Osteoporosis: Treatment

Lord Bethell Excerpts

Tuesday 9th February 2021 Lords Chamber

[Lord Black of Brentwood]

To ask Her Majesty’s Government what plans they have to ensure that people with osteoporosis have (1) equitable, and (2) timely, access to treatment.

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

My Lords, to reduce variation in osteoporosis services, NHS RightCare has published the pathway for falls and fragility fractures, which advises local commissioners on optimising osteoporosis services. The Government have also provided an extra £1 billion to fund elective recovery in 2021-22. Patients can also use the resources of the Royal Osteoporosis Society.

[Lord Black of Brentwood (Con) [V]]

My Lords, broken bones seriously impact on the lives of the elderly, causing significant ill health and premature death. Many arise unnecessarily as a result of undiagnosed or inadequately treated osteoporosis. Is my noble friend aware that one in five women who sustain a fracture have to break three or more bones before diagnosis and that fewer than half of women sustaining a hip fracture after the age of 50 receive treatment for osteoporosis the following year? As these are unacceptable figures, with huge costs to the NHS, what action will the Government take to ensure that patients are identified, treated and managed effectively in primary care, including proper access to fracture liaison services?

[Lord Bethell (Con)]

My noble friend is prescient to raise this issue on a day like today, which is slippy and dangerous for those who may take a fall. He is entirely right that the early diagnosis and treatment of osteoporosis are critical for those suffering bone fractures as well as for the system as a whole. The fracture liaison service can play a key role in reducing the risk of fractures in patients and to this end it has been promoted and recognised as best practice by NHS England. As part of the falls and fragility fracture audit programme the fracture liaison service database measures participation and standards in fracture liaison services.

[The Lord Speaker (Lord Fowler)]

Baroness Chisholm of Owlpen. No? I call the noble Baroness, Lady Bull.

--- Later in debate ---

[Baroness Bull (CB)]

My Lords, the Minister has rightly pointed to fracture liaison services and the vital role they play, but only half of the population in England currently has access to an FLS, compared to 100% in Scotland and Northern Ireland. Is the Minister aware of the recent economic analysis that suggested that upscaling provision to cover all over-50s in the UK could prevent an estimated 5,686 fragility fractures every year, with net cost savings of £1.2 million? Will the Government commit to 100% coverage for fracture liaison services and if not, why not?

[Lord Bethell (Con)]

The noble Baroness is entirely right. There is significant regional variation in the rates of fragility fractures within the older population with the lowest incidence observed in London, the east of England and the south-east and the highest in the south-west of England, Northern Ireland and Scotland. To reduce variation in osteoporosis services in 2017, NHS England’s RightCare programme published cases studies and pathways for the management of osteoporosis and fragility fractures. The noble Baroness is right that we should have high aspirations in this matter. I am not sure that I can commit to 100%, but I will return to the department and see if we could be doing more.

[Baroness Quin (Lab) [V]]

My Lords, I do not have a specific interest to declare, but I have been a member of the All-Party Parliamentary Osteoporosis Group and fully support the Royal Osteoporosis Society. Will the Government commit themselves to some kind of timetable for the achievement of a comprehensive system such as exists in Scotland and Northern Ireland? Will they meet the Royal Osteoporosis Society and interested parliamentarians to discuss the specific issue of delays in access to treatment which have understandably emerged during the current Covid crisis?

[Lord Bethell (Con)]

My Lords, the noble Baroness is right to press me for a timetable but, unfortunately, that is not something I can commit to from the Dispatch Box today. However, I would appreciate the opportunity to meet the Royal Osteoporosis Society and will put an appointment in the diary for as soon as possible.

[Baroness Bowles of Berkhamsted (LD) [V]]

My Lords, given the high incidence of osteoporosis in women aged over 50, of whom 50% are affected, and low levels of vitamin D in the population, what plans are there to help increase the consumption of vitamin D, which helps prevent osteoporosis? Is the mandatory nutritional fortification of some foods under consideration?

[Lord Bethell (Con)]

My Lords, the CMO has recently issued new guidance on the consumption of vitamin D and there has been widespread discussion about its dosage level. My understanding is that we are leaving the matter at that for the moment. I am not aware that the mandatory application of vitamin D to food is on the runway at the moment, but I am happy to check that point and write to the noble Baroness.

[Baroness Wheeler (Lab)]

My Lords, your Lordships’ House recently discussed the importance of medical research and government financial support for the fundraising and work of key charities on new brain tumour research treatments. With an estimated 3.5 million people aged over 50 currently affected by osteoporosis, many suffering chronic pain and disability, research on this is also vital. What resources does the NHS currently spend on osteoporosis research? Will the Minister undertake to consider the financial support, including match funding, that the Government can provide to the Royal Osteoporosis Society’s newly launched research academy and its potentially game-changing road map, which charts the key steps for researching a cure for this extremely debilitating disease?

[Lord Bethell (Con)]

My Lords, I do not have the figures for the precise amount that the Government spend on osteoporosis research at the moment, but I am happy to write to the noble Baroness with them if they are available. We are enormously grateful to the Royal Osteoporosis Society for its contribution to medical research. I can confirm that it has received a grant of £258,000 to support important work providing support for the vulnerable during the pandemic. That comes out of the package of £750 million that the Chancellor of the Exchequer announced to support the charity and voluntary sector during the Covid pandemic.

[Lord Brownlow of Shurlock Row (Con) [V]]

My Lords, I take this opportunity to congratulate my noble friend the Minister and thank him for his dedication at the Dispatch Box over the past 11 months. I declare my interest as a patron of the Royal Osteoporosis Society. Further to the comments of the noble Baroness, Lady Bull, is my noble friend aware that only 55% of the population in England have access to fracture liaison services, which have been shown to diagnose people with osteoporosis faster and move them on to treatment quicker? What plans do Her Majesty’s Government have to improve this and make access to fracture liaison services more available?

[Lord Bethell (Con)]

My Lords, the Royal Osteoporosis Society estimates that there are 95 fracture liaison services across England and Wales. While it is true that many cover more than one hospital, it should be remembered that they are non-specialist services and therefore CCGs are able to refer patients to fracture liaison services beyond their area. As I mentioned, we have a RightCare programme publishing case studies and pathways to encourage the greater rollout of best practice, but we are conscious that gaps remain and are working hard to close them as soon as possible.

[Baroness Stuart of Edgbaston (Non-Afl)]

My Lords, if the Minister were to go to Birmingham, he would find acclaimed fracture liaison services in the south, but in the north and east of the city they are not available, yet they are all part of the same clinical commissioning group. Will he encourage that group to ensure that there is equality of access across its geographical area and not to create a postcode lottery within it?

[Lord Bethell (Con)]

The noble Baroness alludes to a point slightly beyond the reach of the junior Minister in the department; we have a degree of federalisation, as she knows. However, I completely agree with and applaud the sentiment. We need more comprehensive coverage of fracture liaison services. We believe in the principle of 100% coverage, to which the noble Baroness, Lady Bull, alluded. I will look into whether we can do more in Birmingham to get a wider service.

[Baroness Massey of Darwen (Lab) [V]]

My Lords, the Royal Osteoporosis Society points out the enormous cost to the NHS of osteoporosis-related fractures and the distress of those who suffer. This implies that prevention should be improved. Will the Minister say how diagnostic services will be enhanced in relation to, for example, bone density scans and GP practices?

[Lord Bethell (Con)]

My Lords, we do a lot of work on prevention. Vitamin D is made available and we have fracture liaison services to look at those who present themselves with a fracture to diagnose osteoporosis. A vast amount is already done. I am sure that more could be done, but this is an elusive and difficult to diagnose condition, which relies on those who fear that their bone density may be low presenting themselves to their GP for diagnosis.

[Lord Addington (LD)]

My Lords, it is quite clear that preventive healthcare can assist here, through not only vitamin D but exercise patterns. Have the Government considered getting a comprehensive exercise plan for the over-50s that will encourage them to undertake activity that improves muscle mass and bone density, both of which protect against this?

[Lord Bethell (Con)]

My Lords, last year we launched a massive campaign, the Better Health campaign, to encourage healthier living with respect to both eating habits and fitness—I can report to the House that I have committed myself to that campaign and it is bearing some good fruit. We are spending hundreds of millions on marketing, we have engaged dieting services for those who wish to be involved in them, and we have mobilised a huge number of exercise regimes, including the park runs. These are bearing up well, but I encourage all those who wish to have a healthier life to do more.

[The Lord Speaker (Lord Fowler)]

My Lords, the time allowed for this Question has elapsed. We now come to the third Oral Question.

Covid-19: Over-75s

Lord Bethell Excerpts

Tuesday 9th February 2021 Lords Chamber

[Baroness Hodgson of Abinger]

To ask Her Majesty’s Government what assessment they have made of the impact of (1) the COVID-19 pandemic, and (2) the subsequent restrictions put in place to address the pandemic, on those aged over 75.

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

My Lords, it is a sad fact that this horrible virus targets over-75s more than any other group. We should all be proud of the country’s determination to protect the lives of the elderly and the infirm and give thanks for the vaccines that save so many lives. I assure my noble friend that the NHS has remained open to all and will catch up on the backlog for all those who need medical intervention, irrespective of age.

[Baroness Hodgson of Abinger (Con) [V]]

My Lords, we all recognise that the pandemic has had a particularly devastating impact on the elderly, with them not being able to see loved ones, isolation increasing dementia and high death rates in care homes. While I congratulate the Government on vaccinating all those in care homes, can the Minister kindly tell us when those housebound and receiving care will all be vaccinated? Will the Government consider adopting the successful Tubbe system being used in many Belgian care homes, whereby management and residents cojoin in decision-making, thus giving the residents more control of their daily lives and helping them to cope?

[Lord Bethell (Con)]

My Lords, we have now reached more than 80% of over-80 year-olds. Local vaccination services, of which there are more than 1,000 in England, co-ordinate the delivery of vaccinations to people who are unable to attend a vaccination site, including visiting homes, the personal homes of housebound individuals and other settings such as residential facilities for those with learning difficulties. The rollout of the vaccine to those at home is progressing at great pace and we are getting great feedback from the front line.

[Baroness Pitkeathley (Lab) [V]]

Is the Minister aware that many people over 75, notwithstanding their age, are providing care for family members—a spouse or an adult child with special needs, for example? Research by Carers UK shows that two-thirds of these older carers are providing more than 90 hours’ care a week, having had to take on more duties during the pandemic. One-third of them say that they are reaching breaking point and that their own health, physical and mental, has been severely affected. How will the Government ensure that sufficient support is available to these older carers, on whom so many depend?

[Lord Bethell (Con)]

My Lords, I pay tribute to all those elderly carers, who, as the noble Baroness quite rightly points out, provide a huge service to society, to their loved ones and to the community. We have put in place a tremendous amount of support for carers, including PPE support. We have changed the arrangements for domiciliary care so that we can restrict the spread of the virus, and we have changed the way in which domiciliary care is paid for. The noble Baroness is entirely right: we should not forget the considerable contribution made by a large number of unpaid carers, many of whom are themselves elderly.

[Lord O’Shaughnessy (Con) [V]]

My Lords, as well as the direct health impacts that the pandemic has brought on older people, there are the indirect effects of increasing loneliness and isolation, which can have a devastating impact too. As the country emerges from lockdown, will my noble friend ensure that the right support for mental health and other support is in place for this group, including better access to their families and loved ones through more flexibility in the use of support bubbles?

[Lord Bethell (Con)]

My Lords, my noble friend is entirely right about the massive mental health challenge and, if not the challenge to mental health, that of the isolation and loneliness felt by many who are shielding or isolated. Seven hundred and eighty thousand individuals over 70 are considered clinically extremely vulnerable. We have changed the terms of the shielding arrangements to give them more flexibility, and we have published the well-being and mental health support plan relating to Covid-19, which sets out steps to strengthen the support available for those who are struggling. But my noble friend is entirely right: we must do more to support and help voluntary organisations, which play a critical role, as do local authorities.

[Baroness Barker (LD)]

Another wave of Covid is hitting care homes at the moment. Therefore, there is an urgent need for hand-held rapid testing kits that deliver accurate and swift results. What investment is being made in biotech companies and care staff to develop a rapid testing system that works at scale?

[Lord Bethell (Con)]

My Lords, the innovation and partnerships team at NHS Test and Trace has an enormous programme on this. The lateral flow devices are a huge development but, as the noble Baroness undoubtedly knows, the sensitivity of a lateral flow device means that it is not necessarily appropriate for the user case that she described. We have invested in DnaNudge and other small point-of-care devices, but having a fast-turnaround device that can be rolled out in mass numbers is a challenge, and we continue to search for the ideal format.

[Baroness Pidding (Con) [V]]

My Lords, with the opening up of appointment slots for the fourth cohort, as announced by the Secretary of State last night, can the Minister assure all those in earlier cohorts that their second dose of the vaccine will be given in a timely manner within the 12-week timeframe, and how will this be managed?

[Lord Bethell (Con)]

I completely recognise the concern of my noble friend and of many in the Chamber on this point, so I shall provide concrete reassurance. Everyone will receive their second dose within 12 weeks of the first one. All those booked in at vaccination centres will have an appointment, made at the same time, to receive their second dose, and those who do not have a date today will receive one from their GP.

[Lord Laming (CB) [V]]

My Lords, the Minister will know that six out of 10 people with dementia live in their own home, so they depend on a range of care workers coming into their home—sad to say, often without PPE and some even without face masks. In contrast, those living in residential care have now gone almost a year without being allowed a visit from a loved one—they are not able even to hold their hand. Does the Minister agree that now is the time to set up a formal review in order for us to learn the lessons of the impact of Covid-19 on the over-75s suffering from dementia?

[Lord Bethell (Con)]

The noble Lord explains the situation of those who have been in care homes and separated from their loved ones extremely well. We all feel extremely heartbroken by the stories of people who have been separated from their loved ones, but we need to put the saving of life as the first priority. Visits have been allowed outdoors, behind screens and in safe environments. I appreciate that that is not the same as an intimate face-to-face meeting but, where we can, we have put in place guidelines to ensure that people are protected. A review of the guidelines will happen on 22 February, and that seems the right moment to review these procedures.

[Lord Bhatia (Non-Afl) [V]]

My Lords, can the Minister confirm that those over 75 years of age must receive the vaccine first?

[Lord Bethell (Con)]

My Lords, the priority list from the JCVI indicates that all residents in care homes, older adults and those over 80 will be first. But, with the current state of the rollout, all those over 65 should have been offered a vaccine, and I encourage them all to step up and respond to the letter when they receive it.

[Baroness Thornton (Lab)]

I would like to ask the noble Lord about domestic abuse. Next year, ONS data collection will, for the first time, include those aged over 75 who suffer from domestic abuse. That is an important step forward. However, the pandemic has meant that many older people at risk of domestic abuse are indeed isolated and at risk. So what steps are the Government taking to collect data on the impact of domestic abuse on over-75s during the pandemic and to ensure that appropriate support is in place for older victims and survivors?

[Lord Bethell (Con)]

My Lords, the noble Baroness makes the point extremely powerfully. Of course, our prevailing feeling is of admiration for all those who have, through love and companionship, cared for those who are shielding or at home. But of course, as the noble Baroness alludes to, there are instances when, through either domestic tension or simple abuse, there is violence, and we cannot hide from that fact. I am not aware of a current trial or piece of research on this matter but I will take it back to the department and undertake to write to the noble Baroness with an update.

[Lord Roberts of Llandudno (LD) [V]]

I declare a personal interest in this question. One thing that has really helped to keep elderly people informed has been broadcasts, which they have accessed through the free TV licence. I hope that the Minister will make sure that the free licence continues long after the pandemic is over.

[Lord Bethell (Con)]

My Lords, that is slightly beyond the reach of the Department of Health and Social Care, but I appreciate the noble Lord’s point.

[The Lord Speaker (Lord Fowler)]

My Lords, the time allowed for this Question has elapsed and we now come to the second Oral Question.

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) Regulations 2021

Lord Bethell Excerpts

Monday 8th February 2021 Grand Committee

Moved by

[Lord Bethell]

That the Grand Committee do consider the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) Regulations 2021.

Relevant document: 43rd Report from the Secondary Legislation Scrutiny Committee

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

My Lords, at the outset, I thank the massive cross-government and civic movement that has mobilised to fight the disease. It is not possible to name-check everyone, but I single out for thanks all those in the NHS, social care, volunteers, returned healthcare staff and the Army involved in the deployment of the vaccine. I thank scientists at universities and pharmaceutical companies and those running clinical trials for developing new vaccines, antivirals and all manner of therapies to combat the threat of mutant viruses. I thank all those in the Border Force, test and trace, the hospitality industry, Project Eagle and local authorities who have worked so hard in the last week to stand up new mechanisms for protecting the vaccine from variants of concern. Lastly, of course, I thank the general public for continuing to follow the lockdown rules. The attitude of the public remains resolute. I know there are exceptions, and I appreciate that there are huge sacrifices everywhere, but the actions everyone is taking now are doing a huge amount to protect your family and loved ones as well as the family and loved ones of others.

Our focus remains on the rollout of the vaccine, the development of a sure-fire system to battle any mutations, and an exit strategy from this awful pandemic. In the meantime, social restrictions are necessary while this occurs, so it is important that we bring forward this SI.

This SI makes a number of minor technical amendments to the all tiers regulations, which is necessary for legal coherency. It removes the provision for a linked Christmas household—the “Christmas bubble”—to prevent any scope for misinterpretation. It adds the Marriage (Same Sex Couples) Act 2013 to the list of Acts governing permitted marriages, civil partnerships and conversions, so that we treat everyone equally under these restrictions no matter their sexual orientation. It allows cafés and canteens in all post-16 education and training settings to remain open. It inserts an exemption from the closure of sports facilities in tier 3 to allow for elite sports competition, which essentially ensures that elite sports competitions such as the Premier League are permitted. It clarifies that the exception to leave home to collect goods from businesses operating click and collect also applies to libraries. We know that libraries have been a lifeline for many during the pandemic, providing educational and IT support to those who need it, and this amendment will ensure that this keeps happening.

These regulations came into force on 20 January 2021, and we regret that we are only now debating them. However, they were simply technical amendments to existing law. They do not change policy which noble Lords have previously approved.

I thought it would be helpful to provide a short update of the situation we are currently in and our understanding of its impact. The general public recognise the importance of following social distancing rules to control the virus and protect the NHS, which is why the vast majority of people continue to follow the rules. An example of this is limiting social contact. The most recent ONS survey shows that only one in seven respondents reported meeting with someone that they do not live with or are not in a support bubble with outdoors. Some of these people will have met one other person for the purpose of exercise, which is allowed by the regulations. For those people who do not comply, we have a strategy. Police officers will engage, explain and encourage, and for those people who simply refuse to comply, we do enforce. We continue to review the tools available to police to take action and have introduced a new penalty for attending a gathering of more than 15 people in a private dwelling or educational premises, or as a rave.

I am cautiously delighted to be able to inform noble Lords that, as a result of the restrictions put in place and the efforts of the nation to follow the rules, we are now seeing the first signs of improvement. There has been a positive impact in reducing transmission of the virus, and as the Chief Medical Officer stated last week, we have passed the peak of the second wave. I said I was only cautiously delighted because, despite this being a very positive development, we still have more to do. The virus is still prevalent, with approximately 21,000 people testing positive for Covid across the UK each day last week and significant pressure still placed on the NHS.

We also still have approximately 29,000 Covid patients in UK hospitals as of 4 February. That number has been decreasing since the peak on 18 January 2021, when there were more than 39,000 Covid patients in hospitals. That said, the number is still far too high, much higher than the previous peak of just under 22,000, and this sustained pressure is coinciding with the period of greatest seasonal pressure on the NHS. As we know, any new measures take some time to take effect on our hospital numbers, so it is right that we remain cautious and continue, for now, with the restrictions.

This is clearly a challenging and worrying time for everyone. However, there is more good news. There is early evidence that the number of people testing positive has started to fall across England. As reported in the minutes from the SAGE meeting on 14 January 2021, we have indications that new infections are declining in those areas which have been in tier 4 for the longest. This indicates that it is likely that R can be brought down significantly during the lockdown, even with the presence of the new variant. It shows that our approach is working and that we are taking the necessary action to keep us all safe.

We intend to publish our plan for taking the country out of lockdown on 22 February. That plan will, of course, depend on the continued success of our vaccination programme and on deaths falling at the pace we would expect, as more people are inoculated. Our aim will be to set out a gradual and phased approach, easing restrictions in a sustainable way and beginning with the most important principle of all: that reopening schools must be our national priority. If we continue to make the progress that we want to see, and believe we can see, we hope to be able to begin to return to face-to-face education on 8 March. We will set out more detail in due course and will ensure that we give at least two weeks’ notice to allow students, staff and parents to prepare.

I again pay tribute to the wonderful staff of our NHS and social care sector, who are working tirelessly to protect the vulnerable and save lives. I commend these regulations to the Committee.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I want to say a massive thank you to all noble Lords for their questions and, in particular, for the extremely kind and generous comments about the NHS, healthcare workers and all those who have contributed to our pandemic response. It is very rewarding to hear those remarks and I am sure that everyone involved is extremely grateful.

I will try to answer as many questions as I can. If I cannot answer now, I will endeavour to write to noble Lords. The noble Lord, Lord Winston, was right at the beginning of this debate to point out that pandemics last for a long time. We are profoundly conscious of that from the Black Death, Justinian’s plague, the Chinese plague and 1665. We are in it for the long haul and we hope that the remedies and protections we are putting in place today will help protect society for years to come. The noble Lord is entirely right that those worst affected disproportionately come from areas of deprivation, the elderly and the poor. That is very much on our mind.

The noble Lord, Lord Winston, asked about children. The green book is very clear about what vaccines are appropriate for children. We have endorsed the provision of vaccines for CEV children and are doing tests and clinical trials to see if the vaccine can be extended to children because, while not likely to be hospitalised, they are a source of transmission. He rightly raised antivirals. He and I have had correspondence on that subject. He also alluded to a key challenge in the administration of antivirals, which is portability. Access is a profound challenge in primary care for the delivery of antivirals, and that is one of the issues we have to resolve.

The noble Baroness, Lady Barker, asked about first aid training. If first aiders are unable to access annual refresher training face to face during coronavirus, HSE supports the use of online refresher training to keep skills up to date. If the noble Baroness has more questions about this important issue, I will be glad to answer them by correspondence. I reassure her, though, that when we publish the vaccination figures they are not vaccinations offered; they are vaccinations delivered. Some 549,078 were delivered on Saturday.

The noble Lord, Lord Blencathra, rightly raised the massive liberal dilemma of refuseniks. He alluded to the massive public health truism that my health affects not only me but the people I meet. I confirm that surgeons currently have validation for their vaccinations. A surgeon cannot perform surgery if he or she does not have, for instance, a hepatitis vaccination. That is, indeed, food for thought.

The noble Baroness, Lady Massey, asked about police data. We are looking forward to debating that issue on 1 March. On the very challenging question of social care, she asked quite reasonably about when we will be able to change the extremely distressing current regime for meeting those in social care. At the moment, meetings do happen outdoors and with protective measures, such as screens, but close contact is not allowed. This is not just to protect those involved but also to prevent the virus entering care homes, where it runs rife. We are seeking data on asymptomatic infection, transmission and the other relevant details from post-vaccination clinical trials. We will publish updated guidance after this period of national lockdown. More than anyone, I hope that this uncomfortable and challenging regime can be changed.

I completely hear the comments from the noble Baroness, Lady Thornton, on sport. She asked some very specific questions and I will be glad to write to her. In reply to my noble friend Lord Moynihan, I pay tribute to those in elite sports for raising our spirits. The Six Nations this weekend was great entertainment, even if the result was rather disappointing for England supporters. We are engaged with elite sport on the border issues, as he knows. We completely hear his arguments and we are trying our hardest to meet the hopes of elite sport. However, I say to him that we are in the hands of the variant and these matters are not completely in our control.

I reassure the noble Lord, Lord Scriven, that Parliament has a voice and that these debates on regulations do have an impact on the way that they are delivered. We are working within the framework of the laws we have and are doing our best to respect the influence of Parliament. He makes important points about the use of emergency legislation and I suggest that he addresses these comments to the Constitution Committee, which is doing a report on emergency legislation at the moment and would, I am sure, take his comments into account.

To my noble friend Lord Naseby, I am very glad, as I am sure we all are, to hear to hear of both his recovery and, in particular, that of Lady Naseby. I share his tribute to the NHS staff who have been delivering the vaccine. However, I well remember my noble friend’s comments. On six occasions last year, he made comments about cricket. I also remember, on 3 September, his profound scepticism about my comments that a second wave was on its way, so I gently and kindly remind him that we are not through this pandemic yet and I just cannot give him the reassurances on the reopening of cricket that I know he is looking for.

I completely share the frustration of the noble Lord, Lord Clark, and I agree wholeheartedly with his appeal for consistency. The bottom line is that the current guidance is that there should be no travel beyond the most local area—full stop. I completely understand his frustration about those travelling to his area.

My noble friend Lady Warsi’s comments are best directed to MHCLG, which provides guidance on wedding issues. The PM has made it clear that he will be issuing new guidance on 22 February, and the matters she asked about will be addressed in that. Although I hear the concerns of the wedding venue industry, I cannot make any promises on this today. The close proximity that weddings inevitably create does not suit pandemic management.

The noble Baroness, Lady Walmsley, is entirely right on Israel. Vaccinations are not a panacea. Social distancing remains essential, transmissibility after the vaccine is not clear cut, and therefore our message to the British public is to be patient and maintain the face, space and distance rules. She also asked about new genome sequencing. I reassure her that we are increasing our capacity for turnaround times and the amount of analysis that we provide. She is entirely right that about 5% of the positive PCR tests done today are genomically sequenced, so if a couple of cases of the South African variant are found today, you can expect there to be more tomorrow. But she is not right that central testing is more expensive than local testing; it is in fact much, much cheaper. Nor are we standing down resources: 783,851 tests were done yesterday—a phenomenal number. We continue to invest in local outbreak management: £925 million has been put in the contained outbreak management fund, supporting local testing.

I reassure the noble Baroness, Lady Tyler, that the CMO’s very strong view is that 12 weeks is a safe interval for the second dose of the Pfizer vaccine, and that an antibody test is therefore not needed.

I thank the noble Lord, Lord Mann, and the noble Baroness, Lady Thornton, who echoed his remarks, very much for his sincere comments on certification, which he made extremely persuasively. I reassure him that we are at a very early stage of the vaccine rollout at the moment. There are questions of fairness and justice when only a small proportion of the population have had access to the vaccine at all, but I take his points very much on board and will take them back to the department.

I reassure the noble Baroness, Lady Brinton, that the Project Eagle detective work and fire-blanket scheme is proceeding extremely well. It is too early to be able to give her categoric evidence of success, but the implementation is promising so far. She mentioned messaging and payment, and we have addressed those matters before. We have published an assessment of the tiering system, and I would be glad to email her a link to it. On her comments on test and trace, it would be generous and warm-hearted to say at least one word of praise to the management and the tens of thousands of people who work in test and trace for their phenomenal achievement over the past few months, turning around a massive enterprise that is having a huge impact on the virus.

In conclusion, I reiterate the sentiments of the noble Baroness, Lady Thornton, on the NHS. She is entirely right that this shows the NHS at its very best. The vaccination programme has been a phenomenal achievement, and I look forward very much to its successful deployment.

Motion agreed.

Covid-19 Update

Lord Bethell Excerpts

Thursday 4th February 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, we also express our condolences to the family of Captain Sir Tom Moore. He was an inspiration and an example to so many.

The health Statement reminds us that this is HIV testing week. HIV Prevention England rightly says that the message about early HIV testing must be well publicised. I pay tribute to our Lord Speaker for his key role as Health Secretary in the 1980s in managing urgent and uncompromising messages to the public about HIV and AIDS. This Government could learn much from those campaigns about communicating clear messages.

From these Benches, we also echo the excellent news that 10 million people in the first four priority groups have been vaccinated so far. Last week, I asked the Minister whether the vaccine dashboard could break down vaccine take-up below national level. I note that this Statement says that this is happening at local health and local authority level. However, there is still no breakdown between health and social care staff. On Tuesday, the United Kingdom Homecare Association reported that only 32% of its staff had been vaccinated so far. It said that invitation to vaccinate care staff was a local lottery, with some areas having excellent arrangements, but others not. Live-in carers face even harder access to vaccines, as they are often completely left off local vaccination lists.

Further, we know that some care staff have concerns about taking the vaccine, so dialogue is vital. Recently, there was an excellent radio interview with a GP from the north-east who explained how they had talked to staff who were worried about vaccinations at the care home where they worked. Those staff were reassured and were vaccinated. Too many social care staff are just referred to large vaccination hubs with no opportunity to discuss it with a known and trusted GP. Will the Minister ensure that GP surgeries can still have vaccine doses for everyone in groups 1-4, including social care staff, so that the barriers to vaccination are tackled and removed? Please can we see the NHS and care staff separated out on the vaccine dashboard?

This Statement also raises the emerging problems with the South African variant, with further restrictions in some postcodes. These, as well as the new changes to the UK variant discovered in Bristol and Liverpool, remind us that Covid-19 is still challenging us at every turn. I say well done to the local directors of public health and leaders of councils, working with their local NHS, on their excellent speed of response and the clarity of their local messages to people in the relevant postcodes.

I have a couple of questions for the Minister. First, Ministers have said that the new South African variant problems were discussed and planned for last Thursday. So why was there not an announcement before the weekend, ensuring that affected residents could protect themselves and their neighbours as soon as the risk was apparent? Secondly, the Statement says that everyone in these areas must have a PCR test—good. However, a letter sent from the NHS to hospital staff said that no staff were to go to work until they had had the results of a PCR test. Given that hospitals already have a large number of staff off sick or self-isolating, what help are they getting to deal with further staff absences?

The Minister will remember that I have urged the Government to include unpaid carers in the priority list in order to protect those they care for. The announcement of their inclusion in priority group 6 is welcome. However, they are not in the summary lists in the vaccines delivery plan. Will the Minister commit to clear up any confusion by explicitly including unpaid carers in government communications and by publishing specific guidance on making sure that they are vaccinated as part of group 6?

Finally, we look forward to hearing the Prime Minister speak on 22 February about the route map out of this third lockdown. Progress on vaccination is vital, but test, trace and isolate is also essential if we are to avoid a fourth national lockdown. We on these Benches believe that people who are self-isolating should be paid their wages and have access to a proper care package, as in Germany and Taiwan. We have been asking for this for 11 months. The failure of people to comply with self-isolation rules demonstrates that the current system is not working. Will the Government urgently review the arrangements for isolation and encouragement to comply?

Yesterday, Chris Whitty and the Prime Minister were clear that this third lockdown cannot be lifted until it is safe to do so. Yet already MPs and some Peers are pressuring the PM to open schools immediately. Strong, clear messaging is needed every day—as strong as on the AIDS campaign by the noble Lord, Lord Fowler, 30 years ago. We know from polling data that the vast majority of people want to do the right thing. The Government’s role is to tell us what and why and to provide support for those who need help to do it.

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

My Lords, I am enormously grateful to both the noble Baronesses for their thoughtful and provocative questions. I join the noble Baroness, Lady Thornton, in paying tribute to Captain Sir Tom Moore. His story touched on something we have talked about in this Chamber this year: the way in which someone, in their 99th year, can make a tremendous impact on the whole country, bringing us together and raising money for NHS staff. It was an amazing achievement so late in life. It demonstrates that every year of every life, however late in that life it is, is valuable. That is why this Government are extremely proud of the measures that we have put in place to protect the lives of, and avoid severe harm to, the elderly and infirm.

I also share in the noble Baroness’s tribute to NHS staff and the vaccination rollout. She is entirely right; there is huge mental and social attrition across the NHS at the moment. The hard work that goes on, particularly in intensive care, is having a tough impact on those who work there. We hear of the need for some form of respite for NHS staff, loud and clear, but I have to be candid: when we are done dealing with the hospitalisations for Covid, there will be a massive wall of work to manage the huge backlog and restart business as usual. We are looking at the human investment needed. I pay tribute to my colleague Helen Whately, the Minister who covers the NHS workforce. She speaks to the NHS and social care workforce daily. We are looking extremely carefully at the investment that will be needed to support healthcare staff in the difficult year ahead.

The noble Baroness, Lady Thornton, asked about those who refuse the vaccine. I am afraid that those statistics do not exist, because people do not identify themselves as vaccine refusers. However, the overall picture is extremely positive at the moment. Those in categories 1 to 4 are stepping forward for the vaccine in tremendous numbers, and we are extremely encouraged by that. I take on board the insight of Tim Spector and others who have spoken thoughtfully about the barriers. I pay tribute to civic and particularly religious groups, which have often put vaccination sites in their temples, synagogues, churches and other religious settings. That is exactly the kind of trusted civic engagement that has led to vaccine deployment reaching deeply into communities that might otherwise have been worried or suspicious.

The challenge that we will face will be when we turn our attention to the younger. To answer the other question from the noble Baroness, Lady Thornton, we will be rolling out the vaccine to all age groups. The very good news from AstraZeneca about the vaccine being an extremely effective agent against transmissibility is exactly what we need to know, because it gives a green light to using the vaccine to avoid not just severe illness, hospitalisation and death, but transmissibility. We have to get the message across to those whose lives are not necessarily saved by the vaccine—it saves someone else’s life—that taking it is important and something they should feel trusting about and obligated to do. That will be the second phase of the vaccine rollout, and we are thinking carefully about how to do it as effectively as possible.

The noble Baroness, Lady Thornton, alluded to staff vaccination. She is entirely right about the very high number of Covid deaths in homes at the moment, and I reassure her that vaccines have been offered to every person in every home. There is an email address, which I would be happy to share with all noble Lords, for anyone who thinks that they have not been offered the vaccine. There is an absolute backstop for anyone who thinks that they have been overlooked or have missed out. We are doing our level best with an effective deployment and rollout programme to ensure that all social care homes, whatever their status, and all staff in them are protected by the vaccine.

I will say a word about schools and teachers. I completely support the views of the noble Baroness, Lady Thornton, and many other Peers who have spoken thoughtfully and emotionally about the importance of getting schools back. The Government and I agree that this is our priority. I spoke to the Schools Minister, Nick Gibb, about this yesterday. I pay tribute to the work of the Department for Education in rolling out testing in schools. Either today or very soon, we will have had the millionth test in schools, which is a great tribute to the work that schools, teachers and the DfE have done on asymptomatic testing in schools. It is an important way to cut the chain of transmission and to protect all those in schools, from both the disease and being agents of transmission to those who are more vulnerable. I support all the measures on social distancing, PPE and testing that we can put in place to keep schools open.

When it comes to vaccinating teachers, I emphasise that saving lives and avoiding severe harm is the priority for the vaccination programme. While we are sympathetic to teachers and will definitely have them on the prioritisation list, the protection from harm and death is our current priority.

We take the news on mutations from South Africa, Brazil, California, Kent and Bristol, and all the other manifestations of mutations, extremely seriously. The noble Baroness, Lady Harding, spoke about not expecting a mutation, but of course it was not the virus mutating that was not expected—that is commonplace. The CMO spoke about that impactfully and early, in February and March; he utterly predicted that mutations would lead to a second wave. But the virus had not mutated much last year. In fact, it was a phenomenally rigid and consistent virus for a long time. What was not easy to predict was that a highly transmissible disease would emerge that completely outperforms its previous classic manifestation. We saw that only when the infection rates started to climb extremely quickly. We changed our tack accordingly, and we continue to change our tack.

As I have said from the Dispatch Box previously, we are in a different game now. Previously, the focus was on keeping a lid on infection rates and getting the prevalence levels low. That remains an important feature of our battle against Covid. On the other hand, we have to protect the vaccine. We are aware of the potential for a mutation to emerge that escapes the vaccine. That has been seen in other diseases and could be seen in this disease. That is why we have mobilised Operation Eagle to track down the South African variants that have landed in the UK, where we do not have a clear chain of transmission. That is why we are going door to door, offering PCR testing to all those—around 10,000 people—in each of the relevant postcodes, to put a lid on any community transmission. That is why we have deployed a special team, tracing variants of concern, which is tracking down the origins of each infection to stamp out and suppress variants of concern, where they emerge.

This is exactly the kind of capability that we need to put in place should a highly transmissible vaccine-escaping variant manifest itself. I pay tribute to those in test and trace who have put together this capability extremely quickly and are implementing it so thoroughly.

Both the noble Baronesses, Lady Thornton and Lady Brinton, alluded to the important issue of isolating. I hear those points loud and clear. We support those who are isolating, and make a £500 payment to those on benefits, who need it. Charities and local authorities support those who isolate. But I hear the point made about additional measures, and we are looking at further ways to support those who are required to isolate, either because they are infected themselves or because they are the contact of someone who is infected.

The noble Baroness, Lady Brinton, spoke thoughtfully and movingly about the role of the Lord Speaker in fighting HIV and AIDS, and I join her in paying tribute to the Lord Speaker, whose 83rd birthday was earlier this week. The messaging in that campaign was poignant, it cut through and we all remember it very well.

I also pay tribute to those in the communications team who have, during the last year, put through some incredibly impactful campaigning around the Covid messages. There has been massive societal behavioural change because of the clarity and the impact of the campaigns that we have done. Those campaigns have got better and better, and the most recent “look into my eyes” campaign, as it is now called, is one of the most impactful. When we look back on this campaign, we will think very highly of the marketing and communication skills of those in the Department of Health, the Cabinet Office and other departments, who have worked so hard in this area.

The noble Baroness, Lady Brinton, alluded to the vaccination of social care staff. She is absolutely right to allude to lists. One of the current difficulties is that we do not have proper lists of all those who work in various roles in social care, either as domiciliary staff or in unpaid roles. My colleagues are looking at this, and we are moving quickly to address it. I know that the noble Baroness feels very strongly about the vaccine dashboard; I have taken it back to the department and spoken to the vaccine team about it and I will raise the matter with them again. Regarding the unpaid carers and the delivery plan, I will take that to the department again. I will be happy to write to the noble Baroness.

[The Deputy Speaker (Lord Russell of Liverpool) (CB)]

We now come to the 30 minutes allocated for Back-Bench questions. I ask that questions and answers be brief, so that I can call the maximum number of speakers.

[Lord Patel (CB) [V]]

My Lords, science has got us this far and will get us through in the long run. In that context, the recent report from the British Society for Immunology stresses the importance of knowing the efficacy of Covid-19 vaccines across all age groups and the need for immune monitoring across the vaccinated population. With the great news of over 10 million people having been vaccinated, we must know the nature and length of time of immunity that each vaccine delivers. The UK is in the best position to obtain this information that will help to plan future vaccination programmes, but we must start nationwide post-vaccination immune monitoring now. Will the Minister consider meeting the president of the society, Professor Arne Akbar, to explore this further?

[Lord Bethell (Con)]

My Lords, the noble Lord alludes with characteristic insight to one of the great frustrations and mysteries of Covid. It seems to me, a lay person and a neophyte in this area, that understanding the body’s immune response to something as simple as a virus such as Covid should be straightforward, but it is one of the unlocked mysteries of Covid. We are working extremely hard to unlock the mystery of it all. We have invested a huge amount in immunology and the detection of antibodies in the British public. I pay tribute to the UK Biobank study, a massive survey which has been going on for six months. It has found that 8.8% of the UK population had been infected by December 2020; 40% of them did not have a single classic symptom of Covid, and a quarter of those with antibodies were completely asymptomatic. We are doing other assessments as well—through the ONS, REACT, blood donors, the RCGP and others—and I would be very pleased to meet Professor Akbar to discuss this work further.

[Lord O’Shaughnessy (Con) [V]]

My Lords, in asking my noble friend the Minister about schools, I declare my interests as set out in the register. Last week, Public Health England confirmed that the health risks to and from the primary school population were very low, and that teachers are not at greater risk than the rest of the population of getting Covid or suffering its consequences. Other countries with similar case rates, such as the Netherlands, are planning to reopen their primary schools next week. Does the Minister agree that the toll of school closures is particularly acute on younger children and their parents, because those children often are unable to work independently, while the health benefits of these closures are minimal? Should the primary schools not be the very first institutions to open on 8 March?

[Lord Bethell (Con)]

My noble friend hits the nail on the head. Nothing could be a greater priority to the Government than the opening of all schools, and primary schools are at the top of the list. I pay tribute to all those parents and, if I may be so bold, particularly the mums, who have taken on the bulk of the work in dealing with young children at home while juggling other commitments to care and work. This is one aspect of one of the greatest emotional tolls on the British public. My noble friend is entirely right that the opening of schools is a massive priority. It hits hard those communities that depend on schools for care, and those that do not have the resources for at-home teaching. I completely agree with his assessment and assure him that it is a primary priority of the Government.

[Lord Winston (Lab) [V]]

My Lords, the Minister also hits the nail on the head when he talks about a highly infectious new variant that is resistant to the vaccine. As he knows, the scientists have been pointing out that we will be living with this virus for a very long time, and other viruses like it will emerge in due course. I refer to an answer he gave me last week when I asked about antivirals. There are a number of antivirals in development at the moment in this country that look very promising, an interferon beta-based compound by Synairgen and ACTIV-2, which could be used for ambulant patients in the early stages of the disease. If we got people as soon as they had symptoms and tested positive, we could do a great deal of good and reduce the risk of mutation in the population. Have the Government any plans to do what they did excellently with vaccines: pre-order antivirals as they come through phase 3?

[Lord Bethell (Con)]

The noble Lord is entirely right to raise this issue. There is the awful possibility that the mutant vaccine escape virus could get around the vaccine altogether. We need a plan B, which might be dependent on antivirals as an alternative way of managing the disease. That is what happened with HIV, as we discussed last week. The therapeutic taskforce is looking at antivirals and putting together a plan to upscale our investment in that area. I am aware of Synairgen and ACTIV-2, but he is entirely right that this should now be a greater priority. I will take the matter back for the department to look into further.

[Lord Scriven (LD) [V]]

My Lords, virologists tell us that, even with vaccines, we will be living with Covid for years to come. The Statement says:

“Our mission must be to stop its spread altogether and break those chains of transmission.”


To ensure that this happens, what changes have been made during this lockdown to improve the outcomes of the £22 billion test, trace and isolate system, for when the restrictions are eased?

[Lord Bethell (Con)]

My Lords, I pay immense tribute to the test and trace system, which, at 11 am, published remarkable performance figures, as the noble Lord probably knows; 92% of tests were turned around before the next day, and 86% of contacts were traced. This is an incredible performance. On his specific point, the creation of a variant-of-concern tracing group that is targeted at those rare appearances of VOCs in the community is the important development that we have put in place in reaction to the mutant variants. I pay tribute to Steve McManus, who is running that programme, for the impact that he has already made on the problem.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, with the emergence of new variants, questions over vaccine-induced antibody response to these and the risk of children as asymptomatic carriers, will the Government ensure that schools’ policies are flexible, adapted to each child’s needs, so that children shielding a very sick parent or sibling at home will be able to continue with home schooling and not be forced back through punitive threats on parents; while children needing the security of school can continue to access school as at present and when the majority have the benefit of being able to return?

[Lord Bethell (Con)]

I reassure the noble Baroness that we are absolutely putting the arrangements for pupils in the hands of schools themselves, because they know best how to look after their pupils and their teachers. The role of test and trace is to provide testing facilities and the resources to make schools safe, but it is up to the Department for Education, the local authorities and the schools themselves to protect those who need special arrangements, either because they are shielding or because they have other needs.

[Lord Cormack (Con) [V]]

My Lords, I am sure that my noble friend will agree that everything possible must be done to ensure that this is the last national lockdown. To that end, is it not important that all information on vaccines, however sensitive it may be, is shared with Opposition leaders, if necessary, on Privy Council terms? Would it not help to avoid confrontations inside and outside the Chamber of the other place if the Prime Minister and the leader of the Opposition were to have a scheduled weekly meeting?

[Lord Bethell (Con)]

My Lords, they do have a scheduled weekly meeting: it is called PMQs. It is up to either side to decide how well it goes. To reassure my noble friend, we publish absolutely everything on the vaccine. We even publish the formula of the vaccine itself. The data is shared with local authorities—it is out there on the internet—and we could not be more transparent if we tried. We have worked very closely with the Information Commissioner; we have a massive data analytical team; and we are as open as we possibly can be because we believe that trust in the vaccine is absolutely essential to uptake, and therefore it is in our interests to take an open and transparent approach.

[Baroness Andrews (Lab) [V]]

My Lords, the Minister said, quite rightly, that the priority for the vaccine is saving lives. Adults with learning difficulties have death rates comparable to those of the over-80s. Given the success of the vaccine rollout, is there any flexibility now for prioritising highly vulnerable groups, particularly when we know that the variants have to be controlled with extra vigilance?

[Lord Bethell (Con)]

My Lords, the noble Baroness is right, and I am grateful to her for giving me sight of her question in advance. Her point is completely valid and I support her interest in this. The JCVI has made it plain what the initial rollout of priority groups 1 to 4 will be, but there is a mechanism whereby it reviews and reassesses the rollout of further priority groups. That will be the moment when it can look at the kind of questions she raises about groups, such as those with learning difficulties, who have a high rate of mortality. I can reassure her that it is conducting a rolling review of the rollout of the vaccination and will take these matters into account.

[The Deputy Speaker (Lord Russell of Liverpool) (CB)]

Since the noble Baroness, Lady Jolly, has withdrawn her name, I call the noble Baroness, Lady Watkins of Tavistock.

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

My Lords, I ask the Minister about British citizens working overseas. I declare an interest in that my son is in this category. We have done such a fantastic job here on the vaccines to date, but there are many British citizens working abroad in a volunteer, business or diplomatic role. They recognise the need for quarantine and the need for vaccinations to enable them to work between their UK base and their overseas commitments. How best can the Government include those UK citizens in our vaccination programme—clearly, not giving them priority but to ensure that we protect their health, as well as that of people living in Britain at the moment?

[Lord Bethell (Con)]

My Lords, the Government take very seriously their commitments and obligations to those British citizens who live overseas. It is a matter of considerable concern that they be included in the vaccination deployment. However, there are certain practical challenges with this, so we invite those who want the vaccination to return to British shores so that they can be part of the vaccination process, and to ensure that they are registered with their GPs so that they are included in the list. The Prime Minister has made it very clear that we are putting border measures in place that will ensure that we are protected against mutations and variants. Once again, therefore, I invite all those living overseas who want the vaccination to ensure that they have thought-through arrangements in place to return to this country to get their vaccinations.

[Lord Sheikh (Con) [V]]

My Lords, there is evidence of hesitancy to take Covid-19 vaccinations, particularly among some minority communities. I am involved in a national campaign that is actively encouraging everyone to take the vaccine. I raised this point in your Lordships’ House on 13 January, and my noble friend Lord Callanan arranged for us to meet virtually with senior officials from the Vaccine Taskforce. We have had two productive meetings with officials and are moving forward in a satisfactory manner. We received support from Nadhim Zahawi’s office as well as support and participation from a number of other Members from both Houses. Kawsar Zaman, who is a young, bright barrister, is undertaking the bulk of the work on our side. I thank everyone who is rendering this support and assistance, including my noble friend Lord Bethell. I hope that if we all work together, we can achieve the right results in the country. Does my noble friend agree?

[Lord Bethell (Con)]

My Lords, I pay tribute to my noble friend for his work in this matter. I am extremely pleased to hear that the meetings with officials have gone well. I pay tribute to all those parliamentarians in this House and the other place for their spirit of collaboration and for the unity with which those with an ethnic background, in particular, have worked together to champion the message around the vaccine. It is only through example and trusted influencers that we can get our message across. It has been one of the really refreshing and uplifting moments of this awful disease to see the kind of cross-party collaboration that we have in this matter. I am extremely grateful to my noble friend and all his colleagues for the work they are doing in the community to get our message across.

[Lord Dubs (Lab) [V]]

My Lords, I am sure that the Minister will be aware that domiciliary care workers are very vulnerable. They toddle around from person to person, they visit people’s homes, and the people whom they support are also vulnerable. Will the Minister ensure that domiciliary care workers are given the maximum protection, whether through vaccines or through other protective measures?

Secondly—I could not give the Minister notice of this because I only got the details a few minutes before we started—refugees are being held at the Napier Barracks in Folkstone. I am told that there are people there with Covid who are sleeping in the same dormitories as refugees who do not have Covid. There is very little medical support. Will the Minister, as a matter of urgency, have a look at this and see what can be done?

[Lord Bethell (Con)]

My Lords, we have done an enormous amount for those who have been working in domiciliary care. The noble Lord is entirely right to shine a spotlight on those who play such an important role in the community, caring for the elderly and the infirm. The amount of itinerant travel, where these workers move from one person to another, has been dramatically reduced—partly to reduce the fear of infection. PPE has been used and we are putting testing in place for those working in domiciliary care. I am extremely pleased to report that this has had a huge impact on infection rates, and we will ensure that they are prioritised in the vaccine rollout accordingly.

I did not get the full details of the particular issue raised by the noble Lord in his second question, but if he would be kind enough to send me an email, I would be glad to look into it as he requested.

[Lord Walney (Non-Afl)]

My Lords, further to the question from the noble Lord, Lord Winston, on antivirals, I raise the issue of monoclonal antibody production. The work of the Government in establishing an enduring manufacturing capability and rollout capacity for vaccines is deeply impressive. Why, then, do they appear to be stepping back from the push to rapidly manufacture antibodies, which was a core part of Kate Bingham’s Covid strategy?

[Lord Bethell (Con)]

My Lords, I am not sure whether we are completely stepping back from the production of monoclonal antibodies. I am extremely grateful to the noble Lord for the briefing that he shared with me last month and for the opportunities to look at how we can onshore the manufacturing of monoclonal antibodies. He is entirely right: this is a critical area of life science production where Great Britain is frustratingly massively behind. In the resilience of our healthcare supply chains, we have a huge gap in this country, and it is one that we are keen to address. The Therapeutics Taskforce is looking at monoclonal antibodies as a way of supporting our response to Covid and we have, through Project Defend, a workstream to look at how we can encourage onshore manufacturing of these essential healthcare supplies.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, recent laboratory tests by scientists at Cambridge University show that one dose of the Pfizer vaccine may not produce sufficient antibodies to kill off the virus, particularly for the over-80s, leaving them at risk of catching the South African variant. Will the Minister say what assessment the Government have made of these findings and what plans they have to speed up the second dose of the Pfizer vaccine for the over-80s and all care home residents?

[Lord Bethell (Con)]

My Lords, I am grateful for the reminder from the noble Baroness. The analysis we have done of the Pfizer vaccine, and indeed of all vaccines, is extremely encouraging and the impact it has on the body’s antibody production rate is profound. In fact, for many vaccines it might be that a longer delay, of 12 weeks, to the second dose might have an improved impact on the body. The second dose is really important for longevity rather than for efficacy, and therefore, with the data we have at the moment, we do not have any plans to change the pace of the rollout, but we are making sure in absolute terms that the second dose is delivered to all those who have had a first dose, promptly and on time.

[Baroness Hollins (CB) [V]]

My Lords, the Minister repeated the statement earlier that said that all care home residents and staff have been offered vaccination, but this is not true for homes for people with learning disabilities. I was pleased to hear in the Minister’s reply to the noble Baroness, Lady Andrews, that the JCVI is still considering priorities for groups 5 and 6. Is the Minister aware that 80% of the deaths of people with learning disabilities in England were Covid-19 related in the week ending 22 January, compared with 45% of the general population? Does he anticipate that all people with learning disabilities will be included in group 5 or 6?

[Lord Bethell (Con)]

My Lords, I have taken the noble Baroness’s insight on this to the department where it is being plugged into the Vaccine Taskforce and the JCVI. Her championship of this cause is to be lauded. The statistic she just cited is heart-rending, and I will definitely return to the department this afternoon and follow up, to ensure that it is being taken seriously.

[Lord Haselhurst (Con) [V]]

My Lords, such has been the success of the vaccine rollout campaign that it seems that, by Easter, many millions of people will be due their second dose. Can my noble friend indicate how supplies will be allocated between them and the many millions of other people, often in public-facing jobs, who might still be awaiting their first?

[Lord Bethell (Con)]

My noble friend makes a key point on the dilemma we face. Do we prioritise the second dose or do we try to get the first dose to those who need it? Our policy is crystal clear: the second dose at 12 weeks will be delivered. Everyone who has had a first dose should get a letter or a contact in their 10th week and an appointment in the 11th week. That is our commitment, and we believe we have the supplies to see that through.

[Lord Liddle (Lab) [V]]

My Lords, I would like to pick up on the point made by my noble friend Lady Thornton about what is being done about refusal of the vaccine. I was rather alarmed by the Minister’s reply that there are no statistics on this. I accept that the Government have shown great transparency on vaccines, but the fact that there are no statistics on refusals is a worry. Do the Government think that more could be done by local authorities responsible for domiciliary care and care homes in their area to check on this? Could they be more active in trying to identify ethnic minorities on their lists who have not been vaccinated, so that something could be done?

[Lord Bethell (Con)]

I am afraid to say that the noble Lord’s point makes no sense to me whatever. We are not going to go around the country asking people whether they refused to take the vaccine. We have a dialogue with the whole country, and we wait patiently for people to step forward. I cannot give statistics on people who have refused because it would make no sense at all to ask people whether they are in that category.

[Baroness Bull (CB)]

My Lords, can the Minister tell the House what assessment the Government have made of the risks presented by aerosols, which, unlike droplets, are small enough to remain suspended in the air for hours and which expose individuals at distances beyond 2 metres? New evidence is emerging all the time, the latest just this week from the University of Bristol. Does he agree that we need a clearer position and stronger messaging on the risk of aerosol transmission indoors and the importance of ventilation, particularly as the vaccination programme rolls out, which will inevitably lead to calls to release restrictions and to reduce the 2-metre rule? We may need to add a fourth word, “ventilate”, to the mantra “hands, face, space”.

[Lord Bethell (Con)]

The noble Baroness is entirely right that understanding of the role of aerosols is growing. Frankly, I find it quite terrifying. She is right that we need to look particularly at the way our office spaces are ventilated. The statistics I have seen on the potential cost of rebooting the ventilation of the UK’s workspaces in order to make them Covid-friendly are that it would cost tens of billions of pounds. Our focus is therefore on vaccine deployment, but work is going on to reimagine and envisage how workspaces could be made safer, not just for this pandemic but for the future. I can imagine a world where ventilation is given greater hygienic priority in future.

[Lord Dobbs (Con) [V]]

My Lords, I was rather alarmed at my noble friend describing himself as a neophyte. He rather strikes me as being a battle-hardened veteran by this stage. I shall ask him about convalescent plasma. We had high hopes of it a year ago, yet the recovery trial at Nuffield College has now been ended and the BMJ has concluded that there is no convincing evidence of its effectiveness. And yet the NHS website is still seeking volunteers, and just this morning I heard a radio advertisement pleading for more volunteers to come forward. Will he clear up the apparent confusion there? Is it still a possibility that this might be something we are pursuing, or has it been put to one side?

[Lord Bethell (Con)]

My noble friend is right. The story of convalescent plasma is heartbreaking. I had extremely high hopes that it would be a rather wonderful way in which those who had been hit hard by Covid could be agents in the recovery of those who were newly in hospital. Convalescent plasma has a very successful record throughout history of being a source of therapeutic help, but the science is the science and we have to be respectful of the clinical trials, however heartbreaking the news is. We have massively downgraded our expectations. There is hope that convalescent plasma could be used in primary care in a very early intervention, but there are problems with the delivery of that medicine and primary care is not in great shape at the moment to be plugging blood into people just because they show some symptoms of Covid. We are continuing our collection until the last clinical trials in primary care are finalised, but I am afraid to say that our expectations in that area are much less than they were a few weeks ago.

[Baroness Massey of Darwen (Lab) [V]]

My Lords, the Joint Committee on Human Rights has expressed concern about the lack of clarity in the rules for visiting care homes and the impact on the right to family life. Who must be vaccinated in a care home before relatives can visit? Is it all residents and all staff? If so, does that not seem unrealistic?

[Lord Bethell (Con)]

My Lords, I have huge sympathy with those looking at the human rights of those who cannot visit care homes. We have taken a huge hit to our civil liberties in our fight against this pandemic; no one can be under any illusion about that. However, I must say that the noble Baroness is wrong to hope that the vaccination gives any short-term hope that this will be changed. At the moment we are still living in a world where not enough people are vaccinated in order to stop the transmission through society, and where the rules on the transmissibility of the disease by those who are vaccinated have not been fully clarified. Therefore, even those who have been vaccinated should be staying at home.

[Lord Craig of Radley (CB) [V]]

My Lords, the Secretary of State rightly led his Statement with praise, mentioning the NHS and the many who have contributed to the successful jab results so far. However, he did not happen to mention the contribution made by members of the Armed Forces. Can the Minister say how many service men and women have been tasked with supporting this programme, and will the Treasury require the normal interdepartmental contribution to the defence budget to meet these military aid efforts?

[Lord Bethell (Con)]

My Lords, I do not have the precise figures that the noble Lord asks for at my fingertips. All I know is that the armed services have performed an enormously important role in the deployment of the vaccine. Their logistical expertise and hands-on implementation of the jabs themselves have been invaluable. But, without making too much of it, this really has been an NHS-led achievement. It has been the NHS at its best, and I pay tribute to those in social care and on the front line of the NHS who have led this remarkable deployment.

Hotel Quarantine for Travellers

Lord Bethell Excerpts

Wednesday 3rd February 2021 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what plans they have to implement a mandatory hotel quarantine for all travellers arriving in the United Kingdom.

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

My Lords, these new measures at the border are a necessary step to protect the public and our world-class vaccination programme. Every layer of protection we have put in place will help reduce the risk of transmission of the virus and prevent any potential new strain entering the UK. All measures will be kept under review and, if required, further action will be taken to add another layer of protection against transmission.

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, given the good news on vaccines, should we not be ever more vigilant on our borders? The 22 December meeting of SAGE identified the rapid spread of a variant in South Africa, and the NERVTAG meeting of 13 January warned of the rapid growth of variant B1351 in South Africa and called for enhanced border measures. Since then, how many people have entered the UK from South Africa? Why, as Yvette Cooper said yesterday, is it still possible for people to return home to the UK from South Africa and go straight into the community with no tests on arrival, no quarantine hotels and no quarantine taxis? Scotland has announced extensive new quarantine rules today. When will the Government get a grip and bring in the much tougher quarantine measures they should have introduced weeks ago?

[Lord Bethell (Con)]

My Lords, I entirely agree with the noble Lord. He is right that additional vigilance is required. The advent of new variants that could have higher transmissibility or escape the vaccine is a complete game-changer, and that is why we have changed our approach to border management. We have upgraded our border control measures, and there will be further government announcements on that. We have introduced red lists of countries where there are variants of concern, and we have implemented Project Eagle, the tracing project to track down those who have tested positive in genomic sequencing for variants of concern.

[Baroness Jolly (LD) [V]]

My Lords, the Minister will be aware that Australia is imposing a two-week quarantine for all travellers flying in from abroad, with no exceptions. My son, who has dual nationality, is flying out in March to take up a job. He must have a negative Covid test result before flying and stay in a hotel for two weeks at his own expense. Australia has shown the way; when does the Minister expect the UK to follow?

[Lord Bethell (Con)]

The noble Baroness is completely right to cite Australia, and we take our hat off to its remarkable achievement in using its island status to protect itself against the virus. We are responding to the challenge of new variants by upgrading our measures, and announcements on this will be made shortly. The CMO’s view on the variants of concern so far is that we should have a proportionate system, which means an upgrading and not necessarily an Australia-style system. But we are putting in place the kinds of measures that could be upgraded to an Australia-style system were there to be a threat of significant magnitude.

[Lord Lancaster of Kimbolton (Con)]

My Lords, yesterday, the UK recorded 16,840 new Covid cases. Australia and New Zealand recorded six and one respectively. Of course, we should not be encouraging people to travel to the UK, but some people have no choice—for family reasons, for example. I encourage my noble friend, before we adopt a blanket approach to hotel quarantine, which may be appropriate for high-risk countries, to think about the cost. Can he reassure me that the Government are more than capable of adopting a dynamic, risk-based approach to hotel quarantine?

[Lord Bethell (Con)]

My noble friend is right that we have to be proportionate and balance risk. I flag that we are aware of the extreme measures some passengers go to in order to avoid boundary controls. Some people go to extraordinary lengths to undertake journeys that, frankly, are dangerous and irresponsible. I would normally consider travel a right of enormous value which I would fight for individuals to have. But in a pandemic, it is different. In a pandemic, travelling is dangerous. You may be taking a variant of significant danger to the country of your destination, and it cannot be regarded as something done easily and lightly, as in normal times.

[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

The next speaker is the noble Baroness, Lady Masham of Ilton. Is the noble Baroness with us? We will come back to the noble Baroness. Let us go to the noble Lord, Lord Clark of Windermere.

[Lord Clark of Windermere (Lab) [V]]

My Lords, the Minister said that he believed there was a basic right to travel. I put it to him that there is an even greater right to live, yet we have the highest death rate per head of the population of any country in the world. Should we not put the right to live at the top of our agenda?

[Lord Bethell (Con)]

I could not agree with the noble Lord more: the right to live trumps all other rights. It is a sad fact that, while we would normally do everything we could in a liberal democracy to protect rights such as the freedom to travel, under current circumstances these are trumped by the right to live, and that is why I call on all people to limit their travel wherever they humanly can. There is simply no excuse for going to Dubai, taking Instagram photographs of yourself and claiming that that is business travel. You are putting your friends and loved ones at risk, and this Government will not tolerate it.

[Lord Taylor of Goss Moor (LD) [V]]

My Lords, given the significant community transmission of the South African variant, how confident is the Minister that we have in place today sufficient measures to stop the equivalent happening again? It does appear the Government are again running behind events.

[Lord Bethell (Con)]

My Lords, matters are evenly balanced. There are 143 confirmed and probable cases of the variant first identified in South Africa. Most of those have been connected with travel to South Africa, and those involved have been isolated. There are around a dozen in respect of which the chain of transmission is not fully understood. We have put in place a substantial team of dedicated tracing professionals to track down those variants of concern, along with teams in the relevant postcodes, so we are doing both a fire blanket of testing within the community and forensic detective analysis to track down the chain of transmission. It is my belief that that will be enough to keep the spread of the virus under control in this country, but we are watchful and concerned.

[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

We will return to the noble Baroness, Lady Masham, after the next speaker, who is the noble Lord, Lord Vaizey of Didcot.

[Lord Vaizey of Didcot (Con) [V]]

My Lords, it may seem paradoxical to impose tough restrictions just when a version of the winning post is in sight, thanks to the Minister and his colleagues’ excellent vaccine rollout. It may give us some comfort if he could update us on how effective his experts think the vaccines will be against the new variants.

[Lord Bethell (Con)]

My Lords, the good news to date has been that the vaccines have proved extremely robust. Certainly, the readout on the Kent domestic variant and its mutations are extremely positive. A huge amount of work is going on to understand the Brazil and South Africa variants; it seems that the latter does something to escape the vaccine, but not enough for the vaccine not to be extremely useful. The news to date is encouraging but we are extremely watchful. If a variant or mutation emerges that can escape the vaccine, we will do everything we can to protect that essential national project.

[Baroness Masham of Ilton (CB) [V]]

My Lords, I hope you can hear me—I was frozen. After quarantining in a hotel for five days or more and having had a test which proved negative, would a person be released? If a person had to return to the UK because they needed urgent medical treatment, would they be admitted directly to a safe hospital?

[Lord Bethell (Con)]

My Lords, the details of the isolation protocols have not been announced yet. However, I suggest that the amount of time needed to flush out those who have got an infection from travel may need to be longer than the five days the noble Baroness indicated. For those who have urgent need of hospitalisation, of course the NHS is there for them; we have the PHE and infection control protocols in place to protect them.

[Lord Green of Deddington (CB) [V]]

My Lords, can the Minister assure the House that any system introduced will be resilient enough to cope with a significant inflow from Hong Kong, if that were to occur? As he will know, the Government have just granted the right of entry—and, later, settlement—to up to 5.4 million from Hong Kong, roughly the entire population of Scotland.

[Lord Bethell (Con)]

My Lords, I share the noble Lord’s pride in that measure and concern that we extend a warm hand of friendship to those from Hong Kong. He raises the point extremely well. I would like to think that any system we put in place would be resilient to surge demand of the kind he indicates, but I will take his point back to the department and check that everything is being done accordingly.

[Baroness Wheeler (Lab) [V]]

My Lords, UK borders have knowingly been left open and potentially exposed people to new strains of the virus, rather than the implementation of the prompt, concerted action advised by SAGE and a comprehensive hotel quarantine system brought in for all UK arrivals. Does the Minister accept that the current 10-day self-isolation system has failed? If so, why is the policy still being pursued for the majority of travellers? We have been promised that hotel quarantine will be implemented for some countries as soon as possible, with some reports suggesting that this will not be enforced until the week of 15 February. Can the Minister confirm whether this is the target date? Will additional measures be in place for travellers from the red list of countries in the interim? Finally, does he accept that a partial quarantine is doomed to fail, given that global travellers may move across many countries during their journey, passing through multiple travel hubs and departure lounges while encountering and spending time close to many other travellers along the way?

[Lord Bethell (Con)]

My Lords, I acknowledge the detailed and perfectly reasonable questions raised by the noble Baroness, but I am unable to answer them all in detail. A Statement will be forthcoming from the Government on exactly those questions. I remind her that travel has come down by 90% in a comparative period. She is entirely right that travel patterns are complex; any measures we put in place will recognise that many travellers leapfrog from one country to another, brushing against others, and that the spread of the virus cannot be narrowly contained to travel corridors in the way one would sometimes like to hope.

[Lord Sarfraz (Con) [V]]

My Lords, can my noble friend say whether we will try to monitor the physical and mental health and well-being of those in hotel quarantine, including vulnerable travellers, travellers with disabilities and those with small children?

[Lord Bethell (Con)]

The noble Lord is entirely right to be concerned about those who travel for essential reasons but who may face some hardship through their journey. We are putting in place special arrangements to ensure they are looked after in the best way possible. However, I remind him and the House that the purpose of these measures is to reduce dramatically the amount of travel. Travel is no longer a right; it is a danger, and as a result everyone needs to think very seriously before they commit to a journey.

[Lord Loomba (CB) [V]]

My Lords, we need to control the new variant strains entering the UK by controlling the travel corridors at airports and seaports if we want to avoid a third wave of Covid-19. Can the Minister tell us whether the Government deem the mandatory hotel quarantine an important step to ensure the safety of the nation from further devastating deaths from Covid-19 and overwhelming pressure on our NHS, considering the huge impact this would have on immigration, police, medical staff and the parties waiting in hotels at airports and seaports around the country?

[Lord Bethell (Con)]

The thrust of the noble Lord’s question is entirely right. We are now living in different circumstances; the variants of concern could emerge as a real threat to the vaccine. This Government will do whatever we can to protect the vaccine deployment and the reassurance it has given to millions of people, and to protect our hospitals, our NHS and life. We will therefore do whatever it takes. He is right that travel arrangements for people must be subject to mandatory control; it is not possible to hope that people will go home and isolate in cases such as this. Hotels may play an important part in ensuring that that mandate is truly effective. Our plans are being processed at the moment; our monitoring of the variants of concern has been upgraded massively, with huge investment in international surveillance. We will update the House accordingly.

[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

My Lords, I am afraid the time allowed for this Question has now elapsed.

Medicines and Medical Devices Bill

Lord Bethell Excerpts

Consideration of Commons amendments & Ping Pong (Hansard) & Ping Pong (Hansard): House of Lords
Tuesday 2nd February 2021 Lords Chamber

Moved by

[Lord Bethell]

That this House do not insist on its Amendments 2, 3, 12, 13, 14, 23, 24, 25, 30, 40, 48, 49 and 50 and do agree with the Commons in their Amendments 50A, 50B and 50C in lieu.

50A: Clause 42 page 24, line 36, leave out subsections (3) to (9) and insert—
“(3) The procedure for making regulations under Part A1, 1, 2 or 3 is to be determined in accordance with this table and subsection (4)—

If the regulations contain provision madein reliance on	the regulations are subject to
section 5(1)(a)	the negative procedure
section 10(1)(a)	the negative procedure
section 14(1)(a)	the negative procedure
paragraph 9 of Schedule 1	the negative procedure
section 6	(a) the made affirmative procedure, where the regulations contain a declaration that the person making them considers that they need to be made urgently to protect the public from an imminent risk of serious harm to health
	(b) the draft affirmative procedure in any other case
section 15	(a) the made affirmative procedure, where the regulations contain a declaration that the person making them considers that they need to be made urgently to protect the public from an imminent risk of serious harm to health
	(b) the draft affirmative procedure in any other case
any other provision of Part A1, 1, 2 or 3	the draft affirmative procedure

(4) Provision that may be made by regulations subject to the negative procedure may be made by regulations subject to the draft affirmative procedure.
(5) Where regulations are subject to “the negative procedure”—
(a) in the case of regulations made by the Secretary of State acting alone, the statutory instrument containing the regulations is subject to annulment in pursuance of a resolution of either House of Parliament,
(b) in the case of regulations made by a Northern Ireland department acting alone, they are subject to negative resolution within the meaning given by section 41(6) of the Interpretation Act (Northern Ireland) 1954, and
(c) in the case of regulations made by the Secretary of State and a Northern Ireland department acting jointly, the statutory instrument containing the regulations is subject to—
(i) annulment in pursuance of a resolution of either House of Parliament, and
(ii) negative resolution within the meaning given by section 41(6) of the Interpretation Act (Northern Ireland) 1954.
(6) Where regulations are subject to the “draft affirmative procedure”—
(a) in the case of regulations made by the Secretary of State acting alone, the statutory instrument containing the regulations may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament,
(b) in the case of regulations made by a Northern Ireland department acting alone, they may not be made unless a draft of the regulations has been laid before and approved by a resolution of the Northern Ireland Assembly, and
(c) in the case of regulations made by the Secretary of State and a Northern Ireland department acting jointly, the statutory instrument containing the regulations may not be made unless a draft of the instrument has been laid before and approved by a resolution of—
(i) each House of Parliament, and
(ii) the Northern Ireland Assembly.
(7) Where regulations are subject to the “made affirmative procedure”—
(a) in the case of regulations made by the Secretary of State acting alone, the statutory instrument containing the regulations—
(i) must be laid before Parliament after being made, and
(ii) ceases to have effect at the end of the period of 40 days beginning with the day on which the instrument is made unless, during that period, the instrument is approved by a resolution of each House of Parliament,
(b) in the case of regulations made by a Northern Ireland department acting alone, they—
(i) must be laid before the Northern Ireland Assembly after being made, and
(ii) cease to have effect at the end of the period of 40 days beginning with the day on which they are made unless, during that period, the regulations are approved by a resolution of the Assembly, and
(c) in the case of regulations made by the Secretary of State and a Northern Ireland department acting jointly, the statutory instrument containing the regulations—
(i) must be laid before Parliament and the Northern Ireland Assembly after being made, and
(ii) ceases to have effect at the end of the period of 40 days beginning with the day on which the instrument is made unless, during that period, the instrument is approved by a resolution of each House of Parliament and by a resolution of the Assembly.
(8) In calculating the period of 40 days for the purposes of subsection (7)(a)(ii) or (c)(ii) in relation to Parliament, no account is to be taken of any time during which—
(a) Parliament is dissolved or prorogued, or
(b) either House of Parliament is adjourned for more than 4 days.
(9) In calculating the period of 40 days for the purposes of subsection (7)(b)(ii) or (c)(ii) in relation to the Northern Ireland Assembly, no account is to be taken of any time during which the Assembly is—
(a) dissolved,
(b) in recess for more than 4 days, or (c) adjourned for more than 6 days.
(10) If regulations cease to have effect as a result of subsection (7) that—
(a) does not affect the validity of anything previously done under the regulations, and
(b) does not prevent the making of new regulations.”

--- Later in debate ---

Moved by

[Lord Bethell]

That this House do agree with the Commons in their Amendments 11A, 11B, 11C and 11D.

11A: After Clause 6, line 6, after “where” insert “—
(a) the disclosure is”

--- Later in debate ---

Moved by

[Lord Bethell]

That this House do agree with the Commons in their Amendments 22A, 22B and 22C.

22A: After Clause 10, line 6, after “where” insert “—
(a) the disclosure is”

--- Later in debate ---

Moved by

[Lord Bethell]

That this House do agree with the Commons in their Amendments 32A, 32B and 32C.

32A: Clause 35, line 3, after “where” insert “—
(a) the disclosure is”

32C: Clause 35, line 8, leave out subsection (4C)

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

My Lords, with the leave of the House, I beg to move that the House do agree with the Commons in their Amendments 11A to 11D, 22A to 22C, 32A to 32C, and 50A to 50C en bloc. I pay tribute to noble Lords on all sides of the House in reaching consensus on the issues dealt with in these amendments. They were put down in the other place after cross-party discussions and I believe they reflect the aims and agreement of the House.

Amendments 11A to 11D, 22A to 22C and 32A to 32C all make minor amendments to Lords Amendments 11, 22 and 32. These amendments, in the name of the noble Baroness, Lady Thornton, made further changes to the clauses allowing the MHRA and the VMD to share information with relevant persons, such as regulators, outside the UK. Lords Amendments 11, 22 and 32 create a new safeguard that information could be shared only when in the public interest or for pharmacovigilance. I thank the noble Baroness very much for her remarks on Report. She made it very clear that the reference to pharmacovigilance was illustrative. Pharmacovigilance is very important, but it is also very much in the public interest and so does not need to be included outside the reference to the public interest. It is already captured. The Commons amendments therefore remove the reference to pharmacovigilance and the purpose of the amendments remains.

The majority of the Commons amendments deal with the variety of ways that noble Lords sought to create means to bring the Bill, and the principles of the Bill, back before Parliament in the future. Three methods were put forward and, in fact, noble Lords eloquently pressed the point on all of them. Lords Amendments 2, 13 and 24, which were tabled by the noble Baroness, Lady Thornton, put forward a sunset on delegated powers. Lords Amendments 3, 14, 25, 30, 48 and 49, which were tabled by the noble Lord, Lord Sharkey, put in the super-affirmative procedure. Lords Amendments 12, 23 and 40, in the name of the noble Lord, Lord Patel, put forward the idea of bringing forward consolidated draft legislation within three years. I do not intend to repeat my arguments against all three; I have said throughout this Bill that we have been listening carefully to all noble Lords who have put forward very clearly their continued concerns.

Commons Amendments 50A, 50B and 50C are an alternative, which I believe we can agree avoids the issue of introducing a “cliff edge” for legislation—and potentially patient safety—but importantly provides the reassurances that noble Lords quite reasonably sought. They collectively create an obligation for the Secretary of State to prepare a report on the operation of the legislation within five years of Royal Assent, and the amendments specify the considerations that must be addressed in that report: first, whether the legislation should be consolidated or restructured; secondly, whether legislation ought to be in regulations or in Acts of Parliament; and, thirdly, whether any of the powers to make regulations should be modified or repealed.

This would mean actively considering all the questions raised by noble Lords. It would give the time needed for making changes to the current legislation governing medicines and medical devices using the Bill’s powers, and allow for those changes to bed down and for those complex areas of law to reach a steady state, before considering these important issues.

The Secretary of State must also take into account any report of a parliamentary committee in preparing that report. This would mean that if any committee—whether your Lordships’ Delegated Powers and Regulatory Reform Committee or the Health Select Committee in the other place—decided to take a view on the operation of the legislation in the intervening time, its conclusions and considerations would have to be taken into account. If any committee should choose to do so, perhaps on the basis of the post-legislative memorandum that must be prepared within three to five years of the Bill being enacted, Parliament will have expressed a view before being presented with the Secretary of State’s report.

I think this is a satisfactory compromise. It meets the principle of parliamentary review without the practical impact on patient safety of powers lapsing. It ensures that Parliament has the ability to express a view and for that view to be heard, without asking for review before it is practicable. Amendment 50A makes the necessary changes to reinstitute the parliamentary procedure changes made at Lords Committee stage, in place of the super-affirmative.

I hope that noble Lords will be content to accept the amendments from the House of Commons. I beg to move.

[Lord Patel (CB) [V]]

My Lords, I am extremely grateful for the amendments that the Government have brought from the Commons. I am grateful to the Minister and his team for working so diligently with the rest of us, and to all noble Lords who supported my amendments. It is not unusual—but it is infrequent—for the votes that the Government did not get through in the Lords to be reconsidered in the Commons and brought back as government amendments. I am very content that the amendments that the Government have brought are very satisfactory and I congratulate them. I thank the noble Lord, Lord Bethell, the noble Baroness, Lady Penn, the noble Earl, Lord Howe, and the legal team for working with us throughout the Bill. That is all I am going to say.

[Baroness Thornton (Lab)]

My Lords, I am very grateful to the Minister and his team for the manner in which they have engaged and worked with us throughout the passage of this Bill, particularly at this final stage. The amendment in lieu is a good compromise that reflects the need for scrutiny to be at the heart of the Bill. It provides a mechanism to examine the powers of the Act in five years’ time and will open the door for the restructuring and consolidation of the post-Brexit medicines and medical devices regulatory regime. We believe that this will prove both desirable and necessary, and look forward to working with the Minister on such issues when the time comes.

We welcome the requirement that the Secretary of State must specifically consider whether this should be in the form of primary or secondary legislation and hope that this will lead to policy being put into a future Bill rather than scrolled away in regulations. The Secretary of State will also have to take account of all parliamentary committee reports. This would include post-legislative scrutiny undertaken by a Select Committee, as well as the DPRRC and Constitution Committee, whose oversight played a crucial role in reshaping a skeleton Bill into a framework Bill; I thank the noble Lord, Lord Lansley, for explaining that to us all. I hope the Minister can assure me that stakeholders will also be consulted. I am sure that that will be the case. It is very important, given that they are the end users of the legislation, and for the report to have value and credibility it must reflect the experience of regulators, industry, patients and medical professionals.

Finally, the tidying-up amendment that retains the requirement to share information in the public interest is an important provision because it will allow for substantive and ethical issues relating to the sharing of public data to be considered. This is of the utmost importance, given the role that the NHS and patient data may have in future trade deals.

[Lord Bethell (Con)]

My Lords, I do not intend to repeat much of what I said at Third Reading. Many thanks to the noble Lords who have contributed to the changing shape of the Bill. From Committee to ping-pong, we have listened, heard proposals for change and brought workable, practicable compromises forward.

I wish to repeat the remarks made by the noble Baroness, Lady Thornton. She congratulated all of us on the effective communication that has made it possible to make considered progress on this Bill, despite all the challenges that Covid-19 has presented us with. This a very fair assessment; I agree with it completely. From the report of my noble friend Lady Cumberlege to the demonstrated expertise of our medicines regulator, the MHRA, we have seen the importance of patient safety, clinical trials, our life sciences sector and effective regulation bear out in our hospitals, clinical trials and patient community.

I look forward to the debates ahead of us on the regulations that will be made under the Bill. They will be important, as we set forward on our course for the best possible regulatory regime for the UK, with the patient at its heart.

[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

Noble Lords will be pleased to know that no one has requested to speak after the Minister.

Covid-19: Vaccines

Lord Bethell Excerpts

Monday 1st February 2021 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government what plans they have to ensure that the second dose of the Pfizer/BioNTech COVID-19 vaccine is delivered to patients within 12 weeks of receiving the first dose.

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

My Lords, the second dose completes the course and is vital for long-term protection. That is why all patients will be offered a second dose between 77 and 84 days after receiving their first. We have already vaccinated almost 9 million people, with the ambition to reach the 15 million people in the most vulnerable groups 1 to 4 by the middle of February.

[Baroness Thornton (Lab)]

I thank the noble Lord for his partial reassurance; however, the question is actually whether there will be a supply available in the timeframe. Given that any unvaccinated area provides a potential pool for new strains of Covid to develop and re-infect the world, extending immunisation to the whole world is not

“only a matter of altruistic engagement,”

but “of enlightened self-interest,” to quote Tony Blair. Does the noble Lord agree that countries must come together to reject vaccine nationalism in favour of co-operation? At what point in terms of vaccination of priority groups will the UK be able to make vaccinations available to other countries that are in need?

[Lord Bethell (Con)]

I completely agree with both the noble Baroness and the former Prime Minister Tony Blair on this matter. Not only must we vaccinate our own country, but we are not safe until the whole world is vaccinated. That is a basic public health and epidemiological observation. It is why we are very committed to international efforts—to CEPI, Gavi, COVAX and ACT. They are all working hard to get fair distribution of vaccines. We have also put £571 million into the funds at COVAX to support vaccines for the developing world. However, we have to start at home and it is not possible to make a commitment on the schedule for when we will be in a position to think about exporting vaccines until that is completed. When it is completed, I will update the House accordingly.

[Lord Winston (Lab) [V]]

My Lords, we welcome the efficiency with which the UK is providing vaccines, but vaccines affect only part of the problem. As my noble friend Lady Thornton and the Minister said, this is indeed a global issue. Prompt diagnosis and early treatment with antivirals will become vital. Time is limited. Can the Minister inform the House what measures the Government are taking to stimulate investment and make urgent research into effective antiviral drugs specifically designed against SARS-CoV-2, which are likely to be easier to distribute in many countries?

[Lord Bethell (Con)]

The noble Lord is entirely right: the vaccines are a hugely important development, but so is investment in all therapeutic drugs. We are extremely blessed to have had a contribution towards dexamethasone, tocilizumab and other therapeutic drugs which have greatly improved outcomes for patients in hospitals. He is right that antivirals also present an opportunity. The reason we have supported research into antivirals through the urgent regime in our clinical trials is to ensure that there is sufficient commitment in hospitals and primary care on antivirals. We are tasking the Therapeutics Taskforce with a specific mandate to look at antivirals and whether we should give greater resources to this avenue of therapeutic development.

[Lord Scriven (LD) [V]]

My Lords, having the second dose of the Pfizer/BioNTech vaccines in the right quantities in the right place at the right time is vital. Will the Minister guarantee that people will be able to get their second dose of it at the local GP hub where they had their first dose administered without being directed to a mass vaccination centre to receive it?

[Lord Bethell (Con)]

In response to the noble Baroness, I said that we were confident that we had the supplies of the vaccines to do the second dose. It is not our policy that anyone has the second dose of anything other than the vaccine they had the first dose of. We will work with people to give them the most convenient place to have the vaccine, but I cannot offer the guarantee that the noble Lord seeks.

[Lord Patel (CB) [V]]

My Lords, while it is important to extend vaccination programmes at home and abroad, the recent reports of emerging mutations of the virus—the South African, Brazilian and the recent Californian mutations—risk significantly increasing transmissibility and serious illness, particularly in younger people. It is extremely worrying, and it may lead to the virus getting around the vaccine-related immunity. We need to be ahead of the curve if we are to avoid serious illness and deaths in the young. What plans do the Government have to mitigate against this?

[Lord Bethell (Con)]

The noble Lord is entirely right; the threat of a vaccine-escaping mutation is very present on our minds. I pay tribute to the word of Sir Patrick Vallance, Clive Dix and all those who are working on this issue in the expert advisory group on vaccines. The noble Lord mentioned the threat of transmissibility among the young. We have already made the commitment of offering a vaccine to all ages. He is entirely right that we may reach a point where it is particularly important to ensure that young people have the vaccine so that they are not responsible for transmitting the disease to those who are more vulnerable.

[Baroness Sugg (Con) [V]]

My Lords, I congratulate the Government on their very impressive vaccine rollout. Bringing in retired doctors, nurses and non-healthcare professionals to be part of the national vaccination effort will be vital to being able to continue to deliver all doses of the vaccine at scale—and, of course, it will help to relieve the pressure on our hard-working NHS workers. Can my noble friend the Minister update the House on the progress of these applications?

[Lord Bethell (Con)]

My Lords, we have tens of thousands—38,000, I think—currently employed by the NHS delivering the vaccine: a remarkable army of people. We have had further offers from hundreds of thousands of people—300,000, I believe—to support the vaccination effort. Those offers are being processed by voluntary groups; I pay particular tribute to the St John Ambulance, which runs an extremely good training programme and has enabled tens of thousands of people to join the vaccination effort. We continue to engage with those offering to help to ensure that they get the training and opportunities to help wherever they can.

[Baroness Donaghy (Lab) [V]]

How can the Government ensure that the second dose of the Pfizer BioNTech vaccine is delivered to patients within 12 weeks? I do not think the Minister answered that part of my noble friend Lady Thornton’s Question. What steps are the Government taking to ensure that this is done, and are there any circumstances in which vaccines would be mixed at the second dose?

[Lord Bethell (Con)]

When you go to have your vaccine, as several noble Lords have done, you are given a card like the one I am holding, on the back of which the date of your second dose is printed. That is how we ensure that people know where and when to go for their second dose. We are working extremely hard to ensure that there are supplies of the second dose, and I am confident that we have the arrangements in place. It is not our policy to give anyone a second dose of an alternative vaccine to their first dose.

[The Deputy Speaker (Lord Haskel) (Lab)]

I call the noble Lord, Lord Willis of Knaresborough. No? I call the noble Baroness, Lady Deech.

[Baroness Deech (CB) [V]]

My Lords, how can the Minister overcome the reported suspicion of the Covid vaccines among ethnic minorities and, of course, the anti-vaxxers, no doubt fuelled by President Macron’s unfounded attack on the effectiveness of the AstraZeneca vaccine?

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right to be concerned, but I can report from the front line that concerns about the impact of anti-vaxxers have not materialised in a huge impact on confidence. I pay enormous tribute to all those in civic society and religious groups in all parts of Britain who have done a tremendous job of ensuring that groups and communities who might once have been suspicious of a vaccine supplied by the British Government have instead turned up in droves. I am extremely confident that the message has got across: this is a safe vaccine, everyone who qualifies should take it, and you should trust the Government and the NHS to supply it.

[Lord Mancroft (Con) [V]]

My Lords, I join my noble friend Lady Sugg in congratulating the Government on their outstanding work in rolling out this vaccine programme. As I am a bear of very little brain, can I ask my noble friend to explain: if we are to maintain the current level of first vaccinations and at the same time start giving second doses to those who have had their first, will we not have to double our capacity to give vaccinations over the next month or six weeks? Are the Government confident that they can achieve that?

[Lord Bethell (Con)]

My noble friend is entirely right: from March, we will have considerably more work both to deploy the second dosage and to supply it. We have those plans absolutely in place: the supply of the vaccine has been put in place to ensure that we have a sufficient number of doses, and the workforce and locations are in place to ensure that we can deliver them.

[Lord Rogan (UUP) [V]]

My Lords, among Northern Ireland Health Minister Robin Swann’s many achievements since the start of the pandemic, he has overseen the establishment of seven regional centres across the Province where the Pfizer Covid-19 vaccine is now administered. I understand that a further significant consignment of the AstraZeneca vaccine is due in Northern Ireland this week for distribution to general practitioners. Can the Minister assure me that the Province’s stocks of the Pfizer vaccine are also being replenished to allow the regional centres to continue their excellent work at the fastest possible pace, including the delivery of a second dose?

[Lord Bethell (Con)]

I join the noble Lord in paying tribute to the good work of the Northern Ireland Health Minister, Robin Swann, whom I commend for his collaborative approach during this entire pandemic. I reassure the noble Lord that we are allocating doses on the business-as-usual, Barnett formula split, with 2.85% going to Northern Ireland. I pay tribute to the NHS there, where 214,601 people have had their first dose. A further 24,323 have had their second dose, and I reassure the noble Lord that we will maintain that velocity of delivery in the weeks to come.

[Lord Clark of Windermere (Lab) [V]]

My Lords, when I received the Pfizer vaccine, I was given a leaflet that stated

“you should receive a second dose of the same vaccine … 21 days later to complete the vaccination series. Protection against COVID-19 disease may not be … effective until at least 7 days after the second dose.”

Now that 21 days has been extended to 77 to 84 days, what is the efficacy of the vaccine after a gap of six weeks and three months?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I congratulate the noble Lord on having his vaccine so early, and I share his concern on this matter because those who had their first dose early received a leaflet of exactly the kind he described, and, since then, the CMO’s advice has changed. I reassure him that, using data for those cases observed between days 15 and 21, efficacy against symptomatic Covid-19 for the Pfizer vaccine was estimated at 89%. Those kinds of statistics reassured the CMO to change the date to three months, and I reassure the noble Lord that he is in safe hands.

[Baroness Fookes (Con) [V]]

My Lords, I am perfectly happy with waiting for the three months, but I am concerned about people over the age of 80 who are living in their own homes, rather than retirement homes, who I understand are not yet receiving the vaccine. I can understand that it would be difficult to go to individual homes, but can my noble friend tell me what the position is?

[Lord Bethell (Con)]

I reassure my noble friend that we have put in place a systematic arrangement to visit care homes and those living at home with domiciliary care in order to bring the vaccine to their homes. That system includes GPs, community pharmacists and, where necessary, mobile vaccination units. It is proving to be extremely effective. The big numbers will be delivered by the mass vaccination centres, but we will not overlook those who cannot move from their home.

[Lord Craig of Radley (CB) [V]]

My Lords, what information does the Minister have about individuals who may have tested positive for Covid-19 after their first vaccination, either because they are a carrier but healthy or because the first vaccination—which statistically is not 100% successful—did not work?

[Lord Bethell (Con)]

My Lords, the noble and gallant Lord touches on a number of connected issues. The first vaccination does take a little bit of time; depending on which vaccination is administered, it takes between one and three weeks before it is truly in the system and protects the patient most effectively. It is, of course, possible to subsequently catch the disease without showing symptoms. One of the most emphatic results of having a vaccination is not necessarily that you do not catch the disease but that it saves you from serious disease and hospitalisation. That is where the vaccines are making a massive difference. We are expecting a dramatic fall in the number of hospitalisations and deaths as a result, but it is possible that people will still carry the disease. That is why the advice to all people, including noble Lords, is that just because you have had the vaccine, it does not mean that you can travel around the community as you did previously.

[The Deputy Speaker (Lord Haskel) (Lab)]

My Lords, all supplementary questions have been asked.

International Year of Health and Care Workers

Lord Bethell Excerpts

Monday 1st February 2021 Lords Chamber

[Lord Crisp]

To ask Her Majesty’s Government what plans they have to celebrate the World Health Organization’s International Year of Health and Care Workers in 2021.

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

My Lords, to celebrate the work of health and care workers, there are symbolic interventions, such as the social care workforce CARE brand for shared identity and our powerful recruitment advertising, which highlights the remarkable contribution of health and care workers. However, the most important celebrations are tangible: the investment in new recruitment, the £30 million fund for those seeking mental and occupational health support, and the people plan, which is addressing the practical and cultural challenges that workers face in the workplace.

[Lord Crisp (CB) [V]]

I thank the Minister for that very positive response and I agree with him about concrete measures. The World Health Organization has adopted the slogan “protect, invest, together”, which is very powerful and sets out the priorities very well for this year. The Minister will no doubt be aware that there is discussion at the World Health Organization and elsewhere about the need for a new societal compact with health and care workers to whom we owe so much, perhaps similar to the military covenant. Would Her Majesty’s Government support the creation of a compact or covenant setting out our responsibilities to health and care workers, which mirror and match their professional responsibilities and duties towards us? If they have not considered this, will they do so?

[Lord Bethell (Con)]

My Lords, I applaud the WHO’s values of “protect, invest, together”. One of the commendable things during this awful pandemic has been the way in which British society has reconnected with the values of the healthcare community. It has rediscovered the contribution of nurses, doctors, healthcare workers and those in social care. A new relationship has been forged between civic society and healthcare; this is commendable and we should build on it. On the idea for a compact, it is not something that we are working on at the moment as far as I am aware, but I would be glad to take his idea away and find out whether we can develop it any further.

[Baroness Rawlings (Con) [V]]

My Lords, HMG have supposedly funded 85 schemes with EYN UK to develop a vaccine passport, yet they say they have no plans for one. Will they rethink their no plan-policy and collaborate with the World Health Organization in its International Year of Health and Care Workers by producing a worldwide WHO vaccine passport, perhaps even as an app?

[Lord Bethell (Con)]

My Lords, the Minister for Vaccines has been clear on this: the Government are not currently undertaking work on vaccine certification. However, the noble Baroness makes the case well. Certainly, those who have had the vaccine are very anxious to ensure that they have the correct documentation, and we will ensure that that is in place.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, I declare my roles at Cardiff University. Will the Government create a range of funding streams as overseas aid to ensure that UK universities’ successful distance learning programmes in practical health and care specialities and generalist care are affordable and supported in those countries? Will they work with me and others to invest in better provision of public health, infectious disease control, maternity services, dermatology, palliative care and other services around the globe?

[Lord Bethell (Con)]

My Lords, I pay tribute to the work of the noble Baroness in this important area. Her implied insight is exactly correct. We cannot be healthy and safe here in Britain if there are diseases raging around the world. It is both in our pragmatic self-interest and aligned with our values of partnership with other countries that we should indeed invest in the kind of training and support to which the noble Baroness alluded. I will definitely look into how we could do this better.

[Baroness Pitkeathley (Lab) [V]]

My Lords, the WHO puts health and care workers in the same category. Does the Minister agree that we in the UK do not see them as the same, since workers in the care sector are habitually worse paid, less recognised and more poorly trained and supported than those who work in the NHS? Would not the best way to celebrate care workers be to remedy these discrepancies in the proposals for the reform of social care, which the Minister has assured the House will be brought forward this year?

[Lord Bethell (Con)]

My Lords, the noble Baroness makes a completely fair point. Her observation is entirely right and her recommendation is one that the Prime Minister has made clear is part of his thinking. Social care workers have done a phenomenal job during this pandemic. Their role in supporting the elderly and infirm is extremely valuable to the whole country. It is only right that they should be treated fairly; a review of their pay and circumstances will be part of the social care package when that is announced.

[Baroness Brinton (LD) [V]]

My Lords, the WHO notes with concern the increase in international health worker migration; there are also concerns about their workplace treatment in their host countries. The 14% of brilliant non-British NHS staff are essential in holding up our healthcare systems, as has been especially evident during this pandemic. Last week, there were worrying press reports that hospital trusts were telling non-UK NHS staff without NHS numbers that they were not eligible for the Covid vaccine. Please, can the Minister say whether all NHS staff are eligible for the vaccine—and if he cannot, will he explain why not?

[Lord Bethell (Con)]

I take this opportunity to confirm to the noble Baroness that all NHS staff qualify for the vaccine. I would be very grateful if she could communicate to me any incidents where an NHS trust has said otherwise. We are enormously grateful in this country to all those who migrate to support our social care services. We are profoundly grateful for those efforts, and I want to ensure that everyone is treated well in their workplace. Generally, those in the social care workplace are treated well; there are exceptions, and we crack down on those exceptions extremely hard.

[Baroness Wheeler (Lab)]

My Lords, I express our strong support for the WHO statement in recognition of the selfless dedication of health and social care staff to providing care during and despite Covid-19. Following on from the comments of my noble friend Lady Pitkeathley, the WHO statement draws attention to the importance of workforce readiness, education and learning to manage the pandemic and its consequences. Will the Minister explain how the Government are ensuring that both health and social care staff on the front line of social care—particularly care staff, providing vital domiciliary care in the home and in the community—are being given this key support?

[Lord Bethell (Con)]

The noble Baroness is right. Those involved in domiciliary care, particularly part-time, make an extremely important contribution. We are naturally concerned about how they are contracted and their educational needs supported. We would like to think more about how part-time domiciliary care staff in particular, who make such a valuable contribution, can be further supported.

[Lord Moynihan (Con)]

My Lords, does my noble friend the Minister recognise that nurses remain at the heart of the world’s response to the Covid-19 pandemic? As key to the restoration of health systems that have been neglected during the crisis, will the Government support calls by the International Council of Nurses fundamentally to reset preparedness and response systems and work towards the global requirement for an additional 10 million nurses by 2030?

[Lord Bethell (Con)]

My Lords, we massively value the contribution of nurses from all areas. In fact, that recognition has manifested itself in practical terms; we are growing the nursing workforce and are committed to delivering 50,000 more nurses, putting the NHS on a trajectory for sustainable long-term supply in the future. That journey includes giving eligible nursing students an additional £5,000 of funding per academic year. I cannot say more clearly or loudly how much the contribution of nurses to our healthcare system is appreciated. We will do everything we can to ensure that it is recognised.

[The Lord Bishop of Salisbury [V]]

My Lords, in Salisbury we have had good reason to recognise the dedication and sacrifice of health and care workers, both at the time of the Novichok poisonings and in this present pandemic. The use of Salisbury and other cathedrals and churches as vaccination centres indicates a partnership between spirituality and health care, so will the Minister join me in thanking chaplains, among all the dedicated healthcare workers at this time? What we see in this country is in marked contrast with the poorest parts of the world, as in Sudan and South Sudan, with which this diocese is linked. Given that this is a global pandemic, when might the Government recognise the self-interest involved in overseas aid and move to restore the 0.7% of GDP commitment? No one will be safe until everyone is safe.

[Lord Bethell (Con)]

My Lords, the image of the vaccination work in Salisbury cathedral must surely be one of the most powerful images of our times. I found it an extremely touching picture to see those seeking solace in the cathedral and also their vaccination at the same time. I give praise to all those involved. Britain has been utterly emphatic in its contribution to global vaccination. We have given £574 million to developing countries to support those vaccinations. We do that for two reasons. One is self-interest, and the other is to ensure a fair distribution of the vaccines.

[The Deputy Speaker (Lord Lexden) (Con)]

My Lords, the time allowed for this Question has now elapsed. Apologies to the three speakers I was unable to call.

Social Care Funding (EAC Report)

Lord Bethell Excerpts

Thursday 28th January 2021 Grand Committee

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

My Lords, I join those who have congratulated my noble friend Lord Forsyth on securing this debate on this most important subject. The Economic Affairs Committee has done a huge service with this remarkable report. I reassure him and the committee that reform of adult social care is one of the most important priorities for this Government. It was a manifesto commitment and remains a major priority for us.

One of the silver linings of this awful pandemic has been the widespread appreciation for our carers, paid and unpaid, and I start by acknowledging the many fine words from noble Lords about the hard work of carers. I pay tribute to them and the incredible work they do every day. We owe it to them to get these reforms right.

The House of Lords Economic Affairs Committee, in its excellent and often-praised report, and many noble Lords today have made important points on social care which I want to address systematically. The committee’s report sets out the need for reform of adult social care, and on that the Government completely agree. I reassure noble Lords that, as detailed at the spending review, the Government are committed to sustainable improvement of the adult social care system and will bring forward proposals this year.

My noble friend Lord Lansley spoke with candour about the challenge facing Ministers, and I completely agree with him. Putting social care on a sustainable footing, where everyone is treated with dignity and respect, is one of the biggest challenges that our society faces. This is a complex area, a range of options are being considered, and we very much look forward to working with other parties on building a consensus around these reforms.

As many noble Lords noted, a stable social care provider market and a qualified, committed and well-paid workforce will be central to our ambitions to raise the quality of and access to social care. We want to empower recipients of care by supporting people to live independently in their own homes and communities for as long as possible. A number of noble Lords noted the Cinderella status of the sector. We want to improve the information provided to the public on the social care system, enabling them to plan for their care and make better choices when the time is right for them, and to raise the status of the sector in the public consciousness.

As regards our direction, we have made absolutely clear our commitment that nobody needing care should be forced to sell their home to pay for it. Our ambitions will necessarily take place on a longer timescale because of the pandemic, but, as the PM reaffirmed at the Liaison Committee in the House of Commons, we will bring forward proposals this year.

On social care funding, we recognise that the Covid-19 pandemic has imposed significant pressures on the social care sector, but I agree with my noble friend Lord Forsyth that the pandemic is not an excuse for inaction. In fact, it is a reason for supporting the social care sector, and that is exactly what we have done. We have now made £4.6 billion available to local authorities so that they can address the pressures on local services, including social care, that have been caused by the pandemic.

I remind noble Lords, including the noble Lord, Lord Hunt, of some of the measures we have undertaken during this period. Through the infection control fund, set up in May, we have provided over 1.1 billion of ring-fenced funding for the care sector. This has funded important measures for infection prevention and control, such as financial security for staff who are isolating, as well as PPE. On 23 December, we announced an extra 149 million to fund costs associated with increased testing in care homes, to help ensure the safety of staff and residents. Today’s announcement of the test and trace results shows the impact of that money. On 16 January, we announced another £120 million of funding to help local authorities to boost staffing levels in the care sector, which could include setting up their own staff bank to assist care homes when their staff need to isolate.

As well as this specific funding for Covid-19, we have also provided councils with access to an additional £1.5 billion for adult and children’s social care in 2020-21, on top of maintaining £2.5 billion of existing social care grants. As announced in the recent spending review, we are providing councils with access to over £1 billion of additional funding for social care in 2021-22. This includes £300 million of new grant funding for social care, on top of the £1 billion social care grant announced last year, which is being maintained in line with our manifesto commitment.

The Government are also enabling local authorities to access up to £790 million of new funding for adult social care through a 3% adult social care precept or top-up to council tax bills. The Government recognise, as is cited in the Economic Affairs Committee report, that the amount that each local authority can raise from this precept is dependent on a number of factors: for example, council tax bill levels. We are looking to address this through using some of the social care grant funding for equalisation. We also expect to provide councils with estimated funding of around £3 billion to help manage the impact of Covid-19 across their services, including in adult social care, and to compensate for income losses. This is a substantial track record of investment during a time of national emergency, and a significant response to the Covid pandemic.

I will say a word about market fragility. The report raises concerns about the strength of the social care provider market. As many noble Lords have noted, this market is varied and includes public, private and voluntary organisations. This is both a strength and a weakness. As noble Lords have noted, not all providers last for ever, but I reassure the noble Lord, Lord Liddle, and my noble friend Lady Browning that entering and exiting is a normal part of a functioning market, and local authorities should have appropriate plans in place to minimise any disruption of services.

I agree with my noble friend Lord Young of Cookham. I say to the noble Lord, Lord Shipley, that local authorities are best placed to understand and plan for the care needs of their populations, and to develop and build local market capacity. That is why, under the Care Act 2014, local authorities are required to shape their local markets.

To push back gently against the noble Baroness, Lady Brinton, on capacity, the number of overall care home beds has remained broadly constant over the last 10 years, from around 460,000 beds in 2010 to around 458,000 beds this month. At the same time, the number of care home agencies in England has increased. There are over 4,000 more care home agencies now than there were in 2010. This reflects the growing trend, noted by the noble Baroness, Lady Wheeler, towards caring for people in their own homes wherever possible. This is largely to be welcomed.

A number of noble Lords commented on the quality of care. I am grateful to the noble Baroness, Lady Young, for her testimony on her time at the Care Quality Commission, which is the independent regulator of all health and social care services in England. It notes that 84.6% of all social care organisations are currently rated as good or outstanding. As my noble friend Lord Lancaster put so well, this is testament to the hard work of so many people in adult social care, who speak of positive experiences in adult social care. We should not forget this.

I also want to cover unmet demand. We have enshrined in law, through the Care Act, the responsibility of local authorities to meet eligible needs. This eliminated the postcode lottery for eligibility across England. Under the Care Act, everybody who appears to have needs is entitled to an assessment. If, following the assessment, they are found to have eligible needs, the local authority has a duty to meet those needs, subject to a financial assessment.

That brings me to the difference highlighted in the committee report and raised by my noble friend Lord Forsyth between, say, cancer care, which is funded by the NHS, and other conditions that people may be living with, such as dementia, and those who have to pay for that care. The reason for this is the type of care required. There are limited treatment options for people living with dementia, so care is predominantly social care and support, rather than the medical treatment afforded by the NHS for those who have cancer. Social care, as we know, is subject to means testing. As I mentioned earlier, the Government are committed to social care reform, so that no one has to face excessive social care costs in their lifetime, whatever their underlying need. In answer to noble Lords, such as the noble Baroness, Lady Hollins, who asked about a timetable, we will bring forward proposals later this year.

The noble Baroness, Lady Finlay, and the right reverend Prelate the Bishop of Carlisle, asked about personalisation and choice. The report raised concerns about disabled people not having choice and control over basic decisions in their lives, such as when they get up in the morning and whether they can leave the house, due to lack of care and support.

My noble friend Lord Taylor of Holbeach was quite right when he called for dignity and respect in social care. On that, the Care Act introduced new functions for councils to focus on promoting well-being and prevention, including offering personal budgets, which are designed to give people control and choice over how their care is planned and delivered. It is based on what matters to the individual and their needs. It enables a new relationship between people, the care system, and health and care professionals, and is a step towards offering people the chance to have a say about their own care. The evidence suggests that, by doing so, people are more satisfied with their care, have better outcomes and can explore more innovative approaches to meet their needs.

I agree with the noble Lord, Lord Razzall, and other noble Lords that our NHS and social care system is facing increased pressure and that it needs to be fundamentally transformed and adapted to meet this demand. Our mission is to deliver integrated health and care services by placing people at the centre of the health and care system, working with them holistically to deliver the outcomes that matter to them most.

I want to say a word about the workforce, but, before I do, let me recognise the very large number of tributes paid to it by noble Lords. I completely acknowledge the comments on the status, training and workload of those working on the front line of social care. As the report recognises, the 1.5 million people who make up the paid social care workforce provide an invaluable service to the nation. We are indebted to their selfless dedication, and we have a duty to give them the support they need.

I have already mentioned the infection control fund to the noble Lord, Lord Liddle, and I reassure him that the £1 billion of funding to which we have given councils access in 2021-22 is designed to ensure that key pressures in the system are met, including the national living wage and national minimum wage. I reassure my noble friend Lady Fookes that the increase in the national living wage means that many of the lowest-paid workers will benefit from at least a 2.2% pay rise next year. The vast majority of care workers are employed by private sector providers, which ultimately set their pay. They must abide by national wage legislation, but they are independent of central government. Local authorities work with care providers to determine a fair rate of pay based on local market conditions.

On recruitment and vacancy rates, which were raised by a number of noble Lords, including the noble Baroness, Lady Hollins, we completely recognise that adult social care employers can struggle to recruit and retain the right number of staff. We are pleased that the vacancy rate reduced to around 7% for the period March to November 2020 from 8.4% in February 2020. We want this to reduce further and are working alongside stakeholders in adult social care to support a growing workforce with the values and skills to deliver high-quality, compassionate care.

It is vital that the spotlight we have seen placed on the social care workforce during Covid-19 is transformed into a long-lasting legacy of recognition for the workforce, as was noted by a number of noble Lords. We will celebrate their work and give them the acknowledgement and appreciation they deserve. To answer my noble friend Lady Fookes and the noble Baroness, Lady Brinton, we have responded to calls to provide the social care workforce with a shared identity to unite the sector. CARE badges are currently available free of charge, to be worn as a symbol of pride across the social care sector, and 1.1 million of them have been provided.

To noble Lords who asked about unpaid carers, I say that, like the report, the Government recognise the vital role unpaid carers play, especially given the difficulties the coronavirus pandemic has placed on those caring for family members, relatives and loved ones. We were all moved by the testimony of the noble Baronesses, Lady Kingsmill and Lady Wheeler. I want to pause for a moment to reflect the country’s gratitude to the people who have stepped up to help one another in their communities during the pandemic, alongside those who care day in and day out for their older or disabled loved ones. As the noble Baroness, Lady Jolly, said, this pandemic has highlighted the invaluable contribution of unpaid carers just as much as that of NHS and social care workers.

I reassure the noble Baroness, Lady Pitkeathley, that we have supported unpaid carers throughout the pandemic by funding the work of a number of charities that support carers, by publishing guidance tailored to carers, and by working with the social care sector to strike a balance between maintaining day care and respite services that we know are critical to many families and controlling infection risks.

In 2018, we set out a two-year programme of cross-government action on unpaid carers in our carers action plan. We will continue to work with carer organisations to support unpaid carers’ access to the support they need to maintain their own health and well-being while continuing to support their loved ones.

This is a comprehensive report. This debate has raised some really good points, and I acknowledge the frustration felt by many that there has not been more progress on this agenda. However, as my colleague, the Minister of State for Care, wrote in her response to the committee chair, this is an important priority, and we are working hard to make progress on it. We are considering the report’s recommendations carefully, and, as the noble Lord, Lord Lipsey, rightly acknowledged, we remain committed to cross-party talks to build a consensus. We remain committed to this vital work and will bring forward proposals later this year.

Vaccine Rollout

Lord Bethell Excerpts

Monday 25th January 2021 Lords Chamber

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

My Lords, I am extremely grateful for that question, because it will help me to clear up a misconception in this area. Having an NHS number is very important. We cannot know who has had the vaccine and who has not if we do not know what their NHS number is. That is extremely important for their own treatment; it is also best practice. As any clinical practitioner will tell us, it is imperative to know the identity of the person being treated. It is also very important for pharmacovigilance and for the research that will come on the back of the vaccine. If we were to vaccinate a large proportion of the population without knowing who they were, we could not do the research necessary. There will be some people who do not have an NHS number, and we have put in place protocols to ensure either that they can get an NHS number or that a workaround can be found. Those we are pursuing with haste. I emphasise to noble Lords that this is an opportunity to ensure that everyone in this country, whether a visitor or a resident, has an NHS number by the end of this programme.

[Lord Scriven (LD) [V]]

My Lords, here in Sheffield, approximately 45,000 people have been vaccinated, owing to the excellent work of our local GP hubs, but because of lack of vaccine supply, 10 out of 15 of those will be closed and will not be able to get the jab into vulnerable people’s arms again until the middle of next week. Yet the new Sheffield mass vaccination centre has opened today and has vaccine. Local GPs have asked me to ask the Minister why the distant megacentre has been given priority for vaccine supply over the local and effective GP hubs.

[Lord Bethell (Con)]

It is not a question of one place taking precedence over another. I take a moment to applaud and pay tribute to GPs in Sheffield, and to all those who have proceeded at pace and got through their allocation as quickly as they could. That is absolutely the right priority and the right approach, and it is how we are going to get through the population very quickly. However, some people will get through their list more quickly than others, and it would be a mistake then to start asking them to move down the list when there are still those with very high priority who need to be vaccinated. Although I understand that it may be frustrating for a GP to stand idle, those are the practicalities of what we are doing. The mass vaccination centres are essential to deal with the very large numbers of people that we plan to vaccinate over the next few months. That is why the Sheffield vaccination centre is such good news.

[Baroness Hayman (CB) [V]]

My Lords, I support the Government’s utilitarian public health approach to the spacing of vaccine doses, but does the Minister accept that the argument is dependent on an understanding of the full implications of different dosage regimes, and that a lack of specific data on this particular point in relation to the Pfizer vaccine is fuelling concerns? Will the Government now undertake research on this specific point as part of a vaccine rollout programme, to underpin robust and well-supported policy implementation, both here and in many other countries that could benefit from this data?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, the amount of research that we have on the Pfizer vaccine and all other vaccines is huge. Most, though not all of it, is published. I assure the noble Baroness that we have all the data needed to make the decision that we have. She is right that we are doing the pharmacovigilance that is necessary to understanding the efficacy of the vaccine and any possible side effects. That research will be shared with international partners in the way that she suggests.

[Baroness Stroud (Con) [V]]

My Lords, the Prime Minister revealed on Friday the great news that 10% of all adults have now received their first dose of the Covid vaccine, with two-thirds of elderly residents of care homes now meeting that first milestone. This wonderful effort now needs to be matched by a strategy to ensure that it is not only the elderly who are protected but the young, with a commitment to reopening our schools as soon as possible. Social mobility gains that have given a lift to disadvantaged children over the past decade are at risk of being wiped out by Covid lockdowns. The gap between disadvantaged pupils and their peers has already increased by almost half, with 12% of 11 to 18 year olds not having access to the internet at home. Given that the rollout of the vaccine to the most vulnerable is set to reduce deaths by 88% by mid-February, what steps are Her Majesty’s Government taking to increase NHS capacity to ensure that schools can open as soon as possible?

[Lord Bethell (Con)]

My Lords, it is indeed very good news. I pay tribute to the work of my noble friend and of the Legatum Institute in championing the need to address social inequality. She rightly draws attention to the horrific impact that this pandemic and the associated lockdowns are having on social mobility. It is a massive priority for us. The problem that we are wrestling with is not just hospitalisation but the transmission associated with schools, but I assure her that this is a number one priority for us.

[The Lord Bishop of Gloucester]

I wish to make two points and I draw attention to my interests as listed in the register. First, I am very concerned about prisons. There are reports that about 71 prisoners have died, and the number of prison staff who have tested positive continues to rise alarmingly. There is great flux within a prison, with staff coming and going, and those being released from prison and those coming into prison. Will the Government consider prioritising the vaccinating of prisoners and those who work in prisons? Secondly, I add my voice to those calling for teachers and early years staff to be prioritised. Schools are open and our dedicated teachers and early years staff must be able to continue their work safely and not be off sick, if we are to do the right thing by our children.

[Lord Bethell (Con)]

The right reverend Prelate is entirely right to highlight prisons, and I share her deep concern in this area. I pay tribute to the Prison Service for keeping Covid out of prisons for nearly a year. It has done an amazing job, and we should all be very pleased with the incredible protocols that have been put in place to save our prisons. However, she is entirely right that we have a problem on our hands. It is a major priority for the Prison Service, which is bringing in testing protocols and, if necessary, will look at other measures to ensure that prisoners and those who work in prisons are safe.

[Baroness Donaghy (Lab) [V]]

I want to follow up on the answer that the Minister gave to my noble friend Lady Thornton. I was quite shocked by his reply, because I am quite sure that most people working in the National Health Service who do not have a number are probably the lowest paid, from black and ethnic-minority communities, or temporary staff—the very people who are just as much on the front line as doctors and nurses. I do not think that being assured that there will be a protocol, or a workaround, is adequate. Can the Minister say what protocol there will be, what priority it will have, and how soon all of this will be communicated to the people who are affected?

[Lord Bethell (Con)]

My Lords, I assure the noble Baroness that it is communicated on the front line immediately. I did not have a valid NHS number until a week ago: it took me a couple of days to get one, but it was provided extremely promptly. I am hopeful that anyone who is lacking an NHS number can get one extremely quickly when they apply.

[Baroness Hollins (CB) [V]]

My Lords, I am grateful to the Minister for all his hard work on this subject. As he says, the vaccination rollout rightly aims to prioritise the people who are most vulnerable to Covid, but this mainly focuses on age. On the BBC news yesterday, we heard directly from several people with learning disabilities about their well-founded worries concerning the Public Health England data, which shows that they are six times more likely to die from Covid. Given this, and the fact that only 40% of people with learning disabilities reach the age of 65, does the Minister agree that relying on a strategy of vaccinating them at the same age as other people magnifies their existing health inequalities and discriminates by failing to recognise their increased risk?

[Lord Bethell (Con)]

My Lords, the JCVI looked at this very question in great detail. It is very conscious of discrimination, but its focus is on morbidity. Its judgment, which I entirely back, is that age, more than anything else, is the driver of morbidity. That is why the prioritisation is structured in the way that it is. Those who are CEV are also prioritised. Many of those who are most vulnerable and who also have learning difficulties will qualify under the CEV threshold. However, I have passed her arithmetic to the vaccine taskforce. She makes a very good point that those with learning difficulties and autism have a different life profile and die at an earlier age. I have asked the system to ensure that this arithmetic has been considered in the prioritisation list. I will be glad to reply to her when I have the answer.

[The Deputy Speaker (Baroness Henig) (Lab)]

My Lords, the time allowed for this Question has elapsed.