Health Protection (Coronavirus, Restrictions) (England) Regulations 2020

Lord Bethell Excerpts

Tuesday 12th May 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Virtual Proceedings do consider the Health Protection (Coronavirus, Restrictions) (England) Regulations 2020.

Relevant document: 11th Report from the Secondary Legislation Scrutiny Committee

The Motion was considered in a Virtual Proceeding via video call.

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

My Lords, I will outline what the regulations we are considering do, then set out the policies and processes underlying their development, their implementation and finally their monitoring and review. However, first, I will recap the Prime Minister’s announcement.

Informed by scientific evidence and advice, on 10 May, the Prime Minister announced that there will be further changes to the regulations. These will come into effect on Wednesday 13 May. Your Lordships will hear the details of the Statement later today, but in summary there are further regulation clarifications. First, it is permitted for a hotel or other accommodation to provide services to a worker in a critical sector whose need for accommodation is connected to their work. Secondly, additional reasonable excuses to leave or be outside the home will now include visiting a shop that is otherwise closed to collect goods or visiting a local waste or recycling centre.

In addition, there are changes affecting businesses and venues. First, the regulations expand the list of reasonable excuses to leave or be outside the home to include outdoor recreation, including but not limited to exercise, as is currently the case. Secondly, there is an amendment to allow people to spend time outdoors alone, with members of their household or with one member of another household. Thirdly, there are amendments to enable the reopening of garden centres and outdoor sports courts.

The regulations to effect these changes will be for Parliament to approve and I hope that we can use the excellent facilities of this virtual Chamber to do so more speedily. I also add that, unfortunately, our original Explanatory Memorandum contained two typographical errors which, regrettably, we did not spot until after publication. First, it said that the first review would take place on 15 April, not 16 April. Secondly, it said that Parliament would need to approve the instrument within 20 days, when in fact it should have read 28 days.

On 26 March 2020, the Health Protection (Coronavirus, Restrictions) (England) Regulations 2020 came into force. These regulations were then followed by the regulations made on 20 April, which came into force on 22 April. These regulations mandated three key measures to protect the NHS: first, requiring people to stay at home as far as possible, with only limited exceptions; secondly, closing certain businesses and venues; thirdly, stopping gatherings in public of more than two people, with very limited exceptions.

These regulations are similar to those introduced by other countries, and we have worked closely with the devolved Administrations—to which I pay tribute—in developing and reviewing these measures. This country has been, and still is, engaged in a national effort to beat coronavirus, delivering a strategy designed to ensure that our NHS is protected, with capacity always exceeding the demand for ICU beds for coronavirus patients. Flattening the peak, drawing down the rate of transmission of the disease and the number of infections, alongside the work to significantly expand NHS capacity, has helped to protect our NHS and to save lives. I wish to put on record our continued thanks to the NHS, to care workers and to key workers around the country for the phenomenal work that they are doing, caring for people and keeping the United Kingdom going.

The regulations that we debate today have played a crucial role in the success we are seeing in reducing the infection and transmission levels. They place significant demands on individuals and society, with impacts on businesses, the economy and daily life. I understand the sacrifices that people are making at this time, their frustrations and their anxieties, but these regulations are necessary, because the single most important step that we can all take towards beating this disease is to reduce the spread by following these regulations, thereby protecting ourselves and others.

Before we made these regulations, the number of patients in intensive care was estimated to be doubling every three or four days. The Scientific Advisory Group for Emergencies—SAGE—assessed that, at the beginning of the epidemic, the R number was between 2.7 and 3. Each person with the disease gave it to nearly three other people. This type of exponential growth would have overwhelmed the NHS had it not been contained, but then our regulations took effect. The footfall data showed a significant fall of activity; UK daily footfall fell by 80% compared to last year. These regulations came in tandem with a vast and co-ordinated effort, with schools closing and becoming virtual and massive increases in testing and NHS critical care capacity.

The latest assessment by SAGE is that, across the UK, R has reduced to between 0.5 and 0.9, meaning that the number of infected people is falling. On 4 May, 27% of critical care beds in the UK were occupied by Covid-19 patients, compared to 51% on 10 April. The number of patients in hospital in the UK with Covid-19 is under 13,000 as of 4 May, 35% below the peak of 12 April. The measures have been well enforced and, importantly, well received by the public. Between 27 March and 27 April, 8,877 fixed penalty notices have been recorded as issued in England. This is less than 5% of the number of motoring offences issued in England and Wales over a similar period. In mid-March, 62% of people were extremely worried about the threat of Covid-19. It is now 43%, while 85% of people think that the stay-at-home rules should stay in place.

However, I acknowledge the great sacrifice that these regulations have required everyone to make. Whether you are separated from your loved ones, unable to go to a funeral, face restrictions in your religious observance or simply have not been able to meet your friends for weeks, everyone has made a contribution. These are exceptional measures, brought forward to reflect exceptional challenges. They were made by the Secretary of State on 26 March and 21 April respectively and, rightly, following the return of the House after the Easter Recess, are brought before the House today for the scrutiny and debate that they require under emergency procedure approved by Parliament for such measures. The regulations are lawfully made under the power of the Public Health (Control of Disease) Act 1984 and comply with all the Government’s obligations in relation to human rights. Above all, they help to save lives. That is why Parliament has given Ministers these powers. The House will be aware that there are applications for judicial reviews and other legal actions in the offing. I will of course not comment on those.

We do not use these powers lightly or without good reason. We are acutely aware of the burden that they place on society and the challenge that we face in achieving the right balance between protecting the public’s health and safeguarding individual liberties, and between saving the NHS and saving our economy. I believe that we have achieved that balance.

The reasons for my confidence are threefold. First, these regulations set out that a review of these restrictions and requirements must take place at least every 21 days to ensure that each restriction or requirement continues to be necessary to prevent, protect against, control or provide a public health response to the incidence or spread of infection in England. We completed the first review, as required, on 16 April 2020; the most recent was completed on 7 May.

Secondly, the regulations reflect the strategy that we have agreed across the UK, which is led by the best scientific evidence available along with consideration of the economic, operational, social and policy implications.

Thirdly, recognising the potential for harm to public health and the economy if measures were relaxed too soon, we have developed robust criteria to guide policy considerations on when it would be desirable for measures to be eased. These considerations are fivefold: whether the NHS can provide critical care across the UK; whether there is a sustained and consistent fall in the daily death rate; whether infection rates decrease to an acceptable level; whether supplies of PPE and testing meet future demand; and whether the evidence is clear that changes will not risk a second peak.

Ministers conduct the review guided by officials and experts, ensuring that the measures continue to be both proportionate and necessary. However, it would be naive to imagine that there have not been snags that public servants across the UK have had to work day and night to untangle. The JCHR and others have expressed concerns about the variations in enforcement and the approach to it adopted by different police forces. As your Lordships will be aware, guidance was issued to police forces; that has continued to be clarified and updated. It is important that the police operate within the law, as set out in these regulations. That guidance is treated as such: guidance.

In the first review, it was agreed that no changes would be made to the existing restrictions. However, a small number of minor amendments were required to clarify the regulations and ease their operation. They relate to enforcement of the measures and affected businesses and venues.

The changes announced by the Prime Minister earlier this week may well lead to further revisions of these regulations. Your Lordships need not feel, therefore, that this House’s role in scrutinising the Government and holding us to account has, because of the manner in which these regulations were made, become somewhat diminished—far from it. These debates influence the choices made in policy development.

I look forward to a high-quality and informative debate this afternoon. We will take your Lordships’ contributions on board. I beg to move.

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[Lord Bethell]

My Lords, this has been an important debate about what many noble Lords have rightly called important regulations that affect everyone in this country. I thank very much all noble Lords who contributed. Before I address specific issues raised by individual Members, I reiterate the Government’s commitment to working in partnership with opposition parties and Parliament in developing the policies that find expression in the legislation we debate in this House.

This afternoon’s debate has been a classic of its kind: an opportunity for the Government to hear, through parliamentarians, the concerns of a wide range of society, as demonstrated by the excellent contributions to the debate. The delay mentioned by many noble Lords is no one’s preference and it is not for me to comment on it, but I reassure the House that the Government’s commitment to accountability is undiminished. I remind the House that we will have a debate in September on the Coronavirus Act and that there will be a report on the measures in two weeks’ time.

I reassure the noble Lord, Lord Hunt, that the Government are listening to parliamentarians and to the public. I reassure the noble Baroness, Lady Wilcox, that there is daily engagement with the devolved Administrations that is characterised in particular by the very close collaboration of the four CMOs. We listen very carefully to front-line workers and their representatives, remembering that those front-line workers bear the heaviest burden in combating this terrible disease. They are the people who deserve our protection. I reassure the noble Baroness, Lady Thornton, that guidance for employees and their roles in the workplace was published yesterday. I would be happy to send a link if that would be helpful.

We listen to the scientific and other evidence that defines the set of policy options we must choose between. I will take a moment to reassure the noble Lord, Lord Alton, that no one in this Government has ever called for us to “run it hot” and that our priority has always been to save lives. Our choices are influenced by what the country can afford to do, as well as what we can afford not to do. Our challenge therefore is to reconcile what the weight of evidence points to as the right choice, alongside people’s appetite for that choice and the resources that we can bring to bear to implement it.

I reassure the noble Baroness, Lady Barker, that science remains at the centre of decision-making and transparency remains our watchword. My office will forward a link to her office of the table outlining the implementation measures under the Coronavirus Act, which was published on 7 May.

I completely recognise the very good points made by the noble Lords, Lord Hunt and Lord Scriven, and others, that the regulations issued by the Government are complex and sometimes feel overwhelming. Dozens of guidelines are issued by Public Health England to cover every aspect of public, business and civic life. It is a huge publication exercise and the goalposts have quite necessarily moved this way and that as we have sought to be flexible to adapt regulations to changing circumstances and to the advance of science.

On each occasion that we have issued new guidance, there have been, as the noble Lord, Lord Kennedy of Southwark, rightly pointed out, questions and requests for clarification from the public. However, I reassure noble Lords that the public have been hugely supportive. They massively endorse the lockdown regulations, and their understanding of complex guidelines has quickly settled down into common-sense interpretation.

It is worth noting that the number of police interventions has not been large, as suggested by the noble Baroness, Lady Jones. In fact, it has been tiny, with just 8,000 fines in total. That is reassuring considering the massive impact of these guidelines on people’s lives. In response to the noble Lords, Lord Scriven and Lord Rosser, I commend the police, who have applied the guidance on what the new laws will entail with remarkable common sense, professionalism and restraint.

The excellent advice that we get from our advisers is world class and has guided the choices that we have made. I reassure the noble Baroness, Lady Hamwee, that we work very closely with the Behavioural Insights Team. I pay special tribute to the team and its director, David Halpern. They have brought humanity and communication skills to the otherwise clinical epidemiological advice of the scientists.

In response to the noble Lord, Lord Campbell-Savours, a face covering is not the same as a surgical mask or a respirator, which should both be reserved for those who need them most. However, we are encouraging the public to wear face coverings in enclosed spaces where social distancing is not possible.

I reassure the noble Baroness, Lady Finlay, that the most vulnerable have always been at the forefront of the Government’s thinking. We have provided guidance for those implementing the regulations on quarantine, which require that, where a person lacks the relevant mental capacity, the local health protection team should liaise closely with their relatives or other persons in making a decision.

I reassure the noble Lord, Lord Alton, and my noble friend Lord Wei that we are working closely with local authorities, the directors of public health and environmental health officers. That reliance on local services will only increase as our testing and tracing operations are rolled out in the community and our dependence on local knowledge is made all the more important.

However, we have to take account of what people in the UK can be expected to put up with. My noble friend Lady Wheatcroft raised very searching questions about these regulations and their impact on the economy and on personal freedoms. We recognise those concerns. I say in response that I never thought that in my life I would be standing at a digital Dispatch Box defending such draconian and expensive measures. None the less, I reject her analysis. We cannot protect the NHS and the people who are vulnerable to this disease if we do not implement the common-sense measures in these regulations, and the public, by and large, agree. That is why we have decided to protect the NHS and, in doing so, save lives.

I assure my noble friend Lord Blencathra that it is the disease and not the Government that is prejudiced against older people. I reassure my noble friend Lady Altmann that the guidance does not class individuals over 70 as clinically extremely vulnerable, and therefore they are not treated differently from the rest of the population on the basis of their age.

We now need to make careful preparations to return very gradually to a normal life, one day repealing these regulations. I assure my noble friend Lady McIntosh of Pickering that the regulations are due to expire six months after they come into force.

This is neither easy to describe nor simple to carry out. Emerging from the lockdown requires constant and careful watch over a wide range of evidence, followed by expert evaluation of that evidence, then a precise calculation of what legislation and other changes will be needed to bring about the successful outcome. I am sure there will be many occasions over the coming weeks—and, in all likelihood, months—when we can debate these matters further. For now, I assure your Lordships that we have heard today’s contributions and will reflect on them as we develop the policies.

I end by paying tribute to the resilience, patience and fortitude that the people of the UK have demonstrated every day for the last few months in helping combat this outbreak. That investment has been worth it. We have averted a catastrophe and flattened the curve. Because of this, the NHS and other front-line staff have been able to save lives. That sacrifice has been worth it. As a Government, we will play our part by making sure that the burden is no more onerous than it absolutely needs to be. These regulations ensure that.

Motion agreed.

Health Protection (Coronavirus, Restrictions) (England) (Amendment) Regulations 2020

Lord Bethell Excerpts

Tuesday 12th May 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Virtual Proceedings do consider the Health Protection (Coronavirus, Restrictions) (England) (Amendment) Regulations 2020.

Relevant document: 13th Report from the Secondary Legislation Scrutiny Committee

Motion agreed.

Covid-19: Contact-tracing App

Lord Bethell Excerpts

Wednesday 6th May 2020 Lords Chamber

The Question was considered in a Virtual Proceeding via video call.

[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 the way it works. It is designed so that you do not have to give up your personal details to use it. We have worked in partnership with both the National Cyber Security Centre and the Information Commissioner’s Office throughout. We continue to hold discussions with Apple and Google. The app uses only software development tools and mechanisms that are supported by Apple and Google.

[Lord Clement-Jones (LD)]

To be effective, achieve widespread adoption and ensure our safety, the new app needs to gain public trust. So, why have the Government developed a go-it-alone, centralised app which is not optimally privacy-preserving, not interoperable with the apps of other countries—not even Scotland, it seems —not fully compatible with the Apple and Google Bluetooth protocol, and has no mandatory oversight, time limit on its use or public data impact assessment?

[Lord Bethell]

My Lords, it is not a go-it-alone app; others are following our lead on this. It is interoperable, and we are working with other countries to make sure it is. Testing with the public has turned out to be extremely positive and we look forward to publishing the audit shortly.

[Baroness Ritchie of Downpatrick (Non-Afl)]

My Lords, the importance of track, trace and isolate is beyond doubt, but what assurances can the Minister give to your Lordships’ House that this data, as part of data-sharing with the NHS, will be anonymised and protected to prevent information being used by others?

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[Lord Bethell]

My Lords, the anonymised data-sharing is protected by the security protocols that have been agreed as part of the app’s governance. That governance is overseen by the ethics board, chaired by Professor Sir Jonathan Montgomery from University College London, who previously headed the Nuffield Council on Bioethics.

[Lord Truscott (Ind Lab)]

My Lords, can the Minister tell the House what lessons Her Majesty’s Government have learned from South Korea and Taiwan, for example, which have been far more successful than the UK in testing, tracking and tracing, and hence reducing death rates? South Korea, with a population of 52 million, has had 252 deaths and Taiwan, with a population of 24 million, has had six deaths. Can the Minister explain to the House why the UK’s record looks comparatively so poor?

[Lord Bethell]

My Lords, I am in touch with both the South Korean and Taiwanese Governments, and we are greatly inspired by the throughly professional way in which they have gone about epidemic management. I commend both those countries and their efforts. However, the epidemic arrived in Britain in an incredibly fulsome way. The Chief Medical Officer has been very clear that if that had happened in either of those countries, their responses would have been similar to that of Britain. I defend the Government’s response to the epidemic.

[Baroness Blackwood of North Oxford (Con)]

My Lords, one of the core principles of data protection is to gather the minimum amount of data. I understand that one reason given by the NCSC for asking for partial postcodes on registration for the app is to assist with regional healthcare planning and to monitor potential Covid flare-ups. Can the Minister explain why data from Covid tests and NHS 111, for example, would not be sufficient to keep the transmission rate down in a post-lockdown test, track and trace strategy?

[Lord Bethell]

My noble friend Lady Blackwood is entirely right. The testing and the surveillance done by testing give us powerful insight into the demographic reach of the virus and information on a very broad basis on the regional reach, but we are looking for a much more granular level of detail from the very powerful, multimillion level of detail that the app can provide. The value of those surveillance details has led us to design the app in the way we have.

[Lord Scriven (LD)]

Matt Hancock has said that the app is to flag up our proximity to someone else using the app, not to track our movements. So why do the terms and conditions of the app request access to track our precise location based on GPS or network-based systems?

[Lord Bethell]

My Lords, the app works by using the Bluetooth tags which are shared once you have declared symptoms or you have had a positive test. It does not rely on GPS tracking. If the terms and conditions are broader, that is because we want to try to provide the most thorough set of conditions that encompass all the data provided by the user’s telephone. However, I can reassure the House that it is Bluetooth tagging that is used by the app and the surveillance system.

[Lord O’Shaughnessy (Con)]

My Lords, what work is going on to make sure that the app that NHSX is developing is interoperable with other countries’ apps? Clearly we all want to get back to a situation where people can move freely from one country to another for business or leisure, so interoperation is important. I will be grateful if my noble friend can update us.

[Lord Bethell]

My noble friend Lord O’Shaughnessy is entirely right. We all wish to move as quickly as possible back to normal, but I am afraid that travel will be one of the aspects of our former lives that will be slowest to return. That said, we are working extremely hard with other countries to make sure that interoperability can be baked into our arrangements. Of course, the app has not yet been launched and few other countries are ahead of us. We sat with the Irish Government on 24 April in order to work out interoperability protocols since that border is the most important and proximate to us.

[Baroness Lane-Fox of Soho (CB)]

The Office for National Statistics tells us that the highest number of deaths is among the poorest communities at 55 in 100,000 versus 25 in 100,000 in other communities, yet they are also the most digitally excluded people. It is tragic that these inequalities mean that the contact-tracing app will not help those who most need it. What is the Government’s plan to address this enormous challenge?

[Lord Bethell]

The noble Baroness is entirely right to point to the importance of ensuring that the vulnerable are included. Of course, the app is not the only thing we are depending on. Manual track and trace in the conventional way of using a telephone and speaking to those who test positive will still be a core part of our track-and-trace arrangements. Efforts will be made to reach those who are vulnerable or digitally isolated to ensure that they have details of the provisions for these track-and-trace arrangements.

[Baroness Thornton (Lab)]

My Lords, I would like to follow up on the question asked by the noble Baroness, Lady Lane-Fox, because she has put her finger exactly on how this may not work because either our most vulnerable and poorest communities will not have the technology or there will be problems with language. I would like some more detail from the Minister about exactly how the Government intend to roll this out. Given that it took such a long time to roll out the NHS volunteers system, I feel that we might find ourselves with our most vulnerable and poorest communities disadvantaged.

[Lord Bethell]

The noble Baroness is entirely right to be concerned about the vulnerable and our approach. I completely share those concerns. It is a massive challenge, but that does not stop us embracing the advantages of technology where millions of transactions can be done in a day which could never be done by more manual processes. An enormous amount will be invested in trying to reach out to those who are isolated, vulnerable or digitally excluded to ensure that they have details of our track-and-trace arrangements. Hiring an enormous army of track-and-trace experts has already begun, and details can be seen on my Twitter feed of how volunteers who have the right qualifications can join those efforts.

[Lord Wallace of Saltaire (LD)]

My Lords, if we are moving to a centralised app, what assurances do we have about how long the data will be stored? I see references to use for research purposes in various documents. Will there be careful safeguards about the deletion of the data after a certain period?

[Lord Bethell]

I reassure the noble Lord, Lord Wallace, that sunset arrangements will form part of the conditions of the app and that they will be published shortly.

[The Lord Speaker (Lord Fowler)]

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

Covid-19: Government Response

Lord Bethell Excerpts

Wednesday 6th May 2020 Lords Chamber

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

Good evening, my Lords. The Virtual Proceeding on the repeat of the Urgent Question will now commence. I will call the Minister, who will repeat the Statement in the usual way. There will then be 10 minutes for questions, led by the Opposition Front Bench. The Minister will respond to each question in turn. I will call each Back-Bench Member on the speakers’ list to ask a supplementary question and the Minister will answer. I ask noble Lords to ask brief questions and give brief answers. Each speaker’s microphone will be unmuted prior to them asking a supplementary question and returned to mute once their question has finished.

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

My Lords, with leave I shall repeat the Answer given to an Urgent Question asked in the other place yesterday. In the repeat, I will use the most up-to-date figures, which have changed since yesterday. The Answer is as follows:

“Mr Speaker, we have flattened the curve of this epidemic, ensured that the NHS is not overwhelmed and expanded testing capacity to over 100,000 tests a day. As a Government, we are working resolutely to defeat the coronavirus. There are two important areas where I want to update the House today.

First, on the expansion of our work to test, track and trace, we have now built a national testing infrastructure of scale. Because we have this extra capacity, we will be delivering up to 30,000 tests a day to residents and staff in elderly care homes, making sure that symptomatic and asymptomatic staff and residents can all be tested. Our care system represents the best of us, supporting our loved ones with tenderness and dedication at their time of greatest need. Through this unprecedented expansion of testing capacity, we can give them the certainty and confidence that high-quality testing can provide.

Secondly, we are working to strengthen the resilience of the NHS. We currently have 3,382 spare critical care beds in the NHS, and that does not include the capacity provided by our Nightingale hospitals, including the 460-bed Sunderland Nightingale, which opened earlier today. We should all be very proud that we have built up the NHS so fast and that our collective national effort has helped to protect the NHS and flatten the curve. As a result, not only have we been able to restore some NHS services; we are in a position to be able to place the London Nightingale on standby. This is good news, because our NHS has not been overwhelmed by this crisis and remains open to those who need care, which means that this nation’s shared sacrifice is having an impact.

Throughout its time, this Chamber has borne witness to so much, and it has borne witness to the nation’s resolve once more. I am delighted that the British people are well and truly rising to this incredibly difficult challenge.”

My Lords, that concludes the Statement.

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for repeating this Statement. I point out that the Commons took an hour to receive and discuss this update; we are getting 10 minutes. It is almost two weeks since I saw the Minister across this virtual Dispatch Box, which seems a long time in a pandemic. When we went into lockdown in March, he seemed to indicate his enthusiasm for being accountable to the House in lockdown. I regret to say that I do not believe that he or his colleagues have matched that aspiration. I place on record that it is shocking that noble Lords across the House are reduced to submitting vital questions about Covid to a lottery—a ballot of topical questions. That is not serious accountability. Unprecedented times need unprecedented procedures.

I have two questions. First, will the Minister support a proposal that he and his colleagues should come to the House every day and have a Covid-related Question Time, morning or evening, which would discuss the contents of the daily press conference and other urgent matters? Secondly, how does the Minister intend to fulfil his promise to the House that there would be an eight-week review of the Covid emergency legislation? By my reckoning, those eight weeks will be up in two weeks’ time.

[Lord Bethell]

I welcome the noble Baroness’s questions on accountability. However, I remind her that not all Covid-related matters are covered by the department of health; Ministers have been in front of the House every day it has been open, answering questions on Covid, and they have given fulsome and thoughtful answers to questions and scrutiny. I welcome also her question on the eight-week review, which, as she says, is coming up in a fortnight. I will find out how the usual channels wish to mark that occasion in the House, and I would welcome the chance to submit the Government to scrutiny on the matter.

[Baroness Brinton (LD)]

From these Liberal Democrat Benches we echo the points made by the noble Baroness, Lady Thornton. We believe that lockdown should be lifted only using the WHO advice for “test, trace and isolate” to keep people safe. On 23 April, I asked the noble Lord, Lord Bethell, why “isolate” had been dropped from the Government’s slogan. He told your Lordships’ House:

“Turning to track and trace, I confirm that isolation is an absolutely intrinsic part of the track and trace regime: it just does not rhyme so well, so you never put it at the end, but ‘track, trace and isolate’ is the programme.”—[Official Report, 23/4/20; col. 166.]


Today, the Department of Health and Social Care’s Dear Colleague newsletter does not mention “isolate” in the context of lifting lockdown. Can the Minister say what evidence there is of a government plan for isolation, and how will we know that people are isolating, which is absolutely vital if we are to succeed in stopping transmission and keeping people safe? Although testing has increased it has not yet reached a consistent number of 100,000 per day, so what evidence is there for the Prime Minister’s new target of 200,000 per day by the end of May being delivered?

[Lord Bethell]

The Government’s commitment to isolation is spelled out clearly in guidelines published by Public Health England, and it is promoted every day with the Government’s “stay at home” slogan. On the 200,000-test aspiration, we have put in place a remarkable platform for testing. We have strong partnerships with important companies, we have sourced new supply chains of critical reagent swabs and other supplies that are in short measure, and we are making the logistical arrangements necessary for a massive expansion of testing. I believe that those will take us to whatever is necessary to meet the testing needs of the country.

[Baroness Neville-Rolfe (Con)]

My noble friend has described a situation that is still worrying. The rate of deaths and of new infections is still much higher than we wish, and we may soon be faced with a situation where the rules in different geographical locations or in different institutions vary, so we need more information. To enable us to seek optimum changes, could he please publish more information—for example, on how many cases came from hospitals and where, how many involve hospital or care workers, and how many involve other key workers, overseas visitors, self-isolators and the like?

[Lord Bethell]

The Government have gone about the Covid crisis with a great amount of transparency; a very large number of figures are published every single day. I am afraid that some of the questions my noble friend asks are beyond the reach of measurement in our statistical accountability at the moment, but I completely take on board and celebrate her call for transparency. We are working as hard as we can to get as many numbers out to the public as possible.

[Lord Bilimoria (CB)]

My Lords, tracking, tracing and isolating can be effective only if there is adequate testing. It was reassuring to hear the Prime Minister say today that the target was to be 200,000 tests a day by the end of this month. Earlier, he referred to 250,000 tests a day. Can the Minister confirm that millions of tests a week will be available, not just to patients and staff in hospitals and care homes but to the whole British public? In particular, they should be available to workers so that they can get tested and have the confidence to go to work, while consumers can have the confidence to go to restaurants and hotels, bars and venues. Can he also confirm whether pin-prick antibody tests will be available in the millions later this month to the whole British public so that people such as me, who have had Covid-19, can get tested? This would show that we have the immunity to go out to work and participate in the economy without infecting people or getting infected ourselves.

[Lord Bethell]

“Track, test and isolate” does not necessarily depend on doing millions of tests. South Korea, which has an extremely effective regime, does only 20,000 tests a day. That is because its whole society has worked hard to get the prevalence of the infection as low as possible. I celebrate the fact that the British public have committed to the lockdown, but I cannot disguise from the House the fact that the lockdown needs to continue to get the prevalence rate lower.

[The Lord Bishop of St Albans]

My Lords, yesterday the deputy chief scientist said that we needed to “get to grips” with what is occurring in our care homes. As data shows that deaths in care homes are rising while hospital deaths are plateauing, what specific actions are Her Majesty’s Government taking to put a stop to this dreadful crisis, which is unfolding before our very eyes?

[Lord Bethell]

The right reverend Prelate is entirely right to focus on care homes. It is an awful aspect of this disease that it attacks the most vulnerable who live in enclosed environments such as care homes. They have been an absolute priority for the Government. One aspect of our response is to massively increase testing in care homes. The increased capacity that we announced last week has been shifted massively towards care home testing. We are using mobile units and satellite drop-offs to increase the screening of patients and care home workers.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, I was contacted for help by a manufacturer, Thomas Olsen, who was responding to an appeal on television by the Health and Social Care Secretary, Matt Hancock, for ventilators to be made at scale by British companies. With my assistance, and after several attempts, we came up against a brick wall. Over a month later he discovered by chance that sufficient ventilators had been sourced, yet no message was sent down to all those working hard to produce them. Will the Minister ensure, first, that when such an appeal is made in future a single contact point is provided, rather as with Crimestoppers, so that there is no doubt how to get in touch and, secondly, that when the appeal is fulfilled the responders are given the courtesy of being stood down?

[Lord Bethell]

I completely acknowledge the situation and the testimony of the noble Lord. The response by British companies to the ventilator challenge was incredible and, at times, overwhelming. No discourtesy was meant to the firm that he mentioned and I completely take on board his comments about the importance of courtesy, respect and a proper feedback mechanism in such circumstances.

[The Deputy Speaker]

Lord Dobbs. As Lord Dobbs is not responding, we will go to Lord Liddle.

--- Later in debate ---

[Lord Bethell]

I return to my comments to the noble Baroness, Lady Thornton. In the Lords at least, Ministers have been on the Front Bench answering questions on Covid every day since the Lords reopened. Subjects have ranged from social security and housing to, in my case, the Department of Health and Social Care. We remain accountable for the measures that we have put in place. The media also have a huge role in that scrutiny. We remain committed to keeping Parliament open, despite the lockdown regime, and completely respect the importance of parliamentary scrutiny.

[The Deputy Speaker]

My Lords, the time allotted for the Statement is now up. The day’s Virtual Proceedings are now complete and are adjourned. Good evening.

Covid-19: Personal Protective Equipment

Lord Bethell Excerpts

Thursday 23rd April 2020 Lords Chamber

The Question was considered in a Virtual Proceeding via video call.

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

Every NHS and care worker must get the personal protection equipment that they need. We have a PPE plan with three strands: guidance, distribution and future supply. Through buying more PPE from abroad and making more at home, we will have enough PPE to meet our needs. Historically, there has been limited UK manufacture of PPE, but we now have a Make strategy under my noble friend Lord Deighton to encourage manufacturers throughout the UK to produce PPE, including in the textile heartlands of the north.

[Baroness McIntosh of Pickering (Con)]

My Lords, will my noble friend congratulate the company Industrial Textiles & Plastics, which makes the much-needed impermeable material for gowns, and Barbour and Burberry, which are manufacturing these gowns—all, in this case, free of charge and distributed through a Thirsk-based volunteer organisation organised by local NHS trusts? Will the Government agree to use this model for the manufacture and distribution of gowns through local manufacturers and local distributors to disperse to NHS trusts?

[Lord Bethell]

My Lords, I share the noble Baroness’s endorsement of the tremendous response from British manufacturing. Some 176 firms have applied to the scheme and we are processing their suggestions. My noble friend Lord Deighton is a powerful advocate for the Make programme. I thank in particular Don & Low, Ineos and Survitec, which have already made a considerable contribution to production.

[Lord Harris of Haringey (Lab)]

My Lords, NHS Providers warned last night of a very real risk that front-line staff’s confidence and trust in national leaders could be significantly undermined unless trust leaders and staff are confident that they are receiving adequate supplies of the right equipment at the right time. On Saturday, Robert Jenrick promised that a very large consignment of PPE would arrive from Turkey on Sunday. In fact, it was not until yesterday that half of the promised 84 tonnes arrived. Trying to grab headlines with a dubious promise is hardly likely to help staff confidence. Is it true that Turkey was asked to facilitate this shipment only the day after the Minister’s promise? Could the Minister tell us what is the daily requirement for PPE in the NHS and how it compares with the Turkish shipment?

[Lord Bethell]

My Lords, it is not correct that Turkey was asked to intervene only at the last minute. We have been in constant, daily and regular contact with the Turkish Government. We are grateful to the Turkish Government for their help and involvement and we continue to work with Turkish companies on this order. On the NHS’s requirement, this virus undoubtedly requires much more protection than any other disease that we have encountered. The demand for PPE will continue to rise. We will meet that need through our Make programme and continued strong relationships with foreign providers.

[Baroness Brinton (LD)]

My Lords, Methodist Homes has reported the deaths of 250 residents and two staff from Covid-19 since the beginning of the outbreak. Last week, it was forced to buy 200,000 face masks for £200,000—five times the going rate. The current government allocation is 300 masks per home per week, when the reality is that they need over 1,000. The system for providing support for our care homes, which are really struggling—they are actually now the focus of the outbreak—is just going from bad to worse. Can the Minister please tell us exactly when homes will receive the PPE that they need?

[Lord Bethell]

The noble Baroness is entirely right to commend the sacrifice of hard-working care workers who put their safety on the line and put themselves in harm’s way. She is also correct to allude to the challenge for care homes—15,000 of them—that have previously largely looked after their own procurement arrangements. This Covid disease presents an enormous procurement challenge. The Government have stepped up and are helping care homes in many ways. Nearly a billion items of PPE have been distributed in the last six weeks and we will continue our commitment to support care homes.

[Lord Blencathra (Con)]

My Lords, first, I congratulate my noble friend on the excellent job he is doing in the department and on his diligence in answering our questions. I ask him this: if handwashing destroys coronavirus on our hands, why on earth do we not launder these 450,000 so-called disposable garments that we throw away each day? Is that not an appalling waste of resources, as well as bad for our environment? Will we radically step up making our own washable PPE, now and for the foreseeable future?

[Lord Bethell]

The noble Lord makes an entirely reasonable and common-sense request. It is one that I have put to officials myself. The practicalities of PPE are that you have to be prepared to be covered in large amounts of human fluids and for the garments to be waterproof against their impact. Staff are uncomfortable with wearing garments that may have been used in that way previously. In order to maintain levels of hygiene and to rid them of disease, it is very difficult to reuse them. However, we have a committee looking at the potential for reuse, which will be reporting shortly.

[The Earl of Erroll (CB)]

How does the NHS expect to be able to buy PPE when it insists on paying 30 days after delivery, when everyone else is paying upfront, especially internationally? This applies both when we want to import and to pre-empt export. It might explain the interruption in the Turkish supply chain.

[Lord Bethell]

My Lords, the question of payment is a relevant one. We have put in place new facilities for different means of payment, but I just alert noble Lords to the very large amount of fraud that exists in this marketplace at the moment. I am aware of several police inquiries into situations where providers have sought early or upfront payment. We have to protect both the patients from failure to deliver and the taxpayer regarding value for money

[The Lord Bishop of Newcastle]

My Lords, in view of the inability to supply sufficient PPE to where it is needed, despite the very best efforts of central government, will the Minister take note of the achievements of the Northumbria Healthcare NHS Foundation Trust, working in partnership with Wingrove Motor Company, Northumbria University, Barbour and many others, to produce and deliver PPE directly to hospitals and hospices in the region? Will the Minister consider devolving more power to the regions and those on the front line?

[Lord Bethell]

The reference that the right reverend Prelate makes is an entirely right one. I pay tribute to the hard-working professionals in NHS and care home procurement. They have been caught in the eye of the most tremendous storm and, under extremely difficult circumstances, are working hard to meet the challenge. In particular, I pay tribute to the local procurement teams who are using their initiative to answer the challenge. Our approach to PPE procurement is one of collaboration with these sorts of local initiatives. I commend them, and they very much spell the future of PPE procurement.

[Baroness Thornton (Lab)]

I was going to ask about waiving regulatory requirements, but I will instead return to the question asked by my noble friend Lord Harris: is it the case that the Minister does not know the number of PPE required? My noble friend asked that question specifically. How much PPE is required on a daily or weekly basis? If the Minister does not know the answer, that is fine; he probably needs to find out and tell us.

[Lord Bethell]

The noble Baroness asks a perfectly reasonable question. I am afraid that I do not know the individual amount off the top of my head. I can tell her that, to date, we have delivered 135 million masks, 148 million aprons, 1.3 million gowns and 485 million gloves—more than 900 million items in total. The amount that we are providing increases every day. I will not hide from the noble Baroness or the House that this is a fast-moving situation. It is my impression that the demand for PPE will soon extend to other workplace situations and increase. It would be wrong to give the impression that this is a fixed amount that we should try to hit with short-term targets.

[Baroness Blackwood of North Oxford (Con)]

Following on from my noble friend Lord Blencathra, it is vital that we explore all options to increase the sustainability of UK stocks. I understand that UVC is often used for surface sterilisation; early research suggests that it can also be used for gowns and masks, using UV sources, which are found in lots of biosafety cabinets in academic, commercial and hospital labs. If the reuse committee mentioned by the Minister has not started looking at this, can he please ask them to consider whether this is a viable option to extend the lifespan of PPE?

[Lord Bethell]

The noble Baroness is right to champion this point. The Cleveland Clinic is known to us. I will ensure that it is played into the task force that is working on both the regulations and practicalities of reuse.

[The Lord Speaker]

My Lords, that concludes the Virtual Proceedings on Oral Questions. Thank you very much, questioners and Ministers. The Virtual Proceedings will resume at 12.15 pm for the Private Notice Question in the name of the noble Baroness, Lady Smith of Basildon.

Covid-19: Personal Protective Equipment

Lord Bethell Excerpts

Thursday 23rd April 2020 Lords Chamber

The Question was considered in a Virtual Proceeding via video call.

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

My Lords, the full weight of the Government is working to get every NHS and care worker the personal protective equipment that they need. A cross-governmental team is working to source PPE from around the globe, drawing on Foreign Office and Commonwealth teams and a global network stood up by the Department for International Trade. The Armed Forces are helping with logistics. My noble friend Lord Deighton leads the efforts to boost UK PPE production.

[Baroness Smith of Basildon (Lab)]

I am grateful to the Minister. I was rather surprised to see him answering this Question, because I am asking about cross-governmental work and I expected a Cabinet Office Minister. Can I push him on the issue of procurement policy? He will have heard industry complaints, including from overseas manufacturers, that they have been unable to provide PPE to the UK because of the bureaucracy and hurdles involved in the procurement process, so instead they are selling their equipment to other countries. There are also numerous reports of small and medium-sized manufacturers, with the ability and capacity to produce PPE here in the UK, feeling that they have been ignored by the Government and that their approaches are just dropping into a black hole.

Noble Lords are aware that this is urgent; it has been urgent for weeks. It will continue to be urgent and the Government need to be fleet of foot and flexible. We all welcome the appointment of the noble Lord, Lord Deighton, but is there one Minister with responsibility for PPE, with the authority to work across government departments to unblock any hurdles there could be or any problems in provision and distribution? If there is, who is it and, if not, why not?

[Lord Bethell]

The noble Baroness makes a completely fair point. The background is that procurement in the NHS has been lean and efficient. It has been dedicated to choices for local organisations. Therefore a challenge such as Covid, which requires a massive four-nation international procurement programme, requires a different approach. We have stood up that approach and the NHS Supply Chain is working with officials from all the departments. I attended Skipton House to witness for myself the amazing work done by that joint procurement team. Jo Churchill, the Minister responsible, is achieving an enormous amount in this area.

[The Earl of Shrewsbury (Con)]

My Lords, is my noble friend aware of a comment I read recently in an article on BBC News online, which stated that the UK was incapable of manufacturing PPE products? Does he agree that British manufacturers and a number of others—such as schools, part-time workers, people on furlough and many others—are most capable of producing PPE products to a high standard? Is he further aware of a recent survey conducted by the Manufacturer magazine, which produced an extremely comprehensive and lengthy list of names, from corporate giants such as INEOS, BAE Systems, Dyson and JCB down to small, specialist, family-owned manufacturers, and from many different corners of the UK manufacturing family?

[Lord Bethell]

I completely agree. I utterly reject the suggestion that British manufacturers are incapable in this area. I share with my noble friend, though, that this is a low-margin, high-volume game, and those low-margin, high-volume manufacturers are largely found in countries such as China, Turkey and Myanmar. That does not mean that we cannot do local manufacture. We have had 25,000 offers of support from businesses as of yesterday. We are processing those responses, and 175 are through to an advanced round. We have already had three companies deliver PPE goods to the NHS to help our hard-working NHS and care workers.

[Baroness Barker (LD)]

Has the Department of Health and Social Care raised with the Treasury the issue of care homes having to pay VAT on PPE, which the NHS does not?

[Lord Bethell]

The noble Baroness raises a good point. I do not know the precise answer and would be glad to write to her with a clear answer.

[The Senior Deputy Speaker (Lord McFall of Alcluith)]

Lord Hannay of Chiswick. Lord Hannay? We will go on to the noble Baroness, Lady Ramsay of Cartvale.

[Baroness Ramsay of Cartvale (Lab)]

My Lords, I have been puzzled—not for the first time—on the PPE distribution question. The UK has always had a system and structure of deciding on priorities of threats to the security and well-being of the United Kingdom. Pandemics have been on that list and given very high priority for a number of years. If that system is functioning, as it normally does very well, how can we have this problem of production, procurement and distribution of PPE? Is it working as it used to? If not, is that because there has been a lack of resources into it in recent years?

[Lord Bethell]

The noble Baroness is right to question the resilience arrangements in this country. I reassure her that we have extremely well thought-through resilience arrangements. This disease, though, is more infectious than we could possibly have imagined. The need for PPE is higher than we had originally planned for. In the NHS we have an organisation in which efficiency and supply management has been put at a very high level. However, we have moved incredibly quickly to put in place central supply organisations. The entire weight of government is working hard to ensure that PPE is distributed widely and fairly throughout the system.

[Lord Balfe (Con)]

In the last couple of days, there have been news reports that a PPE package of some 400,000 pieces ordered from a Turkish company was delayed by the Turkish Government. It has been put to me that the Turkish Government are not responsible for any delay in this shipment, which was a straightforward business deal between the NHS and a Turkish supplier. Will HMG confirm that the Turkish Government have played a constructive role and have not sought to delay the shipment? Will they publicly thank the Turkish Government for not seeking to stop or delay it, even though they have their own crisis to deal with?

[Lord Bethell]

I reassure my noble friend that we have been in daily and constant contact with the Turkish Government, who have behaved with good faith and in a supportive fashion throughout all our dealings. We are thankful to them for their involvement.

[Lord Patel (CB)]

Does the Minister agree that we have not done well when it comes to the delivery and availability of PPE? As yet, nobody has said sorry to anybody for that. Does he think that somebody should? If I may repeat and slightly rephrase the question asked by the noble Baroness, Lady Smith, at the door of which Cabinet Minister does the buck stop?

[Lord Bethell]

I am not sure that I agree with the analysis of the noble Lord. No one could have anticipated the huge demand for PPE not just in the NHS and care homes but in other workplaces. This is a global phenomenon. The chase for PPE is difficult in all countries around the world. Britain is not alone in struggling with this. I do not think now is the time for apologies; now is the time for delivering PPE, and that is what this Government are focused on doing.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I declare an interest as president of the Health Care Supply Association and thank the Minister for his tribute to procurement professionals in the NHS and the supply chain, SCCL. I return to the issue raised by the noble Baroness, Lady Smith, and the noble Lord, Lord Patel, about cross-government working. It is clear that this is a concern of not just the department of health. It certainly involves the Cabinet Office as well. Is there someone in the Government who has the authority to make the final decisions? It is not clear at the moment.

[Lord Bethell]

The noble Lord asked for clarity; let me be clear. The NHS is the client. The department of health pays the bills. Other departments are doing their bit to help. We are very grateful to the Cabinet Office in particular for providing contract and procurement staff, and we are thankful to all other departments that have lent us their staff or their logistical skills in delivering our PPE commitments.

[The Senior Deputy Speaker]

My Lords, the time allowed for this Question has elapsed. The Virtual Proceedings will now adjourn until 1 pm for the debate in the name of the noble Baroness, Lady Wheeler.

Covid-19: Social Care Services

Lord Bethell Excerpts

Thursday 23rd April 2020 Lords Chamber

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

My Lords, I join the noble Baroness, Lady Wheeler, and others in remembering those who have suffered from this dreadful disease. I pay tribute to those in healthcare and other key workers on the front line who selflessly and heroically help deal with this awful epidemic. I have a personal reason to thank in particular those BAME social care staff who take a particular risk and often take on most challenging tasks.

I thank all noble Lords for the thoughtfulness and scrutiny they have brought in this digital debate to an issue which is, as many have remarked, overlooked but is now, without doubt, at the centre of our national debate. With 40 speakers and a lot of new technology to deal with, I apologise in advance if I cannot respond to all the thoughtful and perceptive questions that have been asked, but I will try to address the most immediate issues raised by noble Lords with a practical update—and I will avoid the lofty, high-level stuff, as requested by the noble Baroness, Lady Thornton.

As the noble Baroness, Lady Wheeler, rightly stated, on 15 April we published our action plan for adult social care. The plan outlines how we have committed to strengthen and support this vital network, for the carers and for the cared. The plan has four pillars, First, our number one priority is to limit the spread of the infection. It is clear, as many noble Lords have rightly said, that personal protective equipment has been an issue for many in the care sector. We recognise that and we set out a PPE plan on 10 April to deal with the issue.

We recognise that PPE is vital to protect NHS and social care staff from contracting Covid and to protect the people whom they care for, and we are acting to ensure that PPE is available where it is needed. We are running hard at procurement; the results are being felt, but there is more to be done. Public Health England has published guidance on good infection control practices, discharge processes, testing and in which scenarios to use PPE to minimise the risk of transmission. We have moved quickly to adapt guidelines to this new, complicated and deadly threat, to be clear in the way we communicate, but I accept that it is sometimes difficult to keep up. I hear loud and clear from the noble Baroness, Lady Wheeler, my noble friend Lady Verma, and the noble Lord, Lord Hain, about concerns on costs. I reassure this virtual Chamber that substantial funds have already been mandated. The question of funding remains under review and, if more is needed, this Government will step up to their responsibilities. We are taking these issues seriously, but the challenge is substantial.

This sector that is made up largely of smaller, independent providers that have historically sourced their PPE on open markets, as well put by the noble Lord, Lord Hain, so we are putting in central procurement support at pace and on the fly. We have developed a parallel supply chain across government with NHSE&I, NHS Supply Chain, Clipper Logistics and the armed services. The parallel supply chain has been established to support care homes, home care and hospices. It is done in the spirit of collaboration, as the noble Lord, Lord Shipley, has rightly recommended. This is already supplying PPE equipment to hospitals and local resilience forums. I reassure noble Lords that this improved speed and reliability of delivery is already relieving pressure on the supply chain.

We are working around the clock to ensure that staff on the front line can do their job safely. As of 20 April, we have released 29 million items of PPE to seven designated wholesalers for onward sale to social care providers. This includes 11.4 million face masks, 13.3 million aprons and 4.2 million gloves.

Let me say something on discharge. We recognise that moving someone from hospital to another area where infection control is important is incredibly delicate. That is why, last weekend, the Chief Medical Officer changed the guidelines so that all patients will be tested before being admitted to care homes, as well as all care home residents. This is welcome news.

On testing generally, I reassure the noble Baroness, Lady Grey-Thompson, and the noble Lord, Lord Hain, that, while testing was initially limited to help manage the demand for tests for the most unwell, this has changed. There is new guidance and considerably more capacity. I reassure the noble Baroness, Lady Wheeler and Lady Brinton, and the noble Lord, Lord Turnberg, that as lab capacity increases every day, we have already expanded testing to include more care home residents and staff.

It is true that the drive-in centres were the quickest to set up, as the noble Lord, Lord Shipley, rightly remarked. However, I reassure the noble Baroness, Lady Barker, the noble Lord, Lord Dubs, and other noble Lords, that this week we have started home delivery of self-administered packs, which will be organised by Amazon, pop-up mobile units organised by the Army, and we will shortly have a retail solution from Boots. This will go a long way to address the concerns of those who find the drive-in centres awkward or unavailable.

On the subject of counting deaths, I reassure the noble Lord, Lord Bilimoria, and other noble Lords that the official ONS figures, which are informed by CQC returns from death certificates, will always capture Covid deaths, whether they are from hospitals, care homes or at home, and that it is the responsibility of doctors to inform PHE of any Covid death.

The 1.5 million social care workers on the front line of the virus are crucial in delivering care to our most vulnerable citizens, so I will say a word on them. I reassure the noble Baroness, Lady Grey-Thompson, that we have capacity for every care worker to be tested, just as there is for NHS staff and their families. PHE will be administering those tests and home testing equipment will be distributed. Social care workers have been designated as key workers, which means that the children of those working in social care can continue to attend school where there is no safe option for them to stay at home.

In response to those who say that government has done nothing, I remind the noble Baroness, Lady Hollins, and other noble Lords that our action plan for adult social care sets out an ambition to attract 20,000 people into social care over the next three months. We will shortly launch a new national recruitment campaign to run across broadcast, digital and social media. The campaign will highlight the vital role that the social care workforce is playing now during the pandemic, along with the longer-term opportunity to work in care.

I am proud to recognise carers and to endorse social care branding with badges and lanyards to create a proper identity and recognition. We have formally introduced the CARE brand to sit alongside the NHS brand in England. It is right that we recognise the hard work of carers and, as the noble Baroness, Lady Wheeler, put it, ensure that they too get support such as queueing priorities like their NHS colleagues. We recognise the immense pressure that the social care workforce may be facing, which is why we have extended a package of helplines and text-based systems across the board to support the well-being of carers and other front-line staff.

Several noble Lords, including the noble Baroness, Lady Finlay, and the noble Lord, Lord Bilimoria, raised the impact of BAME staff working in the social care sector. We have commissioned work from Public Health England to understand how different factors may influence the way someone is affected by this virus.

My noble friend Lord Astor asked about respite for carers—an important point. On 8 April we published guidance for unpaid carers on GOV.UK, which includes general advice, including advice on infection control, links to other information and support and advice on caring where someone has symptoms.

Perhaps I can reassure the noble Baroness, Lady Tyler, who asked about visa exemptions for nurses in social care, and the noble Baroness, Lady Masham, who requested an update on when we might relax the immigration rules to ensure that we have an adequate number of carers, nurses and doctors. The Government are already working with the NHS to ensure that visas are extended to doctors, nurses and paramedics and where, as noted by the noble Baroness, Lady Bull, significant numbers of overseas staff are working on the front line to battle Covid. UK Visas and Immigration has now written to 270 NHS organisations to begin processing these important extensions. I will take away her valuable point that the social care workforce should be included within the scope of these discussions. Many employers across health and adult social care benefit from the skills of overseas staff. However, it is clear that international recruitment will not be straightforward at the moment, nor in the future, due to widespread travel restrictions in place around the world. We are going to have to adapt to this new reality.

The noble Baroness, Lady Sherlock, asked a very valid question on carers’ eligibility for universal credit. We are acutely aware of the issues faced by the self-employed or those on zero-hours contracts. Some individuals employed on zero-hours contracts may be entitled to statutory sick pay; those who are ineligible can claim universal credit or contributory employment and support allowance, depending on their circumstances.

The third strand of our strategy is supporting independence: supporting people at the end of their lives and responding to individual needs. I completely take on board the comment made by the noble Lord, Lord Blunkett, about inadvertently creating a monster in our efforts to slay the dragon of Covid. But I would add that it is not the Government who seek to punish older demographics and those with pre-existing conditions; it is the virus. The objective of our policies is to save lives and protect the NHS and our care services.

Let me give you a few examples. We are working alongside technology firms and voluntary organisations to assist the most at-risk and isolated people with access to vital emotional support and companionship. These efforts are beginning to bear fruit. While unnecessary visits are restricted, we are clear that visits at the end of life are important for the individual and their loved ones, and they should continue. The guidance now makes that clear.

We recognise the specific challenges that disabled people will face as a result of Covid-19, as was raised by the noble Baroness, Lady Bull. We have been taking several important steps to mitigate the impact of Covid-19 on people with disabilities and continue to engage with stakeholders to ensure that their needs are met. For instance, we are improving the accessibility of government guidance and working with the disability unit at Public Health England and NHS England to ensure that important messages reach throughout the communities.

On the DNR notices wrongly sent by some GPs, I totally endorse the comments of the noble Baronesses, Lady Brinton, Jolly and Jones, the noble Lord, Lord Alton, and many others in their condemnation of pre-emptive DNR notices. The CQC has been making that point very well and we all reject that practice.

The fourth strand of our strategy is protecting vulnerable children. The Government understand the importance of having robust social and domestic care provision for disabled and vulnerable children, and the need to ensure the sustainability of social care services. This issue was raised by my noble friend Lord Farmer, the noble Baroness, Lady Massey, and the noble Lord, Lord Addington. We are taking action to ensure that those reliant on such services are identified and supported during the pandemic. I reassure the noble Baroness, Lady Massey, that we are working closely with other government departments, local authorities and partners, such as the Council for Disabled Children, to assess the impact of Covid and local decisions on the provisions of these services.

We know that some families need more support than others and that attending education settings is an important protective factor. That is why we have not only ensured that they can continue attending school but made it clear that we expect them to, as long as it is safe for them to do so. We also encourage families with a child whose SEN needs cannot be suitably supported at home to attend school, but this will depend on a risk assessment. Many pupils with special needs are better off staying at home during the crisis.

Lastly, we are supporting local authorities and providers of care. In March, we announced £2.9 billion of funding to support and strengthen care for the vulnerable. Local government is being supported by £1.6 billion of additional funding to meet extra demands. This funding can be used across all services facing pressure. Further, we have enhanced the NHS discharge process by providing £1.3 billion of funding to allow patients who no longer need urgent treatment to return home from hospital safely and quickly. This funding will cover follow-on care costs for adults in social care or people in need of additional support when they are out of hospital and back in their home, community or care setting. We are keeping future funding under review. We announced over the weekend a further £1.6 billion package for local government to ensure that local government has the funding it needs to respond to the crisis as it develops.

A number of noble Lords asked about VAT. I confirm that providers pay VAT as private entities, but the important thing is that they have support with the costs they are incurring. This is what we are doing through the significant funding. I remind noble Lords that if adult care providers are charities they do not have to pay.

My noble friends Lady Verma and Lord Astor urged the Government to ring-fence this funding. We are taking important steps to ensure that this additional funding is making a difference. For example, as the noble Lord, Lord Dubs, asked, we are asking local authorities to provide information about the distribution of this funding to providers. The Government will continue to monitor pressures in the NHS and local government and will keep future funding under review.

We are also supporting the system through emergency legislation. The Coronavirus Act 2020 came into force on 31 March and brought significant changes to local authority duties under the Care Act 2014. I reassure my noble friend Lord Astor of Hever that the Government are committed to revoking these powers when they are no longer needed. I confirm to the noble Baronesses, Lady Wheeler and Lady Grey-Thompson, that we have received notification that six authorities are operating under the Care Act easement and that I thoroughly support the publication of the details. Those authorities are Sunderland City Council, Middlesbrough Council, Warwickshire County Council, Staffordshire County Council, Birmingham City Council and Solihull Metropolitan Borough Council.

The decisions local authorities may have to consider at this time are not simple and it does not necessarily mean that they are in crisis. The Department of Health and Social Care has issued guidance on easements, including an ethical framework and prioritisation guidance. I reassure noble Lords, including the noble Baroness, Lady Wheeler, that local authorities remain under a duty to meet needs where failure to do so would breach an individual’s human rights under the European Convention on Human Rights. Such easement measures should be used only when absolutely necessary, based on the local authority’s judgment of its ability to meet the needs of people in line with the Care Act.

The disease is a cruel enemy. It attacks the weak and vulnerable, as put very clearly by the noble Baroness, Lady Hollins. Carers and residents are put in a desperate position not because of government policy but because of the reality of this horrible killer. Let me touch on the comments made by the noble Lord, Lord Alton, on the final hours of those in care homes and funeral arrangements for them. As someone who has lost a loved one in a nursing home, I know at first hand that it is a heart-breaking reality of this awful epidemic that we cannot properly say goodbye to the ones we love.

I shall say a few words about the Government’s priorities. We have put this country on hold to save lives and to protect the NHS and our care services. The noble Lord Tyrie, made the financial commitment very clear. I reject the idea put by the noble Lord, Lord Hunt, that this Government treat those in our care homes as second-class citizens. They have been a huge priority in everything that we have done in the past months. Mitigating the impact of the Covid pandemic is the top priority of the British people and of this Government.

This epidemic has undoubtedly put a spotlight on social care. The British people and this Government will never look at social care in the same way again. Today we are working flat out to mitigate the effects of a deadly disease, but things will change. The Government have committed to a substantial review of the sector. It will come when the time is right and, as noble Lords rightly asked, it will be a moment for society to draw up a new contract for social care. It will need cross-party collaboration and a new approach. I would like to hold on to the feeling expressed in this debate. Let us all remember these commitments to a fresh start when that moment comes.

Covid-19

Lord Bethell Excerpts

Thursday 23rd April 2020 Lords Chamber

The Statement was made in a Virtual Proceeding via video call.

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

My Lords, I shall now repeat a Statement on coronavirus that was made yesterday in the other place. The figures have changed since then and this Statement contains up-to-date figures. The Statement is as follows:

“Mr Speaker, first, may I say how pleased I am that the House is sitting once again? At this important time, it is critical that we have the scrutiny and debate provided by this House. I would like to thank everybody involved in setting up these new arrangements. This has demonstrated that no virus, and no threat, will thwart our democracy.

Coronavirus continues to spread throughout the world. The latest figures show that 18,738 people have sadly died here. Our hearts, and the hearts of the whole House, go out to their loved ones. I know that, across the House, we are all united in our determination to fight the virus with everything we have. Today, I wanted to update the House on each part of our battle plan.

First, on the resilience of the NHS, I can tell the House that, for the first time, we now have over 3,000 spare critical care beds in the NHS. That is over three times more than we had at the start of the crisis. It is thanks to the incredible work of an awful lot of people that we have this extra spare capacity, even before we include the new Nightingale hospitals.

Over the past two weeks, I have been lucky enough to attend, either in person or virtually, the opening of four of these new Nightingales—in London, Manchester, Birmingham, Bristol and Harrogate—and there are several more to come, all across the UK, including in Belfast, Glasgow, Cardiff, Exeter and Sunderland. These incredible efforts from our dedicated staff, supported by our Armed Forces, mean that our NHS has at no point been overwhelmed by the coronavirus. Some said this would be impossible.

Today, I want to reinforce the message that non-Covid NHS services are open to patients; the NHS is there for you if you need advice and treatment. I want to address that message very clearly to those most vulnerable to heart attacks and strokes, to parents with young children, to pregnant women and to people with concerns that they may have cancer. I want to emphasise that people with non-coronavirus symptoms must still contact their GP. If you think you need medical help, please contact your GP either online or by phone to be assessed. If you need urgent medical advice, use the NHS 111 online service, or if you cannot get online, call 111. And, of course, if something is serious or life-threatening, call 999. If you are told to go to hospital, the place you need to be in is a hospital. The NHS is there for you and can provide the very best care if you need it.

The second point of our battle plan is on supply and working to boost supplies of core equipment. The full weight of the Government is behind this effort, and again we have brought in our Armed Forces to help us to meet this demand. This includes ventilators—both purchasing extra stock and increasing the production of new ones. We now have record numbers of ventilators, with 10,800 available for use by patients. It includes medicines, so that we can make sure everyone has access to the supplies and treatments they need. And, of course, it includes personal protective equipment too.

In normal times, the NHS PPE supply chain supplies 233 hospital trusts. Currently, 58,000 separate health and social care settings are being supplied with PPE, so we are creating that whole new logistics network from scratch. We have some of the best minds in the country working on this. I am grateful to colleagues from the NHS and Public Health England, the Crown Commercial Service and the Cabinet Office, the Ministry of Housing, Communities and Local Government, the Ministry of Defence and the Armed Forces—again—the devolved Administrations and territorial offices, the Business Department, the Treasury, the Foreign Office and the Department for International Trade, because they are all playing their part.

Last week, I appointed my noble friend Lord Deighton, who delivered the Olympics, to a new role to drive forward PPE manufacturing here. Since the start of this crisis, we have delivered 1 billion items of PPE. We are constantly working to improve the delivery system by buying PPE from around the world. We are also working to make more at home, and I would like to thank all the businesses that have generously come forward with offers to turn their production lines to part of this national effort. I would also like to thank Members from across the House who have put us in touch with businesses in their constituencies. We are actively engaged with more than 1,000 companies that buy from abroad, and we are working with 159 potential UK manufacturers. We have a rigorous system of verifying the offers that we receive, because not all offers have been credible, and it is important to focus on the biggest, most credible offers first. This work is crucial so that we can get our NHS and care staff the kit they need so they can do their jobs safely and with confidence.

The third part is to scale up testing. I have set the goal of 100,000 tests a day by the end of this month. I am delighted to say that that capacity is ahead of plans, even though the demand has thus far been lower than expected. We are therefore ramping up the availability of this testing and expanding who is eligible for testing and making it easier to access the tests. The tests are being conducted in NHS hospitals, as well as through our drive-through testing sites, mobile units and home deliveries. The tests are then sent to laboratories. We now have completed the construction of three Lighthouse Labs, in Milton Keynes, Glasgow and Cheshire. Each site took just three weeks to complete and begin testing. Further, as we have reached the peak and as we bring the number of new cases down, so we will introduce contact tracing at large scale.

The introduction of the new NHS app for contact tracing is also in development. As we do this, we are working closely with some of the best digital and technological brains, along with renowned experts in clinical safety and digital ethics so that we can get all of this right. The more people who sign up for this app when it goes live, the better informed our response will be and the better we can therefore protect our NHS.

Fourthly, we need to make sure that we make the best possible use of science and research to pursue the vaccines and treatments that are essential to defeat this virus once and for all. Here, the NHS is at the forefront of the global effort. We have put more money into global efforts to search for a vaccine than any other country, and yesterday I announced over £40 million of funding for two important projects at Imperial and at Oxford. The vaccine from the Oxford project will be trialled in people from tomorrow, and I am sure the whole House will agree that this is a very promising development.

I will repeat what I said yesterday. In normal times, reaching this stage would take years, and the combination of innovative groups of people at the Jenner Institute in Oxford and the regulator, the MHRA, deserve our special praise because they are both ensuring that the process is safe, yet conducted probably more rapidly than ever before. They deserve the support of the whole House in that work. At the same time, we will invest in manufacturing capability because, if either of these vaccines work, we must make it available to the British people as soon as humanly possible.

The fifth measure that I will talk about in the time available is the one where everyone can play their part: social distancing. I want to thank everyone, across the country, for their steadfast commitment in following the rules, including in this House. It is making a difference. We are at the peak. But before we relax any social distancing rules, or make changes to them, we have set out the five tests that have to be met: first, that the NHS can cope; secondly, that the operational challenges have been met; thirdly, that the daily death rate falls sustainably and consistently; fourthly, that the rate of infection is decreasing; and, most importantly, fifthly, that there is no risk of a second peak.

Finally, we are working to protect the most vulnerable through shielding—this is the sixth part of our battle plan. There has been a huge effort under way across government to contact and support those at risk. We have been boosted by the support and help of the heroic NHS volunteer responders, who signed up in droves within two days of our call to action. An unbelievable 750,000 people put themselves forward for this initiative. With those volunteers, and with the support of the Ministry for Housing, Communities and Local Government, the NHS and local councils, which have done amazing work on this, we are shielding the most vulnerable.

These are unprecedented times for us all. We have all seen the extraordinary impact of coronavirus in our constituencies and all across the country. And even though today we are physically separated, this House is at its best when we are united in our purpose and our resolve. I will keep working with Members right across the House in this fight against this invisible killer. This may be akin to a war, but it is one where all of humanity is on the same side. I commend this Statement to the House.”

--- Later in debate ---

[Baroness Brinton (LD)]

I thank the Minister for repeating the Statement and for his work on testing. We may have some difficult questions for him, but I hope I have the support of the whole House in saying thank you to him and his team for the work they are doing on this difficult area.

I too thank all the staff and volunteers in the NHS and the wider social care sector and other key areas who have been working during this crisis, whether directly on the front line or in supporting families and our children in schools. We send our condolences to the families of the bereaved, and are pleased that many people are recovering, even though we know that, if they have had it badly, it takes time. From these Benches, we echo the concerns about the high percentage of BME deaths, among workers and non-workers alike.

The Statement says that there are 3,000 spare critical care beds, but ITV reports that care home residents now account for up to half of Covid deaths. However, last week the Daily Mail reported that care home residents were still being asked to sign letters to say that they would not go to hospital in the event that they had Covid-19. Will the Minister confirm that these critical care beds in hospital are not spare? There are plenty of people in care homes who could use those beds but they have been put under pressure, no matter how gently, to sign the letters.

It is good to see the Nightingale hospitals coming on board—even if they are empty, for the right reasons. One of the concerns expressed has been about the staffing and the initial request that any patient had to have staff accompanying them from their previous hospital. Can the Minister say that this has now definitely stopped and that staff with appropriate critical care experience are able to be recruited? I gather that this has also been a problem for increasing the number of beds.

There was a good message in the Statement for people to go to their GPs and to use 999 for emergencies, but today there was a report of somebody who had a severe heart attack not being picked up urgently, as heart attacks are still second-level priorities to Covid. As a result of that 20-minute target rate, sadly the patient died. Is there any rebalancing of priorities for ambulances now that we seem to be over the peak of cases?

On equipment and medicines, it is good to hear that there are now just over 10,000 ventilators. Are they full ventilators, or does that include CPAP and BiPAP machines? How many more are to come? There have been some worrying shortages of medicines for those who need to be sedated, and recently we have heard news that there is a problem with kidney dialysis and kidney medicine for people who have come out of intensive care and require long-term support. Is there a shortage of such medicines, what other medicines are at risk and what proposals are there to remedy that problem?

We have spent many hours today talking about PPE. We are still waiting for supplies for everything outside hospitals. On 6 April, Clipper was heralded as being about to solve this problem, but it is still woeful. Until the social care and community sectors get the support they need, they will continue to be worried about the spread of Covid.

The Turkish ambassador has written to various people in the APPG on Turkey, setting out the actual arrangements—as opposed to those reported by the Government—concerning the delay in the package that appeared to get stuck. Turkey actually donated 250,000 pieces of medical protection equipment to us; the rest came through privately. Can the Minister say when the remainder of the consignment due from a Turkish supplier will arrive?

It is good to hear that formal arrangements for testing, tracking and tracing are now under way, but the WHO always puts in a third word alongside “test” and “trace”: “isolate”. Any mention of isolation in the Statement is notable by its absence. Taiwan, South Korea and Hong Kong have all managed to suppress further bursts of Covid because of the arrangements for not just testing and tracing but isolating. It is good to hear that an app will be available, but the Minister will know that there are people with technical experience concerned about whether it is appropriate to use Bluetooth for it, because of security issues. Can the Minister assure the House that this is not the case and that people’s data will be used only for NHS purposes and will absolutely not be able to be used by any providers of the app or beyond? The 18,000 tracers announced by the Secretary of State just before this Statement are a good start, but we will need more for good national coverage. Worryingly, Mr Hancock said a few days ago that all this will be operated centrally. Is that still the case, or will he use the existing trained tracers that there are in local communities, whether environmental health tracers in councils or in local health teams? It seems rather bizarre to try to cover the country on that level.

On shielding, it is good that there is a request to create more volunteers and to celebrate the volunteers, but notable by their absence in the Statement are the many people who have not yet had their letters on shielding and whether any further groupings may have to consider shielding—which I understand is the case.

I congratulate the Government on their progress on test and trace, but confirm that we are extremely concerned about supplies of equipment and medicine and hope that things will be remedied speedily.

[Lord Bethell]

My Lords, I greatly thank the noble Baronesses, Lady Thornton and Lady Brinton, for their extremely perceptive and thoughtful questions. I will answer them, in the words of the moment, at pace.

The noble Baroness, Lady Thornton, asked about BAME. The precise figures for BAME deaths are not to hand. PHE will have a very thorough investigation into this. It will come up with a scope and a delivery date shortly.

On isolation, one of the frustrating and awkward things about the virus is how unpredictable it is and how many unknowns there are. It confounds expectations. The question of isolation remains one for which we are reviewing our advice. We are in constant contact with other countries to learn more about best practice.

On the European project, I make it absolutely 100% clear that there was a cock-up, not a conspiracy. There were emails from Europe to us that were missed; there were meetings that our side missed. It was a great shame that that opportunity was missed, but we have put in place the processes and arrangements to work with our European partners on future procurement if they are helpful to the NHS and our care system.

The noble Lady, Baroness Thornton, is quite right to ask about capacity and testing. The blunt truth is that infection rates have gone down dramatically. The lockdown has had a profound impact. The KCL infection rate graph has gone from 2 million to half a million. That has a profound effect on demand for tests. Access is no longer a problem. At 5 pm, on the No. 10 presser, the Secretary of State explained how key workers can access a test for themselves. A major advertising campaign will begin tomorrow. They can either attend the drive-ins or Amazon will deliver a test to their home. Therefore, for those without a car, travel is not necessary. That capacity will be essential when we build the kind of track and trace capability that we will need to take us out of lockdown.

The noble Baroness, Lady Thornton, asked about postponed treatments. I echo her sentiments entirely. It is of grave concern that the numbers of non-Covid deaths can be worse than of those who die of Covid themselves, as in any epidemic. The message in the Statement is crystal clear: if you need treatment, contact your GP or your hospital. We will do everything we can to give you the treatment that you need. We are trying to use this hiatus to clear some of the backlog. The noble Baroness mentioned cancer. That is a particularly tricky problem because those cancer patients in treatment who have challenging immune systems will not wish to attend hospitals where there is Covid. We are doing all that we can to try to make arrangements and provide hygienic arrangements for them.

The noble Baroness, Lady Brinton, asked about care beds. Let me slay one myth: the ONS is very clear about the proportion of deaths at care homes. It is 10%. It is an offence to misrepresent the cause of a death. Causes of death are reported to PHE. The CQC carries that information to the ONS. These are reliable figures and I would be glad to send those who suggest that it is more than that the details on the ONS website. There is no pressure on anyone to be in a bed that is not recommended by strong clinical advice. It is true that we have spare hospital bed capacity, but it is not true that we are pressurising anyone to stay in a care home who should be in a hospital bed.

The noble Baroness, Lady Brinton, raised the question of medicines. That is an area where our supply chains have been put under extreme stress. Suppliers in China, India and America have all been under pressure and we have been in conversation at government and corporate level to ensure we have supplies. The noble Baroness is right that some of the first-choice medicines for sedation have been in short supply, but there are ample and various back-ups for those medicines. She is right that a feature of the Covid disease, is, it seems, that it attacks the kidneys and there has been a big increase in the need for kidney dialysis and the drugs associated with it. We are putting in place the supply chains necessary to fill that need.

As for the Turkish ambassador, I am not going to give a blow-by-blow account of every plane and truckload of kit that comes to Britain; all I can say is that we are extremely grateful to both the Turkish ambassador and to our Turkish corporate providers and we find the scrutiny they have been put under unfortunate and regrettable.

Turning to track and trace, I confirm that isolation is an absolutely intrinsic part of the track and trace regime: it just does not rhyme so well, so you never put it at the end, but “track, trace and isolate” is the programme. I have been given a thorough briefing by the Taiwanese CMO on their use of track and trace and, having a Taiwanese wife, I can tell noble Lords that I am up to speed on their achievements in that area.

On app security, I assure the House that the Bluetooth we are using is the latent, not the overt, Bluetooth: data is not carried in the same way as in overt Bluetooth, and one of the reasons we have chosen that method is the strong security offered. I also reassure the House that we have strong data arrangements. It is one of the reasons we have gone for a latent Bluetooth technology, and no data will be shared with our technology providers.

Lastly, the noble Baroness, Lady Brinton, is entirely right to raise the tracing part of track and tracing. I reassure her that we will be using a variety of different methods. There will be a central bank of callers. We will also be using local resources where they are necessary, and we will also be using friends networks. We have learned from the best case studies from abroad that often the influence of friends in persuading people to isolate has the most profound effect.

[Lord Mackay of Clashfern (Con)]

My Lords, any decisions on relaxing the present restrictions and on research into treatments and vaccines are very difficult and therefore liable to give rise to differences of opinion, even among scientists and doctors. Will the Government do all in their power to reach agreement with the devolved Administrations on any decision on these subjects? Today, the Scottish Government published Coronavirus: Framework for Decision Making, a valuable aid to reaching the agreement I have mentioned.

[Lord Bethell]

I reassure my noble and learned friend that one of the most distinctive and reassuring aspects of the government response to Covid has been a very strong collaboration between the four nations. That has been epitomised by the strong relationship between the four CMOs, and operationally it has been given teeth by the presence of the devolved Administrations at COBRA meetings, which I attend.

[Baroness Meacher (CB)]

My Lords, I thank the Ministers for all that they are doing in this very difficult situation and, of course, all our wonderful NHS and care staff for what they do every day and every night.

As the Minister knows, the countries most successful in controlling Covid-19 are those with comprehensive testing and contact-tracing systems. We are thrilled to bits that we have two leading research teams in the country—great applause to them—but, until their vaccines are available across the country, the testing regime will be the only approach that will enable a return to any kind of normality. A large-scale sample, or provision, of testing and tracing and so on for care workers will not achieve that objective. Will the Minister tell the House if or when the Government will introduce a comprehensive—I emphasise that word—scheme of testing, contact-tracing and, as has been said, isolation, of all who have symptoms of Covid-19? This means not a sample and not just people in the care sector, but the nation. That is the only way out of the tight corner we are in. If not, can the Minister explain why?

[Lord Bethell]

The noble Baroness, Lady Meacher, is entirely right in the way that she explains things. The driver of that decision is the need to get our prevalence rates and the velocity of the infection down to a reasonable level, so that we have reasonable resources to keep R down by track and trace. I remind her that South Korea, which has used this technique most effectively, does only 20,000 tests per day, because its prevalence levels and velocity of infection are so low.

[Baroness Buscombe (Con)]

My Lords, I should like to say how encouraged I am by what my noble friend the Minister has said today on the progress made in tackling this virus. In asking my question, I stress that I have been urged so to do by many businesses, large and small, across the country—the backbone of our economy.

Will the Minister and his colleagues now accept that we must expect a second wave of the virus, even though we do not know when? If so, it is now crucial to look at working both with and beyond the science, and to take a balanced, proportionate and, frankly, brave decision, with Cabinet colleagues, to put trust in the good sense of the public to ease the lockdown as soon as possible—to allow the economically active to return to work, while retaining sensible social distancing —given that the situation is now having a devastating effect on our economy, and on our ability to afford our NHS, our welfare system, education system and other public services into the future.

[Lord Bethell]

I note my noble friend Lady Buscombe’s question, but I reject the sentiments behind it. I do not regard a second wave as inevitable; I do not share her fatalism. The priorities of the Government are to save life and to protect the NHS and our care system. That requires us to lower the prevalence level, reduce infection and put in place systems such as track and trace to keep a lid on the disease so that we can protect life and our systems.

[Lord Liddle (Lab)]

My Lords, I thank the Minister for his frankness on this occasion. On European co-operation, how have we got ourselves into a situation where for PPE we are so dependent on supplies from China, Turkey and other faraway countries, and allowed ourselves to get into a position where we do not have much domestic manufacture? Similarly, on vaccines, I read a report in the Financial Times that we have no vaccination manufacturing capacity at scale in Britain. If that is the case, should we not look at whether European co-operation can help us there?

I welcome what the Minister said about testing. I had a report locally of care workers in Silloth, in the west of Cumbria on the coast of the Irish Sea, being told that if they wanted to be tested, they had to go to Gateshead, some 80 miles away, with no means of transport to do so. Will there be no repetition of that problem?

[Lord Bethell]

The noble Lord, Lord Liddle, is not entirely right. We have fantastic manufacturing in the UK—I reinforce the view of my noble friend Lady Buscombe that the sector provides jobs for the economy—but we do not have low-margin, high-volume manufacturing. The image of a Burberry gown always sticks in my mind on this point. Burberry makes £500 shooting jackets, but it does not make £5 surgical gowns. That is something that we need to address, and it will be the priority of my noble friend Lord Deighton.

[Lord Scriven (LD)]

My Lords, the South Korean prevalence rate is so low because they have tested, traced and isolated since day one. The Government initially did this and then stopped it. Ten days ago, they said that there would be 1,000 tracers; now, the figure has gone up to 18,000. Why have the Government not kept this system going consistently, which South Korea has proved reduces the prevalence rate of the virus?

[Lord Bethell]

The noble Lord, Lord Scriven, is not correct to say that the Government decided to stop track and trace; there are still PHE track and traces, but when the disease reaches a certain level of prevalence, it simply is not arithmetically possible to track down every new incidence of the disease. Nor is it true that anyone in the Government said that we would have only 1,000 tracers in our call centres. Plans which I have seen are being drafted at the moment which are wildly more ambitious than that. It is our plan to put together a system that is proportionate to the challenge.

[Baroness McIntosh of Pickering (Con)]

My Lords, I declare an interest: I work with the Dispensing Doctors’ Association. It is emerging that all gowns are made to one size, which is posing a problem particularly for larger men and all women. I realise that this matter is being addressed. Can the Minister update us on it today?

I warmly congratulate my noble friend and the Government on introducing the new measures on testing and tracing. It strikes me that, if we could do this as locally as possible and perhaps look to training environmental health officers to be able to do some of the tracking and tracing, it would be a good use of their time.

When it comes to ending the lockdown, I urge the Government to follow the Swedish example of maintaining self-isolation but allowing hospitals, bars, pubs and cafés to open in a regulated and controlled manner.

[Lord Bethell]

My noble friend Lady McIntosh is quite right that we should look at several different workstreams for our track and trace model. As the noble Lord, Lord Scriven, implied, one of the most important things to consider is having surge capacity. Track and trace is very important when you have an outbreak or second epidemic. We need to have in place that additional capacity to track down and isolate those who bring in new infection.

[Lord Touhig (Lab)]

My Lords, refugees and people with irregular status who are medically extremely vulnerable are being deterred from seeking treatment because of concerns around immigration enforcement and charging. What steps are the Government taking to ensure that no one in these circumstances is discouraged or prevented from receiving the treatment that they need?

[Lord Bethell]

The noble Lord raises an issue that I remember was raised during discussions on the emergency Coronavirus Bill. It is my understanding that a generous and open-hearted view is taken on the treatment of those with irregular status in the UK. Now is clearly not the time to try to put in prison those who have irregular status. The precise arrangements escape me, but I would be glad to write to the noble Lord with a precise description.

[Lord Patel (CB)]

My Lords, the Minister mentioned in his Statement the introduction of app-based tracing of contacts, which others have already mentioned. At the same time, I assume that the Government will introduce serology testing and expand the current molecular testing. When will the Government publish the protocol for implementation of this, and how will the public be informed?

[Lord Bethell]

The noble Lord, Lord Patel, will be interested to read the details of our ONS serology tests that have begun earlier this week, which will be published in mid-May. These are surveillance tests and will provide us with the information that we need to understand how the epidemic is developing. At the right time we will also bring in mass serology testing. However, as the noble Lord will be aware, when prevalence rates are around 3%, 4% or 5%, as they seem likely to be, serology tests for managing the epidemic are not relevant yet.

[Lord Lucas (Con)]

I am delighted that the Government are taking resilience seriously. Will my noble friend confirm that the Government will have a permanent stake in the facilities and the intellectual property that they are creating, to ensure that it stays here and is well maintained? Will he also extend the interest in resilience to pharmaceutical intermediates and generics, where we are also seeing problems developing which were also problems when we were contemplating no deal? There seems to be a strong argument for having a better set of arrangements in place in this country to ensure supply in difficult times.

[Lord Bethell]

My noble friend Lord Lucas is quite right about IP, although I bear testimony to the private companies and major corporations which have reacted incredibly generously and enthusiastically by supporting the Government during this crisis. Our supply chains absolutely need to be reviewed. Resilience is clearly more important now than it has ever been. When we look at the way in which our medical, pharmaceutical and device supply chains are put together, they will look quite different in years to come.

[Baroness Walmsley (LD)]

My Lords, the Secretary of State said that he would mention treatments, but he focused only on vaccinations, which are of course important. However, I would like to ask about progress on developing antiviral drugs and the use of serum treatments, about which I have heard encouraging reports. Can the Minister say whether there are any plans to ask recovered Covid-19 patients to donate blood after a suitable recovery period so that the serum could be used to treat very sick patients and help them recover?

[Lord Bethell]

The noble Baroness is entirely right. Serum offers an encouraging opportunity, not least because it is a proven technology. The national blood transfusion service has been asked to start investigating how to collect serum, and a grant for the purchase of new machines to help that has already been made.

[Baroness Pidding (Con)]

My Lords, my question is with regard to testing, and in particular the drive-through testing centres, where we are not seeing maximum take-up. On the priority for testing, that is obviously our key workers, both in the NHS and care homes, but I am mindful that some who may not be able to drive or who may not have access to cars. Therefore, this itself presents a challenge with regard to drive-through centres and their geographic positioning, as they can be considerable distances away. I appreciate that the Minister has already spoken about home testing, and the Statement makes brief reference to the use of mobile units. Surely this has to be the way forward, taking the testing to essential people who are in the front line. Can we not ramp up this operation, employing the expertise in logistical functions of the military? I would be grateful if my noble friend could provide more detail as to what mobile units are and how they operate.

[Lord Bethell]

I would like to recruit my noble friend to our testing organisation, because she has exactly the right ideas, and the programme she described is exactly what we are doing. The Army is putting together 50 transit vans with tents and cones to be able to travel to places such as care homes to conduct testing, particularly at times of epidemic. Amazon is putting together home testing kits, which means that no one need drive anywhere to have a test, and we are working with care homes so that care workers can take the swabs and then drop off bags of them at a reasonable place so that they can be processed by our laboratories. Drive-in testing was an early but limited programme, and we have a lot more going on than that.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I thank the Minister; he has had a lot of work to do in the Lords today. He commented on ONS figures and the analysis it has done on the number of people who have so sadly died. The figure he gave in the Statement was, I think, around 18,000. I assume that these are deaths from the virus of people in hospital. I suspect he will have seen a piece in the Financial Times earlier this week which did some analysis of the ONS figures. It suggested that the figure of deaths caused by the pandemic was as much as 41,000. Have his officials looked into this and can he comment on its veracity?

[Lord Bethell]

I have not seen the piece in the FT, so cannot comment on the noble Lord’s remarks. All I would remind him, as I have said in previous answers to similar questions, is that false reporting of a death is an offence. Doctors are required to make a clear report of a death. If it is associated with Covid in any way, the word “Covid” will be in the death certificate. If it is in the death certificate, it will make its way through the CQC to the ONS figures. There should be no ambiguity about this at all.

[Baroness Ritchie of Downpatrick (Non-Afl)]

Will the Minister provide an assurance that there will be rigorous tracking, tracing and isolation of those in care homes, including the staff and residents? Through its European director, the World Health Organization told us today that there were significant deaths across Europe, including in the United Kingdom and Ireland, and that there is a need to address this.

[Lord Bethell]

The noble Baroness, Lady Ritchie, addresses a very difficult problem. The programme we are looking at, announced earlier today with the change to our guidelines, is the testing of asymptomatic carers and residents in care homes. It is a natural and growing concern that the disease may be present in an asymptomatic form. We are determined to get the infection out of our care homes and the NHS.

[Lord Robathan (Con)]

My Lords, this lockdown is hugely damaging to the country, particularly to the future prosperity and education of our young people. Nobody knows, as the Minister has just said, how many people have had or have this ghastly virus and recovered. Many suggest that it is several million, possibly many millions. If that is the case, it leads to another suggestion: the mortality rate may be less than 1%. Some say—I am not an expert on this at all—that it is as low as 0.1%. If that is the case, what implications would that have on the Government’s policy of balancing the future well-being of this country and its people with dealing with this ghastly health crisis?

[Lord Bethell]

The noble Lord, Lord Robathan, makes a fair point. I reassure him that we are investing in a massive 20,000-person surveillance by the ONS to get to the bottom of the mystery which he describes. Every piece of evidence we have from every country around the world suggests that the number of people who have been through the disease is a tiny proportion of the population, and that the amount of recovery and antibody immunity in the country is likely to be in single figures. This is one of the great challenges of the virus and the situation it presents to us.

[The Earl of Clancarty (CB)]

My Lords, a test, track and trace policy is clearly right, but a week ago, Matt Hancock admitted that 15,000 people a day are entering the UK through airports without medical checks. In just over a month’s time, that will be an extra half a million people entering the country, many of whom may have Covid. Will the Government address this and plug what is surely a gap in their Covid policy?

[Lord Bethell]

The noble Earl, Lord Clancarty, is right that our present guidelines state that those arriving in Britain should isolate if they have symptoms and seek a test from a hospital if it develops seriously. It is clear to me that the way we travel around the world is set to change dramatically in the future, but the CMO has reviewed our airport and port guidelines. He is happy with them, and the evidence suggests that this is not currently a source of new infections in the UK.

[Baroness Altmann (Con)]

My Lords, may I press my noble friend on treatment, particularly with convalescent plasma? As I understand it, other Governments are urgently looking into this. France has put its medical staff into LFB. Have we put any pressure on BPL, which is the only fractionating company available in the UK, to produce pure, hyperimmune immunoglobulins, rather than the whole plasma, so that we can start parametric testing of IVIG and injections of convalescent plasma in the pure hyperimmune form?

[Lord Bethell]

I reassure my noble friend Lady Altmann that we are making this a massive priority. It has huge advantages over other therapeutics because it is plasma and can therefore have an accelerated regulatory advance. I signed for procurement of £20 million-worth of fractionating machines last week to help the blood transplant service create the hyperplasma to which she alludes.

[Lord Randall of Uxbridge (Con)]

The Statement rightly reinforces the message that non-Covid NHS services are open for patients. Would my noble friend agree that it is important to give parents confidence that essential vaccinations, especially MMR, should not be ignored and that they should speak to their GP for further advice and support?

--- Later in debate ---

[Lord Bethell]

I entirely agree with the sentiments and intent of my noble friend’s point. It occurs to me that we should perhaps set up some kind of advertising or promotion of this. I will take that point back to the department.

[The Deputy Speaker]

Baroness Wheatcroft. No? We will move on to Lord Balfe.

[Lord Balfe (Con)]

In the Statement, the Minister referred to the need for people who have other medical needs to still contact their GP. In Cambridge, where I live, the opticians, chiropodists, dentists and surgeries are all closed, with different fierce notices on their doors. When the isolation requirements are lifted, could the Government make it a priority to get these vital medical services open again and get doctors back into surgeries, not at the end of the telephone? Perhaps we could at least teach them that Zoom exists.

[Lord Bethell]

I reassure my noble friend Lord Balfe that the amount of video treatment being given by doctors has gone through the roof. During this epidemic, we have seen the medical trade and patients embrace a huge amount of digital technology. We are working with the colleges to try to get all the services of the medical profession open at this time and the response has been largely positive.

[The Deputy Speaker]

Lord Woolf. No? Lord Dobbs.

[Lord Dobbs (Con)]

Minister, are prisoners in our prison system participating in the manufacture of PPE? Does the crisis not represent an opportunity for many prisoners to not only contribute but move towards some rehabilitation?

[Lord Bethell]

My noble friend Lord Dobbs is right that there seems to be an opportunity, but I have to be candid with him. Our need for PPE runs into hundreds of millions of items. We have delivered more than 1 billion pieces of PPE since Covid began. I am afraid to say that the manufacturing abilities of Her Majesty’s prisons do not reach to that kind of level.

[Lord Blencathra (Con)]

As my noble friend the Minister has just said, in January the NHS had to deliver half a million PPE items to 233 hospitals. It now has to deliver 1 billion items to 58,000 health facilities. The experts in logistics are the military, as we saw from the brilliant No. 10 briefing by General Carter yesterday. Will the Government now hand over complete control of distribution to the Armed Forces? Will the Minister comment on reports that the much-vaunted EU purchasing scheme has not delivered a single item of kit to any EU country?

[Lord Bethell]

I would like to take my noble friend to Skipton House in London’s Elephant and Castle to see the very large room where there is a combination of the diplomatic skills of the FCO, the trade skills of DIT and BEIS, the military skills of the Army and the clinical skills of Health. Seeing all those different skills and abilities work together to deliver the kit that our health workers need is a really impressive sight. That collaboration is the secret to success.

[Lord Sheikh (Con)]

My Lords, my noble friend the Minister referred to the fact that the number of deaths that have occurred as a result of coronavirus stand at 18,738. The BAME community represents about 14% of the UK population, but unfortunately accounts for about 35% of all coronavirus patients in intensive care. The number of people in the BAME community who have contracted coronavirus and died as result is disproportionately high.

My noble friend might perhaps recall that I talked about the burial of Muslims when the Coronavirus Bill was discussed in your Lordships’ House. The Muslim community has got together, and burials are taking place in very difficult circumstances. However, I have been told by leaders of the community that the availability of land for burials should be kept under review and that a system should be provided if the land issue becomes a major problem and burials cannot take place. Secondly, the Government should consider providing additional funds to local authorities, which are dealing with very difficult circumstances. They are stretched to the limit and need additional resources for burials and cremations. Will the Minister comment on those two points?

[The Deputy Speaker]

Minister, if you could be very brief, we might be able to fit in the noble and learned Lord, Lord Woolf.

[Lord Bethell]

I am very grateful for my noble friend’s helpful update, but I remind him that these arrangements are conducted by local authorities. The question that he asks is best answered by those local authorities.

[Lord Woolf (CB)]

I thank the noble Baroness for her consideration. I am afraid that at a critical moment my microphone turned itself off. It is back on now. The Minister rightly referred to hero volunteers. He will be pleased to hear that those volunteers include members of the staff of this House, such as my part-time secretary, who has volunteered. That is worth noting, as are the many others who I am sure are in the same position.

[Lord Bethell]

I thank the noble and learned Lord. Will he please express my and the Government’s profound thanks to his secretary for their contribution? I hope it is proving to be rewarding to him or her personally and impactful to the causes in which he or she serves.

[The Deputy Speaker]

My Lords, the time allotted for the Statement is now up. I thank all noble Lords for being concise, in particular the Minister for his very concise answers.

Covid-19: Medically Vulnerable People

Lord Bethell Excerpts

Wednesday 22nd April 2020 Lords Chamber

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

My Lords, we recognise that though shielding is for individuals’ own protection, it is an immense undertaking. Decisions to advise shielding were taken after very careful consideration. The implications for those concerned are profound. We constantly review all social distancing measures and will continue balancing the need to protect the clinically extremely vulnerable from contracting Covid-19 against the restrictions that this places on their lives.

[Lord Blunkett (Lab)]

My Lords, I appreciate greatly the work that the Minister, his team and his colleagues are doing. I know that he will join me in appreciating the hundreds of thousands of volunteers, and mutual aid programmes at local level across the country as well, who are supporting people who are trapped in their homes. I wonder whether the Minister will discuss with his colleagues whether particular measures, which would not put at further risk those who are most vulnerable, could be adjusted to enable people to be treated in hospital for other conditions, given the concerns of Cancer Research UK and the British Heart Foundation, among others. Could we also take into account that two weeks ago, when I hope we reached the peak of deaths from the virus, there were 2,300 estimated additional deaths not related to Covid-19, which must be a great worry to all of us?

[Lord Bethell]

I completely agree with the noble Lord’s concerns, both about those who are clinically vulnerable and about the potential for a rise in non-Covid excess deaths. The second is a matter of extreme concern. The example of those with cancer who are going to hospital to have operations is a very good and clear example. These matters are very much at the highest level of the Government’s mind.

[Baroness Thornton (Lab)]

I thank the Minister. According to media reports, those who are particularly vulnerable to the virus could be advised to remain shielded for up to 18 months, or until a vaccine has been developed. Can the Minister confirm whether these reports are true? Secondly, the Government have recruited 700,000 NHS volunteers to support those who are vulnerable or shielded. Most of them seem to have been processed but many have been given nothing to do as yet, when there clearly is need. Will the Minister tell me how quickly that issue will be resolved?

[Lord Bethell]

The noble Baroness is entirely right. The prospect of long-term shielding for those most vulnerable is of deep concern. That is why we are pressing so hard on the disease, through the lockdown, to try to get R as low as possible. We will be putting in track-and-tracing measures to ensure that R can be held down and those in lockdown can be freed from their confinement. In terms of volunteers, the response has been incredible. It takes time to turn around all the offers of help that we have, but we are moving extremely quickly to do that.

[Lord Truscott (Ind Lab)]

My Lords, is there not a danger that extending the lockdown for only certain groups might unintentionally discriminate against elderly and vulnerable people? Might a better way forward be mass testing, tracking and tracing, as the Minister mentioned, plus the rapid development of a vaccine? If the Government are going to continue to isolate vulnerable people, will the Minister agree that this should be subject to a view by an individual’s GP?

[Lord Bethell]

The noble Lord makes a reasonable point, but I confirm that it is the virus that makes this discrimination, not the Government. Certain demographics are even more vulnerable than others. It is an unfortunate fact that those who are medically vulnerable are singled out by the virus. We have to put in place measures to protect and safeguard their lives.

[Lord Lamont of Lerwick (Con)]

Following up on the questions from the noble Lord, Lord Truscott, and the noble Baroness, Lady Thornton, when we eventually get to the stage of lifting restrictions I urge the Government not to discriminate against the elderly on the grounds of vulnerability and not to treat them as a single category. Many of the elderly—over half a million—continue to work. They feel acutely the separation from loved ones. They are conscious of their own vulnerability, are perfectly sensible and do not need the threat of law to protect them. Will the Minister remind his colleagues when decisions come to be made about lifting restrictions that the decision is not just for scientists? It is a political question as well. Policy that might be acceptable in China might not be acceptable here.

[Lord Bethell]

My noble friend is entirely right that the political context in Britain is based on rule by consent. We are not an authoritarian state. However, I cannot hide from my noble friend the point that I made to the noble Lord, Lord Truscott: it is the virus that is a discriminator, not the Government. The clinical assessment of risk for many older people, particularly those with medical conditions, is very high. The Government will be guided by clinical advice in their advice and recommendations to all groups, although the effect of safeguarding and lockdown on the elderly is fully understood. We will put in as many mitigation measures as we can to prevent any long-term harm.

[Baroness Brinton (LD)]

My Lords, on 16 March the noble Lord, Lord Bethell, told the House that anyone with an underlying health condition will be contacted by their local GP to clarify what kind of risks they face. A very large number of people still have not had their letter or text from the Government saying that they should be shielding, let alone conversations with GPs. I am in the shielding group and my consultant has told me that I should prepare to be shielding for 18 months. Can the Minister confirm that everyone who should be shielding has now been notified by the Government and their GP that this is the case?

[Lord Bethell]

The noble Baroness is entirely right. Letters should have been sent to all those who should be shielding. I am aware, as she rightly points out, that this process happened extremely quickly and there was a very fast turnaround. I have accounts of people who were sent a letter who should not have had one and I have accounts of people who should have had a letter who did not get one. We are working hard to fill the gap, but 1.3 million letters were sent out and, on the whole, I believe that this exercise has delivered clear recommendations to those involved.

[Lord Lucas (Con)]

To follow on from my noble friend Lord Lamont’s question, can we please ensure that vulnerable people have agency, that those who want to act as the unvulnerable are allowed to, that grandparents who wish to see their children are allowed to, and, at the same time, that those who are young and vulnerable are protected in their decision to continue to isolate and are not discriminated against because of it?

[Lord Bethell]

My noble friend Lord Lucas makes a completely reasonable plea. On a personal level I completely understand where he is coming from. I have elderly relations who I would like to see, hold, touch and socialise with. But, as I said, I cannot hide from the House that this virus is an extremely predatory killer that has in its sights particular demographic groups, including the elderly and in particular those with conditions. It would be wrong of me to mislead the House by pretending that there was an easy way out of this epidemic for those who the disease seeks to attack.

[Lord Carlile of Berriew (CB)]

My Lords, given that some very healthy older people have mistakenly received 12-week lockdown letters, including inaccurate and anxiety-causing assertions that they have underlying medical conditions, will the Government permit an arrangement whereby the relevant GP practice can confirm or refute the issue of the letter and certify to that effect?

[Lord Bethell]

The noble Lord makes a very reasonable request. I have sought clarification from the department on this point, because his suggestion seems eminently reasonable, and as soon as I have a reply I will write to him and share the contents with the Library.

[The Lord Speaker (Lord Fowler)]

My Lords, I regret that the time allowed for this Question has elapsed. I apologise to the few people at the end of the list who have not managed to get in. We will seek to deal with that in the allocation for future Questions.

Covid-19: Extent of Infection

Lord Bethell Excerpts

Wednesday 22nd April 2020 Lords Chamber

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

As of 21 April, 129,044 people have tested positive for Covid-19. This represents less than 0.02% of the population. When the evidence demonstrates that it is safe to do so, we will adjust the lockdown arrangements. We have set out the five conditions that need to be met before lockdown measures are adjusted. These include having reliable data from SAGE showing that the rate of infections is decreasing to manageable levels across the board.

[Baroness Sheehan (LD)]

My Lords, it is very clear that testing is the way out of this. First, there is the immediate urgency of testing front-line health and care workers exposed to high viral loads through lack of proper PPE, and we could do this now if the Government would give the go-ahead to local private research labs with the necessary level-2 clearance, which would not take resources from Public Health England’s needs. Secondly, there is the urgent need for mass testing. Why are the Government forgoing the first in favour of a gold-standard testing regime that they can control from the centre to deliver the second? Can they not do both?

[Lord Bethell]

I thank the noble Baroness, Lady Sheehan, for a very clear Question. I can reassure her on three points. First, front-line staff in the NHS and in care homes are eligible for test on request and we will be opening lines so that they can phone and book their own testing shortly. Secondly, I commend and thank those private research labs already contributing enormously to our testing regime. Thirdly, mass testing is one of the options that we are looking at: the Cabinet Office is devising plans for the medium term and will be publishing them shortly.

[Lord Dobbs (Con)]

First, I very sincerely thank my noble friend for his tireless work during this crisis. Did he by any chance see the BBC report yesterday under the headline “Deaths at 20-year high”? Digging into that needlessly sensationalist headline, intriguingly it reported that the apparent increase was one-third linked to the virus but two-thirds linked to non-virus cases. We all understand that there is an inevitable impact on others while we direct our focus towards the coronavirus, but have the Government undertaken any study of the estimated increase in the number of deaths of non-virus patients during the economic lockdown, and, if so, will they publish its conclusions?

[Lord Bethell]

My noble friend Lord Dobbs is entirely right to put his finger on this important matter. The CMO was clear from the very beginning that Britain’s mortality rate came as much from Covid as from non-Covid deaths. We review this situation regularly and thoroughly, and we will be glad to update the House at a future date. We are very conscious of the threat of which my noble friend speaks.

[The Lord Speaker (Lord Fowler)]

Supplementary question: the noble Lord, Lord Krebs. Lord Krebs? No? In that case, I call the noble Lord, Lord Hain.

--- Later in debate ---

[Lord Hain (Lab)]

My Lords, I declare that my wife is a board member of care providers. How on earth will the Government lift restrictions without universal testing, especially in care homes, where there is virtually no such capacity at all and not even enough personal protection equipment? The charity Leonard Cheshire Disability has been forced to spend an additional £250,000 a month sourcing PPE such as gloves and masks, and a South Wales care provider is spending £100,000 extra monthly. The Government need urgently to give billions more to care homes, instead of leaving them so badly in the lurch during this crisis,

[Lord Bethell]

I reassure the noble Lord that testing has been opened up to all care homes. I pay tribute to the CQC, which played a pivotal role in providing access to Britain’s 12,000 care homes in this regard. Mass testing is an option that we are looking at, but I remind the noble Lord that South Korea, where there is an extremely energetic track-and-trace facility, carries out on average 20,000 tests across the country—fewer than we do in Britain on an average day.

[Lord Oates (LD)]

My Lords, we all understand the immense pressure that the Minister’s department is under, but does he agree that it is unacceptable that capacity is still only at 38,000 tests a day and that much of that very limited capacity is not being used, not least because the testing centres are often in out-of-the-way places that NHS and care staff cannot easily reach? Was an assessment of public transport accessibility made before these centres were chosen, and will the Minister’s department now urgently work with drive-through restaurant chains and other accessible venues to ensure that testing centres are in places that NHS and care staff can easily attend?

[Lord Bethell]

The noble Lord raises a completely valid point on the accessibility of drive-in centres. They suit some people but not all, as he rightly points out. That is why we have brought in at-home testing arrangements, delivered mainly by Amazon. They started on Monday, and we are very ambitious for both their scale and their scope, particularly for the demographics of which he speaks.

[The Lord Speaker]

Supplementary question: the noble Baroness, Lady Lawrence of Clarendon. Lady Lawrence? No? I call the noble Lord, Lord Moynihan, for his supplementary question.

[Lord Moynihan (Con)]

Over 90% of the population will be unlikely to have suffered from Covid-19 when the restrictions are lifted. Will the Government therefore initiate and support a nationwide fitness and recreation campaign, given that physical exercise can help ensure that immune systems become stronger and less susceptible to infections and their most severe consequences and lead to a greater ability to recover from infections?

[Lord Bethell]

My noble friend is entirely right. Fitness and the Covid epidemic are closely connected. The Secretary of State for Health has made it clear that a daily walk should be part of everyone’s lockdown arrangements and we are ambitious to make fitness and diet part of the agenda as we leave the Covid lockdown.

[Baroness Finlay of Llandaff (CB)]

I thank the Minister for being open to communicating with us during the period before Parliament resumed. What assessment have the Government made of combining repeat virus detection with those risk factors that the Intensive Care National Audit & Research Centre’s contemporaneous data has shown are associated with particularly poor outcomes—I refer particularly to high body mass index, indicating obesity—and how will this inform the lockdown exit strategy?

[Lord Bethell]

The noble Baroness speaks of anecdotes of which we are very aware. We are conscious of the stories coming particularly from America about a seeming correlation, if not a causation, between obesity and Covid mortality. Clinical trials and data on this are in short supply. The CMO has not made a declaration on it. But I share her instinct that there is a strong connection. As the noble Lord, Lord Moynihan, suggested, fitness and diet will be important parts of our post-lockdown experience.

[Lord Wood of Anfield (Lab)]

My Lords, we can understand the epidemiological value of antibody—serology—testing. However, I am interested in the public policy uses that may come from this testing. Is it the Government’s intention to use evidence of antibodies in individuals to say that some people rather than others can return to normal life sooner—particularly people of working age and younger rather than older people?

[Lord Bethell]

Serology tests provide important data on the behaviours of the virus. We still do not fully understand what kind of immunity and antibody response will be long-lasting in the body. There are mysteries to this virus that are yet to be solved; serology tests are vital to that and they can play a part in the back-to-work strategy. However, I would remind him that it is a tiny proportion of the population—probably around 5%— who have antibodies. We cannot put the economy back on its feet with just 5% of the population.

[The Lord Speaker]

My Lords, I am afraid that the time allowed for this Question has elapsed. Two noble Lords were not called; I am sure that this will be taken into account in future lists.