Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020

Lord Reid of Cardowan Excerpts

Thursday 7th January 2021 Lords Chamber

[Lord Reid of Cardowan (Lab) [V]]

My Lords, I will make only two points.

First, if our fellow citizens are being asked to undergo testing and tolerate restrictions, self-isolation, lockdown and so on—I support these measures—how on earth do the Government explain why so many visitors to this country have been able to fly into our airports without testing, self-isolation and lockdown? How do they explain that to people?

Secondly, what consideration is being given to the effect of the restrictive regulations on the terminally ill? Each year, some 225,000 people undergo palliative care in the United Kingdom. Some have only weeks or months to live. To them, every day is like gold dust, yet currently those undergoing such treatment outside hospices are behind some 7 million other people in the queue for vaccinations. Do not the restrictions being placed on that group cry out for a commensurate prioritisation in vaccination?

Brain Tumour Research

Lord Reid of Cardowan Excerpts

Thursday 19th November 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the work of the charity sector in medical research is absolutely fundamental to national progress in this area. However, it too has been hit incredibly hard by Covid. We are having a number of dialogues with medical research sector representatives on how we can help. There will need to be a short, medium and long-term approach to getting back to where we were at the beginning of the year. How we bridge the current funding gap is a source of enormous concern to the department and the NHS. I cannot guarantee that we can necessarily embark on exactly the same framework that we envisaged at the beginning of the year, but I can reassure the noble Lord that we are very committed to the research community and we engage with it regularly on how we can help.

[Lord Reid of Cardowan (Lab)]

My Lords, several references have been made to our late and much-loved colleague Tessa Jowell, who I was proud to call a friend. Was she not prescient when in her last speech to this Chamber she said:

“I am not afraid. I am fearful that this new and important approach”—


referring to research—

“may be put into the ‘too difficult’ box”. [Official Report, 25/1/18; col. 1170]

When the Minister tells us in all sincerity that it is just too difficult to spend the £40 million that was promised, will he at least give this House an assurance that after this discussion he will take a personal and direct oversight of this matter, because it would be a great tragedy if those words of Tessa Jowell proved to be correct in the long run?

[Lord Bethell (Con)]

I hear the noble Lord’s words loud and clear. I reassure him that the good news is that Tessa Jowell left behind her in the Tessa Jowell Brain Cancer Mission an incredibly effective organisation that is holding the feet of Ministers firmly to the fire —not least through my noble friend Lord O’Shaughnessy, who is on my case in a very big way.

I recognise that this is one of the tricky scientific challenges of our age. We have struggled to tackle adult brain tumours for a very long time. There has to be investment in the basic science around them, in the techniques, such as the very focused radiology, and in provable therapeutics that work in the field. This is not going to happen overnight, but I reassure the noble Lord that we are committed to finding a solution.

Covid-19: Response

Lord Reid of Cardowan Excerpts

Monday 27th July 2020 Lords Chamber

[Lord Bethell [V]]

My Lords, the Cabinet Office is charged with the role of deciding the order of priority. There are precedents for this; it is a well-established list that is decided at a level outside the DH. I do not know if Cabinet Ministers are given priority, but I slightly suspect that junior Ministers are not.

[Lord Reid of Cardowan (Lab) [V]]

My Lords, I will ask about the poorest of our fellow citizens. According to the ONS report last Friday, in the four months March to June this year, the mortality rate for Covid-19 in the most deprived areas of England was 140 deaths per 100,000 people. This was more than double the mortality rate—63 deaths per 100,000 of population—in the best-off areas. In fact, it was 120% above. Even worse, in June the mortality rate in the most deprived areas was 137.5% higher. In short, it is getting worse. Why was there no mention of any of these in the Statements that have been laid before us? What measures are the Government taking to address this particular problem?

[Lord Bethell [V]]

The noble Lord touches on a subject that is extremely sensitive—it makes me feel emotional to think about it—but he is entirely right that those who are least advantaged in society are hardest hit by this disease and lots of other diseases. There are behavioural reasons for this: the decisions that people make about social distancing and their own health. There are also environmental reasons: the living conditions and the places in which they live. Neither of these detract from the fact that this is a very sad and upsetting truth. However, we are extremely conscious of the challenge, as we are of all health inequalities. The particular lever that we are focused on is trying to get our message out to hard-to-reach communities, who may not have heard the important messages on hygiene, social distancing and isolation. We have in place a programme of marketing in order to reach these communities to communicate these important messages.

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

Lord Reid of Cardowan Excerpts

Friday 24th July 2020 Lords Chamber

[Lord Reid of Cardowan (Lab) [V]]

My Lords, I have one minute in which to make one simple point. These are very detailed regulations, but whatever the level of detail, they will not have the intended effect unless the Government’s communication and messaging is clear, concise, unambiguous and constant. Sadly, I am afraid that until now, on lockdown, testing, quarantine, technology, face masks and many other things, Ministers have often appeared to equivocate, dither or delay, and that only confuses the public with mixed messages. I ask the Minister simply that we should please avoid doing that this time. Can we ensure that there is consistency and clarity in messaging, otherwise the effect of these detailed regulations will be lost?

Social Distancing: Two-metre Rule

Lord Reid of Cardowan Excerpts

Tuesday 16th June 2020 Lords Chamber

[Lord Bethell [V]]

My Lords, social distancing has without doubt been the most effective tool in the battle against Covid. That is why the Prime Minister has appointed the Permanent Secretary, Simon Case, to undertake a review, which will include the Chief Medical Officer and the Chief Scientific Adviser. The use of masks might offer some protection but in no way will it ever replicate the impact of social distancing. That is why we are not prejudging any review or making any assumptions about any changes.

[Lord Reid of Cardowan (Lab) [V]]

My Lords, some of the Government’s own scientific advisers have said that being one metre apart carries up to 10 times the risk of being two metres apart. Are the Minister and the Government willing to take that risk? If so, will any changes to the two-metre rule be reviewed, assessed and changed if necessary, and how often would such further reviews take place?

[Lord Bethell [V]]

The noble Lord’s maths is entirely right. That is why we are moving cautiously in this area, despite many people’s concerns and despite the profound effect on industries such as the hospitality industry, which we regret enormously. However, the main focus is to drive down the infection rate. If we can get the prevalence levels down sufficiently, social distancing will not be required any further, and it is on that target that we are focusing.

Covid-19: Mental Health

Lord Reid of Cardowan Excerpts

Tuesday 16th June 2020 Lords Chamber

[Lord Bethell [V]]

My Lords, supporting children and young people’s mental health during and after the pandemic is absolutely a priority. Mental health providers are offering support using digital and remote approaches to continue assessment and treatment during social distancing measures. This is part of the wide range of support that we are providing. The noble Lord is entirely right that this area requires a huge amount of investment; we have committed to making that necessary investment.

[Lord Reid of Cardowan (Lab) [V]]

My Lords, the Covid pandemic has often been referred to as the invisible enemy. That is all too often true of mental health issues as well. Is the Minister aware that the campaign group Beyond Tomorrow has estimated that 83% of young people have said that the coronavirus pandemic has made their mental health worse? Will he guarantee that all young people and families who need immediate mental health support can get it to prevent the pandemic having long-term consequences for young people’s mental health?

[Lord Bethell [V]]

The noble Lord is entirely right to focus on the impact of the pandemic on young people. It is not yet clear how that mental health impact will take effect. The natural concern is that it will be long standing. One thinks back to the major economic shocks of the past, which often led to long-term mental health issues for those who found economic insecurity. The struggle to find jobs left them with damaged confidence and concerns about the future. With that in mind, we are very much focused on addressing young people’s mental health and the impact of the epidemic.

Covid-19: NHS Contact Tracing App

Lord Reid of Cardowan Excerpts

Monday 18th May 2020 Lords Chamber

[Lord Bethell]

My Lords, I completely hear the noble Earl’s reservations about certification. Our plans are in development. We are fully aware of the concerns that he has expressed about their potentially divisive nature, but the public deserve to know whether they have had the disease. We have to use whatever technology we can to help shake off the economic and social effects of this virus. Therefore, we retain an open mind on the use of certification.

[Lord Reid of Cardowan (Lab)]

Does the Minister accept that the proposed tracking app we are discussing will effectively exclude those who do not have a smartphone or the experience, knowledge or capability to operate apps or Bluetooth? That will disproportionately exclude the elderly, the poor and the disadvantaged—exactly the groups most at risk from Covid-19. What plans do the Government have to include this group in any future tracking and testing regime?

[Lord Bethell]

My Lords, the testing and tracing regime depends on three legs: access to tests; updated methods of the classic contact tracing run by individuals, using phones and the internet; and lastly, importantly but not exclusively, the NHS app. We are very much focused on ensuring that the vulnerable, the elderly and the digitally poor are in no way excluded, which is why we have put the human element at the centre of our plans.

NHS: Brexit-related Risks

Lord Reid of Cardowan Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord O'Shaughnessy]

It would be a big mistake for anybody to tell the British people that they voted the wrong way. I point out to the noble Baroness, however, that, whatever was on any side of the bus, as a result of the funding plan announced by the Prime Minister there will be £394 million a week more in real terms for the NHS by 2024. I am also pleased to say that there are more EU staff working in the NHS today than two years ago.

[Lord Reid of Cardowan (Lab)]

My Lords, the problems and challenges of Brexit will only add to the massive challenges which, in our enthusiasm for the birthday of the NHS, we sometimes underestimate. These include demographic change, an ageing population, new inventions and therapies, new pharmaceutical products and so on. Although I very much welcome extra money, this problem will not be solved just by extra money; it will require massive organisation, radical restructuring, and innovation in technology on a massive scale. That will not be achieved by one party on its own. Why, therefore, do the Government constantly refuse the recommendations of some noble Lords and committees in this House to establish a cross-party consensus on this and take party politics out of it to the maximum extent? That is the only way—accompanied by money—that we can save the NHS for the next 70 years.

[Lord O'Shaughnessy]

The noble Lord knows better than most the challenges of transforming the National Health Service, and is right about the big challenges that we face—although I think it is better to look at them as opportunities. He is also right that reform has to go hand in hand with extra money. We promised the extra money; we now need to see the reform. Every part of the health service—the department, the NHS, and others—needs to drive that through. On his point about consensus, I do not think there is anything stopping that consensus: the Government want consensus. We do not necessarily think that it needs to be in the form of a royal commission or a parliamentary commission. We want to work with all corners of this House and the other place to make sure that there is support for a broad plan for the NHS for the next 10 years.

NHS: Waiting Lists

Lord Reid of Cardowan Excerpts

Monday 26th February 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right to highlight this issue. There simply are not equivalent waiting times for CAMHS. As she mentioned, we have introduced the first waiting times for eating disorders and early intervention in psychosis. I think she will have been pleased to have seen in the Green Paper published before Christmas that a new four-week waiting time for NHS children and young people’s mental health services will be piloted. That will be rolled out in the near future.

[Lord Reid of Cardowan (Lab)]

My Lords, in the eight years before 2010, waiting lists and waiting times were brought down dramatically. In the eight years since 2010, waiting times and waiting lists have risen dramatically. What does the Minister think happened in 2010 to change that?

[Lord O'Shaughnessy]

I think we all know what happened in 2010, but it might be worth pointing out that 10 years ago, half of patients waited more than 18 weeks for referral to treatment and that is now only about 10%.

National Health Service (Mandate Requirements) Regulations 2017

Lord Reid of Cardowan Excerpts

Wednesday 6th September 2017 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, we on these Benches support this Motion.

This debate shines a spotlight on the existential quandary facing CCGs and NHS Providers. I am sure that at the end of the debate the Minister, in his usual courteous and thorough way will, as he always does, give us lots of figures about how much more the Government are spending every year and how many more treatments are being delivered and how well the STPs are doing. With demand rising, naturally the raw numbers are higher, but the Government have chosen an RTT target in percentage terms and they must live with that decision and fund the consequences. Over recent years, the increase in funding for the NHS has not kept up with rising demand. This year we have a lower increase than before, and so now is crunch time. As the noble Lord, Lord Hunt, said, nobody is even pretending that providers will be able to deliver the targets while remaining within their budgets. So there is no point in the Government watering down the targets and pretending that no one will notice. The noble Lord, Lord Hunt, and many others have noticed, and I am grateful to him for giving us the chance to have an honest and open discussion about this.

NHS staff work hard and do their best to meet the targets under difficult circumstances. It is not their fault that the RTT targets have not been met for 16 months. But changing the targets is a political decision, whether it is being done openly or not, and that is only right. It should certainly not be left to local decision-makers, in a postcode lottery, to quietly ignore them or try and fail to live up to them and then take the flack when people criticise. If the Government choose to change the target, they should take the responsibility for the consequences. But the trouble is that patients will live with the consequences, living longer with debilitating and painful conditions. Having those conditions worsen and requiring more complex and expensive treatment, they may even become untreatable, and their quality of life and perhaps their mental health will deteriorate. So although the 2012 Act was intended to pass the blame on to anyone but the Government when things go wrong, everybody knows that the Government’s NHS mandate is the Government’s NHS mandate and nobody else’s. The NHS can spend the money only once, and the Government should not be expecting two treatments for the price of one. The bald facts are that, this year, demand was expected to rise by 5.2% while the funding is only going to rise by 1.3%, which is 2.3% less than last year—which was too little anyway. So this is a deliberate choice on the part of the Government.

Waiting lists are projected to rise to almost 5 million by 2020, and clearing this backlog will require not only funding but appropriately trained staff. With staff who are EU citizens leaving in droves because of Brexit uncertainty, and UK staff leaving because of overwork and stress, NHS Providers is finding it impossible to deliver waiting time targets. At the same time there is spare capacity in the private sector but it charges more than the NHS, so that is a hard choice for managers to make. I therefore ask the Minister a simple question: what assessment did the Government make of the potential impact on patients and waiting lists of deprioritising elective care and taking the decision to relax the 18-week target?

The RTT is not the only target the Government have changed, as the noble Lord, Lord Hunt, mentioned, and this is looking rather like a habit. For example, NHS England and NHS Improvement are reportedly setting new targets for CCGs and providers for bed occupancy levels, to keep them below 92%. This is significantly higher than the recommended safe limit of 85%. The Royal College of Surgeons has warned:

“Anything over this level is regarded as riskier for patients as this leads to bed shortages, periodic bed crises, and a rise in healthcare-acquired infections such as MRSA”.


This is another target that was routinely missed last winter, and the latest figures show that the overnight occupancy rate for general and acute beds hit a record high in the fourth quarter of 2016-17, averaging 91.4%. If the Royal College of Surgeons is right, this high level of bed occupancy is not a measure of efficiency but could lead to greater costs and crises, which put patients in danger.

Is it not time for the Government to stop pretending that all is well and that they have all the right answers, and set up a cross-party commission on the funding of health and social care, as recommended by my right honourable friend Norman Lamb MP? We on these Benches would be enthusiastic about taking part in such discussions. I think that the public are very fed up with health and care being a political football and would like to see us working constructively together. They want some honesty and realism. Of course we do not want to go back to the 1950s: I was waiting for a tonsillectomy and after two or three years, when my mother was fed up of waiting, she discovered that I had been taken off the list on the assumption that I had grown out of it. Actually, I had, but we need to be a great deal more ambitious for the NHS than that.

I know that the Minister makes the best of his brief but I would like to think that he will go back to his department and use his considerable powers of persuasion to stop the Secretary of State from burying his head in the sand.

[Lord Reid of Cardowan (Lab)]

My Lords, I join with this regret Motion, not as a matter of formality but because of deep and genuine regret at the position that the Government have now, by hook or by crook, engineered, which is the effective abandonment of the 18-week target.

I will briefly recall to the House where we were before that target was introduced. With respect to the noble Baroness, Lady Walmsley, we do not have to go back to the 1950s. We can go back less than 15 years, when my predecessor, Alan Milburn, became Secretary of State for Health. The maximum waiting time then was not 18, 24 or 52 weeks for elective operations but three years. Due to his sterling efforts and, I have to say, his adviser, who also advised me—Mr Simon Stevens—we reduced that, but not nearly as much as I thought was necessary in a civilised society.

Therefore I admit a conflict of interest in this debate: I introduced the 18-week target, against some considerable opposition—not in principle but because, I was constantly told, “it couldn’t be done”. But we did it. I remind the House that at that time the number on the waiting list, waiting for as long as three years, was the horrific figure of 1.2 million. It is now 2.7 million and it is estimated that it may rise to 5 million. Therefore there are more and more people, and undoubtedly, once this target has been effectively removed, those pressures will immediately start a process whereby it will go well beyond 18 weeks and we will go back to where we were some 15 years ago.

I will make a couple of points about this situation; the first has already been alluded to. These targets were also to reduce MRSA—hospital-acquired disease —in hospitals by 50% over four years, which we did, despite the fact that we were told that we could not do it. It was also to take hundreds of thousands of people off the waiting list. This was an effective way, not of making a political point but to remove people from pain, distress, discomfort and, above all, the insecurity of not knowing when and if they might have the condition treated. I recall that at the formation of the National Health Service one of Labour’s greatest heroes, Nye Bevan, produced his framework in a pamphlet that was not called “In Place of Pain” but In Place of Fear. The fear that people had for their families, their senior citizens, their children, of the prospect of waiting several years, even with what might appear to others to be relatively small difficulties and medical conditions, is inestimable. Therefore this was, more than anything else, about the relief of human discomfort and insecurity.

Secondly, having been there, I know that this is not easy. It is never easy. I have a great respect for Simon Stevens as a person and an administrator. However, he is caught between all sorts of conflicting demands—an increasing population, people living longer and, I have to say, a relative reduction in resources as well as a shambolic reorganisation which was the worst use of money I can think of in the health service in the past several decades. So I do not blame him, but it is the Government’s job to face up to difficult tasks, and it will take political will.

--- Later in debate ---

As I close, it is important to bear in mind that this Government have increased spending on the NHS year on year since 2010. The NHS will receive around £10 billion a year additional funding in real terms by 2021. NHS spending as a percentage of all public spending is going up all the time while we are addressing the £150 billion black hole in the public finances that we took over in 2010.

[Lord Reid of Cardowan]

No.

[Lord O'Shaughnessy]

That is the truth.

Next year the NHS turns 70. As my noble friend Lady Redfern said, it has a unique place in our society. The mandate to NHS England for 2017-18 goes further than ever before to ensure that we not only continue to deliver the best care and support for today’s NHS patients but also deliver the reform and renewal needed to sustain the NHS for the future. We know there is more to do, which is why we have put our commitment to support NHS England and the NHS in delivering the five-year forward view at the heart of the mandate. We will continue to do so. I hope that I have persuaded all noble Lords, including the noble Lord opposite, that their fears are unfounded, and that the noble Lord now feels in a position to withdraw his Motion.