UK are fully vaccinated and another 17% partially vaccinated, infections will continue to rise steeply; and hospitalisations are rising. Inherent in the strategy outlined is an acceptance that infections will surge further, that hospitalisations will increase and that we will hit a peak later this summer. Some of those hospitalised will die, and thousands—children and young people—are being left exposed to a virus with no vaccination protection, leaving them at risk of long-term chronic illness and personal impacts that might be felt for years to come.

We may have to accept the Government’s argument for a “learning to live with Covid” strategy, but how many deaths, and how many cases of long Covid, does the Minister consider acceptable? Yesterday’s message put the onus on individuals and businesses to self-manage what in recent months has been mandatory. I suspect that this may have left many people confused. As we on these Benches have said on many occasions, ambiguity in a pandemic costs lives. As demonstrated by the lively debates in today’s media, advice can be divisive, leading to disagreements on the interpretation of what is safe. We have government Ministers saying different things about what they personally intend to do; last night, we had a clear message from the CMO about the circumstances under which he intends to wear a mask. So I think that we have every right to be concerned that the debate may cause confusion and compromise crucial safety.

Let us look at public transport, for example. I have been using public transport throughout. I started wearing a mask long before it became mandatory. I still do not feel safe on a very crowded Tube, and I still do not want anyone to sit next to me. I test twice a week, and I have self-isolated twice since January when I got pinged. I do not think that I am unusual or nervous, but I feel strongly that I have a duty not to unwittingly spread the virus, and I do not want people to infect me. In a recent travel study, a majority of passengers said that they would lose confidence if the use of face masks were reduced. Many people, especially those who are more vulnerable, may become more anxious about using public transport if face masks become voluntary.

What is the Minister’s answer to these legitimate concerns? Does it go with the view that we let the virus rip and take the consequences? Given that we know that bus and taxi drivers experience Covid and death, what does the Minister have to say to them about their safety in these circumstances? Masks do not restrict freedoms in a pandemic when so much virus is circulating; they ensure that everyone who goes to the shops or takes public transport can do so safely. Who suffers most when masks are removed? It is those working in the shops, those driving the buses and taxis, and low-paid workers without access to decent pay, many of whom live in overcrowded housing and have been savagely, disproportionately impacted by this virus from day one.

We know that masks are effective when a virus is airborne. Given that high circulations of virus can see it evolve and possibly escape vaccine, what risk assessment have the Government done on the possibility of a new variant emerging? Will the Minister publish that assessment?

Given that the Statement says that isolation will still be needed, does the Minister think that living with the virus means the low-paid will be properly supported, or does he think they would game the system, as the previous Health Secretary suggested to a Select Committee?

As the Prime Minister announced, we can all crowd into pubs. Meanwhile infection rates in school settings continue to disrupt schooling, with nearly 400,000 children off in one week. With one in 20 children off, I look forward to a sensible announcement from the Secretary of State for Education, but I am not holding my breath.

We are not out of the woods. We want to see lockdown ended but we need life-saving mitigation to be in place. We still need sick pay. We need local contact tracing. Mask wearing should continue where it is needed. We need ventilation, and we need support for children to prevent serious illness.

On many occasions in the last year I have stood here and warned the Minister and the Government about not quarantining properly, of a chaotic test and trace system, of not having a circuit-breaker when it was needed and of taking decisions too late. I really do not want to find myself saying in September or October, “We warned you that you needed to take this more slowly and weigh the risks more carefully.” We should keep some measures—for example, mask wearing—until, say, two-thirds of the population are fully vaccinated.

Hospital Waiting Lists

Baroness Thornton Excerpts

Tuesday 29th June 2021 Lords Chamber

[Lord Bethell (Con)]

Surgical hubs are exactly the kind of interesting and progressive medical developments that we need to embrace to get through the backlog; in fact, that kind of specialism creates a huge amount of efficiency for the system and a better service for patients. We are working hard to understand how we can use them more effectively, and I would be glad to write to my noble friend with any details we have on the progress that we are making.

[Baroness Thornton (Lab)]

My Lords, the Royal College of Radiologists tells us that 62,000 patients were waiting six weeks or more for a CT or MRI scan, and there may be as many as 45,000 missed cancer diagnoses. There are terrible shortages of skilled staff, fewer scanners than the majority of comparable countries in the OECD—we have half the number in France and a third of the number in Germany—and about a third of our scanners are obsolete or nearing obsoletion. Given the huge waiting list catch-up that the NHS faces, these diagnostic facilities are absolutely vital. Will the Government provide the necessary investment to address this urgent challenge—and in what timescale?

[Lord Bethell (Con)]

I agree with the noble Baroness that diagnostics is one area where this country needs to make further investment. In the 2020 spending review, we ring-fenced £325 million of capital spending to support NHS diagnostics; the funding will be spent on new equipment, digitising NHS imaging and the pathology networks. New capacity is also coming through the new community diagnostic hubs and pathology and imaging networks. This work is critical, and we are working hard to make sure that it is effective.

Covid-19 Update

Baroness Thornton Excerpts

Tuesday 29th June 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I start by saying how much these Benches identify with the words the Government have issued about the horrifying treatment of Chris Whitty, our Chief Medical Officer. It was completely shocking and disgraceful. For a truly amazing public servant to be treated like this is unacceptable at any level.

I thank the Minister for presenting the Statement and echo the words of my right honourable friend John Ashworth yesterday in welcoming the new Secretary of State to his position. It was pleasing to see the new Secretary of State at St Thomas’ Hospital yesterday; I hope it is the first of many visits to our inspirational and dedicated NHS and social care staff. I hope the Minister’s new boss will be more receptive than the previous one and make arrangements for them to receive a fair pay rise, and not the real-terms pay cut that is currently pencilled in.

Yesterday the Secretary of State let it be known that the 19 July reopening will, in effect, go ahead. He told the news that there is “no going back” and that lifting the restrictions will be “irreversible”. It is probably not an exaggeration to say that many across your Lordships’ House will give a collective and noble eye- roll at these words. Like many here—and unlike the Secretary of State—we have responded to a lot of these Statements in the last 15 months. We heard that there was “nothing in the data” to suggest that 21 June could not go ahead. Noble Lords will remember that children returned to school for one day before the January lockdown and the words “It will all be over by Christmas.” Some time last spring, I think the words “We will send it packing in 12 weeks” were used.

The context this time is that there has been a rise of 84,000 cases in the past week—an increase of 61%. Yesterday saw the highest case rate since January. If these trends continue, we could hit 35,000 to 45,000 cases a day by 19 July. We know that this variant means fewer hospitalisations and fatalities, but it also means that young people will become ill and some will have long Covid. It will again mean disruption to our schools and our youngsters’ learning and socialisation. When will we see a review of the arrangements in schools?

We also all know that this is a race between the vaccine and the infection, but I fear it will not be won by the vaccine in the next three weeks, so if we are looking at possibly 200,000 people infected with Covid on 19 July, the Minister needs to tell us what impact that will have on the road map out of restrictions. Can he confirm whether “irreversible” means the Government are now ruling out restrictions this winter? Have they abandoned the plan that the previous Secretary of State and officials were drawing up for that?

The Secretary of State has promised to give the NHS everything it needs to get through the backlog, so will the hospital discharge and support funding be extended beyond this September, or will trusts have to make cuts instead? We have already had some discussion about the backlog today; for example, when will the NHS again guarantee that 95% of patients will start treatment within 18 weeks of referral? How long is it likely to be until we can reach those sorts of targets again? When will the Government give primary care the resources to meet the challenge of the hidden waiting list of over 7 million patient referrals that we would have expected since March 2020?

Given the pressures on primary care, is it still the Secretary of State’s plan to press ahead with the GP data transfer? Frankly, if this department cannot keep its own CCTV footage secure, how does the Minister expect it to keep our personal data secure? I think that is a legitimate question.

Given the pressures across the whole healthcare system, will the Government now abandon the ill-thought-out top-down reorganisation of the NHS that the previous Secretary of State was about to embark on?

Finally, I have raised with the Minister the importance of the Nolan principles which must guide the ethics and behaviour of us all, particularly those in government. The Good Law Project today published emails which used the noble Lord’s private address. Transparency is the word I am looking for here. The spotlight has been turned on the Minister in recent days, including a formal complaint to the Lords commissioners about the issuing of passes.

The Minister might do well to consider a couple of things: actually referring himself to the commissioners about that matter, if there is a chance he may have acted outside the rules, and—he has had to deal with this question several times and is very robust about it—making his emails and communications transparent and explaining them. He is sure that he has done nothing outside those rules; he would therefore be wise to be transparent about that. It is not the original scandal that gets people in the most trouble—it is the attempted cover-up, or the chance that there might be one. Transparency is the best advice I can give the Minister today.

[Baroness Brinton (LD) [V]]

My Lords, I echo on behalf of these Benches the concerns about the treatment of Professor Chris Whitty. It is totally unacceptable, and it is good news that the police are now investigating this.

Just now, in reply to my question on the Urgent Question, the Minister said that the health and social care Bill has been published. Over the last few minutes I have been searching the web, but I cannot find it— can he help me any further?

Yesterday’s Statement from the new Secretary of State struck an interesting new note. The department is clearly no longer going to be led by data but by dates. Yesterday, 22,868 new cases of Covid were reported. This time last year, when lockdown was finally lifted, daily cases were under 1,000. Even with the high level of vaccinations, this is causing illness and pressures on the NHS—even if it is a different kind of pressure to that of a year ago. On Sunday, Andrew Marr reported on his programme that his own experience of catching Covid had been difficult. He said that, while he had not needed to go to hospital, he was more ill than he had ever imagined possible, and it was not an asymptomatic experience. In the light of this and the reports of growing numbers of people living with long Covid, can the Minister say why data will now clearly not factor into the decisions about 19 July?

On these Benches, we believe that we need to learn to live with this disease, but unlike the Statement from the new Secretary of State, we do not believe that this is just about vaccination, important though that is. This week, Israel has found that, despite early and comprehensive levels of vaccination, the delta variant is ripping through its communities. We have argued since February 2020 that controlling outbreaks is vital. Can I ask the Minister about the provision of test, trace and isolate arrangements moving forward? Specifically, have local directors of public health been given access to emergency funding for the provision of surge testing and tracing and vaccination in their communities? When will the pilots for increased support for those needing to self-isolate be published? We still believe that people should be paid their wages if asked to self-isolate. As that number is considerably fewer than six months ago, it would be not only cheaper for the Treasury but a much more effective way of ensuring that the spread of the virus is reduced.

Usually the Minister agrees with me on the importance of test, trace and isolate, even if we perhaps disagree on how that should be funded and supported. Can he respond to the concerns of the doctors and scientists who are appalled with today’s proposals that company directors will be able to temporarily leave quarantine for business meetings? People are still furious that the Prime Minister delayed adding India to the red list, with the resultant rapid spread of the more transmissible and more serious delta variant. As Professor Christina Pagel says:

“luckily elites don’t get or transmit covid.”


Stephen Reicher, the eminent behavioural scientist, said he was horrified by the

“scandalous misuse of science as a cover for political decisions … which is putting us all at risk.”

When commenting on the DCMS report published on Friday, he said:

“The headlines and the political response isn’t just an exaggeration, they directly contradict what the report says. It warns that the research wasn’t designed to draw any conclusions about the effects of events on transmission and mustn’t be used to do so”.


Yet Ministers and the press are all reporting that these events in the trial had no effect on infections and were safe to reopen.

Yesterday, a No. 10 spokesperson explicitly denied that government Ministers have used private email addresses. They said:

“Both the former health secretary and Lord Bethell understand the rules around personal email usage and only ever conducted government business through their departmental email addresses”.


This is directly contradicted by the Second Permanent Secretary in meeting minutes published by the Sunday Times. Those minutes clearly state that former Health Secretary Matt Hancock

“corresponds only with private office via a gmail account”.

As the Good Law Project has reported, on 19 April 2020, the noble Lord, Lord Feldman, emailed the noble Lord, Lord Bethell, at his private address, about the availability of Covid-19 test kits via a Canadian company, saying:

“Certainly worth contacting … to see if they can help … and the pricing seems competitive.”


Self-evidently, this is government business, and specifically within the portfolio of the noble Lord, Lord Bethell. The noble Lord, Lord Feldman, once co-chair of the Conservative Party, was writing to the Minister at his private email address on government business. In addition, I note that the Minister’s meeting with Abingdon Health on 1 April 2020 was not disclosed on the ministerial meeting schedule.

We note that, unlike the response from the noble Lord, Lord True, on the earlier UQ, it is not possible for the public to access private emails; the Freedom of Information Act specifically excludes it. Not going through the formal government-approved routes, whether for emails or declarations of meetings, gives the impression that perhaps the Minister has something to hide from his dealings with a former chairman of the Conservative Party and the company he was acting for. I note that the company was awarded an £85 million contract after the meeting and the emails.

There has been considerable speculation about the role of Ms Gina Coladangelo as a lobbyist, unpaid adviser to Matt Hancock and then a non-executive director for the Department of Health and Social Care. The press and media have also reported that the Minister gave Ms Coladangelo a parliamentary pass last year. Can he tell the House what personal parliamentary service she provided for him during that period? Does the Minister feel that his position is tenable, given this evidence?

Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) (No. 2) Regulations 2021

Baroness Thornton Excerpts

Wednesday 16th June 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, as we discussed yesterday when we took the Statement about the delay in actioning the road map, the Prime Minister is responsible for the position we are in. He was too slow to protect the country’s borders and too indecisive to take tough decisions. This left the country exposed and allowed a new variant from overseas to take hold. The Minister waxed lyrical yesterday about how much work is being done to keep our borders safe, but the truth is that his Government failed to protect us. Because the British people did their bit by supporting the vaccine programme and getting vaccinated, in effect our Prime Minister is squandering our vaccine. That is the danger of what has happened.

I do not intend to repeat the questions I asked yesterday about why and how the delta variant arrived and thrived in the UK, because other noble Lords have asked them already. We on these Benches understand that cases and hospitalisations are rising and the delta variant is more transmissible; we therefore understand why these regulations are necessary. Even with the current restrictions in place, the daily total of positive tests is rising: the seven-day rolling average is over 7,000 new cases a day. Cases are doubling every seven to 14 days and the delta variant is dominant in the UK.

Although hospitalisations remain low, they are now rising—particularly in the north-west, but other regions are beginning to follow. Early public health data from England and Scotland points to an increased risk of hospitalisation from the delta variant, with the likelihood of hospitalisation 2.3 times higher than for those infected by the alpha variant. So we support these regulations and will be voting against the amendment of the noble Lord, Lord Robathan.

I would like to turn to weddings; let us look at something joyful. These regulations leave thousands of couples, businesses and employees with uncertainty that could and should have been avoided. Under the regulations, the 30-person cap on wedding ceremonies and receptions has been removed. Speeches, cake cutting and the newlyweds’ first dance are permitted—but cash donations, dancing outdoors and hymn singing in church are advised against. Indoor dancing on dancefloors, standing drinks receptions and buffets remain banned.

This Government are of course fond of tiers and traffic-light lists but do not seem to have learned anything from the previous confusion that they have sown by issuing advice that contradicts the letter of the law. Indeed, the amber list of wedding activities that are merely advised against but not explicitly banned will surely be viewed by many as a legal loophole, just as holidaymakers travelled to and from amber-listed countries, despite being advised not to do so.

The banned list is less confusing, but it is unclear who is responsible for ensuring that the rules are enforced: is it the happy couple or the venue? Will the DJ be expected to cut the music if someone starts to sway in time to the beat? What happens if these rules are broken? Many noble Lords flagged up this inconsistency yesterday.

Having said that, the ratio of cases to hospitalisations remains the key uncertainty. Keeping restrictions in place allows more data to be gathered on the delta variant before fully unlocking, as the noble Lord, Lord Lansley, and several others have said.

As the Minister said, vaccination is the key over the next four weeks. Does he believe that we have the vaccine supplies needed to vaccinate everyone to the timetable that he has set out, and what steps will he be taking to increase the speed of vaccinations over the coming weeks? Cases of the delta variant have been found in this country for two months, and yet, in some areas, surge testing and vaccination are yet to be implemented. Does the Minister believe that it is the failure to introduce mitigating measures early that has led to the delay to the easing of lockdown restrictions we are discussing today? We learned from the media today that there may be a shortage of the Pfizer vaccine. Is this the case, and what effect will that have on the drive to vaccinate young people in England?

Why, when we are 15 months into the pandemic, have the Government failed to take meaningful action to help businesses, schools and leisure facilities improve ventilation, when this is an airborne virus? I suggest to the Minister that we need a ventilation strategy.

The issue around care homes has been covered—but when is this likely to happen? This is a significant change and not an uncomplicated one. Will there be time for a proper debate in Parliament before it is implemented?

Leading on from that, I hope that, in a month’s time, we will be in a different place from now. I also hope that this is the last time that the House will have to discuss regulations that have such far-reaching consequences for our citizens without proper accountability and due process. I accept that this is a few days before the regulations are implemented. Surely, it is time to stop using emergency powers for matters that are clearly not actually an emergency and of which we have prior notice.

Yesterday, the Cabinet Office Minister Michael Gove said that he thought partial working from home would become permanent for some people as restrictions were lifted. The Minister needs to confirm how that will happen and whether guidance will stay in place for the long haul as part of a raft of measures being considered by the Government for life after Covid? For example, there have been reports that Perspex screens are ineffective in sufficiently stopping transmission of the disease, despite businesses having invested in them. I would like to know that the ones we sit behind in our Committee Room are indeed safe.

Finally, we on these Benches yet again do not agree with the noble Lord, Lord Robathan. My noble friends Lady Donaghy and Lord Winston raised pertinent questions of ethics and judgment. We will vote against his amendment to the Motion if he calls a Division.

Covid-19 Update

Baroness Thornton Excerpts

Tuesday 15th June 2021 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for this Statement. These Benches agree with Mr Speaker; in the statement he made prior to the Secretary of State’s Statement last night, he expressed a deep frustration on behalf of all parliamentarians about the Government’s conduct. The announcement yesterday was both predictable and, sadly, predicted. I sigh, because the Prime Minister is now referring to 19 July as “terminus” day instead of freedom day, which has probably brought eye-rolls everywhere. When will the Prime Minister learn that caution and the use of data means also being cautious about how you express these matters?

The Minister will know that on these Benches we support the Government’s decision to delay the move to the next stage of the road map, but do so with a deep sense of anger, if not despair, that this should be necessary. Since the delta variant of coronavirus, first discovered in India, was detected in the UK in April, cases have surged across the country, with the variant now making up 96% of new infections. Experts confirmed last week that the variant is 60% more transmissible than the alpha variant, first discovered in Kent in 2020. Scientists at the Wellcome Sanger Institute have used genomic sequencing to produce maps which show how rapidly the delta variant has taken over in England, and I commend them to noble Lords. They are alarming in that they show the rapid spread to almost the whole country by the end of last week. It is doubling week by week—still with small numbers now, but that will change if this doubling continues.

There were warnings of a new variant in India on 25 March. It is reported that Ministers first learned that the delta variant was in the UK on 1 April. I must ask the Minister: is that true? The Government red-listed Pakistan and Bangladesh on 9 April, but did not red- list India until 23 April, by which point 20,000 people had arrived from India. As my right honourable friend Jon Ashworth said yesterday in the Commons,

“Our borders were as secure as a sieve, and all because the Prime Minister wanted a photo call with Prime Minister Modi.”—[Official Report, Commons, 14/6/21; col. 77.]


On 20 April I said to the Minister:

“With regard to protecting our borders, this week Hong Kong identified 47 Covid cases on a single flight from Delhi.”


We were closing our borders on 23 April, and I asked him:

“there will be hundreds of people arriving on flights from India. Is this not very risky?”—[Official Report, 20/4/21; col. 1769.]

I now return to that question. How many people arrived from India carrying the virus during the period from when the Government were aware of the variant at the beginning of April to 23 April, when India joined Pakistan and Bangladesh?

It is unforgiveable that Ministers have consistently promised to take control of our borders and conspicuously failed to do so, particularly at the very moment when it mattered most: when we were succeeding in the vaccination rollout and the gradual loosening up. The Prime Minister not only opened the back door to this variant; he failed to take measures to suppress it when he could.

There has been growing prevalence of this variant among school-age children, yet mandatory mask-wearing has been abandoned in secondary schools. I have raised this with the Minister at least once before. He has to explain why this has happened, despite being repeatedly asked in both Houses. We also know that isolation is key to breaking transmission yet, 16 months on, people are still not paid adequate financial compensation to isolate themselves. When asked about this at the Select Committee last week, the Secretary of State claimed that people would game the system. Does the Minister believe that this is true? After all the sacrifices and rule-following of the public, does the Minister have the same low opinion of our fellow citizens as his boss?

Yesterday, the Prime Minister and the Secretary of State supported extending restrictions by pointing to plans to go further on vaccination. But even after extending the doses as outlined in the Statement, large proportions of the population will still be left unprotected —having had one dose or none—and exposed to a variant that, if left unchecked, will accelerate and double every week. That would mean more hospitalisations, more long Covid, more disruption to schools and more opportunities for variants to emerge. What will happen under these circumstances? Will the Prime Minister still lift the restrictions?

My reading of this announcement and the terms in which is it couched is that the science points to us being in a very dangerous position. We could lose the battle that is going on between the vaccine and the virus. Will there be vaccine surges to counter this in areas where the virus is most prevalent? What is the plan to bring down infections and extend vaccination rates in hotspot areas? We have learned that in some places—Leicester, Chorley, Tameside, Salford and Wigan —the dose numbers have gone down. Has vaccination surging been abandoned in those hotspot areas? Will the Government bring forward accelerated second doses, and how are they working further to overcome vaccine hesitancy?

The Chief Medical Officer said last night that we would be lifting restrictions were it not for the delta variant. The Prime Minister should have moved at lightning speed to prevent the delta variant reaching our shores. Instead he dithered, and today he is responsible.

[Baroness Brinton (LD) [V]]

My Lords, we on these Benches echo the support of the noble Baroness, Lady Thornton, for the Commons Speaker’s statement yesterday on the Government’s continued abuse of Parliament.

We repeatedly warned the Government that sending out mixed messages about lifting restrictions on 21 June would cause problems. Even in March, the Prime Minister made it evident that he wanted us out of restrictions “irreversibly”—his word—by next Monday. What is worse is that we are now in a fourth Covid wave because of his desire to visit President Modi in India in mid-April. The resultant dangerous dithering about putting India on the red list contrasted sharply with the TV news. Every evening, we saw that the then delta variant was scything through India. Even then, Indian epidemiologists were talking about a much faster transmission. We on these Benches have repeatedly asked why India was not added to the red list on 2 April.

At yesterday’s press conference we were warned that the current delta variant wave will likely peak in mid-July, as cases, hospital admissions and patients needing ICU increase steadily. Even if vaccines mean that hospitals are not being overwhelmed, there is an increase. The UK now faces continuing restrictions entirely because of the Prime Minister’s delay.

The academic paper Estimating the Failure Risk of Hotel-based Quarantine for Preventing COVID-19 Outbreaks in Australia and New Zealand, published in February this year, calculated the risks and likely seeding of variants in the light of infection control and surveillance used locally. It now provides an essential baseline to assess seeding of cases coming from abroad. Devan Sinha of Oxford University and other UK scientists have used this to look at the seeding of the delta variant in the UK. He noted that 96% of the seeding of the delta variant occurred after 2 April—that is, after Pakistan and Bangladesh were added to the red list but India was not. He estimates that putting India on the red list on 2 April would have delayed the current wave by a further four to seven weeks. That four to seven weeks would have meant that all over-40s had had access to a second dose and, at seven weeks, most over-30s. He said that the wave would have been

“much smaller and mostly neutered”.

What have the Government learned from this delay? Why did it take so long for the delta variant to be moved from a variant of interest to a variant of concern? Despite MPs, Peers and scientists all asking in early April, Matt Hancock told the Commons that it would be listed as a variant of concern on 20 April. In fact, it was not listed until 7 May. Even worse, surge testing did not start until May either. If it was serious enough for India to be added to the red list by 23 May, why was it made a variant of concern only on 7 May? Was the delay with PHE or with Ministers?

The necessary continuation of restrictions at the current level means that a number of support schemes are now out of kilter with the restriction levels. These include lifting the embargo on evictions, the reduction in furlough support while people are still being asked to work from home if possible, and other business support mechanisms. Please can the Minister say whether they will be extended until we know that we are lifting restrictions completely? When, oh when, will any of these Statements or communications make it clear to the clinically extremely vulnerable and their families and friends what they are expected to do?

The Statement lists the areas where restrictions are to be lifted, many of which will be welcome, especially the 30-person limit on attending weddings, receptions and commemorative events, and out-of-school residential visits in bubbles of up to 30. But I ask again about mask wearing in schools, given the continuing increase in delta variant cases among children. Will there be specific guidance for these events, including lateral flow testing before and after, so that any outbreaks at a wedding could be tracked and managed? What level of new Covid cases per day would change the pilots on large events with higher capacities, especially the ones planned at full capacity?

It is good to see the removal of enforced quarantine for care home residents after trips out of homes. I never did understand that one, given that staff and visitors did not have to self-isolate.

It was good to hear the emphasis in the statement from Professor Whitty and Sir Patrick Valance on the importance of the second dose. I repeat my regular plea that all Ministers use this as a reference point. Far too many only ever use the number of people having had the first dose. With the delta variant, it is even clearer now that two doses are essential.

Why on earth did the Prime Minister say yesterday that 19 July is definitely the terminal day for restrictions? We all hope that he is right, but if he and Ministers are led by data, how can he say that?

Finally, the Statement refers to surge testing in areas where the variant is also surging, but maps show such a steady rise in cases across the country. Can the Minister confirm that there are enough test, trace and isolate staff to manage effectively this fourth wave of Covid?

Covid-19: Proof of Vaccination

Baroness Thornton Excerpts

Monday 14th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I apologise for not being clearer; I will be crystal clear right now. Today, you can have a digital certificate on your iPhone, you can have a digital certificate that is printed out from your computer or you can call a number and have a paper certificate sent to you in the post immediately. All of those options are live today.

[Baroness Thornton (Lab)]

Disability campaigners are deeply concerned about the integration of health data into cultural participation and worry that the Government’s plans to set up the vaccine passport scheme could undermine the rights of disabled workers and audiences who cannot have the vaccine because of a health condition. What steps are the Government taking to ensure that any scheme that is introduced obeys the seven key inclusive principles, including complying with the Equality Act in making reasonable adjustments to ensure that disabled people do not face discrimination?

[Lord Bethell (Con)]

My Lords, I am very alive to the concerns of the disabled. We have to balance the need to limit the spread of this virus to save lives, but in a way that is fair and just to all people. We are very much engaged with disability and other charities to ensure that that works. The noble Baroness is right that there will be some people for whom the vaccine does not work and who could yet catch the disease. We need to make provision for those people, and we are working on that.