Considered in Grand Committee
My Lords, the sharing of information and co-ordination of health protection activity between all parts of the UK and with our international partners is absolutely critical to the prevention of and response to serious cross-border health threats. Covid-19 is a good example. There are others today; there will be more in the future.
These regulations will ensure that this essential co-ordination is maintained following our departure from the EU. They enable us to deliver high levels of human health protection across the whole of the UK. They modify retained EU law on health security to establish a stand-alone UK-wide regime. But these regulations are not alone: they form part of broader, ongoing work to improve our health security capabilities.
This work has included the establishment of the new UK Health Security Agency—UKHSA. The UKHSA combines key elements of Public Health England and NHS Test and Trace, including the Joint Biosecurity Centre. The role of UKHSA will be absolutely critical. It will be our permanent standing capacity to plan for, prevent and respond to threats to health. It will deploy the full weight of our analytic and genomic capability on infectious diseases. It will work with partners around the world to lead the UK’s global contribution to health security.
These regulations will support the UKHSA and the other UK public health agencies—Public Health Wales, Public Health Scotland and the Public Health Agency of Northern Ireland—in quickly identifying and responding to a wide range of health issues. They will ensure that we maintain a robust and consistent UK-wide approach to health security that allows us to work effectively with our international partners, including by linking into international surveillance systems.
On our international collaboration and leadership, I remind noble Lords that last month the G7 committed to working towards adopting a standardised minimum health dataset for patients’ health information. This included: working through the International Patient Summary standard; developing internationally shared principles for enabling patient access to health data; and promoting the use of open standards for health data. This highly technical work will have huge practical dividends.
I will say a word about implementation. Noble Lords will know that the UK-EU Trade and Cooperation Agreement—TCA—was announced on 24 December 2020. These regulations will help us meet the TCA’s health security arrangements. The TCA provides a strong basis for the UK and EU to continue to co-operate on health security. It includes a commitment to inform each other when new public health threats are identified in either the UK or the EU. It gives ad hoc UK access to the EU’s database for sharing alerts: the Early Warning and Response System—EWRS. It provides for the UK to attend the EU Health Security Committee in support of response co-ordination, and a commitment to co-operation between the UK and the European Centre for Disease Prevention and Control—ECDC.
It is because of these arrangements that the UK was given access to the EWRS for Covid-19 from January 2021. Our current access avoids any disruption in the flow of public health data during the pandemic. The UK has also continued to attend meetings of the EU’s Health Security Committee—HSC.
I will say something about the substance of the regulations and why these amendments are being made to retained EU law by this instrument. While a member state, the UK was required by EU law to co-ordinate and share certain types of information on health protection with the EU; to give a recent example, early alerts on newly identified threats. As health protection is predominately a devolved competence in the UK, to meet these obligations effectively the four UK nations had to co-ordinate and share the required information with PHE, the UK’s focal point for communication with the EU.
However, following the end of the transition period, this retained EU law relating to health security no longer operates effectively to set rules for such co-ordination on a UK-wide basis. Therefore, these regulations modify and transfer functions previously carried out by the EU to a new UK health protection committee and to the UKHSA, working in co-operation with Public Health Wales, Public Health Scotland and Northern Ireland’s Public Health Agency.
Let me give some examples: first, on early alerting and the EWRS. The importance of early alerting was amply illustrated by Covid-19. Speed of action is absolutely critical. It is imperative that when a threat is identified, information is shared rapidly to enable the quick implementation of control measures that will reduce transmission rates in the general population and protect individuals. To ensure that we have a robust early alerting system in the UK, these regulations require the UK’s public health agencies to notify the UK’s focal point within 24 hours of any new threats that have been identified. For the purpose of these regulations, PHE is designated as the UK’s focal point, with this function soon to transfer to the UKHSA. In this role, the UKHSA will be responsible for receiving alert notifications of serious cross-border threats to health from the different parts of the UK, then working jointly with them to conduct rapid risk assessments and put in place co-ordinated response measures as necessary.
To meet our obligations under the TCA, the UKHSA must also notify the EU of any threats occurring in the UK which may present a risk to EU member states. In return, the EU will notify the UK of any emerging threat in Europe which may present a risk to us. If the UK and the EU agree it would be beneficial for the UK to have access to the EWRS for any threat, the UKHSA will be responsible for uploading and receiving related surveillance information.
Secondly, I will say a word about UK-wide surveillance. It is critical that we continue to conduct UK-wide epidemiological surveillance on known communicable diseases. Therefore, these regulations make provision for the UK’s four public health agencies to conduct surveillance on a shared list of communicable diseases and related special health matters. This is vital for improving our understanding of the prevalence of infectious diseases across the whole of the UK.
Thirdly, on co-ordination across the union, these regulations require the UK Government, the devolved Administrations and the UK’s public health agencies to consult each other with a view to co-ordinating their respective monitoring and early warning of, and their response to, serious cross-border health threats. They must inform each other of any substantial revisions to preparedness and response planning.
Fourthly and finally, on governance, to support the implementation and functioning of these regulations, we are establishing the UK health protection committee. The committee will have representation from all parts of the UK and will function to provide advice on the list of communicable diseases and related special health matters that are subject to UK-wide surveillance, and the associated operational procedures.
As health security is an area of devolved competence, we have obtained formal consent for the regulations from the DAs. On this point, I pay tribute to the spirit of collaboration across the devolved Administrations. For example, just last week I had a hugely productive call on the life sciences vision with Minister Ivan McKee, Minister Maree Todd, Minister Robin Swann, Minister Paul Frew and Minister Eluned Morgan—the noble Baroness, Lady Morgan of Ely. I thank them for their collaboration. In parallel, we are working together with the DAs to develop a common framework, which will strengthen UK-wide governance arrangements on the prevention and control of serious cross-border health risks.
These regulations are critical. I beg to move.
My Lords, I thank the Minister for his full explanation of these regulations. The need for them is self-evident in the post-Brexit situation and I welcome the intent behind them.
Of course, also behind the regulations is the need for the continuation of effective co-ordination between the UK and the EU. The implementation of the health security part of the trade and co-operation agreement is meant to support effective future working and information sharing; it also enables the UK to request early access to the EU Early Warning and Response System in respect of a serious cross-border health threat.
We debate these regulations at a time when the EU has proposed legislation to ensure that it is nimbler in responding to serious cross-border threats to health in future, including the declaration of an EU emergency situation, an enhanced mandate for the European Centre for Disease Prevention and Control, and a reinforced mandate for the European Medicines Agency to enhance its role in crisis preparedness and management for medicinal products and medical devices.
I have no doubt that a more effective EU response to a serious cross-border threat to health that also affects the UK is to be welcomed, but it will work only if we are in full co-operation mode with the EU. The Minister has been reassuring on this but I would like further assurances on our arrangements. He made mention of the UK health protection committee, which is a governance organisation in respect of the UK Government and the devolved Administrations, and the UK Health Security Agency. Can he give some information about when he expects the agency to be up and running? What is happening in the interim?
I also want to ask the Minister about the specific arrangements in place in respect of Northern Ireland. I know that we are to debate regulations on the placing of medicinal products and medical devices on the Northern Ireland market due to the terms of the protocol. Are there any particular implications for Northern Ireland in respect of these regulations?
Finally, I refer to Secondary Legislation Scrutiny Committee’s report on this SI. Although the committee did not report this instrument to the House, it did comment on the Explanatory Memorandum, stating:
“Although the Explanatory Memorandum (EM) provided is full of information on future EU-relations, it does perhaps overestimate the average reader’s knowledge of the UK’s plans”—
well, quite. I understand that the committee asked a number of questions to which the Minister’s department has provided answers. However, the committee made this point:
“Because of the pandemic, coordination of health surveillance is more important than usually, and an EM needs to make it absolutely clear to the House what it is being asked to agree to.”
Can the Minister assure me that his department has taken note of these comments in respect of further regulations?
My Lords, I am pleased to contribute to this short debate. I thank my noble friend the Minister for introducing the regulations, which, as the noble Lord, Lord Hunt of Kings Heath, quite rightly said, are self-evidently necessary in these circumstances. I have no reservations about introducing them but I want to take this opportunity to explore a number of issues, including how my noble friend anticipates our relationship with the European Union developing in future.
First, the question of where the common frameworks are concerned inside the United Kingdom is fairly straightforward. However, I am not entirely sure how the UK health protection committee will coincide with, or work directly with, the four Chief Medical Officers; perhaps my noble friend can tell me. Certainly in England, the Chief Medical Officer appears to have a different future role in relation to health security than was formerly the case for his predecessors.
So far as the relationship with the European Union is concerned, my noble friend felt that the TCA created a full process for co-ordination. I am afraid I do not agree with him. I think the TCA creates a bare-bones relationship with the European Union for the future. I am not even sure that what is in the TCA has yet been in any sense implemented, since it includes a memorandum of understanding between us and the European Centre for Disease Prevention and Control, and I see no evidence of that being negotiated. Perhaps my noble friend can tell me whether that is the case. One has recently been concluded between the ECDC and Mexico, but not with us.
When one looks at the ECDC, which was established in the wake of SARS in 2004 to enable the European Union to be prepared for a future pandemic, I am afraid one is not impressed. It retreated from its media functions with anything other than national authorities and health professionals—it retreated from public communication—and it needs radically to change its approach. Indeed, as an organisation, it is hamstrung by the simple fact that under the Treaty on the Functioning of the European Union it is dependent on the activities of national authorities. It complements the work of national authorities but in no sense co-ordinates or controls them. For example, by 3 April last year, four European Union member states had failed to supply the ECDC with the necessary data for surveillance purposes. So unless and until the ECDC is in a position to inspect and secure data surveillance in all EU member states, I am not sure that it has the necessary powers and control.
The European Commission, albeit producing reports explaining how well it has done, freely acknowledges this in the way in which it is approaching the development of a European health union, as the noble Lord, Lord Hunt of Kings Heath, suggested. We may no sooner have this in force later this year, and start to create a relationship between the health security committee and the ECDC, than we find that the European Union has created a health emergency preparedness and response authority, which it anticipates should be operational in 2022. There may be a European Union chief epidemiological officer. There may be a major manoeuvre on the part of the European Commission, proposing to legislate for a European health union. It may well move from competence being entirely for national authorities on major cross-border health threats to an EU competence shared with national authorities. That may make a considerable difference. However, when it comes to us co-operating with the European Union on cross-border health threats, it means that we have to be prepared for much more substantial activity on its part and a much more complex relationship with a range of European Union actors.
I shall mention one final thing. In all this, nobody appears to have referred to the role of the World Health Organization’s regional office for Europe. I am reminded that there are 27 member states of the European Union, but 53 participating states—at the last count, but I think it might have gone up to 55—in the World Health Organization’s region for Europe. A number of those states, such as us, Switzerland, those in the western Balkans and so on, will be integral in responding to a cross-border health threat of the kind we have experienced during the pandemic. If, as we wish, and I think the European Union wishes, there is to be enhanced global health security, there is no alternative to us reforming the World Health Organization and, in the process, vesting greater potential in its regional structures. Those have been poor in the past but could be much more effective in future. They take responsibility in relation to all the countries likely to be affected rather than, as in the case of the European Union, only just over half of them in Europe. I hope my noble friend will be able to say something about the Government’s plans for strengthening the WHO in Europe.
My Lords, I largely agree with what the noble Lord, Lord Lansley, said just now.
These regulations, which support and are aligned to the common framework, revoke and restate with modifications retained EU law on health security. The regulations ensure that EU law continues to function effectively following the end of the transition period, and provide a legislative regime for epidemiological surveillance and response to serious cross-border health threats, whether at risk of extending beyond the UK to an EU member state or as may otherwise necessitate a co-ordinated response within the UK to ensure a high level of human health protection. Will the current variant now coming to the UK be dealt with by these regulations?
The noble Baroness, Lady Gardner of Parkes, has withdrawn, so I call the noble Baroness, Lady Brinton.
My Lords, I declare my interest as a vice-president of the Local Government Association. It is essential that, when dealing with future health risks, the UK is equipped to effectively share knowledge, data and skills within our borders and internationally. I support the calls from the noble Lord, Lord Lansley, for clarity over the role of the WHO’s regions—in our case, Europe. I also support his calls for WHO reform, but hope that we and the other member nations will remember that it is the members of the WHO, not the WHO itself, who maintain its power and direction. Too often, the WHO has been the whipping boy, as though the members have no role at all.
The past 18 months have shown how global health threats can shut down the entire world. By leaving the EU, the UK has lost unconditional access to the EU’s Early Warning and Response System. The trade and co-operation agreement states that the UK may be granted access to EWRS on an ad hoc basis via written request. Can the Minister clarify how these requests will be overseen and managed? Are there any plans to negotiate a more consistent and collaborative relationship? It is important that Parliament and public health professionals more widely can see the detail of how this will work before it comes into force.
This SI creates a new body within the health protection committee. How have these plans and new structures been influenced by the learning process of the past 18 months, during which we have been exposed to be woefully unprepared for the health threat that the pandemic has given us? We have had huge issues with data sharing. How will this new framework and committee help us not to repeat those same mistakes?
The Minister said it is vital that the UK has excellent surveillance provisions, and we on these Benches agree, so it is good news that the four nations that make up the United Kingdom are working together on this. It is self-evident that this co-operation is vital to make it work. As we know from Covid, viruses do not recognise boundaries, whether those of devolved states or European countries. I echo the questions raised by the noble Lord, Lord Hunt, about Northern Ireland, given the sensitivities of the Northern Ireland protocol. There seems to be something of a war of words on other matters; it would be awful if there was a war of words on these important health issues.
Our directors of public health are the unsung heroes of the pandemic, yet there has been confusion regarding the structural change of the UK Health Security Agency. It is not clear how much influence directors of public health will have. What they need now is clarity of communication and leadership around the new roles and responsibilities. That is vital as we shift into the endemic phase of Covid-19 management, when we are likely to be very reliant on these directors of public health and their small teams in local authority areas. Alongside this legislation, we need long-term funding boosts for health protection capacity in local councils and our public health budgets, so that our directors of public health are supported in the wonderful but often invisible work they do.
It certainly felt as though their work was invisible to Ministers and Public Health England during the first half of the pandemic—and this is not just about the pandemic. I am reminded of the Salisbury poisonings and how the exceptional director of public health in that area worked locally and nationally to try to resolve a really difficult and unpleasant situation; the BBC’s drama was able to show people on the ground exactly the work that public health colleagues do. Can the Minister confirm that we will be seeing a proper increase in their budgets in this year’s spending review? Otherwise, we will once again have to say that this Government’s words and figures do not agree. It would be awful if large numbers of expensive consultants again had to be contracted at the centre to manage a crisis when we have teams of experts on the ground in our local communities. They cannot magic essential resources to be available 365 days of the year out of thin air.
Finally, contact tracing will continue to be a vital part of public health work in the future. Can the Minister confirm that the Government are still committed to ensuring that we have an effective test and trace system to manage outbreaks of this disease as well as other incidents to do with environmental health locally and to prepare for the possibility of malign forces at work, as with the Salisbury poisonings? Given reports last week that care providers are still failing to get the data that they need, what action are the Government taking to improve this? How will the UK Health Security Agency provide the overarching leadership that is so desperately needed to strengthen partnership at a local, regional, and national level?
My Lords, we debate these regulations today on the 73rd anniversary of the National Health Service. I am sure that all noble Lords take great pleasure in seeing the George Cross awarded to recognise NHS staff past and present across all disciplines and all four nations; it is indeed a worthy honour.
I thank the Minister for outlining the focus and intent of these regulations, which are certainly welcomed. We welcome the focus on co-ordinating data-sharing, epidemiological surveillance and a four-nations approach to the prevention and control of serious cross-border health threats. It is certainly important to see the devolved nations’ public health agencies working in a close, collaborative relationship, which is what we hope to see following the adoption of these regulations. It is worth noting that, throughout the course of the pandemic, we have seen considerable regulatory divergence and differing communication issues between the devolved Administrations and the UK Government, particularly at a political level. As we well know, and as has been referenced in this debate, global health—in fact all—threats do not recognise borders. They do not fit that neatly.
The First Minister for Wales, Mark Drakeford, has consistently asked for a “regular, reliable rhythm” to meetings between the devolved Governments and the UK Government. Can the Minister assure us that this will become the norm? I noted his complimentary comments about the collaborative nature of his recent discussions, and I certainly wish to be assured that that will continue.
According to the Government, the UK Health Security Agency will undertake functions in five core areas in relation to future infectious disease threats. It will also
“act to strengthen health protection capability from top to bottom”
and place a “strong focus” on reducing inequalities in the way that different communities experience, and are impacted by, infectious diseases or environmental hazards. However, there is still very little information about how this will work, and it remains unclear how it will address the wider socioeconomic determinants of health. Perhaps the Minister can help us here.
To be more specific, the UK lost its elimination status for measles in 2016 and that was not about an external threat. That was about the internal competence—or otherwise—of the Government in handling public health issues. Does the Minister share my concern that the decision to subsume Public Health England into a security-focused agency may result in large areas of public health being neglected amid a focus on future pandemics?
What emphasis will be given to tackling the wider determinants of health, which have had a huge impact on the UK’s very poor outcome with Covid? Does the Minister agree that the Government cannot afford to ignore non-communicable diseases, including cancer, the wider health of the UK and those social inequalities, such as cramped housing and unequal access to care, which have exacerbated the experiences of many throughout the pandemic?
One of the big problems as we went into the pandemic was that the health of the population was poor at the outset, and in many cases getting worse. The improvement in life expectancy had stalled from 2012 onwards. Can the Minister confirm whether the agency will deal with this? One of the major failures of the UK’s response to Covid has been the inability of people to isolate. How will the agency address people in precarious occupations in the informal economy—those who do not have access to paid leave in order to self-isolate—and people who live in multigenerational homes?
We welcome the investment in tackling future infectious diseases but remain concerned that at the same time there has been disinvestment in UK Research and Innovation research funding. UKRI has warned of a £120 million hole in its budget following recent cuts. Does the Minister share my concern that this shortfall threatens to undermine overseas scientific projects seeking to understand how we can better mitigate against zoonotic diseases such as Covid-19? Will the Government commit to bringing forward their commitment to increase research and development spending to 2.4% of GDP by 2027?
Like my noble friend Lord Hunt of Kings Heath, I refer the Minister to the comments of the Secondary Legislation Scrutiny Committee on the Explanatory Memorandum, which, it said
“does perhaps overestimate the average reader’s knowledge of the UK’s plans.”
I hope the Minister will be able to assure the Committee that the department will ensure that the Explanatory Memorandum will be explicitly clear on what Parliament is being asked to agree going forward.
My Lords, I am enormously grateful for noble Lords’ perceptive comments and the questions that they raised. As the noble Lord, Lord Hunt, said so persuasively, these regulations are vital to maintaining UK-wide collaboration on health security and put in place the necessary mechanisms to allow us to engage effectively with our international partners on infectious diseases and other cross-border threats to health.
I am grateful for the demanding and analytical questions asked by all noble Lords on closer co-operation with the EU. I reassure my noble friend Lord Lansley that the regulations will ensure that implementation of the health security chapter of the TCA is effective and complete through the establishment of a robust UK-wide regime that can share the information required to meet our TCA obligations.
As to my noble friend’s comments on EU performance and future plans, we will have to wait to see where it is coming from. In the meantime, I reassure him that we were prompt to request access to the EU’s Early Warning and Response System in relation to the Covid-19 pandemic and that the EU was equally swift to grant that access. We are committed to continuing such positive co-operation on monitoring serious cross-border health threats where it is in our mutual interest and to maximising the benefits of TCA provisions. These regulations set the foundation for us to do exactly that.
The noble Lord, Lord Hunt, asked about the timing of the UKHSA/PHE transfer. The MoU between PHE, UKHSA and the ECDC is currently being negotiated. On the noble Lord’s questions on the TCA, the health security arrangements contained within the UK-EU TCA provide for continued collaboration between our world-leading scientists and technical experts and the ECDC, including on Covid-19 as we continue to tackle the pandemic. We are working with the ECDC to consider how we can best support the continuation of this co-operation and collaboration between our respective experts in future, including through the conclusion of an MoU.
The noble Baroness, Lady Brinton, and my noble friend Lord Lansley asked about the WHO. Both the UK and the EU recognise the importance of continuing to work together to protect our citizens from infectious diseases and other cross-border threats to health. We already work together in multilateral groups and organisations, including the Global Health Security Initiative, and this agreement ensures that this will continue where it is in our mutual interest. These regulations address the threats arising from infectious disease and non-infectious threats, such as chemical and environmental hazards. This is in line with existing national policies and the International Health Regulations—IHR—2005.
The noble Baroness, Lady Brinton, asked about the involvement of local health teams. I confirm that the UKHSA design will incorporate effective co-ordination with local authority health protection teams. I reassure the noble Baroness, Lady Merron, that engagement with the DAs is extremely frequent and during the pandemic has been happening on a weekly basis, at least. We are committed to maintaining that very close co-ordination, which is supplemented with weekly meetings among the four CMOs that I understand are extremely productive.
I completely agree with the noble Baroness that this country was hard hit because of the bad health of our population. That is why we are bringing forward plans for the Office for Health Promotion, where the relevant parts of PHE will be rolled into an extremely effective and energetic organisation which will be focused on the country’s underlying health conditions, under the clinical oversight of the CMO. We will unveil plans for that office shortly.
I emphasise that the passage of this instrument is critical in the prevention and control of serious cross-border threats to health in order to maintain a high level of human health protection across all parts of the UK. The regulations act on our intentions to strengthen domestic capability in health security and they are also imperative in helping us meet our obligations under the TCA with the EU. I hope very much that I have been able to answer the questions raised by noble Lords, and with that in mind I commend these regulations to the Committee.