Health Protection (Coronavirus, Restrictions) (North East of England) Regulations 2020

Baroness Watkins of Tavistock Excerpts

Monday 12th October 2020 Lords Chamber

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, I declare my interests as outlined in the register. I thank the noble Baroness, Lady Morrissey, for her important contribution to this debate; I agree with much of it.

When I put my name down to speak, it was to express my concern that Parliament appeared to be managing rises in Covid-19 rates in different areas of the country through myriad secondary legislation instruments—at least 18, I believe. As a member of the committee that considers SIs in this House, I and other members were becoming concerned that it was increasingly difficult to understand the evidence base on which individual SIs were being developed. In addition, it has become crystal clear over the weekend that the public and local authority elected representatives, particularly in the north-east, Liverpool and Manchester, have begun to lose trust in the way in which we are dealing with local restrictions.

Fortunately, the Prime Minister and his Cabinet accept that we must adopt a more strategic approach to legislation, associated with changes in the number of infections per 100,000 of the population. Currently, different parts of the country have significantly different rates, estimated at between 16 cases per 100,000 where I live, here on Dartmoor, and 600 in Nottingham. However, any three-tier system to manage the virus should be applied in a uniform manner associated with virus increases, and hopefully decreases, over time. The three-tier system that the Prime Minister is expected to announce should be passed into law and applied across England equitably as the virus ebbs and flows. Any legislation should clearly indicate when an area will be enabled to move up or down a tier, associated with the ratio of virus cases to the population. This will ensure that the public can clearly understand the core reason for proposed restrictions.

At the core of managing increases in infections are the test and trace system and the public’s buy-in to restrictions of liberty, be this closing licensed premises or requests to reduce travel and meeting friends and family. In March, care homes were largely closed down in terms of relatives’ and friends’ visits; we know that this caused considerable distress in many cases. Careful consideration must be given to trying to ensure that we avoid transmitting the virus from the community to care homes, but we must also weigh up the devastating effects to people of not being visited by ones they love. What approach do the Government intend to take on this issue?

When Governments reduce their populations’ liberties, even for good reason, it is vital that they counterbalance the restrictions with effective leadership. In particular, did the breakdown in recording over 15,000 positive coronavirus tests 10 days ago contribute to the rapid increase in cases in certain parts of the north-west and north-east of England? By this I mean: did a high proportion of those 15,000 cases, where contacts were not traced quickly, occur in this area?

Will the Minister assure the House that, if hospitals in any area of England become overloaded, the Government will ensure that additional test and trace facilities, PPE and other resources required to manage the virus will be made rapidly available from other parts of the country?

Finally, I welcome the honours given this weekend to nurses and other health and social care workers who contributed in the first wave of the pandemic. However, the Government’s recent press conferences have focused heavily on scientific evidence, with little reference to applied, evidence-based public health interventions, which nurses are often involved with. Yet nursing is reportedly the profession that is most trusted by the UK public. Nurses should play an important role in the public health messages we are trying to get across. They can encourage the take-up and delivery of vaccinations, including for flu and tuberculosis, and the mass vaccination for Covid-19 as and when it is developed. Does the Minister agree that now is the right time to more effectively use the voice of nurses, including the Chief Nursing Officer for England, Ruth May, and locally based community, hospital and school nurses, to explain to the public how best to reduce the spread of the virus?

Social Care Workers

Baroness Watkins of Tavistock Excerpts

Wednesday 7th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the recruitment of nurses is extremely encouraging. We have had an enormous response, with more than 10,000 nurses already recruited and recruitment rates to universities for nursing qualifications also up. We have an enormous marketing campaign supported by broadcast and social media. However, more needs to be done and we are very focused on this area. The use of agencies provides some surge capacity for hospitals—it has a role—but I completely acknowledge my noble friend’s point that agency support needs to be used in a considered, thoughtful and commercially intelligent way.

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, the introduction of living allowances for nursing students has improved recruitment this autumn. Stable funding for social care purchasers and providers in both care homes and domiciliary-based service is necessary to ensure dignity in care for the vulnerable in our society. It is essential that careers in social care are attractive and that staff are supported to deliver high-quality personalised care to clients. What plans do Her Majesty’s Government have to support local authorities, further education colleges and social care providers to train and retrain social care staff? Central funding is necessary. Incentives are needed to demonstrate that those joining the social care workforce are as valued by government and society as those working in the NHS.

[Lord Bethell (Con)]

The noble Baroness makes her point extremely well. We want social care to be a profession that people seek out, where they seek professional development and where they can find a fulfilling lifetime career. That will not be true for everyone, but we need a backbone of people who are committed to social care. That is why we have massively increased the funding to local authorities so that they can address the challenge of social care, and why we have published the adult social care coronavirus winter plan in order to provide short-term support for local authorities to achieve exactly what the noble Baroness has spelled out.

Covid-19 Update

Baroness Watkins of Tavistock Excerpts

Wednesday 23rd September 2020 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I thank the Minister for coming to take questions on this Statement. I will ask about two issues. If he cannot answer me now, could he kindly write with information? My main concern is people who are still going to work and caring for people who are Covid positive. Based on the highest prediction of need, how many days’ worth of PPE stock does the UK currently have in store for the NHS and voluntary and independent-sector providers of health and social care, including care homes and domiciliary services? How rapidly can stocks be replenished? What proportion is produced and manufactured in the UK? Have we tested the distribution systems and are they satisfactory?

My second question is in relation to vaccination. Vaccination will obviously be really important, but what are we doing now to support the Prime Minister’s approach, declared in August 2019, that we will increase MMR vaccination rates, among other needs, so that all people are protected as far as possible against other infections during the rise of Covid?

[Lord Bethell (Con)]

My Lords, the noble Baroness asked about PPE, which is naturally a concern as we go into winter. I assure her that the NHS has 15-day, 45-day and 90-day plans for the supply of PPE to the NHS and the independent sector. Roughly half of that comes from British sources. The distribution mechanisms have been radically overhauled and tested, and have proved to be utterly modernised.

We are working extremely hard on the deployment of a Covid vaccination. She rightly mentions other vaccinations. I assure her that we have 30 million doses of the flu vaccination. As she rightly points out, there appears to be a strong link between having flu today, Covid tomorrow and problems with a combination of both at a later date.

Childhood Obesity

Baroness Watkins of Tavistock Excerpts

Wednesday 2nd September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I pay tribute to the noble Baroness, Lady Chisholm, for her expertise in this matter. She is entirely right that decisions made by families together are more powerful than those made by individuals. The obesity campaign launched in July seeks to achieve exactly that by having a campaign on better health targeted at the whole population. I also emphasise the Healthy Start vouchers, a scheme to provide a nutritional safety net to hundreds of thousands of pregnant women and families with children aged under four, which is one way of bringing families together around healthy food.

[Baroness Watkins of Tavistock (CB)]

School nurses play important roles in dietary education for new parents and school pupils. With the anticipated changes to Public Health England, how will the Government ensure, without structured plans, that these services are strengthened to promote healthy eating and exercise to prevent early childhood obesity?

[Lord Bethell (Con)]

The noble Baroness is entirely right that these nurses play an absolutely pivotal role. The reorganisation around PHE is due to start in April. We are seeking the best possible advice on where that work could be best sited. The National Institute for Health Protection is one potential home, but I reassure the Chamber that a safe and important home for those nurses is a priority for the Government.

Medicines and Medical Devices Bill

Baroness Watkins of Tavistock Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Wednesday 2nd September 2020 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I feel that I have drawn the short straw, speaking at this point.

Like other noble Lords, I broadly welcome and support this relatively short, important and necessary Bill. To promote patient safety, the meaning of

“the attractiveness of the … United Kingdom”

environment for medical research in future, particularly in relation to clinical trials, requires clarification. We see the global race to produce safe vaccines for Covid-19 that must, despite their urgency to protect populations, be tested for safety as well as efficacy. The UK currently adheres to the EU protocols that apply to ensure the safety of such products before licences are given for mass use. Can the Minister explain if there are any plans to relax our adherence to current EU legislation on clinical trials?

The Bill refers to regulations relating to medical devices and the fact that Ministers will be given delegated powers in relation to their approval. Do the Government intend to adopt the EU regulation on medical devices 2017/745, which is not due to come into force until after the end of the transition period? Will the Government ensure that, as well as approving new devices in future, any maintenance of devices necessary to keep them safe in operating terms will also be included in the provision of granting such licences? We know that patients have occasionally been put at risk due to inadequate and/or irregular maintenance of devices—for example, with smart infusion pumps used to deliver medication. What onus will the Government put on purchasers of approved devices not only for safe maintenance but for adequate training for people to use the new devices to protect patients? This does not seem to be mentioned at all in the legislation as drafted.

I too fully support the excellent report and recommendations produced by the noble Baroness, Lady Cumberlege, and the way it uses plain English to describe the horror that some patients and their families have suffered. I am reminded of trying to find out, when I was training as a nurse, what “iatrogenic complications” meant. I think it is stark that the noble Baroness uses modern language that we can all understand. That is so important.

Will the Bill be used to incorporate some of the principles of the Health Service Safety Investigations Bill, which reached a Second Reading in this House, or is it the intention that that Bill will not be timetabled for completion and therefore the medical devices Bill will need to take up many of those issues at the same time?

Without doubt, I fully support the concept of a patient safety commissioner being appointed.

Covid-19: Response

Baroness Watkins of Tavistock Excerpts

Monday 27th July 2020 Lords Chamber

[Lord Bethell [V]]

My Lords, that is not in the current guidelines. The noble Lord is entirely right that it is incredibly time-consuming and not currently practicable. For the reasons I outlined in answer to an earlier question, a test today does not guarantee that someone will not be infectious either tomorrow or the next day. That is why we have not focused on testing at ports, but we remain open to suggestions. We assess a large number of options and, as evidence and trials emerge that may demonstrate the efficacy of different policies, we will of course consider them and remain open-minded.

[Baroness Watkins of Tavistock (CB)]

My Lords, the Statement is clear that the intention is to mass-vaccinate the population once we have a vaccine that is safe and effective. Can the Minister inform us of Her Majesty’s Government’s plans to achieve this, in the light of concerns among general practitioners that they will be overwhelmed, and given that as many as one in six people in a recent survey said that they would not take up the vaccine if it was available? Do the Government intend, for example, to deploy the many nurses and doctors who volunteered to assist earlier this year to deliver vaccinations for both flu and Covid-19? Will they engage faith leaders in encouraging the uptake of vaccinations through proper explanation of the benefits to individuals and to society as a whole of so doing?

[Lord Bethell [V]]

The noble Baroness raises an incredibly important issue and I pay tribute to Kate Bingham, who is running the Vaccine Taskforce. She is tackling exactly the issue that the noble Baroness raised. GPs are right to be concerned about capacity, which is why we are looking at ways of massively increasing the capacity to deliver such a vaccine. We will definitely look at resources such as returnees, pharmacists and other sources of people power to deliver the vaccine into the arms of the nation. On the anti-vaxxer groups, the fake news and wrong stories around vaccines are an area of deep concern. We are working with faith groups and other civic leaders to put right the arguments for a vaccine because, at the end of the day, any vaccine requires the participation of a large proportion of the country in order for it to be truly effective. It will cause huge disruption and personal suffering if trust is not maintained in the efficacy of such a vaccine.

Independent Medicines and Medical Devices Safety Review

Baroness Watkins of Tavistock Excerpts

Thursday 9th July 2020 Lords Chamber

[Lord Bethell]

My noble friend Lady Cumberlege has put it incredibly well and I endorse her testimony about the courage and expertise of the patient groups who informed this report. I am only sad that they cannot be here to share this important moment. I pay tribute to the work of my noble friend and her team working on this. Patient safety is uppermost now in the mind of health carers. She is absolutely cutting with the groove. The words of Jeremy Hunt are very well made, and we are utterly committed to looking seriously at these recommendations.

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, I add my apologies to the patients and their families and acknowledge the superb work done by the noble Baroness, Lady Cumberlege, and her team. The report makes very salutary reading. Are we going to make sure that we keep central records relating to any type of implant in future, including mesh used in hernias, so that we can follow up individual cases as appropriate? Will the Government consider returning to the Health Service Safety Investigations Bill, which was delayed and abandoned as a result of the recent general election?

[Lord Bethell]

Health records are absolutely key—that is why we have tabled an amendment on them. That amendment enjoys the support of the Government and of me personally.

Social Care

Baroness Watkins of Tavistock Excerpts

Wednesday 8th July 2020 Lords Chamber

[Lord Bethell]

My noble friend is entirely right: there is a massive potential liability. We are acutely aware of the intergenerational implications of social care reform. It is only right that we treat both those in social care and future generations fairly. Those considerations will be uppermost in our minds.

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, can the Minister assure the House that any reform of the social care system will be accompanied by a comprehensive workforce strategy and fundamental improvements to employment conditions by moving away from zero-hours contracts, perhaps to an annualised hours system, to guarantee social care workers regular incomes?

Medicinal Cannabis

Baroness Watkins of Tavistock Excerpts

Monday 6th July 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is very specific in her questions, and I am afraid I am not able to answer them specifically because they are subject to restrictions and confidentiality. Where I agree with the thrust of her question is that we have been in a bit of a cul-de-sac in this area, but the department is working hard to unblock the problems that have existed. Despite Covid, we appear to be making some progress on this.

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, two cannabis medicines have MHRA approval. One of them, Sativex—prescribed within the NHS for multiple sclerosis—has a high level of the active cannabinoid THC, so we know cannabis has medical value. There is no doubt that many more cannabis medicines will be licensed in the coming years. Does the Minister therefore agree that while we are reviewing our current trials, we should evaluate whether it is justified to regard cannabis, in a medical way, as a controlled drug in the long term?

[Lord Bethell]

The noble Baroness will not be surprised to learn that I have just spent three and a half months looking at drugs that might make a difference to Covid, only to find that many of them are not helpful and often quite dangerous, so I do not share the optimism bias that many have towards unlicensed drugs. We remain conservative in our approach to clinical trials. I agree with the noble Baroness and others who have suggested that progress on this should be quicker, and I am leaning into the subject to try to bring that about as soon as we can.

Covid-19: Mental Health

Baroness Watkins of Tavistock Excerpts

Wednesday 1st July 2020 Lords Chamber

[Lord Bethell]

The area of antenatal and natal services has developed a huge amount of concern and, as my noble friend may remember, we adjusted the guidelines to give parents greater access to mother and child at an early stage. This area does concern us. However, it is a relief that, generally speaking, the disease has not hit pregnant women and early born children in the way that it has hit elderly people, and for that we are grateful.

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, I refer to my interests in the register. As acknowledged by the Minister, the impact of nursing people with Covid-19 on the mental health of nurses is estimated to be considerable. A recent brief report from the University of Manchester into suicide by nurses identified a higher prevalence in female nurses than in women from other professions. It is vital that there is a dedicated support offer for the mental health and well-being of the NHS and social care workforce. Will the Minister ask Her Majesty’s Government to consider extending the current England-wide practitioner mental health service commissioned for doctors and dentists to include all nurses employed in the NHS, community and social care settings?

[Lord Bethell]

My Lords, the confidential helpline for the health and well-being of NHS staff was launched on 8 April. That remains in place and has delivered important mental health support for NHS staff. I will take away the noble Baroness’s recommendation to extend it to a wider community.