Coronavirus

Lord Bethell Excerpts

Thursday 12th March 2020 Lords Chamber

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

My Lords, I shall repeat a Statement made by my right honourable friend the Secretary of State yesterday evening in the other place on coronavirus. In the repeat, I will use the most up-to-date figures, which have changed since last night. The Statement is as follows:

“Mr Speaker, this afternoon, the World Health Organization declared coronavirus a global pandemic. I have spoken to the Leader of the House and we have had discussions; we have resolved that we will keep Parliament open. Of course, in some ways, the House may have to function differently, but the ability to hold the Government to account and to legislate are as vital in a time of emergency as in normal times. Our democracy is the foundation of our way of life.

Turning to the advice that is being provided to Parliament, I start by welcoming the way in which you, Mr Speaker, are working with the Government. I know how seriously you take the well-being of all Members and staff in Parliament, and the Government will continue to work closely with you, the Lord Speaker and the authorities in both Houses in the coming days and weeks. As the Leader of the House said in business questions last week:

“The public will expect Parliament to sit, and to get on with its job ... Our approach will be guided by the best scientific evidence and medical advice, and we will take all necessary measures to deal with this outbreak.”—[Official Report, Commons, 5/3/20; col. 984.]


Mr Speaker, I know that you are committed to providing as much information to Members and staff as possible and to taking any action that is required. A cross-parliamentary group of senior managers meets daily to plan the response to Covid-19 and ensure business continuity, with close input from the Government. It is essential that the parliamentary authorities continue to work closely with the Government and in line with medical advice, and I commit us to that endeavour. Both Houses are conscious of our national role at this time, and by basing decisions on the very best public health advice, we can be confident that we are doing the best we can to respond to this virus.

Around the world, the number infected is rising. Here at home, as of today, 456 people in the UK have tested positive and eight people are now, sadly, confirmed to have died. The positive cases of course include my honourable friend the Member for Mid Bedfordshire. She has done exactly the right thing in following the official advice to self-isolate, and I know the whole House will wish her well as she recovers. Public Health England has world-class expertise in contact tracing, which it initiated as soon as her case was confirmed. It will contact anyone whom it thinks may need testing. This will include only those who have had close contact. The advice of the Chief Medical Officer is that close contact is defined as being within two metres of someone who has active symptoms for more than 15 minutes. Those who have not been in close contact with my honourable friend since Thursday have no cause for concern in this case, and anyone who has concerns should seek guidance from Public Health England. I also know that my honourable friend wants me to pass on her thanks to officials at Public Health England and the NHS, who have been brilliant throughout.

Of course, a Member of the House and Health Minister testing positive has brought this issue home to us all, and I know that the public will be concerned that coronavirus has now been deemed a global pandemic. The official advice is clear: people should go to NHS 111 online or call NHS 111 if they think that they have symptoms of coronavirus, notably a cough and fever. Of course, the best way to minimise the risk to yourself and others is regularly to wash your hands.

Earlier today, I chaired a meeting of COBRA. Our response will be built on the bedrock of science. It is clear that we will need legislation to ensure the best possible response, and I can tell the House that I have invited the Official Opposition to meet with me first thing tomorrow to discuss the proposed emergency Bill that we will set out before the House next week. In addition to the measures that my right honourable friend the Chancellor set out in the Budget earlier, the Bill will include measures to help the national effort to keep vital public services running, to support business and to help everyone play their part.

Adult social care will be at the front line of our response, with social care providers looking after many of the most vulnerable in society. We are working closely with the sector to make sure that it is ready. Tomorrow, the Prime Minister will chair a further meeting of COBRA to decide what further measures may be necessary.

We will do the right thing at the right time. I know how worrying this is. I know that people have deep concerns. I know that everyone will play their part in this national effort to defeat the virus. The best way to beat it is for us to work together. We will do whatever it takes. We will give the NHS whatever it needs. We will do all that we can to keep people safe and get through this together, as a Parliament and as a nation. I commend this Statement to the House.”

My Lords, that concludes the Statement.

--- Later in debate ---

[Baroness Brinton]

I apologise for using an inappropriate term. None the less, even yesterday the Secretary of State said that we were not in delay. I recognise that things are moving very fast, but it is worrying that the Government keep saying that they are following the clinical advice yet there seem to be some differences in this. That matters in the light of what is happening elsewhere in Europe. Whether we close schools is obviously down to the advice of Chris Whitty, who is an epi- demiologist. He has been clear that there are disadvantages as well as advantages. What we are concerned about is that it is beginning to feel as though the professional advice is differing slightly from the political advice.

I am very pleased that the Government have responded to the WHO news about moving to a pandemic, and this morning’s letter from Chris Whitty to all doctors is extremely helpful in setting out their roles in being flexible and having to do things differently. But we know that the Italians have struggled with the number of hospital beds in ITU, and of ECMO beds, ventilators and other specialist equipment. By the way, it is really good that China is now helping Italy out. Learning as a global community from one outbreak area onwards is excellent.

However, the data paints a worrying picture. Japan and Korea top the OECD table for hospital beds per thousand at 13 and 12; Italy has 3.2 and the UK 2.5. What is happening to ensure that we have the ITU beds and ventilators that will be needed for the more severe cases which, as the news from Italy has shown, has been very problematic? Last night, a former public health director, Professor John Ashton, said on “Newsnight”:

“We’ve got a complacent attitude … We’ve wasted a month. If this now spreads the way it looks as though it’s likely to spread, there will not be enough hospital beds and people will have to be nursed at home.”


I am afraid that there are still holes in the advice and action, especially in social care. I shall repeat the concern that yesterday no extra money was provided in the baseline Budget for social care. Also, while the Secretary of State made it clear that social care is being included in the emergency coronavirus grant, that is for adult social care only. I repeat the question that I and my colleagues in another place keep on asking: what about the most vulnerable children who are often on ventilators or, if not, they end up on ventilators if they get even a cold? If there is no extra resource for them, that is a real problem. Many parents are hearing that everything is about care for the elderly. Children may be asymptomatic, but these children will not be, so it is vital that they are given support. If the Minister cannot answer that now, I would be really grateful for a reply outside.

The Secretary of State talked in the Statement about everyone working together. As we move into the delay section, we already know that directors of public health, councils and other key stakeholders such as CCGs are doing fantastic work, but—as many of us know that communication between Public Health England and the directors of public health has been a problem—can the Minister reassure the House that those lines of communication are working effectively and being monitored by senior people in both the NHS and government?

I echo the points about the announcement of the public health grant. That is the Secretary of State for Health and Social Care’s responsibility. We are only a fortnight away from the new financial year. It is ridiculous that we do not have the details.

Will the Government relax appraisal and re-registration requirements during Covid so that we are fighting the virus and the specialists are not having to fill in paper the whole time?

Finally, where is the personal protective equipment for social care? It will undoubtedly be needed, not just in care homes but for those being nursed at home.

[Lord Bethell]

My Lords, I thank the noble Baronesses for those excellent questions. I will take them at some pace, because there were a lot of extremely worthwhile questions and I will try to answer them as best I can.

The noble Baroness, Lady Thornton, asked about advice. I would like to explain to the Chamber the effectiveness of the contact tracing that Public Health England has put in place. Nadine Dorries shared her diary with Public Health England officials. They have gone through an extremely thorough contact-tracing process and have identified those individuals most at risk. It is a feature of our strategy for dealing with this virus that we have put contact tracing very much at the heart of what we do. It has proved an extremely effective measure. I understand from the Chief Medical Officer that more than half of those positively identified as carrying the virus in the UK have been identified through contact tracing, which is an indication of how thorough that process is and how effective it has been.

For those who remain concerned, the guidance from 111 is that it is those who show symptoms who should present themselves for a test. Those who have been in proximity but are not currently showing symptoms should use common sense and isolate if they feel like it, but that is not the positive guidance from 111.

The noble Baronesses, Lady Thornton and Lady Brinton, both asked about containment and delay. The truth is that we are in a transition period. The CMO’s advice is that the virus will almost inevitably spread through the British population, but the testing statistics speak for themselves. On 11 March 2020, 27,476 tests had taken place and only 456 had tested positive. The simple arithmetic of that is that if you are ill and feeling poorly at the moment, you probably do not have coronavirus. We are still at the tail end of the winter flu cycle; many germs are still in circulation. As yet, although coronavirus has been identified in many places in the country, it is not turning up in a very high incidence or proportion of those tested.

We are not complacent about this; we take it very seriously indeed. We can see the storm on the horizon, but the question of timing is incredibly delicate. I understand the frustration and concern in this Chamber, the media and the general public that not enough is being done, but the science, modelling and guidance from those who study epidemics are clear that we have to get the timing right. When we do, we will move emphatically, clearly and in a focused way, but we have to get that choice right.

The noble Baroness, Lady Thornton, specifically mentioned schools. The evidence suggests that, thankfully, children are not strongly affected by this virus, if at all. It is not currently clear whether those who are infected are infectious. There are strong signs that if they are infectious, they are not very infectious. There needs to be a degree of sense when it comes to the infection. In the balance between the social and economic effects of closing schools and taking mums and dads out of the workplace versus the safety of the children, particularly the effects on clinical and care workers, the opinion of the Chief Medical Officer and those who advise him is that closing schools is not the correct option in the UK today.

The noble Baroness, Lady Thornton, asked about the LGA and social care associations. I will reassure her on two fronts. They are very much engaged in all our preparations. Money is very much on the table and the resources that they need to combat this virus will be there to top up their budgets. The same is true on public health funding: the CMO is actively engaged with directors of public health to ensure that they have the resources they need.

The noble Baroness also asked about inspections for care homes and recent submissions by those who run care homes. I assure the House that we are listening to all those organisations that have concerns about inspection regimes and meeting legal requirements when physical resources and resources of people and time are under huge pressure. We hear their concerns loud and clear and will be making realistic provisions about those inspections and legal requirements.

The noble Baroness asked about the charitable sector. I hear its concerns but hope that this incident will be a massive opportunity for communities to come together and for the charitable sector to play an important role in providing support in care and to clinical staff. Funding for the sector is being looked at by DCMS. I have been updated by the Minister concerned, who assures me that their plans are progressing and that engagement is happening in a very serious way.

The noble Baroness also asked about CCGs and shared her anecdotes about the pressures on CCGs. Let me be absolutely clear: pressure is inevitable. There will be huge pressures on the people and the resources at every level, particularly in front-line and primary care, but we are working extremely hard to ensure that they have the physical manpower and administrative resources that they need to meet the challenge. For example, the noble Baroness, Lady Brinton, asked about PPE suits. They are being delivered, if not this week then next week. We have listened to the concerns of CCGs about the provision of suitable protection resources, and deliveries are happening as we speak. I hope that the recent letter from the CMO provides the kind of clear guidance that CCGs have been looking for.

In terms of registration documentation, the noble Baroness, Lady Brinton, asked about those returning to work. It is a primary concern of ours, because the current arrangements for those seeking to return to work in front-line clinical roles are clunky and administratively onerous. The process takes a long time and is completely unsuitable for the challenge we have ahead. That is one of the important measures that we will be addressing in the week ahead.

Specialist beds are our primary concern. The experiences of China and Italy make it crystal clear that those who have severe respiratory responses to the virus are creating the greatest demand on resources and are at the greatest risk. We are doing everything we can to convert existing resources into relevant, suitable provisions for those who will need respiratory help, and we are working hard with the oxygen manufacturers and providers to ensure that we have the kit and the personnel to answer that need.

Both the noble Baronesses, Lady Brinton and Lady Thornton, asked about social care. I reassure the House that the financial provisions outlined by the Chancellor yesterday will include all aspects of social care, including those relating to children and the most vulnerable in society. Directors of public health will be included in decisions about how those financial resources are allocated.

[Lord O'Shaughnessy (Con)]

My Lords, I am grateful to my noble friend for repeating that Statement and providing that reassurance. We all respect that this is an incredibly difficult and finely balanced decision, and, to some degree, we all need to trust in the process and those who are leading it. We have great scientists who are doing so.

Will my noble friend do two things? First, can he talk a little about the welcome funding that was in the Budget yesterday to support the economy and the health system through this outbreak? What exactly will that be spent on and what can be spent quickly to good effect? Secondly, to pick up an issue that was raised by the noble Baroness, Lady Thornton, but was also mentioned yesterday about capacity in the system, particularly in care homes, I am very worried about vulnerable people who require domiciliary care whose workers might get sick. Who will care for those people? We may need to think completely out of the box in how we do this. Can we stand up a volunteer army of post-infected people who have DBS checks to take on these kinds of responsibilities? Going about things in the ordinary way will not deal with the consequences of this crisis when it really hits. I would be grateful if my noble friend could expand on some of the plans the Government are making for these consequential impacts, which are not to do with the virus, but are very much to do with the impact on the health system.

[Lord Bethell]

I thank my noble friend for those questions. In terms of funding, the Treasury has provided immediately a £5 billion contingency fund to ensure that not only the NHS but local authorities have the resources necessary for both clinical and social care. The kinds of items that the money can immediately be spent on include boosting staffing, particularly in the NHS, which might include re-employing retired doctors and nurses and recruiting and offering compensation to volunteers who agree to help provide health and social care services full-time for the period of surge.

The precise arrangements for how that volunteering army can be put together will have to wait until we have the legal provisions for that army because there are important questions of indemnity, legal registration and DBS checks, all of which have been raised in this Chamber previously and which we take very seriously. But it would be premature to describe plans that are being worked on at the moment until we have tabled the sorts of legal requirements that we will need.

Funding will also ensure that we have the right drugs, supplies and equipment. Lastly, there will inevitably be a backlog of care after the virus has passed. We are conscious that this backlog will put a long-lasting strain on our medical and social care arrangements, and we are putting in the resources today to ensure that the backlog can be addressed in the future.

[Lord Judge (CB)]

My Lords, for those of us who are trying to plan next week, when will the Minister be in a position to let us know when the proposed emergency legislation, and in particular the Bill, will be able to be examined; in other words, when will we see a draft that we can look at and reflect on?

[Lord Bethell]

The noble and learned Lord asks a very reasonable question. I reassure him that the Leader of the House will make a Statement to that effect and she will outline the schedule for the publication. That will be for the Leader’s Office to decide.

[Lord Blunkett (Lab)]

My Lords, I commend the Government for the measured approach they are taking and the Minister for his helpful responses this morning. I chair the Sheffield City Partnership board; it will be partnership at local level that will deliver, as the noble Lord, Lord O’Shaughnessy, described, the civil effort that all of us will need to put in. Will the Minister indicate now whether he has taken on board the questions raised about the public health grant and about some of the money from the £5 billion that he mentioned going into facilitating local government—which has been severely damaged over the last 10 years—to provide the capacity to co-ordinate, as it did with the floods, the partnership approach needed at local level?

[Lord Bethell]

My Lords, I reassure the noble Lord, Lord Blunkett, that local authorities will undoubtedly provide a huge amount of the response to the coronavirus, not only in social care but in supporting business, giving pastoral care to those who are vulnerable and left alone and providing the community cohesion that we will need to get through a very difficult time for society. Extremely generous funding has been put in. That money is trickling through the system and I know that my colleagues at the Treasury are working hard to ensure that everyone has the information they need.

[The Lord Bishop of Portsmouth]

My Lords, in thanking the Minister, may I ask him whether he can give any information on the precautions and particular challenges in prisons, where, for instance, social distancing, isolation and provision of hospital services will be difficult to achieve?

[Lord Bethell]

The right reverend Prelate is entirely right to raise the question of prisons. Prisons provide an enormous challenge when it comes to the virus. The idea of prisoners living in prisons while the virus passes through such a tight-knit community concerns us enormously. I reassure him that the Ministry of Justice is looking into this carefully. It is using the experience in Italy and in China to understand how to provide for this in a humane and responsible way that preserves the security of our communities. It will publish advice on that shortly.

[Baroness Jolly (LD)]

My Lords, I declare my interest in the register. I was pleased to hear that the Secretary of State had included social care in the Statement. Could the Minister clarify what support will be offered to providers of social care to vulnerable adults with a learning disability?

[Lord Bethell]

The noble Baroness is entirely right to ask about a specific group. As yet, I do not have a clear answer on the exact demographic that she describes, but I reassure her that our understanding is that this will hit hardest the most vulnerable in our society. The entire focus of our provisions is therefore to make sure that the most vulnerable are looked after best.

[Lord Forsyth of Drumlean (Con)]

My Lords, yesterday I asked my noble friend whether he would give guidance to employers on the standards of deep clean required to enable people to return to premises. He indicated that he thought that the CMO did not think that this was necessary and that such advice would be “red herrings or distracting”. I read in the newspapers today that, sadly, a case was identified in the Treasury, which arranged a deep clean overnight so that people could return to work. Speaking as an employer with buildings where continuing services are important to consumers, customers and others, as well as to maintaining employment, we would like to carry out a deep clean every night, so that, if a case was identified, the premises would be safe, but we do not know what standard of deep clean is required. Frankly, asking a cleaning company what it would recommend does not seem the basis on which best to protect not just the staff of the building but also the businesses. May I reiterate the plea for some guidance? If that is not possible, perhaps we could be told what the Treasury decided.

[Lord Bethell]

I thank my noble friend for his question on deep cleaning. I reassure him that no one is suggesting that the best efforts of any employer to protect the welfare of their staff is in any way irrelevant or undervalued. Cleaning is an important response to this virus and those who decide to put resources into cleaning their premises are entirely to be lauded. There is clear guidance on the PHE website. I have put that guidance in the Library and would be happy to arrange for it to be emailed.

Let me try to explain the nub of the question. The CMO has not put the daily deep cleaning of offices or any work premises at the top of his priorities. The reason for that is that it takes only one person to touch a doorknob at 7 am for that doorknob to be contagious for the rest of the day, whereas a pair of hands can be cleaned many times a day. If you do the arithmetic of how the virus is spread—as the modelling professionals do at SAGE—constant handwashing, which we bang on and on about, is the most effective way of preventing the virus spreading. When that no longer proves an effective measure, the CMO will undoubtedly change the guidance and publish that guidance widely.

[Lord Harris of Haringey (Lab)]

My Lords, I am slightly surprised by that answer. I was not going to ask about this but, none the less, I will. Surely, what the noble Lord, Lord Forsyth, is asking is: if an employer wants to go above and beyond the current minimum level of requirement, where can they get guidance? That seems quite important. The question I would like to ask the Minister is this: obviously, we wish Nadine Dorries all the best for her recovery, but is the line by which she acquired the virus yet clear? If it is not possible to answer that, of those people who have been confirmed to have the virus, in how many cases is the route by which they acquired it known? If that route is not known, clearly this is much more endemic than has previously been said.

[Lord Bethell]

My Lords, not wishing to return to question of deep cleaning too many times, I just reassure the noble Lord that the published guidance is very clear. It says that this virus can be cleaned with conventional soaps and conventional detergents, of the kind already freely available and used by cleaning companies. There is nothing technically challenging about the cleaning of offices, homes or hands in the case of this virus. It is just about thoroughness. That guidance exists. If it would be helpful, I would be happy to share it with noble Lords in this Chamber.

It is not possible to discuss Nadine Dorries’s case in detail. On community contagion, which is the nub of the question, we have reached the stage where the origin of every positive case is not known. In other words, there are people who have picked up the virus for whom no simple explanation can be given for where they got it. Therefore, the CMO has stated clearly, including in briefings to noble Lords, that his opinion is that the virus is present in the community but, as I explained, that the levels of positive testing suggest that it is not very prevalent. The CMO in his briefing estimated that between 5,000 and 10,000 people had the virus earlier this week. Those are the kinds of proportions we are talking about at this time.

[Lord Campbell of Pittenweem (LD)]

With respect to the Minister’s answer on the management of intensive care facilities, is that management being done by health boards, regionally or centrally? In particular, is regard being given to it being done on a United Kingdom- wide basis? I have in mind that, if there is a problem in Newcastle, Edinburgh might be recruited to assist with that and vice versa. Is this being approached on a UK-wide basis or rather more narrowly?

[Lord Bethell]

I reassure the noble Lord that this is a whole-health family challenge. I thank all my colleagues, in every part of the NHS, PHE and all the arms-length bodies, who have been involved in the response. Yes, the guidance and direction are coming from the top, and the expertise is coming from the scientists who advise and guide us, but it has been up to individual managers at every level of the NHS to step up to this challenge. The response has been formidable, impressive and reassuring. I wanted to take a moment to bear testimony to that response.

Regarding the devolved nations, the four CMOs are working incredibly well together. It is reassuring to see how closely their response has been tied. It has been a whole-country, UK-wide response and there is a lot of consistency across the different nations.

[Lord Pickles (Con)]

My Lords, may I ask about the unintended consequences of President Trump’s announcement last night? As my noble friend will be aware, a considerable amount of commercial cargo is carried on passenger flights, including medicine and vital medical equipment, plus time-sensitive exports. While our European neighbours will bear the brunt of the announcement, it will undoubtedly have a knock-on effect on supplies to the United Kingdom. What discussions are the Government planning with airlines to ensure these vital medicines and medical supplies come through?

[Lord Bethell]

The supply of medicines is of concern. We have built substantial stockpiles of all medicines that we feel we need. We are working through what the implications of President Trump’s declaration might be. My understanding is that we are presently very confident about the secure supply of medicines.

[Lord Layard (Lab)]

My Lords, if we look abroad, especially to Japan and China, it is clearly not as inevitable as the Government assume that this disease will become widely spread through the population. Extraordinarily, in Hubei province, the epicentre of the disease, the proportion of the population who caught it was 0.1%. So how can we be hearing our experts talking about up to 80% of our population being affected? This cannot be right; it is based entirely on the assumption that our approach will be very passive. Can the Minister assure me that we will move to a really stringent regime next week?

[Lord Bethell]

The noble Lord asks a question that is on the minds of a lot of people who have been reading into the subject. The concern of the CMO is that if you bring intense social behaviour restrictions to bear on a population, you can temporarily suppress the spread of the virus. If you ask the entire population to stay at home, and close down every business, public space and event, you can suppress circulation. However, the moment you lift those restrictions, the virus spreads with a vengeance. It is often the most vulnerable who are then hit with a second peak, which can take out the provisions needed to support them. That is the CMO’s primary concern. The Government’s objective is to manage the situation so that the virus spreads in as limited a way as possible, and is spread out over time to allow medical and social care resources to be given to those who need support.

[Lord Trefgarne (Con)]

My Lords, my noble friend referred to the inevitable increased level of activity in the National Health Service. What success has been achieved in recalling recently retired NHS staff to help?

[Lord Bethell]

The recruitment of recently retired staff requires some changes to legislation, which are being studied at the moment. We look forward to bringing them to the House in the near future. I am happy to update the House on those provisions, once we have made further progress.

[Lord Foulkes of Cumnock (Lab Co-op)]

My Lords, I welcome the decision of the Government, and the meetings of the joint commissions, that Parliament should continue to operate properly in our democratic society—not least, as the noble and learned Lord, Lord Judge, said, so that we can deal with the draft legislation for this emergency. But has any assessment been made of potential dangers from the large groups of visitors, from many countries, who wander around—and are taken around—this building? That might create dangers that put the question of our sitting in doubt.

[Lord Bethell]

The noble Lord’s point has been raised with me by staff of the Palace, who are concerned about this. It is not for me, I am afraid, to answer this question; it is for the officers of the House. I know they are looking at this matter and are being advised by the Chief Medical Officer.

[Lord Forsyth of Drumlean]

My Lords, I return to the question of deep cleaning. My noble friend says that the advice is clear. Could he confirm that, if an employer arranges for all surfaces within their premises to be treated, that will be sufficient to allow staff to come back into the building safely?

--- Later in debate ---

[Lord Bethell]

My noble friend clearly feels passionately about the subject. I am not personally in a position to provide the reassurance he seeks, but I will try to find the information for him. I will share with him the regulations as they stand.

Dementia: Accident and Emergency

Lord Bethell Excerpts

Wednesday 11th March 2020 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what steps they are taking as a result of the analysis published by the Alzheimer’s Society on 22 January showing a 34.5 per cent increase in the number of people with dementia being admitted to accident and emergency departments in 2017–18.

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

My Lords, we are implementing our Challenge on Dementia 2020 commitment to make this the best country in the world to live with dementia. The NHS long-term plan commits the NHS in England to improving the care provided to people with dementia and their carers, including through supporting people in the community and avoiding unnecessary admissions to hospital. People should receive high-quality care in hospital and be discharged in a timely and appropriate way.

[Baroness Wheeler (Lab)]

I thank the Minister for his response and congratulate him on behalf of these Benches on his confirmation in his post. We look forward to continuing the good and constructive working relationship we have had with him since he took up this brief.

These findings from the Alzheimer’s Society research are truly shocking. The 34% increase in emergency admissions of dementia patients to A&E departments represents an increase of 100,000 patients over five years—the equivalent of over 1,000 patients each day. Much of this is the result of the scarcity of appropriate care support in the community or of care home places able to provide the specialist dementia care that is needed. Does this not also underline the scale of the problem the NHS faces in freeing up hospital beds to address demands from future coronavirus hospital admissions? What is the Government’s strategy for ensuring the continuing care for people with dementia in the coming months and in the longer term? Will further guidance and funding be issued to hospitals and care homes specifically to deal with this situation?

[Lord Bethell]

The noble Baroness will be aware that the identification of dementia patients in England has risen dramatically from 42% to 67%, which more than accounts for the increase in the Alzheimer’s Society’s numbers. We are, however, concerned about this issue and remain focused on pulling together a new challenge on dementia strategy for the next five years and on ensuring that beds are liberated in a timely and reasonable fashion.

Coronavirus is naturally a matter of high concern in our preparations. Care of existing vulnerable and lonely people and the elderly is a massive priority, and we are putting in place plans to provide that care.

[Lord Forsyth of Drumlean (Con)]

My Lords, if the care of people with Alzheimer’s and other conditions is such a priority, why have the Government not responded to the Economic Affairs Committee report on social care which came out seven months ago, and why was there nothing in an otherwise excellent Budget speech on social care, which we have been promised now for year after year after year?

[Lord Bethell]

The noble Lord is quite right to point out the delay in providing an answer on social care. That is why the Secretary of State for Health and Social Care wrote to Peers earlier this month, initiating a round of cross-party conversations and putting in the diary the beginnings of a process to pull together cross-party agreement. That cross-party agreement is essential to providing a long-term solution to this important problem.

[Baroness Brinton (LD)]

My Lords, I want to pick up on the point of the noble Lord, Lord Forsyth, about the lack of any extra funding for social care in the Budget. There was a reannouncement of just over £1 billion from before Christmas, but the Local Government Association states that social care generally needs about £4 billion to be able to maintain any sort of service to meet demand, which rises to £14 billion by 2030. Just saying that we are getting together to start to talk about social care problems is not enough. Where will extra money come from to remove people from hospital who do not be need to be there and to fund social care properly?

[Lord Bethell]

The noble Baroness is entirely right to say that this is an important issue. Short-term funding has been put in place for the best possible short-term arrangement, but this is a long-term problem that cannot be solved by any Government on their own. It requires cross-generational and cross-party agreement. That is why an important and well-organised set of engagements has been initiated. It is timetabled, and the Government have committed to action in this area.

[Lord Laming (CB)]

My Lords, does the Minister agree that it is most unfortunate, to say the least, that many of the staff who are caring for patients with Alzheimer’s disease and other forms of dementia have been classified as unskilled? Most people who have experienced those services and met the staff involved recognise their skill and the contribution that they make to their fellow citizens. They should be valued.

[Lord Bethell]

The noble Lord makes an important point. I completely sympathise with it. Low paid does not mean unskilled or unvalued. We are looking at the classification, but I should like to communicate the value that we put on the people who care for those we love and the importance they play in our society.

[Baroness Ritchie of Downpatrick (Non-Afl)]

My Lords, will the Minister consider a meeting of the British-Irish Council to deal specifically with the rising level of dementia cases throughout our devolved institutions, as well as England, with special reference to social care and the need for investment in it? It is urgently required.

[Lord Bethell]

The noble Baroness is quite right that this issue is not limited to England. The devolved Administrations are very much focused on it. I will look into the relevance and possibility of the kind of meeting she describes.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, will the Minister say what today’s announcement of a freeze on alcohol duties—a continuation of the policy that the Government have pursued since 2012—will do to aid Alzheimer’s? Will it increase it or lessen it? What research is now being done to indicate that there is a clear link?

[Lord Bethell]

This Government are committed to science-based policy. There is undoubtedly a link between personal behaviours and outcomes later in life. Public policy should be aligned to create the best possible outcomes for all people in Britain. The noble Lord’s points are well made and we will follow them up.

Covid-19: Deep Cleaning

Lord Bethell Excerpts

Wednesday 11th March 2020 Lords Chamber

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what guidance they are giving the public authorities and businesses on the deep cleaning of private and public spaces, buildings and facilities in the wake of COVID-19.

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

My Lords, on 26 February, Public Health England published guidance on Covid-19 decontamination in non-healthcare settings. The guidance describes best practice in cleaning, the appropriate disposal of materials, the disinfection of equipment and the personal protective equipment that should be worn. As present, Public Health England advises decontamination only where there has been a possible or confirmed case of Covid-19. In all other situations, normal cleaning procedures should be followed.

[Lord Kennedy of Southwark (Lab Co-op)]

My Lords, I refer to my relevant registered interests. This virus can remain infectious on surfaces for up to 96 hours. My Question stems from my observation that many public and private buildings, facilities and spaces may have been swept and cleaned but not cleansed. There is an important difference here. Does the Minister agree that we have a serious challenge? Can he set out the steps the Government are taking to meet it, particularly how departments are working together and not in silos?

[Lord Bethell]

My Lords, the noble Lord, Lord Kennedy, makes an important point. Cleaning and cleansing will be uppermost in all our minds, and I assure the House that it is a source of great focus in the efforts to combat Covid-19. However, I will try to persuade the noble Lord that we have only limited resources, time of those involved in the cleaning processes and good will from the public, so timing is essential when we are delivering measures to combat the spread of Covid-19. The CMO has been very clear on this: personal hygiene in washing hands and avoiding the spread of the virus to the face and skin should be the priority for us all. That is the focus of the Government’s efforts at this stage.

[Lord Forsyth of Drumlean (Con)]

My Lords, I declare an interest as chairman of a bank. The issue that the noble Lord has raised is very important. If someone is diagnosed with coronavirus, good practice means that no staff are allowed back into the building until it has been deep cleaned. An alternative would be to deep clean the building every night, so that if there were a case people could continue in their work, but to be able to pursue such a policy you need to know exactly what needs to be done to maintain the welfare and safety of the workforce.

[Lord Bethell]

The noble Lord is entirely right that cleaning is important, but the kind of deep cleaning protocols he described are not those recommended by the CMO at this stage of the epidemic. The SAGE group of statisticians and epidemiologists is modelling the outbreak of the virus very closely. Its computer models track the behaviours of the virus, the demographics of the country and the behaviours of people in different circumstances. Its focus is to try to ensure that we channel all our efforts into effective measures and do not explore red herrings or distracting policies that might prove counterproductive or distract from effective measures.

[Baroness Brinton (LD)]

Can the Minister assist the House? He said just now that advice was published at the end of February on how to decontaminate non-hospital environments. It is extremely difficult to find; I have not managed to find it yet. It is clearly difficult for cleaning companies to find. One company in the UK which works across a number of our cities published its own advice to its cleaners which was taken from the Singapore standards. If people cannot find this advice, how on earth do they know what the NHS wants people to do in this country?

[Lord Bethell]

I completely take on board the noble Baroness’s observation. I have here a copy of the regulations and I am happy to lay it in the Library. It is on GOV.UK in exactly the place you would expect to find such guidance, but I take on board the comments. We are spending millions of pounds on public information and employer advertising. More will be done to ensure that this kind of information reaches the people who need it. I will ensure that the message is heard loud and clear.

[Lord Hannay of Chiswick (CB)]

My Lords, does the Minister recognise that there is some anecdotal evidence—I declare an interest, because my grandson is involved—that the time gap between taking a test and verifying whether it is positive is growing? This involves great distress and problems for the rest of the family concerned. Can he look into whether there is any way of ensuring that this gap does not continue to widen?

[Lord Bethell]

I would like to reassure the House that my understanding is that the gap is not widening, but quite the opposite. An enormous amount of resources have been put into the various elements of the testing process, including the transport of tests to the testing centres, the turnaround of the tests and the return path to the testee. They include technological solutions that speed up that process dramatically. For Peers who are concerned, there is a special helpline for those who think they are displaying symptoms. I highly recommend that anyone who is concerned makes use of it.

[Baroness Whitaker (Lab)]

Is the Minister aware that in the city of Brighton, there are notices in almost all the public places advising people to cough only into a tissue and then to bin it? When I went into my local Boots in London, there was no such notice, and I saw four people coughing without any shielding. When I asked the shop assistant if she could advise people not to do that, she said, “There is nothing we can do about it.” Can Her Majesty’s Government not do as well as the government of Brighton?

[Lord Bethell]

The noble Baroness is entirely right to emphasise the importance of personal hygiene. The Government are working hard to drive these messages home. Ultimately, it is up to the public to embrace the messages. A substantial public awareness campaign was launched 10 days ago. From the polling that we have done so far, it appears to have been extremely effective. Based on that polling, we will be launching a further campaign to ensure that everyone is aware of the hygiene protocols the noble Baroness describes.

[Lord Lansley (Con)]

My Lords, the Minister made a good point about timing. Sometimes certain measures require preparation by public authorities and the public before they can be initiated. Does he agree that we may be not too far off a point when we ask those who are elderly and have underlying health conditions not to leave home, and that many public authorities—parish councils, town councils, local government, the NHS and Age UK—might soon want to undertake preparations?

[Lord Bethell]

My noble friend is quite right that measures require preparation. This Government are determined not to be caught on the hoof. In his public statements on Monday the CMO was clear that there are three areas where the modelling suggests there might be a major difference to the delay processes that the House has heard about and understands. My noble friend is also right that the safeguarding of older and vulnerable people would be a likely candidate for that. A substantial amount of time is required though, maybe 10 to 12 weeks or more. It is important that social acceptance of that kind of measure is in place before it is initiated. We are also looking at modelling the kinds of changes which would mean that those who display any symptoms might seek to socially distance themselves or that those who have been tested think about ways of putting space between themselves and their families. These are the kinds of illustrative examples that the CMO has already discussed publicly, and the Government are preparing for those kinds of scenarios at the moment.

[Baroness D'Souza (CB)]

My Lords, I am told on good scientific evidence that the Covid-19 virus is surrounded by a fatty skin, and that therefore the only way to deal with it effectively is by using hot water and soap. Can the Government slightly modify their advice? I am not sure that gels or cold water will have the intended effect; only hot water and soap will.

[Lord Bethell]

The CMO has been very clear on this important point, and I thank the noble Baroness for making it. The virus is washable. Sanitisers, cold water and soap work, but undoubtedly, hot water and soap for 20 seconds while singing a song of your choice is by far the best way of dealing with this threat.

Health Protection (Coronavirus) Regulations 2020

Lord Bethell Excerpts

Wednesday 11th March 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 10 February be approved.

Relevant document: 5th Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 9 March.

Motion agreed.

Coronavirus

Lord Bethell Excerpts

Monday 9th March 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, with the leave of the House, I shall repeat an Answer to an Urgent Question asked in the other place earlier today. The Answer is as follows.

“Madam Deputy Speaker, the coronavirus outbreak continues to advance around the world. The number of cases in China and South Korea keeps rising, but at a slowing rate. However, the outbreak in Iran, Italy, Switzerland and now France and Germany is growing. In Italy alone, we have seen 1,492 more cases overnight and 102 more deaths. Here in the UK, as of this morning, there were 319 confirmed cases. Very sadly, this now includes four confirmed deaths. I entirely understand why people are worried and concerned, and we send our condolences to the families.

The UK response is guided by our four-point action plan. We continue to work to contain this virus, but we are also taking action to delay its impact, to fund research and to mitigate its consequences. Throughout, our approach is guided by the science. That is the bedrock on which we base all our decisions. Our plan sets out what we are prepared to do, and we will make the right choices of which action to pursue at the right moment.

The scientific advice is clear: acting too early creates its own risks, so we will do what is right to keep people safe. Guided by the science, we will act at the right time and we will be clear and open about our actions and the reasons for them. These are the principles that underpin the very best response to an epidemic like this.

Turning to research, I can report that we have made available a further £46 million to find a vaccine and develop a more rapid diagnostic test. We will continue to support the international effort. Here at home, the NHS is well prepared with record numbers of staff, nurses and doctors. I want to thank all those involved for their work so far.

The number of calls to the NHS 111 service has increased and we have recruited an extra 700 people to support that effort. The 111 online service is now dealing with more inquiries than voice calls. To date, Public Health England has tested nearly 25,000 people and the time taken to test is being reduced as we bring in a new system for faster results.

Responding to coronavirus will take a national effort and everyone must play their part. Of course, that means the Government, but it also means everyone washing their hands more often and following public health advice. There is much more that we can all do both through volunteering and through support for those who are most vulnerable. We will shortly bring forward legislative options to help people and services to tackle this outbreak. The Bill will be temporary and proportionate, with measures that last only as long as is necessary, in line with clinical advice.

I can also report that over the weekend we initiated action to assist the 120 passengers on the “Grand Princess” cruise ship off the coast of California in coming home.

We will stop at nothing to get this response right and I commend the Statement to the House.”

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for repeating the Statement. I shall ask three questions as quickly as I can so that as many people as possible can get in to speak.

My first question concerns vulnerable people in residential homes and the learning disabled who may be being supported, either by charities or at home by their parents. We need to include these people in the planning. I do not expect the Minister to respond to the point, but I will put it on the table. There are lots of people who have not been mentioned but need to be taken into account.

The 111 service is clearly under incredible pressure, given that it apparently took 120,000 calls in the first week of March. I want to ask the noble Lord about the training that 111 staff are receiving. If 700 new people have been taken on, how is their training being accelerated and is it being properly funded?

Finally, when the Select Committee saw Professor Whitty last week, he explained that half of all coronavirus cases in the UK are most likely to occur in just a three-week period. Based on recent trends, have the Government estimated when that peak might begin, and is the noble Lord sure that hospitals have enough bed spaces so that they are able to cope?

[Lord Bethell]

My Lords, the noble Baroness has expressed concerns about those in residential homes and people with learning difficulties. The needs of all the most vulnerable in society are paramount. There is no doubt that intense pressure will be put on social services, social care and clinical care. We are doing all we can to ensure that support is in place, which will include the mobilisation of civil society, charities and volunteers to take up some of the pressure being put on those services.

On training provision, modern call centres have very flexible working arrangements whereby staff are brought on and off contracts. Those who have already received 111 training are being brought back on to the front line. The funds for that are properly in place.

On the timing of the peak, it is impossible to say with certainty when that will be, but the CMO is crystal clear: we will do everything we can to spread it out over the summer and we will keep this House and the public up to date.

[Baroness Brinton (LD)]

My Lords, I also thank the Minister for answering the Urgent Question. Going back to my point about advice for vulnerable people, it is good to hear that advice is finally planned, but vulnerable people need that advice now. I have been saying this in your Lordships’ House for about three weeks. Will the Minister please let us know when we are going to get it?

My second question follows up on the previous one about 111. In addition to the worrying report from the woman on the “Today” programme this morning who kept not getting return calls over a three-day period, despite a high temperature, cough and many other symptoms, we also picked up on people ringing 111 with clear symptoms being told that they cannot be tested because they cannot name an individual who has been diagnosed with coronavirus. I repeat the same question: are the new call handlers being trained effectively?

[Lord Bethell]

The noble Baroness is absolutely right about the importance of guidance and I reassure her that an enormous amount of work is being done to draft clear guidance for employers, volunteer groups and all parts of society, which will include case studies, FAQs and detailed recommendations. That work is being guided by the CMO and senior officials at PHE.

As for 111, we look very closely at the metrics for the return of calls. Overall, the headline figures suggest that the 111 service is bearing up incredibly well under intense pressure, but I do not deny that there must be people who have had bad experiences. These pressures sometimes lead to poor results and we will keep a very careful eye on that.

[Lord Kakkar (CB)]

My Lords, I declare my registered interests. Clearly, the decision to move from the phase of containment to that of delay is essential to sustaining the ability of the health delivery system to deal with this problem.

What objective criteria will be used to determine how that decision is taken? How are the behaviour and natural history of this disease elsewhere in the world being used to inform when we should move from containment to delay?

[Lord Bethell]

The noble Lord asks an important question. The truth is that it is more of an art than a science. Efforts were made to look at clear metrics for triggering this result, but it is a complex situation and our understanding continues to develop. It is ultimately up to the judgment of the CMO and the confidence of the Secretary of State to make that call.

[Lord Lamont of Lerwick (Con)]

My Lords, how many intensive care facilities are at upwards of 90% of utilisation and what can be done to increase the amount of facilities for people who need respiratory aid? What additional intensive care units could be created and what other facilities could be made available?

[Lord Bethell]

Enormous effort is being put into increasing the number of intensive care facilities, particularly in the area of respiratory support. Different types of respiratory support unit are being put in place and the number is increasing on a multiple rather than an arithmetic scale.

It is not just the kit that is an issue but the people needed to operate it, because these units and the respiratory machinery are extremely technical. We are putting enormous effort into ensuring that the right people are in place to work the machines.

[Lord Lea of Crondall (Non-Afl)]

My Lords, can the Minister shed further light on which countries research vaccines and how this can be agreed internationally? Are there difficulties with the process by which this division of labour is carried out? There could be a lot of duplication and not sufficient single-minded co-ordination.

[Lord Bethell]

The noble Lord asks an important question about the critical element of the research phase of our plan, and we have announced £46 million of additional funding for this area. Britain’s scientists are providing a leading contribution to the international effort. That effort is being conducted in an extremely transparent, open source fashion, with important details on genomic material being shared widely and openly. My understanding is that it is being done in a spirit of public collaboration.

[Lord Patel (CB)]

My Lords, does the Minister agree that what we have learned so far from the outbreaks in other countries, and even the small number of deaths in this country, is that the vulnerable groups are people aged over 65—more men than women—and those with underlying conditions? What is the Government’s strategy to protect the elderly and reduce their risk of getting this disease?

[Lord Bethell]

The noble Lord is entirely right. The CMO’s effort is now to identify those groups who require the greatest priority of assistance. We are not sure, and the CMO has not declared, at exactly what age that should start. He is considering publication of the exact details of the priorities in future. It seems that it is not necessarily gender-specific but that the state of your immune system is the key driver. In some areas, of course, men have very bad habits when it comes to things such as drinking and smoking. The CMO has made it clear that if you want to do one thing to avoid getting the virus, it is giving up smoking.

[Baroness Finlay of Llandaff (CB)]

Will the Government give specific guidance on deferring or cancelling gatherings of clinicians and other healthcare professionals at conferences and examinations required for career progression, and specifically ask the regulators to allow alternative routes of registration and validation?

[Lord Bethell]

The noble Baroness asks an important question about trying to keep our clinical staff healthy and fit. That is one of the biggest priorities in an epidemic such as this, because the pressures on the NHS are made worse if clinical staff are themselves poorly. At this stage the CMO has not decided that the cancellation of conferences or major events is proportionate, but that remains one of the options laid out in our CV plan. If necessary, provisions for videoconferencing and alternative ways of attending training will be considered and put in place.

Health Protection (Coronavirus) Regulations 2020

Lord Bethell Excerpts

Monday 9th March 2020 Grand Committee

Moved by

[Lord Bethell]

That the Grand Committee do consider the Health Protection (Coronavirus) Regulations 2020.

Relevant document: 5th Report from the Secondary Legislation Scrutiny Committee

[Lord Bethell (Con)]

My Lords, in the time available to me, I would like to remind your Lordships of the level of seriousness with which we should address the level of Covid-19 and the context for the Government’s response. I will then explain the workings of the regulations in detail and how they fit into our wider strategy for addressing the outbreak.

On 31 December 2019, Chinese authorities notified the World Health Organization of an outbreak of pneumonia in Wuhan City, which was then classified as a new disease, Covid-19. On 30 January 2020, the WHO declared the outbreak of Covid-19 a public health emergency of international concern.

Based on current evidence, the main symptoms of Covid-19 are a cough, high temperature and, in severe cases, shortness of breath. It is a new virus, so there is a lack of immunity in the population and, as yet, no effective vaccine. This means that Covid-19 has the potential to spread extensively in the population.

As expected, case numbers are increasing, but the UK remains well prepared for such outbreaks. As of 9 am on 9 March 2020, 24,960 people had been tested in the UK, of whom 24,641 were confirmed as negative and 311 were confirmed as positive.

Although our knowledge is growing by the day, much remains unknown. The four UK Chief Medical Officers have made it clear that the disease currently presents a moderate risk to the public, but that planning and preparation for the potential of a more widespread outbreak is sensible. As the Prime Minister has made clear, there could be a very significant increase in the number of cases of coronavirus in the UK.

Tackling Covid-19 requires a robust, integrated and proportionate response. On Tuesday 3 March, the Prime Minister introduced the UK’s coronavirus action plan, providing the public with information on what the Government have done and on their plans to tackle the coronavirus outbreak.

The Government’s approach to tackling Covid-19 can be summarised in four phases: contain, delay, research and mitigate. The Government have focused hard over the past weeks on the containment phase, taking precautionary measures to limit the spread of the virus as much as possible. A crucial aspect of that is ensuring that people who are contacts of known cases or are considered to be at high risk of infection are isolated from others for a period of time, ensuring that they cannot infect others but can readily access help if they fall ill.

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

My Lords, first, I apologise to the Committee that I came in late. The business proceeded slightly faster than I realised, but I am most grateful to noble Lords for allowing me to intervene briefly.

The comments made by the noble Lord, Lord Campbell-Savours, clearly illustrated the need for messaging out to the public. One of the difficulties is that the answers to many of his questions are just not known scientifically. It is a range of probabilities only; the way the virus behaves on different surfaces and with different substances is different. The infectivity may vary with the viral load to the individual as well as the individual’s own immune system. That makes it really complicated in terms of defining. You cannot give a false sense of security to people by saying, “Well, you are fit and well, and your immune system is okay”, because those people may become very ill, particularly if they have a large viral load. We saw that with the Chinese doctor who initially highlighted the problem. Tragically, he died.

I take this opportunity to ask a few questions. This order refers to Public Health England but we have devolved Administrations, and Public Health Wales and Public Health Scotland operate differently. Some aspects of this statutory instrument concern the police and justice, yet the Ministry of Justice and its overarching responsibilities are not devolved, so there is a difficult interface between the devolved and non-devolved competencies. Can the Minister provide some reassurance on the daily round-table consultations that are going on to make sure that decision-making is absolutely seamless and that the devolved Governments are taking forward—and, I hope, mirroring—such legislation so that we do not end up with different systems operating across what are effectively artificial borders? In areas such as Shropshire, there is a huge amount of cross-border flow between England and Wales. Linked to that, can the Minister clarify that equipment, and its distribution to where it is needed, is also part of the consideration of the protection of the public so that we do not have an outcry if one part of the country cannot access equipment as well as another?

Testing is difficult: it is a complex and finite resource, and it takes some hours to run the test. A lot of the public do not understand that it is not like a pregnancy test; it is not a quick dip and a quick answer. With such a finite resource, will the Minister clarify where the governance sits for the management of negative results? One of my anxieties is that people may have a false sense of security from a negative result, because they may get the infection the day after it and subsequently become positive. Although it is helpful to confirm positive cases, a negative result does not mean that you are not going to get the coronavirus infection further down the road.

Linked to the cross-border issues, can the Minister also confirm that the use of beds and the availability of things such as ITU beds and ECMO are being considered across the whole country? I worry that difficult decisions are going to have to be made and it will be very important to have clear standards against which to make them. If it looks as if we are becoming like Italy, that will certainly more than stretch services to the limit; it will take them beyond it.

Will we need additional statutory instruments for the reregistration of people with healthcare professional qualifications of any sort? If so, when will we see them? I was rather hoping that it might be today. This relates to my earlier question about registration on specialist registers. Is the GMC working to find alternative ways of putting those who have completed training on the specialist register without bringing them all together in an exam hall, which seems to be an unwise move when their competencies have already been assessed through training?

That concludes my questions, but I thank the Minister for his clarity, for explaining things really well, for answering questions on the Floor of the House and for answering unanswerable questions with such honesty. It is terribly important that he and those advising him try to be very clear and open about the things that we do not know.

[Lord Bethell]

My Lords, I will start by talking about two matters that are not central to the regulations but which are important pieces of context. I thank the noble Lord, Lord Campbell-Savours, for his incredibly candid and heartfelt comments, which none of us here could help but be moved by. I would also like to express sympathy for his personal situation. We all know friends, relatives and people who are in a vulnerable position. While the CMO’s advice is that for a lot of us the virus does not present a huge risk, for some people it does. That cannot but be on their mind and we think about them a lot, so I am grateful to the noble Lord for bringing that message of seriousness and his personal testimony.

I will also address directly the noble Lord’s questions. I am afraid that I cannot answer the important technical questions he asked; I am grateful for his appreciation of that fact. However, I reassure the Committee that our approach is to seek to be as transparent as we possibly can be. In answer to the noble Lord’s question, there is a daily update on the PHE website, where all the figures that we know and can prove are published—they go up at 1.45 pm every afternoon. That is a serious matter, and we are looking at ways of making that a more easily accessible dashboard with a deeper set of numbers that you can look at locally; we could then publish as reasonable and proportionate an amount of figures as possible while keeping secure the anonymity of those involved.

The other part of our approach comes very much from the spirit of the CMO himself, whom many of your Lordships will have met. He is an enlightened character who is extremely committed to evidence-based policy recommendations. We all plague him with questions much along the same lines as those the noble Lord, Lord Campbell-Savours, asked, seeking from him reassurances about particular technical questions. He is able to speculate and to say, “Maybe this or maybe that, but I can’t give you any clear reassurance on that because there is no data on it”.

One of the things about trying to preserve the pact with the public that our decision-making is supported by evidence is to avoid going into the kind of tempting speculation that the situation draws you into. There is temptation there, but, as a cardinal rule, we have to apply a self-restraining ordinance on trying to give people the answers and the speculation that, emotionally, they naturally want. The questions of the noble Lord, Lord Campbell-Savours, are exactly right, and I reassure him that battalions of scientists are trying to get to the bottom of those answers. Lots of evidence is being worked up, and I believe that answers to many of those questions will be forthcoming. However, until they have the sign-off from the scientists, it is not right for us to indulge in speculation. That is the foundation of our approach, which I mentioned earlier. Although it is incredibly frustrating, from a public policy point of view it is the right approach. However, I will try to address just a couple of the questions that the noble Lord asked, without falling into my self-defined bear trap.

The noble Lord, Lord Campbell-Savours, asked about masks. Broadly speaking, except for the most comprehensive hazmat suits that cover you from head to toe, masks are mainly used to limit the number of germs that you emit rather than that you consume. I think we are all interested in the work going on in Taiwan, where all schoolchildren wear masks, not to protect them from the germs but to try to stop them infecting the people next to them. That is an interesting insight, but it is not the approach that the CMO has recommended.

On the delicate issue of mortality rates, I completely sympathise with the noble Lord’s point that there is wild speculation on these numbers, and it would be fantastic to have a more reliable set of figures. I will say only that it is extremely difficult to know mortality rates, because you simply do not know how many people have the virus in the first place. Large numbers of people are infected and infectious but completely asymptomatic and never go near a test kit, so we cannot know what the mortality rate is at any age. I recommend that the noble Lord treats all mortality rates data with great suspicion. It is not the way we are guiding ourselves.

--- Later in debate ---

[Baroness Brinton]

In the past they have been on that register, and the big concern is the move from one department to another. If I am being told that that is not the case, that is not the feedback I am getting from directors of public health. As the Minister knows, I have other concerns about the relationship between Public Health England and directors of public health, which is why I asked for clarification.

[Lord Bethell]

I completely understand the point of clarification. If there is information available on what proportion of directors of public health are also public health consultants, we will share it with the noble Baroness. However, the way that the regulations are drafted at the moment means that the powers in the regulations are held not by directors of public health but by public health consultants.

[Baroness Brinton]

I am sorry to interrupt the Minister again but the point is not about the register kept by Public Health England. My point concerns the definition of public health consultant—I am afraid that Hansard now has the relevant document, otherwise I would quote from it—and most directors of public health have to do that qualification because the job description, which is in the statutory guidance, says that they must be registered. That is my problem, and I know that it is clearly a problem for some of them as well. There is a bigger issue here. Should this become a pandemic and we see a large spike in numbers, we will need everyone qualified in public health to be able to do this, and there seems to be a problem in excluding the people at the heart of managing coronavirus within their wider communities.

[Lord Bethell]

The noble Baroness makes a very reasonable point. My understanding is that this decision was made not on a personnel basis but on an administrative basis. We are seeking to restrict the number of people who are able to execute these potentially quite serious powers. Having a list of available people is a legally clear and responsible way of doing things, but creating a new administrative definition goes beyond the powers of these regulations. However, I have already taken on board the noble Baroness’s points about the role of directors of public health in this epidemic. Those points have been listened to and are being followed up, and I will continue the dialogue that we already have in place on that.

The noble Baroness, Lady Thornton, asked why the 2008 powers are not sufficient. The answer is that it is mainly for practical reasons. The 2008 Section 2A powers give local councils powers but mobilising local councils to do things, sometimes at the weekend, sometimes at ports where they are not necessarily administratively present and sometimes overnight, is administratively a challenge. We found that in practice during the containment at Arrowe Park, it was really Public Health England officials on the ground who dealt with the situation and who needed these powers both in their back pocket and in their administration of the situation. That is why we have sought to do this. It is fair to say that a lessons-learned review is expected in the years to come and this will be the kind of issue that we will look at again.

The noble Baroness, Lady Thornton, asked what the difference is between detention and isolation. Although I do not have the legal definitions in front of me, my understanding is that isolation can be in someone’s house—literally holding them away from the rest of society—whereas detention involves confining someone to a place that they cannot leave, such as a police cell or a jail. Both are covered in these regulations. It is worth saying that you could, for instance, seek to isolate someone in a hotel room near the Arrowe Park facility and that would be covered.

The noble Baroness also asked about magistrates’ courts. I reassure her that MoJ colleagues were fully consulted on this and they did not see a problem. The objective was to try to create a low bar for an appeal to make the appeal process as easy and accessible as possible, recognising that these are very serious powers and we want to make them as sensitive as possible. In terms of police involvement and whether the police would wear suitable suits, they absolutely would. Police officials are highly protective of their workforce. Public Health England is working closely with the police to ensure that they have both the guidelines and the kit necessary to protect the workforce.

On the term of the regulations, I agree with the noble Baroness that two years is longer than we hope or pray this virus will continue. However, the advice from the CMO was that we cannot necessarily plan for that. Viruses sometimes last longer than expected; they can create multiple strains, and it may take time to have the lessons-learned review and to bring in new powers. That said, it is also possible that a coronavirus Bill that overtakes these regulations will be brought to the House later this month and the sunset clauses would necessarily be included in that.

[Lord Campbell-Savours]

Will the Minister reconsider something that he said to me? He said that he could not answer many of the questions that I asked. Almost all of them were to do with contamination, and virologists can answer them—I am told by a virologist that they can all be answered; we went very carefully through them. Can the Minister take each of the questions that I asked and answer them individually on the basis that virologists will be able to give him the information that he requires?

[Lord Bethell]

The noble Lord, Lord Campbell-Savours, is entirely right to press me on this. I should be honest: obviously, I am not a doctor. However, we have arranged for another briefing from the Chief Medical Officer in Room G at 4 pm tomorrow. He is the epidemiologist who can convey to the noble Lord both the extent and limits of current understanding of the virus. I have sat with him sufficiently long to have the impression that a lot of speculation, guidelines and history are associated with such viruses that we might reasonably apply to this one. However, its behaviours are not fully understood. Although the genome is broken, we do not fully understand its genetic makeup. The advice from the CMO generally is to hold back on pretending to understand things that are not yet fully explored.

[Baroness Thornton]

I say to my noble friend that I would not use the internet as my source of information on any of these issues. I would use the BBC, which has been running extra programmes—in fact, I have just received an email from the head of the World Service listing all the extra programmes that the BBC is producing which will give us lots of advice. Its website is useful. I want to put it on the record to my noble friend that I would steer clear of those sorts of discussions on the internet and look at the BBC’s websites.

[Lord Campbell-Savours]

The great majority of the British population will not go into some of the technical areas that my noble friend would go into. That is why I am trying to find a single source of information for people to be able to go to which is authoritative and gives answers, with the latest information and knowledge available, on each of the questions I have asked. I persist in believing that the Government should arrange for this information to be made part of the public debate, because it would be helpful to everyone concerned.

[Lord Bethell]

I understand the point and will take it back to the department.

The noble Baroness, Lady Finlay, asked about testing. She is entirely right to focus on that, because we are at the stage of the cycle when questions about testing are very much on our minds. She asked where we were focusing our testing. The most important area for testing is those people who are most vulnerable but who might have the virus. She is entirely right that someone who tests negative today may well test positive tomorrow. Where that is most dangerous is within hospitals. Hospitals are centres of infection. It is one reason why, if you phone 111, they recommend that you do not go to your hospital or your GP. Therefore, testing within hospitals is where we are focusing our resources.

I reassure the noble Baroness, Lady Finlay, that we are moving incredibly quickly to increase capacity of ECMO beds. There will be a huge amount of pressure —we cannot hide that—but those most in need are being prioritised. Training is going on to support those with the technical knowledge of how to run the equipment and purchasing is going on to create new kit.

On reregistration of clinical professionals, all the concerns raised in Committee and in the Chamber about the provenance of people seeking to reregister are fully understood. Provision is being made to make sure that criminal record checks and competence checks are in place. However, these remain incredibly valuable and skilled people who can support us, so we are determined to mobilise them if possible.

[Baroness Finlay of Llandaff]

I referred to difficult decisions possibly being made. Can the Minister reassure the Committee that the Government are working with the heads of all the royal colleges—particularly their ethics committees—to make sure that unified guidance is going out to commissions across all the disciplines? Unfortunately, the different colleges have at times a tendency to work in their own silo, but this will be across all of them. It will have to go across the professions, rather than across the individual trusts and internal organisations. Therefore, a round table or regular consultation with them to make sure they all give the same messages is important, and it would reassure the public.

[Lord Bethell]

The noble Baroness, Lady Finlay, makes an important point. The CMO currently has a weekly call with all the presidents or relevant members of the royal colleges, and there is an incredibly energetic interface between officials at PHE and the colleges. New guidance is being drafted at the moment. As our understanding of the epidemic increases so the CMO’s certainty and confidence about the advice he is giving will be clearer. We are therefore seeking to publish really good guidance for employers, voluntary organisations and all the groups who need it. The CMO also works closely with the CMOs of the other three nations, and I understand that is an incredibly healthy and productive relationship. It has served very well to ensure that the devolved authorities are fully involved in decision-making and that there is transparency on key issues such as ethics, which the noble Baroness was right to mention.

Motion agreed.