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

Lord Bethell Excerpts

Thursday 24th September 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 3 August be approved.

Relevant document: 25th Report from the Secondary Legislation Scrutiny Committee

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

My Lords, the regulations that we are debating today came into force on 3 August and 19 August respectively, but the story of these regulations began a month earlier, on 3 July, when the Health Protection (Coronavirus, Restrictions) (Leicester) Regulations 2020 imposed the first interventions in Leicester and neighbouring boroughs. Those original regulations required the closure of all non-essential businesses and restricted indoor gatherings, overnight visits and visitors. We reviewed the regulations every 14 days, working closely with local leaders.

Aware of the distress caused by local lockdowns to the people of Leicester, we have relaxed restrictions whenever that appeared safe to do so. Thus, on Saturday 18 July we removed the borough of Blaby and Charnwood from the protected area. Then on 24 July we amended the regulations to allow specified businesses, out-of-school childcare and educational establishments to reopen in Leicester. The amendments that came into force on 1 August removed Oadby and Wigston from the protected area.

The regulations that we are debating today repealed the three previous Leicester regulations. That is why we are not debating Statutory Instruments 2020/754, 787 or 823, which have been revoked. The (No. 2) (Leicester) regulations are what we are debating today. They came into force on 3 August. They allowed more businesses to reopen across the city, fine-tuned restrictions on residents and applied the learning of our work in the city. For example, residents were allowed overnight visits, and the restrictions on gatherings were replaced by restrictions preventing different households meeting up with each other inside homes and their gardens.

Then on 19 August the (No. 2) (Leicester) regulations were amended. With a more stable incidence rate of the virus of 70 per 100,000, my right honourable friend agreed that it was safe to allow more businesses to reopen, in accordance with Covid-secure guidance, but not to relax the restriction on households meeting one another in another home. We also published guidance for people living in Leicester to help them to understand what they could and could not do under the restrictions, which was updated each time there was a change.

I am acutely aware that your Lordships are familiar with the detail of these regulations after several debates on local interventions. Rather than rehearsing the detail, I would like to share with the House some of what we have learned from this process, learnings that we have applied to other lockdowns. I reiterate that this has been a partnership between national and local government. National government was required to apply the right legal restrictions. It provided extra analytical insight from the data that was beginning to come on stream from our test and trace operations and other operational resources. NHS Test and Trace provided mobile testing units and supported the development of a local contact tracing service, which achieved a success rate of over 91% in tracing those not reached by the national service, so that was a successful model for other areas. However, that success would have been impossible without the herculean efforts of local leaders and the local community, and I am sure that all noble Lords will wish to join me in paying tribute to them. I give particular thanks to Public Health England’s experienced regional director of public health, Dr Sue Ibbotson, and her team, who have provided invaluable advice and expertise to complement the work of the two excellent local directors of public health, Ivan Browne and Mike Sandys.

From early in July, Leicester City Council, Leicestershire County Council and the local resilience forum co-ordinated testing and tracing, instigated communications and brought about community and business engagement as well as managing education and adult and social care. In doing so, they have used their profound local knowledge to reach all parts of the community. For example, they have translated messages into multiple languages spoken locally and ensured that they have been delivered by trusted local leaders. This has helped to build support for the restrictions across the area. They have engaged with local businesses in the wards with the highest incidence rates to provide advice on Covid-secure practices.

This excellent work was recognised by Dame Ney in her report Rapid Stocktake of Lessons Learnt and Good Practice in the Management of Local Covid-19 Outbreaks, published in August. She noted that there was a

“commitment by all agencies and their staff to work together and tackle the situation.”

She commented on their

“openness and flexibility in seeking solutions”.

She also recognised the ongoing “continuous learning” that was developing both local and national ways of working.

The effective collaboration in Leicester—of central resources and expertise working with local knowledge and implementation on the ground—took a huge effort to get right. There was some grinding of gears, but the lessons learned have informed our response in other areas, and I pay tribute and give thanks to all involved.

We always knew that the path out of the lockdown would not be entirely smooth. It was always likely that infections would rise in particular areas or workplaces and that we would need to be able to respond quickly and flexibly to these outbreaks. This has been the story in Leicester. The protected area covered by these regulations was extended on 22 September so that, once again, it included the Borough of Oadby and Wigston. Unfortunately, following a drop in the incidence rate in that area earlier this summer, rates have now risen to an unacceptably high level: 102 per 100,000 people for the seven days from 9 September to 15 September.

The Leicester regulations have demonstrated our willingness and ability to take action where we need to. We will, of course, use the experience of these measures in Leicester to inform and help us to develop our responses to this and other local outbreaks in the future. As I said earlier, there have been ongoing reviews of the Leicester regulations, and the next review is due tomorrow. We will, of course, make the outcome of this next review public in due course.

I am grateful to your Lordships for your continued engagement in this challenging process and the scrutiny of these regulations. In particular, I thank the people of the protected area in Leicestershire, who have responded so well to the measures put in place. It is thanks to their continued efforts that we are able to reopen non-essential retail, childcare and educational establishments. I reassure the Chamber that we will make further relaxations as soon as the epidemiology permits. I beg to move.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I thank noble Lords for their thoughtful questions. I will try to get through as many of them as I can. I start with the points made by the noble Lord, Lord Hunt, echoed by the noble Baroness, Lady Thornton, about the speed with which the regulations before us were presented. In defence of the work of those who draft the Explanatory Memorandums, there has been a huge amount of legislation going through Parliament because of Covid. The team that draft it has been augmented; we have brought in more parliamentary training in order to bring more people on to that team. I pay tribute to their very hard work, but I completely and utterly recognise the points made by the noble Lord and the noble Baroness. Complex regulations brought into this place at speed rightly deserve a clear Explanatory Memorandum. We will endeavour to ensure that that happens with all the material we bring to Parliament in the future. The noble Baroness rightly praised the work of the Secondary Legislation Scrutiny Committee. I echo that: the work it has done is unsung and deserves our praise.

The noble Lord, Lord Hunt, asked how we judge whether an area should come out of lockdown. This is now done by an extremely thoughtful team run by the joint biosecurity team. They look at a very large number of measures. They look at the connectivity of a given place. A high street in the centre of a busy town with strong community relations up and down the country is inevitably going to be of higher focus than, say, a rural, self-contained area. They look at on-the-ground intelligence from the local infection control teams, who will have their own assessment as to how well the restrictions are being applied and followed by people on the ground. They look at the direction of travel of the infection rate, both locally and nationally, and within the groups in a given area. They look at acceleration—whether something is holding at a given level, or moving in one direction or the other at speed. We are learning all the time from both British and international comparisons, and we look at the response of the people on the ground and the resources of the local authorities for implementing local measures. These are some of the factors that play into the assessment and, as noble Lords can see, an extremely complex but thoughtful process is now in place. 

The noble Lord, Lord Hunt, rightly asked about the involvement of local authorities and whether the leader of the local authority should make a statement. The frustrating truth is that the virus does not respect political boundaries in the way we would like it to; it tends to flood over them. One of the challenges we face is trying to build political alliances across boundaries, where people may have different priorities and alliances. Therefore, building those cross-boundary alliances is a key part of what we do.

The noble Baroness, Lady Bowles, talked about family links. She is entirely right—one aspect of the disease is our understanding now of how far people travel to pursue their family and community connections. We can trace, through genetic detective work, who has what disease and from where, and it is astounding how far and how quickly the disease moves through the corridors of family and community links up and down the country. The noble Baroness also mentioned the challenges of working parents and childcare. We completely recognise those challenges: they are intimate, personal and profound. We have already moved a long way, particularly in the north-east with recent changes, to try to accommodate these important challenges, in particular those of women, who are suffering in a particularly tough way during this disease.

My noble friend Lord Bourne talked about the retrospective flavour of these regulations. I am afraid to say that that is simply an aspect of how quickly we are moving. He also asked about the infection rate in Leicester, as did the noble Baroness, Lady Thornton, and the noble Lord, Lord Bhatia. It is currently 103.9 and rising. That is an extremely frustrating statistic because, as you will remember, it was only just over 100 when these regulations were brought in. In other words, it has gone down and then back up again. The positivity rate is 8%—that is quite high, and it speaks of there being an infection challenge in Leicester.

We acknowledge that, across the country, there is a particular problem with young people. They do not get hit by the symptoms of this disease themselves, but they are vectors of infection. One of the challenges we have in Leicester, as we do in many towns, is that young people are, quite understandably, frustrated about the restrictions placed upon them and are not necessarily abiding by the social distancing restrictions. That is one reason why we have had to bring in new measures beyond the rule of six in the Prime Minister’s recent announcement.

The noble Lords, Lord Bourne and Lord Bhatia, both asked about lessons learned. There are dozens of lessons learned, but I can indicate two that are particularly striking. First, we have learned it is better that plans for local restrictions originate locally, rather than coming from the centre and being passed down. Secondly, no one likes to see added restrictions imposed on their area, or to see this happen because an adjacent geographic area has an infection rate issue. That is one of the things we have had to do, and it is a really big challenge for those concerned.

The noble Lord, Lord Bourne, also asked about Asian communities and what we have learnt about them. Government marketing and communications into hard-to-reach communities, such as the Asian community in Leicester, but also the seasonal agricultural working community in places like Hereford, are not what they should be. We have come a long way in learning how to use languages and community media, and we now have a strong partnership with local radio and TV directed at those communities. We have learnt a lot and come a long way.

The noble Baroness, Lady Uddin, rightly cited mental health as a key issue. It is one that we discussed earlier today, and about which we are particularly concerned, investing £8 million in the Wellbeing for Education Return fund. I welcome the noble Baroness’s suggestion that we work with Barnardo’s, an organisation that has enormous respect and trust in government, and I would be glad to work with her on that.

My noble friend Lady Altmann asked about assessments. May I direct her to the review by Dame Mary Ney, which is a stocktake of local lockdowns? My noble friend questioned the whole principle of lockdowns—but may I reassure her that the principle of local lockdowns is to try to avoid national lockdowns? We have them because the virus largely plays a local role. We seek to impose local restrictions to avoid national restrictions. That is international best practice. But I completely acknowledge the damage done to local health outcomes, and we work hard to avoid it.

The noble Lord, Lord Greaves, rightly cited the importance of investment in local business. I remind him that we have invested £70 million in businesses in Leicester. He also asked about local authorities’ implementation of the £500 bonus. I assure him that it will be in place by 12 October, and that those who have not been paid by then will get retrospective payments.

The noble Baroness, Lady Thornton, asked about whether things had been fair in Leicester. This virus just is not fair, and the way in which we handled it in Leicester represented the very best endeavours possible. Yes, of course there will be people in Leicester who feel hard done by—but we could not have tried harder, and we continue to do our best to crack down on this horrible virus.

Motion agreed.

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

Lord Bethell Excerpts

Thursday 24th September 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 18 August be approved.

Relevant document: 25th Report from the Secondary Legislation Scrutiny Committee

Motion agreed.

Health Protection (Coronavirus, Restrictions) (Blackburn with Darwen and Bradford) Regulations 2020

Lord Bethell Excerpts

Thursday 24th September 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 31 July be approved.

Relevant document: 25th Report from the Secondary Legislation Scrutiny Committee

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

My Lords, it has always been clear that, once the country emerged from a national lockdown, there would be local outbreaks. Our strategy was to bear down heavily on these outbreaks, in line with best practice from around the world. The complex challenge for government has been to tackle these in a proportionate, locally engaged, evidence-based manner, recognising the impact of the virus on the vulnerable and the NHS while being sensitive to the impact of restrictions on local communities and the economy. An added complication in this instance was that we were looking at increasing infection rates in areas with substantial Muslim populations at the same time as the festival of Eid. This is not something we did lightly, and we were reluctant to disrupt this important moment—but action was imperative.

There were regulations predating these that imposed restrictions in Blackburn with Darwen—as well as Luton—that came into force on 24 July. These regulations restricted certain businesses in Blackburn with Darwen and large gatherings in both local authorities. The regulations we are discussing today replaced Luton with Bradford Metropolitan District Council. These regulations were reviewed regularly and came into force on 26 August, 2 September and 3 September. Essentially, each amendment reduced the protected area to focus our restrictions to the smallest reasonable area, which in practice meant specified wards only in Blackburn with Darwen Borough Council and the City of Bradford Metropolitan District Council, releasing wards where incidence rates were lower from local restrictions.

I should stress that the judgment about when to remove restrictions is driven by the evidence, but no single piece of data determines that decision. The infection rate per 100,000 of the population is important, but so is the test positivity rate, acceleration rates, intelligence from local infection teams, hospital data, international comparisons, the national picture, and the robustness of local plans to tackle outbreaks. So, for example, the infection rate in Blackburn with Darwen as of 1 August was over 70 per 100,000 people. By 26 August the rate had fallen to 52, and it fell again to 48 by 2 September. Similarly, at 1 August, the rates in Bradford were around 47 per 100,000, falling to 44 by 26 August and remaining at that level for the following week.

This was important data. But it is also important to understand the local context, particularly an assessment of how well the local communities were prepared to bear down on the outbreak, so we could judge where restrictions could be safely lifted. This is where the partnership between national and local government comes in. From the centre comes a range of support, including extra testing capacity and mobile testing teams, financial support for businesses and communities, and postcode-level data on cases enabling a more granular understanding of the progress of the virus.

Funding is essential to effective infection management to support the right behaviours. In Bradford, for example, central government funding was invested in supporting community-level assets, such as the Council for Mosques, voluntary and community networks that already engaged with a wide range of diverse groups, community wardens, youth ambassadors, and in services that already supported hard-to-reach groups in the community. The Council for Mosques led on development and communication of an Eid management plan.

Similarly, Blackburn with Darwen, responding to rising numbers of cases in July, developed a social movement of guidance, including face coverings in all public spaces and no hugs or handshakes. The local public health team, along with colleagues across Lancashire, has worked with local community leaders and faith networks to spread public health messages.

These examples demonstrate that successfully tackling Covid requires that partnership of central and local government. The Government have therefore consistently adopted the important principle that, wherever possible, decisions affecting local populations should be reached on a consensual basis and have put in the necessary bridge building to create that consensus. During this period, we began to have access to detailed data on infection rates down to ward level—data which we share with local teams. I note that the process of familiarisation with the new data sources, category terms and trends sometimes has a steep learning curve for all concerned.

In summary, I reassure noble Lords that the national teams at test and trace and Public Health England have worked incredibly energetically and swiftly to put in the decision-making connections, the financial resources and the data exchange necessary to implement a joint national-local approach. This has been a learning experience for all parties and agendas are not always perfectly aligned, but, during interventions such as this, there has been tremendous good will and lessons have been learned that inform our current system, which works much better. The Government are deeply grateful for the constructive way in which local leaders have engaged in this process, and I am sure the whole House will join me in paying tribute to the huge efforts of local leaders in the affected populations.

Since these regulations and their amendments have been implemented, the Government have continued to monitor and review the ongoing situation. The incidence rates in both local authority areas have, in fact, risen across most wards. The incidence rate for the seven days from 2 to 8 September in Blackburn with Darwen rose to 110.8 per 100,000 people, and during the same period it rose in Bradford to over 100. While we are only debating these four statutory instruments today, there have been regular reviews since they were made, considering the position in each local authority’s area, and we remain concerned by the continued high levels of the virus in both, driven primarily by community transmission.

In terms of next steps, we continue to learn from the local outbreaks and we will use the experience of these restrictions in Blackburn with Darwen and Bradford to inform and help us develop our responses to any future outbreaks. Furthermore, we will continue to offer transparency in our future reviews.

I am grateful to your Lordships for your continued engagement in this challenging process and for the scrutiny of these detailed regulations. I completely recognise that it is a frustrating process to be considering regulations such as these weeks or months after their implementation. I reassure the Chamber that this approach has given us a valuable legislative framework to react promptly to the fast-changing and sometimes unexpected twists and turns of this horrible disease, and that the scrutiny of sessions such as these, even if it is necessarily post hoc, has informed our decision-making on issues such as data sharing and engagement with local authorities.

Lastly, I thank the people in the protected areas in Blackburn with Darwen and Bradford who continue to respond to the measures put in place. It is unfortunate that the restrictions cannot be lifted at present, but, thanks to their continued efforts, it has not been necessary to impose further restrictions. I beg to move.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I start by acknowledging the touching comments of the noble Baroness, Lady Thornton, about the pain of separation. These thoughts were absolutely on our mind when we brought in these regulations. They were done at a time when we were pleased to be lifting the national lockdown and when we all felt a huge sense of relief after everyone had spent long months cooped up. The relief was profound, and the idea of sending some households in some parts of the country back into lockdown was keenly felt. I completely acknowledge the fact that for some families this is extremely painful.

I also acknowledge the comments of the noble Lord, Lord Greaves, on expectations management. It is true that the disease has bounced around. At moments, there have been false dawns when we thought we might have seen the back of it, and there have been dark moments when it has all seemed to be going wrong. Perhaps I may share with the noble Lord and the Chamber the view of the CMO—that, as the Prime Minister made really clear in his broadcast on Monday, we have six difficult months ahead of us. There is no beating around the bush and no easy way out of it. We have six long months ahead of us—but, at the end of that, there is the prospect that a vaccine and better therapeutics will give us medical alternatives to the disease, and that the innovations that can lead to the kind of mass testing that we are desperate to put in place now and are moving mountains to try to achieve will also give us the security to socialise in the way that we all want to.

Those are two grim notes to start my response with, but they answer in part the challenge from the noble Lord, Lord Hunt: why are these things not working? Well, they have worked in some respects. Since lockdown was lifted, we have seen prevalence levels across the country largely under control and we have had months of freedom. As the CMO could not have made more plain in his presentation with the Chief Scientific Adviser, infection rates are beginning to creep up, but this local-lockdown approach has been effective in some respects.

However, the thing that undermines it and that, more than anything, spreads the disease is socialising—sharing tight-knit space with people from outside your household, face to face in closed environments. That produces the aerosol effect that spreads the disease from one person to another, and that is why these measures target socialising as specifically as they do.

Perhaps I may quickly answer a couple of points that were raised. The noble Lord, Lord Hunt, talked about the importance of getting local authority leaders in front of statements. I reassure him that we have brought MPs into the decision-making process. We have sought to use MPs, with their representative qualities in the other House, as the liaison between local restrictions and the parliamentary process.

The noble Lord, Lord Hunt, and the noble Baroness, Lady Thornton, rightly talked about the importance of business support. In Blackburn, business support has risen to £10 million, and in Bradford to £36 million. Those kinds of numbers across the country have put an enormous investment in business support, so that people can take on board the restrictions that we have put in place and we can continue to support businesses.

My noble friend Lady Wheatcroft asked about the hospitality industry and why it seems that practice differs between venues. She is entirely right. Some pubs and clubs have socially distanced tables, well organised contact tracing on entry, table service and “bookings only”, but some have not, and they are the problem. The app which launched today will have a much easier to use QR code component, and the curfew will see the closure of pubs at 10 pm. Therefore drinking-up time will need to begin at around 9.30 pm. This will help address that disparity, but we will keep the situation under control.

The noble Lord, Lord Greaves, asked whether we had enough tests to go around and whether the testing system was under control. He is right that we are challenged, but we make no apology for the prioritisation we have put in place: clinical need, including for key workers, then social care, then surveillance and research, then the public. We are putting more and more resources into providing the tests that the public need and we are catching up with demand each day. There is a lot of commentary about whether the messaging around the epidemic is right—“This is said one day, this is said another day.” We all have views on whether every single message has been right, but it comes down to this very simple point. The message from day one has been clear: the way to beat this disease is through social distancing, hygiene and isolation. That has been our strategy from the beginning, and it remains our strategy. They are uncomfortable protocols which none of us like following, but there is no point in blaming the messaging. The country must stick with the basic protocols.

The noble Lord, Lord Greaves, and the noble Baroness, Lady Thornton, spoke very movingly about the impact of these regulations on the Muslim community. As I said in my introductory comments, these regulations were brought in just before Eid. It was a tough decision. They were brought in at the last minute, partly because we were trying to avoid causing disruption. As part of their introduction, I had round-table conversations. Although I was not on the notorious Bradford telephone call, I was on similar engagements, and I have no illusions about the depth of feeling on this. I know all about the concerns about conspiracies—that some of these recommendations were brought in on ethnic lines.

I know all about the challenges of housing and poverty in some of these communities, and the noble Baroness is entirely right that this disease tracks down people in poverty, people who live in multigenerational households and people who live cheek-by-jowl with each other. It is one of the unfortunate facts of this disease that it goes after those in deprivation and who have the least advantage. We are extremely conscious of that. It is one of the reasons why we bear down on this disease in such a tough way in the very communities that are most vulnerable to it.

However, I reassure the Chamber that we are working extremely hard to build that trust. There is a phenomenal amount of engagement and we are thoughtful about how we engage with these key communities. We work our hardest to provide all the testing facilities via the kinds of people who will engage with the communities involved. We seek to be sensitive, we have put in the media partnerships and the community engagement proportionate and necessary to win over trust, and I believe that we are making progress.

The message has been received loud and clear that this is an uncomfortable and unhappy way to be regulating on lockdowns. The noble Lord, Lord Greaves, talked about whether there might be some way of formalising a weekly update, or some kind of weekly process. That is an extremely good idea, which I will take note of and take back home. We are seeking to develop a more thoughtful and predictable way of working through these regulations, and I look forward to updating the House on our progress on that. I also reassure the Chamber that the Coronavirus Act debate on Monday has been extended to four and a half hours, which will give us an excellent platform to discuss some of these themes in more detail. I commend these regulations to the House.

Motion agreed.

Health Protection (Coronavirus, Restrictions) (Blackburn with Darwen and Bradford) (Amendment) Regulations 2020

Lord Bethell Excerpts

Thursday 24th September 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 25 August be approved.

Relevant document: 25th Report from the Secondary Legislation Scrutiny Committee

Motion agreed.

Health Protection (Coronavirus, Restrictions) (Blackburn with Darwen and Bradford) (Amendment) (No. 2) Regulations 2020

Lord Bethell Excerpts

Thursday 24th September 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 2 September be approved.

Relevant document: 26th Report from the Secondary Legislation Scrutiny Committee

Motion agreed.

Health Protection (Coronavirus, Restrictions) (Blackburn with Darwen and Bradford) (Amendment) (No. 3) Regulations 2020

Lord Bethell Excerpts

Thursday 24th September 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 3 September be approved.

Relevant document: 26th Report from the Secondary Legislation Scrutiny Committee

Motion agreed.

Covid-19 Update

Lord Bethell Excerpts

Wednesday 23rd September 2020 Lords Chamber

[Baroness Barker (LD)]

My Lords, three months ago the Secretary of State said that test and trace was the single most important thing that had to be done to conquer the virus. Yesterday the Prime Minister said it had “little or nothing” to do with the transmission of the virus. These two things cannot both be right. For six months, the problem has been that we have had confused messages, careless use of statistics and a persistent refusal to work with and listen to people who run local public services and know what needs to be communicated to whom and how.

All those are the fundamental reasons we find ourselves in this situation. We still lack an effective and timely track, test and isolate system. In its place and without any evidence base behind them, we have come up with messages which, quite frankly, do not make sense to the general public. The rule of six does not make any practical sense at all, as was very well evidenced today by my noble friend Lord Newby in an earlier interaction with the Leader of the House.

Yesterday, the Prime Minister said the Government now had granular data that enabled them to understand the transmission of the virus. When will that evidence be released? And when will it be released to Members of this House and the other place, who, next week, are going to be asked to renew emergency powers the like of which have never been seen before to this Government? If the Government cannot come up with that evidence—and, I have to say, over the last six months, they have persistently failed to answer any kind of detailed question from Opposition Benches in this House—why on earth should they be trusted to have those powers renewed? When are we going to get the evidence base?

It is helpful, looking at the Secretary of State’s Statement, to see that finally, after repeated questions from these Benches and the Labour Benches, we have got a clearer statement on who is being prioritised for testing and in which area. But, as the noble Baroness, Lady Thornton, said, it is remarkable that there is nothing about black and minority ethnic communities, which we know are at greater risk, and nothing about the important people who work, for example, in domiciliary care, or who work in hospitals but are not medics.

I would like to ask one final question. When will they start listening to local authorities, who are persistently asking, in helpful ways, what they can do to expand the capacity for testing and to make sure that testing is better tied into the rest of the services? We are about to have an app launched, and local authorities are already telling us that there is soft intelligence that people who think they have symptoms but are unable to get a test just give up, and that people whose children are ill give up. It is all well and good for the noble Lord to say, as he did the other day, that they are going to completely redo NHS 111 to make it a more streamlined portal into the NHS, but if people have given up looking for tests long before they should, we are never going to get the data we need to get on top of this.

So I ask, as I did the other day: when they are revamping NHS 111, will they talk to the Royal College of Paediatrics and Child Health about the NHS 111 protocols? I agree with the noble Baroness, Lady Thornton; I think the public are desperate to do the right thing. They have been extraordinarily patient and have listened throughout, giving the Government the benefit of the doubt. But they will not go on doing that indefinitely while the Government continually fail to come up with a decent evidence base for their actions.

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

My Lords, I am extremely grateful to the noble Baroness, Lady Thornton, for correctly characterising our response to the epidemic as “the best compromise possible”. It is a compromise. We have competing demands on our strategy: we have to protect lives and the NHS, but we also have to be conscious of the economy and the livelihoods of people, and we have to look after our students and pupils. The package of measures being put forward by the Government is the best compromise we can make for this moment, and we are unashamed of that compromise.

But the noble Baroness is wrong when she says we do not have a strategy. The strategy is really clear; it is to suppress the virus and protect the economy and education until the vaccine and mass testing are ready. It may not feel like it now, but there are glimpses of sunlight in the distance. The vaccine and mass testing provide a strong opportunity for us to suppress the virus. The strategy that we have put in place, as the Prime Minister rightly described in his address to the nation, is a way to “get through the months” until we have those arms at our disposal.

Both the noble Baroness, Lady Thornton, and the noble Baroness, Lady Barker, talked about the publication of data. I must confess that I have a genuine sense of confusion about that point, because we publish so much data. If there is one thing that this Government have got wrong, it is that we have published too much data too early. Too much has not been audited; too much has been put out as early as possible in our efforts to be transparent. Tomorrow, we will have a REACT survey; we will have an ONS survey; we will have test-and-trace data. There are SAGE minutes; there is NIHR; there is literally data coming out of every organisation of government. It is a fantastically huge amount of data. It is, I confess, extremely difficult to process all of that data all at once. The story it tells does chop and change at an amazingly fast rate—much faster than any experience I have ever had in my life. It is a rollercoaster that the Government have to ride.

I make no apology, however, for the fact that this Government have sought to act swiftly and to bring in measures quickly when the evidence has changed. In the last few weeks we have seen the latest example of that, where the infection rates have clearly lifted quickly in a way that was not expected, and we have had a discussion about that point in previous sessions in the Chamber. We have moved promptly to address the challenge that those worrying and concerning figures have presented to us.

The noble Baroness, Lady Thornton, raised the question of testing. I completely and utterly acknowledge the frustration of anyone who has not been able to get a test for themselves, for their child or for a loved one. It is true that we have more people wanting tests today than we have supply. However, I cannot avoid pointing out that—boy oh boy—we have come a long way since February, when we were doing 2,000 tests a day, to today, when we are doing 240,000 tests a day, and we are well on the way to doing 500,000 tests a day by October. Our aspiration is to do many times that within the near future.

That is not in any way to avoid the fact that I wish that we had more tests today. I want to convey to the House that this Government are 1,000% committed to answering the needs of this country for testing and have put every resource—human, technological, administrative and financial—behind the testing programme in order to deliver that promise.

The noble Baroness, Lady Thornton, raised the question of tone. I completely accept her point that the people of Britain have made a terrific sacrifice. There is no question at all of blaming the people of Britain, but we have to acknowledge that the spread of the virus indicates as a fact within itself that some people are not respecting the principles of social distance, hygiene and isolation, and we have to move in order to shore up the basic principles of this country and, by the way, of any country that is effectively fighting the virus—because, if we do not, the virus will sweep through the country.

I thought that the Prime Minister put that challenge very well, and in a way that a large majority of this Chamber would support. He said that the choice was before us: we could ask those who are vulnerable and older and shielded to simply lock the door and we could turn our backs on them. That is not the choice that this Government have made. They have made a choice to fight the virus at every level, because we love the people whom we care about; and it is a pragmatic choice, because if we find the virus growing in one part of our society, whether that is young people, health workers or the very young, then sure as night follows day, it will sweep through the rest of society.

I turn to the evidence on the curfew. This is a moment where I do not have the science at my fingertips. However, I have been in pubs and clubs after 10 o’clock enough times to know about the proximity and intimacy of late-night drinking, and I know that what happens then is not conducive to social distancing. This is a moment when plain common sense can tell you that a curfew will help to break the chain of transmission among young people. It is, unashamedly, a signal that we cannot go on like this and, in particular, that young people have to change their behaviours because the signs of infection are crystal clear. The prevalence among young people is too high, and we have to turn that corner.

The noble Baroness, Lady Thornton, asked about symptomatic and asymptomatic testing. The honest truth is that it is very difficult to tell; if someone is standing in a testing queue, we do not turn them away. By the way, in order to get a test, people do have to fill in a form, on which they are asked if they are symptomatic. What we do know from closer analysis and questionnaires is that a proportion of testees—between 20% and 25% at current rates—do not meet the strict criteria of our testing. I am grateful to the British public for beginning to show respect for the fact that every test counts, and for helping us direct them at the most needy.

The noble Baroness, Lady Thornton, asked about domiciliary care, an issue that has been raised in this Chamber a few times. I reassure all those in the Chamber, including the noble Baroness, in answer to her specific questions: yes to PPE, yes to testing and, by the way, yes to new guidelines that help minimise contact and the number of patients seen by each itinerant domiciliary worker; and yes to substantial extra funds for the social care system, specifically to help social care avoid relying on people travelling from patient to patient.

The noble Baroness, Lady Barker, asked about our relationships with local authorities and the local teams. I reassure her that we have moved a very, very long way in the last six months and that the picture she paints is understandable but out of date. We have come a huge way to share all of our insight, data, analysis and systems with local authorities, local directors of public health and local infection teams. Decisions on lockdowns now have a protocol whereby they are led by local teams after engagement with local civic groups and brought to the Secretary of State after they have been agreed at a local level.

Substantial sums—billions of pounds—have been given to local authorities to help them afford the kinds of local intervention that they choose to make in order to support the most vulnerable and disadvantaged during the epidemic. Money is given to local authorities for PPE for the people that they decide need it. Community health is being supported within the NHS in order for communities to be given the support they need. Engagement with local civic groups and business leaders is at a level I have never seen in government before.

I will give one example in relation to contact tracing, which the noble Baroness, Lady Barker, specifically asked about. In Leicester, money has been given to the local council for it to commission its own contact tracing, because we recognise that the local authority may well have the insights, cultural connections and sensitivities, and contacts needed for this kind of work. Therefore, we have provided financial and logistical support, and professional advice on how it can fill the gaps. We recognise that a national system cannot do everything, and that we have to be both national and local at the same time.

The noble Baroness, Lady Barker, ended by talking about the public mood and her concerns that people are reaching a state of despair. I completely recognise the exhaustion that many people feel about the state of the epidemic. I particularly recognise the morale within the NHS and social care, where people have worked incredibly hard, often in circumstances and doing tasks that they did not originally sign up for, and the sacrifice that many people have made, whether they work in the healthcare system, are supporting people they love, cannot do the things they want or are isolated and on their own. Of course, lots of people have made massive sacrifices, but I do not recognise the world she describes.

I think the public largely support the steps taken by this Government to suppress the transmission of this virus. After all, it is the virus that is the enemy. In many respects, we have an incredibly united country in fighting that enemy. The way in which the British public have supported the regulations and guidelines, which have had a tough effect on many people’s lives, demonstrates a huge amount of support. No Government —and certainly not this Government—will stretch that beyond what is tolerable. I posit to the Chamber that, to date, that support is still in place, and I remain extremely grateful for it.

[The Deputy Speaker (Baroness Pitkeathley) (Lab)]

My Lords, we now come to the 30 minutes allocated for Back-Bench questions. As ever, I ask that the questions and answers be brief, so that I can call the maximum number of speakers.

[Baroness Watkins of Tavistock (CB)]

My Lords, I thank the Minister for coming to take questions on this Statement. I will ask about two issues. If he cannot answer me now, could he kindly write with information? My main concern is people who are still going to work and caring for people who are Covid positive. Based on the highest prediction of need, how many days’ worth of PPE stock does the UK currently have in store for the NHS and voluntary and independent-sector providers of health and social care, including care homes and domiciliary services? How rapidly can stocks be replenished? What proportion is produced and manufactured in the UK? Have we tested the distribution systems and are they satisfactory?

My second question is in relation to vaccination. Vaccination will obviously be really important, but what are we doing now to support the Prime Minister’s approach, declared in August 2019, that we will increase MMR vaccination rates, among other needs, so that all people are protected as far as possible against other infections during the rise of Covid?

[Lord Bethell (Con)]

My Lords, the noble Baroness asked about PPE, which is naturally a concern as we go into winter. I assure her that the NHS has 15-day, 45-day and 90-day plans for the supply of PPE to the NHS and the independent sector. Roughly half of that comes from British sources. The distribution mechanisms have been radically overhauled and tested, and have proved to be utterly modernised.

We are working extremely hard on the deployment of a Covid vaccination. She rightly mentions other vaccinations. I assure her that we have 30 million doses of the flu vaccination. As she rightly points out, there appears to be a strong link between having flu today, Covid tomorrow and problems with a combination of both at a later date.

[Lord Hamilton of Epsom (Con)]

Sweden did not go for a total lockdown, as we did in this country. Although there is some evidence that its number of infections is going up at the moment, it still has far fewer deaths from Covid per 100,000 than we do. On top of that, its economy is supposed to be declining by about 5.5%, while ours will decline by at least double that. Does my noble friend think there are any lessons to be learned from Sweden?

My second question is about herd immunity. We started this whole process of dealing with coronavirus by talking about herd immunity. We then seemed to completely desert that idea and did not think it held any promise. Where do we stand now on herd immunity?

[Lord Bethell (Con)]

My Lords, it is with sadness that I note that the infection rate in Sweden is inching up, and with regret that I note that Stockholm is bringing in many lockdown measures similar to those in the UK. The noble Lord is right that Sweden has had a distinctive approach, but it is not as distinctive as would appear. Many of the same regulations that we have had here have been applied in Sweden. One area where Sweden has shown leadership is in compliance among the public. When regulations have been brought in, there have been extremely high levels of compliance, and therefore the optics are different from the reality. This Government have never supported a herd immunity strategy.

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, I remind the House of my presidency of the Health Care Supply Association. I want to ask the Minister about testing. He will be aware that the medicine supply chain rose to the huge challenge presented partly because, early on, pharmaceutical wholesale staff were classified as key workers. That gave them access to priority testing, but on Monday the Government issued a revised list that excludes those pharmaceutical wholesale staff. The Healthcare Distribution Association has reported to me that there are already delays in staff accessing these tests. It is very concerned that, if this continues, it will have a very detrimental effect on the supply of medicines to hospitals and pharmacies. Would the Minister be prepared to take this away, look at it and see whether they could be added back to the priority list?

[Lord Bethell (Con)]

The noble Lord makes an extremely good point. I am grateful to him for alerting me to this question in advance. We take the contribution of pharmacists to the battle against Covid extremely seriously. I am not sure, right now, why pharmacists have been taken off the list and I would be glad to look into the matter and respond to him shortly.

[Lord Greaves (LD)]

My Lords, turning to the new proposals affecting people advised to self-isolate, on the one hand, an isolation payment of £500 is being offered, which is an incentive; on the other, there is a new legal duty, the enforcement of which could result in some quite swingeing fines if people do not do it. It is a two-sided thing. I have two questions about this. First, what involvement will local authorities have in this process? Will it all be done centrally or locally—like the payments in the pilot areas—or will it be both together? Secondly, there is obviously a lot of scope for disputes about this—about individuals and how they are treated and so on. What documentation will be involved? It is rather more than simply getting a telephone call and being asked to do something. It is an offer of quite a bit of money, and it is an instruction to do things. Will they be sent pieces of paper or will it be done by email or whatever? Will there be documentation to back all this up?

[Lord Bethell (Con)]

My Lords, implementation of both the payment and the legal sanctions will run their course through exactly the same channels as any other social care payment or the implementation of any other social duty. That will be led by local authorities, as it would be with any other social penalty. The police will be involved. The courts will be involved. Appeal processes will be involved. We hope that there will not be many sanctions, and that the payments will make a big difference to isolation protocols.

[Baroness Chalker of Wallasey (Con) [V]]

My Lords, I ask the Minister whether the Government have considered better ways of communicating the data to the public. One of the things that many of us have found, in talking the issues through with the general public, is that they simply do not understand the limitations of data analysis, which inevitably will be part of the whole story. Therefore, particularly when it concerns younger people, we should be trying to explain the data better than by giving the absolute numbers that always seem to come over. Inevitably, those who think they are not affected disregard the data. An improvement here would help with people’s agreement to isolate and to take preventive measures to stop the continued transmission of Covid-19.

[Lord Bethell (Con)]

My Lords, I have said on other occasions that we publish a lot of data, and I would be glad to share a full list of our data sources with my noble friend. To put a different perspective on the point she makes, the biggest challenge we have is to persuade people that their personal health is not a private matter that affects only them; it is a public matter that affects the people they love, the people they are standing next to and everyone else. This is particularly challenging for young people, quite understandably. Young people may have very few symptoms or none at all. They may carry the disease without any personal implications whatever but are vectors of disease who carry it to the vulnerable, ill or elderly. Persuading the country that their health is a public matter is our number one priority. My belief is that we are making great progress, but there is some way to go.

[Baroness Finlay of Llandaff (CB) [V]]

To break the chain of transmission, people must isolate if carrying the virus. Therefore, people have to understand that a negative test means only that they were not carrying the virus at the time the test was taken. The new contact tracing app being launched tomorrow has the potential to interrupt the transmission of the virus, but in order for it to work, a large proportion of the population will need to download and use it. Is it true that only just over half the mobile phones currently in circulation in the UK are compatible with the new app?

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right that a test today only proves that you have not got it this morning; it does not necessarily prove that you might not have it in a couple of days’ time, when you go and see your loved ones. However, she is not correct on two points concerning the app. First, all the epidemiological data suggests that even small numbers of downloads—even two people, but certainly 10% of the population—can make a difference. Our aspiration is much higher than that, but it is not true that a large proportion of the population needs to use it for it to be effective. Nor is it true that that it works on only half the phones: our belief is that it will work on a very large majority of phones.

If I may take a moment, I shall use it to advertise the “Distance Aware” badge sponsored by the noble Baroness. It is a really good device for encouraging people who are near those who are shielding to respect the social distancing rules.

[Lord Rooker (Lab) [V]]

Again, I take the Minister to his own department’s weekly statistics for test and trace for the latest week, 3 to 9 September. He said on Monday that I did not understand the chart on page 8. Has he now read the annexe on page 37, which states, in table 1, in bold, that the number of people tested under pillar 1 and pillar 2 was 571,400? This amounts to 81,628 per day. So, can he now tell us the date on which more than 100,000 people were tested?

[Lord Bethell (Con)]

My Lords, I can confirm that in the week to 22 September, in pillars 1 and 2, 188,865 tests were taken during each of those days.

[Lord Bradshaw (LD) [V]]

The noble Lord may know of my interest in public transport. Since the wearing of masks has been mandated by law, is he satisfied now that everything possible is being done to make the use of public transport safe for people?

[Lord Bethell (Con)]

My Lords, I recognise the expertise of the noble Lord on public transport. It is my observation that the public have come a long way on mask wearing. When I was on the Tube this morning, absolutely everyone, including small children, was wearing a mask. That is huge progress. Yes, there is more that could be done, and we have brought in fines and support for isolation, but I pay tribute to the public attitudes that have moved a long way in this matter.

[Baroness Verma (Con)]

My Lords, first, I thank the Minister for all the work that he and the Government have done in Leicester. The many millions that have been spent have been hugely helpful to our communities there. However, given yesterday’s Statement by the Prime Minister about increased restrictions, my concerns relate to the mental and physical well-being of women and girls, in particular, in the densely populated areas of Leicester, as they will not be able to go out and get the right amount of exercise or make good choices when it comes to eating. Will my noble friend assist me in trying to get those messages across to people in communities such as mine in Leicester, where the messaging is so important? If the restrictions are extended, those communities will suffer far worse outcomes, and for much longer

[Lord Bethell (Con)]

My Lords, I recognise that this epidemic has hit women hard—it really has—particularly in high-density areas such as Leicester where women and girls do not have access to the kind of exercise and space that they need in order to lead fulfilled lives. We have given substantial funds to the authorities in all cities, including Leicester. I greatly encourage those authorities, including the ones in Leicester, to think about how they can help women and girls to access the space and exercise that they need to fulfil their lives during this difficult period.

[Viscount Waverley (CB) [V]]

[Inaudible] the presence of the noble Lord, Lord Hunt, perhaps I may refer the Minister to his response to me when he presented a Covid update on 14 September, and indeed as he has confirmed today. On what calculation does he anticipate that

“we are looking at making up to half of our PPE requirements in the UK.”—[Official Report, 14/9/20; col. 1007.]?

Why do the Government have their sights on only 50%, and what plans do they have to increase national production? Is it suggested that this is the sum total of our manufacturing prowess?

[Lord Bethell (Con)]

Absolutely not, my Lords. I pay tribute to British manufacturers, which have come an enormous distance—everyone from high-end manufacturers such as Burberry to those which once made recycled bin bags and have now turned their factories over to producing aprons and other important PPE articles. I pay tribute to my noble friend Lord Deighton, who has done an enormous amount to generate interest among British manufacturers of all kinds in order to support British PPE production. However, we have to have a balance to this. Some specialist goods, such as gloves, are best made elsewhere, but having the capacity and expertise to make 50% of our PPE means that we now have a route to making it all if necessary.

[The Deputy Speaker (Baroness Pitkeathley) (Lab)]

The last question is from the noble Baroness, Lady McIntosh of Pickering.

[Baroness McIntosh of Pickering (Con) [V]]

My Lords, I am delighted to hear that there are 30 million doses of flu vaccine. I remind the House of my interest with the Dispensing Doctors’ Association. How and when will the flu vaccine reach doctors’ and GPs’ surgeries? My noble friend will be aware that PPE will presumably have to be worn for the dispensing of each dose of flu vaccine, which means that the vaccination will be administered at a loss to dispensing doctors and others. That does not seem sustainable. Is that an issue that my noble friend will be able to address?

[Lord Bethell (Con)]

My Lords, flu vaccines are being distributed right now. I know that because I had mine yesterday. The person who gave me the vaccine was not in PPE and in fact spoke very movingly about the way in which walk-in methods are being used to make administering the vaccine as easy and quick as possible, removing all barriers to the public. When I asked him about the commercial practicalities, he gave me an encouraging update on the financial settlement for the distribution of vaccines by pharmacists. I am led to believe that there will be a huge amount of interest by pharmacists in distributing as many flu vaccines as they can.

House adjourned at 6.45 pm.

Health Care: Guidance

Lord Bethell Excerpts

Monday 21st September 2020 Lords Chamber

[Lord Balfe]

To ask Her Majesty’s Government what guidance they have issued since the end of May 2020 to hospitals, General Practitioners and other health care providers about giving appropriate treatment to different patient age groups.

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

My Lords, I make this point very clearly. The NHS provides a comprehensive service available to all, irrespective of gender, race, disability or age. No guidance has been issued on the provision of appropriate treatment based solely on age. The NHS has issued guidance for the restoration of non-Covid-19 health services, working on the principle that the most clinically urgent patients should be seen first, followed by those who have been waiting the longest.

[Lord Balfe (Con) [V]]

I thank the Minister for his reply. He will be aware that there have been letters in the Telegraph and elsewhere, saying an advisory age of 75 is being brought in. First, is any age guidance given in any of the information sent out by his department? Secondly, will he agree to place a copy of all the circulars from the DHSC in the Library so that we can see what is going out?

[Lord Bethell (Con)]

My Lords, I can confirm clearly that reports of any sort of age limit of the kind referred to by my noble friend are completely wrong. On the matter of sharing circulars, there will be certain practical challenges to that, but I will inquire as to what we can possibly share, so that these decisions are as transparent as my noble friend wishes.

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, the distinction between different patient groups has particularly affected care home residents through the blanket use of “do not resuscitate” orders without explanation to patients and families. Will the Minister make clear his abhorrence of this practice, and can he say how he will ensure that the recent winter guidance in relation to this for adult social care will be followed in full?

[Lord Bethell (Con)]

My Lords, there are no blanket DNR notices. These are completely abhorrent and against the NHS constitution. We are not supporting them at all. The noble Lord is entirely right that families should be consulted before any such measures are put in place. The social care plan published earlier this month makes that absolutely clear.

[Baroness Walmsley (LD) [V]]

My Lords, young people have been hit hard by Covid-19, if not physically, then mentally and emotionally. They may be caring for someone who is either sick or vulnerable and therefore isolating. What is being done to ensure that young carers continue to get support during the pandemic—especially in the light of further restrictions—both for their caring duties and for their own mental health and well-being?

[Lord Bethell (Con)]

The noble Baroness is entirely right to focus on the plight of young carers, who play an incredibly important role in society at any time, and who are under profound pressure, particularly when isolating during this epidemic. Substantial financial support has been given to local authorities to provide their social care services with the additional funds necessary to support such cases, and we continue to work through our charity partners to ensure that young carers are supported.

[Baroness Altmann (Con)]

My Lords, I congratulate the Government on avoiding the temptation to discriminate on the grounds of age in connection with this coronavirus illness. The original guidance suggested that a person was vulnerable just because they were over 70, and I welcome the clarification. Could my noble friend assure the House that the Government do not intend to introduce blanket age restrictions and that the individual medical conditions of each person will be taken into account, rather than just age?

[Lord Bethell (Con)]

My Lords, I reiterate the point I made earlier in response to my noble friend’s quite reasonable remarks on the importance of fairness when it comes to age: blanket age restrictions play no role in the NHS and are overtly against the constitution.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, I declare that I chair the National Mental Capacity Forum and am an elected member of the BMA ethics committee. All treatment decisions must be individualised based on the likelihood of benefit to the person, considering their wishes and feelings, without prejudice of age, disability or other pre-existing conditions. Will the Government continue to work with the forum to ensure this is known and understood properly across health and social care in all sectors?

--- Later in debate ---

[Lord Bethell (Con)]

The noble Baroness puts it extremely well: all treatments should be individualised and tailored to the patient’s needs and requirements. I applaud the work of the forum. We are committed to continuing that work, and it is an important part of our correspondence with trusts that these standards are upheld and advertised.

[Baroness Wheeler (Lab)]

My Lords, the Minister will be aware of widespread concern that NHS measures introduced in response to Covid-19 are having serious consequences, with patients denied basic healthcare. Almost half of the 102 million GP consultations between March and July were delivered by phone or video, in line with government guidance to deliver a predominantly remote service. What steps are the Government taking to ensure that vulnerable people, especially the elderly, are not shut out from surgeries under measures introduced to stop the spread of the virus this winter? The reality is many are not online, they struggle with complex information systems and will face further difficulties if they are once again advised to isolate.

[Lord Bethell (Con)]

The noble Baroness is right that half of consultations have been done by telephone or on the internet. Some of those have been successful, but I agree with her that we have to keep GP surgeries open for those who either choose or need face-to-face consultations. That is why the NHS chief executive has written to CCGs and trusts urging them to be open and to have fair access to face-to-face consultations where necessary.

[Lord Rennard (LD)]

My Lords, I refer to my entry in the register of interests. Older people are more vulnerable to complications from the virus. Many more of them will have diabetes, and many more will feel that they need cancer treatment urgently. So why are so many older people still worried that they might be treated less favourably by the NHS due to their age? In particular, will the Minister explain how the backlog in treating cancer patients will be dealt with?

[Lord Bethell (Con)]

The noble Lord is entirely right that there is a large amount of concern among patients—existing patients who are on existing programmes and patients who think to go to the NHS. We are launching a “Help Us Help You” campaign at the beginning of October, which will be a substantial marketing campaign to reassure patients who might be concerned that the NHS is open and there to help them.

[Lord McCrea of Magherafelt and Cookstown (DUP) [V]]

My Lords, during this Covid crisis, many others are suffering greatly yet feeling neglected, such as cancer patients awaiting urgent treatment. There has also been a rise in suicide across every age group. What advice is the Minister’s department giving to hospitals, GPs and other health providers in tackling these things?

[Lord Bethell (Con)]

My Lords, mental health concerns are a major priority at all times but particularly during Covid-19. That is why are giving substantial funds to mental health charities and supporting the work of the mental health trusts that oversee this area, and I commend their work during Covid-19.

[Baroness Gardner of Parkes (Con) [V]]

My Lords, having been a NHS dentist for many years, I was disappointed that dentists were not allowed to keep their practices open during the lockdown period. A number of people sought my advice, which may have helped them but may not have. In past cases where there has been cause for alarm, in dentistry, like in every other part of the medical profession, they arranged a rota system. The dental profession still has these wonderful boards for local dentists to decide how and when each one would take a turn in providing the necessary services. It has gone very badly this time; I have met so many people who are desperate for a dentist and cannot get one anywhere. What can the Minister do about it?

[Lord Bethell (Con)]

My Lords, the challenge faced by dentists has been profound. The challenge of contagion in a dental practice is big and challenging. But I commend dentists who have gone to huge lengths to put in PPE and hygiene arrangements so that they are able to reopen. The scale of reopenings is enormous, but there is an enormous backlog, and we will be providing support for dentists to help them meet the scale of that backlog.

[The Deputy Speaker (Lord Lexden) (Con)]

My Lords, the time allowed for this Question has now elapsed.

Covid-19 Update

Lord Bethell Excerpts

Monday 21st September 2020 Lords Chamber

[Baroness Barker (LD)]

My Lords, I thank the Minister for dealing with this Statement, which comes hot on the news that we are at level 4 as regards the pandemic. Therefore, I want to touch on two or three points in this Statement. The first is the Government’s intention to invest £24 million in increasing call-handling capacity through NHS 111, to make it into a gateway to emergency care, providing the first port of call for patients. I must say to the Minister that it is a bit late to be doing that, and most of us should be somewhat alarmed at the news in the Statement that the Government intend to conduct pilots and will roll out NHS 111 First to all trusts from December. I understand the need to run pilots, but does he not think that time is against us?

On 17 September, six council leaders, cross-party, from across Yorkshire and Humber, wrote to the Minister. It is worth paying attention to what they said in their letter. They said: “It would be worth exploring the protocols and policies that might increase demand for what might be considered lower-value testing in a time of capacity constraint. This would include working with NHS 111 and reviewing their protocols. It seems that any childhood illness may result in a Covid test—that is what GPs are constantly telling us—while the Royal College of Paediatrics and Child Health have produced helpful guidance around that.” I ask the Minister if his department has seen that guidance and whether it will pay any attention to it.

Secondly, back to care homes and the ring of steel that never was. It is very welcome that there is going to be further investment in PPE and coverage for staff who have to take time off. However, there is a real danger in this, and there always has been, because social care is much more than care homes. Only 15% of people aged 85 or over are in a care home—most people who receive care are not. It is not uncommon for domiciliary care workers to visit 10 to 15 different homes in a shift. This Statement is silent on this matter which, given that the advisers are telling us they now know more about the transmission rate, is somewhat surprising. I wonder whether the Minister could talk about that.

The big issue in the last few days is the increasing confusion among members of the public as to who should be tested. Even in areas that are on the watchlist, people do not know whether they should be tested only if they are symptomatic or if they are asymptomatic. Some authorities have been given the power to do asymptomatic testing. Going back to that letter of 17 September, I note that the local authority says that it would be happy to have discussions locally but accepts the need for a co-ordinated approach with the Government. There needs to be a public discussion that provides urgently needed clarification from the department on how long these capacity issues are going to be around and what contingencies are going to be in place to manage them, particularly in high-risk areas.

This is not endless carping but a genuine concern for public health, and I therefore look forward to some detailed answers from the Minister.

[Lord Bethell (Con)]

My Lords, the noble Baroness, Lady Thornton, hit exactly the right note: we are at a sober moment and it is clear from the medical authorities that we are at some sort of tipping point. It is not too grand to say that the British nation faces something of a choice about how we approach the months ahead.

I confirm, as the noble Baroness, Lady Barker, has already done, that we are at level 4. The CMO has confirmed that he has taken the advice of the Joint Biosecurity Centre, and this is an indication of the seriousness of the situation. I acknowledge that there is widespread discussion of further restrictions and, as the noble Baroness, Lady Thornton, alluded to, that the Mayor of London, Sadiq Khan, has grave concerns for London. The CMO and the Chief Scientific Adviser have made their grave concerns crystal clear in their briefing this morning, and the graph showing the potential exponential growth in the case rate is extremely daunting.

I acknowledge that there are people who are concerned that we should put further restrictions in place, but I cannot confirm any of those arrangements. There will be a COBRA meeting tomorrow morning, which will be followed by a Cabinet meeting. The Prime Minister will make a Statement in the House of Commons tomorrow afternoon; how it will be repeated here is being discussed in the usual channels.

The expectations are very gruelling. The noble Baroness, Lady Thornton, queried why we did not see this coming, saying that, surely, SAGE and others had predicted this. The situation a month ago was quite different: when you looked at the dashboard, it was not clear that this sudden spike would turn up. However, the example of France—in cities like Marseilles—the hospitals in Spain and countries such as Israel has been extremely challenging and we are therefore moving quickly.

We completely acknowledge the concerns of parents and teachers in schools and the demands that they have put on the testing regime; we are absolutely determined to do whatever we can to keep schools open. We acknowledge the concerns of those with loved ones in social care, and we continue to pledge a very large amount—half of our testing capacity—to put protection in place for those in social care homes, who work with those in social care and who are in domestic care.

The noble Baroness, Lady Thornton, asked about Moonshot, and she is entirely right. The Moonshot project is adjacent to and parallel to our existing testing capacity, which uses the Rolls-Royce PCR test, which is extremely accurate in terms both of sensitivity and prevalence. Those tests take time to turn around, are costly and are best placed one after another in machines in an industrial process.

We are therefore looking at a much more flexible type of testing capacity, which may not need to be quite as scientific in its approach and may have different use cases. Principally, it would enable people to do the things they seek to do: to be in places where social distancing is more challenging, whether that is a place or work or leisure, or a family context. In answer to the noble Baroness, Lady Thornton, we absolutely apply the inclusionary principle, but there may well be a role for owners of venues such as football clubs and theatres to take advantage of these interesting, dynamic and innovative technologies in order to bring back some of the economic, social and cultural parts of the country that we all love, and that many depend on.

The noble Baroness, Lady Thornton, asked about self-isolation and quarantine. She is entirely right: these are critical components of our first-line defence against Covid. The only reason for having a test and trace programme is that people then isolate. If they do not isolate, there is no point in having that programme. We are absolutely focused on doing whatever we can to ensure that those who have been asked to isolate, because they have been in a risky situation or because they have had a positive test, do indeed do that. The fines we brought in at the weekend, or are set to bring in, are evidence of our determination to double up on the isolation principle. We have also brought in economic support for those who are isolating in certain target areas. As I have said at the Dispatch Box previously, those systems remain under review. If there is more that we can do to support those who are isolating, we will consider doing it.

The same is true of quarantine. The concerns of those in this House who would like to see our airports reopened and airlines and international travel restarted have been heard loud and clear. However, quarantining is essential to breaking the chain of transmission and to protecting this country. Until we have quarantine protocols that we can rely on, we have to live with what we have got.

The noble Baroness, Lady Thornton, also asked whether there was a better way for those in a particular place to understand what restrictions they are living under. I entirely agree. The pace at which some local lockdowns have been enforced or changed is extremely difficult to keep up with, even if you live in one area. That is why the app, which will be released on Thursday, will have a postcode checker. You can put in any post- code in the country and it will give you an indication of the lockdown principles and alert level in that area. That is a helpful device which will put many people’s minds at rest.

The noble Baroness, Lady Barker, asked about call handling and 111. I remember that, not long ago, the very existence of 111 was questioned by many. There were those who thought that closing it down might have been a good idea. During the Covid epidemic, 111 has been a phenomenal success. We have put in more resources, more call handlers, more training and more technology in order to make it more successful. It has proven its value in a massive way.

What we are doing with the trials alluded to by the noble Baroness, Lady Barker, is introducing a pilot so that those going to the emergency services in a hospital can phone 111 to check which services they should attend and, on occasion, book their slot in the emergency services. This is a system that patients have been asking for for a long time. It will help us massively with our load management as well as our Covid hygiene principles in emergency services. The pilots are starting in half a dozen locations, including Cornwall and Warrington, and we have put £24 million and a marketing campaign behind them. My expectation is that this service will prove extremely popular and will change the way in which people engage with hospitals. It will mean that the concerns and treatment of patients will be handled much more efficiently, and patients will go to the place that can best look after their treatment.

The noble Baroness asked about the protection that we are providing for care homes. The winter plan for social care, published last month, is an extremely detailed document that addresses many of the concerns that I have heard here in the Chamber. It is a thoughtful, well-financed and highly detailed plan for how we are going to protect those who are most vulnerable during the winter months. It is backed by an enormous financial commitment, a large number of tests and new guidelines to handle, for instance—as the noble Baroness rightly pointed out—the very difficult challenge of itinerant workers who may work for several different patients all at once; we are providing the financial resources and the new protocols in order to ensure that they do not become vectors of infection.

The noble Baroness, Lady Barker, asked about testing and who should be tested, and addressed in particular the question of asymptomatic testing and public discussion. We are massively engaged in a huge national conversation at the moment with local authorities, civic groups, employers, scientists and every single stakeholder that you could possibly imagine in the testing arena. Every day at the Department of Health we have round tables, webinars and all manner of engagement to understand how best we can serve schools, families, the economy and all the aspects of British life that depend on getting testing right.

One aspect of testing that is being generated by the exciting innovations that I mentioned in my answer to the noble Baroness, Lady Thornton, is the testing of asymptomatic people. That is not possible at the current levels of testing, even at 250,000 per day. We have to be extremely careful, as everyone here knows, to use every test that we have to its most effective use. When there are very large numbers of tests that can be cheaply and quickly delivered, and which are user-friendly by using things such as saliva or even breath tests, that could inaugurate a revolution in the way that we use testing and it may provide a system where those who are seeking to go outside, to go into areas where social distancing is challenging, can check whether they have the virus that morning and, at least for a day or two, have evidence that they will not be vectors of infection. That is potentially a transformative technology and it is the focus of our Moonshot ambitions. The progress that we are making is extremely encouraging and I look forward to updating the House on future days.

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[Lord Patel (CB) [V]]

My Lords, I want to pick up on what the noble Baroness, Lady Thornton, said about the clarity of messages. Enough has been said about test, track and isolate, and I will not go there, but I want to pick up on the comment made by the Chief Medical Officer in the presentation this morning about how people’s changing behaviour may help reduce or suppress the transmission of the virus significantly. The Government’s slogan “Hands, Face, Space” is apt. The Government were quite clear at the beginning of the pandemic about handwashing but less clear about face masks or face coverings and space. In future, as we are facing a serious problem, what message does the Minister wish to give to citizens when it comes to the use of face masks and space?

[Lord Bethell (Con)]

Our message remains clear and the same as when we started this epidemic. There is no other better alternative than the three principles articulated by the noble Lord, Lord Patel: clean hands, clean face, and social distancing. That mixture of hygiene and social distancing is the only thing that can beat this virus; that is our first line of defence. Test, trace, and isolate is our second line of defence. Face masks—in situations where social distancing is a challenge—can provide some secondary back-up, but they are not our primary form of defence.

[Lord Ribeiro (Con) [V]]

My Lords, the statement by the CMO and CSO today fired a shot across the bows of Government and demands action now to prevent the second wave getting out of hand. The message is sobering. As noted by my noble friend, we could see 50,000 cases a day by mid-October if no action is taken, leading to 200 deaths per day by mid-November. They refer to transmissions at home and in social settings. This should direct our attention to pubs and restaurants and whether they should remain open as potential vectors of infection.

We have learned many lessons from the first wave, particularly that there may have been a reluctance on the part of hospitals to refer patients to the Nightingale hospitals, lest this be seen as a sign of failure. This is a war on a pernicious virus, and we need leadership and central direction to ensure that we use these facilities more effectively. I welcome the £450 million earmarked to upgrade and expand A&E units, but we need a plan for the following points. One, triage patients to Nightingale hospitals once capacity in NHS hospitals exceeds 60%. Two, A&E holding bays for suspected Covid patients, who are transferred to Nightingale hospitals if they test positive. Three, a point of care test, be it the new flexible test the Minister mentioned earlier, to ensure we get quick results. The purpose of the Nightingale hospitals must be to enable the wider NHS to fulfil its obligations to maintain elective and emergency services. Can my noble friend the Minister confirm whether this is the Government’s strategy?

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[Lord Bethell (Con)]

It is a war, that is why we are focused on how we manage extra resources such as the Nightingales. We have put in new systems and artificial intelligence for algorithms to help us with our triage. We have invested £450 million in A&Es, which will include building new holding bays. As my noble friend rightly points out, these need development. We have invested in 5,000 DnaNudges and other point-of-care devices to give front-line care workers the diagnostic help they need.

[Lord Young of Norwood Green (Lab) [V]]

My Lords, I welcome the statement from the Minister, but to be candid, when I hear talk about Moonshot, I will believe it when I see it. What members of the public want is the ability to access Covid tests in places such as Bagshot, or Aldershot, or any other testing centre. The reports we get are that they cannot get appointments. Schools are closing because they cannot get test results, classes are being sent back; therefore, it is not just the number of tests, it is how long they are taking to turn around. To say we are surprised by the surge, when we were opening schools, does surprise me.

I have two other points on which I would welcome a response from the Minister. One, raised by noble Baroness, Lady Barker, is about domiciliary care. It is essential that PPE is available. It must be the right quality; we have had examples where large batches have been ordered from Turkey and China and they have been no good. We want quality PPE that is available.

[Lord Young of Norwood Green (Lab) [V]]

I am addressing all these questions to the Minister. My last point is this: will there be testing capacity in general practice surgery?

[Lord Bethell (Con)]

My Lords, we are introducing a new scheme for bringing testing capacity straight to the desks of general practice, and the results from that initiative are promising.

[Baroness Walmsley (LD) [V]]

My Lords, I welcome the further £2.7 billion for the NHS to prepare for winter and the further £150 million to expand emergency departments in England. However, as a resident of Wales, where health is devolved, I ask the Minister whether the Government have provided a proportionate sum to the devolved Administrations, to ensure that their residents can benefit from these improvements too? Furthermore, will the changes to NHS 111 be available in Wales, Scotland and Northern Ireland?

[Lord Bethell (Con)]

My Lords, the noble Baroness raises an important point about the rollout in the devolved Administrations. I do not have the details in my brief but I would be glad to write to her with them.

[Lord Kakkar (CB)]

My Lords, I draw the House’s attention to my registered interests. The Minister has alluded to the strategy, announced by Her Majesty’s Government earlier this month, of moving to mass population testing for citizens, regardless of symptoms. This is clearly predicated on having capacity for high-frequency testing, rapid reporting of results and a minimum threshold of accuracy for the test used. What assessment have the Government made of the threshold of accuracy in relation to sensitivity and specificity required to ensure that the mass testing strategy is successful—which is essential if we are to not only implement public health measures but save our economy?

[Lord Bethell (Con)]

My Lords, the user cases for different tests are being drafted and interrogated as we speak. The user case, for example, of an anaesthetist going into a delicate operation would be very different from the asymptomatic testing of a large school, or of people thinking about going to the pub in the evening. Matching the tests with the user cases is an important and necessary step. Once that is agreed with all relevant scientific committees, we will publish those user cases so that manufacturers can make the tests according to the required dimensions and specifications.

[Lord Randall of Uxbridge (Con) [V]]

My Lords, I am sure my noble friend will agree that at this serious and critical moment it is imperative that all the rules are observed. It is, however, important that the rules are seen to be practical and workable. I urge my noble friend, therefore, to reconsider in the near future the current decision to include children under 12 in the rule of six. Will the Minister also confirm that no woman will have to give birth alone?

[Lord Bethell (Con)]

My Lords, the rule of six treatment of children under 12 is extremely heartbreaking. I have three children under 12 and I find it very awkward. The CMO’s view, however, is crystal clear: children, whether under 12 or not, can be vectors of infection, and if a whole generation of children is infected with the disease it will roll through the generations to those who are older or vulnerable, as sure as night follows day. For that reason, we are holding the rule as it is.

[Baroness Donaghy (Lab) [V]]

I thank the Minister for his Statement and for confirming that the alert level is now at 4. If I heard him correctly, he mentioned that COBRA would meet tomorrow. On Friday I asked why COBRA had not met for four months, and he indicated that it had given way to COVID-O and Covid Gold. I looked these up on the government website; deep into page 15 it announced the names of the operational and strategic committees and their membership. I am anxious that there should be clarity and co-ordination of decision-making, proper consideration of spending public money and accountability in contracting. Can the noble Lord give me an assurance that there will now be better co-ordination at national level and better reporting of decision-making?

[Lord Bethell (Con)]

I pay tribute to colleagues and officials at Downing Street and the Cabinet Office who have organised an extremely detailed, flexible and fast-moving decision-making arrangement through the COVID-O and Covid Gold process. That has proven, as has often been discussed in this Chamber, incredibly quick at responding to events. In terms of spending, I pay tribute to my noble friend Lord Agnew in the Cabinet Office, who is leading the fraud and financial scrutiny efforts to ensure that the money spent on taxpayers’ behalf goes to the right places.

[Lord Taylor of Goss Moor (LD) [V]]

Does the Minister agree that we cannot afford to destroy the economy again and that it would be immoral to destroy the educational future of our children? That implies that people must curtail their social opportunities. It is also incumbent on Government to recognise that education and the economy working will lead to increased cases. Do the Government not therefore need to step up and reintroduce the targeted work on those most vulnerable to this disease, as we know who they are?

[Lord Bethell (Con)]

My Lords, I entirely agree with the noble Lord’s sentiments. The economy and education are critical. I reiterate the Government’s commitment to ensuring that the economy survives in the best possible way and that our children get the education they need. However, it is not quite as binary as he describes. If the public abide by the behaviours recommended in the guidelines, we can enjoy a far greater range of activities than would be the case under a major lockdown. Either way, we are committed to protecting the most vulnerable. I point to the substantial financial investment in protecting those who are shielded and in social care.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, I declare my role in the Distance Aware programme in Wales, intended to help people coming out of shielding. We must focus on breaking the chain of transmission. Oxford University reports that the Isle of Wight Test and Trace pilot with the NHSX app broke transmission rates from among the worst in the UK to zero in three weeks. That app was withdrawn. Now the Google/Apple app trial on the island and in Newham is failing to stop R rising after five weeks. As the NHSX app is the only intervention shown to break the chain of transmission, will the Government now urgently roll it out nationwide?

[Lord Bethell (Con)]

My Lords, the noble Baroness is correct inasmuch as the statistics published for the original app would suggest. However, new statistics about the new app will be published after its launch on Thursday. I reassure her that the circumstances between then and now have changed considerably. The impact of an app that is widely downloaded and implemented across the country can be profound. We are extremely optimistic about its impact.

[Lord Rogan (UUP) [V]]

My Lords, it was announced in Stormont this afternoon that Covid-19 restrictions are to be extended across all Northern Ireland from 6 pm tomorrow. However, given that the Prime Minister is to make his own set of announcements tomorrow, can the Minister offer some clarity on whether the changes in Northern Ireland could be overwritten by Mr Johnson? Can he also offer some insight into what work is going on to try to achieve more consistency of messaging across all four nations of the United Kingdom? It is obvious that the differences are causing profound confusion among the public and putting more lives at risk.

[Lord Bethell (Con)]

My Lords, I note the move by Northern Ireland, which has taken a sincere and thoughtful approach. It is true that there have been some small differences between the different countries, but the vast majority of guidelines, restrictions and lockdown arrangements are shared by all the countries of the United Kingdom. I commend the huge amount of collaboration between all the DAs in working together to fight this horrible disease.

[Lord Rooker (Lab) [V]]

Has the Minister ever read his own department’s weekly statistics paper for test and trace? On page 8 of that for the latest week, from 3 to 9 September, there is a chart and figures for people tested from May. There is not a single day when the number of people tested exceeded 100,000, even when tests under pillar 1 are added to tests under pillar 2. The average for the latest week is 82,000 people tested. Could he ask the Secretary of State to stop playing fast and loose with the figures, especially in interviews where the interviewer is not briefed properly, as on “The Andrew Marr Show” on Sunday? He himself used the figure a few minutes ago of over 200,000, implying that was the number of people—it is not. There have never been 100,000 people tested on any single day.

[Lord Bethell (Con)]

My Lords, I would be glad to talk about the weekly statistics with the noble Lord in detail, if he would like. The number of tests per day is frequently over 200,000. The number of people includes a huge amount of duplication, because some people have had more than one test. Those people are often in social care or hospitals. If a person is tested in March and goes on to be tested 20 more times, they are counted once in March and not again. That is why the number he is looking at is quite different from the daily “tested” figure.

[Lord Willis of Knaresborough (Lab) [V]]

My Lords, another statistic we seem to forget is that some 20,000 Covid-related deaths have occurred in care homes to date. Yet, as we face another massive surge, there is no guarantee that we have learned any lessons from them. I welcome the resources spent on PPE, and I hope the Minister will guarantee that no patients will be dumped into care homes as they were earlier in the year. Unless we can protect the 1.2 million social care workers, 465,000 of whom work in care homes, the same will happen again. Last Friday, as reported by the York Evening Press, a care home in York waited over seven days for 100 test results to be returned—seven days when people got more ill and faced the prospect of an early death. Unless the Minister can guarantee at the meeting tomorrow that all tests in care homes will be offered on a weekly basis and returned within 24 hours, we will be putting our whole care home sector in peril.

[Lord Bethell (Con)]

My Lords, the noble Lord, Lord Willis, does the care home sector, the NHS and those who work in them a massive disservice. There are hundreds of ways in which we have learned to deal with this disease better, such as how we use therapeutic drugs; how we store and use PPE; how we manage and protect our workforce; how we handle mental health and the entertainment of those who live in care; how we use modern technology, including television and diagnostic devices; how we transfer patients in and out of hospitals; and how we use testing. I could continue, but I think I have made my point.

[Lord Craig of Radley (CB) [V]]

My Lords, Lord Sumption and others say older people should be allowed to take their chances with the virus if they prefer that to cutting off contact with family and friends. Does the Minister agree that senior citizens—I am 91—should be allowed to take responsibility for their own safeguarding, rather than face their remaining years in perpetual lockdowns and feeling guilty that their protection is at the expense of younger, working people and the economy?

[Lord Bethell (Con)]

My Lords, I do not like telling anyone what to do. I do not like telling anyone that they should lock themselves up or stay away from the people they love—of course I do not—but in this epidemic we have learned that my health affects your health and your health affects my health. If you wander around catching the disease and giving it to other people, the impact on the whole of society is enormous. We all have to get used to this fundamental public health truism.

[Baroness Wheatcroft (Non-Afl) [V]]

My Lords, we know that Covid attacks the most vulnerable in society so, while I sympathise with the noble and gallant Lord, Lord Craig, I wonder whether the Minister sees merit in sending a clear message to those over 70 or with underlying conditions that they should consider isolating. This message would not be simply to protect them but to protect the NHS and allow the country to keep its schools and economy working.

[Lord Bethell (Con)]

My Lords, a clear message could not have been more emphatically sent to those over 70 about the dangers of this disease. The problem we have today is not one of irresponsible over-70s; it is a problem of prevalence among the young. We need to think thoroughly about how we address the issue of young people, who rarely get symptoms or even know they have the disease, transporting that disease in a dangerous way to those who are more vulnerable.

[Baroness Massey of Darwen (Lab) [V]]

My Lords, the Minister has emphasised that targeted action in local areas is essential and that the Government are listening to local authorities. Will he confirm that local authorities will now truly have a powerful presence in fighting this pandemic and will be given adequate funding appropriate to their needs? Will he also assure us that we have moved away from empty boasts about UK initiatives being world beating and are now approaching this pandemic with greater insight and maturity? For example, what can we learn from Europe and other countries about the pandemic and how they plan, and how will we take note of that? Tracing and testing would be a good example.

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[Lord Bethell (Con)]

The noble Baroness is right to point to the lessons we can learn from other countries, and we spend a huge amount of time on the telephone in round tables with those in other countries who have much to teach us. We have spoken at length and continue to speak to those in Asia, including in Taiwan, Japan and South Korea, which have pioneered different ways of doing things, and we note the work of the civic authorities in Antwerp, which recently brought in local measures that massively reduced a runaway situation. They are an inspiration to us all.

[Lord Addington (LD)]

My Lords, will the Minister give us some idea of the advice the Government are giving to institutions such as amateur sports clubs about how they are supposed to function in the changing environment? There has been some activity, and they will presumably have to pull down in certain places. Also, is there any government strategy for making sure that these clubs and groups can still survive if we have to go through another six months of this isolation?

[Lord Bethell (Con)]

My Lords, I pay tribute to amateur sports clubs, which have jumped through enormous hoops to keep operating and to provide important leisure and fitness to the country during an incredibly difficult period. They have been extremely disciplined and entrepreneurial in the way they have applied hygienic protocols. On Sunday I went to three amateur sports clubs, taking one of my children to each. The warning the noble Lord, Lord Addington, gives about the financial future of these clubs is extremely well made. The Department for Digital, Culture, Media and Sport is looking at ways in which it can provide both the financial and infrastructure support for those clubs and will work hard to ensure that they survive.

[Viscount Waverley (CB) [V]]

My Lords, the Minister has touched on critical countrywide issues but, as regards those who have crossed the channel, does automatic Covid testing take place for migrants detained by the UK border agency on the Kent coast, for example?

[Lord Bethell (Con)]

My Lords, all those resident in local authority hostels or accommodation will be tested regularly to prevent the transmission of this disease.

[Lord Truscott (Ind Lab)]

My Lords, will the Minister commit Her Majesty’s Government not only to an independent inquiry into their handling of Covid-19 but to a public inquiry? The Government need to look at the massive human cost of the pandemic as well as the financial one. Have the many billions of pounds spent on the pandemic been spent wisely?

[Lord Bethell (Con)]

My Lords, I am afraid that any decision about an inquiry is way beyond my pay scale, but the noble Lord is entirely right: there will clearly be massive lessons that we need to learn about the ways in which we do government, and health, and manage our public health. Those lessons should certainly include the economy since the impact of this disease on it has been profound. We will be living with those consequences for some time to come. We need to learn how to protect the economic future of our children when dealing with these kinds of national epidemics.

[Baroness Andrews (Lab) [V]]

My Lords, one of the most public failures of communication has been the refusal of the Prime Minister to talk to his counterparts in the devolved nations. Yesterday, they had the privilege of a conversation with Mr Gove. The Prime Minister has still not spoken to them since May. I find that extraordinary. I have never seen Mark Drakeford so angry. Does the Minister agree that unilateral decisions taken in England can have a perverse impact, particularly on Wales, as many people live in Wales but work in England? Will the Prime Minister now engage? Will those devolved Ministers be at the COBRA meeting tomorrow, for example? When will the Prime Minister set up the regular, reliable meetings with his counterparts for which they have been asking for months?

[Lord Bethell (Con)]

My Lords, the noble Baroness makes a powerful point but it is at odds with my own experience. I deal with my counterparts in the devolved authorities on a very regular basis. We have extremely strong bilateral relations and I pay tribute to the collaborative spirit in which they go into those conversations. All I can say is that I am extremely grateful to those in the devolved authorities who have worked so closely with us in a four-nations response to this epidemic.

[Baroness Uddin (Non-Afl) [V]]

My Lords, 50,000 is a frightening enough number but SAGE has made public pronouncements that, as we approach the winter, up to 500,000 people or more may display Covid and flu symptoms. With schools and universities returned, there is nationwide concern about this increasing exponentially, as the Minister has said. We have heard that some schools and universities are already facing partial closure. What specific advice has been issued to NHS front-line staff, including GPs, so that they are vigilant and adequately prepared to respond to the needs of teachers and families—particularly those within ethnic minority communities—who are deemed at higher risk of being affected by this dangerous disease? Regarding the Help Us to Help You campaign, is the Minister working closely with ethnic minority communities in particular? They have obviously been disproportionately affected, and we want to avoid that continuing, at all costs.

[Lord Bethell (Con)]

My Lords, the noble Baroness is quite right to raise the question of the Help Us to Help You campaign and the work that is being focused on hard-to-reach communities, whether BAME communities or other communities where we struggle to get some of our health messages through. I reassure her that there is an enormous focus on getting these important messages through to those who are particularly vulnerable to the effects of Covid, and who we have to work harder to reach.

House adjourned at 7.24 pm.

NHS Counter Fraud Authority (Establishment, Constitution, and Staff and Other Transfer Provisions) (Amendment) Order 2020

Lord Bethell Excerpts

Friday 18th September 2020 Lords Chamber

Moved by

[Lord Bethell]

That the draft Order laid before the House on 11 June be approved. Considered in Grand Committee on 7 September.

Motion agreed.