Category: Health

Alex Norris – 2020 Speech on Organ Donation

Below is the text of the speech made by Alex Norris, the Labour MP for Nottingham North, in the House of Commons on 19 May 2020.

I have to say that I am used to clearing rooms when I start speaking, but this is quite impressive even by my own standards. Nevertheless, it is a privilege to make my debut at the Dispatch Box as shadow public health Minister on a topic as important as this one. Currently, everything we are addressing is a matter of life and death, but when we are talking about critical transplants, that could never be clearer.

I thank the Minister for everything she is doing during this crisis, not only on this particular issue but on everything related to protecting us from the coronavirus. She and her ministerial colleagues are working around the clock and have been doing so for weeks; we appreciate that.

This is my first opportunity to express publicly in this place my thanks to our NHS and social care staff for all the wonderful things that they are doing in my community and communities up and down the country to keep us as safe as possible.

We clap with you on a Thursday, but we think about you always and we are really grateful for everything you are doing.

The transplant of organs and human tissue changes and saves lives. It brings hope, it can bring happiness and it is the ultimate altruistic act. The Organ Donation (Deemed Consent) Act 2019 promises a significant breakthrough in the ability to save and change lives. Those who campaigned for it spotted the public mood and understood the British people on this issue. However, a key part of understanding that fundamental desire of the British people to do well by each other is to understand that this change has to hold within reasonable limits. It is therefore right that we are completing the process today and setting out clearly the sort of tissue that goes beyond routine transplantation. That is a critical part of maintaining public confidence in the process.

The Opposition supported the Act during its progress and we support the regulations before us today. We have many people to thank for last year’s Act. I will start by thanking Geoffrey Robinson, the former MP for Coventry North West, for introducing the Bill. His legacy in this place is significant on a number of issues, and this legislation will certainly have long-lasting and far-reaching implications. I also thank my hon. Friend the Member for Barnsley Central (Dan Jarvis) for taking up the baton in 2019 and getting the legislation over the finishing line—he continues to be an excellent champion of the Act, and I think we will hear from him shortly—and, in the other place, the noble Lord Hunt for his stewardship of the legislation.

Of course, I also pay tribute to Max Johnson and Keira Ball, after whom the Bill was known. Keira tragically died in a road accident, but her heart saved Max’s life at age nine, after an eight-month wait. They are truly inspirational and a huge part of why we are here today, as indeed is everyone who supported the campaign, not least the Daily Mirror and its readers. Each and every supporter has helped to bring us here today to do this important job.
It is impossible to talk about anything, especially anything health related, without referencing the coronavirus outbreak and its effect on all aspects of our lives. However, it is particularly pertinent when we talk about transplants, so I will touch on it now before getting into the substance of the regulations. From 1 April to 10 May, 155 transplants took place in the UK from deceased donors. In the previous year, that figure was 404, a drop of more than 60%. There have been no transplants at all from living donors, which usually make up close to a fifth of the total, and current waiting list figures will not accurately reflect the need that may have been created for organ transplant due to the pandemic, which will only cause greater strain in future months.

I do not say these things to criticise the Government. Kidney transplants are the most common form of transplants, and in answer to a written question, the Minister for Care shared with me the fact that the early data show that both dialysis patients and those who are immunosuppressed through a transplant are more vulnerable to covid-19. The fact that transplants have been taking place at all therefore suggests that decisions are being made on the balance of need and on a case-by-case basis, an approach that I think we would all support. However, we know that, as the Minister said, patients were dying on the transplant waiting list even before the outbreak because the supply of donor organs failed to meet the demand. Fewer transplants quite simply means that the mortality rate will increase.

What assessment has the Minister made of the impact of covid-19 on the mortality of patients waiting for transplants, and what plans do the Government have to deal with the increasing backlog? I have raised this issue with her colleague, the Minister for primary care and public health, in relation to cancer and have not yet heard clear answers. We need to know what efforts the Government will be making to deal with the bubble challenges that will be coming through the system in future weeks and months. The Minister in the other place talked yesterday about a tremendous effort to restore transplant services. Will this Minister take the opportunity today to outline what the recovery plan is likely to look like and what the timeframes will be?

At the beginning of the coronavirus crisis we all talked of it as a great leveller and said that the virus would not recognise our differences, but we have seen in the weeks and months since just how much that is not the case. The coronavirus has exposed what many Opposition Members have said for many years. Britain is an unequal country, across regions, across gender and across protected characteristics. These inequalities are terrible for our nation’s health, and tackling them must be a post-covid priority.

The black, Asian or minority ethnic community suffers particularly when it comes to transplants. In 2018, 21% of those who died waiting for transplants were from a black, Asian or minority ethnic group. There is a higher chance of a successful transplant if the organ comes from an individual of the same ethnic background, but that means that those from black or Asian backgrounds currently wait six to 11 months longer for an organ match. This inequality will not do, and there have to be practical things to change it, starting immediately. The culture change that the Minister talked about is at the heart of that—us all having those conversations with our loved ones—but we know that we have to be doing something specifically different to reach those communities experiencing the most unequal outcomes. For that reason, I would like to press the Minister on something her colleague in the other place said yesterday. He said that the Government would be following up with an awareness campaign aimed at BAME audiences. Can the Minister give a firm commitment today that this will take place, tell us when it might happen and critically—I had this conversation frequently during my time in local government—confirm that it will be developed by BAME communities, rather than on their behalf? If it is to be effective, it will have to be different from how it has been in the past.

A key aim of the 2019 Act, which the regulations will, I hope, supplement today, was to reach an 80% consent rate in England. This will take time but certainly seems possible. In Wales, where the opt-out mechanism was implemented by the Welsh Labour Government in 2015, the consent rate has risen from 58% to 77%. In England, we start from a base line of 67%, so we are better placed, and if we reach the target, we are talking about as many as 700 more transplants a year—700 lives that can be extended, transformed or saved. The Minister has been challenged on the timing of the regulations—I have reflected on that question myself—but that number seems a strong reason to push on. As she says, the recent weeks and months have shown us how precious human life is and that we should not waste moments if we can improve lives.

Yesterday, the noble Lord Bethell told the other place that the restoration of all transplant services would include training nurses on the new law as soon as possible after they return. I would be keen to know a bit more about that. It was not something we had heard of before, and we would want a sense of the scale of that and the precise timeline the Government are expecting.

As I said, the Opposition are happy with the regulations as laid, but I seek to make three points. First and foremost, we agree that deemed consent should only apply to routine transplants. This is a matter of ensuring that public policy going forward matches the public’s expectation. I share the Government’s view that this would not reflect rare or novel procedures, including to create advanced therapy medicinal products, taking place without explicit consent. I will reflect on those ATMPs in a couple of seconds.

Secondly, I welcome the Government’s response to the consultation on the statutory instrument. Following the responses received, they have rightly revised the regulations with additional clarifications on tissues from sexual and reproductive organs, which will not be subject to deemed consent. That is particularly welcome. It is nice—I dare say even novel—to see a Government consultation leading to such concrete changes. It is a good thing and long may it continue.

Thirdly, the Government indicated in their response to the consultation that they do not expect the list of accepted tissue to need regular updates, and I agree with that in principle. The Minister mentioned how a process might happen if things were to be revised later, but I would like to understand a bit more about what would have to change for her to start such a process.

On those rare and novel transplants, it is important that public policy matches what people expect from the legislation, but we should be proud that the UK leads the world on such transplants. It is a good sign of the health of our country in this regard. They are not currently included under deemed consent, but developing these new technologies and techniques enables us to save more lives. We lead the way in both development and implementation. We have pioneered the OCS—organ care service—heart system, a portable device that can preserve a donor heart in a near-normothermic beating state until it is transplanted, which is currently being used in three heart transplant centres in the NHS and is being introduced in a fourth. We have also shown that abdominal organs can be assessed and their function improved using normothermic regional perfusion technology. As is the aim with this legislation, these developments can save lives, and we should be proud of that, but we should not rest on our laurels, so could the Minister reaffirm the Government’s commitment to continuing the UK as a leader in this regard and to providing the necessary funding to transplant units to ensure they can take advantage?

I turn now to resources, because what we are agreeing today, though very important, will have resource implications for us to pick up. An increase in the number of transplants will necessitate increased support for families who lose loved-ones. It is a difficult and emotional experience for them, and they will require high-skilled care and support, so what extra support will be available for them as these numbers increase?

Similarly, we will need specialist nurses for donation, not just for the direct care but for the implementation, providing advice and support to families and playing the vital role of determining what the deceased’s last known decision was, so that no procedures take place without the appropriate consent. As I say, the Minister in the other place yesterday mentioned specialist training. Could the Minister here today expand further on that?

I welcome the Government’s commitment to ensure that there are enough staff to do this. Will the Minister also commit to providing the additional funding required to ensure that the required increase in specialist nurses continues in line with the increase in transplants, so that they are not having to be begged or borrowed from other parts of the service?

We support these regulations. This is the next staging point in a really important journey. It will make a difference to hundreds and hundreds of lives—lives of people who are completely unaware that these discussions are even taking place today, not knowing that they will need this. This is the right thing to do and the right time to do it, and we support the regulations.

May 27, 2020
Helen Whately – 2020 Statement on Organ Donation

Below is the text of the statement made by Helen Whately, the Minister for Care, in the House of Commons on 19 May 2020.

I beg to move,

That the draft Human Tissue (Permitted Material: Exceptions) (England) Regulations 2020, which were laid before this House on 25 February, be approved.

Before I explain the draft regulations, I would like to say a few words about why we are changing the law on organ donation. Today more than 5,000 people in England are waiting for a transplant, but, sadly, by the time a suitable organ is found some people will have become too ill to receive one. Tragically, last year alone 777 patients were removed from the transplant list and 400 died waiting for a transplant. There is no option but to take decisive action to address the acute shortage of organs and save the lives of those waiting for a transplant. That is why we passed the Organ Donation (Deemed Consent) Act 2019, which amends the Human Tissue Act 2004 and sets up the new system of consent for organ and tissue donation in England, which is known as “deemed consent” or “opt-out”.

I wish to thank the hon. Member for Barnsley Central (Dan Jarvis), my hon. Friend the Member for South Basildon and East Thurrock (Stephen Metcalfe), my right hon. Friends the Members for Maidenhead (Mrs May) and for South West Surrey (Jeremy Hunt), a previous Member of this House, Geoffrey Robinson, and Lord Hunt of Kings Heath for their work and support, which has got us to where we are today. They all started this journey for us showing immense leadership, and they continue to show their strong commitment to this cause.

Subject to approval of these regulations, we aim for deemed consent to become legal on 20 May. While not many transplants are taking place earlier, during the peak of covid-19, NHS Blood and Transplant has already started the recovery process to get transplant units up and running as much as possible. Guidance on how best to restart or extend the transplant service was sent by NHSBT to all transplant units on 26 April. A letter was then sent on 1 May to all trusts with transplant units, asking them to actively review the situation where transplant units have reduced their services.

To illustrate the progress that is being made to get the transplant system up and running again, on a normal day NHS Blood and Transplant would have received about 55 referrals of a potential donor and would aim for five actual donors, and it would carry out about 70 transplants a week. During the peak of the pandemic, there were days when there were no referrals, many days when there were no donors, and many days when there were no transplants. As of last week, there have been 167 referrals, 11 donors and 38 transplants. Continuing the tremendous effort to restore all transplant services will enable us to reap the benefits of the deemed consent legislation as soon as possible; by “benefits” I mean save the lives of people waiting for transplants.

I understand that some have disagreed with the timing of going ahead with this law, but we assessed the impact of going ahead with deemed consent very carefully. This horrific pandemic taught us a lot about how precious human life is, and we know that the fight against it will continue for some time, while thousands of people will still be waiting for a transplant. I therefore believe very strongly that we have a duty now, more than ever, to push ahead with measures that will reduce human suffering and help people to improve their quality of life. That is exactly what this law does.

We are of course fully aware that public confidence is important. The deemed consent legislation was first introduced to the House in July 2017, and became law in March 2019, so it has had a long process of parliamentary scrutiny, alongside three public consultations. The Government have been raising awareness of the law and the choices available for over a year, and the 20 May implementation date has been used actively in communications since late February. Putting this legislation on hold would increase the anxiety of thousands of people, who see this law as their only hope to get a new lease of life, and would confuse the communications that have already been in the public domain for some time.

From the outset, we have been clear that deemed consent would apply only for routine transplants, to increase the number of organs and tissues available and help those that are on a waiting list. Examples of routine transplants are heart, kidneys or lungs. Novel transplants will still require express consent. The organs and tissues specified in the regulations are included because they could be used for non-routine transplants, such as a face transplant. Such transplants are outside the scope of what we want to achieve. Demand for novel transplants is very low, and people would not normally identify organ donation with them.

During formal scrutiny of the regulations, the Joint Committee on Statutory Instruments cleared the regulations with no comments. Meanwhile, the Secondary Legislation Scrutiny Committee drew the regulations to the attention of the House, and this is testimony to how integral the regulations are for making the new system of consent work, and how important the law change will be when it is introduced.

Let me now discuss the detail of the regulations. The Organ Donation (Deemed Consent) Act 2019 sets out that deemed consent to transplant activities in England will apply only to permitted material. The Secretary of State has a delegated power to specify in regulations what relevant material—meaning, what organs, tissue and cells—will be excluded from the system of deemed consent. To clarify, the organs, tissues and specific cells that are listed in the draft statutory instrument are organs, tissues and cells that cannot be transplanted without express consent being in place, as that would be a novel transplant.

Regulation 2(2) sets out the detailed list of organs and tissues that will require express consent in order to be transplanted under all circumstances—such as the brain, spinal cord and face. As a result of our consultation, we expanded the list of reproductive organs and tissues in this regulation, to provide clarity and put it beyond doubt that removing any parts of a reproductive organ will require express consent in all cases. This is to ensure that if and when such transplants are carried out in future in the UK, they will be outside the scope of deemed consent.

Regulation 2(3) sets out that some relevant material—for example, skin or bone—will require express consent if used for a novel transplant, but not if used for a routine transplant. This is to ensure that current practices for tissue donation, under which tissue from a leg, for example, is removed routinely, are not disrupted by deemed consent. So, although a leg transplant would require express consent, if only the skin from a leg is taken, deemed consent may apply; however, if tissue is required from reproductive organs, this will always require express consent. That addresses the feedback from our consultation.

Regulation 2(4) allows for the trachea to be removed under deemed consent when it is attached to the lungs. This is to allow routine heart and lung transplants, which also require the trachea to be removed with the heart and lungs, to continue under deemed consent. However, the trachea is also listed in regulation 2(2), as trachea transplants by themselves are novel and therefore excluded from deemed consent.

Regulation 2(5) excludes the removal of certain cells if they are to be used for advanced therapy medicinal products—also known as ATMPs—which are therapies made from tissue cells or genes after manipulation in a laboratory. They are used for treatment of a disease or injury, and often use human tissues and cells as starting materials. For example, an ATMP can treat knee damage by taking cartilage cells from a living patient, growing and modifying them in a lab, and re-injecting them into the patient’s knee.

ATMPs are an exciting technology, and new therapies are being developed all the time. Current ATMPs are being developed using tissue and cells taken from living donors, but it is also possible to use material from deceased donors to develop novel ATMPs. As such ATMPs are novel, we want to make sure that the donation of such cells cannot happen without express consent being in place. Our consultation raised questions about the public’s understanding of such novel technologies, so we want to ensure that express consent is required.

Now that I have set out the detail of the regulations, I must highlight that before deciding whether a change to the regulations would be needed in future, the Government would need to consider evidence, public acceptability and clinical need, guided by recommendations from NHSBT’s advisory group research and innovation in transplants. Any changes would need to be approved by Parliament, following the same procedure as we are now, so Parliament would have full oversight. The regulations restrict deemed consent to routine transplants, so they continue current practice, under which express consent needs to be in place for non-routine transplants. There is no additional cost to the health system, so no impact assessment has been prepared.

In conclusion, I am glad that I am able to present these regulations to the House today. They are an important part of the implementation of the 2019 Act, as they prevent deemed consent from applying to novel transplants. The new system of consent will help to save and improve the lives of many people waiting for a transplant. Donating organs is one of the greatest gifts a person can give. I urge everybody to talk to their families and their loved ones about their wishes. I am proud that all of us present are playing a part in making something positive happen in these very challenging times. I commend the draft regulations to the House.

May 27, 2020
Matt Hancock – 2020 Statement on the Coronavirus and Care Homes

Below is the text of the speech made by Matt Hancock, the Secretary of State for Health and Social Care, in the House of Commons on 19 May 2020.

One of the first things we knew about coronavirus as it began its dismal spread across the world was that it reserves its greatest impact for those who are physically weakest, especially the old. In the UK, 89% of all deaths have been of those aged above 65. From the start, we have worked hard to protect those in social care. In early March, we put £3.2 billion into social care—half through the NHS and half through local authorities—and we have repeatedly set out and strengthened guidance for infection control and support.

For anyone who has a loved one living in a care home and for all the residents and staff, I understand what a worrying time this has been. I am glad that we have been able to protect the majority of homes, and we will keep working to strengthen the protective ring that we have cast around all our care homes. As I said in the House yesterday, last week we set out a further £600 million to strengthen infection control, and this comes on top of a substantial programme of support.

First, on testing, from the start we have tested symptomatic residents of care homes, even when testing capacity was much lower, and this has always been a top priority. We are now testing all care home residents and staff in England—those with symptoms and those without—and this is being done according to clinical advice, starting with the most vulnerable, and extending to working-age residents, too.

Secondly, we have strengthened the NHS support available to social care. We are putting in place a named clinical lead for every care home in England and have brought NHS infection-control expertise to the sector.

Thirdly, we are making sure that local authorities play their part. Councils are conducting daily reviews of the situation on the ground in local care homes, so that every care home gets the support that it needs every day.

Fourthly, we are supporting care homes to get the PPE that they need.

Fifthly, we have increased the social care workforce during this crisis and provided more support. Altogether, this is an unprecedented level of support for the social care system. I thank colleagues across social care for their hard work.[Official Report, 20 May 2020, Vol. 676, c. 2MC.]

We have also broken down some of the long-standing barriers, including between health and social care, and we have learned the importance of making sure that money for social care is ring-fenced specifically for social care, as the £600 million agreed last Friday has been. On top of that, we are requiring much better data from social care, because partial data has bedevilled the management of social care for many years and made policy making more difficult. Regular information returns are required in return for the latest funding, and we are looking to change the regulations to require data returns from every care provider, so that we can better prepare and support social care.

Our elderly care homes provide for people towards the end of their life. They do an amazing job and deserve the praise that they have received from the public during this crisis. Residents are looked after when they need care the most: their hands are held, their brows are mopped and they are made comfortable. As a collective result of our efforts—especially the efforts of care colleagues throughout the country—62% of care homes have had no reported cases of coronavirus.

The figures released today by the Office for National Statistics show that the number of deaths in care homes has fallen significantly and is down by a third in just the past week, from 2,423 to 1,666. This morning’s statistics confirmed that 27% of coronavirus deaths in England have taken place in care homes, compared with a European average of around half, but whatever the figures say, we will not rest in doing whatever is humanly possible to protect our care homes from this appalling virus, to make sure that residents and care colleagues have the safety and security they deserve.

May 24, 2020
Jonathan Ashworth – 2020 Speech on the Covid-19 Response

Below is the text of the speech made by Jonathan Ashworth, the Shadow Secretary of State for Health and Social Care, in the House of Commons on 18 May 2020.

On symptoms, the right hon. Gentleman will know that many healthcare specialists were making these warnings eight weeks ago, so can he explain why there has been a time lag in updating the case definition?

I note what the right hon. Gentleman said about social care, but he will be aware that more than 12,500 people have sadly died in care homes because of covid-19. Last week, he said that he had put a protective ring around care homes from February, but yesterday a care home provider wrote in The Sunday Times:

“Elderly people weren’t a priority”

They also wrote:

“The government was asleep at the wheel.”

Is the reality not that there was no early lockdown of care homes when needed, and there was no testing of people transferred from hospital to care homes until mid-April, seeding the virus? Personal protective equipment was requisitioned from care home staff and given to the NHS because of wider shortages. There was guidance suggesting that infection was unlikely, and that guidance was still in place when there was community transmission.

We still do not have full testing of all residents and care home staff 12 weeks later. No wonder Age UK has said that this is “too little, too late”. I note that the right hon. Gentleman said that testing will be expanded. Can he bring forward the date by which all care home residents and staff will be routinely tested? The document last week says that it will be by 6 June. Why can the date not be sooner?

Has this crisis not shown that our care sector is staffed by exceptional, dedicated people, and that migrant care workers are not low skilled but immensely able? Does the right hon. Gentleman agree that the Home Office should acknowledge that, and praise such potential workers, not penalise them?

I welcome the wider roll-out of testing. The right hon. Gentleman did not mention the antibody test. Could he update the House on that front? It has also been reported today that 20% of hospital patients got covid while in for another illness. Two weeks ago, he suggested to me in the House that he planned to roll out screening of all healthcare workers, whether symptomatic or not. Can he update us on that front?

On tracing, I have long argued that the safe way to transition out of the lockdown is by having a test, trace and isolation strategy in place, but it depends on a quick turnaround of test results. Can the right hon. Gentleman tell us the current median time for test results to be received by someone when carried out by the Deloitte and other private sector testing facilities, and how soon do directors of public health and GPs receive those results?

The right hon. Gentleman knows that I believe he should be making better use of local public health services. None the less, he is pressing ahead with the national call centre delivered by Serco. Can he tell us by what date that tracing service will be operational? Will it be operational by 1 June?

The right hon. Gentleman did not talk about isolation as one of his key elements of the test-trace strategy. Many poorer people will not be able to self-isolate. Will he look at providing facilities for such people, such as empty hotel rooms so they can quarantine? Will those in insecure work be guaranteed sick pay if they are asked to isolate for seven or 14 days?

On the R number, will the right hon. Gentleman guarantee that every easing of restriction, such as asking children to return to school, is accompanied by a Government statement on the expected impact on the R number and the underlying prevalence of infection? If R rises to be greater than one in a region or local area, how will the Government respond?

As the right hon. Gentleman says, this is Mental Health Awareness Week. We are very fearful of a growing burden of mental health issues, especially in children, as a result of the lockdown. What extra investment is he putting into mental health services, particularly children’s health services? NHS staff, who are threatened not only by exposure to the virus, but the trauma, emotional distress and burnout associated with working on the frontline, need support as well. They need PPE, they need fair pay, they need mental health support. Those care workers who are caring for us need us to care for them and we should thank them again in Mental Health Awareness Week.

May 21, 2020
Matt Hancock – 2020 Statement on the Covid-19 Response

Below is the text of the statement made by Matt Hancock, the Secretary of State for Health and Social Care, in the House of Commons on 18 May 2020.

With permission, Mr Speaker, I will make a statement on coronavirus. This is the most serious public health emergency in 100 years, but through the combined efforts of the whole nation, we have got through the peak. Let us not forget what, together, has been achieved. We flattened the curve, and now the number of people in hospital with coronavirus is half what it was at the peak. We protected the NHS, and the number of patients in critical care is down by two thirds. Mercifully, the number of deaths across all settings is falling.

This Mental Health Awareness Week is an important reminder that we need to look after ourselves, as well as each other. If someone needs support with their mental health, the NHS is there for them. This is particularly important for frontline staff, and we have supported all NHS trusts to develop 24/7 mental health helplines.

Our plan throughout this crisis has been to slow the spread and protect the NHS. Thanks to the resolve of the British people, the plan is working, and we are now in the second phase of this fight. I will update the House on the next steps that we are taking as part of that plan. First, we are protecting the nation’s care homes, with a further £600 million available directly to care homes in England. We have prioritised testing for care homes throughout, we made sure that every care home has a named NHS clinical lead and we are requiring local authorities to conduct daily reviews of the situation on the ground, so that every care home gets the support it needs each and every day. All this amounts to an unprecedented level of scrutiny and support for the social care system, and a level of integration with the NHS that is long overdue.

Secondly, the four UK chief medical officers have today updated the case definition to include a new symptom. Throughout this pandemic, we have said that someone who develops a new continuous cough or fever should immediately self-isolate. From today, we are including anosmia—losing one’s sense of smell, or experiencing a change in the normal sense of smell or taste—which can be a symptom of coronavirus, even where the other symptoms are not present. So from today, anyone who develops a continuous cough or fever or anosmia should immediately self-isolate for at least seven days, in line with the guidelines. Members of their household should self-isolate for 14 days. By updating the case definition in line with the latest science, we can more easily recognise the presence of the virus and more effectively fight it.

Thirdly, we are expanding eligibility for testing further than ever before. Over the past six weeks, this country has taken a small, specialised diagnostics industry and scaled it at breathtaking pace into a global champion. Yesterday, we conducted 100,678 tests. Every day, we create more capacity, which means that more people can be tested and the virus has fewer places to hide.

Today, I can announce to the House that everyone aged five and over with symptoms is now eligible for a test. That applies right across the UK, in all four nations, from now. Anyone with a new continuous cough, a high temperature or a loss of, or change in, their sense of taste or smell can book a test by visiting nhs.uk/coronavirus. Anyone who is eligible for a test but does not have internet access can call 119 in England and Wales or, in Scotland and Northern Ireland, 0300 303 2713. We will continue to prioritise access to tests for NHS and social care, patients, residents and staff, and as testing ramps up towards our new goal of a total capacity of 200,000 tests a day, ever more people will have the confidence and certainty that comes with an accurate test result.

Fourthly, I want to update the House on building our army of contact tracers. I can confirm that we have recruited more than 21,000 contact tracers in England. That includes 7,500 healthcare professionals who will provide our call handlers with expert clinical advice. They will help to manually trace the contacts of anyone who has had a positive test, and advise them on whether they need to isolate. They have rigorous training, with detailed procedures designed by our experts at Public Health England. They have stepped up to serve their country in its hour of need and I thank them in advance for the life-saving work that they are about to do.

The work of those 21,000 people will be supported by the NHS covid-19 app, which we are piloting on the Isle of Wight at the moment and will then roll out across the rest of the country. Taken together, that means that we now have the elements that we need to roll out our national test and trace service: the testing capacity, the tracing capability and the technology.

Building that system is incredibly important, but so too are the basics. We need everyone to self-isolate if they or someone in their household has symptoms. We need everyone to keep washing their hands and following the social distancing rules. We need everyone to stay alert, because this is a national effort and everyone has a part to play. The goal is to protect life and allow us, carefully and cautiously, to get back to doing more of the things that make life worth living. That is our goal and we are making progress towards it. I commend this statement to the House.

May 21, 2020
Lindsay Hoyle – 2020 Statement on the Department of Health and Social Care

Below is the text of the Speaker’s statement made in the House of Commons on 11 May 2020.

Before calling the Prime Minister to make a statement, I would like to make a statement of my own accord. I am aware of widespread concerns across the House about delays in Government Departments, and the Department of Health and Social Care in particular, responding to written questions and correspondence. I have received representations on this matter from the Procedure Committee and from Back Benchers across the House from Opposition parties.

Last Wednesday, the Leader of the House argued that a degree of latitude is allowable for the Department. However, the Secretary of State himself has referred repeatedly to the value of parliamentary scrutiny. Written questions and letters to Ministers are integral to such scrutiny. I accept that the Department of Health and Social Care faces many challenges, but I am sure that resources across Whitehall can be mobilised to support it in maintaining proper standards of accountability.

While I think it is right for me to call for improvements within the Government, I also make a plea to all hon. Members to be targeted and considered in the written questions that they table at this time, and to avoid swamping Departments with questions on a fast-moving situation that will be superseded before they can be answered.

I now call the Prime Minister, who should speak for no more than 10 minutes.

May 11, 2020
Michael Howard – 2004 Speech on the Voluntary Sector and Public Services

Below is the text of the speech made by Michael Howard, the then Leader of the Opposition, at Toynbee Hall on 30 November 2004.

Since becoming Leader of the Opposition, I’ve spent a lot of time travelling round Britain. And wherever I go, I meet remarkable people who give up their time to help those who are less fortunate.

I meet people that have pulled together to tackle the problems they face. I visit communities who have been emancipated by the realisation that they can help themselves. And I see society working to meet the needs of its most vulnerable people, often more successfully than the State.

As Beveridge wrote in 1948:

“The making of a good society depends not on the State but on the citizens, acting individually or in free association with one another, acting on motives of various kinds, some selfish, some unselfish, some narrow and material, others inspired by love of man and love of God. The happiness or unhappiness of the society in which we live depends upon ourselves as citizens, not on the instrument of political power which we call the State.”

Central to my approach is a belief that voluntary organisations are often better at delivering services than government.

Just because the State pays for services, it doesn’t always have to provide them. Involving the voluntary or private sectors helps to drive up standards – benefiting everyone.

Voluntary organisations are often more flexible and more responsive than the State. They tailor their services to the communities they work in. They do not simply hand out money – they know how it’s going to be used. They rarely suffer widespread fraud – because they know their clients personally. Some of the most successful organisations in the country – the schools, care homes and child care centres catering to the poorest people in society – are independent charities.

Institutions like Toynbee Hall do not simply offer a contract with their customers. They offer a covenant: a relationship, an understanding of the emotional aspects of life, a recognition that we are not economic units or faceless statistics, but human beings.

That’s why I would like to involve the voluntary sector much more in the delivery of public services. In education, we want charitable schools to be able to compete for the money which the taxpayer spends on each child – so that parents have a greater choice of school. In health care, we want charitable hospitals and clinics to qualify for NHS funding, if they can deliver care at NHS standards and NHS prices.

But voluntary activity is more than about providing services to people in need. It’s part of a mindset, it’s a set of values, it’s a sense of humanity by which people can show responsibility for others. It’s practical. But it can also be wonderfully inspirational.

A thriving voluntary sector, by virtue of the fact that it is voluntary, is a sign of a society in which people recognise that freedom brings responsibility – responsibility not just to our communities but to those less fortunate than ourselves. It offers the decisive and positive answer to that age-old biblical question: am I my brother’s keeper?

What drives me forward is my trust in people.

I believe that if people are given a choice they will make the right decisions for themselves and their families.

I believe that if professionals – doctors, nurses and teachers – are trusted to exercise their judgment, they will take the right decisions: decisions that are in the best interests of patients and pupils.

And I believe that if the voluntary sector is trusted to help run our schools and hospitals, we can improve the services on offer.

My ambition is simple – to give everyone the choice in health and education that today only people with money can buy.

As Winston Churchill said in 1940:

“When this war is won, as it surely will be, it must be one of our aims to establish a state of society where the advantages and privileges which have hitherto been enjoyed by the few shall be far more widely shared by the many”.

It’s a dream worth turning into reality.

May 10, 2020
Vaughan Gething – 2020 Statement on Scientific Advice in Wales

Below is the text of the statement made by Vaughan Gething, the Minister for Health and Social Services in Wales, on 4 May 2020.

The Welsh Government’s Chief Scientific Advisor for Health Dr Rob Orford joined the UK Government’s Scientific Advisory Group for Emergencies (SAGE) COVID-19 meetings on 11 February 2020.

SAGE is responsible for ensuring timely and co-ordinated scientific advice is available to decision makers to support UK cross-government decisions in the Cabinet Office Briefing Room (COBR).

Wales’ Chief Medical Officer Dr Frank Atherton and Dr Orford agreed a formal technical and scientific advisory structure within Welsh Government was also needed to provide official sensitive advice to Ministers. The terms of reference for a Technical Advisory Cell (TAC) were agreed on 3 March, in accordance with SAGE guidance. TAC meets three times a week.

The TAC is designed to:

Interpret SAGE outputs into a Welsh context

Relay relevant information and questions from Welsh Government to SAGE

Ensure indirect harm is not caused by the proposed interventions

Help inform NHS and social care planning guidance

Ensure Welsh Government and Public Health Wales have timely access to the most up-to-date scientific and technical information

Brief Local Resilience Forum and Strategic Coordinating Group chairs about scientific and technical outputs, via the

Strategic Health Coordinating Support Group, which is chaired by Public Health Wales.

TAC does not replace statutory functions of Public Health Wales or use the technical or scientific information, which has not been agreed or discussed by SAGE, unless this has a specific Welsh context.

The priorities of TAC are aligned to SAGE and include:

The detection and monitoring of coronavirus

Understanding effective actions to help contain a cluster

Understand, measure and alter the shape of the UK epidemic

Ensure indirect harm is not caused by the proposed interventions

Model the UK epidemic and identify key numbers for NHS planning

Understand risk factors around demographics, geographies and vulnerable groups

Generate behavioural science insights for policy makers

Ensure NHS tests and trials key interventions

Consider emerging therapeutic, diagnostic and other opportunities.

TAC is co-chaired by Dr Orford and the Deputy Director for Technology and Digital. Membership is drawn from Welsh Government, Public Health Wales, Cardiff University and Swansea University. A range of experts from different disciplines are included covering public health, health protection, medicine, epidemiology, modelling, technology, data science, statistics, microbiology, molecular biology, immunology, genomics, physical sciences and research.

Membership of TAC is kept under constant review.

May 9, 2020
Vaughan Gething – 2020 Statement on the NHS and Covid-19 in Wales

Below is the text of the statement made by Vaughan Gething, the Minister for Health and Social Services in Wales, on 6 May 2020.

We are moving out of a period of COVID-19 critical planning and response and into a longer period where our health and care system must remain both prepared for any future peaks and effectively providing essential services and other high quality care and treatment for the people of Wales.

In March I made a number of decisions to ensure early and decisive action to continue to provide care and support to the most vulnerable people in our communities, whilst also making sure organisations and professionals were supported to prepare local responses to the public health emergency. The NHS in Wales has already delivered a remarkable response to the COVID-19 health emergency since receiving the first coronavirus patients and now we must take the next steps.

To maintain momentum and to ensure the system continues to focus its attention on the provision of a wider range of services, I have issued an NHS Wales COVID-19 operating framework for quarter 1 (2020/21).

The document highlights four types of harm that could emanate from Covid-19 which we must remain focused on and guard against. These are;

Harm from COVID-19 itself

Harm from an overwhelmed NHS and social care system

Harm from a reduction in non COVID-19 activity

Harm from a wider societal actions / lockdown

This framework will drive, even further, our systems focus on the two components of ensuring both a continued effective response to COVID-19 whilst providing other essential services in a careful and balanced manner.

I have taken advice from professional colleagues, including NHS Chief Executives and Medical Directors. This advice demonstrates consensus across the health and care system that we must ensure delivery of essential services for our population and where possible recommence more routine care. The advice I have received also says that this must be done progressively, with caution and in a flexible and agile manner to ensure confidence for the public and staff.

This framework is set under a number of themes;

New ways of working and workforce wellbeing – Staff have created and quickly embraced new ways of working to respond to the COVID19 challenge- offering benefits in terms of safety and quality to both staff and patients whilst also contributing to reduced congestion in primary care and hospital settings. We must continue to build on this work and harness the opportunities it has provided.

Examples of the scale of transformation include the rollout of video consultations safely to primary care. Locally and nationally these new ways of working must be sustainably embedded.

This framework recognises the importance of the wellbeing of our workforce, and in particular those staff who have been under significant pressure in responding to COVID 19 and they must be at the forefront of our minds. Pressures may increase again in the next few months. I am clear that appropriate testing systems must be in place and be informed by the impending Testing Strategy being developed to support and help sustain staff.

Managing COVID 19 – It will always be difficult to guarantee that health and social settings will be COVID free, however patients using the NHS must be confident that hospital environments are as safe as possible. The key criterion I will looking to organisations to be assured on include:

Ongoing and consistent application of Infection Prevention and Control guidance.

Identification of COVID “zones” and dedicated isolation facilities. I will be anticipating that regional solutions are explored along with the targeted use of independent sector hospitals and field hospitals to support the separation of covid and non-covid activity in the immediate term.

New service or specialty based triage and streaming processes in both unscheduled and planned care to support the separation of patient services.

Continued implementation of Acute Pathways for COVID 19 and the related rehabilitation
Assurance on the availability of sufficient physical and workforce capacity that reflect the need to maintain social distancing and infection prevention and control measures.

The framework reflects my determination that we retain our ability to quickly activate additional critical care capacity, if we enter into another peak.

“Essential” services – I am clear that Essential Services should be maintained at all times throughout the pandemic. An Essential Services technical document has been developed in line with The World Health Organization (WHO) guidance. If, in any areas of essential services, the response to COVID 19 has led to backlogs they must be urgently addressed. Ultimately I recognise that some decisions on treatment will rest between patients and their clinicians, taking account of their specific risks during the COVID outbreak.

“Routine” services – We know that capacity exists in some parts of our system to support the re-introduction of routine services. The reintroduction of these services is a local operational decision for Health Boards and Trusts in conjunction with relevant partners. These decisions must be taken with care, and organisations need to assure themselves that it is safe and appropriate to do so. I outline how they need to assure themselves in the framework.

Primary care – For General Medical Services we have seen a shift to telephone first triage; this must remain in place during Quarter 1 and I encourage it longer term. Equally our community pharmacy services have been under significant pressure and have introduced new ways of working to manage patient care safely and efficiently, these too must continue where the benefits are clear.

All routine primary care dental treatments and check-ups continue to be cancelled. Dental practices with NHS contracts remain ‘open’ for remote triage, the provision of advice and the issuing of prescription. Further guidance will be issued separately to this framework about the future status and restoration of dental services. In optometry services, a number of practices remain open for emergency and essential eye care services. Health boards must continue to ensure urgent patients are seen.

Social Care Interface – Finally the framework makes clear that NHS organisations must continue to work with partners to ensure an effective interface with social care. This is in line with the approach set out in “A Healthier Wales” and the framework makes clear how this must happen.

There has been clear and consistent messages for the public that the NHS is still available at times of need despite COVID-19. We must continue to ensure that key services are available and patients can access them, now and in the future.

To help patients access these services over the last eight to ten weeks there has been a seismic level of transformation across our system. We must reflect on these changes but not dwell on them. They must be adopted, adapted and applied. This framework supports the health and care system in moving to the next phase of providing services.

May 9, 2020
Liz Kendall – 2020 Statement on Exercise Cygnus

Below is the text of the statement made by Liz Kendall, the Shadow Social Care Minister, on 7 May 2020.

The report on Exercise Cygnus provided clear warnings that we were not properly prepared for a pandemic.

In particular it highlights that local plans for social care were inadequate and that social care services wouldn’t be able to cope with the number of people discharged from hospitals to ensure the NHS had enough beds to meet demand.

These warnings have now proved all too sadly true as the unfolding tragedy in our care homes shows. Care providers confirm they were not involved in subsequent discussions on how to put these problems right.

Ministers must be clear about why they failed to act on the report’s recommendations and what they will now do to fully protect and resource these vital services in future.

May 8, 2020