Covid-19: Contact-tracing App

Baroness Thornton Excerpts

Wednesday 6th May 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is entirely right to point to the importance of ensuring that the vulnerable are included. Of course, the app is not the only thing we are depending on. Manual track and trace in the conventional way of using a telephone and speaking to those who test positive will still be a core part of our track-and-trace arrangements. Efforts will be made to reach those who are vulnerable or digitally isolated to ensure that they have details of the provisions for these track-and-trace arrangements.

[Baroness Thornton (Lab)]

My Lords, I would like to follow up on the question asked by the noble Baroness, Lady Lane-Fox, because she has put her finger exactly on how this may not work because either our most vulnerable and poorest communities will not have the technology or there will be problems with language. I would like some more detail from the Minister about exactly how the Government intend to roll this out. Given that it took such a long time to roll out the NHS volunteers system, I feel that we might find ourselves with our most vulnerable and poorest communities disadvantaged.

[Lord Bethell]

The noble Baroness is entirely right to be concerned about the vulnerable and our approach. I completely share those concerns. It is a massive challenge, but that does not stop us embracing the advantages of technology where millions of transactions can be done in a day which could never be done by more manual processes. An enormous amount will be invested in trying to reach out to those who are isolated, vulnerable or digitally excluded to ensure that they have details of our track-and-trace arrangements. Hiring an enormous army of track-and-trace experts has already begun, and details can be seen on my Twitter feed of how volunteers who have the right qualifications can join those efforts.

Covid-19: Government Response

Baroness Thornton Excerpts

Wednesday 6th May 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for repeating this Statement. I point out that the Commons took an hour to receive and discuss this update; we are getting 10 minutes. It is almost two weeks since I saw the Minister across this virtual Dispatch Box, which seems a long time in a pandemic. When we went into lockdown in March, he seemed to indicate his enthusiasm for being accountable to the House in lockdown. I regret to say that I do not believe that he or his colleagues have matched that aspiration. I place on record that it is shocking that noble Lords across the House are reduced to submitting vital questions about Covid to a lottery—a ballot of topical questions. That is not serious accountability. Unprecedented times need unprecedented procedures.

I have two questions. First, will the Minister support a proposal that he and his colleagues should come to the House every day and have a Covid-related Question Time, morning or evening, which would discuss the contents of the daily press conference and other urgent matters? Secondly, how does the Minister intend to fulfil his promise to the House that there would be an eight-week review of the Covid emergency legislation? By my reckoning, those eight weeks will be up in two weeks’ time.

[Lord Bethell]

I welcome the noble Baroness’s questions on accountability. However, I remind her that not all Covid-related matters are covered by the department of health; Ministers have been in front of the House every day it has been open, answering questions on Covid, and they have given fulsome and thoughtful answers to questions and scrutiny. I welcome also her question on the eight-week review, which, as she says, is coming up in a fortnight. I will find out how the usual channels wish to mark that occasion in the House, and I would welcome the chance to submit the Government to scrutiny on the matter.

Covid-19

Baroness Thornton Excerpts

Thursday 23rd April 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for repeating the Statement. I join him and the Government in saying that our thoughts are also with all those who have lost their lives to this horrible virus. I pay tribute to the NHS and social care staff who have lost their lives. I know the Minister agrees that the number of victims who appear to have come from BAME communities is very concerning. Can he confirm reports that BAME people make up 72% of all NHS and carer deaths with Covid-19?

We welcome the announcement of an inquiry. It would be great if the Minister could provide further information about the scope of the inquiry and when it will report its initial findings.

The Minister said he believes that we are now at the peak, but we are nevertheless heading for one of the worst death rates in Europe. The Government have told the public that their response to the pandemic will always be guided by science but, as the Minister will be aware, there are often different views within the scientific community, so I repeat the call that we have made from these Benches in the past that the Government should publish the evidence underpinning their decision to recommend, for example, a seven-day rule for isolation. This is important for public confidence, given that the Government’s advice appears to contradict the advice by the World Health Organization, which advocates a 14-day rule for isolation based on evidence that people can still transmit the virus after 10 days or more.

Despite many questions, it remains unclear why the UK did not participate in some of the European procurement projects. The Chancellor of the Duchy of Lancaster said this was because we missed an email, whereas a senior civil servant at the Foreign Office said in evidence to a Select Committee that it was a political decision, before retracting that comment several hours later. The lack of transparency is deeply unsatisfactory. It would help if the Government published a background briefing so that we could see exactly what happened. We believe that it is necessary to get to the bottom of this situation now to ensure that the UK takes part in any future EU schemes that may help us deliver PPE to those putting their lives at risk on the front line.

The Government have repeatedly said that they are “ramping up”—this is an expression I do not enjoy, and I certainly intend never to use it myself—testing capacity, but the latest statistics show that only 14,629 NHS tests were carried out in the last 24-hour period, eight days before the Health Secretary’s self-imposed deadline to reach 100,000 tests. This is despite testing centres having a capacity of 39,000 checks a day. Why is more than half the country’s testing capacity still going unused when tens of thousands of NHS and social care staff, along with other critical workers, are being forced to self-isolate because they have not been tested? It is very concerning that the number of tests being undertaken is not increasing. Even if the capacity does reach 100,000, that is not the same as access. The latest statistics reveal that the number of tests performed on Tuesday was two-thirds that of the previous day. The Minister needs to tell the House what on earth is going to happen and when we can see the daily increase of tests.

Earlier this week the Health Secretary pledged to test immediately anyone in the social care sector who needed it. While elderly residents can be tested in the homes they live in, staff still have to travel. I learned earlier from the Minister that there are plans in place to change that, so I would like him to explain how soon those alternatives will come on stream.

Testing and contact tracing are vital to managing the UK’s response and easing lockdown restrictions. The new NHS app mentioned is very welcome. Can the Minister set out the timeline for when that will become available?

Finally, will the Minister confirm that the combination of some spare capacity in the NHS and the Government’s view that we now have reached the peak of the virus means that postponed NHS treatments and procedures will resume imminently? Although we understand why some elective treatments were postponed, the delay for many illnesses, including cancer, involves its own risk. It is therefore important that people receive the necessary treatment as soon as possible when it is safe to do so considering the impact of the virus. What support are the Government giving to trusts to help them manage demand amid the ongoing situation and give patients confidence that they will be treated in a Covid-free hospital?

[Baroness Brinton (LD)]

I thank the Minister for repeating the Statement and for his work on testing. We may have some difficult questions for him, but I hope I have the support of the whole House in saying thank you to him and his team for the work they are doing on this difficult area.

I too thank all the staff and volunteers in the NHS and the wider social care sector and other key areas who have been working during this crisis, whether directly on the front line or in supporting families and our children in schools. We send our condolences to the families of the bereaved, and are pleased that many people are recovering, even though we know that, if they have had it badly, it takes time. From these Benches, we echo the concerns about the high percentage of BME deaths, among workers and non-workers alike.

The Statement says that there are 3,000 spare critical care beds, but ITV reports that care home residents now account for up to half of Covid deaths. However, last week the Daily Mail reported that care home residents were still being asked to sign letters to say that they would not go to hospital in the event that they had Covid-19. Will the Minister confirm that these critical care beds in hospital are not spare? There are plenty of people in care homes who could use those beds but they have been put under pressure, no matter how gently, to sign the letters.

It is good to see the Nightingale hospitals coming on board—even if they are empty, for the right reasons. One of the concerns expressed has been about the staffing and the initial request that any patient had to have staff accompanying them from their previous hospital. Can the Minister say that this has now definitely stopped and that staff with appropriate critical care experience are able to be recruited? I gather that this has also been a problem for increasing the number of beds.

There was a good message in the Statement for people to go to their GPs and to use 999 for emergencies, but today there was a report of somebody who had a severe heart attack not being picked up urgently, as heart attacks are still second-level priorities to Covid. As a result of that 20-minute target rate, sadly the patient died. Is there any rebalancing of priorities for ambulances now that we seem to be over the peak of cases?

On equipment and medicines, it is good to hear that there are now just over 10,000 ventilators. Are they full ventilators, or does that include CPAP and BiPAP machines? How many more are to come? There have been some worrying shortages of medicines for those who need to be sedated, and recently we have heard news that there is a problem with kidney dialysis and kidney medicine for people who have come out of intensive care and require long-term support. Is there a shortage of such medicines, what other medicines are at risk and what proposals are there to remedy that problem?

We have spent many hours today talking about PPE. We are still waiting for supplies for everything outside hospitals. On 6 April, Clipper was heralded as being about to solve this problem, but it is still woeful. Until the social care and community sectors get the support they need, they will continue to be worried about the spread of Covid.

The Turkish ambassador has written to various people in the APPG on Turkey, setting out the actual arrangements—as opposed to those reported by the Government—concerning the delay in the package that appeared to get stuck. Turkey actually donated 250,000 pieces of medical protection equipment to us; the rest came through privately. Can the Minister say when the remainder of the consignment due from a Turkish supplier will arrive?

It is good to hear that formal arrangements for testing, tracking and tracing are now under way, but the WHO always puts in a third word alongside “test” and “trace”: “isolate”. Any mention of isolation in the Statement is notable by its absence. Taiwan, South Korea and Hong Kong have all managed to suppress further bursts of Covid because of the arrangements for not just testing and tracing but isolating. It is good to hear that an app will be available, but the Minister will know that there are people with technical experience concerned about whether it is appropriate to use Bluetooth for it, because of security issues. Can the Minister assure the House that this is not the case and that people’s data will be used only for NHS purposes and will absolutely not be able to be used by any providers of the app or beyond? The 18,000 tracers announced by the Secretary of State just before this Statement are a good start, but we will need more for good national coverage. Worryingly, Mr Hancock said a few days ago that all this will be operated centrally. Is that still the case, or will he use the existing trained tracers that there are in local communities, whether environmental health tracers in councils or in local health teams? It seems rather bizarre to try to cover the country on that level.

On shielding, it is good that there is a request to create more volunteers and to celebrate the volunteers, but notable by their absence in the Statement are the many people who have not yet had their letters on shielding and whether any further groupings may have to consider shielding—which I understand is the case.

I congratulate the Government on their progress on test and trace, but confirm that we are extremely concerned about supplies of equipment and medicine and hope that things will be remedied speedily.

Covid-19: Social Care Services

Baroness Thornton Excerpts

Thursday 23rd April 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, it is an honour to be winding up this historic debate on behalf of the Labour Benches. It is the first substantial debate to be held in our demi-virtual House.

For two reasons, it is completely appropriate that social and domiciliary care are the subjects of this debate. First, we could only suspect when my noble friend Lady Wheeler proposed this debate how important would be our scrutiny of the effects of Covid-19 on care homes, on domiciliary care, on the 6.5 million carers in our community, and indeed on the elderly and those living with disabilities, whether they are old or young. That has been mentioned by many of my noble friends, including my noble friend Lord Dubs, Lady Pitkeathley, Lord Hunt and Lord Turnberg. Secondly, my noble friend framed this Motion for debate in terms of both the short term and the long term.

I congratulate noble Lords on the brevity and eloquence of their contributions, which were outstanding, but also on their command of the virtual world in which we now operate. I also thank the many organisations that sent briefings to us and gently remind them that a briefing arriving yesterday will have less impact than one that we might have received a week ago.

It is right to separate the short term, where we all wish to work together to mitigate the worst of the crisis, from the long term, where we learn lessons and address with honesty the inertia, political cowardice and long-term cuts that have made it impossible to design and put in place a decent, modern, integrated care system. My noble friend Lady Wheeler and I—the Labour team—have lost count of the number of times we have raised the inadequacies of the Government’s response to the stress experienced on the front line in our social care system over the last five years, with no Green Paper, inadequate budgets and huge cuts to council infrastructure. It would be laughable were it not so awful in its consequences for the most vulnerable in our communities in this pandemic. The fact that in PMQs yesterday the First Secretary of State did not know how many social care workers had lost their lives to Covid-19 tells us all we need to know about the priority that the Government have given social care over many years. That must change.

Finding solutions means that issues are identified by good data, reported honestly and openly, and that all those involved, from care homes, trade associations, charities and trade unions, contribute to finding solutions. The employment and business solutions found by the Chancellor were a result of discussions with many different groups, including the CBI and the TUC. Why has that not been a model for social care during this pandemic? Will the Minister commit the Government to bringing together all the stakeholders in this sector to discuss the future, not just the immediate issues of survival?

Yesterday we learned that the current lockdown is unlikely to end soon. The CMO tells us that the probability of lifting social isolation in the next calendar year is incredibly small. We should be realistic about that. We will have to rely on other social measures which, of course, are very socially disruptive, as everyone is finding out right now. The Chief Medical Officer said that without a “highly effective vaccine” or “highly effective drugs” to treat coronavirus, Britain will have to get used to this new way of life. We do not know exactly what that means, partly because the Government have chosen not to have a national conversation about the best way forward, but to inform us of their decision about ending lockdown at some time—who knows when? We already know that, in the short, medium and indeed long term, the impact will be significant for the communities we are discussing.

I beg the Minister not to talk to us in lofty terms about how hard he and the Government are working—we know and appreciate that—but instead to be honest about the challenge we are facing as a nation and in this sector, and have some discourse about solutions with the communities affected. Perhaps Ministers have had incorrect or incomplete information, but time and again lofty promises and bold assertions have collided with reality. This risks undermining trust in the Government, which is so important at the moment. Levels of trust influence our behaviour. The lessons for our leaders are clear: to have humility to admit they do not know everything; to be authentic in their narrative; to have empathy and provide reassurance for the anxious; to have clarity and consistency of messaging; and above all, to have honesty.

On 9 March I asked the Minister the following question:

“My first question concerns vulnerable people in residential homes and the learning disabled who may be being supported, either by charities or at home by their parents. We need to include these people in the planning.”—[Official Report, 9/3/20; col. 849.]


Social care planning was published five or six weeks later, during which time Covid took hold in our care homes with continuing devastating effect. Only in the last few days have we seen testing offered to residents and staff in these homes, for which we are of course grateful. We are fortunate that the noble Lord, Lord Bethell, is the Minister responsible for testing, which will now be rolled out. Clearly, testing centres which are miles away and can be accessed only by car are inappropriate for residents and many staff. When will this testing, when it is accessible, kick in? What is the timeframe?

We must be honest and say that reports of serious failures have reached us all: vulnerable people denied the care they are entitled to expect, and some even denied life itself. Many with disabilities have expressed how strongly they fear the withdrawal of or reduction in services vital to their well-being, as mentioned by many noble Lords. Not enough has been done to reassure them.

In the short term, we have seen unprecedented action: the Care Act being effectively suspended, with only the protection of the HRA in place, and the injection of literally billions of pounds into the care system, although nobody seems to know exactly where it will end up or whether it is enough.

The loss of hard-won rights in the field of adult care, outlined by the noble Baroness, Lady Grey-Thompson, and others, is a major concern. Service user groups, lawyers and advocacy groups are questioning whether the powers taken are in fact disproportionate to the extent of compromising human rights and are wondering whether these rights will ever be returned after this period of emergency. These are major concerns, and the rhetorical downplaying of the value of low-skilled and low-paid workers has been replaced by treating them as heroes, as many have mentioned.

This really sets up a challenge for the future. It has proved hard in many places to set up proper systems for identifying who is vulnerable and how they can be protected and not fall through any cracks. The lack of good information and the absence of data-sharing are exposed. Market mechanisms, through contracts and regulation, failed to embrace the ability to react in a major crisis. The deep-seated organisational barriers between the different sectors of care and between local authorities and the NHS have been laid bare, despite heroic attempts in many places through local initiatives. We now see, finally, that there has been some recognition of how valuable care staff are, but this must be matched by giving them the pay, conditions, training and equipment they need.

Our current social care model does not work. Integration, despite laudable attempts in Manchester and some imaginative STPs—my own included—is not going anywhere fast. The move to a national well-being strategy avoiding all artificial barriers and tribalism in the NHS and between the NHS and social care is essential.

Labour has set out its vision for a long-term solution. Like everyone else, we will study what we can learn from the crisis and adapt our policies as required—we want to work across parties and nations, and believe that work needs to start sooner rather than later. The NHS and social care must be seen as two sides of the same coin and supported in their efforts to respond to the Covid-19 outbreak. It has never been more important to invest in this critical partnership.

Social care providers and their staff have had to adapt as the crisis evolved and new issues emerged, and are playing a key role in supporting vulnerable people at home and enabling people to return home with appropriate support. This pandemic has laid bare the challenges facing social care and highlights the urgent need for a sustainable, long-term funding solution. This must be a key priority for the Government.

In conclusion, I thank all noble Lords for their contributions to this important debate. I heard a care home manager say in despair on the television last night, “We were not prepared and we are not being led.” She is right. This must change for the short term and the long term.

Covid-19: Personal Protective Equipment

Baroness Thornton Excerpts

Thursday 23rd April 2020 Lords Chamber

[Lord Bethell]

The reference that the right reverend Prelate makes is an entirely right one. I pay tribute to the hard-working professionals in NHS and care home procurement. They have been caught in the eye of the most tremendous storm and, under extremely difficult circumstances, are working hard to meet the challenge. In particular, I pay tribute to the local procurement teams who are using their initiative to answer the challenge. Our approach to PPE procurement is one of collaboration with these sorts of local initiatives. I commend them, and they very much spell the future of PPE procurement.

[Baroness Thornton (Lab)]

I was going to ask about waiving regulatory requirements, but I will instead return to the question asked by my noble friend Lord Harris: is it the case that the Minister does not know the number of PPE required? My noble friend asked that question specifically. How much PPE is required on a daily or weekly basis? If the Minister does not know the answer, that is fine; he probably needs to find out and tell us.

[Lord Bethell]

The noble Baroness asks a perfectly reasonable question. I am afraid that I do not know the individual amount off the top of my head. I can tell her that, to date, we have delivered 135 million masks, 148 million aprons, 1.3 million gowns and 485 million gloves—more than 900 million items in total. The amount that we are providing increases every day. I will not hide from the noble Baroness or the House that this is a fast-moving situation. It is my impression that the demand for PPE will soon extend to other workplace situations and increase. It would be wrong to give the impression that this is a fixed amount that we should try to hit with short-term targets.

Covid-19: Medically Vulnerable People

Baroness Thornton Excerpts

Wednesday 22nd April 2020 Lords Chamber

[Lord Bethell]

I completely agree with the noble Lord’s concerns, both about those who are clinically vulnerable and about the potential for a rise in non-Covid excess deaths. The second is a matter of extreme concern. The example of those with cancer who are going to hospital to have operations is a very good and clear example. These matters are very much at the highest level of the Government’s mind.

[Baroness Thornton (Lab)]

I thank the Minister. According to media reports, those who are particularly vulnerable to the virus could be advised to remain shielded for up to 18 months, or until a vaccine has been developed. Can the Minister confirm whether these reports are true? Secondly, the Government have recruited 700,000 NHS volunteers to support those who are vulnerable or shielded. Most of them seem to have been processed but many have been given nothing to do as yet, when there clearly is need. Will the Minister tell me how quickly that issue will be resolved?

[Lord Bethell]

The noble Baroness is entirely right. The prospect of long-term shielding for those most vulnerable is of deep concern. That is why we are pressing so hard on the disease, through the lockdown, to try to get R as low as possible. We will be putting in track-and-tracing measures to ensure that R can be held down and those in lockdown can be freed from their confinement. In terms of volunteers, the response has been incredible. It takes time to turn around all the offers of help that we have, but we are moving extremely quickly to do that.

Covid-19: Removal of Restrictions

Baroness Thornton Excerpts

Tuesday 21st April 2020 Lords Chamber

[Lord Bethell]

The noble Lord is right that the British public have been incredibly diligent, and I commend all those who have followed the guidelines to stay at home for the impact they have had on the infection rate and the mortality rate. However, we cannot fool ourselves into thinking that the epidemic is over. We have to be clear with, and level with, the public that any changes in the guidelines are some way off, and that they will be presented to the public when our understanding of the medium-term strategy is clear.

[Baroness Thornton (Lab)]

My Lords, I thank the noble Lord for the answer that he has just given, but it still begs the question of why the Government are treating the British public as if they were children. I am sure that it would be possible for them to share their thinking, even at this stage. My question concerns testing. Professor Paul Nurse, director of the Francis Crick Institute, said on 19 March about the way to deliver vital testing at scale:

“Institutes like ours are coming together with a Dunkirk spirit—small boats that collectively can have a huge impact on the national endeavour.”


Does the Minister agree with that approach? Can he tell the House when the Government will be able to utilise all the laboratory capacity, which will ensure mass testing and tracing, and will speed up the likelihood of an exit from the current lockdown?

[Lord Bethell]

The noble Baroness is entirely right. I have spoken to Paul Nurse and commend the Crick Institute on the work it has done to build up the remarkable capacity of 2,000 tests a day. However, there are practical issues with the “Dunkirk spirit”. There are enormous logistical challenges in getting swabs and serology to laboratories. There are logistical problems with them registering the correct patient details and then getting the responses back. We have made substantial advances—the Crick Institute has been a pioneer in this—in bringing industrial levels of organisation both to the very large number of tests done each day and to the logistical backbone necessary to process those results.

Coronavirus Bill

Baroness Thornton Excerpts

3rd reading & 3rd reading (Hansard) & 3rd reading (Hansard): House of Lords
Wednesday 25th March 2020 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, I offer profound thanks to all concerned. I thank the Bill team, who have put together a balanced, thoughtful Bill in an amazingly fast turnaround. I thank my own team at the Department of Health for their enormous support. I thank the team in the Leader’s office and Whips Office who have worked to manage a remarkable programme in order to pass the Bill. I thank those in other parties who have worked in a collaborative, positive and supportive way during the whole process. I thank those who work in Parliament and in the House of Lords who are here today at considerable risk to themselves; they have displayed amazing commitment to this remarkable organisation by being here. I beg to move.

[Baroness Thornton (Lab)]

My Lords, on behalf of these Benches, I thank the Minister for the way he has conducted the Bill. It has been a perfect exercise in consultation and work across the House. I thank not just the parties but other noble Lords who have taken part in this Bill for co-operating and working together in a way that has allowed us to scrutinise it as best we possibly could. I think we raised every issue that we could during its passage. It is important to have those things on the record because, as we move forward, we will need to know that we have asked those questions, and the Government will need to address them.

I thank my team, particularly my noble and learned friend Lord Falconer, who got drawn into this about a week ago, and my noble friend Lady Wheeler. I also thank the people in the office, who of course do all the work. In our case, that is Rhian Copple, who has done a brilliant job in keeping us informed and on the go.

I thank all my noble friends and noble Lords who are not here, but who gave us their views and have been patient. I know that they would have wanted to be here.

[Baroness Barker (LD)]

My Lords, from these Benches I too thank the Minister, the Bill team and all the civil servants who have worked with them for the collaborative and inclusive way that they have conducted the Bill through this House. I thank Members on other Benches for their immense understanding and patience as at times we have had to rattle through some very difficult issues that normally, in other circumstances, we would not have dealt with in that way.

Coronavirus Bill

Baroness Thornton Excerpts

2nd reading & 2nd reading (Hansard - continued) & 2nd reading (Hansard - continued): House of Lords
Tuesday 24th March 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, we are living in a strange and frightening time. I congratulate all noble Lords on their speeches and questions today. I refer to my interests as listed in the register, including the fact that I am a member of a clinical commissioning group until the 31st of this month, when it will be abolished and absorbed.

As always, our thoughts have to be with those who have lost loved ones to this virus. Also, all of us would praise, as we have done today, the extraordinary efforts of our NHS staff and other dedicated public servants. We are for ever in their debt. My nephew, Oliver Carr, is a newly qualified first-year doctor at the Royal Free Hospital here in London. I cannot stress enough how proud we are of Oliver, but we are also, like thousands of families everywhere with loved ones working in our NHS today, very concerned for his safety.

Today, we are being asked to make decisions of a magnitude that we would never have dreamed of a few weeks ago. None of us came here to put on to the statute book powers that would curtail so many basic freedoms which our forebears had fought so hard to put in place and which we take for granted. As my honourable friend Jonathan Ashworth said yesterday:

“This virus spreads rapidly, exploits ambivalence, thrives on inequality”.


I shall speak about health and social care. My noble and learned friend Lord Falconer covered justice and dealt with the aspects relating to coroners—I am very pleased to say—as well as the sunset clauses. Also, I shall not refer to education, because, between them, my noble friends Lady Blackstone and Lord Watson covered the waterfront on the educational questions that need to be asked with regard to the Bill.

The reference in last night’s statement by the Prime Minister to the fact that social isolation and distancing must be enforced was welcome. It was necessary because too many people were not following the advice. I think that we all watched with incredulity and horror the pictures at the weekend of bustling markets and packed Tube trains, beaches and parks, so I am afraid that the public health message was not heard loud and clear, and we now have to see whether it will be.

Everyone who should be at home, must be, and they must work from home. I am afraid that that includes your Lordships. There are six or seven speakers in this debate, including on our Benches, who should not really be with us. They are breaking the Government’s guidelines—now, instructions—and they endanger themselves, which is really worrying. I hate to say this but I know that they are here because most of their friends, including me, would not dare tell them not to be, and they have a contribution to make. However, it does not reflect well on this House after the magnificent example that has been set by the Lord Speaker. Hundreds of our colleagues are not here and have been sending messages to us, for which we are all grateful. They have been giving us advice, as many of us have mentioned.

I happen to think that Parliament must continue to sit as best it can. We must hold the Government to account, not least because, as many noble Lords have said, inevitably this Bill will have its flaws. Normally, we would have pointed those out over a period of months. It does not adequately cover some very serious areas which we have discussed today, not least the homeless, the self-employed and renters. Therefore, although I feel that the emergency powers, while draconian, are needed, that does not mean that the Government cannot regularly be held accountable. As the Minister said, the powers should be only in the context of this virus.

Turning to the health and social care workforce, one thing that we certainly now know unambiguously, as a result of this pandemic, is that nobody can be unaware of the importance of care workers in our community. There is definitely awareness of social care. It has to be accepted and of course properly funded.

The next few months will present a different level of challenge for the NHS and anyone working in the caring professions. We know that an increasing number of people will become ill and some will require medical treatment in hospital. The additional patient volumes will place enormous pressure on all sectors of our health and social care system. There will be pressures from increased absence by staff who are unwell and self-isolating in their households, so testing is absolutely vital, as is adequate PPE.

I will divert slightly from discussing the health and social care workforce. Several noble Lords mentioned the police, including the noble Baroness, Lady Barker, and the noble Lord, Lord Adebowale. If we are putting on the statute book, as we have been and will do, things that mean that you might be breaking the law if you go out or do something you should not be doing that might involve our police, what protection are we giving them? I will read on to the record what a female police officer has said in a message I have received:

“We need masks for every officer and prisoner, at least four washable masks for police officers: one to use, one to have in the bag for three days to decontaminate before washing, and two to change during the shift. Shower facilities for police officers—there are not enough showers. Gloves. Where do we take prisoners who are symptomatic? Where do we take people in a domestic situation? What happens to child contact arrangement orders? Can a person on bail not sign for bail who is self-isolating? What’s the process for breach of bail? What about registered sex offenders? Do they have to tell us if they intend to be at a different address? They have to attend police stations and register where they are. What do they do if they are symptomatic and away from home?”


She goes on, including on serving warrants and all the issues that our police have to face on a daily basis and which will increase. The Bill does not address those issues, but the Government absolutely have to address them.

The Bill includes provisions for regulators to register suitable healthcare professionals, such as nurses, midwives and paramedics, as well as social workers, including those who have recently retired or are on career breaks. To facilitate the return of experienced staff, we understand that rules that prevent retired NHS professionals working for more than 16 hours a week and which affect their pension entitlement have been suspended. However, procedures must be in place to ensure that background checks and other measures are fast-tracked. We must ensure that the well-being of these people is prioritised.

The Government will also be registering final-year nursing and medical students who are near the end of their training. These students have to be supported, supervised and properly remunerated. I absolutely back what the noble Baroness, Lady Watkins, said about the debt that nurses face.

We recognise that it will be appropriate and necessary for doctors, nurses and other registered health professionals to work outside of the usual scope of their practice and specialisms, and that a far wider range of staff than usual will be involved in directly supporting Covid-19 patients with respiratory needs. The Bill includes indemnity provisions for those undertaking these services. However, it is vital that NHS staff working outside their usual scope of practice are trained in how to care for vulnerable patients. Can the Minister outline what training will be available, what it will entail and how many staff will need to be trained to use ventilators?

We also recognise that health staff will need to depart, possibly significantly, from established procedures to care for patients in highly challenging but timebound situations at the peak of an epidemic. Can the Minister advise what guidance will be issued to assist clinical staff to make these calls? Can he assure the House that they will be kept under constant review?

I echo and support the words of the noble Lord, Lord Adebowale, about the importance of support for social enterprises. That is based on the role and importance that they have in the delivery of social care in this country. Can the Minister commit that he and his colleagues will meet with Social Enterprise UK and its colleagues to discuss this matter urgently?

The Bill also includes provisions for drafting in volunteers, which noble Lords have discussed, but we have to recognise that people with disabilities and chronic conditions often have some of the most complex care needs. It is very unlikely that volunteers will be able to provide the care that they need. We need reassurances that these people will continue to receive the appropriate care they need from professionals.

The Bill will allow NHS providers to delay undertaking the assessment process for NHS continuing healthcare for individuals being discharged from hospital until after the outbreak has ended. We understand that this will allow hospitals to discharge all in-patients who are clinically fit to leave without delay. Sir Simon Stevens has advised that this will potentially free up 15,000 acute beds. However, it is important that these measures are brought into operation for only the shortest possible time at the peak of the outbreak. The increased burden on social care services, already creaking before the pandemic, means that they will simply not be able to cope. We are concerned that the sector will be unable to cope. It is understandably a great worry for existing service users, who will know how dependent they are on the social care they receive daily.

There is huge concern about how domiciliary social care will cope during the crisis. It really is the front line of social care, with dedicated but low-paid care workers providing vital personal care services, visiting people in their homes daily, moving from client to client and providing the link with the outside world for people who depend on them, particularly if they are without family and care support. Can the Minister reassure us, for example, that the 15-minute visits will be extended to make sure that there is adequate time for a care worker to take the effective Covid-19 precautions as well as seeing to people’s needs, reassuring them and addressing any problems? What guidance has been issued on this?

Finally on social care, the risk to care and nursing homes with older people living in them cannot be overstated. There is a huge responsibility on managers and staff to keep the virus out. Does the Minister anticipate that care workers will be required to self-isolate with residents in the event of a quarantine or lockdown? I think it is obvious: if the pandemic takes hold in a care home, that care home could account for all the acute beds in that area, so it is a very serious problem indeed.

The noble Baroness, Lady Barker, covered the waterfront on mental health issues. On the powers to detain and treat patients who need urgent treatment under the Mental Health Act, to be exercised using one doctor’s opinion rather than two if that proves impractical or would result in unhelpful delay, can the Minister just clarify for us what the thresholds are for impracticality and unhelpful delay? I think that was the only question the noble Baroness did not ask on this.

On deprivation of liberty, I echo what the noble Baroness, Lady Barker, said. Also, pressure on care homes is already significant. The legislation—which the Minister was not involved in getting through the House, but many of us here were—is being carried through now, so this really increases the pressure on care home managers.

One of the side-effects of the Government’s Bill will possibly be to reduce access to terminations. I agree with the noble Baroness, Lady Barker, that this is a problem. The Minister and the Government really need to address that.

On supporting the public over domestic violence and abuse, the evidence suggests that domestic violence may increase during this time and that children are particularly vulnerable. What are the Government doing to recognise this? Are they improving funding to this sector? Are they considering the most vulnerable, including ensuring immediate funding as well as replacement income for refuges that have already had to close?

Turning to renters, it is clear that nobody should have to lose their home because of the virus and its impact. The Government have acknowledged that with their action on mortgage holidays, yet have failed to protect those in the rented sector. Despite suggestions otherwise, we believe that the Bill fails to legislate for a ban on evictions. I hope that the Minister can confirm that the Government intend to amend the Bill to this effect or to introduce further primary legislation. There seems to be an overwhelming case here. Some 20 million people in England rent, 6 million of whom have no savings whatever, so they are particularly vulnerable if they lose their job or have their hours cut as a result of this virus. Last week, Shelter estimated that 50,000 households could face eviction through the courts in the next six months, thereby creating yet another crisis. We therefore remain extremely concerned that a three-month pause on evictions will defer this crisis only to the end of that period because landlords will then demand the total arrears of three months’ rent from many tenants who may not have been able to work at all and certainly will not be able to pay.

I turn now to the homeless. The Government need to address the specific question of people who have no recourse to public funds. As noble Lords will know, people experiencing homelessness, particularly those who are rough sleeping, are especially vulnerable in this outbreak. They are three times more likely to experience chronic health conditions, including asthma and COPD, and many are unable to access healthcare or housing because they have no recourse to public funding and benefit restrictions. These people include those on appeals whose rights are exhausted, EU and EEA migrants, people with existing visas, those whose status is not regularised, domestic workers and other migrant workers, as well as the victims of trafficking and torture, so it is critical that this is resolved. It is in everyone’s interests that it should be resolved—if we have people on our streets who are either infected or infectious, that will put yet more strain on the NHS.

On income support, we need income protection for those in precarious forms of employment. Apart from anything else, it would stop them packing Tube trains. One reason the Tube is packed is that many people in very low-paid jobs have to get to work. Like other noble Lords, we remain concerned that the Bill fails to give many people the financial support they need to get through this crisis. They should not be expected to make the choice between their health and hardship. Several noble Lords have talked about the self-employed and they are absolutely right to do so. The Government need to look at the position of the self-employed in a generous way. The Government should also act now to assist millions of people through the universal credit scheme by increasing it, suspending sanctions and scrapping the five-week wait for the first payment. We await to hear what the Chancellor will announce on this as a matter of urgency.

The issue of food is important. Stockpiling is clearly taking place and it is happening because people are not reassured that there is enough food to go around. The most vulnerable are losing out, so the Government have to take this very seriously. We understand that military personnel might be brought in to help with food chain logistics. Can the noble Lord explain what their role would be? Additionally on our food supply, by this summer we will need some 80,000 seasonal workers to pick fruit and vegetables, so we will have to train a reliable workforce for that.

The noble Baroness, Lady Grey-Thompson, covered the issues affecting the lives of disabled people. The Government’s plans in the Bill for this crisis will roll back 30 years of progress for disabled people. While we may tolerate this for a short period, we cannot tolerate it for very long. All the years that we fought for disabled people’s right to social care are being eroded and undermined, along with their civil liberties and right to support. We need to put the noble Lord on notice that, particularly in this House, we will tolerate this for as short a period as possible.

I want to say a word about food banks, which are suffering from, or are in danger of suffering from, shortages. Here I pay tribute to some of our major retailers, the Co-op in particular, for ensuring that deliveries to FareShare schemes are going through. Today I saw a message from the manager of a Boots shop, complimenting the staff on dealing with a totally unacceptable level of abuse. Apparently, it happens particularly when they run out of Calpol. Such scenes are being repeated over and again in our shops and supermarkets, so I pay tribute to all their staff and managers, who are doing very hard jobs, along with other shopkeepers and indeed our farmers.

In conclusion, as my noble and learned friend Lord Falconer said in his opening speech from these Benches, we lend our support to the Government to put this legislation on to the statute book without delay, but not without comment or scrutiny. This is just the beginning of the challenges of the crisis facing our nation and our democracy.

Covid-19: Critical Care Capacity

Baroness Thornton Excerpts

Monday 23rd March 2020 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government, in the light of Northwick Park Hospital’s declaration of a “critical incident” and an increasing number of patients across the UK with Covid-19, what steps are they taking to increase critical care capacity in the NHS.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, Covid-19 is the major challenge of our generation. This Government’s priority is to protect life, which is why we are taking urgent action significantly to increase care-bed capacity throughout the NHS, including freeing up almost a third of existing beds. Yesterday, the Government announced a major deal with independent hospitals. That will add to the NHS’s pandemic response 8,000 hospital beds, 1,200 more ventilators and a significant front-line staff number of 10,000 nurses, 700 doctors and 8,000 other clinical staff.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. It is of course incredibly worrying that, at this stage in the pandemic, Northwick Park Hospital was forced to declare a critical incident over the weekend. That means that it ran out of critical care beds and had to ask neighbouring hospitals to take its Covid-19 patients. It is likely to be two weeks before we may see a steadying of the spread as a result of social distancing measures. If one hospital is already finding itself in such a position, then more might do so in the coming weeks and months. As the Minister said, it is urgent to expand capacity by increasing the number of intensive care beds and ventilators available. Will the Minister detail how many ICU beds and ventilators the Government aim to have in place by the end of the two-week period, at which we hope infection rates will reflect the new measures?

Also, the House may be aware that a fit and healthy 36 year-old nurse is now on a ventilator in Walsall Manor Hospital, having contracted Covid-19. Are the Government confident that the supply of personal protective equipment is no longer an issue after an increase in delivery in recent days and that there are plans to further increase the production of such equipment?

[Lord Bethell]

My Lords, the decision by Northwick Park was entirely welcome, because we welcome the realism and practicality on the part of the management in seeking help when it is needed. We are moving at pace to address the issues around PPE, and I can confirm that there is a massive amount going into the system as we speak. We currently have 3,700 critical care beds; total usage is currently 2,428, of which 237 are Covid-19 related; and our ambition is to increase this dramatically to perhaps 30,000 in time for the crisis arriving in full.