Covid-19: Extent of Infection

Lord Fowler Excerpts

Wednesday 22nd April 2020 Lords Chamber

[Lord Bethell]

My noble friend Lord Dobbs is entirely right to put his finger on this important matter. The CMO was clear from the very beginning that Britain’s mortality rate came as much from Covid as from non-Covid deaths. We review this situation regularly and thoroughly, and we will be glad to update the House at a future date. We are very conscious of the threat of which my noble friend speaks.

[The Lord Speaker (Lord Fowler)]

Supplementary question: the noble Lord, Lord Krebs. Lord Krebs? No? In that case, I call the noble Lord, Lord Hain.

--- Later in debate ---

[Lord Bethell]

The noble Lord raises a completely valid point on the accessibility of drive-in centres. They suit some people but not all, as he rightly points out. That is why we have brought in at-home testing arrangements, delivered mainly by Amazon. They started on Monday, and we are very ambitious for both their scale and their scope, particularly for the demographics of which he speaks.

[The Lord Speaker]

Supplementary question: the noble Baroness, Lady Lawrence of Clarendon. Lady Lawrence? No? I call the noble Lord, Lord Moynihan, for his supplementary question.

[Lord Moynihan (Con)]

Over 90% of the population will be unlikely to have suffered from Covid-19 when the restrictions are lifted. Will the Government therefore initiate and support a nationwide fitness and recreation campaign, given that physical exercise can help ensure that immune systems become stronger and less susceptible to infections and their most severe consequences and lead to a greater ability to recover from infections?

--- Later in debate ---

[Lord Bethell]

Serology tests provide important data on the behaviours of the virus. We still do not fully understand what kind of immunity and antibody response will be long-lasting in the body. There are mysteries to this virus that are yet to be solved; serology tests are vital to that and they can play a part in the back-to-work strategy. However, I would remind him that it is a tiny proportion of the population—probably around 5%— who have antibodies. We cannot put the economy back on its feet with just 5% of the population.

[The Lord Speaker]

My Lords, I am afraid that the time allowed for this Question has elapsed. Two noble Lords were not called; I am sure that this will be taken into account in future lists.

Covid-19: Removal of Restrictions

Lord Fowler Excerpts

Tuesday 21st April 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is entirely right. Tracking and tracing will be absolutely essential for keeping down R0, the transmission rate, when it comes to the implementation of our medium-term strategy. We are working extremely hard to dramatically increase our testing capacity. I assure the House that that capacity is growing enormously, at scale and exponentially. It is our expectation that it will easily meet the requirements of tracking and tracing. That tracking and tracing will be implemented by several work streams. The app already unveiled will be an important part of that, as will the PHE manual contact-tracing resources and the use of any other technological advances and innovations developed as part of this response to the epidemic.

[The Lord Speaker (Lord Fowler)]

Lord Mackay of Clashfern. No? Okay, we will go on. Lord Patel.

[Lord Patel (CB)]

Noble Lords cannot see me, but I hope they can hear me. One of the five conditions the Government have set themselves before any changes will be made to the current lockdown is that they will have to be confident that there will not be a second wave of infection. What scientific evidence will the Government need in support of this decision, and what role will population-based serology testing play in this decision?

--- Later in debate ---

[Lord Bethell]

The noble Lord is entirely right. I commend the colleagues from all the nations with whom I have been working over the last month. One of the most singular and impressive aspects of the response to Covid-19 has been the way in which the four nations have worked together. I am enormously grateful to my colleagues for the consistent, collaborative and helpful approach that has characterised this response. Geographical difference is the kind of subject that the CMO will give us advice on. This is, naturally, a huge concern to those who feel that they might be left behind, but the CMO will provide the best advice and we will follow the science.

[The Lord Speaker]

My Lords, I afraid that the time allowed for Questions has now elapsed. I thank all noble Lords who have contributed to the first Oral Questions session by way of a Virtual Proceeding. As the noble Lord, Lord Baker, said, it shows that we can hold the Government to account in different ways. We will, doubtless, get better at it as the weeks go by, but this was a very important beginning and the information that came out was valuable. I thank all noble Lords and apologise to those who did not get to speak. That brings the Virtual Proceeding to an end.

Health: Eating Disorders

Lord Fowler Excerpts

Tuesday 7th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

My Lords—[Interruption.]

I am getting some help from the other side.

The noble Baroness is quite right on this matter. It is vital that professionals are trained to look out for potential signs. Obviously, with such a deadly mental illness—

I am not sure whether to stop or carry on.

Diagnosing eating disorders is an important area of mental health practice, so Health Education England is taking forward a significant package of work at the moment to review current education and training offered to identify gaps and ensure that not only junior doctors but general practitioners and nurses have the right kind of training.

[The Lord Speaker (Lord Fowler)]

My Lords, we now come to a number of First Readings. It might be helpful to the House if Members were kind enough to switch off their mobile phones before coming into the Chamber.

Blood Safety and Quality (Amendment) (EU Exit) Regulations 2019

Lord Fowler Excerpts

Wednesday 19th December 2018 Lords Chamber

[Lord Foulkes of Cumnock (Lab Co-op)]

Object.

[The Lord Speaker (Lord Fowler)]

Then we will take the first Motion on the blood safety regulations.

NHS England: Pre-exposure Prophylaxis for People at Risk of HIV

Lord Fowler Excerpts

Tuesday 7th June 2016 Lords Chamber

[Lord Prior of Brampton]

As I said in response to the earlier question, this is really not about the efficacy of the drug. There is evidence that it is very efficient; that will be confirmed or otherwise by the extra work done by PHE. It is purely a question of the independent legal advice given to NHS England that it does not have the power to commission this drug.

[Lord Fowler (Con)]

The independent advice seems extremely curious and the Minister should go into more detail, because surely we are past the stage of needing a pilot. The international evidence on PrEP is overwhelming. Is not the underlying fear here that policy on HIV has gone off the boil, in spite of the fact that prevention measures such as this are good in both human and financial terms?

[Lord Prior of Brampton]

All I can say in response is that NHS England has had independent legal advice that it does not have the power to commission this particular drug for this particular purpose, and for this purpose the drug itself is not yet licensed. It is not to do with any decision made on efficacy grounds for this drug; it is purely that they have received independent legal advice.

Health and Social Care: State Pension

Lord Fowler Excerpts

Thursday 21st January 2016 Lords Chamber

[Lord Prior of Brampton]

The NHS plan is for the whole five-year period—the lifetime of this Parliament. It was signed up to by all the arm’s-length bodies within the NHS. The Government support that plan and are front-loading the financing to support the plan as well, so we believe that the plan is achievable.

[Lord Fowler (Con)]

Is not the key point exactly the one that has just been made? We are talking not about the five-year plan but about the years that come after that and how you get a National Health Service which can be financed over the long term. Surely that is what we should also be looking at, apart from the Government’s own plan.

National Health Service

Lord Fowler Excerpts

Thursday 14th January 2016 Lords Chamber

[Lord Fowler (Con)]

My Lords, I did not agree with everything that the noble Lord said, but I congratulate him on how he set out the pressures that the health service faces and will face in future. As he forecast, it is for reasons like that that I advocate a royal commission to examine the future financial—and I emphasise financial—requirements of the health service and propose ways in which that demand can be met. My proposal has absolutely nothing to do with the current industrial dispute. Indeed, I suspect that the BMA would not be a natural supporter of such an independent investigation. Basically, I want a commission to investigate how we can continue to afford a National Health Service providing care irrespective of income, which is what everyone in all parties wants, while recognising the financial challenges of an ageing population and the extra cost involved in medical advance. At the same time, we must recognise that public spending on health should not crowd out all other areas. I also want to see good education, a strong police service and—if noble Lords are interested, we are debating this subject next Thursday at about the same time—better prisons. If this is not an intrusion into private grief, I want a strong defence policy as well.

It is against that background that I would set out four requirements for a royal commission. First, it should be absolutely independent; it should be neither a political body nor an insider body. Secondly, it should look at how we finance the health service, otherwise there is absolutely no point. What we want are the best ideas on financing a service that we all value, irrespective of party, and we should re-examine old policies—for example, policies such as prescription charges, which mean at the moment that 90% of prescriptions are prescribed free. Thirdly, a royal commission should look at all the options; it should certainly examine experience, particularly in other countries of Europe, but it should investigate the potential of a health tax—a ring-fenced contribution to the costs of healthcare, which would have the advantage of connecting the taxpayer much more closely to the cost of the health service that they finance.

Fourthly, and lastly—and personally I regard this as crucial—a royal commission should investigate the long-term savings and benefit of better public health. Both Governments have failed here. The national health basically remains a sickness service, not because that is what Health Ministers want but because that is what the Treasury allows. The Treasury will try to provide resources for treating the casualties, but it is very reluctant to invest in preventing those casualties. It says that you cannot show that it will work, when the evidence is clear that prevention policies can and do work, not least in the 1986 AIDS campaign, which reduced not only HIV but all other sexual diseases at the same time. Even worse than this general failure is the fact that the Treasury has now chosen public health as the one area in the whole of the health field where spending is to be reduced, which is an entirely retrograde step.

There is a vast amount to do, and what we do now has implications for years to come. I believe that a royal commission has the potential to provide a proper base on which to face the financial challenges and to win public support.

Junior Doctors Contract

Lord Fowler Excerpts

Friday 20th November 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, the noble Lord said that this was a serious concern. It is a tragedy that we are in this situation. Of course I want a settlement, as does the Secretary of State. The last thing we want is a strike. We want the junior doctors to come back to the negotiating table and not to go on strike. The only people who will suffer from a strike are patients. I cannot believe that there are many junior doctors who want to go on strike, so it is in all our interests to find a settlement, and the Secretary of State, myself and others are very keen that we do so. The Secretary of State has made it absolutely clear that there are no preconditions, save that we settle this issue within the existing pay envelope. The door is open to the BMA to come back for talks at any time.

[Lord Fowler (Con)]

My Lords, is my noble friend aware that in 1982, when I was Health Secretary, there was lengthy industrial action not involving doctors. When I went to St Thomas’ Hospital over the river, I was met by a deputation of doctors protesting at the damage that was being done to the health service. It is the successors of those very doctors who are now threatening industrial action. Should we not all, quite irrespective of party, condemn industrial action, which will damage patient care? Should we not also recognise that this action is not just against the Government? It also involves the rejection of the independent doctors’ and dentists’ remuneration review body, which is valued and respected throughout the health service and which doctors over the years have pressed to have. Surely we are faced with a failure of BMA leadership in this case, and the obvious course is to go back to the negotiating table very quickly.

National Health Service: Sustainability

Lord Fowler Excerpts

Thursday 9th July 2015 Lords Chamber

[Lord Fowler (Con)]

My Lords, first, I congratulate most sincerely the noble Lord, Lord Patel, on his speech and on the debate. He talked about exactly the kind of issues that we should be talking about, and which the public generally should be talking about. As he might imagine, what he said about a commission was music to my ears. We should take note of what he also said about the financial problems in the NHS, which are endemic.

It is spending not just today about which we should be concerned—although I congratulate the Chancellor of the Exchequer on the resources he has made available—but spending in the future. For far too long, there has been a political preoccupation with structures and organisations to the extent that today there cannot be one person in 100 who could say how the National Health Service is actually organised. That includes quite a number of people working in the health service.

I hope that the debate can now change and tackle the obvious problems that we face. The principal one is clear. We all want a health service free at the point of delivery so that people are not denied healthcare because of a lack of income. That is basic. However, we also know that the costs of the health service are increasing because of medical advance, rising expectations and an increasing elderly population. The question is: how can we finance this increasing demand? That is an appropriate question on the day after the Budget. It is also appropriate because it seems to me that the dangers are clear. We are funding health through general taxation but what is crystal clear is the pressure on public spending. That pressure will continue. At the same time we find that large areas of public spending are exempt from economies and reductions. Health, of course, is one of those and 60% of social security spending is another.

The Government are forced to look at the areas not protected for reductions, such as the 40% of the social security budget. It is for such reasons that they are driven into eccentric policies, such as putting the costs of the over-75s television licence fee on to the BBC. I say “eccentric” although I could put it rather higher than that—I might on Tuesday when we debate this issue. The fact that the Government are driven to such policies shows just how uncertain the position is. It raises the question of whether public spending will be sufficient to meet the emerging needs in the long term, and whether we can keep going on the same basis and keep going back to the same departments to make economies.

I raised that issue in the Queen’s speech debate, but received what I term a dusty ministerial reply from the first Conservative Government for nearly 20 years, which was that Derek Wanless had gone into all these issues a few years ago. I find it slightly odd that the Government should rely on a report commissioned by Gordon Brown, published in 2002 and prepared by Derek Wanless and the health trends review team of Her Majesty’s Treasury. It is particularly odd when you consider that the report looked at the resources required, but said quite explicitly:

“Its remit was not to look at how those resources should be financed”.

It also said that there should be further and regular reviews.

To my mind—and I very much echo what the noble Lord, Lord Patel, said—what is required at the start of the new Parliament is a thorough, independent and authoritative review of the financial pressures that the health service will come under, and at the same time to set out the options for financing healthcare. We may find that funding it out of general taxation is the best and most cost-effective method—I certainly argued that it was a cost-effective service when I was Secretary of State—but we cannot have a sensible debate on the way forward without examining the other issues. We could have a ring-fenced health tax, or look at a potential system of health insurance. We should explore the part that charges could play: I always found it extraordinary that, for example, prescription charges caused so much upset, given that about 70% were prescribed absolutely free. We should look at economies that can be made in the drugs bill and a whole range of other things.

These are difficult questions, particularly given how health is exploited as a political issue—any change is alleged to mean the destruction of the health service as we know it—but they are options that should be explored. That is why I believe that a royal commission, made up of independent members and working quite openly, would be the way forward. It would look at the resources needed to deliver a high-quality health service that is free at the point of delivery, but also examine how those resources should be financed. I am sure that many will say that this cannot be done and that it is politically too difficult. Frankly, however, we have an exceptional opportunity, at the beginning of a Parliament, to mount a thorough and open investigation into the financial pressures that the health service is and will be under and how they can be met. That would be supported by those who are concerned about not just the state of the health service today, but its future over the coming years. I very much hope that this is a challenge the Government will not duck.

NHS: Immigration Rules

Lord Fowler Excerpts

Wednesday 24th June 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, the Royal College of Nursing figure I saw was closer to 3,000 than 7,000, but in a sense that is not what is important. What is important is that over the long run we train our own nurses in this country. Although we recruit some exceptionally wonderful nurses from places such as the Philippines, it does not seem a good long-term strategy to rely on recruiting nurses, often from third-world, quite poor countries, so I am very pleased that we are going to train 23,000 new nurses over the next five years. That is the right answer to any short-term, temporary shortage.

[Lord Fowler (Con)]

My Lords, surely the central point is that we should review the policy of recruiting nurses from overseas, as I think my noble friend is indicating. Should we not in a bipartisan way now concentrate on training our own nurses in this country rather than permanently taking them from other countries, for example, in Africa, which often desperately need their care?

[Lord Prior of Brampton]

My Lords, I agree with my noble friend; it cannot be right for a rich country such as ours to recruit nurses from much poorer countries. I will just say that the Philippines, for example, produces more nurses on a deliberate basis than it needs for itself, so that they can go overseas, usually for temporary periods, not permanently. Interestingly, over the last five years, the number of non-EU overseas nurses working in this country has reduced by 41%.