Covid-19 Update

Lord Bethell Excerpts

Wednesday 1st July 2020 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, first, on behalf of the Lib Dem Benches, I once again pay tribute to all of those who are helping to curb the coronavirus pandemic, whether in the front line or behind the scenes, and especially in Leicester. We know that there are many unsung heroes who continue to work long hours in stressful and ever-changing environments. Secondly, on behalf of these Benches, and in memory of the outstanding report by William Beveridge, I extend our congratulations to the NHS on its birthday, and note that of the five evil giants, many are still present in those most affected by Covid.

If the Minister is unable to answer all the questions asked, will he write to noble Lords with an answer? I hope that I can speak for other Members of your Lordships’ House when I say that we understand that the nature of a pandemic means that there are many questions to raise, but to repeatedly not have answers from Ministers is disappointing.

On that note, I ask the Minister for the fifth time in just over two weeks what the problem is with ensuring that every local council and director of public health has full test and tracing data as it becomes available. Over the past three weeks, it has become clear that full data has not been provided, and directors of public health, council leaders and mayors have all had to beg for data so that they can intervene early to prevent further cases, hospital admissions and deaths. Information is being dribbled out and it appears that pillar 2 testing lies at the root of the problem.

Stella Creasy MP asked a Written Question in the Commons, which was replied to by Minister Nadine Dorries on 11 June. It states:

“The contract with Deloitte does not require the company to report positive cases to Public Health England and local authorities.”


Does that remain the case, or has the contract now been varied to ensure that that information is made available immediately to key partners? The issue of why any such contract should not require positive cases to be reported is quite extraordinary but for another day; however, with low transmission, tracing pillar 2 cases is absolutely critical. Are all local authorities and directors of public health now getting full data, including pillar 2 data immediately so that they can prepare for small or larger local outbreaks? That is important because there are reports from across England of areas with increasing cases—indeed, as the noble Baroness, Lady Thornton, said, Sky News reported this morning that 35 other local authority areas may face locking down if their cases do not reduce quickly.

That raises an issue about the powers of local lockdown. It was rather strange to hear Matt Hancock saying on Monday evening that he would bring forward legislation for local lockdown, but this morning on Sky News he said that he would rather not do that by legislation but by consent. So I put what I hope is a hypothetical case to the Minister. If this Saturday a number of Leicester residents get in their cars, what powers to the police have to prevent them from going to Loughborough, Derby or Sheffield to be able to go into a pub? Clearly, at the moment, local authorities do not currently have the powers to stop them: their powers relate only to single buildings. But if the Secretary of State believed on Monday that there needed to be legislation, why not today?

This feels very much like policy by press release, and local legislation enforcers, whether they are police or local authorities, need to know what powers they have as a matter of extreme urgency. I also ask again, why will Ministers not give the powers of local lockdown to local authorities and directors of public health, obviously working with Public Health England, the NHS and Ministers? For any final decision to rest with the Secretary of State inevitably slows down processes, as we have seen in the Leicester case over the past three weeks. Above all, we must keep people safe.

Finally, will the Minister inform the House whether there is sufficient supply of PPE in Leicester and other areas where cases are increasing for hospitals, primary care, care homes and care in the community? The Health Service Journal reports today that there is still much panic buying of PPE, with some orders costing 10 times the amount that would have been paid before March.

This Saturday marks the lifting of lockdown for most of England except for those of us shielding and the people of Leicester. Will the Minister ensure that the wider public will remain safe with the increases in cases in at least 35 other local authority areas? Will the Government move much more quickly to ensure that public safety is guaranteed?

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

My Lords, I thank the noble Baronesses, Lady Thornton and Lady Brinton, for their thoughtful questions. To answer directly, it is extremely important that we are currently here debating the outbreak in Leicester, because in a way it is a tribute to the success of the hygiene, isolation and social distancing strategy that has borne so heavily down on this disease that we are now in the position of focusing on those rock pools of the epidemic that have been left behind by the tide of this disease going out. But I completely accept the importance of this outbreak management. That is where the Government’s focus is centred.

I reassure both noble Baronesses that the data that local authorities and local directors of public health require is being given to them and access is being provided. All local authorities were issued with data-sharing agreements to access personally identifiable local testing data on 22 June. After signing those data-sharing agreements, the first local authorities accessed the data on 24 June. Leicester accessed it with its log-in details on 25 June. An enormous amount of progress is being made in an area that is now very much our focus. Local authorities, public health directors and infection control teams have worked hard in the past few weeks knuckling down on those lockdowns that did not get away, on the local outbursts that were well managed and that have not hit the headlines and that are now falling lines on the epidemiological graph.

The noble Baroness, Lady Brinton, asked about the legal aspect. I reassure her that the lockdown in Leicester is being carried out under the Public Health (Control of Disease) Act 1984 at the request of the local authority as the provisions of that Act require. Therefore, regulations will not be brought to this House. The Secretary of State and the Government have sought to manage the epidemic through the consent of the people, not through making things mandatory. That has been our consistent approach because trust and collaboration are at the heart of this country’s response and we do not believe that making things mandatory through regulation will be as effective. However, if regulations are necessary, we will bring them to bear in order to protect lives and save the NHS.

I pay tribute to the British people for their enormous collaboration and the huge sacrifice that many have made in order to put in social distancing and other necessary measures. I pay tribute to the shops, pubs, churches and other venues that are working so hard in order to apply the necessary regulations for reopening on 4 July, which will be an incredibly important but worrying experiment in opening up our society.

On further lockdowns around the country, none is currently planned. Our profound hope is that none will be necessary. Our severe fear is that they will be, because epidemiological experience suggests that a virus that has a doubling rate of two or three days very quickly spirals out of control in geographical focal points. But we remain incredibly vigilant, and the focus of our effort is to use the necessary data to identify outbreaks when they happen and to move epidemiological resources into place in order to deal with those outbreaks.

On further data, we hope to make announcements shortly in order to get the most local data open to the dashboards available to local authorities and public health officials in the very near future.

The noble Baroness, Lady Thornton, asked about the involvement of the Mayor of Leicester in decision-making in Leicester. I reassure the noble Baroness that he was very much at the heart of all the analysis, the meetings with PHE, the gold meetings of the JBC and the process of agreeing the lockdown arrangements. That is entirely right and proper for such a situation.

The noble Baroness, Lady Brinton, asked about PPE in social care. I reassure both noble Baronesses that the measures in place to manage imports and the manufacture of the necessary domestic PPE have proved to have a huge yield and at the moment our RAG rating is extremely positive on PPE for all aspects of the healthcare system.

[The Deputy Speaker (Lord Faulkner of Worcester) (Lab)]

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.

[Baroness Pidding (Con) [V]]

My Lords, as we have sadly seen in Leicester, it is clear that this virus still lives in our communities. We know that testing is key in helping to keep the pandemic under control. Does the Minister agree that anyone who has been in close contact with someone testing positive for coronavirus should be able to get a test, whether they have symptoms or not? At present, this is not the case. In Buckinghamshire, for example, there is only one testing facility that offers this.

[Lord Bethell]

I reassure my noble friend that anyone who has reason to believe that they may have been infected by the virus is eligible for the test. The resources we have put into testing are now enormous. There are nearly 300,000 tests a day. Those in Buckinghamshire who are too far away from the drive-in testing facility should apply for an at-home testing kit.

[Lord Patel (CB) [V]]

My Lords, I agree with much of what the noble Baronesses, Lady Thornton and Lady Brinton, had to say. In response to them, the Minister said the dashboard will provide data about the infection rate to local authorities and local healthcare. If that is so, I welcome it. Does that mean a change in policy towards greater involvement of local public health directors in managing this pandemic?

[Lord Bethell]

To be clear to the noble Lord, the dashboard was made available on 22 June. It has a very large amount of local information, including information from 111, hospitals and the test and trace programme. The analysis of the data will be enhanced using the latest technology in order to give the most granular information possible. Those enhancements will be rolled out very shortly.

[The Lord Bishop of Coventry]

My Lords, the Minister said that data required by local authorities is given to them, but I am told by the leader of Coventry City Council and our director of public health that, although data sharing has improved over the past two weeks, it still comes from different sources and does not include data on workplaces and other settings that people regularly visit or, as we have heard, on ethnicity. Can the Minister provide further assurances that local authorities will be supplied with the full data that they need to respond to local outbreaks in a streamlined form and at an early point?

[Lord Bethell]

The right reverend Prelate is right that bringing together data from a very large number of sources is a challenge. One could include social media data, digital tracking data, hospital data and 111 data. We are working on systems that bring all the possible data one could imagine to one place at the joint biosecurity centre. We have made huge strides on that, but there is work to be done, and we are very much focused on it.

[Lord Bach (Lab) [V]]

My Lords, I declare my interest as the elected police and crime commissioner for Leicestershire and Rutland. I want to make it clear that I agree with the decision the Government have taken. The data makes it clear that it is necessary at the present time. This is primarily a health matter, but the excellent Leicestershire Police will be expected to play its part. It will do so proportionately and reasonably in the British tradition of policing by consent. The police may well incur extra costs in policing this matter. Will the Minister today make a promise that any extra costs the force incurs will be met fully by the Government?

[Lord Bethell]

My Lords, it is beyond my brief to comment on Home Office funding for the police force, but I emphasise that funding has been put in place— £300 million—for local authorities specifically to cover outbreak management and further funds are being looked at to cover this area.

[Lord Hussain (LD) [V]]

My Lords, around half of Leicester’s residents are black and minority ethnic. Given that the Public Health England report COVID-19: Review of Disparities in Risks and Outcomes shows that BAME people are more likely to suffer from the disease seriously and to die from it, what can the Minister do to ensure that specific advice is given as a matter of urgency to BAME residents?

[Lord Bethell]

The noble Lord is right to raise the question of marketing and communications to BAME audiences. We are looking at it very closely, because there is a natural concern about the regular epidemiological phenomenon that those who do not feel in the mainstream of society are sometimes the hardest to reach. We are focused in both our communications and our marketing on working with the groups that most fairly represent BAME communities to ensure that the message gets through. I would welcome any recommendations or suggestions from him on how we can do that better.

[Baroness Verma (Con) [V]]

My Lords, I declare my interest, as listed in the register, as a social care provider in Leicester. I am currently in Leicester and I have listened to noble Lords very carefully. Perhaps I may quickly pick up on a number of points. We in Leicester consistently pointed out to our local authorities and to the mayor and his councillors that they should look at areas where we believed there would be peaks in outbreaks of the virus, particularly in factories. We were totally ignored. We have raised the communications issue over and again, and we have been totally ignored. Now that the data is coming in and is being shared properly, will my noble friend confirm that there will be strong and swift enforcement in areas where we know that breaches have gone on, are going on and continue to go on, so that other parts of the community stay well protected?

[Lord Bethell]

My noble friend points to the crux of the matter, which is that the correct response to such a local outbreak requires careful collaboration between PHE, with its expertise, insight and data, and local leaders, who have local insight, regulatory muscle and influence. Her account of talking to the mayor and raising these issues is very important and interesting. All I can say is that we are now focused on making sure that PHE and the local authorities in Leicester work together very closely. We have learned lessons in this area. Certainly, outbreaks in some other towns and cities have been handled with a higher degree of collaboration at an early stage.

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

My Lords, I declare my interests as outlined in the register. The Statement makes no mention of day centres, many of which are lifelines for carers who have had little or no respite during the UK-wide lockdown. They support people with long-term conditions, including learning disabilities, dementia and severe, enduring mental illness. In the event of local restrictions associated with Covid-19 hotspots, how will such centres be affected? With the increasing stigma associated with working in areas with high Covid-19 rates, many agency staff are refusing to work in certain care homes. Can the Minister explain what safeguards around care and treatments, including access to higher levels of healthcare and specialist services, are being planned to ensure that care home residents will not be adversely affected by further restrictions associated with high localised infection rates?

[Lord Bethell]

It is my understanding that many day centres will be reopened, although they will have to undergo a very careful risk assessment and, depending on the physical layout, may not be able to open at full capacity. However, I am happy to check that point and reply to the noble Baroness in detail. The issue of agency staff is a big problem, particularly where the staff are itinerant, but I remind her that we are embarked on a massive recruitment programme for the social care sector, including a large recruitment marketing campaign. That is bearing fruit and we are filling spaces very quickly.

[Lord Turnberg (Lab) [V]]

My Lords, when will the Government begin to make the test available to the whole population and not just to those with symptoms, so that we can discover the 80% of asymptomatic carriers? If there is a lack of capacity, why not use private and university labs around the country, as is the case at the Francis Crick Institute in London?

[Lord Bethell]

My Lords, there is very wide access to tests. Anyone who wants a test can apply for one today and, in almost any location in the country, will get one this afternoon. Whole-population testing is not the Government’s strategy, because testing at this level of prevalence would throw up more danger of wrong results than positive results. In terms of private and university labs, I absolutely pay tribute to the Crick, the University of Birmingham, the University of Cambridge and all other university and private labs that have contributed to the test and trace programme.

[Baroness Pinnock (LD) [V]]

I am a councillor in Cleckheaton, where there was a significant outbreak in a meat-processing factory, with 165 positive cases identified. The Secretary of State has, rightly, praised the local response. However, the national testing response has been described as “shambolic”, and it hindered an effective local response. What has been learned from the incident? Apart from belatedly sorting data-sharing, how will government actions change as a result?

[Lord Bethell]

The noble Baroness talks of an incident that I do not know the details of, but I do not deny that we are on a learning curve. We will publish new guidelines tomorrow on our local outbreak response; we are publishing guidelines on the opening of venues for 4 July; and we are working extremely hard to stitch together much better relations between the centre, where a lot of the data inevitably ends up in a big system, and the insight of local actors in local PHE, local infection, NHS and local authority bodies. This has been happening for many weeks and we have already made huge progress, but there is still more to do.

[Lord Ribeiro (Con) [V]]

My Lords, the noble Lord, Lord Hussain, referred to the risks for the BAME population. The PHE report found that those of Bangladeshi ethnicity were at twice the risk of death compared with people of white British ethnicity. That, of course, is particularly relevant in relation to Leicester. The PHE follow-up report, Beyond the Data: Understanding the Impact of COVID-19 on BAME Groups, which came out last month, identified long-standing inequalities exacerbated by Covid-19. Occupation, population density, the use of public transport, housing conditions and the risk to key workers are all factors in acquiring Covid-19. What actions will the Government take to address the seven recommendations in the report?

[Lord Bethell]

My Lords, we take the PHE report extremely seriously but there is still work to do in understanding how the disease affects different groups, including ethnicities. Some effects are behavioural, such as obesity; some are social, such as population density, to which my noble friend alluded; and some might be genetic. It is not clear which of those three is the main driver and what the balance is between the three. We are investing a large amount in medical and clinical research to understand that dilemma. In the meantime, we are prioritising the safeguarding of BAME workers in the NHS who might be at risk and in need of specific treatment.

[Baroness Falkner of Margravine (Non-Afl) [V]]

My Lords, what specific plans do the Government have to host people in Leicester who test positive for Covid-19 in hotels to isolate them from multigenerational households and to keep the other members of the family safe?

[Lord Bethell]

The noble Baroness asks a sensible question. It is, however, an unfortunate truth that, by the time someone tests positive, it is likely that they may have infected other members of their household. So, our current guidelines are that anyone who tests positive should isolate themselves with all other members of their household for 14 days, thereby containing the virus and breaking the chain of transmission.

[Baroness Hollins (CB) [V]]

My Lords, are services that care for people with learning disabilities—a group with an even higher death rate than the over-65s—being provided with home testing kits? I hear of services that are having difficulty getting access to them. Secondly, what proportion of people completing a home test fail to register their test online and therefore do not receive their test result?

[Lord Bethell]

My Lords, home testing by those with learning difficulties should be a straightforward matter. Anyone seeking a home testing kit can apply for one online; we have a large supply and there is no capacity issue. The registration of home testing kits is improving all the time; we are working through a checklist of things to get that rate higher. At-home testing is a hugely valuable resource for specifically the reason that the noble Baroness alluded to, and to get the geographical spread we need if we are to make testing available to everyone in the country.

[Lord Dubs (Lab) [V]]

We have frequently been told that the key figure to look at is the R figure. Will the Minister confirm that whereas after lockdown the national R figure was 0.84, it is now 0.94—so we are on a bit of a knife edge? Secondly, can he explain why the R figure is not released locally at the same time as the national figure is released?

[Lord Bethell]

The noble Lord is right that the R figure is important, but in many ways, at this stage of the epidemic, the prevalence figure—the total number of people who carry the disease—is more meaningful. A higher R on a smaller prevalence is less worrying than a smaller R on a higher prevalence. As to having regional Rs, the data to date has not been strong enough for that to be a reliable figure. However, we are working towards that situation and I can envisage a moment when it would happen.

[Baroness Sheehan (LD) [V]]

Can the Minister say categorically that there will be enough properly equipped staff and support staff across all departments in local hospitals in Leicester to cope with the upcoming spike in admissions? What are the plans if local hospital capacity is breached? Will the Minister categorically assure the House that there will be no transfers from hospitals into care homes as a consequence of the projected spike in admissions?

[Lord Bethell]

I pay tribute to the NHS in the Leicester area, which has done magnificently. I understand that the facilities there are extremely resilient. In Leicester, as in many other places, a major source of concern is the spread of the disease among younger, working-age people, particularly those in their 20s and 30s, many of whom are not showing symptoms—are not touched negatively by the disease and may be socialising—but become infectious to their parents and grandparents. That is the cycle that we have seen in places such as Texas where, after the Easter break, young people led to a large outbreak of the disease. At this stage, hospitals are not facing the pressure, but we are leaning into the disease to prevent the cycle from heading that way.

[Lord Polak (Con)]

Sadly, social media is rife with speculation about local lockdowns. People are naturally anxious and often pass on the speculation, which can make matters worse. Can my noble friend the Minister tell the House what he is doing to combat fake news and false data, so that the Government’s messaging can be heard loud and clear?

[Lord Bethell]

My Lords, we have an energetic fake news and rebuttal team at the Department for Health—which I regard as an enormous shame. It is a waste of our time and indicates how dangerous speculation and false information of this nature can be. I have noticed in today’s social media a large amount of extremely irresponsible recycling of fake news by those who, frankly, should have known better. I urge all influencers, whether from the worlds of media, politics, health or other parts of society, to think carefully before recycling fake news and speculation on outbreaks in a way that wastes the time of public health officials and creates anxiety among the public.

[Viscount Waverley (CB) [V]]

My Lords, moving beyond the unfortunate Leicester situation, is it the case that Covid is mutating at such speed that it will diminish the effectiveness of a vaccine, and does it therefore follow that emphasis would best be placed on a cure?

[Lord Bethell]

The noble Lord stretches my scientific expertise to the limit, but my understanding from the CMO is that a distinctive feature of this virus is its surprising lack of mutation. It has proved to be an extremely sturdy and consistent virus. While many viruses get less deadly but more infectious, this one has remained pretty much the same. Cures for coronaviruses, particularly those that hit the lungs, are extremely rare and difficult to track down. I am advised that a vaccine is the quickest and most effective route, and I am extremely pleased that, in Imperial and Oxford, Britain has two of the leading vaccine candidates.

[Lord Campbell-Savours (Lab) [V]]

My Lords, last week I raised the issue of the report by the German IZA Institute of Labor Economics entitled Face Masks Considerably Reduce COVID-19 Cases in Germany: A Synthetic Control Method Approach. I had asked that the Minister arrange a fully considered response to me in a letter on the report’s findings. On that occasion, the Minister, who is always courteous, failed, probably inadvertently, to give me that assurance. Can I now have that assurance please?

[Lord Bethell]

My Lords, I remember the incident well and I intended no discourtesy whatever. I reassure the noble Lord that I left the Chamber and instructed my officials to draft that letter; on leaving today, I will chase it down and ensure that it goes to him speedily.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, local lockdown plans in Leicester and elsewhere are vital to ensure that a proper place-based response takes full account of existing health inequalities. At an all-party group meeting yesterday, Sir Michael Marmot explained that Covid-19 has exposed existing inequalities in society and amplified them, with Covid-19 mortality rates closely linked to health inequalities and deprivation more widely. Does the Minister agree that, before the Summer Recess, your Lordships’ House must have a full debate on tackling inequality before a second wave hits us, with a sharp focus on the disproportionate impact on specific groups, particularly the BAME community?

[Lord Bethell]

My Lords, it is beyond my reach to instruct the House on its debates, but I would entirely agree with the noble Baroness that one of the saddest and most challenging aspects of Covid is that it hits society where it is weakest. It has undoubtedly hit those with health issues the hardest and has exacerbated health inequalities. It is my sincere hope that this Covid epidemic will be an inflection point, when this country embraces a strong public health agenda and addresses those health inequalities with energy.

[Lord McColl of Dulwich (Con) [V]]

Does the Minister agree that the reason why so many people in the United Kingdom and the United States have suffered from Covid-19 is that the majority of people in both countries are obese? Covid-19 and obesity is a lethal combination. We urgently need a nationwide campaign to reduce the obesity epidemic—to persuade people to put fewer calories into their mouth before the next pandemic arrives to affect even more people.

[Lord Bethell]

The noble Lord overstates his case a bit—it is 28% of Britons who are obese—but his point is very well made. We have undoubtedly been challenged as a nation because too many of us are overweight, and I say this with a degree of personal humility. As I said in my previous answer, there is a significant opportunity for this country to regard Covid as a massive warning shot and a potential inflection point where we address overeating and, as a nation, embrace the opportunity to get fit and lose some weight.

[Lord Wood of Anfield (Lab) [V]]

My Lords, on Monday the Mayor of Leicester said:

“It was only last Thursday that we finally got some of the data we need but we’re still not getting all of it.”


Is he mistaken, Minister?

[Lord Bethell]

Yes, the mayor is mistaken. He has been presented with all the data that we had. He has sat down with public health officials and been through that data, which has been re-presented to him on several occasions. I am pleased to say that he has finally come round to the lockdown measures that we have recommended.

[Lord Bradshaw (LD) [V]]

My Lords, currently we are dealing with coronavirus problems, but another problem is approaching us: we are telling people not to use public transport but, at the same time, we are filling our cities with cars, pollution and congestion. Can I be assured that all the health issues are taken into account in deciding how many people can travel on buses?

[Lord Bethell]

The noble Lord raises a significant challenge that has emerged from Covid: our profound reliance on public transport to keep our major cities and, candidly, much of our economy going. The idea that we can quickly return to packed tubes and crowded buses feels unlikely at this stage, but the answer is a difficult one to imagine, not least our need to get nurses and doctors to the front line of their hospitals and care provision. The health agenda on this is extremely important, and the noble Lord can rely on the Department of Health and Social Care to pursue it with energy.

[Lord Singh of Wimbledon (CB) [V]]

My Lords, it is important for children, particularly vulnerable children and those of key workers, to get back to school as soon as possible. Will the Government consider a shift system, whereby the day is divided into shorter hours with smaller class sizes to ensure maximum safety and maximum education?

[Lord Bethell]

The noble Lord is entirely right. I have four children, all of whom have returned to school this week, and they are all attending smaller classes for smaller amounts of time on different days of the week. As a parenting challenge this is considerable, but it has meant that they have returned to both the social and disciplinary aspects of school. I embrace this development and entirely agree with the noble Lord’s prioritising of this important subject.

[Lord Lansley (Con) [V]]

My Lords, will my noble friend the Minister commit the Government to maintaining their financial support for the Covid-19 volunteer testing network? He will know the important work that it is doing.

[Lord Bethell]

My noble friend is right to raise this important subject. I know the volunteer testing network; I value it enormously and am extremely grateful for its support. I am currently looking into its funding, and I would be glad to write to my noble friend to provide a clearer answer on that.

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

The Minister graphically described Leicester as a rock pool while the tide of the pandemic goes out, but tides have a strange habit of coming back in again. The Government have decreed that all the pubs in England will open on a Saturday—4 July. As my noble friend Lady Thornton said, that has been described as another New Year’s Eve, and of course it is followed by a Sunday. What plans do the Government, and particularly the Department of Health, have to respond to any problems that may arise after this rather early New Year’s Eve?

[Lord Bethell]

The noble Lord is right to be concerned. I think we are all concerned about the unlockdown because we want to return to opening the economy and society, but we are naturally anxious about the consequences. I have met the leaders of pubs, clubs and others in the hospitality industry, and I am working extremely closely with them to put in systems with which we can record those who attend those venues to support our tracing efforts—and to provide a subliminal message to all those who attend that they are at a place of risk and have to behave with some common sense. I am extremely hopeful that the experiment will be a success, but we should not be under any illusion: if the tide returns and the experiment does not work out, we will have no hesitation in suspending the experiment and going back to closing the pubs if necessary.

Health Protection (Coronavirus, Restrictions) (England) (Amendment) (No. 3) Regulations 2020

Lord Bethell Excerpts

Thursday 25th June 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 1 June be approved.

Relevant document: 17th Report from the Secondary Legislation Scrutiny Committee.

Approval period expires 27 June.

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

My Lords, the amending regulations that we are discussing were made by the Secretary of State on 31 May and came into force on 1 June, and again on 12 June, with changes coming into effect between 13 June and 15 June. Following the Prime Minister’s announcement on Tuesday of this week, there will be a further set of amendments made to the regulations next week.

I begin with the issue of sequencing, which I completely acknowledge is a concern and would like to address up front. Amendments to the regulations have been rapid and frequent. This has been necessary to ensure that the Government can respond quickly to the changing threat from this horrible disease. Events have demonstrated that the regulations have been a success and critical to helping us to reduce the infection rate and protect the NHS. However, the Government recognise that the measures have come at a significant cost to many aspects of our lives. The British people have made sacrifices that few would have previously predicted in order to control the spread of the virus. It is our duty to relieve them of these sacrifices by lifting restrictions as soon as it is safe to do so.

The use of the emergency procedure, which involves the unusual step of bringing regulations into force prior to them being debated in the House, has enabled us to do just this. Through this process, we have been able to adapt social distancing measures to best reflect public health interests while beginning a welcome shift towards normality and reopening the economy.

I recognise that there may be frustrations because we have had to run several of these amendment processes in parallel. However, as I outlined to the House 10 days ago, I believe that government action and parliamentary scrutiny working in tandem, even under difficult circumstances, has demonstrated the merits of our constitution. Nevertheless, I wish to reiterate that we do not see this as a precedent for how government engages with Parliament on other matters in more usual times. I have heard the concerns of many noble Lords, I acknowledge their worries, and I am grateful to all parliamentarians for their continued support in this matter during this peculiar period.

Coronavirus is the biggest challenge the UK has faced in decades. That is why the Government needed to introduce these extraordinary regulations to put in place social distancing measures that would slow the spread of the virus and protect our NHS in order to save lives. I am extremely grateful to the public for their continued support for these onerous measures—a commitment which has been instrumental in making these regulations a success.

I am proud of the strength and resilience shown by this country. This strength and resilience has helped us to make great progress, culminating in the continued decline in daily death rates and the drop in our Covid alert level from 4 to 3. Now, we must look towards recovery and a return to our normal way of life as soon and as safely as possible.

On 11 May, the Prime Minister made a Statement to the House outlining the Government’s roadmap for easing restrictions as we entered phase two of the recovery strategy. This involved gradually replacing the current social distancing restrictions with smarter measures that would have the largest effect on controlling the epidemic but at the lowest health, economic and social cost. This began with the amendments on 13 May, debated in this House on 15 June, which were a small step in reducing those restrictions. The regulations were further amended on 1 June and subsequently on 12 June.

The 1 June and 12 June amendments, which we are discussing today, were crucial stepping-stones in this process. It has been necessary for the Government to respond quickly to the reduced rate of transmission and to protect individual rights, all the while ensuring that the regulations in place are proportionate and necessary. We are now looking ahead to phase three of the recovery strategy. Further amendments will be made to the regulations, which will allow us to go even further in relaxing the restrictions placed on the British people and the economy, while protecting public health.

I will now outline the changes made on 1 June, which included: first, allowing increased social contact outdoors, in either a private or public space, in groups of up to six people from different households; secondly, enabling elite athletes to train and compete in previously closed facilities; thirdly, opening some non-essential retail, while expressly providing which businesses remained closed; fourthly, ensuring that venues such as community centres can open for education and childcare services; and fifthly, ensuring that those required to self-isolate on arrival in the UK can stay in hotels. We also amended the maximum review period to 28 days. This longer review period ensures that we will be able to take fully into account the impact of any previous amendments before making further changes.

The changes made subsequently on 12 June included: first, increasing social contact for the most isolated through support bubbles; secondly, further opening of non-essential retail; thirdly, allowing individual prayer in places of worship; fourthly, and finally, opening certain outdoor attractions such as zoos and drive-in cinemas.

The Government continue to work on the process of easing restrictions as soon as it is safe to do so, in line with the ambitions set out for phase three in the roadmap. Working alongside scientists and experts, we must act swiftly to respond to current infection rates and our assessment of the five tests that the Government have set out previously. I am sure that we will support the aim to protect and restore livelihoods by keeping in place only those restrictions which are proportionate unnecessary.

I am grateful to all parliamentarians for their continued engagement in this process and their valuable scrutiny, which is entirely right and an important aspect of each set of amendments.

--- Later in debate ---

[Lord Bethell]

My Lords, I would like to say an enormous thanks for a valuable and important debate. Over the coming weeks and months, we will continue to ease the restrictions put on individuals, society and businesses by these regulations as it becomes safe to do so. The amendments debated today play an important role in that gradual return to normal life, as outlined in the Prime Minister’s Statement on Tuesday. I remind noble Lords that the Leader of the House was here earlier holding a debate on that Statement, as she has done when there have been other announcement of a similar nature. I acknowledge the value of giving people warning of these changes, as referenced by the noble Lord, Lord Hunt, and I acknowledge the frustration of the noble Lord, Lord Purvis, and the noble Baroness, Lady Thornton, about the sequencing of these amendments, which I think I addressed in my earlier comments.

I am pleased that, as of 4 July, we will relax additional restrictions in a safe way. This is an exciting step towards a more normal way of life. Nevertheless, this return to normal life requires constant and careful surveillance of the latest epidemiological evidence, making changes only when the facts suggest it is safe to do so. We understand the burden these restrictions have placed on not only individuals but society as a whole, so the Government will maintain only the restrictions that are necessary and proportionate.

To reassure my noble friend Lady Wheatcroft, and in reply to the thought-provoking challenge made by my noble friend Lord Robathan, I say that, whatever the argument of those who are sceptical of the evidence-based approach to science-led policy-making, the Government are determined to be led by the science. We will sometimes be in conflict with public attitude and the headline writers, but that will remain our commitment. On that point, I cannot hide from the House that we remain ready to reimpose stricter measures if it becomes necessary. As the Prime Minister outlined in his Statement on Tuesday, we will not hesitate to apply the brakes if a national-level response is required.

The debate has provided an opportunity for Peers to raise points relating to the whole spectrum of our activity. I remind the noble Baroness, Lady Jones, that on 23 March the French Government declared a widespread state of emergency that granted the executive branch enormous powers. This has not been our approach. I assure her that trial by jury remains a cardinal tenet of the British constitution.

I will take a moment to address some of the issues highlighted by noble Lords. I start by paying tribute to the noble Lord, Lord Campbell-Savours, for his remarkable and determined perseverance on masks and distancing. In part due to the kind of pressure that he has characterised, our advice will change from 4 July to one metre-plus, which is one metre’s distance plus mitigations when people cannot stay two metres apart. These mitigations will depend on the workplace or setting. For example, people must wear a face covering on public transport since it is not always possible to stay two metres apart. Put another way, this is one metre plus a face covering. In other spaces, mitigations could include installing screens, making people face away from each other, putting in handwashing facilities, minimising the amount of time people are together and so on. Having mitigations in place at one metre can be broadly equivalent in reducing transmission to staying two metres apart. We have set out Covid-secure guidance to help businesses take the measures that are right for them.

On face coverings, in reference to my noble friend Lord Blencathra, the noble Baroness, Lady Meacher, and the noble Lord, Lord Campbell-Savours, who I mentioned, I say that passengers have been told they will be required to have face masks when travelling from 15 June. There are some exemptions for health, age or equality reasons. Transport usage has been slowly increasing as restrictions are lifted. Social distancing remains the most important way to keep safe, but on public transport it is not always possible to follow this guidance.

[Baroness Thornton]

Will the Minister give way? I know that it is a strange thing to ask these days. I am using public transport all the time to get to and from your Lordships’ House. I can report that particularly men and young men are not wearing their masks.

[Lord Bethell]

The noble Baroness is entirely right. It is incredibly tough to persuade people to wear their masks. There is a huge cultural gap. That reason and the insights of our behavioural scientists have led us to move relatively slowly, despite the articulate and passionate exhortations we have had on this subject. We are looking at ways to encourage mask wearing, but it is a struggle and not one that we think that we can necessarily rely on.

On non-essential retail, in response to my noble friend Lady Anelay, I say that I have recently met the Association of Medical Research Charities and I acknowledge the pressures faced by good causes supported by charity shops. The Prime Minister announced a timeline for the reopening of non-essential retail businesses on 25 May. I hope very much that that can bring some relief to that important sector.

We completely understand the impact of the lockdown on the hospitality industry and, as the noble Lord, Lord Scriven, alluded to, garden parties. That is why I am pleased that, following the Prime Minister’s announcement, significant parts of the hospitality and tourism industry will reopen from 4 July. However, to make sure that this is done in as safe a way as possible, all hospitality indoors will be limited to table service. Our guidance will encourage minimal staff and customer contact.

The regulations made on 12 June permitted the use of places of worship for individual prayer. Following the Prime Minister’s announcement on Tuesday, this will be relaxed further and places of worship will be permitted to be open more generally. In response to the noble Baroness, Lady Jolly, I say that this will be a welcome change for those who have been unable to use places of worship for their usual religious practice, and I thank those who have made sacrifices.

In response to my noble friend Lord Naseby, I say that here is no avoiding the fact that singing spreads an aerosol of virus-laden moisture into the air. On cricket, in the words of the Prime Minister, it is plain to everyone that the cricket ball is an infectious vector of disease spreading. I assure the noble Lord, Lord Clark, that we will not hesitate, in the face of a local spike, to bring back whatever lockdown measures are required to save lives and protect the NHS.

The noble Baroness, Lady Ritchie, asked about progress on vaccine development. I am delighted that the UK is taking a leading role in this work. Our best chance of defeating the virus is by working together globally. We have put £84 million into accelerating the work of Oxford University and Imperial College. I pay testament to the work of the scientists there. The noble Baroness also asked about social care; we have set out a comprehensive action plan to support the adult social care sector in England throughout the coronavirus outbreak, including ramping up testing, overhauling the way PPE is delivered to care homes and helping minimise the spread of the virus to keep people safe.

In response to the noble Baronesses, Lady Thornton and Lady Brinton, we cannot avoid the costs of PPE. The global price of PPE has risen dramatically. These costs will have to be borne somehow, somewhere. We are working with Treasury and DH colleagues to figure out ways in which they can be borne.

In response to the noble Baroness, Lady Brinton, on shielding, from 6 July those shielding can spend time outdoors in a group of up to six people, including those outside their household. This can be in a public outdoor space or a private garden. Also from 6 July, those shielding will be able to create a support bubble.

I have answers to questions from a number of noble Lords, including on the devolved Administrations, parliamentary scrutiny and local powers. I will not be able to get through all of them in the time remaining. I thank noble Lords for all their contributions and valuable points during this debate. I reassure the noble Lords, Lord Rennard and Lord Liddle, that a lessons learned process will be undertaken when the time is right, but we are not through this yet.

These regulations have been hugely successful in tackling the spread of the virus. While recognising some local limitations, as mentioned by the noble Lord, Lord Goddard, we are enormously grateful to the public for their sacrifices and to the NHS and social care workers for their hard work on the front line.

[Lord Purvis of Tweed]

Before the Minister sits down, the noble Baroness, Lady Thornton, made a very good intervention—

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

Lord Bethell Excerpts

Thursday 25th June 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 12 June be approved.

Motion agreed.

Personal Protective Equipment

Lord Bethell Excerpts

Wednesday 24th June 2020 Lords Chamber

[Baroness Watkins of Tavistock]

To ask Her Majesty’s Government what contingencies they have put in place to ensure adequate stocks of personal protective equipment for (1) a potential second wave of Covid-19, and (2) sustainable long-term infection control management in the United Kingdom.

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

My Lords, thanks to the efforts of my noble friend Lord Deighton and to brilliant British manufacturers such as Polystar, we have now massively expanded our national effort to buy PPE from around the world, to produce more PPE in the UK and to deliver PPE to the front line, where it is needed most. Despite the global challenge around PPE, we are now confident that we can meet the needs of health and social care over both the next seven and 90 days.

[Baroness Watkins of Tavistock (CB)]

I thank the Minister for his reply. Could he be more specific? Based on the analysis of the maximum use of PPE in the NHS and social care community recently, how many days’ worth of PPE supplies do Her Majesty’s Government plan to hold permanently as a contingency for a potential second wave in the long term? Is it the Government’s intention to work with the devolved Administrations to adopt a four-country approach to supply and distribution according to need?

[Lord Bethell [V]]

My Lords, we have contacted over 175 new suppliers and recently secured a further 3.7 billion gloves alone to meet demand. This approach will massively increase our stockpiling as we prepare the resources that we need for the winter ahead. We would like to have line of sight for 90 days’ worth of PPE supply, and that is what we are working against at the moment.

[Lord Browne of Ladyton (Lab) [V]]

My Lords, in the last 10 years we have had three pandemic strategies, two national security assessments, a national biosecurity strategy and Operation Cygnus, and all have mandated the stockpiling of PPE, with advance purchase arrangements for what could not be stockpiled. The current NAO audit will reveal inadequate implementation of PPE plans, including logistics that needed to be rescued by the Army. Does the Minister appreciate that no one will trust or believe the Government about PPE unless stockpiles and logistics are openly reviewed, publicly reported on and independently audited? Will the Government put that in place now?

[Lord Bethell [V]]

The noble Lord is entirely right that public confidence is important here. I emphasise that huge progress has been made. We have signed contracts for over 2 billion items of PPE with over 20 UK-based manufacturers alone. The progress made on face masks, visors, gowns, aprons and so forth is enormous, and the accounting for that will continue through the usual channels of government procurement publication.

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

My Lords, to what extent are the Government engaged in the procurement of PPE in a collective effort with the devolved institutions, and what discussions are taking place to ensure that every region is well equipped with adequate PPE and will have long-term infection control in place over the next 90 days and beyond?

[Lord Bethell [V]]

My Lords, we have had regular engagement with the devolved Administrations and have discussed how we manage cross-border services. The balancing of stockpiles of PPE around the nation is something that we are very much focused on. We have moved from the supply of PPE to a few NHS trusts to nearly 55,000 individual users of PPE. This is a massive undertaking that has hugely expanded the scope of our PPE supply.

[Baroness Blackwood of North Oxford (Con) [V]]

My Lords, I was pleased to hear the Minister’s ambitions for a 90-day stockpile. NHS Providers has now stated that most trusts are receiving the right PPE when they need it, but it highlights the need to move from a crisis day-to-day supply to secure access to 14 days’ worth of all PPE. Obviously this is important for planning, restarting elective care safely and especially for patients being asked to isolate for surgery. When will a 14-day supply of PPE at trust level be achieved?

[Lord Bethell [V]]

My noble friend is entirely right that having adequate stocks on hand is important, but having line of sight is also important. Individual trusts are able to make their own decisions on whether they wish to have stockpiles on the premises or a flow of supplies from their suppliers. At present we are working on supporting the trusts in their decisions on this matter.

[Baroness Brinton (LD) [V]]

At yesterday’s Home Affairs Select Committee, Dr Jane Townson of the United Kingdom Homecare Association said that domiciliary and personal care workers are still struggling to get access to testing and PPE because the system is not designed for care at home, which means that infection control is almost impossible. Will the Minister undertake as a matter of urgency to review home care workers’ access to testing and PPE to protect them and their clients?

[Lord Bethell [V]]

The noble Baroness is entirely right to emphasise the importance of getting home care workers adequate supplies. The expectation is that the majority of social care providers, including home care providers, would continue to access PPE via their normal wholesale suppliers, but we are rapidly overhauling the way in which PPE is delivered to care homes and domestic care supplies, including through emergency dispatches via the pilot e-portal and the national supply disruption response.

[Lord Dobbs (Con)]

My Lords, it is not simply stockpiling but the ability to supply PPE as and when needed that is so important. Will my noble friend join me in welcoming and congratulating the private sector—firms up and down the country, big and small—which provided such tremendous support in meeting our recent PPE demands, demands not always recognised by Public Health England at the time? Can he assure us that we have learned the lessons and that we can rely on the experience, initiative and abilities of the private sector? Is he able to tell us that in future he expects, if he cannot guarantee, that all future PPE demands will be available from firms in Britain, rather than relying on sources from other, perhaps less reliable, countries?

[Lord Bethell [V]]

My noble friend Lord Dobbs is entirely right: British companies have done an amazing job of stepping up to this challenge. I pay testament to Survitec, Bollé, Jaguar Land Rover, Don & Low and Burberry, which have all made huge contributions, and to the 350 firms we are currently negotiating with to create a new domestic supply. Nearly 2 billion items of PPE have been supplied through UK-based manufacturers. The moment when we are exclusively and entirely dependent on UK supply is some way off, but this provides a critical cushion and helps to build resilience for these important products.

[Baroness Coussins (CB) [V]]

My Lords, the Minister will not be surprised that I want to ask once again about interpreters in the NHS. I appreciate that because of Covid-19 many hospitals are using interpreters by telephone, but there must still be many cases where the physical presence of an interpreter is needed, Covid-related or otherwise. No answer has yet been given to my Written Question of 12 May about who is responsible for providing PPE for interpreters. I would also like to be reassured by the Minister, who I know appreciates the importance of interpreters, that they will not be forgotten when it comes to stockpiling PPE to cope with a possible second wave, when interpreters are likely to be needed more often if the disproportionate level of infection among certain minority groups continues.

[Lord Bethell [V]]

The noble Baroness is entirely right to emphasise the disproportionate balance of infection among BAME people and the importance of interpreters in ensuring that they get the treatment they deserve. However, we are emphasising the use of telephone services because we want to keep people out of areas of potential infection. That remains part of the service that we deliver, and telephone arrangements are proving extremely effective. However, I take on board her point about providing PPE for those interpreters who are on site, and I will continue to press those in the department who oversee this important area of activity.

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

My Lords, the time allowed for this Question has elapsed and we come now to the third Oral Question, from the noble Lord, Lord Wallace of Saltaire.

Covid-19: Test and Trace App

Lord Bethell Excerpts

Monday 22nd June 2020 Lords Chamber

[Lord Clement-Jones]

To ask Her Majesty’s Government, in the light of the announcement made on 18 June regarding the switch in technology for the NHSX Covid-19 Test and Trace app, what is their assessment of (1) the operational impact, (2) the financial impact, and what lessons have been learned.

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

My Lords, we remain optimistic that high-tech can help our fight against this horrible disease, but we have learned that consumers want a personal touch rather than a text exchange, that tools that assist outbreak management are our immediate priority and that the challenges of proximity detection have confounded many Governments around the world. That is why we are working with the best companies to build the best app that meets the needs of the British people.

[Lord Clement-Jones (LD) [V]]

My Lords, I hope that the Minister understands the anger at the Government’s and NHSX’s sheer incompetence and lack of humility in what was rightly called a fiasco by the Daily Mail last Friday, and that their go-it-alone approach and attempt to shift the blame on to tech companies simply will not wash. Is it not time that the Government just accepted that we cannot develop our own app and went straight to adopt the available interface, or API, behind the off-the-shelf, decentralised app now in widespread use? Such apps have been introduced in Germany, Italy, Switzerland and Denmark, where they appear to be working well, and are close to release in Holland, Ireland, Latvia and Estonia. They would help travellers avoid quarantine this summer, and many of us were urging this on the Government back in April?

[Lord Bethell]

I want to say a profound thanks to those at NHSX, NHS Digital and others who have worked so hard on the NHS app. They have made phenomenal progress and their hard work is hugely appreciated. I also want to say a profound thanks to those at Apple who are working with us to design an app that suits the British public. Both teams have faced enormous challenges and I look forward to their working together to overcome them.

[Lord Browne of Ladyton (Lab) [V]]

My Lords, getting back to the fundamentals, why did NHSX decide to make a new contact tracing app and not collaborate with other countries which had successfully produced such apps? What is the specific business case or use case if the app continues to require a different design from those implemented already?

[Lord Bethell]

My Lords, from the beginning we have worked closely with other countries, including in Asia, Europe and America. We have worked closely with companies including Apple and started our dialogue with it the moment it launched its app. There are a number of challenges. A most profound one is our need to use technology to tackle local outbreaks. Without local information on where new cases have originated, it is difficult for the Government to achieve that task. We look forward to working with Apple to try to define a use case around that.

[Baroness Morgan of Cotes (Con) [V]]

Has this experience prompted broader reflection in government about the influence of big tech companies in so many spheres of our lives? Has it prompted a need and desire for proper regulation of those companies now to be brought to bear?

[Lord Bethell]

My Lords, it has been my experience that working with some of the biggest companies in the world in pharmaceuticals, in diagnostics and in tech has brought to the fore the paramount importance of partnership with big industry. We have benefited enormously from such partnerships and I thank some of the major companies that we have worked with. However, it is undoubtedly the case that government has its own agenda and it is important that we work to champion the needs of the British public, which is where our biggest interests lie.

[Lord Scriven (LD) [V]]

All avenues to reduce the transmission of coronavirus have to be seriously explored, so what was to be gained by NHSX and the UK Government refusing over a period of months positively to engage with those involved in the COVID Symptom Study app?

--- Later in debate ---

[Lord Bethell]

My Lords, I completely endorse the noble Lord’s point. We have followed the principle of working in parallel in all cases possible. However, I should explain that pressure is incredibly intense, and one cannot focus on everything all the time. I understand the point that he makes, but I suggest that, at some points, one has to focus on one part at a time. That is what we have sometimes needed to do, but we have remained in contact with all players at all times.

[Lord Patel (CB) [V]]

My Lords, I have one question in two parts. First, in the event of a substantial increase in the number of new infections, what plans do the Government have to manage such an increase, and will they publish them? Secondly, what plans do they have to use antibody screening of the population?

[Lord Bethell]

My Lords, our plans for the winter are in development and I look forward to their publication. The noble Lord is entirely right to prioritise antibody screening. We have invested considerably in antibody testing from a number of suppliers, including Roche and Abbott. As he knows very well, the science remains ambiguous, but we are optimistic. That is why we are putting our best minds to understand it better, and we are world-leading in that respect.

[Baroness Wheeler (Lab) [V]]

My Lords, the PNQ refers to the lessons learned. One key one—[Inaudible]—launch of a system that was not ready and serious IT—

[Lord Duncan of Springbank (Con) [V]]

My Lords, I have listened to my noble friend and feel that confidence in the Government has been shaken by this approach. I have one question: how do we anticipate this approach now being rolled out across the four nations of the United Kingdom and how will they interface, one with another?

[Lord Bethell]

My Lords, in all aspects of our battle against Covid, we have sought a four-nations approach. We hope to work together for one solution. I am aware that other nations are looking at their own options, but it is our hope that, in time, they will all come together for one solution.

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

What were the governance processes behind the decision to abandon rather than complete the last stages of development of the NHSX app and where are they published, given that the NHSX app had MHRA and security clearance and was days away from being finalised?

[Lord Bethell]

My Lords, the decision to change strategy was taken ultimately on operational grounds. The regulatory environment was not necessarily relevant for that. We cannot avoid the fact that there have been technical issues with both the Apple and the NHS apps. We are still some way from resolving those issues, but we hope to overcome them, in partnership with Apple, and the House will be updated when we do.

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

My Lords, the SAGE minutes of 1 May indicate that 80% of contacts should be isolated within 48 hours of the original case becoming ill. The SAGE meeting on 19 May included the summary point that a test, trace and isolate system would be necessary, though not sufficient on its own, to allow changes to distancing measures without pushing R above 1. Given the failure of the Government’s app, and their intention to reduce the two-metre social distancing rule, has SAGE now changed its mind?

[Lord Bethell]

My Lords, the Government have the two-metre rule under review, but no decision has been made on it. Enormous progress has been made on reducing the turnaround times of tests. A large proportion of them now take place within 24 hours and we remain focused on this important index.

[Lord Strasburger (LD) [V]]

My Lords, make no mistake: this fiasco will have fatal consequences. Which Ministers will have the decency to stop trying to dodge the blame and to apologise and resign?

[Lord Bethell]

My Lords, I do not think anyone needs to apologise for their efforts. I have already paid tribute to the teams at NHSX and NHS Digital for the incredibly hard work they have put in. I cannot disguise how complex and challenging are the issues we face in this area. Some of the best Governments in the world are wrestling with them and they have not been overcome in many territories. I am extremely proud of our achievements to date and look forward to more in the future.

[Lord Mann (Non-Afl) [V]]

What about the pensioners? Half of Germans say they are not going to use the new app and the German system is underpinned by local health boards ringing up people to trace and test. Why are we not doing the same thing at the local level?

[Lord Bethell]

The noble Lord, Lord Mann, is entirely right. One of our learnings—and a point made by many noble Lords—is that, ultimately, the most effective response is the local one. We are at a moment in the epidemic when local outbreaks are what we fear most. The way to handle those is through local contact and tracing. That is currently done by a large tracing team, putting in telephone calls which prove extremely effective. The uptake of the isolation protocol has been extremely high.

[Lord Truscott (Ind Lab) [V]]

Can the Minister tell the House how much this technical fiasco has cost taxpayers? If the Minister does not have the answer to hand, could he please put it in writing to noble Lords and place a copy in the Library?

--- Later in debate ---

[Lord Bethell]

The cost to date has been £11.8 million.

[Baroness Rawlings (Con) [V]]

My Lords, I declare my interest as a former chairman of King’s College London. Will the Government endorse KCL’s COVID Symptom Study app, now used by 3.5 million people, as soon as possible? Meanwhile, I repeat the simple interim measure of encouraging everyone to keep a daily diary of people met and places visited, to help tracing should they be infected.

[Lord Bethell]

I pay tribute to the KCL symptom tracker app. I have been a subscriber since the early days of its launch. The data it provides has been extremely useful to the Government and is used regularly. I also pay tribute to my noble friend, who has spoken before about the need for diaries. The work on diary keeping in South Korea and New Zealand has proved important.

[Baroness Wheeler [V]]

My Lords, the PNQ refers to lessons learned. A key one from the sorry story of the NHS app is that the Government should have involved local councils in the trace and contact system from the outset and used the decentralised local PHE expertise and knowledge of infection control already in place. Instead, we had a chaotic government launch of a system that was not ready, with serious IT problems experienced by many of the 25,000 new staff recruited by the NHS to carry out manual contact tracing, as well as training problems and many staff literally not having anything to do. Current figures show that they are doing just 11% of the total work while the vast majority of manual contact is being completed by trained PHE officials. Can the Minister reassure the House that the Government will make sure that councils have the necessary powers they are calling for to be able to fully respond to local outbreak hotspots, and ensure that PHE directors and local infection officials have the funding and support they need?

[Lord Bethell]

The noble Baroness is entirely right that local councils are pivotal to our response to Covid-19. I pay tribute to Tom Riordan, CEO of Leeds City Council, for the important work he is doing to stitch together the alliance of councils which is working closely with the joint biosecurity centre to organise that response. However, I do not agree with the noble Baroness on the role of the tracing teams—it has been incredibly important. There has not been the capacity in the decentralised PHE teams to provide the response necessary to this national epidemic. A central team was necessary and is proving to be effective. We have put PHE expertise at the heart of that programme.

[The Deputy Speaker]

My Lords there are no more supplementary questions.

Coronavirus

Lord Bethell Excerpts

Monday 22nd June 2020 Lords Chamber

[Baroness Thornton (Lab) [V]]

To follow on from the question asked in the previous debate by the noble Baroness, Lady Rawlings, in the last week the Secretary of State, when explaining the failure of the NHSX app, said that the Government are committed to trying and supporting any innovation that might work in this pandemic. That attitude is to be applauded, as long as it is not linked to exaggerated promises—and of course it means that some things will not work. It is therefore puzzling that the Government refuse to partner and adapt the Covid Symptom Study app, which might close the gap on the two-thirds of infections not currently being identified and fit into the existing human contact tracing effort. Some 3.5 million of us take 30 seconds a day to report our health; with government support, that could easily and quickly be 10,000,000. The founders from King’s College and ZOE have written to the Prime Minister today. In the spirit of trying everything to find a solution, will the Minister encourage a positive response to that initiative?

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

My Lords, I pay tribute again to those at KCL who developed the symptom-tracking app. The information from it has been enormously helpful over the last few months. In many ways we have benefited from the app’s independence as a source of important front-line intelligence. I am aware of the letter written to the Prime Minister, and I hope very much that we will be able to work more closely together. The information on asymptomatic references is very important. However, I stress that the ONS study suggests that, unfortunately, many people who declare the symptoms of coronavirus are mis-self-diagnosing, and we have to bear that factor in mind.

[Baroness Brinton (LD) [V]]

Following last week’s Urgent Question, the Secretary of State responded to questions about new outbreaks in local areas and local authorities not being given access to all the necessary data. He said:

“We have provided more data to them, and we will continue to do more.”—[Official Report, Commons, 17/6/20; col. 810.]


I am still hearing from local authorities that the data sent to local areas is still incomplete, which means that vital urgent local tracing teams are trying to do their job with one hand tied behind their back. This includes the outbreak at the meat-processing factory in Kirklees. When will local authorities and directors of public health get the data they need?

[Lord Bethell]

The noble Baroness, Lady Brinton, is right that the creation of a seamless network between the centre and local authorities is challenging. A huge amount of work has gone into refining the accuracy and speed of the exchange of data, and the joint biosecurity centre is investing a huge amount of effort in getting this right. The responses to Kirklees, Leicester and Cardiff show the progress that has been made, but also some of the shortcomings. We are fully aware of the challenge and difficulty of getting this right; we are very much focused on it and it is our top priority.

[Lord McColl of Dulwich (Con) [V]]

As obesity makes one more likely to suffer with Covid-19, and as more than half of people in the UK are obese, will the Government launch an all-out campaign this summer to reduce obesity by persuading people to put fewer calories into their mouth before the next pandemic arrives to kill even more people? Exercise is good for general health but will reduce weight only in grams, whereas eating puts on weight in kilos.

[Lord Bethell]

My noble friend makes a tough but serious set of points. It is undoubtedly true that this country has been hit hard by Covid because of the prevalence of obesity, and it is a truth long explained by Public Health England that there is a direct correlation between calorie intake and weight—there is no getting away from that. The Government are looking at how to address this issue, public health remains a massive priority for us and, when the time is right, we will look at ways of using marketing to communicate the message on this.

[Lord Bilimoria (CB) [V]]

My Lords, it is very good news that the trials of dexamethasone have gone successfully and that other trials are progressing well; I hope that the vaccine trials will also yield success. However, can the Minister confirm reports that more than a third of care home patients have not yet been tested? When will all care home patients and staff be tested fully and regularly? Secondly, with the good news coming from the Prime Minister—we hope—of the economy opening up from 4 July, will widespread testing be available for businesses on top of the two-metre social distancing being reduced to one metre?

[Lord Bethell]

My Lords, the progress on testing in social care is dramatic. The rollout of testing to all care homes is complete, and tests have been offered to all those who are symptomatic. The focus is very much on staff who travel between more than one home, and asymptomatic testing. As for the economy, all those who show symptoms can have a test, but we are talking to business about how businesses can also contribute to their own testing regimes, and we look forward to developing those plans.

[Lord Harris of Haringey (Lab) [V]]

My Lords, knowing who has and who has not had the virus is clearly essential in knowing who should be isolating themselves. The Minister has failed to answer my questions on what proportion of the self-testing kits are being returned, and on the estimated number of false negatives as a result of people not swabbing themselves properly or because of inherent weaknesses in the test itself. However, at the moment, NHS staff are being given antibody tests and many who have palpably had the virus and been exposed to it are showing as negative. What is the department’s working estimate of what proportion of false negatives there will be in those antibody tests?

[Lord Bethell]

My Lords, the noble Lord makes an important point. How it is that some people have palpably had the virus, as he rightly says, but do not show a positive antibody test, is a mystery that we do not fully understand. It seems that the tighter—more minimal—the amount of antibody left in the bloodstream, the less likely it is to register in the test. We are undertaking a massive antibody testing programme through the health service to understand this phenomenon more closely, and we look forward to publishing those results as a priority.

[Lord Pickles (Con) [V]]

My Lords, successfully passing a test does not predict the future. We know that 20% of people who have contracted the virus did so in hospital. So those in certain professions come into daily contact and will require periodic, regular tests. What plans do the Government have to ensure that those in the professions at greatest risk receive a regular test?

[Lord Bethell]

My noble friend Lord Pickles is entirely right to say that people in some professions are clearly at higher risk. Bus drivers, taxi drivers and hospital porters are three such professions, and I pay tribute to those who put themselves in harm’s way in order to serve the public. The Prime Minister announced, I think two weeks ago, a special programme to introduce regular, asymptomatic testing to protect people in those professions, and we are working very closely with their representatives to roll out the necessary schemes at pace.

[The Earl of Clancarty (CB) [V]]

My Lords, in view of the large number of cases that have been confirmed at a meat processing plant in Anglesey and the likely reduction in social distance, will the Government seriously consider extending the mandatory wearing of face masks for people in enclosed spaces, including workplaces, for staff and customers in shops, and certainly for staff in restaurants and pubs?

[Lord Bethell]

My Lords, the introduction of face masks is something that has been recommended by the Government, but the mandatory wearing of them is not. We are looking at the various recommendations from SAGE to inform the proposals that might come after the lifting of social distancing, but our focus remains on hygiene, social distancing and isolation. Those are the three most effective measures and we remain committed to them for the moment.

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

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

Covid-19: Track and Trace System

Lord Bethell Excerpts

Thursday 18th June 2020 Lords Chamber

[Baroness Anelay of St Johns]

To ask Her Majesty’s Government what progress they have made with the implementation of the COVID-19 track and trace system.

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

My Lords, this country has gone from 2,000 tests a day to 200,000 tests a day, with capacity to trace 10,000 indexes a day. We took 39,000 antibody tests yesterday and we are dramatically reducing turnaround times. The “test and trace” programme is a remarkable national asset that protects us from this virus through diagnosis, research and surveillance. I am very proud of the remarkable collaboration of the NHS, PHE, universities, the private sector, the military, local government and many other inspiring colleagues.

[Baroness Anelay of St Johns (Con) [V]]

What impact do the current lack of a nationwide NHS Covid-19 app and the statement by the director-general of the biosecurity centre that they do not expect to reach full operating capability until the end of the summer have on the Government’s decision about when and how to ease lockdown conditions?

[Lord Bethell [V]]

My Lords, the current low level of prevalence of the virus means that the pressure on automated tracing devices such as the app is less heavy than it would be under other circumstances. The biosecurity centre is already making a massive difference to co-ordinating our local response to the disease. We have made terrific progress so far and our management of lockdown measures will reflect that fact.

[Baroness Young of Old Scone (Lab) [V]]

Statistics on the first full week of operation show that less than 58% of the contacts of confirmed symptomatic cases are traced and say that they will self-isolate—it is difficult to know whether they do so. “Test and trace” tracks only contacts of symptomatic cases, and the ONS infection study shows that only one-third of total new infections are symptomatic. Will the Minister admit that “test and trace” is resulting in the isolation of an ineffectively small proportion of the contacts of all new cases and will not prevent a second wave of the disease?

[Lord Bethell [V]]

My Lords, last week’s figures suggest that 67% of people who tested positive for coronavirus were reached by our contact tracers. This figure is rising every week. The epidemiological logic is that a system such as “test and trace” will never be 100% ubiquitous or track everyone who carries the disease—asymptomatic infection is a part of this terrible disease. However, it can have a profound effect on its spread and break the chain of transmission. That is why we have invested in this infrastructure and why we appealed to the British people to comply with the isolation protocols.

[Baroness Jones of Moulsecoomb (GP) [V]]

When will the people of the Isle of Wight be allowed to stand down in terms of the app that they have been guinea pigs for, and to concentrate on a wider “test and trace” and their own recovery?

[Lord Bethell [V]]

My Lords, we are enormously grateful to the people of the Isle of Wight for their collaboration on the pilot. There is no question of them needing to stand down. Other measures for “test and trace” are working extremely well on the Isle of Wight, and both the pilot app and the manual “test and trace” have helped break the chain of transmission. We remain extremely grateful for their support.

[Lord Ribeiro (Con) [V]]

My Lords, six weeks ago, the contact tracing app was launched on the Isle of Wight, since when, the emphasis has shifted from the app to the use of 25,000 call centre workers to identify the contacts of people testing positive for Covid-19. What lessons have we learned from countries such as Australia, Singapore, Italy and Switzerland, which all launched contact tracing apps, and is the purpose of the “test and trace” app to help end this pandemic or to protect us from the next?

--- Later in debate ---

[Lord Bethell [V]]

My Lords, we are in regular contact with many of the countries that are working with apps. Two things are crystal clear. The opportunity of using automated technologies to create extra tracing contacts is enormous, and we are working extremely hard to chase down that opportunity, but the technical challenges are also enormous. We are working very closely with our tech partners and with other countries to develop the best possible app, particularly for a moment when the prevalence in society might increase, for that is when the mass automation delivers its unique advantage.

[Baroness Walmsley (LD) [V]]

My Lords, can I press the Minister on his answer to the noble Baroness, Lady Young? In the first week of “test and trace”, over 8,000 cases were referred, but the ONS said that there were 33,000 cases. If only a quarter of cases are being referred, how does the Minister think that we will ever stamp out this virus? When will we get more widespread asymptomatic testing and tracing?

[Lord Bethell [V]]

My Lords, the epidemiological maths is as the noble Baroness describes, but our focus on symptomatic cases does not mean that the system does not work. Taking out more than a quarter of infected cases is a massively important and impactful event. Asymptomatic testing has started in healthcare and social care workers. It is making a big difference in both those forums, where prevalence is higher than the community prevalence, and we will be learning lessons from those schemes.

[Baroness Blackwood of North Oxford (Con) [V]]

My Lords, a key priority of “track and trace” is to monitor the emergence of localised hotspots and intervene before wider community transmission can occur. Local authorities and public health officials have expressed concerns that they do not have the powers to deliver swift local interventions and that a top-down approach might be too slow. Can the Minister say what process is in place to prevent community transmission when “track and trace” finds evidence of such localised hotspots?

[Lord Bethell [V]]

My noble friend is entirely right that local action is central to an effective response to Covid-19. We are working extremely hard through the JCVI to take the intelligence from our testing programme to identify hotspots when they occur and to move resources to those areas to support local directors of public health and local infection officials with the resources they need, whether in terms of testing or surge control of the disease.

[Baroness Coussins (CB) [V]]

My Lords, the Government have translated Covid-19 advice and information into a number of languages, but can the Minister assure me that proper mechanisms and a budget have also been built into the “track and trace” system for the use of interpreters where needed—by that I mean professionally qualified human beings, not a down-the-line Google Translate service—so that no one from any minority group experiences delayed or inadequate instructions about contacts or isolation, which could be damaging at best and fatal at worst?

--- Later in debate ---

[Lord Bethell [V]]

I pay tribute to the perseverance of the noble Baroness on the issue of interpreters. She is entirely right that marginal communities are incredibly important in this process and can be like rockpools when the tide recedes—left as areas of infection if we do not focus on them effectively. That is why we are working extremely hard to identify those communities that might be left behind and to use resources such as interpreters to ensure that the message gets through.

[Baroness Wheeler (Lab) [V]]

My Lords, the ambition of the Minister, reported yesterday, to get a national “track and trace” system going before the winter is in marked contrast to the hype and promises of the test trial launched in May, when Matt Hancock promised that where the Isle of Wight leads, Britain follows—though obviously now not until Christmas. Does the Minister acknowledge that the failure to have an effective system up and running this summer will have a huge impact across vital services, including residential and nursing care homes? Do the Government expect care homes not to open for regular and routine visits from family, friends and others until the end of the year?

[Lord Bethell [V]]

I do not agree with that analysis. I am afraid that areas such as care homes are where the app is least effective, because the residents are static and therefore the app is not really the facility for identifying infections. This is where the manual “test and trace” process is the most effective. That is why we are super-focused on getting it right. We are working very closely with the social care community to ensure that the “test and trace” systems are working well. We are flooding social care with tests and ensuring that our tracing agents are well trained to handle local outbreaks in care homes and to deal with care home staff.

[The Lord Speaker (Lord Fowler)]

My Lords, I regret that the time allowed for this Question has elapsed, so we come to the second Oral Question. I call Lord Clark of Windermere.

Nurses: Recruitment

Lord Bethell Excerpts

Thursday 18th June 2020 Lords Chamber

[Lord Clark of Windermere]

To ask Her Majesty’s Government what plans they have to facilitate the recruitment of nurses onto degree courses beginning in September 2020.

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

My Lords, the health and education sectors are working jointly to increase applications and places. The Government announced 5,000 more healthcare places from September. In England, nursing students can access more funding worth at least £5,000 per academic year. During July in clearing, there will be marketing campaigns aimed at students considering nursing.

[Lord Clark of Windermere (Lab) [V]]

My Lords, one reason why we were so ill prepared for Covid-19 was that the NHS was short of over 40,000 nurses. Will the Government ensure that the number of nursing places available at universities this coming September will significantly begin to reduce that dire shortage of nurses?

[Lord Bethell [V]]

I reassure the noble Lord, Lord Clark, that from September 2020 eligible pre-registration students in English universities studying nursing, midwifery or one of the many allied health professional courses will benefit from additional funding of £5,000 per academic year. The correct number of places will be made available to hit our objective of 50,000 more nurses by 2025.

[Baroness Verma (Con)]

Can my noble friend say what the take-up is of nursing apprenticeships, and will his department consider a combined apprenticeship that includes social care workers to ensure a route to career progression?

[Lord Bethell [V]]

My noble friend makes an incredibly interesting suggestion on a combined course. I am prepared to look into that and write to her about whether work has been done on such a measure.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interests as outlined in the register. Not only do we need to recruit new students this year, but we must retain those entering their second and third years of study and ensure that those in their final year, who are currently helping the NHS in a working capacity, complete their training. It is vital that we introduce universal cost of living maintenance grants that reflect students’ needs. I understand that the Prime Minister said that he will look into that further following a meeting of the Education Select Committee. Will the Minister confirm that in addition to the £5,000 maintenance grants there will be an additional £1,000 for mental health and learning disability nurses this year? Is he willing to meet me and other interested Peers to look at the long-term support for nursing students?

[Lord Bethell [V]]

The noble Baroness is entirely right about retention: we are battling the leakage of skills and experience from the NHS. In September 2019, the Government announced a £210 million boost for front-line NHS staff, which includes, as she referred to, funding for a £1,000 personal development budget for every nurse, midwife and allied health professional working in the NHS. I would be glad to meet her and her colleagues to discuss what more can be done.

[Baroness Pitkeathley (Lab) [V]]

Among the extra 4 million people who have become carers during the pandemic, 72,000 left the NHS to take on caring responsibilities. Many will eventually want to return to work or training. How will the Government support those who will need to combine caring with employment or training? Are there plans to enable career progression, as the noble Baroness, Lady Verma, suggested, so that skills learned in caring can be translated into professional qualifications?

[Lord Bethell [V]]

My Lords, the Covid epidemic has thrown a spotlight on the essential role of carers, who have clearly played an enormous role in looking after those who are vulnerable. I completely support the sentiments of the noble Baroness that we should do more to help carers in their professional development so that they can convert to different secondary careers. I would be happy to look at any suggestions she has for ways in which we can do that better.

[Baroness Jolly (LD) [V]]

Not for a long time have nurses had such a high national profile. The career options are many and now many more men are nurses too. Will the Minister explain to the House what careers material is available to schools, what opportunities there are for potential nurses to see what the role entails, and what efforts are being made to encourage young men?

[Lord Bethell [V]]

My Lords, we have backed an enormous marketing campaign called “We are the NHS”, which throws a huge spotlight on the role of nurses of all genders, backgrounds and professional focus. That campaign includes a strong schools element. It seeks to attract a broad range of backgrounds of people who might think of applying to the nursing profession.

[The Lord Bishop of Winchester [V]]

My Lords, support for key public service staff and maintaining quality training for those professions will be strategic in the successful rebuilding of our post-Covid society. In the Royal College of Nursing 2019 employment survey, 37% of qualified nurses said that they were seeking a new job outside the profession. Does the Minister agree that the retention of qualified nurses, midwifery and allied health professional staff is just as important as the recruitment of trainees? Will he therefore say more about how the Government will review the support packages available to both students and new post-qualification nurses and allied health professionals, in order that more of those newly qualified are encouraged to remain in the profession?

[Lord Bethell [V]]

I entirely support the observations of the right reverend Prelate. I have already said that retention is incredibly important. The culture in which nurses work is vital to achieving the kind of retention objectives we have in mind. That is why we are working on a people plan for the NHS. One thing we have learned from Covid is that when you give professionals the scope to deliver their best professional results, you get the best out of them. That is something we want to apply in the NHS people plan.

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

I was pleased to hear my noble friend announce the additional funding for nursing students, but will he give serious consideration to reviewing funding considerations for all nursing students in England, perhaps with a view for the Government to cover tuition fees for future students as long as they stay in the NHS for a period of years?

[Lord Bethell [V]]

We have made a clear, well-defined and thoughtful new funding package for nurses. We would like to see how that is applied and what the response is. Once we have done our review, we will look at alternatives or potential supplements.

[Lord Singh of Wimbledon (CB) [V]]

My Lords, the Covid pandemic has underlined the vital role of nurses in the health system. Bearing in mind that nursing students do unpaid work while learning, does the Minister agree that the £5,000 bursary is not enough to meet the fees and living costs of those whom the Government are trying to attract?

[Lord Bethell [V]]

The noble Lord is entirely right that the role of nurses in the healthcare system has been extremely well exemplified by the response to Covid. The £5,000 bursary was agreed in collaboration with, and with the input of, the Royal College of Nursing. There is of course other support that students can already access through the student loans system and the existing learning support fund, and that goes a long way towards paying for childcare, travel and other costs in cases of exceptional hardship.

[Baroness Thornton (Lab)]

My Lords, does the Minister agree with the Chief Nurse, Professor Mark Radford, that student nurses who volunteered to be redeployed on the front line during the pandemic are now feeling cast aside due to the uncertainty about their future, with some finding themselves out of a job but still with debts of up to £30,000 from having done a degree? If he does agree, can he say what the Government intend to do about making them feel less abandoned?

[Lord Bethell [V]]

The noble Baroness raises a very concerning point. I take the Chief Nurse’s advice and observations at face level. I express my profound thanks to all those nurses who have been redeployed to the front line and have performed an important task but who are now feeling a sense of either anti-climax or uncertainty. I reassure them that there is an enormous number of job opportunities in the NHS, that there is a role for them in the NHS of the future, and that we will be investing massively in the role of nurses in the years ahead, as exemplified by our commitment to recruit.

[The Lord Speaker (Lord Fowler)]

My Lords, I regret that the time allowed for this Question has elapsed. It would be very helpful if colleagues would keep their supplementary questions short so that we can get everyone on the list to ask their question. The third Oral Question is from the noble Lord, Lord Arbuthnot of Edrom.

Covid-19: Mental Health

Lord Bethell Excerpts

Tuesday 16th June 2020 Lords Chamber

[Baroness Tyler of Enfield]

To ask Her Majesty’s Government what assessment they have made of the report The mental health effects of the first two months of lockdown and social distancing during the Covid-19 pandemic in the UK, published by the Institute for Fiscal Studies on 10 June; and what steps they plan to take in response.

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

My Lords, the noble Baroness raises an important issue, and I am grateful to the IFS for this thoughtful report. It is too early to know for certain the mental health consequences of Covid, but we are deeply concerned about those who suffer from isolation, young people, those who have fears of economic uncertainty, and those with existing mental health vulnerabilities. I give thanks to mental health professionals, who have worked hard during the epidemic, despite difficult circumstances.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, last week’s report by the IFS reveals how Covid-19 and the lockdown has had a major negative impact on mental health across the population, with women and young people particularly badly hit. Pre-existing inequalities in mental health have widened yet further. The report states that the scale of deterioration in mental health is of a magnitude unlike anything seen in recent years. What immediate steps are the Government taking to prevent this looming mental health crisis turning into an epidemic in its own right?

[Lord Bethell [V]]

My Lords, the report is extremely helpful and throws a spotlight on an issue that we are deeply concerned about. Immediate help includes a £4.2 million support fund for mental health charities, and a £5 million fund for Mind, specifically to support charities dealing with Covid-related mental health issues. We will continue to invest in mental health in the long term, to support this important area.

[Baroness Thornton (Lab) [V]]

My Lords, four in 10 pupils are not in regular touch with their teachers, there is a sharp educational divide between the rich and the poor, one in eight children and young people already has diagnosable mental health conditions, and the IFS research now reveals that those groups with the poorest mental health pre-crisis will see the largest deterioration. Does the Minister agree that the Government should put the same amount of resource, energy and imagination that they put into the development of the Nightingale hospitals, for example, into getting our children and young people back to school? Will the Minister commit to the YoungMinds five-point plan, which includes additional support for young people’s mental health as we move out of the pandemic, to meet rising demand, including recommitting to the measures outlined in the NHS Long Term Plan, in full, and funding additional early intervention services?

[Lord Bethell [V]]

My Lords, the noble Baroness, Lady Thornton, raises an important point on the mental health of young people. A primary concern is the effect that the epidemic has on young people, at a delicate stage of their development. However, the return to schools is a very delicate matter. It requires the confidence of both parents and young people. We do not want to create further distress or concern. Therefore, we are taking steps in a thoughtful and measured fashion, to ensure that both pupils and parents are confident about the journey back to school.

[Baroness Brinton (LD) [V]]

My Lords, research led by Louisa Codjoe at King’s College London on tackling mental health inequalities found that BAME people are less likely to contact their GP about their mental health, to be prescribed anti-depressants or to be referred to a specialist mental health service. Any failures by the professional health services lead to fear and mistrust among the community, perpetuating a cycle of poor access. How do the Government plan to prioritise access for BAME communities and training for GPs to overcome these barriers?

--- Later in debate ---

[Lord Bethell [V]]

The noble Baroness, Lady Brinton, is entirely right to raise the issue of attendance. One of the greatest concerns during the epidemic is the declining attendance at mental health services, at primary care level and in hospitals. We are working hard on that. Last week, we launched the first aid kit for psychological first-aiders. Public Health England has launched this important resource, and it is indicative of the kinds of measures we are putting in place to address the inequalities of which the noble Baroness speaks.

[Lord Lilley (Con) [V]]

My Lords, although it is strange to describe people who are, not surprisingly, worried about the current situation as suffering mental health problems, we should be concerned that so many young people are worried and stressed at present. Will my noble friend reassure any young people who have exaggerated fears of Covid-19 that they are more likely to be killed by lightning? I expect that many more young people have justified worries about the threat to their education and future job prospects. Will he abandon the physical distancing rule in schools and colleges, where it is unnecessary, and cut it to one metre elsewhere to enable the economy to recover?

[Lord Bethell [V]]

My noble friend is entirely right that the fears described as mental health issues are about not only Covid itself but the economic and social consequences. The impact on mental health of the financial crisis 10 years ago was profound, and largely driven by fears of economic hardship. That is paramount. Reducing the distancing is not currently government policy, but we have that under review and news is expected.

[Baroness Campbell of Surbiton (CB) [V]]

My Lords, the CQC reports that deaths of patients detained under the Mental Health Act have doubled in one year, to 122; 56 of these patients died with either confirmed or suspected Covid-19. In the same period, we have also seen the increased use of restraints and seclusion within secure units. What plans do the Government have to address and help reduce inequalities, to prevent further tragic deaths? What steps have they taken to review these questionable restraint and seclusion practices in psychiatric hospitals?

[Lord Bethell [V]]

My Lords, the investment we are making in mental health is profound. Our commitment is to £2.3 billion of extra funding by 2023-24. This is the sort of money necessary to provide the resources that will lead to a kinder, gentler type of mental health provision. I hope it will address the issues that the noble Baroness raises.

[Lord Haskel (Lab) [V]]

Has the Minister made any assessment of the effect on women of the ending of the self-employment income support scheme, since the inequalities report says that women still earn less, save less and are overrepresented in low-income insecure self-employment, notably in hospitality and leisure?

[Lord Bethell [V]]

The noble Lord is entirely right that the burden on women during an epidemic such as Covid is probably more profound in some instances than on men. Women carry a huge amount of the domestic burden and of the financial concerns for the family. The IFS report puts a spotlight on the huge pressures placed on women. That will be a focus for our study and work.

[Lord Purvis of Tweed (LD)]

My Lords, the Minister said that young people were the Government’s primary concern, but the Government’s waiting times and standards guidance of 2015 said that by 1 April 2016 more than 50% of young people would be treated within two weeks of referral. NHS England’s statistics for 2019 said that only 15% were receiving treatment within zero to four weeks and a shocking 25% were still waiting after 12 months. If this is the record before the crisis, what faith will there be in the Government’s addressing the problem after the crisis? Will the Minister apologise for this record of letting so many vulnerable young people down?

[Lord Bethell [V]]

My Lords, supporting children and young people’s mental health during and after the pandemic is absolutely a priority. Mental health providers are offering support using digital and remote approaches to continue assessment and treatment during social distancing measures. This is part of the wide range of support that we are providing. The noble Lord is entirely right that this area requires a huge amount of investment; we have committed to making that necessary investment.

[Lord Reid of Cardowan (Lab) [V]]

My Lords, the Covid pandemic has often been referred to as the invisible enemy. That is all too often true of mental health issues as well. Is the Minister aware that the campaign group Beyond Tomorrow has estimated that 83% of young people have said that the coronavirus pandemic has made their mental health worse? Will he guarantee that all young people and families who need immediate mental health support can get it to prevent the pandemic having long-term consequences for young people’s mental health?

[Lord Bethell [V]]

The noble Lord is entirely right to focus on the impact of the pandemic on young people. It is not yet clear how that mental health impact will take effect. The natural concern is that it will be long standing. One thinks back to the major economic shocks of the past, which often led to long-term mental health issues for those who found economic insecurity. The struggle to find jobs left them with damaged confidence and concerns about the future. With that in mind, we are very much focused on addressing young people’s mental health and the impact of the epidemic.

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

My Lords, I am afraid that the time allowed for that Question has now elapsed. That also concludes the hybrid proceedings on Oral Questions.

Social Distancing: Two-metre Rule

Lord Bethell Excerpts

Tuesday 16th June 2020 Lords Chamber

[Baroness Wheeler (Lab) [V]]

My Lords, the National Audit Office is the latest in a long line of independent organisations and care bodies to conclude that people and staff in care homes are an afterthought in the Government’s planning for Covid-19. We know that hundreds of thousands of vulnerable people who are shielding from the disease were not warned or included in the last-minute government decision on 30 May to lift shielding. Will the Minister please reassure the House that the impact of any change to two-metre social distancing in care homes, social care and for people whose shielding periods are coming to an end will be fully considered in the review and that advice to them will be a key part of the revised guidelines in good time for any 4 July announcement?

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

The noble Baroness highlights an incredibly important consideration in the review on the two-metre rule. Clearly, those who are vulnerable or in social care deserve the best protection necessary. SAGE has been extremely clear that two metres provides emphatically more protection than one metre, and the protection of our vulnerable people will be an important consideration in any review.

[Lord Rennard (LD) [V]]

My Lords, yesterday a Health Minister in the Commons repeated the mantra that advisers advise and Ministers decide. But trust in government has diminished greatly in recent weeks, so people need to know what is advised before accepting what Ministers decide. Can the Minister assure us that the advice to be provided by the Government’s scientific and medical advisers to this review will be published as it is written and submitted by them, independently of any government pressure, so that we will know whether or not any proposed change really is based on scientific and medical advice? There is a consensus that the Government were late on lockdown, late on face masks and late on testing and tracing, so we do not want to be premature in reducing the two-metre distance rule. Should we not be sure that we have a full track and trace system in place before considering easing the distance rules?

[Lord Bethell [V]]

I do not recognise the contention of the noble Lord. Having been in many meetings with our scientific advisers, I deny the suggestion that scientists are open to being pressured by politicians. The advice that they have given is clear-cut and it is for us to consider its value. The noble Lord does scientists no favours by implying that they might be changeable under pressure.

[Lord Bowness (Con) [V]]

There is a reluctance to give specific dates and targets, although targets on their own are not precluded in that reluctance. I am sure that my noble friend is aware that subjecting businesses, especially in the holiday and travel area, to this great uncertainty is giving rise to many problems, including among the general public, who do not understand why more specific dates or targets cannot be given. That means that there is a considerable lack of confidence. We have been told today that travel insurance companies are talking about not covering people unless they can show that they have complied with local social distancing rules. What efforts are being made by the Government to get a Europe-wide agreement on social distancing, especially at airports and on aeroplanes, and in restaurants and hotels?

--- Later in debate ---

[Lord Bethell [V]]

My Lords, I completely and utterly share my noble friend’s frustration about the lack of clarity, but a fact of this epidemic is that the Covid germ is incredibly unpredictable. We have fought really hard to apply the best and most up-to-date science possible, which has meant that there has been a real struggle to lay out the kind of clear framework that he and the public would like to see. We remain guided by the science; we work closely with our foreign neighbours; and we are working hard to put in place a clear plan to take us out of lockdown.

[Baroness Meacher (CB) [V]]

My Lords, does the Minister anticipate that the two-metre social distancing rule will in fact be reduced following the review? I might be wrong but I think that it will be, in which case access to masks on high streets and at stations will become absolutely urgent. What plans do the Government have to ensure ready access to masks across the country? Would the Minister like me to send him details of one company that provides and installs dispensers of masks and hand-sanitising gel free of charge? I declare that I have no personal interest in this company but I believe that it and others like it, if they exist, will have a vital role to play in tackling Covid-19 if the social distancing rule is in fact changed.

[Lord Bethell [V]]

My Lords, social distancing has without doubt been the most effective tool in the battle against Covid. That is why the Prime Minister has appointed the Permanent Secretary, Simon Case, to undertake a review, which will include the Chief Medical Officer and the Chief Scientific Adviser. The use of masks might offer some protection but in no way will it ever replicate the impact of social distancing. That is why we are not prejudging any review or making any assumptions about any changes.

[Lord Reid of Cardowan (Lab) [V]]

My Lords, some of the Government’s own scientific advisers have said that being one metre apart carries up to 10 times the risk of being two metres apart. Are the Minister and the Government willing to take that risk? If so, will any changes to the two-metre rule be reviewed, assessed and changed if necessary, and how often would such further reviews take place?

[Lord Bethell [V]]

The noble Lord’s maths is entirely right. That is why we are moving cautiously in this area, despite many people’s concerns and despite the profound effect on industries such as the hospitality industry, which we regret enormously. However, the main focus is to drive down the infection rate. If we can get the prevalence levels down sufficiently, social distancing will not be required any further, and it is on that target that we are focusing.

[Lord Forsyth of Drumlean (Con) [V]]

Do the Government accept that each day’s delay in reducing the two-metre rule will result in needless redundancies, that many of these jobs will go in the next few days and will not be replaced in the short term, and that we cannot wait weeks for a review? Failure to act now will see the loss of hundreds of thousands of jobs, and that will hang like an albatross around the neck of the Administration.

--- Later in debate ---

[Lord Bethell [V]]

No, I do not accept my noble friend’s analysis. In fact, social distancing, which is central to our strategy, has had an incredible impact on saving lives and protecting the NHS. You have only to look at the spike that is occurring in places such as Texas, Florida and, according to today’s news, Beijing to see what happens if you do not tackle the underlying prevalence of the disease and you allow the lockdown to end too early.

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

My Lords, do the Government recognise that if the blanket rule is relaxed for some, such as most primary school children, who appear to have a lower rate of infecting others, people who are shielding someone will be terrified that reducing the distance will endanger the life of the person they are protecting? Their need to maintain a greater physical distance will need to be clearly signalled—for example, through an officially issued lapel badge or lanyard, as I suggested yesterday—and they will need to have antibody testing.

[Lord Bethell [V]]

The noble Baroness is entirely right. The kind of differential shielding that she suggests may well play an important role in what we do going ahead. We must do our utmost to protect those who are shielded. However, we are also aware of the challenge of having confusing regulations. That is why we are currently holding the line. We are aware of the effects on the economy, and that is why a review is on the horizon, but until then we are focused on reducing the prevalence rate and protecting those who are most vulnerable.

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

My Lords, most people in my area of Durham appreciate Dominic Cummings for putting Barnard Castle on the tourism map—for the wrong reasons—but does the Minister accept that the prime ministerial adviser’s breach of the self-isolation rules, with the hypocritical support of members of the Cabinet, was a major cause of the loss of faith in the Government’s credibility regarding continued acceptance of the distancing rules in England?

[Lord Bethell [V]]

My Lords, I pay tribute to the British public, who have remained sensible and thoughtful to others, have largely borne the cost of social distancing and have abided by the rules of the lockdown. I express gratitude to all members of the public who have gone along with this incredibly impactful regime—a regime that continues to have a huge amount of support among the broader general public.

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

My Lords, I am afraid that the time allowed for questions on this Urgent Question has now elapsed. I call on the Whip to move that the House be adjourned until 1.30 pm for the Committee stage of the Corporate Insolvency and Governance Bill.