Dental Care
Lord Bethell Excerpts(3 years, 11 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, the NHS and the Chief Dental Officer have worked hard to reopen the dental sector, with the aim of restarting routine dental care as soon as we safely can. In the meantime, over 500 urgent dental treatment centres have been set up in each NHS region, to provide urgent face-to-face care for patients.
Lord Farmer (Con)
I thank the Minister for his reply. Untreated and moderate dental problems can become severe and potentially life-affecting. Infected teeth were a major cause of death in the 19th century. I note the 500 urgent dental care hubs already set up in England following strict guidelines, but can my noble friend say why the regulator cannot simply modify the existing guidelines used in the hubs to make them transferable to local dental practices?
Lord Bethell
The noble Lord is entirely right that poor dental care is extremely damaging to individual health. The current situation is one that we massively regret, but the safety of patients and dental professionals is paramount. The aerosols generated by dental drilling and other dental practices leave the threat of germs in the air in a dental practice for hours to come, which could be caught by staff or future patients. It is for that reason that we have focused the infection protocols in 500 special units that have the right kit, the right training and the right arrangements.
Lord Hunt of Kings Heath (Lab)
My Lords, I declare my interest as president of the British Fluoridation Society. I recognise the work done in setting up urgent treatment centres, but they are patchy in England and many provide only for pain relief and tooth extraction. Many high street dentists are in danger of bankruptcy, because the Chancellor’s schemes to help businesses have not been applied to them. Will the Minister consider setting up a programme of work with the BDA and the Chief Dental Officer to establish a national plan to get dentistry back on track and save the profession from ruin?
Lord Bethell
My Lords, I completely understand the points that the noble Lord has made. He refers to a situation that we are fully aware of, and I completely agree with his analysis. The truth is that tooth extraction avoids some of the risks that I described, but treatment in the centres is not limited to extraction and other protocols are arranged. The Chief Dental Officer is working on a dental plan, and we are liaising with colleagues in the Treasury to see what more can be done to help dental practices.
Lord Rogan (UUP)
My Lords, United Kingdom dentists, too, are heroes and heroines of this pandemic. In Northern Ireland 100 dentists were sought to run emergency clinics, but more than 400 stepped forward, and dozens more have volunteered to work in care homes. A recent BDA survey warned that three-quarters of Northern Ireland’s dental practices could collapse by the summer because of Covid-19. Like the noble Lord, Lord Hunt, I ask the Minister urgently to consider adopting a UK-wide approach to saving our dental sector from disaster.
Lord Bethell
The noble Lord’s concerns are well understood. Practices that depend on private income are particularly affected, because the NHS has guaranteed the income to NHS practices for their NHS work. We are working on a UK-wide national plan, and it is a massive priority for the Government.
Lord Duncan of Springbank (Con)
My Lords, I echo the points made by the previous speaker: £7.8 billion is spent on private dental health care, yet dental practices of this nature are among the only businesses not to receive the full business rate relief. Will the Minister commit to ensuring that they receive adequate provision, as a matter of urgency, to ensure that these practitioners do not disappear from the high street?
Lord Bethell
My Lords, I cannot make the commitment that my noble friend seeks at the Dispatch Box, but I promise to convey his thoughts to the discussions taking place between DHSC colleagues and the Treasury.
Baroness Harris of Richmond (LD)
My Lords, a recent poll of around 2,000 dentists and dental professionals found that 97.5% of them supported a vote of no confidence in the leadership of the office of the Chief Dental Officer of England. What is the Government’s assessment of this?
Lord Bethell
My Lords, it is not the role of the Department of Health and Social Care to have a view on the popularity of the Chief Dental Officer. All I can say is that the support he has provided for the profession is enormously appreciated, and we have a lot of confidence in his work.
The Earl of Shrewsbury (Con)
My Lords, I declare an interest in that my brother-in-law is a dentist. My noble friend will be aware that many private dental practices have already sourced and stocked their requirements of PPE. Is he satisfied that when NHS dental care resumes, practitioners will have adequate supplies for dentists, their staff and their patients?
Lord Bethell
My Lords, the Government are buying billions of items of PPE and putting them into the supply chain. That supply chain includes dentists, and we are working hard to ensure that all dentists, both in the urgent treatment centres and in other dental practices that may reopen in the short term, have exactly what they need.
Lord Low of Dalston (CB)
My Lords, when will the NHS be able to look beyond the current crisis and get back to routine eye care by opticians and eye clinics, which plays such a vital part in preventing blindness?
Lord Bethell
The arrangements for eye care, similarly, are an extremely delicate matter, because the eye is a potential source of infection, and both workers and patients are at risk through work done by opticians. We are extremely keen to get back to normal, but we put the safety and care of patients and staff first.
Baroness Thornton (Lab)
My question to the Minister is an amalgam of those already asked, and I want to press him on them. Everyone needs dentists to be able to survive this pandemic and to be open to do their job as soon as possible. What financial support might be given to the sector to make that happen? What steps are the Government taking to ensure that there are treatment guidelines and access to PPE?
Lord Bethell
My Lords, I completely endorse the point made by the noble Baroness, Lady Thornton. I lost a front tooth a few weeks ago and I cannot wait for the dentists to reopen because it is both uncomfortable and embarrassing. We are providing enormous financial support through NHS contracts, which we have honoured 100% through the epidemic whether or not dentists are seeing patients. However, we recognise that there is a problem with the private sector, and we are working with colleagues in the Treasury to try to find a solution.
Lord Bradshaw (LD)
It is the private dental sector that is probably in most trouble, because of a lack of financial support given by the Government and the question whether private dentists have adequate access to PPE, to which the Minister has referred. Will he address those questions? What meetings have taken place with the BDA to deal with these problems?
Lord Bethell
My Lords, at present there are restrictions on private dentists opening; the guidelines are clear on that. We are putting in place provision of PPE for when those guidelines are amended to allow the reopening of dental practices. We are also giving thought to how we will get through the large backlog of dentists’ work that will need to be done to catch up on those missed appointments.
Baroness Boycott (CB)
It was pointed out recently by Public Health England that snack buying has gone up hugely in the past few weeks of the crisis. As Ministers know, the main reason that children go into hospital and have anaesthetics is to have all their teeth out as a result of eating sugary foods. Will the Minister guarantee that, when the crisis is over, the Government will bring the obesity Bill back to Parliament and get it through this time, because this is a tragedy for our youngsters?
Lord Bethell
The noble Baroness is entirely right. I confess to having a profound biscuit habit through the Covid epidemic which I am wrestling to get over. On a serious note, the Covid epidemic has put a spotlight on the health of the nation. There seems to be some evidence that we have suffered badly from the epidemic partly because of obesity. The Prime Minister has commented personally on this issue. It will be a priority of the Government to address this point once the epidemic is over to restore the health of the nation and to tackle obesity.
The Lord Speaker (Lord Fowler)
My Lords, the time allowed for this Question has now elapsed. I thank all who put questions and the Ministers who answered. That concludes the Virtual Proceedings on Oral Questions. The Virtual Proceedings will resume at a convenient point after 12 noon for the Private Notice Question on scientific evidence relating to the reopening of schools.
Covid-19: Care Homes
Lord Bethell Excerpts(3 years, 11 months ago)
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Baroness Wheeler (Lab)
My Lords, this Urgent Question taken yesterday in the Commons on coronavirus and care homes covered much of the ground in the Statement taken by us last night. Sadly, it is clear that Ministers’ claims to have thrown a protective ring around care homes ring hollow in the light of the latest ONS figures on deaths in care homes: 9,495 residents in England and 480 in Wales. These figures are still ringing alarm bells, as the number of deaths involving Covid-19 as a percentage of all care home deaths continues to rise this week. As Martin Green of Care England told MPs yesterday, most care home residents should have been prioritised from the start. He also stressed that there are still huge issues with testing, with results lost and staff waiting eight to 10 days to find out whether they have coronavirus.
I ask the Minister about reports on the PHE study on genome tracking to investigate outbreaks in care homes, which last month found that bank and temporary agency care workers, often employed on zero-hours contracts, had unwittingly transmitted Covid-19 between care homes as cases surged and they were moved from home to home to cover staff vacancies. Does this not raise even further doubts and questions about this ring of protection? Why was this issue not recognised early on as a crucial factor in any infection-control strategy?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, the issue the noble Baroness raises was recognised in the very early stages. The problem of itinerant staff who move from one resident or patient to another was always going to be one of the most difficult to tackle. They perform an absolutely vital role in the care of non-domiciliary patients. That is why we put more money in to pay for more staff, provided PPE for the staff who were working and continue to upgrade the testing arrangements for both staff and patients, to ensure that they are protected.
Baroness Brinton (LD)
Yesterday, Professor Dame Angela McLean said testing had been prioritised in the NHS over care homes. Today, Justice Secretary Robert Buckland said the Government had prioritised the NHS over care homes as well. Yesterday’s Health and Social Care Select Committee also heard members of the care sector report continuing and widespread problems with PPE—chaotic, unreliable and extremely expensive, with the Clipper system promised two months ago still not rolled out. When will the Government ensure that our care sector gets the urgent priority support outlined in the Government’s social care action plan on 15 April, needed to keep residents and staff safe?
Lord Bethell
The noble Baroness is quite right to focus on the importance of social care, but I think she unfairly characterises the effort made to ensure that social care is protected. The social care action plan announced on 15 April has been enormously important and extremely effective. Also on 15 April, we rolled out outbreak testing for all symptomatic care home staff and residents. We brought in extra funding on 16 April, with £850 million in existing social care grants. There has been new guidance and more money for local authorities, and we have launched a workforce recruitment campaign for care home staff. An enormous amount has been done. Care homes were always vulnerable, and we have sought to put every possible measure in place to protect them.
Baroness Newlove (Con)
My Lords, I am grateful for the Statement. Unfortunately, I am having hearing issues, which are overriding the voices.
Can the Minister tell us what the business model is for care homes? We are seeing so many deaths in our care homes because of Covid-19 that it highlights that there may be underlying issues. We must think of the staff who are caring for the most vulnerable in our society.
Lord Bethell
My noble friend raises one of the key features of our social care system. It is provided by 12,000 different care home providers—or 16,000, depending on how you measure it—many of whom have very different business models. This creates a rich and diverse tapestry of provision, but it is also extremely difficult to engage with from a central campaign provision. That is one of the challenges that we have faced when rolling out support such as PPE and testing. We do not believe that the business models are inappropriate, but undoubtedly we have challenges when we are trying to reach all the care homes with an equal and central format.
Lord Bilimoria (CB)
My Lords, the Statement says that 27% of coronavirus deaths in England have taken place in care homes, whereas in Europe the average is around half—but does the Minister agree that in Hong Kong, Singapore and South Korea there were zero deaths in care homes, and in Germany, a country with a population of 90 million people, 3,000 deaths? Also, can he confirm that no patients were ever sent from a care home to a hospital and then back from a hospital to a care home without being tested? Can he reassure us, as the Statement says, that the testing of all care home residents and staff, with and without symptoms, is now taking place? That is 2.5 million people. When will it be done by, and will it be done on a regular basis? Some care homes are saying that it will be necessary to test many times a week.
Lord Bethell
The statistics which the noble Lord refers to are correct. It is probably more appropriate to compare the British care home statistics with those in Europe rather than Asia, which had previous experience and different models. With regard to care home testing, not everyone needs to be tested every day. Not every care home has an outbreak, and we must focus our resources on those that do. Regular testing may be necessary for them, but it is not correct that, for example, 2.5 million people need to be tested every week. That is not the advice from the scientists or the CMO. We want to focus our tests where Covid-19 has been found, and we must use our testing resources to expunge the disease from those locations.
The Lord Bishop of Portsmouth
My Lords, we know how crucial the social care sector is, and the huge challenges it faced even before Covid-19, with 120,000 care assistant vacancies. Can the Minister therefore respond to the excellent suggestion from the most reverend Primate the Archbishop of Canterbury that we establish a royal commission on social care, not to blame but to learn, so that we have the right information to make the right decisions and provide the right services for these most vulnerable people?
Lord Bethell
My Lords, this Government have already made a very clear commitment to review the social care sector; that was made before coronavirus. The experience of coronavirus will no doubt put a massive spotlight on our provision for social care. It is entirely right that we review all of our arrangements. The vacancy question that the right reverend Prelate raises is an important one, and that is why we have launched a massive recruitment campaign, and why we have brought in minimum wage legislation which has seen rises in the pay of social care workers that are historically at the high end.
Baroness Altmann (Con)
My Lords, care homes tell me that they are still being required to take residents from hospital who may have Covid-19. May I ask my noble friend whether scientific and medical advice supported the guidance issued in the action plan of 15 April that, prior to discharge into care homes, patients must be tested but will be discharged “pending the result”, despite spare capacity in the NHS? Will the Government urgently consider altering that guidance?
Lord Bethell
My Lords, the guidance has been reviewed by the CMO, and we stand by it. I can confirm that all patients leaving hospital for care homes are, as a routine, tested. When they arrive at a care home, they are treated as if they might have Covid, and they are put into an area of isolation, until either the test has come through or their diagnosis has been confirmed. This is a way of protecting care homes, and it is necessary to continue the traffic of people from hospital to care homes, in order to have the beds available for those who need them more.
Lord Turnberg (Lab)
My Lords, among the many reasons why we have done so badly in protecting our care home residents from this dreadful illness is the almost complete lack of adequate public health services at the local level. A few years ago, when I was chairman of the then Public Health Laboratory Service, we had a robust network of public health expertise in every locality which did all the testing and tracing of infectious diseases across the country. All that has been eroded over very many years, and I fear we have lost that local expertise—the doctors and the other staff that could have done the job that we are now left struggling to fulfil far too late. I ask the noble Lord whether he will make it a priority now, as a matter of urgency, to begin to fill that huge gap in our network of local public health services.
Lord Bethell
The noble Lord is more expert on the history of public health than I am, but I do not doubt the story that he talked about. I reassure him that Covid has definitely made us all think again about the very clear priority that local public health provision must and will provide. I would like to pay testimony to those public health officials—public health directors, environmental health officers, infection control officers—who play, and are currently playing, a huge role in controlling the epidemic.
Baroness Prashar (CB)
My Lords, the Statement is encouraging on one level but very disappointing on another, since it does not recognise that initially there were delays and problems. Consequently, care workers in those homes were working in very difficult and distressing circumstances, often without PPE and on low pay, in many cases below the real living wage. Will the Minister agree that they deserve not just applause but proper protection and a real living wage?
Lord Bethell
My Lords, we ensure that the social care system is funded so that providers can pay the national minimum and living wages to care workers. Since the introduction of the national living wage in 2016, care worker pay has increased at a faster rate than before. I share the noble Baroness’s praise for care workers. As a group, our million-plus care workers have massively delivered for the country. They deserve our praise, our thanks and a tribute from this House.
Baroness Blackwood of North Oxford (Con)
My Lords, I congratulate the Government on publishing the data behind their assessment of the Roche and Abbott ELISA tests. The transparency is welcome, but given the latest evidence on how asymptomatic cases affect transmission and how challenging infection control has been in care homes, can the Minister say whether care workers and care home residents will now be prioritised for antibody as well as PCR tests to give them the best data to improve infection control?
Lord Bethell
My noble friend Lady Blackwood is quite right that the Roche and Abbott antibody tests are a great step forward. It shows how diagnostic technology is progressing very quickly. We are determined to use all the benefits of modern technology in the fight against Covid. Our announcements on antibody testing in the NHS, in the care service and for key workers will be announced shortly. When it is, I assure her that NHS and social care workers will be on an equal footing.
Lord Dubs (Lab)
My Lords, in answer to an earlier question, the Minister said that it was not appropriate to compare us with what happened in Hong Kong, South Korea and Singapore, which had no deaths in care homes at all. He preferred to compare us with Europe. Is the truth not that we took our eye off the ball and that as a country we failed to learn from what was happening elsewhere? We failed to learn good practice and we actually lost two months, where we did nothing very much until we tried to catch up just now. Surely we failed pretty badly.
Lord Bethell
The noble Lord makes a comparison that history will have to judge on, I am afraid to say. I think that I am making a fair point when I say that Britain can really only benchmark itself against its close neighbours. The experience of Asian countries taught them an enormous amount, but it is not one that has seemed proximate or relevant to us in recent times. I am afraid that I can only leave it to history to judge whether we made mistakes. It would be wrong for me to prejudge that at this moment.
The Deputy Speaker (Baroness Finlay of Llandaff) (CB)
My Lords, I must apologise because I allowed everybody to come in. I had mistaken the timing and had allowed this to run for 15 minutes instead of 10. I must make it clear that this does not set any precedent. It was my error.
The Virtual Proceedings will now adjourn until a convenient point after 7 pm for the second Urgent Question repeat.
Covid-19: BAME NHS Staff
Lord Bethell Excerpts(3 years, 11 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, the Government are deeply concerned about these groups. That is why we have asked Public Health England to review the evidence. In advance of PHE’s recommendations, NHS England has written to NHS services so that, on a precautionary basis, employers can risk-assess staff at potentially greater risk and make appropriate arrangements accordingly.
Baroness Lawrence of Clarendon (Lab)
I thank the Minister for that Answer. I have been asked by the Labour leader to conduct a review into the effects of Covid-19 on the BAME community. Are the NHS and Government making sure that BAME nurses are properly shielded with adequate PPE? Have they considered taking BAME nurses and staff off the front line, as they are overrepresented in the death toll of the virus?
Lord Bethell
As I mentioned in my previous Answer, arrangements have been put in place for local trusts to risk-assess all employees, including BAME nurses, and to assess whether they are at a higher risk and, if necessary, to change their rotas and staffing arrangements accordingly. I understand that some trusts have already taken these measures.
Baroness Wheeler (Lab)
My Lords, I pay tribute to my noble friend Lady Lawrence for the leading role she is playing in finding out why BAME communities and health workers are disproportionately bearing the brunt of Covid-19.I understand that the Public Health England review of ethnic minority health records and data is due to report at the end of May. It is looking into how factors such as ethnicity, deprivation, age, gender and obesity can affect the impact of Covid-19. People from ethnic minorities may also be at a higher risk due to the prevalence of co-morbidities such as diabetes, cardiovascular conditions and sickle cell disease. Overall, black people are dying with Covid-19 at almost double the rate of white people. Can the Minister say what the next steps will be after the PHE review and what are the Government’s plans, remits and timescale for the more in-depth analysis and inquiry that is needed to better understand entrenched health inequalities and to respond to the needs of BAME communities and health staff?
Lord Bethell
The noble Baroness put this very well. We are deeply concerned about genetic differences between groups. This virus is like malaria and other viruses in that it affects different ethnic groups differently. We are concerned about behavioural issues such as diet and environmental issues such as urban versus rural living arrangements. We have already invited health trusts to put in place arrangements to protect our BAME NHS workers. We are also inviting other academic studies, of which there is a large number, to look at the various concerns about how the virus has hit different groups. We will be commissioning a very large amount of medical research into this important area.
Baroness Uddin (Non-Afl)
I salute my noble friend for her relentless uphill struggle to combat institutional discrimination in our country. No one can ignore the sobering statistics on front-line deaths among members of minority communities. These have raised the deepest fears about the tragic number of deaths. Leaders in the NHS who are responsible for diversity have also said that the Government have been too slow to act to protect NHS front-line staff. What measures are in place to monitor this situation and to assure BAME staff that they can be confident about continuing to provide their services to the NHS in safety?
Lord Bethell
I completely and utterly reject the suggestion by the noble Baroness that there is institutional racism in the NHS. That is a completely inappropriate slur and I invite the noble Baroness to retract it at a future date.
Lord Bourne of Aberystwyth (Con)
My Lords, I recognise that this one nation Minister and one nation Government are committed to action, but clearly there is an urgency about this. I realise that we have the Public Health England review, but after that, how soon will the Minister be expecting to take action to ensure that its recommendations are implemented forthwith?
Lord Bethell
I can reassure my noble friend that action is already being taken. Individual trusts are putting in place trials and arrangements to try out different forms of amelioration, including changing staff rotas and taking vulnerable staff out of the front-line wherever possible. We will build on these pilots and trials in order to move as quickly as we can. The causes of the massive difference in the effects of the disease on different ethnic groups are not clear yet, so it is not possible to say for sure which pilots will work. However, we are moving as quickly as we can and we will build on the evidence base in order to put in effective measures.
Baroness Hussein-Ece (LD)
My Lords, this pandemic must be a wake-up call for us all. The Government’s review is not sufficient. BAME people make up 72% of NHS and social care staff and are 4.2 times more likely to die. Given all these separate initiatives referred to by the Minister, will he meet key leaders from BAME communities to look at establishing a Covid-19 race equality strategy, to find solutions to the current crisis based on the collective experiences of service and sacrifice from these communities?
Lord Bethell
My Lords, I share the noble Baroness’s tribute to BAME staff in the NHS, who, as she rightly points out, are on the front line and putting themselves at risk. We should all, as a nation, be enormously grateful for their contribution. I also salute those in the NHS moving quickly to address the concerns and evidence that the disease itself is discriminatory. I would be glad to meet representatives, but I want to be clear that the processes in place in the NHS are reasonable, proportionate and will, I believe, deliver the needed results.
Lord Blencathra (Con)
Will my noble friend the Minister please ensure that the inquiry carefully and thoroughly investigates all anomalies? While black Afro-Caribbeans have a much higher than death rate than white people, I understand that the rate is even higher for Filipinos and far lower for the Chinese. Will the inquiry also look at why 70% of those dying are men, which is nothing to do with race, and why obesity, diabetes, vitamin D and blood thinners all seem to be factors in this epidemic?
Lord Bethell
The noble Lord is entirely right. This disease is racist, fatist and sexist. We need to understand why it is discriminatory in all these areas. I reassure the noble Lord that the National Institute for Health Research and UK Research and Innovation have jointly called for research proposals to investigate emerging evidence of an association between ethnicity, behavioural and social factors, and the adverse health outcomes it is generating.
Baroness Finlay of Llandaff (CB)
Given the association that there seems to be between a wide range of factors, are these being centrally collated? Are the Government producing guidance on, for example, vitamin D supplementation in the event of deficiency being detected, so that the national results are rapidly rolled out, and those cases where risk is discovered can be managed and supported?
Lord Bethell
I reassure the noble Baroness that the data is being centrally aggregated. ONS has published figures on ethnicity and the CMO and PHE are both scrutinising them. On their list of issues to consider is the role of vitamin D, where the evidence is interesting but unproven.
Baroness Healy of Primrose Hill (Lab)
To follow further on the data, many medical bodies, and the Science and Technology Committee today, are calling for greater collection of real-time data on infection and deaths by protected characteristics, and for it to be recorded, analysed and shared so that urgent action can be taken to prevent deaths of front-line staff. What assurances can the Minister give that this work is actively underway now?
Lord Bethell
I reassure the noble Baroness that we have a large amount of data—although we could do with more and better. The collection of death certification data, for instance, has already improved dramatically and we are working hard to ensure that the evidence is there to inform our policy-making.
Baroness Benjamin (LD)
My Lords, the coronavirus crisis has exposed the fact that the majority of NHS BAME healthcare staff—including Filipino workers, who are often forgotten—hold junior positions and are therefore more likely to find themselves on the front line in the fight against Covid-19; many have lost their lives doing so. After this crisis, what will the Government do to encourage the NHS to develop better career paths and promotion initiatives for its BAME staff?
Lord Bethell
The noble Baroness is entirely right. We owe a huge debt of gratitude to those BAME staff, whether black Afro-Caribbean or Filipino, who have put their lives at risk on the front line. It is a wake-up call; we should always be thinking about how we can accelerate opportunities for all members of staff. Those who start at the lower ranks should be given whatever opportunities are available to progress to a higher rank. The noble Baroness is entirely right that this puts a spotlight on our commitment to those groups. I completely endorse her point.
The Lord Speaker (Lord Fowler)
My Lords, unfortunately the time allowed for this Question has elapsed.
Mental Health Services
Lord Bethell Excerpts(3 years, 11 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, the NHS has issued guidance to services to support them in managing demand and capacity across in-patient and community mental health services. Services have remained open for business as usual as a result. We remain committed to the additional investment in mental health services set out in the NHS long-term plan. We have provided an additional £5 million to mental health charities to support their work during the pandemic.
Baroness Tyler of Enfield (LD)
My Lords, the Royal College of Psychiatrists warned last week that the nation faces a mental illness “tsunami”. Those on the front lines of our health and social care services have gone above and beyond to tackle this dreadful virus, but now may themselves face significant mental health problems. Thousands have lost colleagues, endured serious illness or experienced major trauma. Will the Government commit to investing in a world-class mental health response to Covid-19, including by setting up specialist support services for those on the front line of our NHS and care services, mirroring the services available to our armed services personnel?
Lord Bethell
I join the noble Baroness in paying tribute to those working in mental health in the NHS. They have kept services running in extremely difficult circumstances and their impact has been extremely powerful. Although we are aware of the deep threat of a mental health tsunami, as was warned, the evidence to date is that these people have done an amazing job of addressing the concerns of those who are suffering under coronavirus and the lockdown.
Lord Howarth of Newport (Lab)
My Lords, does the Minister accept that the implications of the Covid-19 pandemic include loneliness, a sense of entrapment, income and employment insecurity, substance abuse, relationship problems, bereavement and other factors that are liable to be severe? Resources will be needed for many interventions. Is he aware of the growing evidence base on the important benefits of the arts and creativity for mental health? What plans do Ministers and NHS England have to accelerate the spread of social prescribing, supporting people with mental health conditions to engage creatively with the arts, culture and nature?
Lord Bethell
My Lords, I completely recognise the noble Lord’s warnings. He rightly warns about the huge pressure of lockdown on people, and rightly mentions the benefits of the arts—particularly social prescribing, of which I am particularly supportive. I pay tribute to the Permanent Secretary of the Department of Health and Social Care, who has allowed me to bring Tilly, my working cocker spaniel, into the office to provide me and my fellow workers with some kind of support from an animal. I know that canine support is valuable. We are working hard to support the kind of social prescribing of which the noble Lord speaks.
Baroness Newlove (Con)
My Lords, this is an interesting area which I was concerned with both in my former role as Victims’ Commissioner for England and Wales, and personally. As well as viewing mental health services through Covid, we must recognise the risks to pre-existing services, which were an underfunded postcode lottery with not enough qualified professionals. Our front-line workers are now dealing with a pandemic that none of us could envisage. Will the Minister speak to the Secretary of State for Health to ensure sustainable funding for access to mental health services, and that support is given to mental health workers, who will be the front-line workers again? We must ensure that people’s ability to access the services does not just become a tick-box system governed by an algorithm within an app. There has to be sustainable funding for a least five years to invest in the care and support needs of the most vulnerable in society.
Lord Bethell
I recognise the insight of my noble friend Lady Newlove, who speaks from experience of these matters. I reassure her that the funding in place from the long-term plan for mental health has been substantial and will support a dramatic change in mental health services. We will be supporting mental health workers who, as my noble friend says, have delivered under difficult circumstances. Their creativity is demonstrated by the introduction of video and other technical facilities to keep mental health services going during the lockdown. I pay tribute to their inventiveness and creativity at this time.
Baroness Barker (LD)
My Lords, is data on mental health support, A&E presentations, referrals to community mental health services, crisis resolution callouts and detentions under the Mental Health Act being collected during this period—yes or no?
Lord Bethell
My Lords, I understand that it is a firm “yes”, but I will check that answer and revert to the noble Baroness if there is any different information.
Baroness Hollins (CB)
My Lords, yesterday the Guardian reported a study by Public Health England which showed that agency staff working between multiple care homes in London were unwittingly spreading Covid-19 during the surge of the pandemic. Given the evidence of the vulnerability of those receiving care, which includes working-age adults with mental health needs, is there really a commitment to parity of esteem between physical and mental healthcare? Why has the testing strategy not been amended properly to cover these groups?
Lord Bethell
The noble Baroness rightly points to one of the most difficult aspects of the Covid epidemic—the itinerant staff who pass from one vulnerable person to the next. We recognised this issue at the beginning and put money in to try to ameliorate it. When testing was expanded weeks ago to key workers, it was deliberately targeted at these staff and this continues to be prioritised.
Baroness McIntosh of Hudnall (Lab)
My Lords, children’s lives have been disrupted, not only educationally but socially and emotionally, as friendship patterns have changed. The Minister will know that these relationships can be fragile but are essential to good mental health and well-being. What are the Government planning to do to provide additional support to schools to help with the problems they will inevitably encounter when children return?
Lord Bethell
The noble Baroness is entirely right. I am living with four children who are greatly distressed at losing their friends and not being able to stay in touch in the way they would like. We will undoubtedly need to provide support to schools to cover a list of mental health issues. The Secretary of State for Education is working on plans for that.
Baroness Thornton (Lab)
My Lords, as a nation, a vast number of us have seen our mental health deteriorate during the coronavirus crisis, so the challenges facing our mental health services are even greater than they were before. Surely we need a strategy to take us through the Covid-19 pandemic that takes account of the most welcome promises in the NHS long-term plan and addresses and scrutinises the impact of the pandemic on mental health and learning disability settings, including the impact of the temporary measures in the emergency legislation. Such a strategy must address how and when the DoLS legislation will be rolled out, and when and how the Government will bring forward reforms arising out of the review of the Mental Health Act. Does the Minister agree that these are the key ingredients of such a strategy? When will we see progress in this area?
Lord Bethell
The noble Baroness is right: the Covid epidemic will throw a spotlight on our mental health provision. That provision is already benefiting from an extra £2.3 billion a year by 2023-24. We have already brought forward the 24/7 crisis lines that were due to be delivered in 2023-24, and I think there is a good case for bringing forward other parts of our mental health strategy to address mental health issues during the Covid epidemic. Undoubtedly, we will focus very shortly on ways of doing that.
Baroness Jones of Moulsecoomb (GP)
The Stevenson-Farmer review of 2017, which was set up by the then Prime Minister, recommended strengthening the 1981 health and safety regulations on mental health first aid. Will the Government commit to picking up those recommendations and implementing them?
Lord Bethell
The noble Baroness raises an important point. I will confess that I am not, and will not pretend to be, completely across the matter she raises, but I will write to her with a clear answer.
Lord Polak (Con)
My Lords, I declare an interest: my daughter Natasha is an art therapist and co-founded the charity Arts Therapies for Children, which works in 19 schools. The impact on the mental health of children brought up where domestic abuse is the norm is sadly clear; it is all they know, and often they think that the problems encountered are their own fault. It is during these years that they develop and learn how to value themselves and others. Therefore, the impact of domestic abuse can lead to a skewed view of who they are, which can be taken into adulthood. Will my noble friend the Minister ensure that resources are targeted at supporting charities and mental health services that work with these vulnerable children?
Lord Bethell
I pay tribute to exactly the sort of charity that my noble friend’s daughter works in. They provide invaluable and often unseen benefits to society. We have already made available considerable financial support for similar such charities. If my noble friend would like to write to me with the details of the one he described, I would be glad to consider it. Undoubtedly, these charities will play an important role in dealing with mental health issues of the kind he describes during the mop-up after Covid.
Baroness Verma (Con)
Will my noble friend assure me that all communities will be able to access appropriate mental health services? What work is being done to speak to local women’s and girls’ groups in the ethnic-minority communities, where language and access to online services may often be a barrier?
Lord Bethell
One thing that Covid has thrown a light on is that digital communications have been greatly improved; the use of video conferencing in mental health services is one of the things that have helped. Groups that do not have access to video conferencing need to be reached in other ways. We are working on using telephones and community outreach to do that. My noble friend is entirely right that this needs to be a focus of our work.
Lord Ramsbotham
My Lords, does what the Minister has said apply to prisons and probation?
Lord Bethell
I pay tribute to the Prison Service, which in extremely difficult circumstances has managed to provide pastoral care and clinical segregation in our prisons in a way that has completely outperformed expectations. The effect in prisons has been profound and the mental health of prisoners is concerning. The degree of lockdown in prison cells is an awful aspect of this disease, and undoubtedly we will have to work very hard to manage and deal with the mental pressures on prisoners, which are extremely unfortunate.
The Senior Deputy Speaker
My Lords, the time allowed for this Question has elapsed. The Virtual Proceedings will now adjourn until a convenient point after 12.45 pm for the Motion in the name of the noble Baroness, Baroness Stedman-Scott. Proceedings in the Chamber will be taken at a convenient point after 12.30 pm.
Covid-19: Response
Lord Bethell Excerpts(3 years, 11 months ago)
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Baroness Brinton (LD)
My Lords, I thank the Minister for the Statement. The ONS statistics this morning showed that over 44,000 people have lost their lives, with the Financial Times estimating that the total figure is now well over 60,000 when a percentage of excess deaths is taken into account. From these Benches, we send our sympathies to all bereaved families and friends, and our thanks and support to the amazing front-line staff in the NHS, social care and community sector, and to others in key roles working to save lives and keep people safe.
The Secretary of State began his Statement by talking about flattening the curve, but yesterday an article in the British Medical Journal said:
“What is clear is that the UK’s response so far has neither been well prepared nor remotely adequate … Above all, the response to covid-19 is not about flattening epidemic curves, modelling, or epidemiology. It is about protecting lives and communities most obviously at risk in our unequal society.”
We agree.
I echo the points made by the noble Baroness, Lady Thornton, about the acceptance, at last, by the Government of a third symptom, anosmia, but many other countries have more symptoms. France says that you should self-isolate if you have any symptom on a list of 10. Why do our Government still refuse to increase that list?
The Secretary of State has repeated his claim that he has prioritised testing in care homes, yet he still repeats that testing for everyone in care homes, whether staff or residents, will be only “offered” by 6 June. The Adult Social Care APPG is still hearing of care homes waiting for that “offer” of tests, and of others that have had tests but results still going astray or taking 10 to 14 days to be returned. On that basis, if Ministers are really prioritising care homes, why does the Statement announce testing for members of the public over the age of five now while people at the heart of the firestorm of Covid in care homes still have to wait up to two weeks before being offered a test?
Still on testing, can the Minister tell us the percentage breakdown of PCR testing results versus antibody testing results? If not, can he tell the House when this information will be publicly available? We need as many PCR tests as possible as part of an effective test, trace and isolate programme. How many of those carrying out testing are paid roles versus volunteers? A couple of weeks ago, the Minister told your Lordships’ House that testing would be extended through, among other things, a deal with Boots. Five days ago, Boots had an advertisement seeking volunteer testers taken down after public outrage that a company that had been given a commercial contract with the Government was relying on volunteers to carry out the work. Was using volunteers part of its tender to government? If so, does the Minister approve of companies using volunteers while pocketing public money in a contract?
On tracing, it is encouraging to hear that more than 21,000 tracers have been recruited, but today there are reports of people recruited receiving multiple emails congratulating them on being successful or attending online training that has completely fallen over and failed technically. Can the Minister say what percentage of those 21,000 have received full training and are now working as tracers? Last week, the Secretary of State said that local tracers would be used, whether local health or environmental health tracers, as well as central ones. Can the Minister say how many local tracers—that is, not Serco call-centre tracers or central NHS tracers—there will be from the 21,000?
The Statement asserts that the Government now have all the elements to roll out their scheme of test, track and trace, but I repeat that there is no focus on isolation for those who have to quarantine. Test, trace and isolate is used not just by the WHO but by many countries. What plans are in place to support people isolating, whether at home or in a quarantine unit, once lockdown is lifted? They will feel much more vulnerable at that point, when everyone else is moving back into their normal lives. Experience from Taiwan, Germany and South Korea shows that community health support for those in quarantine is more likely to make it successful. Again, countries that have been successful in containing the virus all had fully operational test, trace and isolate programmes up and running from day one. Given that each new venture the Government have undertaken during this crisis, as outlined in the BMJ article—from expanding PCR tests from a low base to manufacturing ventilators, supplying PPE and now the tracer app—has had a very problematic start, to put it kindly, are the Government starting to run full contact tracing now, using new staff in an area that has sufficient cases of coronavirus, before lockdown starts to be lifted but particularly by 1 June? It would be inappropriate for schools to return and people further to return to work without such a system in place.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I thank the noble Baronesses for their penetrating and searching questions. I will go through them systematically.
First, I want to say a few words, partly in response to the appeal for transparency from the noble Baroness, Lady Thornton, and partly in response to some of the suggestions about the performance of the Government in their response to Covid. I assure the House that the Government approach this epidemic in a spirit of openness and transparency, and we would like to work in partnership with other parties. I simply reject the suggestion, consistent in some of the questions, that the projects undertaken by the Government have in any way been characterised by failure or disappointment.
I bear testimony to the huge achievements of those who have worked extremely hard to throw up remarkable schemes which have been enormously successful and massively mitigated the effect of this disease. The testing network, the ventilators, the lighthouse labs and the nightingale hospitals were all hugely ambitious ventures, greeted with scepticism when launched and accompanied by complaints while being thrown up. But their achievements have been enormous: they have had a huge impact.
I would therefore like to turn around the tone of this debate, to be a little more positive, and celebrate the huge achievements of those who have thrown their heart and soul into the response to coronavirus. I pay tribute to their achievements and to the personal sacrifices many of them have made by giving up their time, and even putting their lives at risk, to conduct these important roles.
Quite reasonably, both noble Baronesses asked whether the Government regard isolation as part of the programme. I can reassure them that isolation is absolutely the key point. The way to stop transmission is for those who have symptoms, and especially those who have tested positive, to shield themselves from the rest of society in order to prevent the spread of the disease. Everything that we do in the test and trace programme is ultimately to promote good behaviours by the British public, so that people who have symptoms will distance themselves from the rest of society, putting a brake on the disease. It is absolutely imperative, and at the heart of all our communications.
I pay tribute to the British public, who have made huge personal sacrifices during this lockdown. The culture of isolation will be an essential part of keeping a lid on the disease. The Government are committed to providing mental health support, and practical and cultural support, for those who are in a state of isolation. I thank both noble Baronesses for throwing a spotlight on that.
I want to convey to the House the enormous complexity of identifying the key symptoms of this disease. By any common sense, it would seem incredibly obvious how to spot Covid, but I have sat in numerous meetings running through the data and know how difficult it is to have a consistent set of symptoms that can be understood clearly and communicated simply to the public. The data on this disease is extremely complex. As I have said to the House before, this disease is a very difficult adversary, as characterised by the way in which symptom checking is so difficult. We have moved to a new and upgraded set of symptoms, and we may well have to move again. However, we are seeking to encourage absolutely anyone who has any symptoms to declare them and seek a test.
Perhaps I may move quickly through the questions put by the noble Baroness, Lady Thornton. I reassure her that the NHSX app is very much part of our plans. The Isle of Wight programme has been enormously successful and take-up rates have been huge. But it did teach us one important lesson: that people wanted to engage with human contact tracing first, and quite reasonably regarded the app as a supplementary and additional automated means of contact tracing. We have therefore changed the emphasis of our communications and plans to put human contact tracing at the beginning of our plans and to regard the app as something that will come later in support.
I reassure the noble Baroness that the testing of NHS and care staff is an absolute priority. Testing by the NHS of both groups is well under way. As announced by the Secretary of State, we are looking carefully at bringing in antibody testing to answer the question from staff who may query whether they have had the disease in the past, and to understand better what the role of immunity might be. The science is not firm; the lessons are not clear; but we need to understand the role of antibody testing and find out how it can help us combat this disease.
I advise the noble Baroness, Lady Thornton, to be very wary of private tests. They vary enormously in quality, as I know through my own experience. The time after having the disease when you take the test impacts enormously on the test and the assumptions one can make about a positive test are not proven. You cannot currently share with an employer any impression that you might have immunity, on the basis of a test.
I reassure both the noble Baronesses that our involvement with local groups in the tracing operation is being energetically promoted. We have appointed Tom Riordan, the chief executive of Leeds City Council, to lead this part of the programme. He is running an excellent programme to work with local authorities, directors of public health, environmental health officers and local resilience forums to ensure that our tracing system is as local as it possibly can be. It cannot all be done locally: some of it is better done digitally, and the highly automated routines of the app are very good. Some of it must be done at scale on a national basis by the massive call centres that we are throwing up, but some of it is best done by local groups. Those processes are being put in place energetically and I thank GPs, local directors of public health and all those who are engaged in them. We will be putting together local Covid plans that will be implemented by the relevant local authorities. These will form an important part of keeping a lid on this contagion.
I also pay tribute to those who are helping to organise the major test centres, including Serco, and those who have stepped up to take roles as contact tracers. They are going through complex training at the moment; it is a challenging task. No one wants to hit the phone and tell someone that they have to isolate; it is a tough message to have to deliver. I have no doubt that there will be problems with this complex and difficult task, but I pay tribute to those involved and express my gratitude to those running the programme.
On care homes, as the noble Baroness, Lady Thornton, rightly described, every death is a source of great sadness. However, I pay tribute to all those who have put their safety on the line by delivering tests in care homes. I reassure the noble Baroness, Lady Brinton, that there is a website where any care home that wants a test can register their interest and get a response promptly. Any care home worker who wants an individual test can access a site where, as a key worker, their test will be prioritised. There should be no reason why any care home or care home worker should wait two weeks, as suggested in the question.
I put my hand up and explained that mistakes were made 10 days ago when, due to problems with our Northern Irish test laboratory, some care home tests were either delayed or voided. That was an enormously regretful situation, but, when you put together an operation of this scale at such pace, some mistakes will be made. We have done an enormous amount to rectify those mistakes. Bringing in the noble Baroness, Lady Harding, to run the operational side of our testing regime is a great step forward.
I will also say a word in defence of the volunteers who are working at our drive-in test centres. These are often furloughed workers who do not need paid employment, but they are spending their time usefully and are often committed and have a sense of public service. I bridle at the thought that they would be sneered at or in any way insulted. The role of Boots in recruiting them is entirely honourable, legal and appropriate for the times we are in, and I very much thank those volunteers who have dedicated their time and risked their personal safety to do this difficult and possibly risky job. It is not appropriate to suggest that there has been public outrage at this arrangement—quite the opposite. The British public support this kind of individual public service.
The recruitment of tracers is going extremely well indeed: 21,000 have been put in place, which is way beyond our initial expectations, and the training is going well.
This programme is developing very quickly. We will seek to make announcements about it later this week and there will be a further rollout next week. I am extremely proud of the achievements that we have made, and I thank everyone who is involved very much indeed.
The Deputy Speaker (Lord Faulkner of Worcester) (Lab)
My Lords, we now come to the 30 minutes allocated for Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of speakers.
Lord Bethell
My Lords, as I stated this morning, I would be glad to meet with community leaders. However, I emphasise, as I said this morning, that it is the disease that is racist, and the Government and the NHS are doing an enormous amount to try to protect BAME workers, to whom we owe a huge debt of gratitude. I will do everything I can to help protect them.
Lord Balfe (Con)
My Lords, this morning, the ONS revealed that some 50,000 UK citizens are cross-border workers—in other words, English people who work part of the time outside the UK. Roughly 25,000 appear to be businessmen. There is no evidence that they are carriers; there is every evidence that when they fly back or come back on the Eurostar, they would be happy to be tested. The government proposals to suddenly clamp down on this and basically stop international business happening are not welcome and will do enormous damage to the British economy. Can the Minister try to influence his colleagues in transport to the effect that this development is not needed?
Lord Bethell
My Lords, I pay tribute to my noble friend’s commitment to freedom of travel—and he will remember my father’s own commitment to it. The sad truth, however, is that it is very difficult to prove a negative: to prove that someone does not have the disease or that they have not recently become infected and have the disease in a latent way or that they are young, fit and well. The restrictions are in place for those reasons. I advise my noble friend that we are working on finding a solution, but none is immediately available.
Baroness Jolly (LD)
My Lords, with many GP appointments now held online, the public are going to their local pharmacies for advice as never before. Pharmacies have received from the department little or no support with reconfiguring their premises, many have had no support sourcing PPE and staff are not automatically considered for routine testing. Have the Government forgotten the pharmacy profession? Will additional support be made available to our high street pharmacies as they continue to serve patients throughout the Covid-19 pandemic?
Lord Bethell
The noble Baroness is entirely right: this epidemic has demonstrated, if it needed to be demonstrated at all, the key role that pharmacists play in the health of the nation. I pay tribute to the role of pharmacists in providing support and filling the gap after GPs’ surgeries have closed. I reject, however, the idea that they have had no support. PPE has been provided, any pharmacist is prioritised as a key worker, and we will continue to offer support and to help grow this valuable sector.
Lord Hope of Craighead (CB)
My Lords, is there not a danger of sending out mixed messages? The Statement begins by celebrating what has been achieved together by flattening the curve, but the devolved nations in the UK are still behind the flattening of the curve achieved in London. It then says that, thanks to the resolve and shared sacrifice of the British people,
“we are now in the second phase of this fight.”
This is not so in Scotland, where I live. We are still firmly in lockdown and likely to remain so until June. Should those who prepare these Statements not be a bit more careful in their choice of language? Is there not a risk to those who live in Wales and Scotland if people who live in England are misled into believing that those other parts of Great Britain are in the second phase of the fight too?
Lord Bethell
I first pay tribute to the devolved nations for working so closely together, as characterised by the very close work of the four CMOs. The noble and learned Lord is entirely right that different parts of the country move at different paces—the disease does not respect national boundaries in any way—but public health messages have to be clear to be effective. It is difficult to speak in terms of one region or another being in different phases of the disease, but I completely accept his point that local variations may well be necessary. When they are, and if it is possible, we will have to shape our communications to that cause.
Baroness Crawley (Lab)
My Lords, if, as the Statement says, we in England are now in the second phase of the fight against coronavirus, and given the need to turn our attention to the huge backlog of operations and procedures for those non-Covid NHS patients on waiting lists, will the Minister inform the House if and when NHS England will renew its current important contract for capacity and diagnostics with independent hospitals? I understand that the contract is coming to a close at the end of June.
Lord Bethell
The noble Baroness is entirely right: the backlog of operations and procedures will be a daunting task for the NHS to tackle. We have prioritised it. Simon Stevens has told the NHS to throw the doors open to try to get through this backlog. As a result, we will live with the effects of Covid for months to come. I am not fully aware of the contract of which she speaks, but I will try to find out its status and will write to her with additional information.
Baroness Meacher (CB)
My Lords, I thank the Minister for his helpful responses so far. The UK had just under 50,000 excess deaths in less than six weeks from 20 March. Does the Minister agree that the NHS was overrun at that time and had the unbearable choice either to let Covid-19 patients die or to deny treatment to patients with life-threatening illnesses such as cancer and kidney failure? Were we unable to make extensive use of the Nightingale hospitals to save lives due to staff shortages or for some other reason? I would be grateful for the Minister’s response.
Lord Bethell
I am extremely grateful for the noble Baroness’s comments. Since she asks for my personal opinion, I would say that, no, the NHS was not overrun. It has been a huge achievement that the NHS has stood firm on its feet. Operationally, it has been extremely sound. It was never overwhelmed, either by Covid-19 or by other operations. The Nightingale hospitals were not needed in the end because the lockdown was adopted by the British public and the infection rate was reduced. That is a huge testimony both to the British people and to the NHS.
Baroness Ludford (LD)
When the Health Secretary told the other place yesterday that he was preparing to roll out his contact-tracing app, he rejected the plea from my colleague, Daisy Cooper MP, for a law providing for specific, rigorous safeguards. When does the Minister expect to get the response from the Information Commissioner on the data protection impact assessment for the app, which has been judged by privacy experts to be confusing and misleading?
Lord Bethell
The noble Baroness raised the data protection impact statement, which I have read. I did not find it confusing; I thought it was extremely straightforward and it has been welcomed by a large number of the privacy groups I have spoken to.
Baroness Bennett of Manor Castle (GP)
A few minutes ago, responding to the Front-Bench questions the Minister said that the heart of the Government’s message was that
“people who have symptoms must isolate themselves”.
How does the Minister square this with what he said to me last Thursday? He said:
“No one working in the NHS should go to work if they feel ill or have a temperature”
but that this
“is not necessarily true for people who work in normal workplaces.”—[Official Report, 14/5/20; col. 806.]
We were of course at that point talking about care homes. If we look at the Government’s launch last Tuesday for the document Our Plan to Rebuild, this says:
“If a negative test is returned, then isolation is no longer required.”
If the Government’s position has changed, should this not be made clear to the public?
Lord Bethell
The noble Baroness undoubtedly knows that anyone who is ill with anything whatever should not go to a hospital. Being ill is not the same as having the symptoms of Covid-19. Anyone who has the symptoms of Covid-19 should isolate immediately.
The Earl of Clancarty (CB)
My Lords, what support is the Department for Health and Social Care giving schools in the provision of the PPE needed before schools open?
Lord Bethell
It is the responsibility of the Department for Education to provide schools with PPE.
Lord Truscott (Ind Lab)
My Lords, I find the Government’s Statement very complacent. Sadly, for many in care homes, these initiatives have come too late. I have three questions for the Minister. Given the increasing disquiet over Her Majesty’s Government’s response to Covid-19, will the Minister commit to a public inquiry on the part of the Government?
I return to two other questions asked earlier, which the Minister did not answer. When will the proposed testing, tracking and tracing system go live? Lastly, are the 21,000 contact tracers sufficiently trained in his view?
Lord Bethell
It will be for others to decide whether an inquiry is necessary. For my part, I am enormously proud of the Government’s response and the NHS’s response to Covid-19, and I stand full square behind the decisions and actions we have taken.
Lord McConnell of Glenscorrodale (Lab)
My Lords, I welcome the fact that in the Statement it is clear that the Chief Medical Officers of the four nations of the United Kingdom agreed jointly to amend the identifiable symptoms for Covid-19. That stands in stark contrast to the mixed messaging of the weekend of 10 May and the days thereafter. What action have the Government taken since 10 May to ensure that the next round of announcements by the Prime Minister and the three First Ministers are more coherent and better co-ordinated in the interests of not only a clear public health message across the United Kingdom but the economic recovery that we will need in all four nations afterwards?
Lord Bethell
My Lords, we work extremely closely with the devolved Assemblies, the four CMOs and the four nations to have a consistent four-nations approach to Covid. We very much welcome Nicola Sturgeon’s support for this consistent approach.
The Earl of Erroll (CB)
How are vaccines going to work if, as the Government say, the presence of Covid-19 antibodies in a test do not mean that a person is immune? I think that quite a few people are confused.
Lord Bethell
My Lords, the noble Earl is stretching my scientific knowledge with his question. All I can say is that different vaccines work in different ways. Anyone with antibodies who has beaten the disease has the capability of beating the disease, but vaccines ensure that that capability lasts longer, hopefully for life.
Lord Rennard (LD)
My Lords, does the Minister listen to the excellent BBC Radio 4 programme “More or Less”? If so, he may have heard the total demolition of the claim that 100,000 tests were being conducted each day by the end of April. Much doubt has also been cast on claims that care homes were always included in government figures. Trust in government is vital at the moment, so does the Minister think that a body such as the Office for National Statistics should be given the role of vetting figures that are quoted in the daily Downing Street press conferences?
Lord Bethell
My Lords, I do listen to “More or Less”. I absolutely love it, and it is a shame that I did not hear the episode to which the noble Lord refers because I would have reprimanded them greatly. The 100,000 tests a day are done very clearly. I would be glad to take the noble Lord, Lord Rennard, to visit our Lighthouse Labs to see the remarkable automation and robotics that achieve that remarkable effect. On the care home figures, we work hard in order to create prompt, immediate, daily figures. Those are then verified and put into the official national figures that are curated by the ONS. Having operational figures that are delivered quickly is important for decision-making. Having figures officially verified by the ONS to audit those results is an entirely appropriate way of doing things. It is a system that works, and we currently have no intention to change it.
Baroness Ritchie of Downpatrick (Non-Afl)
Is the Minister confident that the public health surveillance system in the UK is able to detect and manage cases and their contacts and identify at-risk cases—that is, test, track and trace?
Lord Bethell
I am afraid I did not hear the full question from the noble Baroness, but if I understood her correctly, she referred to track and trace. I reassure her that we are putting a huge amount of resources into that surveillance. It is true that surveillance does not currently exist. We do not have the facilities that some Asian countries, such as Taiwan and South Korea, had following SARS, about which we now know so much. We are putting the correct resources in place, and we hope very much to have a detailed local and demographic understanding of where and how the disease is progressing. That information is essential to beating it.
Baroness Bull (CB)
My Lords, many people in learning disability care services have very complex care needs that make them vulnerable to Covid-19. Indeed, recent numbers from the CQC showed that the provisional number of deaths reported across all settings where autistic people and/or people with learning disabilities may live was 175% greater than expected over the month from 10 April. When will the welcome extension of testing to all care settings announced today roll out? Can he confirm that regular testing will be available, given the potential of the virus to be spread between care homes by so-called bank staff filling temporary vacancies?
Lord Bethell
The noble Baroness is entirely right that the deaths of those with learning difficulties have been one of the most disturbing and sad aspects of this disease. We are focused very much on ensuring that we protect those with learning difficulties, such as those with autism, in whatever way we can. With regard to recurrent testing, the tests that we have are not a limitless resource and we have to prioritise them. Although we have massively increased the number of tests that we have, it is not possible to test millions of people on a very regular basis with hundreds of thousands of tests. However, we are using them intelligently and prioritising areas where there are infection control problems. We believe that that is the most effective way of using our resources.
Lord Campbell-Savours (Lab)
I want to return to the issue of face masks, which I have been raising with the Minister since early March. Are Ministers following the intense debate going on among a worldwide line-up of international experts, particularly virologists, who forcefully argue the need for their use? If Ministers are not, will they now ask their civil servants to dig out the hundreds if not thousands of articles and research papers written by those experts, which have convinced over 50 countries worldwide to introduce face masks on a mandatory basis? The position that we are taking looks increasingly ludicrous.
Lord Bethell
I reassure the noble Lord that we look at this issue constantly. It is a subject that the British public are deeply concerned about. There is an instinctive human belief that face masks make a difference, but the scientific proof that they do so is not crystal clear. Although some countries have committed to them, we are still in the process of reviewing them. We have a positive attitude towards implementation but we are guided by the CMO and by scientists. As the evidence builds up, and the noble Lord is quite right that in many places it is indeed building up, we will make the right decision on face masks.
The Deputy Speaker
I call the noble Lord, Lord Low of Dalston. I do not think he is on the call, so I call the noble Baroness, Lady Randerson.
Baroness Randerson (LD)
I have listened carefully to this debate, and the Minister seems to say in every answer how well the Government have done throughout this whole pandemic. If that is the case, how have we come to the point where well over 35,000 people have died? I invite the Minister to tell us now where the Government went wrong.
Lord Bethell
The noble Baroness is entirely reasonable. I apologise if I give the impression that I am in any way complacent or if I am unapologetic about what we have done. She is entirely right: this is an awful disease that has hit this country extremely hard and not everything we have done has worked as well as we had hoped. Undoubtedly, when we look back, it will be judged that the Government have made mistakes; of that I am absolutely sure. I approach this question with humility. I completely take on board her point that questions that resist the idea that we have made mistakes are quite wrong.
However, I want to try to convey the enormous commitment and focus that the Government, the NHS and the people who are involved in the greater project have thrown into this project. It is not a massive shambolic mess littered with political stupidity and corruption, as is implied by some of the critics of the Government. Actually it has been a venture that has had a huge amount of innovation, collaboration and good will behind it. I am afraid I cannot help but seek to salute and pay tribute to those who are involved.
Baroness Jones of Moulsecoomb (GP)
My colleague on the Isle of Wight, Vix Lowthion, tells me that the public there are not clear about the aims and objectives of the trial they are taking part in. Can the Minister tell me now what are the criteria for success of the Isle of Wight trial?
Lord Bethell
One of the criteria of success is to learn from the pilot, which takes an early version of the app and hopes to develop learnings from it; we now have two or three. One of them, which I have mentioned, is that it is probably a mistake to launch an app before you have got the public used to the idea of tracing. As I mentioned in an earlier answer, that is something we have taken on board. When it comes to launching the test and tracing programme, we will begin with the tracing, not with the app.
Lord Bilimoria (CB)
My Lords, the Minister said that isolation is essential for those who have symptoms. It was only yesterday that the Government finally included the loss of the senses of smell and taste as a symptom. I fell ill with coronavirus on 15 March and lost my senses of taste and smell. At the time, it was not an official symptom. I could not even get tested then—indeed, not even doctors and nurses could—yet the WHO has been saying since the middle of March that we should “Test, test, test”. Eventually we have come around to doing it now and we are ramping it up. As the noble Baroness, Lady Thornton, pointed out, the WHO said eight weeks ago that the loss of taste and smell should be considered a symptom. How many hundreds of thousands of people have now been infected and have infected others because this was not an official symptom? The WHO has also said that social distancing should be one metre, but we say two metres. Why are we not listening to the WHO, or only eventually listening to it? Why are there these inconsistencies?
Lord Bethell
I am very sorry that the noble Lord had coronavirus, and it is good to see him on such fine form and in characteristically enthusiastic shape. The bottom line is that lots of people do not lose their sense of smell or taste, and the addition of this symptom was delayed because we did not want to put off those who had not lost their sense of smell and taste from declaring their symptoms. The WHO is right about many things but not about everything.
Lord Liddle (Lab)
I thank the noble Lord, Lord Bethell, for the directness and frankness of his answers tonight, and I agree with his praise for the NHS workers and many others who have played such a valiant role in fighting this virus. However, does he not agree that, as time goes on, it is becoming clear that we have the highest number of deaths in Europe and that this gives a new and very tragic meaning to the concept of British exceptionalism? Does he not agree that there will have to be some kind of independent inquiry into where this all went wrong?
Lord Bethell
My Lords, the noble Lord is right. As a nation, we have been hit really hard by this disease and it is heart-breaking. I would have loved this country to have somehow dodged the bullet and not been the one that was hit so hard. We all feel it: we feel a great sense of responsibility and a great sense of sadness that so many lives have been lost, and that there are so many for whom the result of having had the disease and survived will be life changing. One thing that we have learned is that this disease hits you really hard and some people will never fully recover from it. However, I cannot help but pay tribute to those involved.
I do not know why we have been hit so hard. I do not know whether it is due to British behaviours and the fact that we have obesity in this country. I do not know whether it is because we are such an international country with such a large number of people coming to and fro, particularly from China. I do not know whether the Government made massive and colossal mistakes, as their critics suggest, and whether we got it all completely wrong. All I know is that the response to this disease by the British public, the NHS and the Government has not lacked energy, innovation and enthusiasm, and I stand here at this virtual Dispatch Box extremely proud of our country and of the people who have played a role in the response to this disease.
Baroness Wheatcroft (Non-Afl)
My Lords, the public might find it easier to stick within the rules now governing our life with coronavirus if they understood the logic. Therefore, can the Minister explain the logic or the science behind the fact that a household consisting of my son, his wife and their daughter can meet with only one member of a household consisting of his father and his mother at any one time?
Lord Bethell
It is very simple. If you have one person from another household meeting your household, the chances are that you will all respect the two-metre social distancing recommendation. The moment a second person is present, the proximity gauges and the way in which you all relate to each other become confused. You all start standing nearer to, and breathing all over, each other, and it becomes easier to catch the disease. That is just a simple human observation and is based on human nature and on the physical science of proximity. The example that the noble Baroness gives is a really good one, and I completely feel her frustration that her two families cannot spend time together. However, the behavioural scientists are absolutely adamant on this point, and to me at least it is common sense.
The Deputy Speaker
My Lords, I apologise to the noble Baroness, Lady Coussins, who is the only speaker whom we were not able to call within the 30 minutes. The time allotted for the Statement is now up. The day’s Virtual Proceedings are now complete and are adjourned.
Covid-19: NHS Contact Tracing App
Lord Bethell Excerpts(3 years, 11 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, we have put privacy at the heart of the app and how it works so that you do not need to give your personal details to use it. We have worked in partnership throughout with the National Cyber Security Centre and the Information Commissioner’s Office. The science around immunity is currently uncertain and there are a number of issues that we need to address to understand potential certification.
Baroness Jones of Moulsecoomb (GP)
I thank the Minister for his response but that is certainly not the information that I am getting from other places. A Dr de Montjoye from Imperial College’s department of computing has written a paper in which he says that, if the Government are to use this app properly, it is very important that they are transparent about it. Can the Minister commit the Government to transparency about whichever app they use?
Lord Bethell
Professor de Montjoye is entirely right that transparency is key. That is why we have published the open source code for our app, as well as a PPIA privacy notice, and blogs setting out the approach that we are taking. We will continue to go about our business in a transparent way.
The Lord Bishop of Portsmouth
My Lords, the Minister has reminded the House that tens of thousands of people on the Isle of Wight have downloaded and used the app. People of the island often feel—with, I regret, some justification—that they are considered last if at all. Now, despite the questions about privacy, effectiveness and rollout, they have been the first to step up and make a significant contribution to the nation’s common good. Will he undertake to look at how their service might be recognised?
Lord Bethell
My Lords, where the Isle of Wight leads, the country follows. We are enormously grateful to islanders for taking this pilot on board with energy and enthusiasm. I would like to consider ways of recognising that. One important lesson that we have learned from the island project is that the human touch of contact tracing is incredibly important and we will be implementing that at later stages.
Lord Arbuthnot of Edrom (Con)
My Lords, I declare my interest as chairman of the Information Assurance Advisory Council. In normal times, the cybersecurity advice that we would all give would be to keep the Bluetooth on our mobile telephones switched off unless and until we need it in a private setting. But these are not normal times. What advice would my noble friend the Minister give to help us protect ourselves while using this app?
Lord Bethell
My Lords, the Bluetooth used by the app is the latent Bluetooth, which does not need to be turned on and off. Our advice is for everyone to ensure that they keep their Bluetooth on. In fact, we will be issuing specific advice to doctors and other health workers who spend a lot of time in each other’s company, to ensure that the app does not create erroneous data.
The Earl of Clancarty (CB)
Does the Minister agree that immunity or health certificates have the potential to be socially divisive and foster prejudice if they were valued by employers? Why else would you want them? They would also implicitly endorse the Government’s original, much vilified, herd immunity policy. They are a terrible idea and the Government would be wise not to go down this road.
Lord Bethell
My Lords, I completely hear the noble Earl’s reservations about certification. Our plans are in development. We are fully aware of the concerns that he has expressed about their potentially divisive nature, but the public deserve to know whether they have had the disease. We have to use whatever technology we can to help shake off the economic and social effects of this virus. Therefore, we retain an open mind on the use of certification.
Lord Reid of Cardowan (Lab)
Does the Minister accept that the proposed tracking app we are discussing will effectively exclude those who do not have a smartphone or the experience, knowledge or capability to operate apps or Bluetooth? That will disproportionately exclude the elderly, the poor and the disadvantaged—exactly the groups most at risk from Covid-19. What plans do the Government have to include this group in any future tracking and testing regime?
Lord Bethell
My Lords, the testing and tracing regime depends on three legs: access to tests; updated methods of the classic contact tracing run by individuals, using phones and the internet; and lastly, importantly but not exclusively, the NHS app. We are very much focused on ensuring that the vulnerable, the elderly and the digitally poor are in no way excluded, which is why we have put the human element at the centre of our plans.
Lord Scriven (LD)
Will the Minister give a cast-iron guarantee that, as the app evolves, it will not use location tracking or seek personal identification information as a condition of use?
Lord Bethell
My Lords, we have no current plans for using geolocation information. However, we have an open mind on options for users being able to share data of several different kinds, and we are open to the idea of consumers making those choices.
Lord Balfe (Con)
I want to ask the Minister about the immunity certificates. At the moment, as I understand it, medical science does not tell you whether you are immune. It can tell you whether you have had it, but surely we do not yet know whether Covid mutates. So how can you issue an immunity certificate, and, importantly, how can you make sure that it is not forged?
Lord Bethell
My noble friend is entirely right. The science on immunity is confounding and we do not fully understand it, although we are investing a huge amount of time, money and effort into understanding it better. We believe that there may be an opportunity to understand immunity better, and that will inform and make safe people’s commitment to going back to work. No decisions have been made yet, though, and we have in our minds all the reservations that my noble friend described.
Baroness Falkner of Margravine (Non-Afl)
Given what we know about the NHS app, I have to say that my greater concern would be about the data held by Amazon or Google, rather than by the NHS. Does the Minister accept that the countries implementing track and trace, particularly those in the EU, are all countries that have an ongoing system, decades-old, of using ID cards? Would the Government consider the fact that trust in government in those countries, even privacy-obsessed Germany, is higher due to the state having held data, not centrally but in some form, through an ID card system? Maybe they should look at that.
Lord Bethell
My Lords, ID cards do not form part of the British tradition. We work on a system of consent and we have a very high level of trust in the Government. The app is particularly well suited to a country that has a universal NHS system, and that is one reason why we have designed it in the way that we have.
Baroness Thornton (Lab)
Can the Minister confirm that the national rollout of the NHSX app has now been delayed until June? Does he share my concern that a government spokesperson has said that it is possible for the test and track system to work without an app, and for the lockdown to be relaxed further without a system operating at all? This is deeply worrying, given that the Government have admitted that they should never have stopped track and trace in the early stages of the pandemic and now appear to be reneging on a commitment to make it a priority.
Lord Bethell
My Lords, it is entirely right that test and trace does not need a digital app to be effective. I reassure the House that prevalence levels are reducing across the country, as is the infection rate. It is only because prevalence and infection are reducing to manageable levels that we can even consider reducing the lockdown and maintaining pressure on infection through test and trace. The app brings many benefits of being able to automate millions of transactions a day, but it is not intrinsically necessary, and we believe that it would benefit from being introduced later, rather than earlier, than human-based tracing mechanisms.
Lord Randall of Uxbridge (Con)
My Lords, what discussions has my noble friend’s department had with other Governments around the world, and what lessons can be drawn from their experience of such apps?
Lord Bethell
My Lords, we are in discussions with many other Governments—those in the east, which have a tradition of these apps, and fellow travellers like ourselves. It is a highly technical and difficult area; Britain is leading the way in many ways and we have learned an enormous amount. I have personally spoken to the Taiwanese Government, who have taught me an enormous amount, and those conversations continue regularly.
The Lord Speaker (Lord Fowler)
My Lords, the time allowed for this Question has elapsed. It is worth noting that, in the whole Proceeding, we excluded only two possible questioners, so apologies to them. I thank your Lordships. That concludes the Virtual Proceedings on Oral Questions. Virtual Proceedings will resume at 3.30 pm for a Private Notice Question on post-Brexit customs arrangements in Northern Ireland.
Draft Human Tissue (Permitted Material: Exceptions) (England) Regulations 2020
Lord Bethell Excerpts(3 years, 11 months ago)
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Lord Bethell
That the Virtual Proceedings do consider the draft Human Tissue (Permitted Material: Exceptions) (England) Regulations 2020.
Relevant document: Special attention drawn to the instrument by the Secondary Legislation Scrutiny Committee, 8th Report
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, before I explain the draft regulations I will say a few words about our motivation to change the law for organ donation. Currently over 5,200 people in England are waiting for a transplant. By the time a suitable organ is found, some people will be too ill to receive one. Last year alone, 777 patients were removed from the transplant list and a further 400 died while on the active list waiting for a transplant.
It was therefore clear to us that we had to take decisive action to address the acute shortage of organs and help those whose lives were on hold waiting for a transplant. That is why we passed the Organ Donation (Deemed Consent) Act 2019 last year. The Act amends the Human Tissue Act 2004 and sets up the new system of consent for organ and tissue donation in England known as “deemed consent” or “opt-out”.
Subject to approval of these regulations, we aim for deemed consent to become legal on 20 May. While not many transplants were taking place earlier during the peak of Covid-19, NHS Blood and Transplant has already started the recovery process to get transplant units up and running as much as possible. To illustrate the progress we are making I can say that, on a normal day, NHSBT would receive around 55 referrals of a potential donor, aim for five actual donors and carry out 70 transplants a week. During the peak of the pandemic, there were days when there were no referrals, many days when there were no donors and many days when there were no transplants. As of last week, there have been 167 referrals, 11 donors and 38 transplants. I salute those in the NHS blood transfusion service who have worked so hard to save some lives and improve others.
Continuing the tremendous effort to restore all transplant services will include training nurses on the new law as soon as possible after they return. This will allow us to reap the benefits of the deemed consent legislation when it is safe again. I understand that some have disagreed with the approach, but I reassure the House that we made a detailed assessment of the options in front of us before taking the decision to restart donations on this new basis. This horrific pandemic has taught us a lot about how precious human life is. We know that the fight against this disease will continue for some time, while thousands of people are waiting for a transplant. I therefore believe very strongly that we have a duty, now more than ever, to push ahead with measures which will reduce human suffering and help to improve people’s lives. That is exactly what this law does.
We are of course fully aware that public confidence is important. The deemed consent legislation was first introduced in July 2017 and became law in March 2019. It has therefore had a long process of parliamentary scrutiny, alongside three public consultations. The Government have been raising awareness of the law and the choices available for over a year, and the implementation date of 20 May has been used actively in communications since late February. Putting this legislation on hold would only increase the anxiety of the thousands of people who see this law as their only hope to get a new lease of life, and would confuse the communications which have already been in the public domain for some time.
From the outset, we have been clear that deemed consent would apply only to routine transplants, to increase the number of organs and tissues available and help those on waiting lists. Examples of routine transplants are hearts, kidneys and lungs. Novel transplants would still require express consent. The organs and tissues specified in the regulations are included because they could be used for non-routine transplants—for example, a face transplant. Such transplants are outside the scope of what we want to achieve. The demand for novel transplants is very low, and people would not normally identify organ donation with them.
During formal scrutiny of the regulations, the Joint Committee on Statutory Instruments cleared them with no comments. Meanwhile, the Secondary Legislation Scrutiny Committee drew the regulations to the attention of the House. This is testament to how integral the regulations are for making the new system of consent work, and to how important the law change will be when it is introduced.
Let me now deal with the detail of the regulations. The Organ Donation (Deemed Consent) Act 2019 sets out that deemed consent to transplantation activities in England will apply only to “permitted material”. The Secretary of State has a delegated power to specify in regulations what “relevant material”—human organs, tissue and cells—will be excluded from the system of deemed consent. To be clear, I say that the organs, tissues and specific cells listed in the draft statutory instrument are organs, tissues and cells which cannot be transplanted without express consent being in place, as that would be a novel transplant.
Regulation 2(2) sets out the detailed list of organs and tissues which will require express consent in order to be transplanted under all circumstances: for example, the brain, spinal cord and face. As a result of our consultation, we expanded the list of reproductive organs and tissues in this regulation to provide clarity and to put beyond doubt that removing any parts of the reproductive organ will require express consent in all cases. As I mentioned, this is to make sure that if and when such transplants are carried out in the UK, they will be outside the scope of deemed consent.
Regulation 2(3) sets out that some relevant material —for example, skin and bone—will require express consent if used for a novel transplant but not if used for a routine transplant. This is to ensure that current practices for tissue donation—where, for example, tissue from a leg is removed routinely—are not disrupted by deemed consent. So while a leg transplant would require express consent, if only the skin from the leg is taken, deemed consent may apply. However, if tissue is required from reproductive organs, this will always require express consent. This is to address feedback from our consultation.
Regulation 2(4) allows for the trachea to be removed under deemed consent when it is attached to the lungs. This will allow routine heart and lung transplants, which also require the trachea to be removed with the heart and lungs, to continue under deemed consent. To clarify, however, the trachea is also listed in Regulation 2(2), as trachea transplants by themselves are novel and therefore excluded from deemed consent.
Regulation 2(5) excludes the removal of certain cells if they are to be used for an advanced therapy medicinal product, known as an ATMP. ATMPs are therapies made from tissues, cells or genes after manipulation in a laboratory. They are used for treatment of a disease or injury and often use human cells and tissues as starting materials. For example, an ATMP can treat knee damage by taking cartilage cells from a living patient, growing and modifying them in the lab, and reinjecting them into the patient’s knee. ATMPs are an exciting technology and new therapies are being developed all the time. Current ATMPs are being developed using tissues and cells taken from living donors, but it is also possible to use material from deceased donors to develop novel ATMPs. As these ATMPs are novel, we want to make sure that donation of these cells cannot happen without express consent being in place. Our consultation raised questions around the public’s understanding of these novel technologies and we therefore want to ensure that express consent is required.
Now that I have set out the detail of the regulations, I must highlight that, before deciding whether a change to the regulation is needed in the future, the Government would need to consider issues around evidence, public acceptability and clinical need. Any changes would need to be approved by Parliament following the same procedure as now; therefore, Parliament will have full oversight.
Because the regulations restrict deemed consent to routine transplants and they therefore continue current practice, where express consent needs to be in place for non-routine transplants there will be no additional cost to the health system, and therefore no impact assessment has been prepared.
By way of a conclusion, I am pleased that I am able to present these regulations to the House. They are an important part of the implementation of the Organ Donation (Deemed Consent) Act 2019, as they prevent deemed consent from applying to novel transplants. The new system of consent is expected to save and improve the lives of many people waiting for a life-saving or life-enhancing transplant. I am proud that all of us here have played a role in making something so positive in these challenging times. Many of your Lordships will know of Jim Lynskey, a high-profile campaigner who, through his own charity, Save9Lives, campaigned for the law change but sadly died at the age of 23 before seeing this law become a reality. I know that his twin sister Grace has continued to campaign. We owe it to Jim, Grace and many others to embrace the opportunities of deemed consent and save more lives. I commend the draft regulations to the House.
Lord Bethell
My Lords, this has been an excellent and wide-ranging debate. I welcome the moving and constructive contributions. We are committed to restoring transplant services as soon as possible and reaping the benefits of this excellent legislation. The statistics that I presented earlier are a ray of sunshine at a difficult time.
The noble Lord, Lord Hunt of Kings Heath, put it all very well: there are thousands of people up and down the country who are in desperate need of a transplant. While Covid-19 has completely stopped services in some countries, in Britain we have been able to continue with very urgent transplants, which is a testament to the great work of NHS Blood and Transplant and NHS England.
We now want to go further and take something positive from this horrible pandemic, which has been a stark reminder of how fragile life really is. We must take the chance offered by this excellent law to save lives. I thank the noble Lord, Lord Hunt, for his excellent contribution last year, as the noble Baroness, Lady Thornton, rightly reminded us all, in taking the Bill forward in the first place. He has shown remarkable commitment in following up this important cause and I reassure him that we will make sure that resources are in place to make this policy a success.
On marketing, I reassure the noble Lord, Lord Oates, and the noble Baroness, Lady Thornton, that we will pick up the campaign that was delayed at the beginning of the Covid-19 epidemic. We have every hope that it will cut through. As the noble Baroness, Lady Barker, rightly said, this campaign will target BAME audiences, who are often underrepresented among donors and often cannot find the match that they seek. In 2018, my department launched a campaign to address the myths and barriers, and to create a culture of normality around organ donation. This included funding of £140,000 for the community investment scheme for grass-roots projects. We invested a further £280,000 in 2019 and this work will now pick up again. I reassure the noble Lord, Lord Naseby, that, according to a survey by NHS Blood and Transplant, 58% of people are already aware of this change in the law and, with our marketing, this percentage will keep rising.
Noble Lords also raised the important issue of equality for those waiting for a transplant. Our aim is to help with health inequalities and we are aware that people from black and Asian backgrounds wait for six to 11 months longer for an organ match, compared with the general population. This is clearly unjust and we will put in measures to address it.
I reassure the House that discussions with the family will remain our paramount consideration at all times. On that point, I want to assure the noble Baroness, Lady Deech, by repeating the assurances made by my noble friend Lord O’Shaughnessy that, if the family strongly disagrees, no donation will go ahead as no doctor and no nurse will want to upset the family further. My noble and learned friend Lord Mackay, my noble friend Lord Blencathra and the noble Baroness, Lady Randerson, also raised an important point on deemed consent. However, as linked to the above point, from the outset we have said that the family will be involved. If the family is not around, clinicians cannot establish the medical history and other crucial information about the deceased, and the transplant would be risky.
Of course we take deemed consent very seriously. We have based it on the successful implementation in Wales since 2015. To respond to my noble friend Lord Blencathra, the Human Tissue Authority specifically consulted healthcare professionals and that body will be monitoring implementation in its role as the regulator. In addition, we will keep raising awareness of the importance of organ donation.
I reassure the noble Lord, Lord Hunt, that we will ensure that the additional specialist nurses are well trained, carefully managed and thoughtfully recruited so that they are the right people to have these delicate conversations. I reassure my noble friend Lord Blencathra that they are in fact much better suited than senior clinicians who, if I may put the point delicately, might not have the emotional intelligence or delicacy for such a sensitive moment. I reassure the House that I have spoken to the team about how they will continue their training on deemed consent, taking into account, if necessary, videoconferencing technology to hold the necessary conversations in a Covid environment.
My noble friend Lord Bourne of Aberystwyth asked an important question about deemed consent across borders. To be clear: you can deem the consent to remove, store or use the organ only in England under our new law, but once removed that organ can be transplanted to a patient anywhere in the UK.
The noble Baronesses, Lady Barker and Lady Thornton, made important contributions about continuing to secure organ transplants in the context of EU exit. Each year the UK exchanges a small number of organs with EU member states. In 2018-19, the UK received 14 organs from EU countries and there were 3,951 UK transplants. The focus is on negotiating a future relationship with the EU, but my department is also preparing for a scenario where no further agreement is reached with the EU, which is the legal default position. The current regulatory framework for organs is well established and sets high-quality safety standards for organs imported into the UK.
I thank the noble Lord, Lord Goddard of Stockport, for his positive words around this legislation. I reassure him that we want the conditions of deemed consent to be met, which means that transplants can go ahead when it is safe and training for returning specialist nurses has been completed. The legislation will come into effect on 20 May, but we acknowledge that it may not come into practice straight away due to the limitations of Covid.
I was greatly touched by the testimony of my noble and learned friend Lord Mackay, who spoke movingly of his friend’s experience. I remember that on 15 September 2002 my wife called me with a pain in her eye. She had a corneal puncture which threatened the sight in her right eye. Her left eye is very weak from childhood infections. I cannot disguise from noble Lords that that diagnosis was very grim and she was looking at a life without sight. The surgeon, the wonderful Mr Bruce Allan at Moorfields, helped find a cornea for transplant, which is an organ for which many families are reluctant to give consent. As a result, I am glad to say that my wife retains her eyesight today. To that donor and their loved ones, the Bethell family are enormously grateful.
Through the noble Baroness, Lady Randerson, I thank our friends in Wales, as we are in the privileged position of having modelled deemed consent in England and its implementation on its successful implementation in Wales. As the noble Baroness rightly suggested, our specialist nurses here will benefit greatly from their colleagues’ experience in Wales.
I reassure the noble Lord, Lord Oates, that we will make sure that the NHS has the resources to carry out the additional transplants, including using affordable novel technologies as appropriate. Following funding from the department, NHS Blood and Transplant has recruited 27 new specialist nurses, which is an increase of more than 10% in that important role.
The noble Baroness, Lady Deech, the noble Lord, Lord Mann, and my noble and learned friend Lord Mackay of Clashfern raised the important issue of faith. We are aware that organ donation is in some cases against someone’s culture, faith or belief. That is why we have worked closely with a wide range of faith and belief representatives regarding the change in the law. For example, there are pages on the NHS Blood and Transplant website about organ donation in the context of each of the major UK faiths and beliefs. We are grateful to the all those faith and belief groups which have engaged with us. We and NHS Blood and Transplant will also continue our work with faith communities as the law is implemented.
It is right that this legislation is approved to provide legal certainty that deemed consent will apply only to routine transplants which so many people in this country need. I reassure the noble Baroness, Lady Deech, that, after consultation, we have expanded the list of parts of the reproductive system that are to be excluded from deemed consent. We have clarified that no part of the reproductive organs, for example, vessels, will be removed without express consent, even if they were to be used to support a routine transplant. We have also added renal and lung epithelial cells to the list of advanced therapy medicinal produces as they are possible future technologies.
I thank all noble Lords for sharing their views on these regulations. I thank my predecessors, my noble friends Lord O’Shaughnessy and Lady Blackwood, and many others in this House and in the other place, such as Dan Jarvis and Geoffrey Robinson, who have supported this important measure. I join the noble Lord, Lord Hunt, in thanking the many charities which have campaigned for this, such as Kidney Care, the British Heart Foundation, NBTA and Team Margot. The regulations are an integral part of making the new system of consent work and I urge all my fellow parliamentarians to approve them. We owe it to everyone waiting for a transplant to make sure that this law comes into force and makes a difference to those in need.
Covid-19: Testing
Lord Bethell Excerpts(3 years, 12 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, testing is a critical part of the Government’s test and trace programme. It will enable the UK to start to come out of some elements of lockdown. We salute the efforts and innovation of our NHS, public health and private sector partners. Their hard work will bring forward the easing of important restrictions that keep people safe and protect our NHS.
The Earl of Clancarty (CB)
My Lords, public health specialists have been worried from the beginning of this crisis that a large-scale nationwide test, trace and isolate infrastructure was not straightaway put in place. I did not hear the word “isolate” in the Minister’s reply. Will the Government yet set this up, perhaps headed by an independent epidemiologist? To that end, will they address the concern that commercial lab test results are not reaching councils and the local NHS so that proper action can be taken to isolate and eradicate this virus across all communities before lockdown is substantially eased?
Lord Bethell
My Lords, I pay tribute to Public Health England, which stood up the CTAS system that provided track and trace services at the beginning of the epidemic. I pay tribute to Dido Harding, the track and trace director whose appointment was announced earlier this week. I pay tribute to Professor John Newton, who provides scientific guidance and co-ordination for the track and trace programme.
Lord Wood of Anfield (Lab)
My Lords, we have seen from the Covid outbreak at a nightclub in South Korea that speed is of the essence in ensuring an effective test, trace and isolate strategy. However, given the limited availability of test kits and the fact that it can take three to four days to process them, and in the light of the fact that what the Government called “operational issues” led last week to 50,000 tests being sent for analysis to the US, can we really be confident that the tests can produce sufficiently timely information to form the basis for a test, trace and isolate strategy?
Lord Bethell
The noble Lord is entirely right. Speed is essential and the South Korea example is a good one. More than half of our tests are turned around within 24 hours. I pay tribute to the track and trace team, who handled an extremely complex and difficult laboratory failure last weekend and used innovation to turn around 50,000 tests, the results of which were reliably given to people. However, we will continue to work on shortening the result times and getting the information back speedily so that isolation can happen in a thorough way.
Baroness Barker (LD)
What is the average time between a swab being taken and a patient getting the result, and what is the average time for that test result to show up in national tracking data?
Lord Bethell
The average times are not at my disposal, but I reassure the noble Baroness that more than half the results are turned around within 24 hours. Our target time is currently 48 hours and the vast majority of tests are done within that time. As the noble Lord, Lord Wood, rightly said, speed is of the essence, and we are working hard to compress those times.
Baroness Rawlings (Con)
My Lords, testing and tracking are vital in working towards the lifting of restrictions. Can the Minister therefore consider looking at encouraging people to keep a daily diary on everyone they meet, wherever they go outside their home? Should they fall ill with Covid-19, that would provide a simple, easy way to trace the source of further testing?
Lord Bethell
My noble friend Lady Rawlings is entirely right: we all have an important role to play. There is good evidence that personal tracing by individuals of contacts within their networks has a powerful role to play in isolating those who might have been in contact with the virus. Defeating this virus will be the responsibility of everyone in the community; we cannot rely just on digital apps and central databases.
Lord Patel (CB)
My Lords, what evidence do the Government use to calculate the value of R0?
Lord Bethell
The noble Lord will know that we have set up one of the most ambitious surveys, conducted by the ONS, to study on a weekly basis a large number of viral and serological tests. Those are used by statisticians to understand both the prevalence and the spread of the disease. Figures for that are emerging—we now have three weeks-worth of figures. They are being published regularly and I would be glad to send the noble Lord a link to the relevant data.
Baroness Thornton (Lab)
My question is relevant to what has been in the news today concerning antibody testing. PCR testing is the most reliable but most resource-intensive test. Will it ever be sufficiently scalable for widespread regular testing of all key workers and to track clusters of reinfection? Are the Government investigating the potential of increasing the reliability of antibody testing by double testing? Now that a range of tests is being manufactured globally, will the Government publish their assessment of their relative efficacy in testing the two relevant antibodies?
Lord Bethell
The noble Baroness is entirely right. PCR testing is an important guide as to who has the virus, and we have made it available to all key workers who exhibit symptoms. However, we are sceptical of whole-population surveys. Double testing might help if there is damage to serological equipment, but the challenges of serological testing are more to do with the blood, and unfortunately people do not change their blood. We are very proud of British universities, which regularly publish assessments of the various serological approaches. That work is under way and continues, and we hope to make more progress on it in the months ahead.
Lord Hussain (LD)
My Lords, all the evidence shows that BME communities are suffering disproportionately more from Covid-19. Many of them work on the front line as doctors, nurses, care workers, cleaners, porters and hospital security staff, who deal directly with difficult people. Can the Minister assure the House that these front-line staff will be prioritised and tested frequently for Covid-19? In asking this question, I declare an interest, as a close family member works in hospital security.
Lord Bethell
My Lords, I pay tribute to those BME workers on the front line. There is no doubt that their courage and bravery in the face of heightened risk is one of the things that has kept the NHS and our care service working and we owe them a huge debt. That debt will be paid by providing testing for anyone who needs it. To answer the noble Lord’s specific question, we started rolling out asymptomatic testing throughout the NHS and care service last week. The results of that will be published by the NHS shortly.
Baroness Ritchie of Downpatrick (Non-Afl)
My Lords, the Minister will be aware that, to be effective, testing in care homes of residents and staff needs to be done continuously. Can he confirm when this testing system will be established and then achieved?
Lord Bethell
Testing in care homes is absolutely a number one priority. We have massively ramped up testing: we are now running it at 30,000 tests a day. We will test 300,000 care home residents and 500,000 care home staff before mid-June. That will make a massive difference, but we will not stop there. The ongoing and regular testing of both residents and staff will be a core part of our test and trace programme.
Lord Cormack (Con)
My Lords, with the encouraging announcement of the ending of virtual proceedings in the other place and in the hope that we will not be too far behind, can my noble friend assure me that adequate, permanent testing facilities will be available for all who work in the Palace of Westminster and all Members of both Houses?
Lord Bethell
My Lords, workplace testing for not just Peers but all workers is an important part of our return-to-work strategy. We need to work with employers of all kinds and the diagnostics industry to put in solutions so that people can go back to work with confidence that they are not infectious and that the person sitting next to them is not infected.
Baroness Finlay of Llandaff (CB)
My Lords, what national policy control mechanisms will be used to monitor and report on false negatives and false positives as testing is rolled out to complement a contact tracing app?
Lord Bethell
I did not hear all the question, but I think I understand what the noble Baroness is asking. The truth is that, however strong the sensitivity of the machines, false negatives and false positives are an inevitable part of the testing process. However, PHE conducts extremely thorough validation processes so that these are kept to a minimum and we will use algorithms to ensure that rogue test results are picked up as soon as possible.
Care Homes: Covid-19 Testing
Lord Bethell Excerpts(3 years, 12 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I assure the House that the provision of tests for care home staff and patients is a number one priority for the Department of Health and Social Care. We are currently making available 30,000 tests a day through satellite, mobile and at-home channels. By early June we aim to have offered tests to all care home residents and staff specialising in the care of older people and those living with dementia.
Baroness Wheeler (Lab)
My Lords, the Minister will be aware that there have been stark warnings from across the sector that, unless testing of staff and residents in care homes is urgently and significantly improved, there could be a second peak in deaths, potentially coinciding with the autumn flu season. Lives are being put at risk and conditions for dementia sufferers have worsened because of the continued failure to test hundreds of thousands of staff and residents. While the DHSC, the CQC and Public Health England will squabble over who is responsible and what each has or has not done, the Government’s own recovery strategy document now admits that they cannot even guarantee that every care home will be offered testing until 6 June, so we have yet another false and misleading promise. The Government themselves admit that only tens of thousands of tests have so far been done in care homes, and over 1.5 million are needed to cover staff and residents. Will the Minister explain to the House how he plans to get to grips with the total and tragic chaos that currently prevails?
Lord Bethell
My Lords, I completely acknowledge the threat of a second peak. It focuses the mind and is very much a priority for the Government, but there is no squabble of the kind the noble Baroness describes. I pay tribute to colleagues at the CQC, Public Health England, the NHS and the private care providers with which we work. Care home testing is offered to all care home staff and patients who need it. We are prioritising those who ask for it first and working through the list for any who need it by early June.
Lord Ribeiro (Con)
My Lords, given the press briefing by Dr Jenny Harries on Wednesday 13 May, when can we expect testing of all residents and staff in care homes? Covid-19 infects older people in care homes at different times. Therefore, a test is valid only on a specific day. Do the Government understand that one test per resident is not enough? Repeat tests are often required. Can my noble friend the Minister say what steps have been taken to increase the number of tests in care homes to save lives?
Lord Bethell
The noble Lord is correct: it is one test per resident for each infection. I pay tribute to the many care homes which have no infection at all, which have applied the correct disciplines and systems and for which no demand for the tests is currently present. We are prioritising homes that have infection and working through all their residents and staff, offering second and regular testing until the infection is eradicated. That logical prioritisation is exactly the right way to use the resources of both time and supplies, which are necessarily limited.
Lord Whitty (Lab)
My Lords, I welcome the Minister’s reassurances, but is it not the case that this Question had to be asked because it was not clear whether the issue in care homes was a priority at the beginning of this crisis? That is shown by both the release of hospital patients into care homes and the failure to provide testing and PPE for their staff and residents. Was it true that the list of priority sectors at the beginning of this crisis did not include care homes?
Lord Bethell
My Lords, it is not true that the list of priorities did not include care homes. In every epidemic, care homes are always a priority. History has taught us that and we knew it from the beginning. We have focused on them enormously; that is why care homes are a number one priority at the moment. We are determined to reduce the rate of infection so that infection does not leak into the community.
Baroness Brinton (LD)
In a reply during Oral Questions earlier today to my noble friend Lady Barker, the Minister said that test results for the care sector are turned around within 48 hours. Yesterday, care home organisations told the APPG for Adult Social Care that many are not getting any results back—a big black hole—that those which do say that 10 days is not unusual, and that local resilience forums are not being allowed to get the results either. They cannot plan support. While 6 June is three weeks away, the crisis in our homes is now. Given his previous Answer, can the Minister give a date by which all care sector results will be returned within two to three days?
Lord Bethell
I think the noble Baroness casts the situation unfairly. There are undoubtedly cases where test results have taken longer. Last weekend, a laboratory let us down and we had some delays, but I pay tribute to the team who turned around a very difficult situation. By far the vast majority of tests are turned around within our target time, and we are currently trying to reduce that time by using mobile and satellite units to take the tests to residents. That work is showing great and encouraging signs of improvement.
Lord Laming (CB)
My Lords, will the Minister assure us that the department accepts that residential care homes exist for those who suffer from multiple and serious health problems? That being so, can he help us understand better why, when we have known for months that Covid-19 was a severe threat to residents and staff, it is still not possible to guarantee either testing or essential equipment?
Lord Bethell
I completely acknowledge that one of the most horrible aspects of this disease is that it targets those who are most vulnerable and live closely to each other. Care homes are therefore a priority. I also acknowledge that we started with a very low base of diagnostic testing and have had to work extremely hard to build that up. But now that that capacity is there, we are focusing it on care homes and using innovative methods to get those tests directly to people. We could not be working harder to get the right people tested in the care home sector.
Baroness Bennett of Manor Castle (GP)
NHS England recommends to staff that if they have symptoms after a negative coronavirus swab test they do not return to work, given the estimates of false negatives of up to 30%. But the Government’s official advice to someone with a negative test, in Our Plan to Rebuild, says:
“If a negative test is returned, then isolation is no longer required.”
What is the Minister’s advice to care home workers after a negative coronavirus swab test?
Lord Bethell
No one working in the NHS should go to work if they feel ill or have a temperature. That is true for anyone working on the front line, but it is not necessarily true for people who work in normal workplaces.
Baroness Altmann (Con)
Is my noble friend aware of the guidance released to the NHS on 24 April announcing that all residents of care homes must be tested before admission? In paragraph 1.30, the guidance specifically states that:
“Where a test result is still awaited, the patient will be discharged and pending the result, isolated in the same way as a COVID-positive patient will be”.
Even now, this has resulted in care homes being required to take people out of hospital without knowing whether they have the virus and without necessarily having the appropriate PPE.
Lord Bethell
I am aware of that guidance. It is sensible guidance. It is necessary to free beds in our NHS hospitals to make them available to those who need them more. It is also necessary to isolate people when we are not sure whether they have Covid. These are 80uncomfortable truths and I do not deny that this will result in uncomfortable outcomes for some patients. One aspect of the disease is that it targets care homes and I make no apology for those arrangements.
Lord Hain (Lab)
Following the question asked by the noble Baroness, Lady Altmann, why in an English care home where a close relative of mine lives do staff and patients—including, astonishingly, patients discharged from hospital—still have to wait up to 21 days for the results of their Covid-19 tests?
Lord Bethell
The noble Lord gives powerful personal testimony. I cannot possibly argue with the details of his story, but I reassure him that the data I have is that the turnaround time for tests is, in the vast majority of cases, radically less than what he described. We are on course for hitting the target of 48 hours for a very large number of tests and 24 hours for a lot of tests.
The Senior Deputy Speaker (Lord McFall of Alcluith)
My Lords, the time allowed for this Question has elapsed. The Virtual Proceedings will now adjourn until a convenient point after 1 pm for the Motion in the name of Baroness Boycott. Proceedings in the Chamber will be taken at a convenient point after 12.30 pm.
Covid-19: Vulnerable Populations
Lord Bethell Excerpts(3 years, 12 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, social distancing and shielding measures are in place to protect vulnerable and clinically extremely vulnerable populations. Those identified as clinically extremely vulnerable are advised to stay at home with no face-to-face contact until at least the end of June. Our approach is under continuous review. The Government’s position on shielding and social distancing reflects the latest SAGE and clinical advice from the Chief Medical Officer.
Baroness Bull (CB)
My Lords, every person with a learning disability has the right to be supported to live in their community, but Covid-19 is putting already-delayed in-patient transfers at risk. In March some 1,900 adults and 200 children were still locked away in in-patient units, the majority sectioned under the Mental Health Act and staying for five years in facilities intended to be short-term. Can the Minister share his department’s updated assessment of whether the Mental Health Act easements provided for in the Coronavirus Act will be required, now that the peak in infections has been passed and a plan for lifting restrictions is taking shape? Does he share concerns that these easements, if enacted, would risk the delivery of the care needed to support community living and the achievement of the goals set out in Transforming Care?
Lord Bethell
The noble Baroness, Lady Bull, asks a searching question. On whether the Mental Health Act easements of which she speaks have already been enacted, I will have to find out exactly what those arrangements are and write to her. However, I assure the House that the care of the most vulnerable is absolutely the Government’s number one, top priority. It is true that some of those caring and providing important pastoral care for the most vulnerable have been worst hit by Covid—the examples she gives are really good ones—but we are absolutely putting the care of the most vulnerable at the top of our priorities.
Baroness Healy of Primrose Hill (Lab)
Yesterday, the Prime Minister said of his road map:
“it is a plan that should give the people of the United Kingdom hope.”
But on examination of the plan, I see no hope offered to the clinically extremely vulnerable, who are just told that they must continue to shield beyond June. The Government offer only a future review into the effects on their well-being. Can the Minister say how and when this review will be conducted, and by who?
Lord Bethell
My Lords, the advice from the Government is that the clinically extremely vulnerable should continue to be shielded until the end of June. That is under review at the moment. We are seeking to have more refined and more targeted guidance after the end of June, and we will publish that before the end of that month.
Lord Truscott (Ind Lab)
My Lords, can the Minister reassure those healthy over-70s that they will not be obliged to self-isolate against their will? Will he also comment on evidence that many care homes were forced to admit Covid-19-positive patients, so causing this pandemic to spiral out of control in those homes?
Lord Bethell
I reassure the noble Lord that the Government are not obliging healthy over-70s to self-isolate. However, the guidance is clear: they are a vulnerable group and the disease targets those who are older. They are therefore advised to avoid all social contact, if necessary. That advice is based on the science of the disease, and we will seek ways of trying to ameliorate that once the disease has fallen back.
Baroness McIntosh of Pickering (Con)
My Lords, does my noble friend agree that the most vulnerable are clearly the residents of care homes and their care workers? Will he confirm the very sad figures of, as I understand it, 10,000 deaths suffered in care homes? Will he also confirm that these figures have now been added to the total? Will the Government now prioritise care home workers for the full kit of PPE, to give them the utmost safety as they look after our most vulnerable people?
Lord Bethell
I reassure the House that deaths in care homes have always been part of the official figures. It is a very sad affair, and it shows how the disease attacks those who are most vulnerable. The arrangements for PPE in social care settings have improved dramatically, and we have put in place measures so that any care home can make its own application for PPE as it needs it.
Baroness Jolly (LD)
Will the Minister tell the House what advice or support local authorities have been advised to give to the more than 100,000 vulnerable adults aged over 70 caring for their adult children who have a learning disability?
Lord Bethell
The advice given to local authorities is spelled out in guidelines. Those who are vulnerable are advised to avoid social contact. Where necessary, those whom they live with, including any children they have with learning disabilities, should also avoid the same social contact.
Baroness Verma (Con)
My Lords, I refer the House to my interests in the register. Will my noble friend tell me what work has been done to ensure that public health messaging and advice on access to support for mental health and anxiety issues among the BAME community is easily available to those communities, particularly where they live in densely populated home environments?
Lord Bethell
My Lords, mental health advice is very clearly available, most of all from GOV.UK/coronavirus, where there is a huge amount of practical and pastoral advice, and access to resources.
Baroness Finlay of Llandaff (CB)
My Lords, I declare that I am an honorary fellow of the Royal College of Emergency Medicine. How will the Government ensure that emergency departments never again become the crowded places that they were, which act as a source of nosocomial infection—hospital-acquired infection—for the vulnerable and those caring for them, especially child carers, who might present with acute injuries, particularly once they are out and undertaking more activities?
Lord Bethell
My Lords, a strange and peculiar feature of the epidemic has been that accident and emergency wards are, surprisingly, below normal capacity since people have sought to avoid them because of the obvious threat of the disease. That said, nosocomial infection is of grave concern. It is an inevitable and frequent feature of any epidemic, but we are applying new ways of working and seeking to section off those with the disease to ensure that the infection does not spread in our hospitals and from there into the community.
Baroness Thornton (Lab)
My Lords, I am pleased to note that today is International Nurses Day. I pay tribute from these Benches to all our nurses, at home and all over the world, for their work and courage in these dark pandemic times. I will ask the Minister about testing in our care homes. On 15 April the Government announced that they were rolling out testing to all care workers. On 28 April they extended this scheme to all staff and residents in care homes. Could the Minister explain why, then, yesterday’s strategy document set a target of 6 June? Which is it? It looks like the Government failed to meet the promise to provide the tests on time and have now moved the goalposts again.
Lord Bethell
I share the noble Baroness’s celebration of Florence Nightingale Day, which is an important day for the nursing profession and for all of us. We have made huge progress on testing in care homes in the last three weeks. The new portal was made live on Monday and care homes are now massively supported by satellite care home facilities manned by the Army. I am not sure about the 6 June date of which she speaks, but I reassure the House that care home testing is the number one priority of our testing facilities and is benefiting from the large increase in capacity.
Baroness Tyler of Enfield (LD)
My Lords, over the course of this crisis we have seen substance misuse and mental health services adapt their provision to better support homeless people facing multiple problems. Could the Minister say what the Government, in particular the new homelessness task force, will do to ensure that these flexibilities remain in place?
Lord Bethell
The noble Baroness is right to raise concern for the homeless—surely one of the groups suffering the most in the current epidemic. We are putting in place facilities for testing, housing and mental health support for the homeless. We envisage that these will continue for the length of the epidemic.
The Lord Speaker (Lord Fowler)
My Lords, I fear that the time allowed for this Question has elapsed.