Pandemic Preparedness

Lord Browne of Ladyton Excerpts

Monday 15th April 2024 Lords Chamber

[Lord Markham (Con)]

I totally agree with the noble Baroness. What I am interested in as a Health Minister is what lessons we can learn so that we are better prepared next time round. My understanding is that stage 1 is going to be reported in early summer, and that should give us some of those findings. I completely agree that that is what really matters.

[Lord Browne of Ladyton (Lab)]

My Lords, an international pandemic treaty and government policies from 2021 are currently being negotiated by the World Health Assembly, aimed at preparing for the next global health emergency and preventing a repeat of what South Africa called vaccine apartheid, where countries had vastly unequal access to vaccines and drugs. Next month, World Health Organization member states are expected to vote on the final text. Where do we stand on the key issue of pathogen access and benefit sharing? Do we stand on the side of the group for equity or with those rich countries that have suggested that such an approach would undermine their sovereignty?

[Lord Markham (Con)]

I think our record in this speaks for itself. I am very proud of the action that we took as a Government to make sure that the AstraZeneca vaccine was prepared quickly, put in arms quickly and offered all around the world on a not-for-profit basis very quickly. Action speaks louder than words, and that is something that we are well-prepared on. I have been involved in some of the conversations about world pandemic preparedness. There is action that we think we can take collectively as a world, but what we are not prepared to see happen is our sovereignty—the management of our health services—being ceded to other countries.

United Kingdom: Future Pandemics

Lord Browne of Ladyton Excerpts

Monday 16th January 2023 Lords Chamber

[Baroness Williams of Trafford (Con)]

I was just about to confirm that it is the turn of the noble Lord, Lord Browne.

[Lord Browne of Ladyton (Lab)]

My Lords, I am sure that the Minister is aware that it took repeated FoI requests from an NHS doctor to get the Government in 2021 to reveal that they had carried out Exercise Alice in 2016, which was designed to recognise the challenges should a coronavirus hit our shores. The report, redacted when published, revealed shortages of PPE, no plans for pandemic-related travel restrictions, and a failure to have a working contact-tracing system—all of which we had to improvise when it actually happened. Is the department carrying out similar exercises? Is it producing solutions, not just identifying problems? Will the Government publish these reports, so that the public can see what needs to be done to prepare this country?

[Lord Markham (Con)]

As previously mentioned, there were many things that we did not get right. The whole reason that we set up the UK Health Security Agency was because we were not happy with the response in some areas. That agency was set up with a team of experts to make sure that, learning from those lessons, we are properly prepared for all eventualities next time around. There are lessons to learn but, as the Covid inquiry will show, there were also many things that we did right. It is important that we have that balance.

Covid-19: PPE Procurement

Lord Browne of Ladyton Excerpts

Wednesday 30th November 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. My understanding is that there have already been three NAO reports and three PAC reports on this, so it has been covered in depth. I think people have accepted that mistakes were made and that the high-priority lane, so to speak, should not have been on the basis of referrals but more burden of proof should have been put on the applicants, so we could get more information and sift it that way. Again, to put it all into context, there were 19,000 applicants at the time. This was led by officials, and they put the high-priority lane in place to try to sift those. Also, of the 430 that went into the high-priority lane, only 13% actually ended up in contracts. Are there lessons to learn from this? Of course, but the NAO and PAC reports have outlined those lessons.

[Lord Browne of Ladyton (Lab)]

My Lords, experience tells us that the best deterrence against fraud and corruption are the twins of transparency and accountability; in the absence of such transparency and accountability, the reporting of the saga of PPE Medpro risks tainting others by association. So, for transparency if nothing else, will the Minister agree that relevant correspondence between PPE Medpro or its representatives, and Ministers or their officials, should be published and placed in the House of Lords Library, perhaps soon after the current investigations are concluded? Also for transparency, surely the public are entitled to understand what due diligence was conducted on this company and other similar ventures that emerged, apparently from nowhere, during the initial stages of the pandemic?

[Lord Markham (Con)]

I thank the noble Lord. As I am sure we are all aware, this is subject to a criminal investigation at the moment, so in terms of paperwork we need to let that take its due course. What I can talk about is what we are doing as a department on that, particularly in terms of the contracts for gowns which were defective, and it is in that area that we are in dispute with them. We have made a claim and put in place a process so that we will take it to court, and we will pursue that if we do not come to a negotiated settlement which is satisfactory.

Health and Care Bill

Lord Browne of Ladyton Excerpts

Lords Hansard - Part 2 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I congratulate my noble friend Lady Chakrabarti, the noble Baronesses, Lady Lawrence and Lady Brinton, and the noble Lord, Lord Russell, on supporting and promoting this amendment. Its explanatory statement says:

“In the event of a public health emergency of international concern, this new Clause requires the Secretary of State to support domestic and international knowledge-sharing, to combat the emergency.”


I cannot see why anybody would object to that.

I would like to say one more thing. The former Prime Minister, Gordon Brown, has led this country on how one should respond to a global pandemic with his work at the World Health Organization on the importance of sharing knowledge, vaccines and technology across the world. This amendment is about the pandemic that is coming down the track as well as the one we are dealing with at the moment, so we on these Benches certainly support it.

[Lord Browne of Ladyton (Lab)]

My Lords, I support this amendment. I do not intend to repeat the excellent points that have been made by others because the case in equity—and the case in our own interests—is absolutely compelling in my noble friend’s excellent amendment. However, for a short period of time, I do intend to test just how good the Government’s resistance to this is; I will do so by referring to the Minister’s own speech in Committee on this very amendment. I will ask two questions of the Minister; I hope that he will be able to answer them because, if he cannot, there is no resistance to this amendment.

On 9 February, on the ninth day in Committee, the noble Lord the Minister repeated the Government’s oft-repeated view on this issue when it has been debated in your Lordships’ House that

“the Government remain open to all initiatives that would have a demonstrably positive impact on vaccine production and distribution. However, we believe that waiving intellectual property rights would have the opposite effect. Doing so would dismantle the very framework that helped to develop and produce Covid-19 vaccines at the pace and scale now seen. It would risk undermining the continued innovation in vaccines and technological health products that is required to tackle a virus, especially as it mutates and evolves, so we believe that doing so would be a mistake.”

Social Care Sector: Private Equity

Lord Browne of Ladyton Excerpts

Thursday 27th January 2022 Lords Chamber

[Lord Kamall (Con)]

What is important is to make sure that we have continuous and high-quality care for patients. Therefore, where there are concerns about the financial stability of any company, whether it is funded by private equity or otherwise privately owned, it is important that we have a system to make sure that we manage that. If a company goes under, there is the ability to transfer patients to high-quality care. The important thing for us is the quality of care for patients—it is important that we put patients first.

[Lord Browne of Ladyton (Lab)]

My Lords, last year, during the pandemic, the business that my noble friend has referred to, HC-One, paid 10%—nearly £5 million, tax free—of those dividends to its financial controllers, who are holed up in the Cayman Islands. At the same time, it was given almost £20 million from the Government’s infection control fund to help it through the pandemic. Clearly, people’s pockets are getting picked here. If ever anything called for an independent inquiry, it is this behaviour by private equity businesses. Such behaviour is concerning the Bank of England: the Financial Stability Report shows that the level of leveraged debt that these businesses have is a threat to our economy.

[Lord Kamall (Con)]

The noble Lord makes an important point about the level of debt, but I am sure he is aware that a number of private companies operate with levels of debt. As we saw in the financial crisis, the issue is whether that debt is sustainable. The noble Lord, Lord Sikka, who is an accounting standards expert, understands all of the issues around IFRS 9 and all of the downsides to that when sufficient provision is not made for debt.

Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)

Lord Browne of Ladyton Excerpts

Wednesday 20th October 2021 Grand Committee

[Lord Browne of Ladyton (Lab)]

My Lords, it is an honour to follow the noble Viscount, Lord Ridley. I am pleased to accept his advice that, before we address the challenges, we should celebrate the achievements of medical science. If he will excuse me, I will take some time to reflect on some of his other advice, and I will certainly not introduce him to my sons until I have worked out what the implications might be.

It was a privilege and an education to have been a member of the Science and Technology Select Committee while it was carrying out this inquiry under the expert chairmanship of the noble Lord, Lord Patel. I associate myself with his words of recognition and thanks to the committee staff and our expert adviser, and I thank him for his impressively comprehensive introduction of a complex report in an accessible way. I do that principally because I will use it as reason for concentrating on one aspect of the report, which was raised both by my noble friend Lady Young of Old Scone and the noble Baroness, Lady Sheehan—the impact of inequalities. Over the months during which we took evidence, we found that inequality was the most significant challenge.

Our committee heard evidence from many witnesses to support the finding set out in the first conclusion of our report, which is that inequalities in healthy life expectancy remain stark. People in the most deprived groups on average spend almost 20 years longer in poor health than those in the least deprived groups. There are also shockingly large differences in healthy life expectancy among ethnic groups. The evidence that we received more than justified our recommendation that the Government prioritise reducing health inequalities and our request that they set out a plan for reducing health inequalities over the next Parliament—a request with which they respectfully declined fully to engage. There is hope yet. The Government, via the Minister, have been invited three times to engage with this issue, so it will be interesting to hear his response.

Our relatively short paragraphs on inequality disguise the scale of the evidence that we received of the all-pervasiveness of its effects on longevity and healthy living and the degree to which it repeatedly raised its head in our evidence sessions. In our report, the word “inequalities” is used 77 times.

We conducted our inquiry largely over the course of the pandemic, during which there has been a growing awareness of the degree to which poverty and the underfunding of public health have been associated with a large and unequal mortality caused by Covid-19 across the whole UK. However, before the pandemic, in many communities both life expectancy and, in particular, healthy life expectancy had begun to decline after a period of improvement. Hitherto, this decline in longevity was explained by growing unemployment or the replacement of long-term secure jobs by largely insecure and low-wage employment because of de- industrialisation and changes in the economy of the UK in the latter part of last century. Largely, these trends resulted in greater loss of good economic opportunities and jobs in the north as opposed to London and the south-east, where the burgeoning service economy and education opportunities gave young people, including some from poorer areas, a better chance to succeed in that changing environment.

However, during the period of austerity, these long-term changes were worsened by a deliberate decision to reduce social support, welfare payments and funding to local government and public services. By 2018-19, one in five people in the UK, including many in work, was living in poverty and many still are—in fact, those numbers are increasing. Like the changes in the economy, these austerity cuts had a greater impact in the poorest communities, making the effects of the loss of secure employment worse. Poverty and reduced funding of this nature were reflected in increased unhealthy and harmful behaviours, such as poor nutrition, alcohol use and smoking, and less provision of or use of preventive healthcare and, consequently, increased mortality.

Pedantically—and I hear this said regularly—it is correct that healthcare spending was affected less by austerity than other sectors. There has been an annual 1% to 3% increase since 2010, but it has been insufficient to keep up with the increasing demands of an ageing population. This imbalance has led to longer waiting times for primary and specialist care and, once again, the most significant effects have been in deprived areas. The real-term cuts in public health spending have also been larger in the north and north-east, where life expectancy lags.

To make matters worse, helping people to stop smoking and health checks, which affect diseases with substantial contribution to mortality inequalities, had greater than average funding cuts. To arrest and reverse this trend of falling life expectancy, we need economic and social policies that specifically address inequalities, supported by greater investment in public health and healthcare in the communities with the lowest healthy life expectancies.

Despite the terms of the Government’s response to the committee’s recommendations, thus far the post-Covid “build back better” agenda does not explicitly address equity. The levelling-up funding plans to address these regional inequities, particularly in the so-called left-behind districts, appear to be focused on investment and infrastructure. At best there has been a limited specific focus on areas such as child poverty, public health or high-skilled education.

An awareness of place is crucial to tackling inequity. It is regrettable that place-based improvement in northern cities, for example, remains limited to local action facilitated by devolution in cities such as Manchester, and community resilience, well-being and regeneration initiatives. Without additional resources for education, employment and health, these positive steps will prove insufficient to address this issue. To reverse the decline in longevity in many of our communities, health equity needs to be a key outcome of policy.

The date set for the publication of the spending review, 27 October, is the opportunity for the Government to provide at least some certainty on these important areas of spending and investment, including those identified in this report. It could also be the foundation for at least the outline of a coherent plan for reducing health inequalities over the next Parliament, as recommended in this report.

Personal Protective Equipment

Lord Browne of Ladyton Excerpts

Wednesday 24th June 2020 Lords Chamber

[Lord Bethell [V]]

My Lords, we have contacted over 175 new suppliers and recently secured a further 3.7 billion gloves alone to meet demand. This approach will massively increase our stockpiling as we prepare the resources that we need for the winter ahead. We would like to have line of sight for 90 days’ worth of PPE supply, and that is what we are working against at the moment.

[Lord Browne of Ladyton (Lab) [V]]

My Lords, in the last 10 years we have had three pandemic strategies, two national security assessments, a national biosecurity strategy and Operation Cygnus, and all have mandated the stockpiling of PPE, with advance purchase arrangements for what could not be stockpiled. The current NAO audit will reveal inadequate implementation of PPE plans, including logistics that needed to be rescued by the Army. Does the Minister appreciate that no one will trust or believe the Government about PPE unless stockpiles and logistics are openly reviewed, publicly reported on and independently audited? Will the Government put that in place now?

[Lord Bethell [V]]

The noble Lord is entirely right that public confidence is important here. I emphasise that huge progress has been made. We have signed contracts for over 2 billion items of PPE with over 20 UK-based manufacturers alone. The progress made on face masks, visors, gowns, aprons and so forth is enormous, and the accounting for that will continue through the usual channels of government procurement publication.

Covid-19: Test and Trace App

Lord Browne of Ladyton Excerpts

Monday 22nd June 2020 Lords Chamber

[Lord Bethell]

I want to say a profound thanks to those at NHSX, NHS Digital and others who have worked so hard on the NHS app. They have made phenomenal progress and their hard work is hugely appreciated. I also want to say a profound thanks to those at Apple who are working with us to design an app that suits the British public. Both teams have faced enormous challenges and I look forward to their working together to overcome them.

[Lord Browne of Ladyton (Lab) [V]]

My Lords, getting back to the fundamentals, why did NHSX decide to make a new contact tracing app and not collaborate with other countries which had successfully produced such apps? What is the specific business case or use case if the app continues to require a different design from those implemented already?

[Lord Bethell]

My Lords, from the beginning we have worked closely with other countries, including in Asia, Europe and America. We have worked closely with companies including Apple and started our dialogue with it the moment it launched its app. There are a number of challenges. A most profound one is our need to use technology to tackle local outbreaks. Without local information on where new cases have originated, it is difficult for the Government to achieve that task. We look forward to working with Apple to try to define a use case around that.