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

Baroness Thornton Excerpts

Wednesday 30th December 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I join with other Noble Lords in giving wholehearted welcome to the approval of the AstraZeneca vaccine which, for once, will be a game-changer in defeating this horrible virus. I thank and pay tribute to our scientists and the volunteers who came forward to be tested. It means, crucially, speeding up on vaccination. This is now a race against time. I ask the Minister how many of those over 80, and how many care home residents, have been vaccinated? As for the substantive issue before us today, as ever the Government are behind the curve in their control of the virus and our debates on them, as we will see later when the Statement that is likely to extend tier 4 is made in the Commons.

The major changes to Christmas provision were late but welcome. But they were devastating for many. The Prime Minister announced the changes on Saturday 19 December at 5 pm. Why was guidance not published at the same time to give people much-needed clarity? People who were due to attend funerals or get married the next day were unsurprisingly desperate to know and very anxious. Why were the Government not better prepared, given the rapidly rising infection rates and the identification of the new strain? It was known in September that we had a new strain; this was not news. The Government knew that the three-tier system was not enough and should have had contingency arrangements and communications ready to go.

We all saw the scenes of chaos following the announcement, with packed trains leaving London. Does the Minister accept that the appalling communication strategy contributed to this, and will have contributed to the spread of the virus? That is to say nothing of the issue of face masks raised by my noble friend Lord Faulkner. What assessment has the Government made of compliance over the Christmas period? What additional support is available in tier 4 areas? Is there access to testing and income support? There is a need to incentivise people on low incomes whose jobs are in jeopardy to stay at home. The events of 19 December were totally typical of the procrastination, the constant overpromising and underdelivering, the opaqueness of information, the refusal to release SAGE advice in a timely fashion, a Prime Minister who seems incapable of taking timely decisions and a pandemic out of control.

Yesterday, we learned that all the hospitals in Essex were 48 hours away from having to refuse any more patients, Covid or otherwise—so, if you broke your leg, you would be refused entry. This is because over 700 staff in south-west Essex alone were off isolating with symptoms, with no strategy to get temps in from tier 2 areas, no vaccines for the staff and no lateral flow tests, as promised in October. Today, the leaders of the councils in Essex have declared a major incident—so how quickly, and how, will the Government give Essex hospitals the urgent support they need?

We on these Benches support the regulations, but we must ask ourselves, as we have so many times before: can the Minister tell us if this is enough action necessary to contain this virus? As the noble Baroness, Lady Watkins, and others asked, what is going to happen in the next 24 hours? How will the Government seek to control people going out to celebrate the new year?

This virus is out of control. Yesterday, over 50,000 cases were reported, and there are now more patients in hospital in London than at any other time in the pandemic—and, last week, 3,000 people died. So far, tier 4 areas show no sign of slowing down, and the NERVTAG minutes of 18 December suggest that this strain could add 0.4% to the R number. This new variant means that it will be harder to bring infections under control, so harder measures are needed. Will the Government publish, in real time, the advice they are now receiving from SAGE? As other noble Lords have asked, do they really intend to move people from London hospitals, with the new variant virus, to other parts of the country? I would like a yes-or-no answer to that question.

This takes us to the Nightingales. Is it true that the ExCeL Nightingale in London has been mothballed and its equipment removed? Again, a yes-or-no answer would be appreciated. There have been white elephants, stunts and overpromising, and getting the army and others to work their socks off, thinking they were helping their country—absolutely typical of the handling of this pandemic, where national interests and people’s lives seem to have been secondary to political expediency, the threat of Tory backwoodsmen and a photocall for the Prime Minister and the Secretary of State. This is very serious indeed; for the sake of our country, we need to get this under control.

I finish by talking about our children and young people. The way this Government have treated our teachers and headteachers with such contempt is shocking. There are five questions that the Minister needs to answer. What does the science tell us about Covid in schools? What is the plan for next week that we do not know? Will all students have IT for home learning? What is the plan on support for mass testing? When will school staff be vaccinated? How much worse does this have to get before further action is taken?

Covid-19: Vaccinations

Baroness Thornton Excerpts

Thursday 17th December 2020 Lords Chamber

[Lord Bethell (Con)]

I hear the concerns of both the noble Lord and his mother very clearly but I assure him that, to date, the rollout has very much focused on the 70 hospital hubs where we are getting the protocols and practices about getting this extremely difficult vaccine into people’s arms correct before we roll out distribution to all GP services. It is not at all my expectation that every GP service in the country will have the vaccine, nor that they will necessarily be ready to deliver it this week, but that guidance has been distributed. If the noble Lord would like to send me the details, I will ensure that that GP practice is up to speed on this important matter.

[Baroness Thornton (Lab)]

My Lords, my concern is about NHS staff. They may need to deal with a third wave in the new year, they will be required to work through the Christmas period dealing with the current spike and they will be co-ordinating the vaccine—so they might be completely overstretched in January and February. Would it be a good idea to ensure that at least front-line, high-risk clinical area staff are vaccinated immediately? Does he agree that this would make sense from an operational point of view? I know from my work as a non-executive director of a London hospital that it would be a huge morale booster for the staff to whom we owe so much.

[Lord Bethell (Con)]

I take on board the noble Baroness’s points on the NHS. Its staff have been under huge pressure, which is likely to be sustained into the new year. I pay tribute to their hard work. The JCVI has looked extremely carefully at the prioritisation. The most important thing is to avoid pressure on ICUs and the threat of mortality. That has been done by prioritising age over role. I also pay tribute to the St John Ambulance service, which has done an amazing amount of work in gathering 40,000 inquiries for training on delivering the vaccine. By undergoing training, those people will relieve NHS staff of an enormous amount of the pressure that the noble Baroness rightly describes.

ONS: UK Life Expectancy

Baroness Thornton Excerpts

Thursday 17th December 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Lord makes his point extremely delicately and politely, but he is entirely right. We have a commitment for five extra healthy years by 2035, and the combination of the Marmot review, the ONS figures and Covid make that seem an extremely daunting challenge indeed. I am not sure if I have the complete answer standing at the Dispatch Box right now. I would be glad to write to him and explain how we will undertake the Green Paper on prevention, the response to which will be published next year, as an opportunity to outline the kind of strategy he calls for.

[Baroness Thornton (Lab)]

The Minister’s response to my noble friend Lord Davies of Brixton was an abrupt one, which kind of suggested that it was an accident that we are where we are with life expectancy and that the Government’s policies have no impact on that. My question actually follows very neatly from that of the noble Lord, Lord Patel. Do the Government intend to establish life expectancy and well-being as a strategic marker and measure for the whole nation’s well-being and welfare in all Acts? How will that feed into reforms for the NHS?

[Lord Bethell (Con)]

My Lords, I think that healthy living and life expectancy is a strategic marker. We are naturally focused on it and, in particular, the disparities between communities, which have been alluded to by a number of noble Lords. The huge gap between life expectancy in Blackpool and west London is extremely disturbing, and something that the Government are highly focused on. These are complex issues. They involve government policy—as the noble Baroness quite rightly points out—but also personal behaviours, and it will very much form part of the NHS plan going forward and the rebooting of the NHS in a post-Covid world.

Covid-19 Update

Baroness Thornton Excerpts

Tuesday 15th December 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for the debate today. A total of 34 million people will be living under tier 3 Covid rules from midnight tonight after London, parts of Essex and Hertfordshire were placed under the most severe level of restrictions. My first question for the Minister is: what have been the criteria for deciding these tiers, and will the Government commit to publishing the rationale for their decisions?

It was noticeable during the Statement yesterday that the Secretary of State spoke with firmness and confidence when he announced the new restrictions and why he was making them, and spoke about the worrying new strain of the virus. It was only when he was pressed on the effect of, and scientific story behind, the Christmas relaxation that he became less sure. One has to ask why that might be the case.

Talk of acting decisively and boldly seemed to go out of the window. In its place came fudge and obfuscation, dither and blather. Professor Chris Whitty, when commenting on the Christmas rules, said:

“This is, in a sense, a limited relaxation which will have some impact on the upward pressure on the coronavirus.”


Well, yes. The Government’s answer seems to be to fall back on ‌the idea that this is all about “personal responsibility”—about the public taking a minimalist interpretation of the rules, not a maximalist one. The Health Secretary eventually gave a vague bit of concrete advice on Christmas, coming close to saying that we should self-isolate for a few days before meeting grandparents.

“The best thing you can do if you want to see elderly relatives at Christmas is to be extremely careful now about who you see”


was how he put it.

I therefore have to ask the Minister whether the Christmas relaxation is being reconsidered. What is the Secretary of State’s plan to keep people safe through Christmas and avoid huge pressures on the NHS in January? What is his plan to support an exhausted, underfunded and understaffed NHS through January to deliver the care that patients will need? Is he confident that our NHS will not be so overwhelmed in January that it impacts on the vaccination programme? Will the Government publish an impact assessment on their decision to allow a temporary relaxation that will allow three households to mix over the festive period?

This is a virus that, without adequate restrictions in place, spreads with ferocity. Case rates are increasing again, hospital admissions are climbing and the R is edging up. Last week, the England-wide rate was 159 per 100,000; now it is 188 per 100,000. That is a 20% increase. Across London, cases have increased by 30% and across the east of England by 36%. None of us is therefore surprised at the action that the Secretary of State took yesterday. Indeed, he was warned that tier 2 would not be enough to contain the spread of the virus in many places. It looks as though in some areas, such as Kent, tier 3 is not enough to contain the spread there.

Elsewhere in the country, tier 3 appears to be forcing the virus to flatline. Indeed, in the north-west it is trending down. However, overall, cases in the increasing areas are rising faster than those in the decreasing areas are falling. As things stand, we are heading into the Christmas easing with diminishing headroom. As my honourable friend Jon Ashworth said yesterday:

“The buffer zone that the tiers were supposed to provide is getting much thinner.”—[Official Report, Commons, 14/12/20; col. 25.]


London, like other parts of the country, will now suffer dreadfully from these further restrictions, which we support, but we think there are some serious problems. Businesses and livelihoods will suffer and there will be a cost to mental health and our NHS. The Minister has often praised Liverpool, but is not the biggest lesson to draw from Liverpool that people still struggle to isolate if they do not have the financial means to do so? The eligibility criteria for the £500 payment are still too tightly drawn: people need decent sick pay, people in some circumstances need alternative accommodation and people need help with their shopping and medicines. Surely, some of the £22 billion spent on test and trace could be reallocated to offer people adequate isolation support—as has happened elsewhere in Europe and the world?

Why is there still not a plan to make lockdown easy for people to do? Will the Government address the wide gaps that exist in economic support for the self-employed, for example? The IFS has noted that many would

“fall through the gaps completely”

and estimated that nearly two in five people with some self-employed income were excluded from the Government’s support schemes—this is not adequate.

I turn to the vaccine. Can the Minister update us on how many people have received the vaccine? Can he set out exactly when unpaid carers will be given the vaccine, given that they spend their time caring for extremely vulnerable people and could pass on the virus? I echo what my honourable friend Jon Ashworth said in the other place yesterday, when he asked whether priority could be given to those who are terminally ill to get the vaccine as soon as possible.

Can the Minister also explain what guidance is being put in place for autistic people, for example, in in-patient settings to go home for Christmas? Autism charities have warned that autistic people in residential care will have to isolate for 14 days when they come back from visiting their families—that is not fair on those who need routine and support. The Government must make their guidance autism-friendly.

The PHE report last month found that people with learning disabilities had a death rate 4.1 times higher than the general population, and this could be 6.3 times higher—what steps are being taken to protect them as infections rise? In November, the Minister in the other place said she was asking SAGE to review this report and make further recommendations; what is the outcome of that?

[Baroness Jolly (LD) [V]]

I support the points made by the noble Baroness, Lady Thornton, on lockdown; she and I have repeated them regularly in these debates, and yet there is no change. My points will be around vaccines, acute hospitals and their staffing, and Christmas. I thank the Minister for repeating the Statement and join him in welcoming the news about vaccines. Anyone in need of a real feelgood story should watch last night’s “Panorama” programme about the development of the Oxford team’s AstraZeneca vaccine.

How confident is the Minister of 100% vaccine coverage, for those that are entitled, by Easter 2021? This is a lot of people, and we are not certain of all vaccines being available by that time. Could he explain to the House what determines who receives the AstraZeneca vaccine and who the Pfizer—or indeed any other vaccine that may come along? Is he confident that the new vaccines will be effective against the new variant that is emerging?

Can the Minister give us a statement about acute hospitals in tier 3 areas? At the moment, it looks as though the rise in cases in the London area and the south-east is almost matched by the rise in hospital admissions—they are just a percentage point apart. Are the Government confident in London’s hospital capacity? We know that, in some areas, there are Nightingale hospitals; is the NHS intending to bring them into use if necessary? Are there the clinical and other staff to run them?

For many of us, an in-person Christmas may not be possible. We need to look at the impacts that Thanksgiving had on the US Covid-19 figures and assess our risk. Many of my contemporaries have decided not to travel to celebrate with friends and family, and our children have told us that this is what we are going to do as well, so it looks as if many will be resorting to whatever is their favourite conferencing software to catch up with family.

Finally, will the Minister outline the Government’s communication strategy for Christmas? Clear messaging is imperative but many of the public who have been interviewed are unclear. Will ads be used in newspapers, broadcasts and online social media? Christmas is 10 days away, and people would appreciate a clear steer from the Government. This needs urgent and professional communications attention.

Ockenden Review

Baroness Thornton Excerpts

Monday 14th December 2020 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, I first declare an interest as a non-executive director for a London hospital trust. I thank the Minister for the debate today. This is a harrowing report, and the latest in a series of reports over recent years. It follows on the heels of the Morecambe Bay report, and we know that the East Kent report was launched earlier this year to investigate 54 babies dying between 2014 and 2019.

I first congratulate Donna Ockenden on this interim report. As she rightly says in her letter to the Secretary of State,

“we want to bring to your attention actions which we believe need to be urgently implemented to improve the safety of maternity services at The Shrewsbury and Telford Hospital NHS Trust as well as learning that we recommend be shared and acted upon by maternity services across England.”

The scale of the findings in this interim report is distressing in the extreme. The relentless campaign of parents Rhiannon Davies and Richard Stanton, and Kayleigh and Colin Griffiths, must be recognised, and we must pay tribute to and thank them. At a time of greatest grief—the loss of a baby—they have done something vital to ensure that other parents do not suffer the losses they have.

Babies suffered fatal skull fractures from forceps use; women were left screaming in agony for hours; infants developed long-term disabilities as a result of terrible maternity care. There were baby deaths, high maternal deaths, and a catalogue of incompetence, neglect and cruelty. There was failure to handle high-risk cases correctly, an overzealous pursuit of natural, vaginal births leading to a reluctance to perform caesarean sections, and inadequate consultant supervision. Struggling mothers were mocked and called lazy. Mothers were blamed for their baby’s death. Parents were not listened to; legitimate questions were not responded to and blocked; responsibility was not taken.

There was poor assessment of risk and no discussion of risks with mothers. Practice in assessing ongoing risk was poor. Escalating problems were spotted too late, leading to delay in transfer to hospital and death. There was poor ability to spot the refusal to acknowledge. Escalation was seen by midwives as a slight on their ability, not a prudent response to risk. As bad was the internal culture which allowed this to carry on without proper, effective management or regulatory oversight. There were adversarial attitudes between doctors and midwives. Perhaps the Royal Colleges need to talk to each other about the lack of mutual respect for their particular expertise and experience, and the value placed on these.

This is an interim report because Ockenden is rightly concerned that change needs to start immediately. One hopes that it has already been happening in the trust, rather than waiting for the full report and for the Government to take time to consider it. That might literally cost lives. It might mean more babies suffering damage, which means disability for the whole of their lives. This concerns not only deaths but sometimes severe disabilities, which cause huge suffering for the child and have a huge impact on and cost for their families and, indeed, for the state.

It is now clear that the Ockenden review will be far larger and take far longer than was originally intended. Can the Minister assure the House that the review has the resources necessary to complete the final report as soon as possible? There are seven immediate and essential actions outlined in this interim report. What progress is being made to implement these recommendations? What actions is NHS England taking to implement these interim recommendations across England? The turnover of leadership at board and officer level in this trust was surely a warning sign that something was amiss. Why was there not earlier support and intervention by NHS England? I know how appointments are made at senior level; they have to be signed off by NHS England. It must have known. What happened? One needs to ask the same questions of the CQC, both in terms of leadership instability at the trust and why the glaringly obvious warning signs of infant and maternal death were not acted upon sooner.

More broadly, can the Minister explain what action is being taken to ensure that there are enough staff in all maternity units? Perhaps the Government can, this time, commit to legislating for safer staffing levels. What is being done to tackle the current estimated 3,000 midwife vacancies?

Finally, for the vast majority of us who give birth in NHS hospitals, it is a wonderful experience, and a very safe one. We want that to be available to all women.

[Lord Scriven (LD)]

I declare an interest, as my husband is a medical director for NHS England, but not in the region where this hospital is located.

From these Benches, I want to start by sending our heartfelt love and admiration—as, I am sure, do many across the House—to those parents and families who will have an empty place in their home this Christmas, due to the poor care they received at Shrewsbury and Telford Hospital NHS Trust maternity services. This report is distressing and shocking to read. It is hard to comprehend that it describes a care system in this country, in this century. It describes everything from the lack of basic things like human empathy, compassion and support, to poor medical practice and lack of carrying out best practice and adhering to agreed professional standards. This has led to grief, long-term disability, lifelong complications and the unnecessary deaths of newborn children and mothers.

This is not the first case of poor practice in maternity care that has come to light after brave families and parents have refused to be cowed and silenced. Morecombe Bay should have been a wake-up call for ensuring that systematic, integrated changes took place. It is clear that cultural and systematic change at scale and in depth has not happened, despite previous warnings. The healthcare regulator this year reported that four out of 10 maternity services do not meet the safety threshold of care. I ask the Minister why, in 2020, that is an acceptable statistic.

In 2017, the £8.1 million national maternity training fund was withdrawn. Does the Minister now, in hindsight, regret this, and will he seek to re-establish this fund urgently? Will the Minister inform the House who is responsible—politically and managerially—within NHS England for ensuring that, this time, the changes highlighted are implemented, particularly in the seven areas seen to be urgent? What is the timetable for implementing the seven immediate and essential actions required across the NHS? What resources will be allocated to implement the 27 local and 7 immediate and essential actions required?

This must not be another report that gets sympathetic words from those with political and managerial responsibility but then ends up on a shelf gathering dust. That is why the Minister needs to outline a timetable for implementation, what resources will be allocated and who, ultimately, is accountable for ensuring that the systematic, deep changes happen, so that no family has to deal with the kind of grief and trauma that so many families in this report have had to deal with.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2020

Baroness Thornton Excerpts

Thursday 10th December 2020 Grand Committee

[Baroness Thornton (Lab)]

My Lords, it is quite clear that the smaller first statutory instrument is a tidying-up regulation and I thank the Minister for introducing it. The other regulation is, as the Minister put it, about developing a private market for testing. The questions that have been addressed to him in this short debate will have told him that there are some concerns about how that works.

My first question is: why is the CQC not the obvious body to do this? What has led to it being the UKAS? The time it takes to be accredited does not seem that different.

That leads to my next question, which was raised by my noble friend Lord Hunt: what additional resources and staffing has the UKAS been given to carry out this new responsibility? I looked at its website. Obviously, it is a creditable and important body. I am not undermining it at all, but I am questioning it taking on this new responsibility, which involves more expertise and more funding. Because it is a public health issue we are talking about here—the spread of Covid—what are its responsibilities when somebody gets a negative result? What happens when someone is infected with Covid? I would like to know what responsibility is being placed on the UKAS for it to place on the private sector deliverers of this service when they test someone who tests positive for Covid? It seems absolutely vital that that person is placed in the test and trace system. Can the Minister explain to the Committee what the “trace” bit of this is?

The noble Baronesses, Lady Wheatcroft and Lady Altmann, raised the potential for fraud and testing scams. How will the Government make the public aware of the need for test providers to be properly accredited? Also, how will they ensure, as part of the monitoring and regulation, that the certificates that are issued cannot be falsified or sold on, and what are their powers to intervene if they suspect or it is reported that that is happening? It is inevitable that some investigative journalist or programme will indeed try to do that in order to test the system. If it is found wanting, it will be a very serious undermining of what should be safe private testing.

There are a number of commercial providers offering Covid-19 “fit to fly” tests in the UK. As other noble Lords have mentioned, Which? found that the costs varied considerably, from £60 at London’s Gatwick Airport drive-through test—the cheapest test—up to £214 at a clinic in London. Of course, for a family of four going on holiday, that is a significant amount of money. Is there an intention to cap the price of these tests to make sure that individuals and families are not priced out? I think it is important for the Minister to explain the link and relationship between public sector procurement of these tests and the private services. We now have a long list of procurement problems—to put it mildly—in the testing and tracing regime and possibly billions of pounds of public money have been wasted; we will find out. We do not want to add to that with this new regulatory framework.

Covid-19 Vaccine Rollout

Baroness Thornton Excerpts

Wednesday 9th December 2020 Lords Chamber

[Baroness Thornton (Lab) [V]]

My Lords, I thank the Minister for the update today, and for the all-Peer Zoom this morning. Yesterday was indeed a happy day. Like many—including, it has to be said, the Secretary of State—I was very moved watching 90 year-old Margaret Keenan get her jab. However, the challenges of the next period are as acute as, if different from, those of the period we have been through. What is the timeline for the vaccine for people who are housebound or shielded and cannot attend a surgery, whether in a hospital or anywhere else? It seems that the easy distribution of the vaccine will depend on the new vaccines coming down the track: communications will be vital. So what communications will people receive, from whom? Will that be centrally controlled or will it be done locally—through primary care networks, for example?

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

My Lords, the JCVI has laid out a clear prioritisation, putting great emphasis on those who are older—the over-80s—and those in social care. The vaccine will come to those who are shielded and living alone in due time. There are some practical issues with getting the current Pfizer vaccine: as the noble Baroness undoubtedly knows, it has to be kept in cold storage and comes in substantial batches, which are difficult to break up. The initial cohort consists of 6 million people—those over 80, and the health and social care workers who support them. As for future vaccines, those looking forward to being vaccinated should wait for a letter. Those letters are being organised through their doctors, who have access to a central database to ensure that the right prioritisation takes place.

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) Regulations 2020

Baroness Thornton Excerpts

Tuesday 1st December 2020 Lords Chamber

[Baroness Thornton (Lab)]

Perhaps I may say how pleased I was to see the noble Baroness, Lady Brinton, in the Chamber today, joining in our debates.

I thank the Minister for introducing these very important regulations to the House. I hope that he, like me, does not feel too second division, as the debate in the other place was opened by the Prime Minister and the leader of the Opposition, but I am sure that he and I can probably do more than justice to this subject. I think that his right honourable friend the Prime Minister might be feeling just a little worried at the moment because I gather that he had 56 rebels on the vote that has just taken place in the Commons.

This statutory instrument sets out that the Secretary of State must review whether each area that is part of tier 2 or tier 3 should continue to be part of those tiers at least once every 14 days, with the first review to be carried out by 16 December 2020, and review the need for each of the tier 1, tier 2 and tier 3 restrictions at least once every 28 days. The first review is to be carried out by 30 December 2020, so I hope that the Minister will have some Christmas. The shame of the statutory instrument is that it offers a binary choice. If this were primary legislation, we could really test the legitimate concerns in a way that we are not able to do this evening. The regulations will expire on 2 February 2021. I urge the Government to think very carefully about how the discussion on renewal, or whatever happens next, takes place. We are many months into this regulatory review; I think it is time that it ended and we had proper primary legislation.

The allocation of the areas of the revised tiers was announced on 26 November. As the noble Baroness, Lady Hayman, said in her very wise contribution, it has cemented the deep sense of divisiveness in the nation. The Government have published information alongside a Written Statement which sets out the rationale behind the allocations. Many noble Lords have already criticised that, so I will not go into detail on it. However, it means that tier 1, which had 23.5 million people in it pre-lockdown, now has 713,000 people, and tier 2 now covers 32 million people whereas it previously covered 24 million. So it is not surprising that people are concerned about where they have been put.

The new map of the three-tier system in England looks very much like a depiction of the north-south divide, and as Danny Dorling, the Oxford Professor of Human Geography, said on Saturday:

“What’s certain is that the key to understanding the map is the underlying social and economic geography of England. To understand the changing medical geography of this pandemic, you must first understand how the country lives and works”.


There is the rub. If the Government do not have a real understanding of how people live their lives, the conditions under which they work, the security or otherwise of their jobs, the adequacy of their homes, the transport they rely on, their relationship with schools and local facilities and their reliance on informal support networks, it is difficult to see how the current proposals and the ones that have gone before can work effectively.

The combination of vaccines, mass-scale rapid turnaround testing and therapeutic advances offers a way out of the current Covid-19 challenges in the spring and early summer, but in the meantime, restricting social contact is the only way of reducing the pandemic, protecting our National Health Service and allowing it to do its job, as my noble friend Lord Hunt and the noble Baroness, Lady Watkins, explained. We can see some success, and I applaud that, but the Minister needs to understand that many people believe that the success in getting the R rate down has been achieved despite the Government and not because of them. Why do we need to be still learning the lessons of being too slow?

It is of course welcome news that the R rate is below one, but today we learned what that means—and it does not mean that we can return to any sort of normal life. The news on the vaccines is of course tremendously good. Like others, I am allowing myself to hope that one day I will be able to see my sisters, nieces and nephews in Yorkshire and to hug people. I am also hoping not to have to queue for the supermarket, and maybe I will be able to sit at the same table as my noble friend Lady Wheeler in the Guest Dining Room, rather than sitting six feet apart at separate tables.

However, we have been here before: overpromising and underdelivering. As my right honourable friend the leader of the Opposition said, we are now on plan 5. The slowness with which we have entered these different plans is the reason why the UK economy has been hit particularly hard. As the OBR reported, a sharp slowdown in activity meant that the UK experienced one of the larger falls and that activity was then slower to recover.

The shame of this is that the Government learned none of the lessons from the first wave of the crisis and failed to listen to SAGE—or to Labour, when we argued for a two to three-week circuit-break to coincide with half term. Instead, we have had a longer national lockdown and the economy has taken a bigger hit.

It is therefore vital that the tiers work, and that the relaxation of Christmas does not lead to a further spike and lockdown in the new year. How could that be done? We have a few ideas. We need to end the topdown, centralised model of testing, tracing, isolating and supporting. Local teams with local knowledge must be put in charge, and they must be given the resources to do the job. We need to get rid of Serco and give the testing, tracing, isolating and supporting to our local teams. Frankly, if the Government have spent £22 billion on this and it is still not working, there has to be an alternative.

We need to ensure routine testing for all high-risk workplaces and high transmission areas for NHS and care staff, of course, but those in retail, hospitality and transport, teachers and pupils in secondary schools should also have access to tests whenever they need them.

Furthermore we need to overhaul the failing support for self-isolation, for both businesses and individuals. We need to support our businesses. The Government’s approach to supporting areas under local restrictions is fundamentally unfair and risks a gulf in support opening up across the country. The idea that the Isle of Wight should receive the same amount of support as Manchester is patently unfair.

Businesses are in the dark about the future of the furlough scheme, which is up for review in January. What will happen next? The Chancellor is still refusing to help millions of people excluded from his support schemes for the self-employed, despite having had months to plug those gaps.

What about our students? What will be the impact of their return home before Christmas? What is the Government’s assessment of the risk of students contracting the virus between having the test—which I hope will be available in the universities—and returning home? What steps are the Government taking to ensure that transport capacity is not overwhelmed by the numbers of non-socially-distanced travellers next week? It is completely irresponsible for the Government to leave tier 3 areas across the north and the Midlands in the lurch again.

What about Christmas? What is the scientific assessment of the risk that five days of relaxation will entail? I raised this matter yesterday with the Minister, and I am still seeking an answer. Covid-19 cases have spiked across Canada in the past month, since Thanksgiving and Halloween. On 12 October, Canada had 185,000 Covid cases. Only six weeks later that number has nearly doubled. Canadians and Americans alike are saying that the surge is proof that nothing is worth the risk. I would, therefore, like the Minister to address this issue: what will the cost of Christmas be in infections?

Does the Minister believe that the three-tier system provides for the necessary post-Christmas restrictions, or is a third lockdown inevitable? Given the prediction that cases will increase after Christmas, what plans are in place to prepare the NHS and safeguard services in the coming months, until a vaccine allows life to return to normal? Front-line resilience is already at a premium and will be critical over the next weeks and months, particularly after Christmas, especially if we do not wish to look back on those activities with very deep regret.

With regard to the amendments to these Motions proposed by the gaggle of Conservatives, I sort of feel sorry for the Minister. It is noticeable that yet again the Government find themselves under fire from their own side. As I have said at least twice to the noble Lord, Lord Robathan, he has form in being a Covid restriction objector and seems prepared to risk people’s lives instead of supporting them to do the right thing. This is my view of the noble Lord’s—

[Lord Robathan (Con)]

It is wrong.

[Baroness Thornton (Lab)]

Well, that is my view; I think it is right. I think that is what will happen if he gets his way. The noble Lord does not seem to understand that, until his Government actually manage to build and support the systems that will contain the virus, particularly in deprived communities, his proposal would only cost lives—and they will be the lives in our poorest communities, the BAME and the vulnerable.

I believe the other two are legitimate regrets and at least show consistency from the movers. However, as we have in the past, we on these Benches will abstain if any of the movers choose to test the opinion of the House.

HIV: Pre-exposure Prophylaxis

Baroness Thornton Excerpts

Tuesday 1st December 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Lord makes a completely fair point. There is absolutely no question of there being a social stigma associated with taking PrEP or any kind of moral cloud over those wishing to take this important therapy. That is not in any way our purpose. He makes a valid point that there are good arguments for the supply of PrEP to be not just through GUM units but also through GPs and perhaps pharmacists. These are arguments that we hear and that we are looking at very closely. I hope that, at some point, I will be able to update the noble Lord on our progress on this matter.

[Baroness Thornton (Lab)]

I remind the Minister, with regard to his last answer about funding, that just because you cannot solve all the world’s problems does not mean that you should not try to solve some of them. On that basis, can the Government provide an update on the rollout of PrEP in England? Is the Minister aware that there are local authorities that are still not providing the drug? When the ring-fenced funding for PrEP runs out in March 2021, will the Government commit to at least the £16 million per annum to make this happen for the future?

[Lord Bethell (Con)]

The noble Baroness makes a fair point. The rollout of PrEP has reached a great many local authorities but not all of them. The funding for it, at £11 million, has made a big impact but it has not covered all the ground. We are aware that this funding package runs out next year and we are in active engagement with local authorities in order to find a new mechanism going forward before July, when the funding will change. That said, our commitment, as I said earlier, to the principle of PrEP and its impact on reaching our targets for transmission remains resolute. I look forward to being able to announce a resolution of this funding formula.

Covid-19 Update

Baroness Thornton Excerpts

Monday 30th November 2020 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for taking this Statement, and I look forward to discussing the regulations that will flow from it tomorrow, if they successfully pass through the Commons. Although we can see that cases are going down—and that, of course, is a matter for celebration and relief—we are still seriously in the pandemic. We still seriously stuck in what seems like an endless cycle of lockdowns, which have not been working.

The Government have again wasted the opportunity, over the past few months, to get a handle on testing, tracing, isolating and supporting. Once again the hospitality industry in many parts of the country will be absolutely battered. Once again jobs will be in further jeopardy. Once again our theatres are closed. Once again older people, disabled people and people with learning difficulties remain stranded in care homes without visits from their families. Exactly what will be the difference this time that will make people’s sacrifices yield a reduction in the infection rates? When shall we see testing in care homes, for example?

Reflecting on the debate in the Commons following the Prime Minister’s and the Secretary of State’s announcements last week, we see that all MPs of all parties were desperate for two things. They were desperate to understand the basis on which these decisions were being taken, and they were desperate to understand how their constituents might be able to move from, for example, tier 3 to tier 2, or tier 2 to tier 1.

As my honourable friend Rachel Hopkins MP says:

“The good people of Luton will want to get out of tier 2 as soon as possible, but the current resources provided to Luton Borough Council for the lateral flow rapid testing pilot are insufficient to enable it to provide the level of mass testing that is being described nationally. The contained funding—£8 per person—just will not cover tests for 10% of Luton’s population, as the funding also needs to be used for the wider covid response, including wellbeing support for vulnerable residents.”


She asked the Secretary of State, and I now ask the Minister here, to

“confirm that there are national plans to provide additional support and resources to expand testing if the intention to test close contacts daily is pursued”.—[Official Report, Commons, 26/11/20; col. 1012]

The news about the vaccine is the light at the end of the tunnel, but noble Lords must be well aware that we are still well into the tunnel, and probably will be for months to come. The only sure way to contain the virus is for people to obey personal rules and, most crucially, for us to have an effective and locally controlled test, trace, isolate and support system. We on these Benches have known this and have been asking, if not begging, for the last part of this deal for many months. Despite the Minister’s constant issuing of large numbers one way or the other, it is still not working as it should be. It is not surprising that confidence in the Government’s ability to deal with the pandemic is at a low ebb, much lower than in March and April.

Yesterday I heard the Conservative Rother Valley MP Mr Stafford say on television that he thought we were in trouble with this virus because people had broken the rules—in other words, let us blame the public. He was taken to task firmly by my honourable friend Naz Shah MP, but I have to ask the Minister whether he agrees with his colleague Mr Stafford.

When areas such as Bury and Trafford went into lockdowns in the summer, the Secretary of State promised that MPs would be involved in the decision. Has that commitment now been abandoned? Then Ministers agreed to involve regional leaders but, it has to be said, took exception to being challenged by Andy Burnham. What role do regional leaders now have in these decisions, or is the position really that the Prime Minister imposes from Downing Street restrictions on communities across the Midlands and north that will have huge impacts on the livelihoods of families and small businesses? What are the plans to alleviate the hardship that these rules will create? Leicester, Bury, Leigh and Heywood have been under a form of lockdown for months, with families forced to part and grandparents not seeing their grandchildren. Those families will want to know today what the exit strategy is and what voice they have in that strategy.

The Secretary of State in this Statement has outlined five criteria by which local lockdowns will be judged. Will that be published, with clear, transparent rules for areas entering and leaving tiers and a scorecard for every area, assessing its Covid progress against its criteria so that everyone can judge this in a transparent fashion?

What have the SAGE advisers said to the Minister about the risks which go with the proposed lifting of restrictions for Christmas? The Canadians have a very clear message about this. They say, “Stay home and stay safe”, and the reason they say that is because the worst surge in Covid-19 they have ever experienced followed six weeks after their Canadian Thanksgiving. They have given warning to their southern neighbours—the United States—that they will see an even bigger and more devastating spike following their annual gathering for turkey and gratitude at Thanksgiving. This is a warning that we need to heed. Does the Minister agree?

[Baroness Jolly (LD) [V]]

I thank the Minister who is going to respond to this Statement.

The first case of this coronavirus was just over a year ago, on 17 November 2019. Since then, over 1.3 million people have died worldwide and over 50 million people have been infected. The first case here in the UK was on 29 January this year. We watched Italy deal with the cases in late winter, and I am sure that plans were being fetched out of the archives on how we might deal with a pandemic. I know that in 2015 there was a pandemic plan published for an influenza outbreak. Will the Minister tell the House what lessons were learned from that exercise?

I remember walking back to my flat in London on 17 March and my son, who was living with me then, said, “You either go home today, or you stay until this clears”. I went home, and on 23 March lockdown started. Along with many other noble Lords, I stayed away for some considerable time, and Zoom, Teams and virtual working became the new normal.

Hong Kong, which is always waiting for a SARS outbreak, keeps a stock of PPE for all care homes in the event of a pandemic. Is it too early to ask the Minister whether that is something he would now consider for England? I think it was a recommendation of that pandemic preparedness document in 2015.

One area where I would also be grateful for clarification is that of test, track and isolate. At what stage was it decided not to involve the local experts and local authorities? This caused much regional frustration, as this was the biggest public health crisis for many years, and local public health leaders were being sidelined. They know their regions well, and in areas where they did work, it worked well. Let me be clear that in a Lib Dem world, local authorities would test then track those with a positive result and support them practically and emotionally in their isolation.

As the noble Baroness, Lady Thornton, has articulated, many of the public have said that they did not fully understand restrictions. When putting messages together, who did the Government picture they were talking to? From whom did they get their advice? Who did they test their messaging on? This is a case where conversations with the Plain English Campaign, or perhaps the Canadians, would have been helpful.

The last time tiered restrictions were in place, less than half of people in the UCL Covid-19 Social Study said that they fully understood the rules. With changes to the tier system and a five-day relaxation, will the Secretary of State make changes to the Government’s communications strategy to aid compliance?

Some of the Covid economic measures have helped people in the short term, such as the furlough scheme, which our colleagues in the other place fought so hard to get. However, the Government excluded more than 1 million people from Covid support and froze pay for local authority staff, who have also played a vital role in combating this pernicious disease. It is an assault on local authority workers and services.

Nurses too have been hoping for a pay rise. The Chancellor stated:

“Our health emergency is not yet over and our economic emergency has only just begun”.


He explained that the

“immediate priority is to protect people’s lives and livelihoods”,

and that the spending review is set to deliver stronger public services. He continued:

“taking account of the pay review bodies’ advice, we will provide a pay rise to over a million nurses, doctors and others working in the NHS.”

He promised

“the 2.1 million public sector workers who earn below the median wage of £24,000”

that they

“will be guaranteed a pay rise of at least £250.”—[Official Report, Commons, 25/11/20; cols. 827-28.]

That should include porters, auxiliaries, and other key, low-paid hospital workers.

Countless families are facing serious financial hardship. More than 1 million people have lost their jobs, and the devastating impact of this pandemic will continue to be felt acutely throughout the next year. We are also facing big challenges in deep-seated inequality. We must ensure that no one is left behind. The Government win plaudits for the furlough scheme, but they have failed to provide a serious economic strategy for dealing with unemployment, climate change and inequality. I fear the Government’s Brexit plans will make job losses and business closures much worse. No deal or a bad deal would be a huge blow for businesses and jobs just when we need to be recovering from this crisis.

Although the winter plan broadly outlines the five criteria used for determining the tier system, would the Minister be more transparent about what the exact entry and exit points of the tiers will be? I understand it is not always possible to give exact criteria, but even a rough idea would help the public know what they are aiming for when the Government are asking them to make so many sacrifices.

This has been relentless since the middle of May. At a briefing meeting today, we heard that the acute care sector was at full pelt, and this is before winter sets in. The Minister is rightly proud of the Nightingale units. Do we have staffing for them? Should we need them? Many clinical staff are totally exhausted. Many question whether they want to carry on in the profession. Are the Government making sure that a safety-critical profession can reach safe staffing levels by filling tens of thousands of unfilled nursing jobs?

Children are the most vulnerable to the social impacts of local restrictions and have had formative years of their lives severely affected. With the rule of six being reinstated after national lockdown, will the Minister commit to an exemption from the rule of six for children under 12? It really does make sense.

What is the Minister’s current estimation of the likely length of the restrictions? Being open and transparent on likely timings and not creating false hope are critical to maintaining public support for any public health measures. After all, the PM said earlier this year that we would be back to normal by Christmas, and how wrong he turned out to be.