Covid-19: Local Restrictions

Lord Bethell Excerpts

Friday 9th October 2020 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what plans they have to seek Parliamentary approval for new local COVID-19 restrictions before they come into force.

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

My Lords, as the Secretary of State for Health and Social Care told the other place last week, for significant national measures with effect on the whole of England or UK-wide, the Government will consult the House of Commons wherever possible and hold votes before such regulations come into force. The arrangement of business and scheduling of debates in this House is a matter for discussion through the usual channels. Noble Lords will know that in this House the Government do not schedule debates without consulting the usual channels first.

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

My Lords, that is a very disappointing Answer. Last week, Mr Speaker criticised the Government for treating the Commons with contempt in the way that Covid regulations were dealt with and called for the most significant to be debated and decided on at the earliest point. The Government now propose to introduce a new tiered level of restrictions for local lockdowns. They are of national significance; whatever their justification, they involve a serious restriction of people’s personal liberties and will put many businesses in jeopardy. Does the Minister accept that Parliament should be asked to approve them before they come into force? Can he tell me what discussions have taken place to ensure that this happens?

[Lord Bethell (Con)]

My Lords, any new regulations will be scrutinised by both Houses in line with the requirements set out by Parliament in the relevant parent Act. The procedures for approving affirmative instruments are set out in your Lordships’ Standing Orders, and it is not in my gift to amend, suspend or ignore these. The local measures need to be enforced quickly if they are to be effective.

[Lord Robertson of Port Ellen (Lab) [V]]

Do the Government realise that they are losing control of the virus because they are losing control of public support? Public support and the self-discipline that we have seen up to now requires that any more rigorous regime is the subject of people seeing and believing the evidence on which the Government make their decision. In addition to that, local and national elected representatives should be able to see and believe the evidence for the decision being made. Up to now, that has not been happening.

[Lord Bethell (Con)]

Well, I very much welcome the noble Lord’s comments, but I reiterate what I said earlier. As my right honourable friend the Secretary of State for Health and Social Care said on 30 September, for significant national measures with effect for the whole of England or UK-wide we will consult Parliament—and, wherever possible, we will hold votes before such regulations come into force. Of course, we will balance that with ensuring that our response to the virus means that it is delivered with speed when required. We cannot hold up urgent regulations that are needed to control the virus and save lives.

[Baroness Barker (LD)]

What evidence do the Government have that introducing statutory instruments without notice rather than with parliamentary debate and approval is more effective than developing effective local Covid strategies which are understood and adhered to by the population?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, where the department has used secondary legislation to put in place measures to tackle the coronavirus pandemic, these regulations stipulate that a review of the measures will take place within 28 days. In making a decision on how to proceed, we comply with our legal duties, and all the relevant Acts—the Equality Act, Public Health Act, National Health Act and the family test. We keep the situation under continuous review to consider whether the measures contained in the regulations are still a necessary component of our effective response.

[Baroness Hayman (CB) [V]]

My Lords, Covid is not a one-off, short-term emergency. There will be difficult judgments and hard decisions to be made for many months ahead. Does the Minister accept that it is imperative that we find a way to ensure legitimacy for those decisions by gaining parliamentary assent before, not after, they are taken, and that parliamentary assent before should be the rule, not the exception? Does he further accept, as I believe, that those decisions would actually be improved and better accepted by the population because of the challenge they would receive in public, in Parliament?

[Lord Bethell (Con)]

Well, my Lords, our rule—if there is a rule—is that we are clear that our measures should be locally led. We work with local leaders first and communities to take swift action to prevent and manage outbreaks, ensuring that our responses work for them, supported by a national service which they plug into. It is for that reason that we are considering local tiers. Local alert levels or tiers are designed to standardise the interventions in place in local areas across England to make it easier to communicate what restrictions apply, and in what areas, to the public.

[Baroness Thornton (Lab)]

I follow on from the question asked by the noble Baroness, Lady Hayman. I thought the answer was remarkable, but maybe the Minister did not understand the question. In March, the Government were very keen to work with all parties and many others to get the emergency powers in place and, since then, really it has been nothing—letters to leaders informing them, diktats to local government, and accusations of undermining the national effort when legitimate questions are asked and comments are made. As we face another spike, will the Government change their habits and let stakeholders and Parliament, including your Lordships’ House, play a fuller role in designing and agreeing the national effort?

[Lord Bethell (Con)]

My Lords, I take exception to the noble Baroness’s characterisation of our approach. In fact, local planning and response are recognised as an essential part of our response to Covid, and are very much at the heart of the service. We want to have local outbreak control plans across the country. The development of local outbreak control plans is led by directors of public health; they are done on behalf of upper-tier local authorities, where the statutory responsibility for directors of public health sits, and are regularly reviewed by the local NHS, GPs, local employers, voluntary organisations and other community partners. There is also a link with local resilience forums, integrated care systems, combined local authorities and directly elected mayors as appropriate.

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

My Lords, this begs the question of whether local administrations in England might be given blanket parliamentary authority to make their own rules and guidance, as do devolved regions. Is that acceptable to the Government? What evidence do the Government have on whether these divergences in rules and guidance create public confusion, misunderstanding and breaches of them?

[Lord Bethell (Con)]

Our approach is based on the partnership between central and local government. Local government has a distinctive and unique role to play; local authorities work with employers, businesses and other relevant commercial groups to help prevent and control outbreaks, and their local outbreak plans will provide opportunities to build on that information best to support businesses and other local services to return to normal operations in a safe way. It is that partnership between national and local government that will build a successful response to the Covid epidemic.

[Baroness Clark of Kilwinning (Lab)]

Parliamentarians on all sides in both Houses say that they feel that they have not been included in decision-making so far. Mayors and leaders of local authorities have made it really clear over the last few days that there has not been communication with them; they seem very angry about the way the Government have conducted themselves. There was huge compliance with the restrictions imposed during the lockdown. Surely the Minister accepts that he needs to ensure that local authorities, mayors, and indeed local MPs need to be on-side and he needs to rebuild that trust. What can he do to make sure the Government take on board the points being made?

[Lord Bethell (Con)]

My Lords, I completely recognise the importance of stakeholder engagement, building alliances and collaboration. I emphasise our commitment to the partnership between local and national government. When it comes to Parliament’s engagement in these measures, I can only repeat what I said earlier: my right honourable friend has made it very clear that for significant national measures with effect in the whole of England or UK-wide, we will consult Parliament and, wherever possible, hold votes before such regulations come into force. Until then, it is through the usual channels that the schedule of the House of Lords will be arranged.

[Baroness Finlay of Llandaff (CB)]

Building on the Minister’s commitment to locally led decision-making, will the Government confirm that they will now consult daily with the devolved Administrations and share evidence prior to any press release, as confused messages have undermined public confidence? That way, they may avoid some of the debacles that have happened when local authority decisions have been undermined by leaks to the press.

[Lord Bethell (Con)]

I completely defer to the noble Baroness’s expertise in matters to do with the devolved Administrations, but I reassure her that there are numerous calls every day between Whitehall and the DAs on Covid. We very much celebrate the achievement of a four-nations approach. There are divergences in some procedural matters between the different countries; that is entirely to be expected—indeed, celebrated—as it enhances the effectiveness of our measures. But I completely take on board the noble Baroness’s points and we will endeavour to ensure that communication between Whitehall and the DAs remains firm and solid.

[The Deputy Speaker (Lord Alderdice) (LD)]

The noble Lord, Lord Mann, has withdrawn, so I call the next speaker, the noble Viscount, Lord Waverley.

[Viscount Waverley (CB) [V]]

My Lords, the issue is indeed about collaboration with local government. However, the Government’s decision to introduce the Coronavirus Act marred the use of secondary legislation in respect of the Civil Contingencies Act, suggesting that the Executive believe that existing legislation is not robust enough to counter the threat of pandemics. Given that we live in such a world, what plans do HMG have to review the robustness of all existing legislation? If they do, can they confirm that it will not infringe on parliamentary sovereignty?

[Lord Bethell (Con)]

My Lords, I note and take very seriously the noble Viscount’s comments on the state of our legislative response to the epidemic. There will no doubt be a time for reflection, learning the lessons of the epidemic and reviewing the legislative processes that we have available. This is not the time; the challenge of Covid is still very much a clear and present danger, but we will take on board his recommendation to reflect and improve on the structures we already have.

[Baroness Andrews (Lab) [V]]

My Lords, to go back to my noble friend Lord Hunt’s question, given the exponential rate of the increase in Covid in the north and Midlands, have we not again lost the advantage of acting early and acting fast? Now we are told that the Government are considering introducing a national scheme based on three tiers of severity. What is holding this up? To what extent and how are local authority leaders—who still say publicly that they are being treated with contempt—involved in this decision? And when will Parliament be told?

[Lord Bethell (Con)]

My Lords, I cannot help but observe the palpable irony of being told, on the one hand, to engage, form alliances and double up on stakeholder engagement and, on the other, being told to hurry up and get a move on. An effective response means a combination of both national and local systems. A huge amount of work needs to be done to build the consensus, support and technical arrangements for that response. We are putting a huge amount of work into that process and look forward to making announcements on it. Until then, I reassure the noble Baroness that officials and politicians are working night and day to make that response as effective as possible.

[Lord Bilimoria (CB) [V]]

My Lords, does the Minister agree that, with almost 30% of the country under lockdown and more lockdowns to come, the key solution is mass testing? Does he also agree that we could have the equivalent of the ventilator challenge to manufacture the portable LAMP machines, which could greatly enhance testing capability, and have the Abbott Laboratories Binax-type, $5, 15-minute test available widely? Why are we not hearing more about this being implemented urgently?

[Lord Bethell (Con)]

I reassure the noble Lord that we are making progress. He is entirely right: the ventilator challenge is an inspiration, and I note that we have hit our target of 30,000 ventilators. I note that we have 300,000 tests a day at the current run rate; we have re-registered 50,000 new clinicians to return to support the NHS; we have had 16 million downloads of the NHS app; we have recruited 14,200 nurses as part of our recent recruitment; we have processed over 24 million tests in laboratories as of 8 October 2020; and the Vaccine Taskforce has secured access to six different vaccine candidates across four different vaccine prototypes. These are enormous achievements and we will continue to pursue our response with energy and vigour.

[The Deputy Speaker (Lord Alderdice) (LD)]

My Lords, the time allowed for this Private Notice Question has elapsed. I regret that we have not been able to hear all the speakers.

Social Care Workers

Lord Bethell Excerpts

Wednesday 7th October 2020 Lords Chamber

[Lord Dubs]

To ask Her Majesty’s Government what estimate they have made of the shortage of social care workers for (1) residential care homes, and (2) domiciliary care.

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

My Lords, there is no doubt that we need more people to choose to work in social care. Prior to the pandemic, the vacancy rates for care workers in residential care and domiciliary care were 6.4% and 11.4% respectively. By June 2020, that had declined to an overall rate of 6.6%. We would like to see this number reduced further, which is why we are taking action to support recruitment nationally, and we expect local authorities to support care providers locally.

[Lord Dubs (Lab) [V]]

My Lords, yesterday the Prime Minister promised again to deal with the problem of social care. First, how will the Government fill these vacancies as a matter of urgency? Secondly, what priority will there be for social care in the Government’s digital and healthcare strategy?

[Lord Bethell (Con)]

My Lords, the immediate focus is on the national recruitment campaign across broadcast, digital and social media. We acknowledge that there needs to be more recruitment in social care. Encouragingly, the vacancy rate is down, from 7.8% to 6.6%, but we recognise that more needs to be done. We have launched the CARE brand to try to create a stronger employment brand around the care profession.

[Lord Flight (Con) [V]]

My Lords, I welcome the increase in the number of social care workers but there is more to be done not just in social care but across the wider NHS. Can my noble friend update the House on progress on wider NHS recruitment and, in particular, the manifesto commitment of 50,000 more nurses for the NHS? I hope, too, that there will be a reduction in the proportion of expensive agency-employed staff.

[Lord Bethell (Con)]

My Lords, the recruitment of nurses is extremely encouraging. We have had an enormous response, with more than 10,000 nurses already recruited and recruitment rates to universities for nursing qualifications also up. We have an enormous marketing campaign supported by broadcast and social media. However, more needs to be done and we are very focused on this area. The use of agencies provides some surge capacity for hospitals—it has a role—but I completely acknowledge my noble friend’s point that agency support needs to be used in a considered, thoughtful and commercially intelligent way.

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, the introduction of living allowances for nursing students has improved recruitment this autumn. Stable funding for social care purchasers and providers in both care homes and domiciliary-based service is necessary to ensure dignity in care for the vulnerable in our society. It is essential that careers in social care are attractive and that staff are supported to deliver high-quality personalised care to clients. What plans do Her Majesty’s Government have to support local authorities, further education colleges and social care providers to train and retrain social care staff? Central funding is necessary. Incentives are needed to demonstrate that those joining the social care workforce are as valued by government and society as those working in the NHS.

[Lord Bethell (Con)]

The noble Baroness makes her point extremely well. We want social care to be a profession that people seek out, where they seek professional development and where they can find a fulfilling lifetime career. That will not be true for everyone, but we need a backbone of people who are committed to social care. That is why we have massively increased the funding to local authorities so that they can address the challenge of social care, and why we have published the adult social care coronavirus winter plan in order to provide short-term support for local authorities to achieve exactly what the noble Baroness has spelled out.

[The Lord Speaker (Lord Fowler)]

Short supplementaries, please.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I pay tribute to all those who contribute to the care of loved ones, neighbours and people in their community. The noble Baroness is entirely right to acknowledge the enormous contribution, born of civic duty and personal love, that people put into caring for those in need. I acknowledge the 10 extra hours that she mentioned; I have no doubt that many have had to put in extra work during the pandemic. That is why we have put in significant financial support for the charity sector, and these are the considerations that we will put into future social care reform.

[Baroness Walmsley (LD) [V]]

My Lords, health and care workers can now be reimbursed for the immigration health surcharge. While this is unlikely to fill the gap identified by the noble Lord, Lord Dubs, it is welcome. How are the Government ensuring that all care workers who do not work in large hospitals are aware of their right to the refund, and how are they monitoring what percentage of those eligible are making the claim and what sort of establishment they work in?

[Lord Bethell (Con)]

This is a very important piece of communication. We have sought to work through the colleges and through the CQC system in order to make sure that employers make knowledge of these funds available to those in social care. I will look at the department to see what we are monitoring and what the take-up rates have been, and if I have any further information I will be glad to write to the noble Baroness with that data.

[Baroness Wheeler (Lab)]

My Lords, on agency staff, according to workforce statistics from the Department for Education in February, the number of agency social workers grew by 10% last year. Cheshire East Council, for example, spent more than £1.3 million on agency social workers last year, and these costs also include the fees that the authority has to pay to the agencies. What funding and other support has been provided to local councils specifically to enable them to reduce the reliance on agency staff and to ensure that the money spent on temporary staff in social care departments, care homes and domiciliary care can instead be used to increase the number of permanent, full-time and part-time staff in social care that are so desperately needed?

[Lord Bethell (Con)]

My Lords, the use of agency staff in itself is not something that we are fighting against. Agency staff, although often denigrated, provide an incredibly valuable contribution to the social care efforts of the country. That said, the main way in which we can address the dependence on sometimes expensive employment practices is to ensure that there is a really large pool of people taking the kinds of jobs offered in social care. That is why we are marketing those roles heavily, improving the employer brand around social care and improving the financial arrangements for those seeking training in social care.

[Baroness Eaton (Con) [V]]

My Lords, the latest annual Care Quality Commission State of Care report shows that quality levels in adult social care have been maintained, with 84% of services rated as either good or outstanding, up from 82% last year. Given the dedicated service of our care workers, will my noble friend the Minister update the House on whether a new deal for care workers will include action on pay, training and development, career progression and professionalism, as well as ensuring that those working in care are recognised in the same way as those working for the NHS?

[Lord Bethell (Con)]

My Lords, I echo the tribute paid by my noble friend to those working in social care during the pandemic. Naturally we have a huge amount of concern about those in social care during the pandemic. However, it is amazing how much hard and committed work those who work in social care have put into the arrangements and how effective many of those arrangements have been. The numbers that she cites are really impressive. I cannot make the commitments that she asks of me right now, because the deal for social care workers has not been written, but I completely acknowledge the suggestions that she makes; those are very much on the wish list and the agenda for any social care reform when it happens.

[Lord Crisp (CB) [V]]

My Lords, is the Minister familiar with the work of the Tribe Project? It was set up by a successful digital entrepreneur and is now being used by six local authorities to predict the needs for care, match people with carers, and, very importantly in this context, support professional carers in setting up independently as microenterprises. This reduces overheads and therefore both improves care income and reduces costs. Does he agree that this approach could be very useful in helping with this crisis, and will he explore it further?

[Lord Bethell (Con)]

My Lords, I am extremely grateful for the noble Lord’s recommendation. The project that he describes is incredibly interesting. I am not aware of it today, but I will definitely seek it out and try to find out more. I emphasise the broader point that the noble Lord is making: fresh thinking, digital innovation and the work of entrepreneurs to try to create new ways of working—to pool, for instance, the efforts of teams of people and to use platforms like the one that he describes—can make a massive difference in the area of social care. We are very supportive of digital entrepreneurs bringing fresh thinking to this important area of work.

[The Lord Speaker (Lord Fowler)]

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

Food Hygiene Rating Displays

Lord Bethell Excerpts

Wednesday 7th October 2020 Lords Chamber

[Lord Rooker]

To ask Her Majesty’s Government what is the estimated cost to the taxpayer of requiring food business operators in England to display the relevant food hygiene rating score at the entrance to premises.

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

My Lords, the highly successful food hygiene rating scheme plays a key role in protecting public health. I thank the noble Lord for championing the scheme and am grateful for his continued support. Making display of ratings mandatory is a sound proposal to which we are giving great consideration. There would be some minimal cost to the taxpayer but significant benefit in terms of improved food safety.

[Lord Rooker (Lab) [V]]

I am grateful for that positive answer from the Minister. From my time at the Food Standards Agency, I realise that the legislation is there in place and we now have the evidence. Since 2014, when all English local authorities joined the scheme, we know that 70% of food businesses that scored only zero to two do not display it. It would be tragic if we ended up with a food poisoning outbreak before acting. We know from Wales and Northern Ireland that it can be very successful. I wish the Minister well. It could be slipped in on the back of any Bill going through the House that is related to public health.

[Lord Bethell (Con)]

My Lords, I completely endorse the noble Lord’s points. There is robust evidence that the FHRS has driven up hygiene standards in food businesses, thereby reducing the risk to consumers. It was identified by the Royal Society for Public Health as one of the top 20 public health achievements of 21st century. We have received a case for a statutory scheme in England, and Ministers have given a commitment in Parliament to consider the scheme in due course.

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

My Lords, I pay tribute to the local authorities, not just in connection with this scheme but in connection with the testing that they do, particularly environmental health officers. They are at the front line of keeping us all safe from food poisoning and food fraud. But does my noble friend share my concern that, while some individual councils have an excellent track record of testing, others do hardly any at all? Is he concerned at the lack of resources that cash-strapped councils might face at this time to prevent food fraud occurring?

[Lord Bethell (Con)]

My Lords, the pattern of food inspection rates across the country is uneven, as my noble friend points out. However, the costs of implementing this scheme should not and might not be a hurdle for implementation. We believe that it would actually serve as a potential encouragement for those doing food inspections to see the results of their work published in a mandatory fashion.

[Baroness Boycott (CB) [V]]

My Lords, I come back to the point made by the noble Lord, Lord Rooker. I was left a little uncertain as to when the Government would make it mandatory for all food outlets in Britain to display these notices, as it is in Northern Ireland and indeed in Wales. Everyone agrees that it is a brilliant, simple and overall cost-effective way of ensuring health, so when will it become mandatory and universal across England?

[Lord Bethell (Con)]

My Lords, I cannot commit at this point at the Dispatch Box to a date, as the noble Baroness has asked. However, I will express an enormous amount of warmth towards the idea. I acknowledge that only 55% of businesses in England display their ratings for their premises, whereas in Wales, where it is mandatory, the number of businesses with the highest rating of five has increased by 25% since the introduction of mandatory displays in 2013. That is surely good evidence that the scheme has impact and works.

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

My Lords, but is the Minister aware that in Uxbridge, of 263 food outlets, 21 have not been inspected and 30 scored only between zero and two and, as my noble friend Lord Rooker said, are unlikely to display that? If this is replicated throughout England, there will be thousands of outlets not displaying it. Until it becomes mandatory, what are the Government going to do about it?

[Lord Bethell (Con)]

Well, my Lords, the situation in Uxbridge is clearly one of grave concern, and I share the noble Lord’s concerns—but that is not the national picture. As I said earlier, in England generally 55% of businesses display their rating. This is not enough, which is why we are considering the measure with the scrutiny that we are.

[Baroness Bakewell of Hardington Mandeville (LD)]

My Lords, we all agree that the food hygiene rating scores are important to give the public confidence in the food being prepared, sold and served to them. As we have said, there is no legal requirement to display that score. If you have a score of five, you proudly display it; if you have a one or two, it is in some dark corner which nobody sees. As other noble Lords have said, it is really important, especially at this time, to restore public confidence. I urge the Minister to go back to the Government and get this done soon. It is a local government issue, not really a health and safety one.

[Lord Bethell (Con)]

My Lords, I completely acknowledge the persuasive statistics from the noble Baroness. FSA analysis suggests that food-borne illness outbreaks are twice as likely to occur in businesses with a low rating than those with a rating of three, four or five. These are very concerning figures. We completely take on board the statistics that the noble Baroness has cited, and I shall take them back to the department, as she suggests.

[Baroness Altmann (Con)]

My Lords, has the pandemic had any impact on the overall food standards and hygiene ratings of various outlets? Do local authorities need more resources to continue to carry out the checks that they are required to make?

[Lord Bethell (Con)]

My Lords, it is probably too early to make an accurate analysis, but one impact that has happened in the food industry is the move to online deliveries. That is why we are considering the application of mandatory rating for online deliveries as well as for restaurants. Online deliveries are a terrific benefit to society, but it is important that they also have regulatory scrutiny, and we will bear that in mind in any future review.

[Baroness Wheeler (Lab)]

My Lords, the consumer magazine Which? has warned that customers are at risk of being left in the dark or misled about food hygiene standards and that the regulator and local councils need to take strong action against businesses that fail to display ratings, or display incorrect ratings that mislead customers. What action are the Government taking to address this? Would he agree that England following Wales and Northern Ireland in the mandatory display of food ratings, as well as restoration after the savage cuts to local council food hygiene budgets and local environmental health services and staff, would help to tackle this problem?

[Lord Bethell (Con)]

The noble Baroness puts the case very well. I completely acknowledge that the FSA favours extending mandatory display ratings to England and that in June and November last year the National Audit Office and the Public Accounts Committee respectively recommended that the FSA pursues this ambition as soon as possible. We very much take on board the views of all these public bodies and will consider the advice given to Ministers as soon as possible.

[Baroness Ritchie of Downpatrick (Non-Afl) [V]]

My Lords, the Minister has indicated a warmth towards placing this rating on a mandatory footing. For the avoidance of doubt, can he indicate what is stopping the Government from doing it? Is it the legislative timeframe?

[Lord Bethell (Con)]

My Lords, the immediate concern is, of course, the epidemic, which has slowed things down. It means that management resources that should be dedicated to things such as this are currently distracted. But I reassure the noble Baroness that work is being conducted on the advice being given to Ministers. Updates have been given in the other place on the progress of this policy. I can do nothing more than express warmth at the moment, but there will be decisions and movement on this in the near future.

[Baroness Warsi (Con)]

My Lords, I draw the House’s attention to my interests in the register. Do the Government have national details of the number of inspectors employed by local authorities to carry out these food hygiene and environmental health inspections? What is the national guidance, if any, on the frequency of these inspections, and is funding a determining factor?

[Lord Bethell (Con)]

My Lords, the role of the inspectors is a local authority responsibility. While there may be national figures, I am afraid that I do not have them at my disposal, but I would be glad to write to my noble friend Lady Warsi with whatever data we have on the questions that she has asked.

[Baroness Burt of Solihull (LD)]

My Lords, could not the taxpayer get even greater value for money if the rating incorporated a rating on how well premises were adhering to Covid safety measures? That is the kind of reassurance that I would like to see before I walk through the doors of any catering establishment.

[Lord Bethell (Con)]

Well, the noble Baroness makes a strong case. I think a lot of consumers would like to see the kind of rating that she describes. I am not sure whether it is rightly the responsibility of food inspectors to provide that complex service, but we are working very closely with the hospitality sector on both tracing and the implementation of Covid-friendly measures. The response from the sector has been extremely strong, but we are maintaining a close analysis of progress.

[The Lord Speaker (Lord Fowler)]

My Lords, the time allowed for this Question has elapsed. We now come to the fourth Oral Question.

Health Protection (Coronavirus, Collection of Contact Details etc and Related Requirements) Regulations 2020

Lord Bethell Excerpts

Wednesday 7th October 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 14 September be approved.

Relevant document: 27th 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 virus continues to spread. We will put in place measures to break the chain of transmission and to protect the NHS, but at the same time our strategy is to support the economy, keep our schools open and, wherever possible, maintain normal life—for friends and family to meet and for businesses to remain open. These regulations play an important part in that objective by contributing to enhanced contact tracing, some, but not all, through the NHS app.

The instrument before the House requires designated venues to collect contact details and display an official NHS QR poster. To give a sense of the impact of these regulations, as of 9 am this morning there were 16,302,038 users of the NHS Covid app. Any one of them can check in at 634,488 posters that have been downloaded by designated venues. We know that this is proving popular, because there have been an astonishing 19,721,804 check-ins so far. I encourage noble Lords to exercise their digital skills and take advantage of this important protocol.

If local public health officials determine that one of these venues is linked to an outbreak, they can send a message with the necessary health advice to all those whose timing and proximity coincides with the infection. This might include a requirement to isolate for 14 days.

Privacy is key. An individual who has been in one of the venues in scope of this policy can rest assured that their contact details will be shared confidentially with local public health officials. This will then allow the individual to receive the necessary health advice. Alongside other requirements, this will increase public confidence to go out and use these venues.

I will now set out why this measure is necessary and how uptake has increased following the introduction of the regulations. On July 2, the Government issued guidance to the hospitality sector and asked designated venues to collect contact details. This led to manual, handwritten logs in some venues, and homemade and commercial logging systems in others. The guidance was in place for two months, but there was a growing level of non-compliance. Surveys indicated that around two-thirds of respondents were asked for their contact details some or all of the time, but many were not. According to our surveys, only 43% of people said that they were asked for contact details in all the venues they visited. We saw video evidence as part of media reports showing multiple establishments not adhering. My experience endorsed this coverage: I pay tribute to the Prince Bonaparte pub in Notting Hill for its diligent commitment to these protocols, but I shall not mention some other pubs I have visited where standards have been more lax.

This uneven application of voluntary rules meant that local public health officials often struggled to obtain the contact tracing information they needed. In one instance, a pub in Bolton had been identified as a potential outbreak source, as many of the positive cases had been on the premises. Unfortunately, when contact tracers contacted the venue to access its logs, they contained only names and postcodes. It took up significant amounts of precious time, using appeals on social media, to trace potential infection. This prevented public health officials providing targeted public health advice to those who had been at risk and raised needless worry among others. This is only one of many examples, and something needed to be done to address this significant risk at a time when daily case numbers were rising rapidly across the country.

This instrument has made the requirement on businesses clear. It has given local authority officials powers to enforce penalties on businesses which do not comply. Since bringing in this measure, we have seen the public and business community embrace this policy. It is hugely significant. If an outbreak is then linked to a venue, a message can be sent to the app user on the advice of local health protection teams, providing the necessary public health advice.

We know that the Covid pandemic has disproportionately affected vulnerable groups such as the elderly and people living in high deprivation. These at-risk individuals are less likely to have access to smartphones, so it is essential that a system is in place to contact-trace people who do not have the app. The logs that designated venues must have achieve this. From a recent engagement with industry, we know that designated venues are implementing these requirements. For example, one trade association found that 95% of businesses were fully compliant. Two-thirds of members are capturing data electronically in advance through online or telephone bookings, whereas remaining businesses have introduced customer and visitor logs.

Research in New Zealand, which has a similar system to ours, has assessed that rapid case detection and contact tracing, combined with other basic public health measures, has over 90% efficacy against Covid at the population level, making it as effective as many vaccines. This shows the importance of ensuring that NHS Test and Trace can reach more contacts overall, meaning that more people are provided with appropriate public health advice when they need it.

While these measures apply to England only, we have learned from the approach taken in Scotland and Wales. Colleagues have found a marked improvement in compliance, and although these regulations have been in place for less than three weeks in England, we are already seeing positive signs.

Because of the issues I have just described, we have used emergency powers to introduce these regulations. I recognise that in different circumstances, it would have been preferable to publish them in plenty of time before they were laid and to have brought them before the House before their enforcement. This point has been made in the past, it is acknowledged, and it is understood. We have put together a register of future potential regulations in an effort to improve our housekeeping. However, perhaps I may say a few words in mitigation.

We were hesitant about mandatory enforcement, as we seek to apply Covid-related regulations through voluntary compliance wherever possible. However, we decided to act because of the increasing rate of positive Covid cases, the evidence of non-compliance and the feedback from local public health officials, who were unable to contact people who may be infectious to provide the necessary public health advice.

I know these regulations place additional requirements on businesses and other sectors, which we have sought to mitigate. To reassure noble Lords, we continue to work closely with the sectors in scope to ensure that these measures do not cause undue burdens. Furthermore, the regulations set out that a review must take place within six months of their coming fully into force, and the Secretary of State for Health and Social Care keeps their necessity under consideration between formal review points. We will have these measures in place only for as long as necessary.

This instrument is already benefiting individuals and businesses, and as your Lordships have heard today, individuals and businesses recognise that this is a key tool to prevent further societal and economic restrictions, which we all desperately want to avoid. These regulations are enabling NHS Test and Trace and local public health officials to suppress the virus, to support the economy to remain open, and to protect individuals and their loved ones. The public should therefore be confident to visit and work in these venues, knowing that they will be contacted if they have been exposed to the virus. Providing this reassurance is essential to returning to a more normal way of life and supporting businesses to prosper. I beg to move.

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

As the noble Lord, Lord Liddle, is not contactable at the moment, I call the noble Baroness, Lady Barker.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I am enormously grateful for the thoughtful questions and rich debate that we have had. I shall try to knock off some detailed questions about the app, and I will then address some of the broader themes in the 10 minutes I have. I will try to move as quickly as I can.

A number of speakers asked about feedback on the app over the past three weeks. It often takes three years for government policies to get concrete feedback. We have sought to give as much feedback as we can on this app, and I pay tribute to the app team for operating in as transparent a manner as possible.

A number of noble Lords asked about the fixed penalty fine. Fines are in accordance with the BEIS obligations of undertakings regulations and are independently adjudicated. The initial fine is £1,000 and is reduced to £500 for prompt payment. In response to my noble friend Lady McIntosh, as I understand it, no first offence would incur a fine.

A number of noble Lords asked about exemptions. There are exemptions in the legislation for police and others because it is our assumption that they would be wearing facemasks, so the requirements for them would be different. There is also a facility in app for those who would be in PPE and in close proximity to others, either through a visor or through their personal PPE, such as doctors or shop assistants. The proximity meter on the app can easily be turned off, and it turns itself back on at the end of the day.

My noble friend Lord Bourne asked about Airbnb and other detailed arrangements. There are specific guidelines on guest accommodation, and my understanding is that they would capture Airbnb. We have sought to be as detailed as we can, and there are helpline arrangements for those who wish to query whether their venue is covered by the Act.

The noble Lord, Lord Paddick, asked about commercial purposes. I reassure him and all those in the Chamber that there is absolutely no commercial dimension to the use of the data in the app, and I would be very grateful if the noble Lord sent me any evidence that he or Big Brother Watch think they have to the contrary.

The noble Lord, Lord Bilimoria, mentioned Birmingham University, to which I pay tribute. It has been a terrific partner and ally in NHS Test and Trace and other things, lending us important and valuable equipment. I reassure the noble Lord that this is not simply a matter of having a piece of kit that allows you to run a testing programme. A massive logistical and data programme is required, and its challenges are enormous, so I question the proposition that we should simply send the piece of kit back to Birmingham University and let people there get on with it.

A number of noble Lords asked about the 10 pm closure of pubs and hospitality. There will be a debate on this, but intimacy and the drinking of alcohol plainly encourage people’s closer proximity to each other. This is borne out by the evidence from our tracing programme.

Noble Lords also asked about outbreak management. It has become a pretty clear rule of thumb that if you want to find someone with Covid-19, find someone who has already tested positive and introduce yourself to their friends, because they are the most likely carriers. I reassure noble Lords who asked about Abbott UK and mass testing that we are engaged with all the distributors and manufacturers of testing equipment, including Abbott, and we are validating and assessing their equipment at pace.

The noble Baroness, Lady Thornton, asked about interoperability, which is quite right; we are working hard to ensure that the various nations’ apps work together and that the apps of different countries can one day work together. We are hopeful that UK interoperability will be built into the second version of the current app. On her question of whether there is a point at which the app is more effective, I reassure her that there is no specific threshold. At the current level of 16 million-plus, the app is extremely effective at breaking the chain of transmission.

Regarding privacy and open logs, I completely agree with the noble Baroness, Lady Jones, that a piece of paper lying on a table at the front of a pub is completely suboptimal. There is a gender issue there, and the safety of vulnerable people, and women, is of great concern. That is why we require pubs and hospitality to comply with GDPR, why the ICO has issued special guidance for pubs, and why we brought into place the QR codes, which we hope will be a suitable alternative for most people.

I assure noble Lords that a huge amount of consultation went into the development of the app and our contact tracing, with local government and with privacy experts and advocates. Massive trials were held on the Isle of Wight and in Newham, and we had important learnings from those, and with the hospitality industry itself, which has embraced these recommendations, a point that has been slightly lost in this debate. However, I take on board the comments about parliamentary scrutiny. If I may repeat myself, my right honourable friend has made a commitment in the other place to greater parliamentary scrutiny, and said that regulations with a national impact, such as these, would be brought before the Chamber and the other place before they are laid. I remind noble Lords that it is up to the usual channels to programme the business of the House, and the Joint Committee on Statutory Instruments reviews SIs such as this before they come to the House, so it is not possible for me, from this Dispatch Box, to give the noble Lord, Lord Hunt, all the reassurances that he asked for.

The question of what the alternative is to these regulations has also been raised. What if we did not have mandatory apps? What consideration has been given to the impact of the mandatory contact-tracing arrangements? There would be a grave danger that hospitality would once again be closed altogether. Hospitality is a vector of infection, and the specific purpose of these regulations is to try to keep our pubs, clubs and hospitality sector open. There is a binary alterative. If we do not seek to protect these industries and venues by measures such as these contact-tracing arrangements, they are vulnerable to being perceived and identified as places where the disease spreads. Therefore, to break the chain of transmission, we would be obliged simply to close them down. Neither I nor anyone affected with the Covid-deranged syndrome want to envisage that, which is why we have brought these measures before the House.

The alternative is to let things just run hot. My noble friend Lord Naseby asked about the impact of our lockdown measures on social care. I remember that in April, in a given week more than 2,000 people died in social care, whereas in the last week it was a much smaller number—fewer than 100 people—which shows that if we apply measures that break the chain of transmission, we can keep control of the virus, but if we let it run hot, the consequence will be a huge number of deaths. In reply to my noble friend Lord Hamilton, any economic analysis of either the lockdown or these measures must include an assessment of the value of those lives.

I genuinely believe that the contact-tracing measures of the NHS app are good news wherever you come from. If your priority is to reopen the economy, these measures help keep open the hospitality industry, on which a great many livelihoods depend, and if your priority is to protect the NHS and those vulnerable to this disease, these measures help protect those either at risk from, or who have been in contact with, the disease, and to help infection-control officers who can give accurate health advice and isolate those who have the disease. I commend the regulations to the House.

Motion agreed.

Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 4) Regulations 2020

Lord Bethell Excerpts

Tuesday 6th October 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 14 September be approved.

Relevant document: 27th Report from the Secondary Legislation Scrutiny Committee

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

My Lords, I will start by summarising the changes to the regulations. These regulations, which were made on 13 September and came into force on 14 September, amend the Health Protection (Coronavirus Restrictions) (No. 2) (England) Regulations 2020. They mean that people may not participate in social gatherings, in any place, inside or out, in groups of more than six. The exceptions are members of the same household, two linked households, or exceptions that apply such as for work and schools. This is the measure we call the rule of six; its sole purpose is to halt the spread of the virus by breaking the chain of transmission.

Our message is clear. Those who flout the rules cannot do so with impunity. However, for those who follow the rules, we will provide support and encouragement. That is why the regulations gave police powers to enforce these legal limits, including issuing fines to a maximum of £3,200. It is also why we have introduced financial support for those in isolation.

After a period in the summer of reduction, or stabilisation, in the transmission of the virus, the headline numbers were clear: by mid-September we were seeing daily case numbers rise rapidly in most parts of the country. For example, on 14 August 2020, 1,168 confirmed cases were announced; whereas a month later, on 11 September, 3,286 confirmed cases were announced. That is why the Government, the Chief Medical Officer and the Chief Scientific Advisor jointly agreed the changes we announced.

We know that an increase in infections leads to increases in hospitalisations and deaths, and early indications were of hospital admissions increasing. For example, on 14 August, 99 patients were admitted to hospital; whereas on 11 September, 219 patients were admitted to hospital. We also looked at international data on the feedback on the transmission of the virus in large groups from contact tracing and the advice of infection control teams on the local front line who said the old rules were clearly being flouted. That is why we took the decision to act promptly to introduce these changes.

Regulations such as these are meaningful only if people comply with them. We recognise that in the last eight months the sum of all our regulations had become confusing for many people. Anecdotally, local leaders told us that the term “households” was not well understood—and could be misunderstood as including people’s extended family, whether or not you lived with them—and that a numerical limit was likely to be better understood. Our instincts and these anecdotes were supported by evidence from the Health Protection Research Unit at King’s College London, to which we owe thanks. That is why we have moved to the rule of six: one number; in all settings; inside and out; at home or in the pub. Clear, easily understood guidance, based on clear principles—that is what we have sought to do.

To be clear, in this instance, the buy-in of the public and adherence of the majority are more important than the epidemiological transmission analysis and fine-tuning points of the committees of experts. Breaking the chain of transmission is all that matters. We tightened the regulations so they exactly reflected the guidance, rather than there being one set of numbers in guidance and another set in the legal framework.

I accept that there are seemingly many inconsistencies, injustices and perceived unfairnesses in rules such as these. I have heard many of them already. Probably everyone in this Chamber has an instance where the rules do not seem to make sense. We cannot legislate for every scenario. The virus does not respect special circumstances, however moving. However, there is wisdom in simplicity and there is effectiveness in being easily understood. That is why the rules were simplified and strengthened: so that they were easier to understand, people knew where they stood, the police can act without hesitation and we can get the virus under control. If we achieve that, it is our sincere hope and expectation that the measures will be effective, and we can potentially lift the restrictions.

Let me say a few words about the impact of the measures—I note of course that they have been in place for only three weeks. We have seen the proportion of people who have socialised with six or more people from outside their household at the same time reduce by over a third to 7% last week, compared to 12% in recent weeks.

Let me say a few words about the impact of the measures by giving some examples of where local lockdowns have worked. In Northampton, the weekly incidence rate on 21 August was 116 per 100,000, mainly because of an outbreak in the Greencore factory. We brought in measures and the prevalence rate was brought down to 25.8 per 100,000. Swindon was put on the watchlist, the rise there being linked to a large-scale workplace outbreak and car-sharing issues. These were addressed and the prevalence was brought down to 15. I could go on. I accept that the picture for local lockdowns is complicated, and there are places where the numbers have gone up and have come down, but where measures have been supported by communities, we have broken the chain of transmission.

I want briefly to say something about the way these measures were introduced. Our natural inclination is to lift restrictions wherever and whenever we can. In the summer, we were hopeful that the country had got the message, that our exhortations on hands, face and space had got through and that, except for some local outbreaks, we had basically got a lid on it. However, the numbers told another story. It was therefore essential that the Government moved quickly. As in the past, we used the powers under the public health Act. Our lawyers diligently crossed every “t” and dotted every “i”, so the paperwork was not laid until hours before the measures became law.

None of this is ideal. The Government accept that parliamentary scrutiny has an important role to challenge the detail and to build support. That is why the Secretary of State for Health and Social Care told the other place last week that, for significant national measures with effect in the whole of England, the Government would consult the House of Commons wherever possible and hold votes before the regulations came into force.

I reassure noble Lords that the Government have heard the message on this point and that we are building on the success of these regulations to take them forward. For that reason, I beg to move.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I am extremely grateful for this debate, not because it was particularly enjoyable for any Minister to be described in the terms that I was—although I am grateful for some of the kind words—but because it was an important one. What I heard, loud and clear, was huge frustration: it was like listening to an elastic band being stretched to breaking point—not a pleasant sound. However, it was an important moment when we heard quite clearly the deep and heartfelt concerns of noble Lords about the key issues around this statutory instrument. I will address those concerns in turn.

Fundamental is the science, and I will talk a little about the background to this statutory instrument because there is clearly enormous concern about that—about the Government’s strategy and its complexity, and about the sheer volume, sophistication and confusion of the guidelines and the requests that are being made to the public, and the process by which these instruments are being put together. It is a lot to bite off, but I will cover it as well as I can.

I want to convey to noble Lords that in the past six months our understanding of the virus has changed dramatically. From receiving telephone calls from the front line of the health system we now have a massive information system plugged into the Joint Biosecurity Centre, which was designed by the best minds that the Government have from the intelligence services, the data services and the Cabinet Office. That gives us a very clear picture of what is going on on the ground. Some of that information is data flows from the health system, hospital logs and test and trace, while some is local intelligence from infection control teams on the ground, local resilience forums and local councils. Some of it is then filtered by analysts with epidemiological training, who plug into the proper scientists—the white-coated scientists—who provide their own analysis.

I do not offer this Chamber a volume and say, “This is the science”. Rather, I offer a huge amount of technical insight that is pored over every day, is delivered in extremely sophisticated dashboards, is interrogated by inquiring minds and is challenged by sceptics. We now have a much clearer day-to-day picture of what is going on, in the country as a whole and in different parts of it. When we drafted these regulations, we considered all that information.

The story being told in mid-September was that the public had miscued: that they had, during the summer, massively relaxed their behaviour. The key form of transmission—the trigger to a huge amount of infection —was families taking an extremely lax interpretation of what social mixing they could do. The insight that came from the ground—not from the top—was that we needed to give a much clearer, more easily understood and more enforceable story, or instruction, to the public in order to separate people.

For all that has been said in the Chamber, it is clear to all of us how this disease is spread. It is spread in the aerosol from our breath and by our touching and feeling things. At the end of the day, what we are talking about here is something deeply uncomfortable. We can rightly challenge the regulations for being too complex, and I have enjoyed the speeches that poked fun at some of the difficult and potentially ludicrous parts of sophisticated and complicated guidelines. I can hear the frustration in that kind of challenge, but the bottom line is that social distancing means putting space between ourselves and the people we love. There is no avoiding that bottom line.

You can try to blame the laws, if you like, and blame the regulations for being at fault—“We’ve drafted bad regulations”. But it is not the regulations; it is the space. We all want to spend a lot more time with the people we worry about and care about. We want to enjoy the conviviality of groups we know and trust. We want to plug into the networks of spiritual connection, interest, power and familial connection. These regulations emphatically break those connections. Where there was love, they put in space. I cannot apologise for that. I cannot change it or find some form of words that transforms that simple fact, or in any way changes the grim realities of how we have to limit the transmission of this disease.

I completely hear the ridicule. I feel the frustration and I do not doubt that things could have been done better. Some of these regulations could have been written better. My noble friend Lord Lamont has rightly queried the differences between weddings and funerals. There is an explanation for why they are treated differently, but it would be churlish of me to stand here and plod through it in a bureaucratic and, frankly, frustrating manner. However, I would be glad to write to my noble friend with that explanation. The honest truth is that they are hurtful, they do damage the way in which we show our love, and they will leave a lasting effect on the psychological health of the country and on the economy. I would like quickly to address those two points.

I have been questioned on the strategy many times but, as most noble Lords know, the strategy is clear. The Prime Minister was clear about it last Thursday, as was the Chancellor this morning. We will suppress the virus, while supporting education and the economy, until we eliminate it by vaccine, therapeutics and mass testing. This is a middle way. It emphatically is not a national measure to lock down the country—we tried that and it was horrible, although successful and made a big difference—nor is it running hot. It is the middle way. Therefore, we have to accommodate. We have complexity. We are using local lockdowns and we are trying to instruct by consent, rather than by force. We are trying to be flexible with those who have special needs. Most importantly, we are letting those trying to defend their jobs and education pursue those interests. Those are our two major priorities.

Time is tight, so I will address just a couple of points. As a father of four children, three under 12, I completely hear the point on children. There are many parents and grandparents here who feel it harshly, but the research from the front line was crystal clear: people were using children’s birthdays, drop-offs and congregations around children to flout the rules and create events where infection was happening. Clarity and preventing those nodes of transmission became a priority, which is why we have pursued the route we have.

In reply to my noble friend Lord Dobbs, I can be crystal clear: the Vaccine Taskforce has done brilliantly in researching, identifying and buying vaccines. Advice on how they will be distributed will be given by the JCVI. Our policy on vaccine distribution will be to listen to the JCVI, which has yet to pronounce on it.

My noble friend Lord Robathan is right that some of long Covid is post-viral fatigue, but there is more to it than that. Neurological, cardiac and renal failure are being seen in many people, which is extremely alarming.

I have to draw stumps there. I reassure the House that we have learned the lesson about parliamentary scrutiny, which builds support and brings the light of scrutiny to these measures. We would not have had this debate today, with all the pain and frustration that has been present, if we had had more debates like it previously. My right honourable friend has given a commitment in the other place to bring measures to the House more promptly. In response to the noble Baroness, Lady Thornton, it will be up to the usual channels and the Joint Committee on Statutory Instruments to bring these instruments to the Chamber for debates more promptly, as has rightly been suggested today.

Covid-19 Update

Lord Bethell Excerpts

Tuesday 6th October 2020 Lords Chamber

[Baroness Barker (LD)]

I thank the Minister for yet again turning up at the crease to defend what is becoming increasingly indefensible: the poor performance of the NHS Track and Trace system.

The noble Baroness, Lady Thornton, was right to note the admission in this Statement that 16,000 positive results had not been uploaded, and that by yesterday only 51% of those people had been contacted, despite the injection of resources into NHS Track and Trace over the weekend to try to make up the deficit. Given that we know that each person who tests positive is likely to report between four and five contacts, that is potentially 60,000 people who last week were walking around, not self-isolating and possibly infecting others. It is not their fault—they did not know. It is a really significant breach of trust.

In the part of the Statement that I find most curious, the Secretary of State said that the Chief Medical Officer’s analysis of the Government’s assessment of the disease as a result of the new data was that

“its impact has not substantially changed.”

Can the Minister give us further detail about that? The omission of 60,000 people not having any impact does not add up at all. The Secretary of State went on to say that the Joint Biosecurity Centre had confirmed that

“it has not impacted the basis on which decisions about local action were taken last week”.—[Official Report, Commons, 5/10/20; cols. 625-6.]

When will that data come through and when will we be able to see the impact on local areas? As these statements make clear, the virus is beginning to have different impacts in different places. Can the Minister say at what point directors of public health were informed about this breach? Six months in, it is clear that, when local authorities are properly resourced and given correct and timely information, the virus is managed and contained. The major problems come about when decisions are made centrally, poorly communicated and badly executed.

Time and again, it comes back to track and trace, whether it is about a lack of skills and capacity or a lack of foresight. Who could not have foreseen the impact that hundreds of housefuls of students moving around the country in September would have on transmission?

Yesterday when this Statement was debated in another place, speaker after speaker, mostly from the Conservative Benches, got up to complain about the effect of the 10 pm arbitrary cut-off. They explained how well-run businesses, especially in the hospitality sector, will be going to the wall because of continued use of blunt instruments designed nationally and applied over wide geographical areas. How long will it be before the Government realise that local people—local professionals, directors of public health and environmental health officers—have detailed knowledge about businesses in their area, their hygiene ratings, their previous breaches of licensing conditions and where crowds congregate? When we can get decision making to a more local and granular level, we will be better able to protect good businesses without jeopardising public health.

I welcome the announcement of hospital funding for upgrades to A&E departments. We need a greater capacity for A&E. However, could the Minister give the House the definition currently used by this Government of what constitutes a new hospital?

On the Orbis project, we go into this having left a safe and highly effective system of medicines regulation, one where patient safety is paramount. How does the Government propose to withstand the commercial imperatives of American pharmaceutical companies in these circumstances?

The public are getting very worried about the extent to which the Government continue to wing it. It is time for them to bear down on the fundamental flaw in their strategy—thinking that they know best in the centre, above people who are professionals at a local level.

[Lord Bethell (Con)]

My Lords, I thank the noble Baronesses, Lady Thornton and Lady Barker, for their remarks. The noble Baroness, Lady Thornton, is entirely right about the situation that we face. The latest update, as of 4 o’clock today, is that we have 14,542 daily positives today: 2,833 are in hospital with Covid; of those, 496 are on ventilators, and I am sad to report there were 76 deaths.

These are numbers that make us extremely focused on the challenge of Covid. Earlier today we debated the rule of six, when there was a large amount of challenge about whether such rules on social distancing were really necessary. We were reminded in clear terms about the social impact of separating those who love each other. Here we are talking about the impact on the health of the nation and the threat presented to those who are vulnerable, elderly and have pre-existing conditions. Getting the balance between these two things is extremely challenging, but that is the strategy of the Government—to bear down on the virus while protecting the NHS, education and the economy until we can see a way out through the vaccine, through therapeutic drugs and through mass testing. That is our approach.

I make no bones about it; the errors made over last weekend with the data was extremely regrettable. It undoubtedly causes grave concern among those in Parliament and the general public. I cannot hide from anyone the importance, impact, and severity of the situation. However, I would like to say a few words in mitigation. First, I pay tribute to those at PHE who have pulled together a remarkable system in extremely difficult circumstances, across the length and breadth of the country, integrating many systems into one. I know that that may seem like a trivial challenge and beside the point when we are dealing with a national emergency like this, but these are incredibly complex and difficult tasks. They have involved extremely committed personnel on the technology side of things who have personally checked a huge amount of the numbers. As my noble friend Lady Harding explained, it was through the perseverance of some of those personnel that the mistake was identified.

Between 17 and 23 September, 87,000 were identified through our testing and tracing programme; that is a phenomenal number of contacts where we had the opportunity to intervene and break the chain of transmission. Some 83.7% of those were reached and asked to isolate. I completely appreciate the concerns of those speaking in the Chamber today about the test and trace programme, but those figures are remarkable. That we have set up a system that can intervene in the lives of so many who are carrying coronavirus and can bring to bear such pressure on the disease after such a start as we had at the beginning of the epidemic is a phenomenal achievement. I know that the last thing one wants to be, at this stage of things, is a hollow champion of empty achievement, but that is a hell of a thing for this country to have got to.

There have been questions about the collaboration between the centre and northern leaders, and I cannot hide the fact that there are some quite fruity discussions on the pages of the newspapers and news channels between different community leaders. However, we have to be adult about this and acknowledge that there are different roles for different parts of government. The mayor of a city simply does not have a huge laboratory in which to do tens of thousands of tests a day. The mayor of another city simply does not have a control room filled with PhD analysts who can crunch the numbers and run massive supercomputers with complex algorithms to look at millions and millions of items of data within minutes. These are not the functions of local government, nor will they ever be.

Likewise, the JBC, the Department of Health and Social Care and the Cabinet Office do not have the local knowledge of what is going on on the ground and are not expected to speak a wide range of languages. We do not know what the behaviours are of people on a street-by-street basis. That is the role of local government, and it is through the collaboration of the local and national that we will beat this disease. To try to throw up a false dichotomy and set up test and trace as a scapegoat to blame and punish for the frustrations we all feel about the disease is counter- productive and reveals a shallow understanding of a complex situation.

The noble Baroness, Lady Thornton, said that perhaps care home testing should be sent to hospitals. In many cases, hospitals are involved in care home testing and handle the staff of care homes, but hospitals have to cover their own clinical demands, and pillar 1 is stretched to do the testing of hospital staff and patients. Landing that additional burden is not something that the NHS would welcome.

With regard to the northern leaders and their running commentary on the work of test and trace, I reassure the House that the conversations held in private on a daily—and sometimes hourly—basis have an altogether more collaborative tone. I have been privy to a large number of those conversations; there is a huge amount of expertise on both sides of the conversation, and one should not take too seriously the knockabout commentary in the newspapers and on TV.

The noble Baroness, Lady Barker, asked for an update on contact tracing, and she is entirely right. To have missed a substantial number of contacts during those days was a really big disappointment, but we have moved a huge amount of resources in order to catch up. There has been a phenomenal catch-up already, and I understand that my right honourable friend the Secretary of State will be updating the other place on the progress of that shortly.

I reassure the Chamber, however, that all those who had a positive test were informed promptly. There was no omission in that respect. Therefore, the primary index case, and the person of greatest threat to community transmission, was identified and isolated, and that chain of transmission was shut down.

I will now address the questions about the CMO and the JBC and their analysis of our numbers. I reassure the noble Baroness, Lady Barker, that the integrity of the CMO is unimpeachable; if he judges that the change in numbers has not changed policy, I reassure the Chamber that that is a good judgment that is completely consistent with the way in which we have behaved over the last few weeks.

The noble Baronesses, Lady Thornton and Lady Barker, both asked about Project Orbis. This is a welcome move, enabling the UK to join an international framework to provide concurrent submissions and regulatory views of oncology products, which may allow UK patients to receive earlier access to medicines in the future. I pay tribute to colleagues at the MHRA, who I know have worked really hard on collaborating with American, Canadian and Australian regulators. I am extremely optimistic about the dividends from this collaboration. It augurs, promisingly, similar future collaborations across the health sphere.

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

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

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

My Lords, cars can kill, but driving is not banned. Medical treatment reduces the mortality of those badly infected, but will banning work, study and family meetings through lockdowns and crashing the economy be the right strategy for months to come while leaving the more vulnerable to choose which precautions to adopt?

[Lord Bethell (Con)]

My Lords, I completely sympathise with the observations of the noble Lord. No one wants to see the economy crashed. No one wants to see families separated. Nor do we think that locking up those who are either vulnerable or elderly is a thoughtful or reasonable way to approach this epidemic. What we are seeking is a middle way—a strategy that balances the needs to preserve the economy, education and the NHS with the importance of suppressing the virus and breaking the chains of transmission. That is the approach that we are pursuing today, and it continues to be our strategy going forward.

[Baroness Rawlings (Con) [V]]

My Lords, the Minister said in the Statement that all people testing positive are required by law to self-isolate. Can he tell the House what the fine is if someone breaks the law? Have all the people who travelled on the train and tube with Ms Ferrier MP been traced and tested? If so, how, and if they tested positive, have they been quarantined?

[Lord Bethell (Con)]

My Lords, the case of the SNP MP has shocked the nation. I do not want to comment on it in detail. I do not have the details of what after all is a private matter. That is for the police and the House authorities to examine.

However, the principle to which my noble friend refers is very clear and simple. If you are positive, you isolate. If you are contacted by the contact-tracing system, you discuss your recent contacts with the contact tracers, who will coach you and rehearse with you fully the length and proximity of those contacts and will give a thoughtful clinical judgment on which ones need to be subjected to further contact and isolation procedures.

This is absolutely essential to breaking the chains of transmission. It has a huge amount of support among the public and a tremendous amount of compliance, and we are building on the existing compliance with the enforcement regime that we brought in recently. I call upon all members of the public to support this important approach.

[Baroness Clark of Kilwinning (Lab)]

The Minister will appreciate that the 10 pm curfew, the restrictions already in place in many parts of the country and, indeed, the likely further restrictions that will be brought in, given the levels of Covid, will have a big impact on employment. Other countries are continuing with their furlough scheme, but the scheme that we are introducing to replace it is not as generous. Will the Minister not accept that unless the Government put significant further financial support in place, we will face huge levels of unemployment in this country, with millions of people out of work, an increase in poverty and probably the worst recession that any of us have ever known?

[Lord Bethell (Con)]

My Lords, the impact of all the restrictions, on the hospitality sector in particular, are particularly acute. I completely recognise the noble Baroness’s point that this touches on the lives of many hard-working people from low-income backgrounds who have casual labour arrangements with the hospitality sector. There are millions of people involved, and this epidemic has hit them particularly hard. That is why we put schemes in place like the furlough scheme.

The Chancellor spoke very movingly this morning on the “Today” programme about his intentions and his determination to ensure that people are protected from the worst outrages of Covid. We are also putting in economic measures to avoid the kind of recession which the noble Baroness describes. The honest truth is that other parts of the economy are doing extremely well. It is an awful shame and sadness that, once again, Covid is hitting the most vulnerable the hardest, and the noble Baroness is quite right to identify the people she does.

[Lord Farmer (Con)]

My Lords, in the other place yesterday, the Secretary of State was very definite that the virus is transmitted from surfaces. However, this has been recently disproved, for example by Professor Gandhi of the University of California and the microbiologist Emanuel Goldman, who state that while the virus may persist on surfaces, the traces involved are not viably infectious. Will their important new research now be instilled into our response to Covid, so that we can start to move on to “project hope”?

[Lord Bethell (Con)]

My Lords, I am extremely grateful for my noble friend’s recommendation. It is a source of huge frustration, and amazement to me on some level, that the precise nature of transmission in all cases is not crystal clear. I am not sure that I would completely agree with my noble friend that it has been thoroughly disproved that the disease can never be transmitted from surfaces. In fact, there are others who think that this may actually be a very important vector of transmission. We certainly do not understand the full nature of the way in which aerosol transmission behaves, and it is likely that it is a mixture of them both. That is why we urge the country to comply with the Hands, Face, Space protocols.

[Baroness Armstrong of Hill Top (Lab) [V]]

My Lords, it is significant that, in what can only be seen as a gloomy Statement, no reference has been made to the most vulnerable, many of whom were in the shielded category. National Voices has been listening to these people over the summer and published its report today. Too many in the most vulnerable category say that they feel, and felt, abandoned. They say, for example, that they want to be:

“given information that is relevant to me, in a way I understand.”

That is what many in the country, around all of this, are actually asking for. If we get it right for the most vulnerable, we might begin to get it right for the rest. When are the Government, after promising that they were going to issue more guidance and support to those shielding, actually going to do that?

[Lord Bethell (Con)]

My Lords, I am touched by the testimony of the noble Baroness. I pay tribute to the work of National Voices, which has presented an extremely thoughtful and helpful guide and presented the testimony of those who have been under the extremely harsh regimes of shielding. She is entirely right that those who have had to go into the most extreme forms of lockdown depend the most on government guidelines. Those guidelines can be complex, and people can feel confused or lonely and separated because of their status. We have invested a huge amount in local authorities and in charities specifically to reach those groups. It is through that kind of civic and public service support that we can work with those people. It is not properly the role of central government to have individual communications with those who are shielding at home. We rely on our partners, and we have provided an enormous amount of resources to ensure they can do that job properly.

[Lord Hamilton of Epsom (Con)]

My Lords, if I was diagnosed with coronavirus today and subsequently recovered or showed no symptoms over the next couple of weeks, in 27 days I might get knocked over by a bus and killed, and that would be registered as a Covid-related death. My question to my noble friend is this: why are we including all these deaths that are nothing to do with Covid in the overall statistics that we publish every day?

[Lord Bethell (Con)]

My Lords, if my noble friend caught Covid today and recovered in two weeks’ time, I would personally celebrate that enormously, as I am sure would others in the Chamber. He is right that we have existing protocols for identifying cause of death, and we approach Covid in exactly the same way we do all other causes of death. This is to help our demographic analysis. Of course, the example that he gives—which is entirely correct—is an extreme example, but it is helpful for us to understand, when we are doing retrospective analysis, who has been touched by Covid in order to explain at a later date where the causes of those deaths may have come from. A death that is not apparently from Covid today may in future have a clearer connection.

[Baroness Donaghy (Lab) [V]]

I have a question for the Minister and a follow-up to his response about local government. How can the Government prove that public money being spent on test and trace and IT systems fulfils all the requirements of public procurement? I support my noble friend Lady Thornton in her expression of concern. Some years ago, I was a non-exec director at King’s College foundation trust, and the responsibilities of the board for good governance, accountability and proper procedures for public procurement were very clear. I do not have the same feeling for the contracting and other procurement services in the Government today. The Minister says the Government are extremely focused. It feels more like the Mad Hatter’s tea party.

Secondly, the Government’s response to the approach today by council leaders in the north for help, including local test and trace systems, has been made clear by the Minister this evening. Frankly, it was breath-takingly patronising. Will he take the offer from local government seriously?

[Lord Bethell (Con)]

My Lords, I will tackle those in reverse order. I would not seek to be patronising for a moment. We value the contribution of local leaders enormously, and if I hit the wrong note then I regret that. What I was trying to get across is that the rhetoric in the public media and the realities of the day-to-day conversations between government and local government are not exactly as they might appear. The roles performed by both are complementary, rather than a zero-sum game. It is worth in this Chamber remembering that.

On procurement, the noble Baroness is entirely right; there is a real tension between the absolute requirement to move quickly to meet the challenge of Covid—to stand up facilities and services that did not previously exist—and to move on a national population-wide scale in a way that is not frequently seen in the health system. I can reassure the noble Baroness that a huge amount of work is being done on the auditing, checking and supervision of these contracts. They are not entered into in either a naive or flaky way—quite the opposite. We have put a huge amount of audit and legal resources into striking the right contracts. Cabinet Office colleagues provide a huge amount of analysis and challenge to the way in which these contracts are drafted and in checking against the delivery of the products and services involved.

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

The noble Lord, Lord Robathan, has scratched, so I call the noble Baroness, Lady Bennett of Manor Castle.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, questions in your Lordships’ House on this Statement have understandably focused on Covid-19, but the Statement as delivered in the other place is a broad-ranging survey. It starts by talking about treatments for Covid and then shifts to approvals for new cancer treatments; it looks at the expansion of urgent and emergency care; and those mysterious 40 new hospitals appear yet again, as the noble Baroness, Lady Barker, alluded to. In that context, I ask the Minister whether this Statement is sufficiently balanced. If this is a survey, where is the public health element?

Covid has exposed, even more than we recognised before, a deeply unhealthy society with terrible diets, inadequate opportunities for exercise, poverty, stress, and a mental health epidemic. We know from Victorian and early 20th-century times that it is public health measures that really make the difference. In facing up to tackling Covid, surely that is the direction in which we need to be looking. For example, new research today showing the impact of air pollution includes some very stirring suggestions that childhood exposure has an impact on the rates of dementia and Alzheimer’s. My questions to the Minister are these. Are the Government paying enough attention to public health? Is their strategy sufficiently balanced? Are they funding and doing enough on the broad measures that will create the healthier society that is so clearly desperately needed in the time of Covid or at any other time?

[Lord Bethell (Con)]

In her analysis of the Statement, the noble Baroness is, as ever, inspiring and optimistic. I am extremely grateful for her remarks. The Building Back Better programme will put a vision for public health at the centre of our efforts. We will build on this awful epidemic to ensure that our public health outcomes improve.

[Lord Rooker (Lab) [V]]

My Lords, the Minister will be pleased to know that I do not intend to ask any questions about the report from the department on testing between 17 September and 23 September. As the noble Baroness, Lady Barker, said, there is a reference in the Statement to the Chief Medical Officer and his analysis. I have a simple, very specific question. On what date, and at what time on that date, did the Chief Medical Officer become aware of the missing data issues? On what date, and at what time on that date, did he issue his analysis? If these answers cannot be given now, I would like a commitment that I will receive a letter with the answers.

[Lord Bethell (Con)]

I am grateful for the noble Lord’s question. My right honourable friend was very clear. The Chief Medical Officer analysed our assessment of the disease and its impact, and assessed that it had not substantially changed as a result of these data. The Statement from my right honourable friend is crystal clear. I will be glad to send the noble Lord a copy of that Statement if he does not have it.

[Lord Balfe (Con)]

My Lords, this afternoon’s release from the Office for National Statistics tells us that:

“There were 215 deaths involving … COVID-19 … in England and Wales in the week ending 25 September”.


This remains far below the numbers seen earlier in the pandemic and accounts for just 2.2% of all deaths in the latest week. Our liberties are being trashed and our freedoms removed. When will the Government get down to putting some hope into things? Most people do not know what the rules are, and if they do they are getting round them. I should like a commitment as to when we can open up surgeries and hospitals, and a promise that by Christmas people will be able to visit their elderly relatives in care homes and those who are unfortunate enough to be in hospital. Can we not have a bit of hope, as opposed to this constant gloom?

[Lord Bethell (Con)]

I hear my noble friend’s frustration, and he is right to call for hope. We all want some hope—we are all feeling exhausted by Covid. But it is ironic that my noble friend mentions the low level of deaths as though that were a bad thing. To me, that number is a source of huge pride, because it shows that we have kept a lid on Covid—our NHS is improving the treatment of people who have Covid and we are winning the battle against Covid. I celebrate that.

[Lord Mackenzie of Framwellgate (Non-Afl) [V]]

My Lords, it is increasingly apparent that the key to successful test, track and trace is the provision of a speedy test result, without which the whole process is delayed. Sir Paul Nurse of the Crick Institute makes the case for locally based laboratories to do this more efficiently. A similar argument applies to using the skills of local authorities to track and trace contacts. Will the Government reconsider their obsession with a centralised, world-beating system?

[Lord Bethell (Con)]

I completely endorse the views of Sir Paul Nurse on this and on all matters, wherever I can. The noble Lord is entirely right: speed is critical, which is why we have put major laboratories in regions up and down the country. There are nearly a dozen of them now; they are paired with the pathology networks of the NHS, and our tracking and tracing system works closely with local government. When the large call centre-based tracking and tracing has gaps or when local teams can supplement, augment or complement the work done by the major teams, we seek those opportunities wherever we can.

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

My Lords, I remind the House that I am president of the Health Care Supply Association. I come back to procurement and contracting. Will the Minister respond to the question of my noble friend Lady Thornton about a break clause in the contract with the private suppliers of test and trace? Will he confirm that Public Health England is fully a part of his department, that its staff are officials of his department and that the Secretary of State is fully accountable for its performance?

[Lord Bethell (Con)]

My Lords, I cannot give a detailed analysis of the thousands of contracts that the test and trace system have gone into, but I reassure the noble Baroness, Lady Thornton, and the noble Lord, Lord Hunt, that these contracts are pragmatic, commercial and thoughtful. The interests of the taxpayers are paramount, and a substantial team of commercial professionals and lawyers from the Department for Health, the NHS and the Cabinet Office is focused on making sure that we get value for money.

The noble Lord, Lord Hunt, is right: PHE is entirely accountable to the Department for Health. I do not know the precise status of the contracts for staff, but they are an important and valued part of the Department for Health’s family, and we work extremely closely together.

Covid-19: Adult Social Care Complaints

Lord Bethell Excerpts

Monday 5th October 2020 Lords Chamber

[Baroness Greengross]

To ask Her Majesty’s Government, following the suspension of all casework by the Local Government and Social Care Ombudsman between 26 March and 29 June due to the COVID-19 pandemic, what steps they have taken to ensure that complaints made during that period were handled in line with the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009; and what steps they are now taking to ensure that complaints about adult social care are handled appropriately.

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

My Lords, it is essential that people can voice concerns about their care and have complaints properly investigated. The ombudsman is a vital part of that process. The ombudsman temporarily suspended its usual procedures to protect front-line services. It has now fully reopened and is working through complaints received during that pause. No one has lost their access to justice because of the pandemic and usual time limits on complaints have been eased to allow for this.

[Baroness Greengross (CB)]

My Lords, I thank the Minister for his reply. Can the Government confirm that they still intend to introduce a statutory appeal system for adult social care, as originally planned for in April 2020? If so, do they intend to reopen consultation on that process, given that this was last undertaken more than five years ago, and no response was published?

[Lord Bethell (Con)]

The noble Baroness is entirely right that in April 2016 we committed, in fact sheets about the Care Act, to introduce an appeals process. That is still on the horizon, but this is best placed as an overall reform of the social care system that puts it on a sustainable footing where everyone is treated with dignity and respect. We have, therefore, delayed the implementation of this appeal system until we can make it part of a larger commitment to reforming social care.

[Baroness Altmann (Con)]

My Lords, I urge my noble friend to encourage his department to come forward with its plans for social care reform as soon as possible. How many complaints relating to Covid has the Local Government and Social Care Ombudsman received since it reopened on 29 June?

[Lord Bethell (Con)]

Last week, the Local Government and Social Care Ombudsman indicated that it had had around 100 Covid-related complaints. The department is closely monitoring the situation, including through our normal safeguarding networks. The ombudsman has confirmed that the current level of complaints is no higher than normal. We will be making sure that there is no backlog that ticks up this number.

[Lord Loomba (CB) [V]]

My Lords, with families now reluctant to send their loved ones into care and opting to look after them themselves, what measures are the Government taking to support the sector and ensure that existing residents are not traumatised by being forced to move home due to financial pressures forcing the closure of their current care homes?

[Lord Bethell (Con)]

No one should be under any pressure, financial or otherwise, to move unless they are absolutely determined to. I emphasise that anyone who has a complaint should complain either to the ombudsman or through the CQC and Healthwatch system. To encourage knowledge of and access to that complaints procedure, we have launched the “Because we all care” campaign, which is encouraging people to use the NHS and social care feedback systems in a way that captures the learnings from Covid during this difficult time.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, given the close relationship between social care and the health service, the Government initially agreed that they would combine the two ombudsmen—the PHSO and the one for local government and social care. That is desired by both ombudsmen. We have had a consultation and we have had the Bill, but we heard, on 9 September, that there are no plans in government to proceed with that merger. Will the Minister explain how on earth that can be in the interests of consumers, be they patients or clients?

[Lord Bethell (Con)]

The noble Baroness is entirely right. There are very good arguments for combining the two ombudsmen and that is recognised by both of them. However, the framework and structure for that kind of reform is best conducted when there is an overall reform of social care. The Government made it crystal clear during the election that they are committed to a major and significant overhaul of the social care system. That has been reiterated by the Prime Minister and the Secretary of State for Health and Social Care. When it happens, we will review the combination of those two ombudsmen, as the noble Baroness described.

[The Lord Speaker (Lord Fowler)]

Baroness Warsi? We will move on to the noble Baroness, Lady Thornton.

[Baroness Thornton (Lab) [V]]

My Lords, given the pattern and themes of complaints emerging during Covid, what will the role of the Health and Social Care Ombudsman be in the forthcoming inquiry into the pandemic? Will the Minister give a guarantee of full involvement of that ombudsman, given the evidence it can bring to the table?

[Lord Bethell (Con)]

My Lords, the nature of any future inquiry has not yet been defined. However, all parties will be taking learnings from Covid and bringing forward their lessons-learned experience. As the major regulator, the CQC will play a leading role in bringing together the data and information from the front line but, as the complainant of last resort, the ombudsman will also play an important role in that process by bringing insight from patients and those who have made complaints.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, as the noble Lord, Lord Loomba, indicated, in the context of Covid many families and patients will be looking to stay at home and receive private care there, for longer than they might have. The Minister referred to the “Because we all care” publicity campaign about the ombudsman and its services. However, the annual review of adult social care complaints called for mandatory signposting. Will the Government be introducing mandatory arrangements and rules to be followed by all private providers to ensure that the services of the ombudsman are signposted to people who may need them—not just a publicity campaign but clear direction and information being provided to everyone who might need it?

[Lord Bethell (Con)]

My Lords, I recognise that the ombudsman’s recent report on adult social care did call for a statutory requirement for signposting. We have worked substantially with the sector to improve signposting of the ombudsman and other routes of complaint. The commitment by CQC and Healthwatch to the “Because we all care” campaign is an important and effective measure to fill the gap and raise awareness of the complaints procedure. It is right to wait until we see the results of that campaign. We acknowledge the possibility of mandatory signposting but would like to see a voluntary and more effective marketing campaign work if it possibly can.

[The Lord Speaker (Lord Fowler)]

My Lords, all supplementary questions have been asked. We now move to the second Oral Question.

Covid-19: People with Learning Difficulties and Autism

Lord Bethell Excerpts

Monday 5th October 2020 Lords Chamber

[Baroness Bakewell]

To ask Her Majesty’s Government what provisions they have put in place to meet the needs of those with learning difficulties and autism during the COVID-19 pandemic.

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

My Lords, we recognise that the pandemic presents serious risks and challenges for people with a learning disability and autistic people. That is why we have increased provision of PPE and testing in social care, we have enabled access to NHS volunteer responder schemes and we have developed tailored guidance informed by stakeholders. We have made reasonable adjustments to policies and funded charities with more than £1 million to provide support. The winter plan outlines work to protect all areas of people who need care.

[Baroness Bakewell (Lab) [V]]

My Lords, I thank the Minister for that Answer. He will appreciate that, as he said, people suffering from learning difficulties have particular problems when isolated by the pandemic—terrible loneliness, depression and challenging behaviour. Their families and many agencies, such as Mencap, the National Autistic Society and Care England, feel that government oversight and greater enforcement of existing provisions are needed. Will the Minister draw attention to the urgency of this need?

[Lord Bethell (Con)]

My Lords, the noble Baroness puts it extremely well, and it is an area we are deeply concerned about. We have commissioned Public Health England to carry out an analysis of the existing data on those who have suffered under Covid. We will be reviewing that data extremely carefully to understand the phenomenon more deeply. In the meantime, the Chancellor has announced £750 million to support the charity sector in response to the pandemic. Some of that money has been targeted specifically at charities that are supporting those with learning difficulties to ensure that they get the support that they need.

[Baroness Warwick of Undercliffe (Lab)]

My Lords, many families really struggled to get effective support or even to know where to go to find out what is available. I understand that evidence gathered by concerned charities like Carers UK and Carers Trust shows that many family carers have had no effective support or advice since the end of March, yet they look after some of the most vulnerable in our society. Will the Minister and his colleagues at the Department of Health and Social Care meet with these organisations to discuss what could be done to improve this very sad state of affairs?

[Lord Bethell (Con)]

My Lords, I would like to pay tribute to the work of the learning disability and autism advisory group for its social care task force. Its recommendations have informed the development of the social care winter plan, which provides specific provisions for those with learning disabilities and autism. I would be very glad to meet whichever groups the noble Baroness recommends, because this is an important issue that we care about immensely and are determined to get right.

[Lord Wigley (PC) [V]]

My Lords, I draw attention to my registered interest as a vice-president of Mencap. Does the Minister recognise the challenges facing many parent carers of people with a learning disability who are older people, who often themselves are having to shield during lockdown? What are the Government doing specifically to ensure such households have the support they need as we enter the second wave of Covid this autumn?

[Lord Bethell (Con)]

My Lords, the role of any carer is one that we should applaud and pay tribute to, for they are often the overlooked supporters of those with learning difficulties and autism. The plight of those families during Covid has been very hard, and we recognise the tough challenges faced by older parents in particular, who have big responsibilities for children with learning difficulties. The main support will be through local government, and we have put through a huge amount of finance to local authorities and charities to support those families. The adult winter plan has £500 million for the infection control fund, and the NHS has £588 million to support those who are moving from one part of care to another. We will continue this financial support in this area.

[Lord Astor of Hever (Con) [V]]

My Lords, I declare an interest as the father of an autistic daughter. Can the Minister say when clear guidance will be provided to day centres for the disabled, and when we can expect they will reopen?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, the guidance for day centres in particular is not something I know the specific date for, but I would be glad to take my noble friend’s question back to the department and seek a date, as he asks. We all wish for day centres to be open, but keeping infection control in day centres for those with learning disabilities and autism is extremely challenging, and our primary concern is the safety and protection of children. Therefore, we have to weigh those considerations with the natural pastoral concerns and the contribution of day centres to the care of children.

[Baroness Walmsley (LD) [V]]

My Lords, the lockdown has led to distress for many autistic children due to different routines and limited social interaction outside the family. Many have found returning to school difficult. The National Autistic Society has recommended that schools provide all autistic children with a personalised transition plan to help with their return to school. Has this been happening?

[Lord Bethell (Con)]

The noble Baroness puts the plight of those with autism extremely well. Who could not feel sympathy for those with special needs and autistic sensibilities, with the distress and trauma of changes and the unfamiliarity of the Covid regime? I do not know the precise status of a personal plan for all those transitioning back to school, but I would be glad to inquire back at the department and write to the noble Baroness with a reply.

[Baroness Stroud (Con) [V]]

My Lords, prior to the pandemic, the Social Metrics Commission’s report found that half of all people in poverty live in a family that includes a disabled adult or child. Given that education is one of the key drivers to transitioning out of poverty, could my noble friend outline the work he has been doing with the Department for Education and the Department of Health to address the skills and education gap created by Covid for disabled children who have special educational needs and to ensure that these children’s needs are the focus of any pandemic measures in the coming months?

[Lord Bethell (Con)]

My noble friend Lady Stroud speaks very movingly of the tough figures around the prevalence of disability among those in poverty. I completely take on board her recommendations about training in education. The Prime Minister spoke last week about the opportunity that Covid presents for a reboot around skills. That reboot will include provisions for those with learning difficulties and disabilities. I would be glad to inquire at the department exactly how developed those plans are and to update the noble Baroness with the information that I have back at the department.

[Baroness Hollins (CB) [V]]

My Lords, a ministerial response in the other place last week stated that only some supported living settings would be able to access asymptomatic testing. People with learning disabilities have had excess death rates higher than over-65 year-old care home residents, and many live in supported living settings. When do the Government intend to extend regular asymptomatic testing to all supported living settings, where the majority are still effectively shielding, and thus perhaps also enable day centres to open?

[Lord Bethell (Con)]

We are seeking to extend asymptomatic testing as widely as we possibly can and as soon as we possibly can. At the moment, our focus for testing is on residential social care, where we have committed to 100,000 tests a day. That is where the greatest threat comes from. But as the number and range of tests increase, we hope to be able to roll out asymptomatic testing to a much broader set of user cases, and the kind of care centres that she describes will surely be near the top of the list.

[Baroness Thornton (Lab) [V]]

My Lords, figures from the CQC show that there has been a 175% increase in unexpected deaths among learning disabled and autistic people during the pandemic. The Cabinet Office’s disability unit, which is charged with developing the national strategy for disabled people, has been silent so far. Does the Minister agree that, rather than Covid-19 necessitating delays for a national disability strategy, the impact of the crisis on disabled people makes its publication all the more vital? When will the national disability strategy be published?

[Lord Bethell (Con)]

My Lords, let me clarify with an update on the numbers. As of 25 September 2020, 690 deaths from Covid of people with learning disabilities have been reported to the leader programme since 16 March. We have commissioned Public Health England to carry out additional analysis of the existing data, which will be published as soon as it is completed. We are not trying to hide from this issue. Covid has raised very serious questions about the impact of a pandemic on those with learning difficulties, who are often more susceptible to disease and mortality than others. We absolutely accept the challenge of figuring out how to protect the most vulnerable in our society. Therefore, we will embrace the opportunity to take these learnings and put them into a disability report at some point in the future.

[The Lord Speaker (Lord Fowler)]

My Lords, I regret that the time allowed for this Question has elapsed.

Hospitals and Nursing Homes: Do Not Resuscitate Notices

Lord Bethell Excerpts

Thursday 1st October 2020 Lords Chamber

[Baroness Browning (Con) [V]]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and refer to my interests in the register.

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

My Lords, the department is very clear that the blanket use of DNACPR and DNR is unacceptable. An agreement to a DNACPR is an individual decision and should involve the person concerned or, where the person lacks capacity, their family, carer, guardian or any other legally recognised advocate. I can inform the House that the Minister for Patient Safety and Mental Health will be writing to the Care Quality Commission requesting that it investigates and reports on DNACPR issues.

[Baroness Browning (Con) [V]]

I am grateful to my noble friend and am aware of the letters written in respect of people with learning disabilities and autism during the first phase of the Covid-19 outbreak. However, with the second wave looking as though it is on its way, my noble friend will be aware that there is still concern from charities such as Mencap and the National Autistic Society, not least because of the attitude in some areas that people who have social care support needs are rather lesser human beings than the rest of us. How will the Care Quality Commission carry out this assessment as the second wave increases?

[Lord Bethell (Con)]

My Lords, it is completely unacceptable for any group of people to have blanket DNACPR provisions apply to them. The adult social care winter plan published on 18 September reiterates that and makes the position crystal clear. The General Medical Council is providing additional support and guidance to clinicians on how to meet the needs of patients and relatives, and the Resuscitation Council UK is creating a large amount of resources to provide training. The CQC is monitoring the situation extremely carefully.

[Baroness Jay of Paddington (Lab) [V]]

My Lords, the distressing circumstances of the pandemic have once again highlighted the difficult and sometimes controversial issues about end-of-life treatment in general and individual choices. Will the Government set up a long-proposed review to examine all these issues, particularly to improve real patient choice?

[Lord Bethell (Con)]

The noble Baroness is entirely right. The Covid epidemic has shone a spotlight on the awful arrangements around end of life at a time when contagious disease presents a threat to all those present in a nursing home or hospital. Our thoughts and prayers go out to all those who have lived through such an experience or will face one in the near future. I note the noble Baroness’s call for a review. There is no current plan for one but I will carry the idea back to the department.

[Baroness Bakewell of Hardington Mandeville (LD)]

My Lords, I sympathise with the medical profession engaged in saving lives at all costs. However, many people will have spent a great deal of time in thought and consultation with relatives before deciding not to be resuscitated, should they become desperately ill, especially with Covid, with possible permanent physical or mental impairment. It is inconceivable that their wishes should be overturned by medical professionals who do not know or understand their background. What are the Government doing to ensure that that does not happen?

[Lord Bethell (Con)]

My Lords, I completely agree with the noble Baroness’s sentiments—so does the department and so do the Government. We have noted what happened during the Covid epidemic. The CQC is investigating potential lapses at that time. We have reinforced guidance in the winter plan and the CQC continues to review the situation. New training and guidance provisions are being put in place. We take the situation extremely seriously and are putting in the procedures and investment necessary to ensure the right outcome.

[Baroness Chisholm of Owlpen (Con)]

What training is being given to physicians and healthcare workers for when they discuss DNR with patients and next of kin?

[Lord Bethell (Con)]

The department is aware of the Queen’s Nursing Institute report on training and, although the majority of responses were positive, it raised questions about the training of, in particular, care home staff on the instruction to change resuscitation orders for patients without discussion. We are looking at that report very carefully. We cannot comment on individual cases but the report raises important questions. In the meantime, the General Medical Council is providing additional support and guidance to clinicians and the Resuscitation Council is creating a large range of resources for clinicians to help guide them and provide training.

[Baroness Thornton (Lab) [V]]

I am pleased that the Minister has recognised that, although DNR is a medical decision and not something that requires a patient’s consent, not consulting with the patient and their family is an unlawful breach of human rights. We should be grateful that the scandal was exposed by Turning Point and other charities during the pandemic. Does the Minister have plans to review the DNR decisions that were made during the pandemic and does he know, or perhaps he can find out, how many DNRs were issued in excess of what one might have expected during the pandemic?

[Lord Bethell (Con)]

My Lords, NHSE&I is currently engaged with stakeholders, including people with lived experience, to develop better information for patients and to understand whether procedures need to be changed. I reassure the noble Baroness that DNRs are not issued, they are agreed with families and relevant loved ones. On no account should DNRs be unilaterally issued. They are for a joint decision; that kind of blanket application is something that we are extremely concerned about and seeking to avoid.

[Baroness Walmsley (LD) [V]]

My Lords, when someone who has a DNACPR is well enough to leave hospital, can the Minister assure me that the notice will be reviewed as a matter of course after consultation with the patient and their carers?

[Lord Bethell (Con)]

The noble Baroness makes a fair point. Of course, someone who walks healthy from a hospital need not have such a notice left on their clinical records. I will admit that I do not know the precise arrangements for how that is conducted but I will be happy to write to the noble Baroness and explain the procedure.

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

My Lords, the Minister has already said that he quite understands that there will be people, particularly the elderly, who do not wish to be resuscitated. One easy way of ensuring that resuscitation does not happen is for people to have a living will. Will the Minister undertake to try to encourage GPs to ensure that all their patients understand this and that they have the potential to have a living will?

[Lord Bethell (Con)]

My Lords, the benefits of living wills are enormous, both for those entering the last stages of their life and their loved ones. It is something that we are keen to encourage. I do not know the precise arrangements for how GPs play a role in that, but I will be glad to write to the noble Baroness and explain what provisions are in place for encouraging the use of living wills.

[Lord Robathan (Con)]

My Lords, I commend my noble friend for his balanced comments on this extremely fraught situation—I think everything has just about been said. Every life is, of course, to be valued but many of us as we get older—dare I say, we are quite a lot older in this House than the average population—will be looking at whether we want a do not resuscitate order in our living will. That is why I commend the idea from the noble Baroness, Lady Wheatcroft, of spreading this information around.

[Lord Bethell (Con)]

My noble friend puts it all very well. It is my birthday today, so I am feeling a little bit older and thoughtful on these subjects. On a serious point, living wills have enormous benefits and give peace of mind to those who enter nursing homes and hospitals, and their loved ones. We will look carefully at this important point and I will share my correspondence with the noble Baroness, Lady Wheatcroft, with my noble friend.

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

Happy birthday to the Minister. Given the dangers of the shortcut abbreviation of DNR, which can result in essential care decreasing, has the Department of Health considered adopting NHS Wales’s concept of a natural, anticipated and accepted death—NAAD? In five years, this has had no problems reported and gently and sensitively leads to DNACPR conversations with patients and those who love them.

[Lord Bethell (Con)]

My Lords, I welcome the testimony of the noble Baroness. We often keep track of Wales’s use of innovative health measures and, while I am not aware of this concept in particular, I will be glad to take the advice back to the department, recommend it and return to the noble Baroness with a response on how we are going to take it forward.

[The Lord Speaker (Lord Fowler)]

My Lords, the time allowed for this Question has elapsed—my apologies to the noble Lord, Lord Foulkes.

Covid-19: NHS Application

Lord Bethell Excerpts

Thursday 1st October 2020 Lords Chamber

[Baroness Massey of Darwen]

To ask Her Majesty’s Government what measures they will take to encourage the uptake of the National Health Service COVID-19 application; and how the effectiveness of that application will be monitored.

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

My Lords, we have TV advertising, celebrity endorsement, stakeholder mobilisation, social media engagement and newspaper wraparounds. We have done an enormous amount to support the app launch, with a massive campaign—but the greatest promotion is a great product. Fifteen million downloads, 500,000 QR downloads, 8 million venue check-ins and thousands isolated suggest that the British public have embraced the app as a valued tool to protect the ones they love.

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

My Lords, I thank the Minister for his reply, on his birthday. The number of people downloading the app is important, but in assessing its effectiveness, what problems or elements of success will the Government look for, apart from numerical take-up?

[Lord Bethell (Con)]

My Lords, the primary purpose of the app is to break the chain of transmission. Therefore, alerting as many people who have been in close proximity to a Covid threat as we can is a primary objective. However, the app also does an enormous amount to provide information for those trying to understand the regulations in their local area. It also does a lot to support those in isolation and we very much hope to be able to connect the payments for isolation benefit with the app in later versions.

[Lord Triesman (Lab) [V]]

My Lords, the uptake and positive development of the Covid app is likely to be greater if it picks up on all the testing regimes, enables the user to enter a unique code that they have been given and is front and centre of having tests available to record the incidence of illness. Does the Minister agree that urgent, comprehensive testing and tracing is needed for care and health workers if all medical care is to return to normal levels, and for teachers and pupils if schools are to have the best chance of remaining open for all? Does he agree that the app would prove most effective if these goals were accomplished rapidly alongside the development of the app?

[Lord Bethell (Con)]

My Lords, I entirely agree with the noble Lord’s observation. These are parallel developments and we are indeed working on them. It is important that the app captures all testing information. We are working extremely hard to ensure that all tests, wherever they come from, whether pillar 1 or pillar 2, are captured in the app. We are also doing an enormous amount to ensure that there are supporting measures for those who work in social care and teaching, so that they have the security of knowing that their workplaces are protected.

[Lord Scriven (LD)]

My Lords, I wish the Minister a happy birthday. So far, £35 million has been spent on the development and testing of the app, which is approximately £15 million more than any other western European country has spent on such app development. Other than the QR code, what functionality has that £15 million been spent on, which is not available in the app of any other western European country?

[Lord Bethell (Con)]

My Lords, the secret sauce of the app is the algorithm at its heart, which takes data from Apple and Google phones and the Bluetooth component, and applies a risk-scoring analysis that judges proximity, velocity and context to give a true assessment of risk. That is how we seek to avoid false positives and false negatives. We have invested in the algorithm in conjunction with Apple and Google and it is an incredibly important piece of added value. Without that algorithm, the app would not work properly.

[Baroness Altmann (Con)]

My Lords, I too congratulate my noble friend on his birthday and I congratulate the Government on introducing this new technology. As he is aware, I am very supportive of this. I would be grateful if he could explain to the House what evidence there might already be from Scotland on the effectiveness of the Protect Scotland app in tracing contacts, ensuring isolation and reducing deaths.

[Lord Bethell (Con)]

My Lords, the Protect Scotland app has delivered huge value for the Scottish people. It has guided many to isolate and it has been downloaded a very large number of times. We seek to get the UK app and the Scottish app working together in the second version. We have learned an enormous amount by collaborating with Scottish colleagues and have gained enormous value from their learnings.

[Baroness Deech (CB) [V]]

Does the Minister agree that the purpose of tracing is defeated if millions of people cannot download the app because their phones are a few years old, even models as recent as those from 2018? I discovered this and felt obliged to spend a great deal of money upgrading and took the risk of travelling to a phone shop and spending an hour there doing this. However, millions will not, especially elderly people and those who live in poorer, crowded areas. What can be done for the people who cannot download the app?

[Lord Bethell (Con)]

My Lords, I greatly regret that the noble Baroness, Lady Deech, had to make that journey. That is a troubling thing for her to have had to do. I reassure her that 89% of the population have phones whose hardware and software is compatible. Even on today’s numbers, one-third of the 16-plus population of Britain has the app on their phone. This number is high enough to make the app extremely effective; it is an enormous penetration. While this does not account for absolutely everyone, it is terrific progress and we will build on that success.

[Baroness Andrews (Lab) [V]]

My Lords, the Minister just gave a figure for the over-16s. In view of the outbreak of Covid in universities, what proportion of university students have accessed the app and actually used it? Am I right in thinking that it is accessible only if you are over 16? Why is this the case?

[Lord Bethell (Con)]

My Lords, I cannot answer the noble Baroness’s question. There is a very good reason: the privacy arrangements of the app mean that we do not know who has downloaded it. This information is available only to those who have downloaded it. It is precisely because of those privacy arrangements that an enormous amount of trust is placed in the British people. However, I do not deny that it is frustrating that we do not have the kind of demographic insights that the noble Baroness quite reasonably asks for.

[Lord Willis of Knaresborough (LD)]

My Lords, I am delighted that this app has now been produced. Fifteen million adopters in a week is excellent news, and I genuinely congratulate the Minister on that. However, 34 countries are already using the ENX system with Bluetooth, and it is to be regretted that we are not ahead of them, but we are not. What conversations have the Government had with some of those countries to ensure that we do not repeat the mistakes that they have made on their journey? Given the importance of mass take-up—which is important before going on to talk about other things—have the Government considered discussing with Apple, Google and mobile phone suppliers such as Samsung the possibility of putting the app straight on to people’s phones at the point of sale, or point of update, with of course the option for the customer to remove it, should they wish to do so?

[Lord Bethell (Con)]

The noble Lord has made a very detailed and technical inquiry. We are studying the ENX system very closely. However, as I mentioned earlier, the secret source of the British app is the algorithm that takes the data from Bluetooth and the phone and analyses it to give the risk assessment. Our view is that that algorithm is absolutely critical. Without it, the ENX system fires off alerts to anyone who has been proximate to another Bluetooth phone that has registered a positive test, even if they have only driven past that phone on the motorway. Those are exactly the kinds of circumstances that the British public made it crystal clear to us they simply would not tolerate. Therefore, we have put an enormous investment into that algorithm. We have had an enormous amount of interest from other countries, and we are happy to share that learning with companies as we develop our intelligence on it.

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

I wish my noble friend many happy returns on his birthday. Clearly, the app is a very useful tool. Does he imagine that the Government will use it in conjunction with the testing of international passengers arriving at airports? When might testing be rolled out at airports?

[Lord Bethell (Con)]

My Lords, version 1 does not have an international component to it, but that is something that we would seek to develop. I emphasise that the app in its current form is very much focused on providing a huge amount of personal privacy and is therefore not an appropriate vehicle for putting in place any form of surveillance or quarantine management. That would be in breach of our arrangements with our technical partners, Apple and Google. Therefore, although I cannot give my noble friend Lady McIntosh a complete answer, I would like to hint that perhaps this will not be the vehicle for accelerating airport testing.

[The Lord Speaker (Lord Fowler)]

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