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NHS Update

Volume 814: debated on Thursday 22 July 2021


The following Statement was made in the House of Commons on Wednesday 21 July.

“Before I start my remarks, I would like to take the opportunity to pay tribute to the noble Lord Stevens, who will shortly be standing down as chief executive of the NHS. I thank him for his dedicated service over the past seven years, especially his stewardship during our battle against this virus and his huge contribution to this nation’s vaccination programme. I am sure that the whole House will join me in thanking him and giving him our best wishes for the future.

With permission, Madam Deputy Speaker, I would like to make a Statement on our support for the NHS. In the NHS’s proud 73-year history, no year has been as tough as the last. Everyone working across the NHS has achieved incredible things in the face of great difficulty—from building the Nightingale hospitals in just a matter of days to rolling out our life-saving vaccination programme. They have been there for us at the best of times and at the worst of times. As a Government, we have sought to give them what they need at every stage of the pandemic.

Today, I would like to set out for the House some of the support we have been giving. Throughout the pandemic, we have worked to deliver manifesto commitments—50,000 nurses, 40 new hospitals and 50 million more GP appointments—and we are taking every opportunity to invest in our NHS to make sure that patients feel the benefits of the latest treatments and technologies.

Only this week, we announced a new innovative medicines fund to fast-track promising new drugs. This builds on the amazing work of the cancer drugs fund, which has already helped tens of thousands of patients access promising cancer treatments, while we use the data to make sure that they represent good value for the wider NHS. It is estimated that one in 17 people will be affected by a rare disease in their lifetime, and this fund will support the NHS to fast-track access to treatments that could have clinical promise. This new £340 million initiative takes our dedicated funding for fast-tracking promising drugs to £680 million, showing that we will do everything in our power to give patients access to the most cutting-edge therapies.

Doing right by the NHS means making sure that colleagues have the right team around them. This was true when we made our manifesto commitment for 50,000 more nurses by March 2024, and it remains especially true in the face of the challenges brought by the pandemic. I am pleased to report that we have almost 1.2 million staff working in NHS trusts, an increase of over 45,300 compared with a year ago. This includes over 4,000 more doctors and almost 9,000 more nurses, taking us to over 303,000 nurses in total, and we are on track to deliver on our 2024 commitment.

We recognise that, with so much being asked of our NHS staff, many will not yet be feeling the difference of these extra colleagues on the front line, but I can assure those hardworking nurses that you will feel it soon. Yesterday, I heard from NHS Employers that, for the first time, Hull University Teaching Hospitals NHS Trust will have a full complement of nursing staff when the intake of new nursing graduates begins work in September. I know that we all look forward to hearing that kind of news from more and more places across the country.

Finally, I want to update the House on our autism strategy. Our NHS long-term plan set out our commitment to improving the lives of autistic people. Today, we have launched our new autism strategy, which sets out how we will tackle the inequalities and barriers faced by autistic people so that they can live independent and fulfilling lives. I am truly grateful to everyone who has contributed to shaping this strategy, including autistic people and their families, and the All-Party Parliamentary Group on Autism in particular. I would like to take a moment to recognise the contribution of Dame Cheryl Gillan, the former Member for Chesham and Amersham, for her incredible advocacy of autistic people, including the inquiries she led in 2017 and 2019. She left an incredible legacy, and we are all so grateful to her for her work.

Today’s strategy builds on our previous strategy, “Think Autism”, and we have made so much progress since then. We now have diagnostic services in every area of the country and a much better understanding and awareness of autism, but there is much more to do. The life expectancy gap for autistic people is still about 16 years on average compared with the general population, and almost 80% of autistic adults experience mental health problems during their lifetime. The coronavirus pandemic has been tough for many autistic people. Far too many autistic people face unacceptable barriers in every aspect of their lives—in health, employment and also education—so we have worked together with colleagues in the Department for Education to extend the strategy to children and young people as well as adults, reflecting the importance of supporting people all through their lives, from the early years of childhood and through adulthood.

The strategy is fully funded for the first year, and it contains a series of big commitments, including getting down the Covid backlog; investing in reducing diagnosis waiting times for children and young people; preventing autistic people from avoidably ending up in in-patient mental health services; improving the quality of in-patient care for autistic people when they are receiving it; funding the development of an autism public understanding initiative so that autistic people can be part of communities without fear or judgment; funding to train education staff so that children and young people can reach their potential; and many more commitments. This landmark strategy will help to give autistic people equal opportunities to flourish in their communities, as well as better access to the support that they need throughout their lives, so that all autistic people have the opportunity to lead fuller and happier lives, as they deserve.

We owe so much to our NHS and the incredible people who work there. They have done so much to support us at this time of national need. As a Government, we will give them what they need, not just through this pandemic but to face the challenges that lie ahead. I commend the Statement to the House.”

My Lords, I first record from these Benches our thanks for the hard work of the noble Baroness, Lady Penn, who has gone on maternity leave. We wish her and her baby all the very best for the future. Also, adding to the words of the Government Chief Whip, I thank the clerks, the virtual technicians, the managers and all our staff, for keeping the show on the road and for keeping us safe throughout this year. I particularly echo his words about their patience with us. We have continued to do our job and could only have done so with the support of these dedicated teams. I also thank the Lord Speaker, his predecessor, and Members of all those Committees that have been in almost permanent session this year, for guiding us through.

This is the last repeat Statement before the summer—I think this may be number 50; the Minister will know. We have three matters to deal with today: the somewhat puzzling Statement made in the Commons yesterday afternoon, the Written Statement from the Secretary of State which announced the results of the NHS pay review and—I have given the Minister notice—I will also address some of the issues raised in the Covid update given in the Commons this morning.

The Statement made by Helen Whately yesterday was an odd moment. We of course join her and the Minister in thanking Sir Simon Stevens for all his work in the NHS—he has also taken up his place in your Lordships’ House. We also join others in welcoming progress on the autism strategy, which the honourable lady talked about in her speech; although, in due course I will seek the views of the organisations who are experts in this area. However, the honourable lady gave what can only be described as a parliamentary doorstep clap for the NHS and its staff. Welcome though that might be, it does not pay the bills or provide the respect that this Government owe to our NHS staff.

The Statement was followed within hours by a Written Ministerial Statement outlining the NHS pay award. This is not a respectful way to treat Parliament or our NHS staff. As my honourable friend Dr Rosena Allin-Khan said yesterday, once again the Government have had to roll back on a shoddy, ill-thought-through position, with their 1% pay rise—a real-terms pay cut —rejected by the independent pay body. Less than an hour before, there were competing briefings on what the deal was to be and, at that moment, it turned out to be nothing. Our NHS staff deserve better than this. My honourable friend invited the Minister in the other place to shadow her in the A&E department where she has worked shifts throughout the pandemic. I suggest that she takes her up on that offer, and that the Minister here might do the same.

My right honourable friend John Ashworth has said:

“Ministers were dragged kicking & screaming to 3% for NHS staff. But after years of cuts & rising pressures, NHS staff will feel let down & disappointed especially after today’s chaos. And where is the pay rise for junior docs? Where is a fair pay rise for care workers?”

It really was not worthy of a Government. We had chaos and confusion, with the Government once again rowing back on their position. Does the Minister agree that the pay review body has done what Ministers could not and would not do in recognising that our NHS staff absolutely could not be given a pay cut? Does he accept that, after last year, this is not enough?

Does he accept that this is not an NHS-wide pay settlement? It does not cover all the health and care workforce, who do not fall under this pay review body, and it does not cover junior doctors—I declare an interest, as two are nephews of mine, both of whom were redeployed during the pandemic. We know that our junior doctors have been put on the front line, caring for sick patients, and redeployed across an understaffed, pressured NHS, and that their training has been disrupted. Will the junior doctors get a pay rise? Will all health staff employed in public health receive the settlement? Again, when we know absolutely the value of care workers, why do the Government not guarantee a real living wage for those working in social care?

How will this pay settlement be funded? NHS trusts do not even know what their budget is beyond September, and NHS employers pointed out that this settlement will cost the best part of £2 billion, so where is that coming from? Is the Minister expecting trusts to find it from their existing budgets? These Benches keep repeating this question: the Government seem not to appreciate how central this is to stopping the spread of the virus, so when will they address support for low-paid workers who have to self-isolate?

I posed many of the immediate questions yesterday to the Minister. Sometimes I felt enlightened by his answers and sometimes I did not, but the one I wish to go back to concerns the Government’s plans for September. Are they ready to reimpose safeguards? Will our schools get filtration units over the summer so that we can feel that our children will be safer? Will our teenagers be vaccinated so that, next year, this cohort can do a full year of learning without being sent home in their millions?

My Lords, I echo the thanks to all the staff who have made a hybrid Parliament work over the last year especially, from these Benches, to the health team, because of the high workload of health and Covid business. I also repeat the good wishes to the noble Baroness, Lady Penn, as she starts her maternity leave.

Along with colleagues in the Commons, I am unconvinced that the first half of this Statement was planned to be delivered by the Minister yesterday. In the bizarre events of this week, of Covid restrictions being lifted, a rush of announcements—Monday’s, and today’s on vaccine passports—U-turns, and No. 10 contradicting Ministers, this Statement is definitely filed under “Y” for “You couldn’t make it up”.

Yesterday morning, the press were briefed and opposition politicians heard on the parliamentary grapevine that the NHS staff pay rise would be announced in the Statement. Even Sky News and the BBC news channel were saying that there would be an announcement on NHS pay in the Commons yesterday afternoon. Yet, when the Minister stood up, there was not one word about the pay award, just an end-of-term report and a much-deserved paeon of praise about how wonderful our NHS staff are—they are, and they deserve that praise. However, an extraordinary line in the Statement says:

“But I can assure those hardworking nurses: you should feel it soon”.

Well, they did. Four hours after that Statement, a Written Ministerial Statement and a press release were slipped out, bypassing parliamentary scrutiny, presumably in the hope that it would not be spotted. NHS staff, especially junior doctors and nurses, are appalled. I am not sure this is what the Minister meant by

“you should feel it soon”.

However, it gets worse. This morning’s Times says that the 3% NHS staff pay rise will be funded by robbing the expected increase in national insurance contributions reserved for the social care proposals leaked earlier this week by the Government. That is an absolute disgrace, especially given the appalling way that No. 10 has handled the social care reform proposals. After the Queen’s Speech, Ministers told us that it would be this autumn. Last week, they suddenly said that there would be an announcement this week but, this week, they have thrown the proposals back into the long grass, with a promise—again—of later this autumn, two years after the PM promised us, on the steps on No. 10, that this was his absolute priority. His actions are showing otherwise.

I know that the Minister understands that social care needs urgent reform and that it has borne the brunt of the first year of the pandemic. Can he confirm the Times story about the funding of the NHS pay rise and whether this decision was made by the Secretary of State for Health and Social Care or by the Chancellor of the Exchequer? Can he also say when the full proposals for social care will now be published, including the funding arrangements?

Moving to the only substance of this Statement, the autism strategy, we on these Benches also pay our respects to the late Dame Cheryl Gillan MP, who was such an advocate for those with autism. Peter Wharmby, the autistic writer, speaker and tutor, says that the autism strategy sets its targets very low in saying:

“Moreover, we have been able to transform society’s awareness of autism, as … 99.5% of the public have heard of autism … which is so important in autistic people being able to feel included as part of their community.”

Peter Wharmby is right. Much of the strategy talks about continuing as usual, but if you talk to autistic people or parents of autistic children, they all say that much needs to be done in supporting those with autism, especially in education and at work. Knowing that autism exists is not the same as providing the best environment for those with autism to overcome the barriers they face in society and giving them the support that they need to succeed. The Disabled Children’s Partnership points out that the pandemic has exacerbated existing problems around support for those with autism, creating further social isolation and poor health outcomes. It is depressing that the autism strategy is so unambitious.

One particular problem that parents face when trying to get support for their autistic children is an automatic assumption that parent carers are treated as a resource—worse, their parenting capacity is often questioned. There is no mention here of support for their needs. As John Bangs, a special needs expert, points out, this deliberately ignores carers’ legal rights. It is noticeable that this autism strategy makes no real reference to ensuring that parental and familial carers are supported. When will these wider issues relating to positive support for those with autism and their familial carers be addressed?

Finally, briefly on the Covid Statement in the Commons today, page 4 says that

“two doses of a covid vaccine offers protection of around 96% against hospitalisation.”

But the key bit of information we need in the “pingdemic” at the moment is the rate of double-jabbers getting Covid. I understand that it is part of the same study that is quoted, but what is the answer and where can we find it? If the pingdemic is due to the virus spreading —we hear of police and control rooms unable to operate and empty shelves at supermarkets—perhaps it is time we actually understood how many double-jabbers are getting Covid and having to go into self-isolation, and thereby creating a problem. The Minister needs to consider whether lifting all restrictions on Monday was the right thing to do.

My Lords, I join the noble Baronesses, Lady Thornton and Lady Brinton, in thanking my noble friend Lady Penn for her hard work over the last 18 months and wishing her well in her pregnancy. She looked absolutely fantastic as she left, and our hopes and good wishes are with her.

I also thank the usual channels, the House of Lords staff and the Speaker’s office for all their contributions to the virtual House and for keeping the business of the House going during this awful pandemic. There has been an enormous amount of traffic from the Department of Health—more than 50 Statements, 2 Acts and hundreds of regulations. I thank all noble Lords for their challenge, their scrutiny and their patience during this difficult time.

The pay review body has given us its recommendations, and we have accepted them. I thank it for its work and insight. I reassure the noble Baroness, Lady Thornton, that the Office of Manpower Economics will publish its analysis online shortly. We are extremely pleased that we can follow the guidance of the pay review body. Junior doctors have their own separate framework, worth 8.2% over four years. They are working from that framework today.

On the funding of the pay review, as noble Lords know, we gave the NHS a historic £33.9 billion settlement in 2018 and have provided £92 billion to support front-line health services throughout the pandemic. The pay uplift will be funded from within that budget, but we are very clear that this will not impact funding already earmarked for the NHS front line. We will continue to make sure that the NHS has everything it needs to continue to support its staff and provide excellent care, throughout the pandemic and beyond. That is why we accepted the PRB’s recommendations in full and provided NHS workers in scope with the pay rise.

On the question from the noble Baroness, Lady Brinton, on safeguards in September, I cannot make any guarantees but I definitely hope not. We very much hope that we are in the final stages of this pandemic, as the impact of the vaccine is being felt, bringing down the R number and saving those who are infected from hospitalisation, severe disease and worse.

The noble Baroness, Lady Thornton, talked about filtration for schools, and I noted her question on this yesterday. I said that we had been looking at it. I am not aware that the results of that analysis have come through yet. To be honest, I am wary of investing too much in unproven technologies. The two things that have been proven to work are isolation and vaccination; we are backing those two measures most of all. However, I accept her point about the importance of ventilation and will continue to look at it.

Likewise, the JCVI is looking very carefully at vaccination for children. We are working with international partners to get to the bottom of it. At the moment, we have a clear read-out—we will move—but our priority is providing either third shots or variant booster shots in the autumn to the most vulnerable. That is where our priorities are at the moment.

The noble Baroness, Lady Brinton, asked about social care. I note the Government’s statement on that; we will bring reform recommendations in the autumn. On her point about the autism strategy, I also pay tribute to the contribution of Cheryl Gillan, who worked so hard in this area and whose impact is still being felt.

I think the noble Baroness, Lady Brinton, overlooks some of the really good work in this strategy. There is £74 million of funding for a number of high-priority projects, which have been designed in collaboration with stakeholders from the community. I guide her to the implementation plan that accompanies the strategy, which has detailed recommendations on a six-point implementation matrix that has grit and traction. I would be very grateful for her feedback on that.

I pay tribute to parent supporters; the noble Baroness, Lady Brinton, is entirely right that they often bear the brunt of care and are often best placed to care for and support those with autism. I remind her that we have provided £31 million through the mental health and well-being recovery action plan specifically for the parents of those with autism, recognising how the pandemic was hitting that group in particular.

My Lords, we now come to the 20 minutes allocated for Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of speakers.

My Lords, following our debates on the Medicines and Medical Devices Act earlier this year on an innovative medicines fund, the announcement in this Statement of a ring-fenced £340 million budget for innovative medicines is very welcome. When will those become available, so that clinicians and patients can access this funding? Given that it now takes us beyond cancer drugs and innovations, will there be a focus on those diseases for which there has been no effective treatment?

My Lords, I am grateful to my noble friend for highlighting this important development. The cancer drugs fund was a great success, and we are building on it with a substantial investment. The new fund will support patients with any conditions, including those with rare and genetic diseases. Dementia is one area where we are extremely interested in looking at investing further, and I hope that this would be captured, but we are waiting for recommendations from NICE and the data that it will provide before we set the right prioritisations. In terms of the date, I do not have that at my fingertips, but I would be glad to write to my noble friend with the details.

My Lords, the strategy promises millions to prevent mental health crises for autistic people and to help people detained in hospital back into the community. The Written Ministerial Statement responding to my 2020 independent report about people with learning disabilities and autistic people detained in long-term segregation was laid in the other place after the Minister’s Statement had finished. My report emphasised the urgency of these strategy promises. Will the noble Lord commit to meeting me, with the Secretary of State, to discuss the full implementation of my recommendations?

My Lords, I am enormously grateful to the noble Baroness for her hard work in this area. We are taking a range of actions to drive further, faster progress on reducing the number of autistic people and those with learning disabilities in in-patient mental health settings, including robust action by the CQC, work on our new cross-government “building the right support” delivery board, and reform of the Mental Health Act. I would be very glad to meet the noble Baroness and her colleagues to discuss these and other measures in more detail.

I declare my interests as set out in the register. My Lords, Ministers rightly come to these Chambers and praise NHS staff for all they have done throughout the pandemic, yet a third of NHS staff are considering leaving their job. Vacancies are endemic and, to top that, we have a looming summer crisis. For an average nurse, 3% is equivalent to £15.40 a week. Inflation removes £11.58 of that; so, for all the Minister’s kind words, in real terms that is a pay rise of £3.82 a week, or 55p a day, and less than half of that for a newly qualified nurse. Does the Minister think this is fair, and what does he think the nurses should do with their 55p a day?

My Lords, I am also enormously grateful for the contribution of NHS staff at all levels and from all parts of the United Kingdom. This pay settlement is based on the recommendations of the pay review body. We said that that was the mechanism we would follow, and we are following it; in that respect, we are doing what we said we would. I reassure the House that recruitment to the NHS is extremely strong. We are hitting our targets on the recruitment of 50,000 nurses and our targets for GP trainees and in other parts of the NHS.

My Lords, I welcome the Minister’s offer to meet the noble Baroness, Lady Hollins, to discuss her devastating report. We should be ashamed to see the way some of our people with learning disabilities and our autistic young people have been treated. I would like to know whether the Government’s action plan can give some realistic dates on when there is likely to be proper service and support given within local communities and within homes that should be created for them.

Secondly, on Covid generally, I have been double-jabbed with Pfizer, so it is unlikely that I will go into hospital, but I have Covid. I would like to pick up on the question from the noble Baroness, Lady Brinton—what are the figures for the number of people who have had their vaccinations but are now starting to suffer from Covid? This is not flu; it is quite different from flu. You get the jab for the flu and you stay clear of it. With this, you get the jabs but you can get it just the same—and I have been suffering. Why are the Government giving mixed messages that people are now going back to normal? This is just not the case. We are sending out mixed messages and giving the impression that we have this “freedom day”. Yes, there will be freedom, but there will be freedom to spread on a scale that we have not experienced latterly. So I hope the Government will be cautious with the mixed messages they have been issuing and they will underline that having the double jab does not necessarily mean that people are clear of catching the disease.

The noble Lord has my profound commiserations. It is an extremely tough and nasty disease, as he rightly points out. Even for those who have had two jabs, if they get the disease it can still be a really horrible experience, which he has at this moment.

He is not quite right, though, on the mixed messages. We have been crystal clear from the very beginning, even before the first vaccine arrived, that the vaccination was not going to be a panacea in itself. It will not prevent all people from getting all Covid diseases for all time, immediately. These things are incremental. The societal impact of the vaccine is to drive down the infection rate to the point that R is below one; that is the objective. But, in the meantime, those who have had the vaccine not only remain infectious but can be heavily symptomatic, and I am very sorry for the position he is in. Incidentally, that is also true of the flu vaccine; it is not a 100% vaccine, but it does an enormous amount to break the chain of transmission and to reduce the spread of flu on exactly the same basis.

My Lords, if more people anxious to show their support for our magnificent NHS staff would see being vaccinated and wearing masks in crowded places as a smart move on their own part, would they not also see it, crucially, as sending a signal of support to all those in the NHS?

My Lords, my noble friend hits the nail on the head. Not only is getting vaccinated and wearing a mask in the right settings a sign of support for NHS staff, it is a sign of support for the whole of society. We depend on each other during this pandemic. When someone catches the disease asymptomatically and spreads it to someone else, they hurt all of us. We all have to be careful to take our tests when we are going into a position of risk, to wear our masks when we are close together and, of course, now that the vaccine is available to all over 18 year-olds, to ensure that all the people we can persuade have taken two jabs.

My Lords, the Minister has on more than one occasion in the last few minutes been asked about the position of care workers. They have been totally left out of the pay settlement. They are working on extremely low wages. Does the Minister not agree that something must be done to help care workers, whether in domiciliary care or in care homes, to have a decent wage and not be treated as the country cousins in this whole thing?

The noble Lord is right: we are concerned about the pay, conditions, career prospects and retention of care workers. I have spoken about this in detail in debates on social care, and I share the sentiments of the noble Lord. When we come to social care reform, the correct provisions for social care workers will form an intrinsic part of those reforms. I do not wish to be obtuse, but this is about the NHS. The NHS is a direct employment body, whereas social care has a different employment system and is therefore not covered by this particular settlement.

My Lords, while I am sure that we appreciate the work done by NHS staff, I remind noble Lords that it was NHS staff in the Radcliffe Infirmary in Oxford who put a “Do not resuscitate” notice on my good friend Caroline Jackson’s bed without her knowledge—she found out about it only much later. I have asked the Minister about this. The last Written Answer I got said that a report would be produced “in due course”. Can the Minister ensure that these notices are rigorously reviewed before they are put on people’s beds and certainly not, as in the case of Mrs Jackson, put on the bed without her or her husband or anyone close to her knowing that it had been put there? Not all NHS staff are perfect.

As my noble friend will know, I know Dr Jackson extremely well from the old days and heard her story with great regret. I took the story back to the department and played it into the system, as I told him I would do. A report is being drafted and I can reassure my noble friend that it is being taken seriously. The clarification of guidelines has been sent to all wards and there has been additional training for staff put in the position of needing to consider and engage with loved ones on this issue. However, may I push back against my noble friend? It is not right to try to generalise about staff on this point. I have the highest regard for NHS staff. In the very large majority of cases, they have worked extremely well in difficult circumstances in these situations and they are owed our respect for that.

My Lords, the Minister made that point very well. I declare an interest as a member of the board of the GMC because I want to ask him about workforce strategy. Clause 33 of the Health and Care Bill sets out a duty on the Secretary of State to publish

“at least once every five years … a report describing the system in place for assessing and meeting the workforce needs of the health service”.

The Minister will be aware that a number of NHS organisations say that this is not going far enough and that what is needed is the development of regular, public, annually updated long-term workforce projections so that the health service can meet the undoubted challenges that lie ahead. Is the Minister prepared to consider this?

My Lords, I have heard the noble Lord on this point two or three times and he makes the argument extremely well and persuasively. As he knows, a huge budget of the NHS goes on the workforce; essentially, the NHS is a mobilised healthcare workforce. It is intrinsic to the success of the NHS that we manage our workforce correctly. There are substantial workforce transformation programmes in place at the moment, including the People Plan, and a huge recruitment drive is going on, including the creation of a much clearer employer brand, which has landed very well among the workforce generally. However, I take the noble Lord’s point. I am not the workforce Minister but I will take it back to my colleague Helen Whateley in the department and ask her for her consideration.

My Lords, I hope that my noble friend, who deserves a real holiday, will accept that it would have been far better and more honest had the pay award been made in an Oral rather than a Written Statement. We all send our warm wishes to the noble Lord, Lord Brooke of Alverthorpe, for a speedy recovery. However, does not his story underline the need for clarity in Oral Statements? I put to my noble friend last week the idea of statements in all the newspapers which would be clear, cohesive and coherent. Is that idea still being followed up, as he promised it would be?

My Lords, I have followed it up. We have invested a huge amount in our statements. This takes up a large bandwidth for our broadcasters and of the advertising budget of the Cabinet Office and the department—we could not have spent any more money on advertising than we have done to try to get our messages across. However, some of these messages are difficult to understand and sometimes difficult to accept. We all wish that the vaccine was as clear-cut and emphatic as are the vaccines for polio or the other blockbuster vaccines. However, as the noble Lord, Lord Brooke, just described, and as poor old Sajid Javid is currently feeling, two jabs do not guarantee that you will not be infected and infectious. However, neither of them is in hospital and neither of them is suffering from severe disease. The message is nuanced: the vaccines work, will reduce transmission and will help us to get this country out of the disease, but people will still have to proceed with caution, isolate when they are in contact with those with the disease and protect themselves from transmission with masks and social distancing.

My Lords, I express my gratitude to each and every one in the House for their care and attention these past difficult months. To echo the noble Lord, Lord Balfe, I, too, have been messaged on hundreds of occasions over the last few months on the issue of DNR, on which I will ask a question. In the light of the reports of 39,000 deaths in care homes and the fact that 59% of all those who perished had a disability or autism, when will the Government commence the national inquiry so that those who lost their loved ones can be reassured that no deaths occurred unnecessarily due to government policy decisions and lack of proper and adequate safeguards for all residents in care homes and their well-being and that DNR was not applied disproportionately to people with disability and autism without sufficient oversight, given the incredible pressures on the NHS during these months?

My Lords, we will be accountable for the use of DNR and it is right that the noble Baroness’s specific question should be asked: were any groups disproportionately at the wrong end of this? She is right to ask the question. I cannot give her a precise date for the inquiry, but I have given absolutely cast-iron reassurances that it will happen. I am very tired, as is everyone else, and the thought of starting an inquiry today while preparing for the winter is not one that will help our productivity or help to save lives in the difficult time that we have ahead. The right time for the inquiry is probably when the pandemic is truly behind us.

My Lords, the NHS is highly regarded by most people because it is available to all for free. But, as the Statement rightly recognises, despite record investment, it faces major challenges. In particular, survival rates for many cancers trail those in comparable countries. How do we secure the necessary improvements in the NHS, especially at a time when it faces record waiting times?

My noble friend gives me an opportunity to raise one of my main ambitions for the health service, which is clearly outlined in the life sciences vision. She is right: we catch too much cancer at stage 3 or 4, when there is sometimes not much that we can do, and anything that we do will be very expensive and make only marginal differences. That is not the same in all countries and it is not good enough in this country. That is why we need to invest in diagnostics and preventive medicine. We need to reweight our health system away from clinical interventions on lumps and bumps at a very late stage. We need to interact with patients at a much earlier stage of their disease. Only in that way will we be able to afford the healthcare system that this country deserves and to give people longer, better lives.

My Lords, as we have reached 2 pm there is no need to adjourn the House, but I will arrange a short pause to allow the relevant people to be in their places for the next item.