Coronavirus Act 2020 (Early Expiry) Regulations 2021

Lord Bethell Excerpts

Monday 5th July 2021 Grand Committee

Moved by

[Lord Bethell]

That the Grand Committee do consider the Coronavirus Act 2020 (Early Expiry) Regulations 2021.

Relevant document: 1st Report from the Secondary Legislation Scrutiny Committee

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

My Lords, the one-year status report of the Coronavirus Act, which was laid in Parliament on 22 March, recommended the expiry of 12 provisions, and the suspension of a further two provisions and two parts of a third provision. I am sure noble Lords will join me in recognising that this is testament to the hard work and sacrifice that has helped us to get to this point. The regulations were laid under the draft affirmative procedure to allow noble Lords this opportunity to scrutinise the Act, as we have always committed to.

Having helped bring this Act through Parliament last year, I am enormously pleased to speak in support of this draft statutory instrument. Taking steps towards returning to normal and being able to switch off some of the temporary emergency powers in this Act is very much in line with the direction our country is moving in and fulfils the commitments the Government made from the Dispatch Box at the time.

The Coronavirus Act was introduced to enable the Government to support and protect as many people as possible during the pandemic. It has been, and continues to be, an essential tool in our toolkit, helping to mitigate transmission in our communities, enabling crucial financial support, and protecting and supporting the NHS and other public services. Ultimately, it has helped to save lives.

The Act ensures that the NHS has the capacity to deal with peaks of the virus by allowing the temporary registration of nurses and other healthcare professionals. It protects critical societal functions—for example, providing courts with the ability to use video technology—and allows us to provide effective support packages to individuals and businesses, such as the Coronavirus Job Retention Scheme and the Self-employment Income Support Scheme.

Now to the matter in hand. The Government conducted in-depth assessment of all the Act’s provisions as part of the one-year review. Today we are debating 12 provisions that we propose to expire early. I thank colleagues in the devolved Administrations for their engagement, support and consent in expiring the relevant provisions that apply to them. Eleven of these powers will be expired for all the nations they extend to—for example, Sections 8 and 9, which across all four nations were never needed thanks to the extraordinary alternative arrangements put in place. I firmly believe that this highlights our desire to remain aligned as a United Kingdom as we move to the next phase of our response.

On the specific provisions, we are expiring Sections 8 and 9, which facilitated emergency volunteering leave and compensation leave for emergency volunteers. Thanks to the fantastic effort by the NHS, these provisions were not needed. Other measures, such as NHS Professionals, other agency and bank staff, and the Bring Back Staff scheme, have been more appropriate to address the need for trained clinical staff.

Section 15 allowed local authorities to ease some responsibilities under the Care Act so that they could continue to meet the most urgent and acute needs in the face of Covid-19 by streamlining assessment and charging for care retrospectively. In England, only eight authorities used these powers—and none since 20 June 2020. There is strong support for expiring the provision, as the social care workforce has remained resilient under pressure and able to continue to deliver its duties. Expiry of this provision shows just how much progress we have made through the resilience of the health and care system.

We are also expiring Section 24, which allowed biometric data held for national security purposes to be retained for additional time; five provisions that required information for businesses and people involved in the food supply chain; Section 71, which allowed a single Treasury Minister to sign on behalf of all Treasury Commissioners; Section 79, which extended arrangements for business improvement districts; and Section 84, which allowed for the postponement of General Synod elections. We also suspended a further three provisions in the Act when, on 21 April, the Coronavirus Act 2020 (Suspension: Temporary Judicial Commissioners, Urgent Warrants, and Disposal of Bodies) Regulations 2021 came into force.

I have always been clear that these powers should not be in place any longer than needed. That is the approach we have sought throughout. All powers in the Act have been kept under continuous and close review. The powers we are debating are not required anymore; we have taken steps to remove them through this instrument.

The Government recognise the vital importance of parliamentary scrutiny. We heard and responded to the calls from this House, and we built rigorous checks and balances into the very fabric of the Act. Arrangements to facilitate accountability and transparency include conducting two-monthly status reports on the non-devolved provisions, as well as a one-year status report. Under Section 98 of the Act, the temporary provisions are also subject to a six-monthly review and renewal vote in the House of Commons. The first and second of these were held on 30 September 2020 and 25 March 2021 respectively, in which Parliament agreed to the continuation of the temporary provisions in the Act. We will lay a report covering the next six-monthly review before the end of September. The third six-monthly debate and renewal vote will take place shortly after; this will provide the opportunity, as previously, to debate the provisions in detail and consider their continued application based on the latest evidence.

The remaining provisions in the Act serve three core purposes: shoring up capacity in the health and care system; ensuring the delivery of essential public services, such as enabling virtual court proceedings; and providing financial and other support to businesses and individuals. While the period of the pandemic remains, so does the need for the Act. However, the six-monthly review process concluding in September will assess each of the temporary provisions rigorously, and we will expire all those deemed no longer necessary and proportionate to the response.

People and businesses need certainty. They, and we, want to see restrictions being lifted. This is the direction we are looking towards, and this is the direction we are taking. We have come a long way, and we should look ahead to the next six months as a chance to focus on the positives, on recovery and on reaching the next milestone in our road map. I beg to move.

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[Lord Bethell (Con)]

My Lords, I am enormously grateful to noble Lords for their thoughtful and perceptive comments. I will try to answer some of the points made in this important debate directly.

The noble Lord, Lord Hunt, asked about the synod. I assure him that this provision allowed Her Majesty the Queen, by Order in Council and at the request of the most reverend Primates the Archbishops of Canterbury and York, to postpone the dissolution of the synod of the Church of England and so to postpone the election that had been due to take place in the summer of 2020. The Church of England agreed that the provision had served its purpose and may be expired, with elections being held online this year.

For the noble Lord, Lord Hunt, the noble Baroness, Lady Merron, and the other noble Lords who asked about the Care Act, I will spend a moment providing some reassurance on the easements that we are expiring. The Care Act easements were a temporary measure to help local authorities to continue to meet urgent needs in the face of Covid when they were expecting extraordinary pressures. Following our review of the provision in March 2021, which included consultations with stakeholders across the adult care sector, the decision was made to expire the provisions as they had not been used since 29 June 2020. I emphasise that point to any noble Lords who may be unclear on it: the provisions have not been used since then.

There was strong support to expire the provision from groups representing people with care and support needs. Local authorities were in a better position in terms of planning, support and the use of mutual aid than they were when the easements provision was first introduced. No local authorities have operated easements since 29 June. Only eight local authorities out of 151 operated easements before then. A report by ADASS showed that local authorities used easements in very limited ways, such as using streamlined templates for assessments, conducting virtual assessments and postponing reviews and rescheduling them to a later date. No council moved from Care Act eligibility to a human rights threshold.

I want to address the anecdotes raised by the noble Baroness, Lady Brinton. Let me be absolutely clear that no support was necessarily removed as a result of these easements. The department has worked with Think Local Act Personal—TLAP—and the Association of Directors of Adult Social Services to understand the impact on individuals. Across this research, there have been no concerns that the councils that enacted easements ceased to support people, nor data to suggest that any groups were adversely affected by the easements.

However, we noted that, due to poor communications, some people reported feeling that they were impacted by easements even in areas where easements were not operated. We have commissioned research via the National Institute for Health Research to explore the impact of easements on individuals. The outcome of this research will be published over the next year. Anyone who feels that they have not had the care and support they should have had should first place a complaint with their local authority.

I will now move on to the impact of Section 24 and the regulations made on it, since that was raised by a number of noble Lords. On 29 April 2021, the independent Biometrics and Surveillance Camera Commissioner published a statement on the regulations made under Section 24. It sets out that almost 1,500 individual biometric profiles have had their ordinary statutory retention deadline extended as a result of the regulations, thereby protecting against the loss of biometrics of individuals assessed as presenting a risk to national security. The commissioner commented that he is

“satisfied that the section 24 power has been used in a responsible and proportionate manner and only when scarcity of resources or time limitations meant that the biometrics of individuals assessed as presenting a real risk to national security might otherwise have been lost.”

He also stated that he has

“seen nothing to indicate that the police have applied the provisions in anything other than the manner intended: necessarily, temporarily and proportionately.”

Section 24 is a regulation-making power; no further regulations are being made under it. This is because the mitigations put in place by CT policing mean that it is confident that, despite the ongoing effects of the pandemic, no extension will be required.

On the question asked by my noble friend Lord Moynihan, I express massive sympathy for all those missing out on important rites of passage, such as graduation, and other important events in the calendar, particularly for our young people. There cannot be a noble Lord in this proceeding who does not have an anecdote of this nature from their own friends and family group. We look forward to the day when we can change these arrangements; that day is drawing closer every moment.

I will say a word about tenants and residential tenancy to my noble friend Lord Bourne. On 12 May, a statutory instrument was laid that extended longer notice periods for residential tenancies until 30 September. My noble friend asked about the possibility of further financial support for tenants; I will take his questions back to the department and write to him accordingly.

In response to question from the noble Lord, Lord Scriven, about when the regulations will come into force, I assure him that they will come into force as soon as possible, once approved by both Houses of Parliament, and will be signed by a different Minister in the department.

The noble Baroness, Lady Brinton, asked about provisions for CEV individuals. I assure her that these have not been publicly announced and that the Secretary of State’s statement, which will occur in another place shortly, will provide some information on that.

On my noble friend Lord Moynihan’s point about Wembley, these events are part of the events research programme, which is why they are allowed to have large crowds. They are essential to our understanding of Covid transmission.

The noble Baroness, Lady Fox, asked whether we can go further and faster with the expiry of the Act. I can confirm that the next six-monthly review of the Act will take place in September; we are certainly assessing the remaining powers with this in mind. It is too early for me to make further proclamations on the decisions to be taken in September or in advance of the next review date for step 4 of the road map. Noble Lords will have listened to my Statement last week on the review of the data. We have to be cautious in our journey along the road map but we have reason to be optimistic about the future. More and more people are receiving the vaccine and giving us greater protection.

I thank everyone for participating in this debate and for their sacrifices throughout the pandemic.

Motion agreed.

Health Security (EU Exit) Regulations 2021

Lord Bethell Excerpts

Monday 5th July 2021 Grand Committee

Moved by

[Lord Bethell]

That the Grand Committee do consider the Health Security (EU Exit) Regulations 2021.

Relevant document: 6th Report from the Secondary Legislation Scrutiny Committee

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

My Lords, the sharing of information and co-ordination of health protection activity between all parts of the UK and with our international partners is absolutely critical to the prevention of and response to serious cross-border health threats. Covid-19 is a good example. There are others today; there will be more in the future.

These regulations will ensure that this essential co-ordination is maintained following our departure from the EU. They enable us to deliver high levels of human health protection across the whole of the UK. They modify retained EU law on health security to establish a stand-alone UK-wide regime. But these regulations are not alone: they form part of broader, ongoing work to improve our health security capabilities.

This work has included the establishment of the new UK Health Security Agency—UKHSA. The UKHSA combines key elements of Public Health England and NHS Test and Trace, including the Joint Biosecurity Centre. The role of UKHSA will be absolutely critical. It will be our permanent standing capacity to plan for, prevent and respond to threats to health. It will deploy the full weight of our analytic and genomic capability on infectious diseases. It will work with partners around the world to lead the UK’s global contribution to health security.

These regulations will support the UKHSA and the other UK public health agencies—Public Health Wales, Public Health Scotland and the Public Health Agency of Northern Ireland—in quickly identifying and responding to a wide range of health issues. They will ensure that we maintain a robust and consistent UK-wide approach to health security that allows us to work effectively with our international partners, including by linking into international surveillance systems.

On our international collaboration and leadership, I remind noble Lords that last month the G7 committed to working towards adopting a standardised minimum health dataset for patients’ health information. This included: working through the International Patient Summary standard; developing internationally shared principles for enabling patient access to health data; and promoting the use of open standards for health data. This highly technical work will have huge practical dividends.

I will say a word about implementation. Noble Lords will know that the UK-EU Trade and Cooperation Agreement—TCA—was announced on 24 December 2020. These regulations will help us meet the TCA’s health security arrangements. The TCA provides a strong basis for the UK and EU to continue to co-operate on health security. It includes a commitment to inform each other when new public health threats are identified in either the UK or the EU. It gives ad hoc UK access to the EU’s database for sharing alerts: the Early Warning and Response System—EWRS. It provides for the UK to attend the EU Health Security Committee in support of response co-ordination, and a commitment to co-operation between the UK and the European Centre for Disease Prevention and Control—ECDC.

It is because of these arrangements that the UK was given access to the EWRS for Covid-19 from January 2021. Our current access avoids any disruption in the flow of public health data during the pandemic. The UK has also continued to attend meetings of the EU’s Health Security Committee—HSC.

I will say something about the substance of the regulations and why these amendments are being made to retained EU law by this instrument. While a member state, the UK was required by EU law to co-ordinate and share certain types of information on health protection with the EU; to give a recent example, early alerts on newly identified threats. As health protection is predominately a devolved competence in the UK, to meet these obligations effectively the four UK nations had to co-ordinate and share the required information with PHE, the UK’s focal point for communication with the EU.

However, following the end of the transition period, this retained EU law relating to health security no longer operates effectively to set rules for such co-ordination on a UK-wide basis. Therefore, these regulations modify and transfer functions previously carried out by the EU to a new UK health protection committee and to the UKHSA, working in co-operation with Public Health Wales, Public Health Scotland and Northern Ireland’s Public Health Agency.

Let me give some examples: first, on early alerting and the EWRS. The importance of early alerting was amply illustrated by Covid-19. Speed of action is absolutely critical. It is imperative that when a threat is identified, information is shared rapidly to enable the quick implementation of control measures that will reduce transmission rates in the general population and protect individuals. To ensure that we have a robust early alerting system in the UK, these regulations require the UK’s public health agencies to notify the UK’s focal point within 24 hours of any new threats that have been identified. For the purpose of these regulations, PHE is designated as the UK’s focal point, with this function soon to transfer to the UKHSA. In this role, the UKHSA will be responsible for receiving alert notifications of serious cross-border threats to health from the different parts of the UK, then working jointly with them to conduct rapid risk assessments and put in place co-ordinated response measures as necessary.

To meet our obligations under the TCA, the UKHSA must also notify the EU of any threats occurring in the UK which may present a risk to EU member states. In return, the EU will notify the UK of any emerging threat in Europe which may present a risk to us. If the UK and the EU agree it would be beneficial for the UK to have access to the EWRS for any threat, the UKHSA will be responsible for uploading and receiving related surveillance information.

Secondly, I will say a word about UK-wide surveillance. It is critical that we continue to conduct UK-wide epidemiological surveillance on known communicable diseases. Therefore, these regulations make provision for the UK’s four public health agencies to conduct surveillance on a shared list of communicable diseases and related special health matters. This is vital for improving our understanding of the prevalence of infectious diseases across the whole of the UK.

Thirdly, on co-ordination across the union, these regulations require the UK Government, the devolved Administrations and the UK’s public health agencies to consult each other with a view to co-ordinating their respective monitoring and early warning of, and their response to, serious cross-border health threats. They must inform each other of any substantial revisions to preparedness and response planning.

Fourthly and finally, on governance, to support the implementation and functioning of these regulations, we are establishing the UK health protection committee. The committee will have representation from all parts of the UK and will function to provide advice on the list of communicable diseases and related special health matters that are subject to UK-wide surveillance, and the associated operational procedures.

As health security is an area of devolved competence, we have obtained formal consent for the regulations from the DAs. On this point, I pay tribute to the spirit of collaboration across the devolved Administrations. For example, just last week I had a hugely productive call on the life sciences vision with Minister Ivan McKee, Minister Maree Todd, Minister Robin Swann, Minister Paul Frew and Minister Eluned Morgan—the noble Baroness, Lady Morgan of Ely. I thank them for their collaboration. In parallel, we are working together with the DAs to develop a common framework, which will strengthen UK-wide governance arrangements on the prevention and control of serious cross-border health risks.

These regulations are critical. I beg to move.

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[Lord Bethell (Con)]

My Lords, I am enormously grateful for noble Lords’ perceptive comments and the questions that they raised. As the noble Lord, Lord Hunt, said so persuasively, these regulations are vital to maintaining UK-wide collaboration on health security and put in place the necessary mechanisms to allow us to engage effectively with our international partners on infectious diseases and other cross-border threats to health.

I am grateful for the demanding and analytical questions asked by all noble Lords on closer co-operation with the EU. I reassure my noble friend Lord Lansley that the regulations will ensure that implementation of the health security chapter of the TCA is effective and complete through the establishment of a robust UK-wide regime that can share the information required to meet our TCA obligations.

As to my noble friend’s comments on EU performance and future plans, we will have to wait to see where it is coming from. In the meantime, I reassure him that we were prompt to request access to the EU’s Early Warning and Response System in relation to the Covid-19 pandemic and that the EU was equally swift to grant that access. We are committed to continuing such positive co-operation on monitoring serious cross-border health threats where it is in our mutual interest and to maximising the benefits of TCA provisions. These regulations set the foundation for us to do exactly that.

The noble Lord, Lord Hunt, asked about the timing of the UKHSA/PHE transfer. The MoU between PHE, UKHSA and the ECDC is currently being negotiated. On the noble Lord’s questions on the TCA, the health security arrangements contained within the UK-EU TCA provide for continued collaboration between our world-leading scientists and technical experts and the ECDC, including on Covid-19 as we continue to tackle the pandemic. We are working with the ECDC to consider how we can best support the continuation of this co-operation and collaboration between our respective experts in future, including through the conclusion of an MoU.

The noble Baroness, Lady Brinton, and my noble friend Lord Lansley asked about the WHO. Both the UK and the EU recognise the importance of continuing to work together to protect our citizens from infectious diseases and other cross-border threats to health. We already work together in multilateral groups and organisations, including the Global Health Security Initiative, and this agreement ensures that this will continue where it is in our mutual interest. These regulations address the threats arising from infectious disease and non-infectious threats, such as chemical and environmental hazards. This is in line with existing national policies and the International Health Regulations—IHR—2005.

The noble Baroness, Lady Brinton, asked about the involvement of local health teams. I confirm that the UKHSA design will incorporate effective co-ordination with local authority health protection teams. I reassure the noble Baroness, Lady Merron, that engagement with the DAs is extremely frequent and during the pandemic has been happening on a weekly basis, at least. We are committed to maintaining that very close co-ordination, which is supplemented with weekly meetings among the four CMOs that I understand are extremely productive.

I completely agree with the noble Baroness that this country was hard hit because of the bad health of our population. That is why we are bringing forward plans for the Office for Health Promotion, where the relevant parts of PHE will be rolled into an extremely effective and energetic organisation which will be focused on the country’s underlying health conditions, under the clinical oversight of the CMO. We will unveil plans for that office shortly.

I emphasise that the passage of this instrument is critical in the prevention and control of serious cross-border threats to health in order to maintain a high level of human health protection across all parts of the UK. The regulations act on our intentions to strengthen domestic capability in health security and they are also imperative in helping us meet our obligations under the TCA with the EU. I hope very much that I have been able to answer the questions raised by noble Lords, and with that in mind I commend these regulations to the Committee.

Motion agreed.

Health: Dementia

Lord Bethell Excerpts

Monday 5th July 2021 Lords Chamber

[Baroness Couttie]

To ask Her Majesty’s Government what is the national average waiting time for a referral to a memory service following a suspected dementia diagnosis; and how this has changed since January 2020.

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

My Lords, data on wait times for referrals is not collected for memory services. However, NHS Digital does collect data on new memory assessment referrals, which saw 2,136 people referred to a memory service in May 2021—a 17% increase compared to April 2021. This compared to 2,896 new referrals made in January 2020. The Government take referrals extremely seriously: they have made £17 million available this financial year to NHS England and NHS Improvement to support memory services and increase diagnoses.

[Baroness Couttie (Con)]

I thank my noble friend for his Answer and declare my interest: my brother is a trustee of Dementia UK, an organisation which recently produced a report, Facing It Alone—which I hope my noble friend has read—highlighting the challenges faced by families and health professionals when tackling dementia. What steps are the Government considering to address the gap in diagnosis and access to post-diagnostic support, such as increasing the number of admiral nurses and the amount of primary care, as called for by Dementia UK? Will he also consider facilitating a meeting between the appropriate Minister in the other place and Dementia UK to discuss what more can be done to meet the requirements of these vulnerable people?

[Lord Bethell (Con)]

My Lords, I pay tribute to the role of admiral nurses and the model developed by Dementia UK; it is indeed a very valuable contribution. The dementia team at the department met with Paul Edwards, director of clinical services at Dementia UK, in April 2021, to discuss how we could work together more closely. I am happy to follow up on that meeting with any recommendations that Dementia UK might have for how we can focus on this important area.

[Baroness Crawley (Lab) [V]]

My Lords, is it not the case that there are just not enough diagnostic consultants and memory service nurses to reduce the waiting list that the noble Baroness, Lady Couttie, referred to? Given the number of people with dementia who, sadly, have passed away during Covid, when will the Government change the law to enshrine the rights of care home residents to have family visits?

[Lord Bethell (Con)]

My Lords, the focus on diagnosis is critically important. That is why Challenge on Dementia 2020 set a target of two-thirds of people living with dementia receiving a formal diagnosis. At the end of May 2021, DDRs were 68.8%, compared with 61.7% at the end of April. We are working hard to get these numbers back up, and the £17 million fund which I referred to is one contribution to that. But the noble Baroness is entirely right that this is an important area, and we are focused on it.

[Baroness Barker (LD)]

My Lords, during Pride month, the Alzheimer’s Society and Opening Doors London did a lot to highlight the experiences of LGBT people with dementia. Does the Minister agree that when the Secretary of State for Health insists on wearing a rainbow badge, it is unacceptable for people to turn up to services only to be misgendered or to have their family relationships ignored or undermined, and that there should be a process of sorting out training for staff so that people are dealt with appropriately?

[Lord Bethell (Con)]

My Lords, I take seriously the testimony of the noble Baroness. I am not aware of the specific concerns that she describes, nor am I completely up to speed on the precise arrangements of the training, but I would be glad to correspond with her on this matter.

[Baroness Blackwood of North Oxford (Con)]

My Lords, while virtual assessments were vital during the pandemic, without further diagnostics many led to a diagnosis of unspecified dementia. An accurate diagnosis of dementia subtype is critical to good management, especially in complex cases. Given the backlog, there will understandably be a temptation to deprioritise those who have a preliminary diagnosis from a virtual assessment, but this would be a false economy. How can the Minister ensure that those with a provisional diagnosis will be invited back for a comprehensive assessment after the pandemic has finished, and for imaging and other diagnostics where necessary?

[Lord Bethell (Con)]

Few people are as enthusiastic as I am about the benefits of digital medicine and virtual consultations, but I completely acknowledge my noble friend’s point: this is one area where we absolutely must have face-to-face assessment. The diagnostic tests and assessments she describes play a critical role, and those whose conditional assessment was done virtually must be cascaded into a face-to-face assessment, as she says. That is why we have put the funds in place to ensure that this backlog is caught up with.

[Baroness Wheeler (Lab)]

My Lords, not only are there deep concerns about the sharp drop in memory clinic referrals during the pandemic; the Alzheimer’s Society also has very real fears that the virtual assessments currently taking the place of attendance at memory clinics run the risk of exacerbating inequalities in treatment and excluding large cohorts of patients. What is the Government’s overall strategy for ensuring that vital day care and hospital services are reopened and that the backlogs in referrals are addressed, for providing the rehabilitation that people with dementia need to counteract the effects on their cognitive and physical function, and for providing support for their mental health and well-being?

[Lord Bethell (Con)]

My Lords, guidance to help enhance best practice in dementia assessment and diagnosis was recently updated and published to support a personalised approach and choice in the delivery of remote consultation or face-to-face diagnosis. The guidance was developed in collaboration with stakeholders, including those with lived experience, and through the Dementia Change Action Network. I completely acknowledge the point that the noble Baroness makes. We are working as hard as we can to get the kind of face-to-face assessments she describes. They play an essential role in what we do.

[Baroness Brinton (LD) [V]]

My Lords, the 2019 national memory service audit carried out by NHS London reported that a quarter of English dementia services were unable to provide or refer on for carer psychoeducation. Knowing the struggles that my stepmother had over a decade ago getting recognition, let alone support, as my father’s dementia worsened, these figures remained stubbornly low. Can the Minister say when early support will automatically be available for all carers of those diagnosed with dementia?

[Lord Bethell (Con)]

My Lords, I pay tribute to the role of carers in the kinds of situations the noble Baroness describes. We are doing an enormous amount to supply training for carers in all facets of their delivery, including support in caring for those with dementia. I am not sure that I can make the guarantee that she seeks right now, but I reassure her that this is one area of our investment in carers that we take extremely seriously.

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

My Lords, while these patients are waiting for appointments, could some way be found to encourage relatives and close friends to help those with early dementia by having frequent conversations with them and helping them learn by heart poems they used to be able to recite in earlier years? That might also prove helpful to those relatives and friends, because loss of memory tends to affect us all as we grow older.

[Lord Bethell (Con)]

My noble friend makes a very touching and constructive point, because social engagement and involvement in the community keep older people sharp and their brains engaged and help stave off the ravages of age and the diminution of mental faculties. We all have a role to play in supporting the elderly and those with mental challenges. My noble friend is entirely right to call on the entire community to step up to that role.

[Lord Blunkett (Lab) [V]]

I draw attention to my declaration in the register as a dementia champion. The corollary of the question that has just been put is that reduced contact, reduced socialisation and reduced activity accelerate the onset of dementia. Of course, that has been happening over the past 16 months. Will the Minister commit to investing in the voluntary and charitable sector in this area so that it too can play its part in supporting families and helping it to reaccelerate back into social action?

[Lord Bethell (Con)]

I accept the noble Lord’s point. The corollary is right: there are those who have not had the engagement they once had, and it is fair to assume that that has accelerated their decline. The role of charities and communities in trying to provide that back-up support is critical. That is why we have provided £515,000 to the Alzheimer’s Society to support its Dementia Connect programme.

[Baroness Fox of Buckley (Non-Afl)]

I am very glad to hear the response from the Minister on virtual consultations, but can I press him to urge an immediate reinstatement of face-to-face memory services and recognise that for those with cognitive and sensory impairments, Zoom is especially disorientating—it is for me, let alone anyone else? Will he also urge GP surgeries to open fully face to face—they are not at present—as doctors often spot signs of dementia when patients access services for other reasons? I think that would help.

[Lord Bethell (Con)]

I completely accept the noble Baroness’s point. It is clear that the benefits of digital do not play out for the elderly and those who face dementia and other similar conditions in the same way as they do for younger people and those accustomed to and familiar with Zoom and other digital services. She is entirely right that the symptoms and features of dementia, Alzheimer’s and Parkinson’s are sometimes picked up only through face-to-face engagement. That is why we are working hard to reopen GP surgeries and to ensure that such appointments can take place.

[The Lord Speaker (Lord McFall of Alcluith)]

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

Covid-19: Wuhan Institute of Virology

Lord Bethell Excerpts

Wednesday 30th June 2021 Lords Chamber

[Viscount Ridley]

To ask Her Majesty’s Government what assessment they have made of the possibility that the COVID-19 virus escaped from a laboratory at the Wuhan Institute of Virology.

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

My Lords, with the increasing threat of zoonotic diseases crossing the animal-human divide, learning how Covid was transmitted to humans and is spread is absolutely crucial to preventing future pandemics. The much-delayed WHO-convened Covid origin study reported on phase 1 of its investigation in March. The report made recommendations for further studies. The Government’s belief is that it is vital that phase 2 of the investigation does not face the same delays and that it is given full access to the data necessary for the next part of its work.

[Viscount Ridley (Con)]

I thank my noble friend for that Answer. Viruses like this have not been found near Wuhan in bats or any other animals. The closest relative to this virus was brought to Wuhan by scientists from 1,000 miles away to a laboratory that had been manipulating SARS-like viruses for 15 years. There it was sequenced in 2017 and 2018 in a biosecurity level 2 laboratory. Most of that information was found out by independent investigators, not volunteered by the Chinese authorities. Will my noble friend unequivocally condemn that lack of transparency and join other nations in calling for a full and independent investigation? Will he clarify who is in charge in the British Government of answering that question?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I entirely agree with the sentiments expressed by my noble friend. We are absolutely calling for a timely, transparent and evidence-based phase 2 study, including further investigation in China, as recommended by the experts’ report. We agree with the Independent Panel for Pandemic Preparedness & Response that member states should give the WHO greater powers to investigate outbreaks of pathogens with pandemic potential within member states.

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

My Lords, I commend the Minister for an excellent reply to the noble Viscount’s Question—a reply obviously informed by the excellent staff at the Department of Health and Social Care. In the light of that, can I gently ask why, as a Minister, did he feel it necessary to have a parliamentary research assistant?

[Lord Bethell (Con)]

My Lords, I have written to the commissioner for standards in response to that precise question and I should be glad to share that correspondence with the noble Lord.

[Baroness Walmsley (LD) [V]]

It is believed that given the slow rate of mutation of Covid viruses, Covid-19 would have taken around 35 years to evolve from its nearest known relative. What has been done to identify any intermediaries in which it may have lived during that period and any knowledge useful for preventing future pandemics that may arise from that knowledge?

[Lord Bethell (Con)]

I entirely agree with the noble Baroness. It is extremely frustrating that we do not know the steps of evolution that this virus went through. It has come to us completely out of the blue. That leaves us in a vulnerable state when we are preparing for the next pandemic. It is absolutely essential, as any epidemiologist will say, that one knows and understands where the virus came from—whether that is the water pump handle for an outbreak of cholera or a virus from China.

[Baroness Blackwood of North Oxford (Con)]

My Lords, the situation could not emphasise more clearly the need for genuine global participation in transparency in surveillance and pathogen sequencing to respond to future pandemics and epidemics. I was pleased to see the progress at the G7 on this but, if the global anti-pandemic action plan is to have any teeth, we will need to ensure that countries such as China contribute trustworthy data to global surveillance in the future. What steps does the Minister envisage to ensure that this happens?

[Lord Bethell (Con)]

I completely agree with my noble friend. The international health regulations need to be amended in that respect. It was one of the aspects of the pandemic preparedness treaty that was brought to Carbis Bay for the G7 earlier this year. We are working extremely hard, through our G7 chairmanship, to ensure that this relatively obscure but absolutely critical international treaty has the teeth it needs to do the work on genomic sequencing and pathogen identification that needs to be done.

[Lord Patel (CB) [V]]

My Lords, does the Minister agree that for a better understanding of the current pandemic and future pandemics, identification of the progenitor genome of SARS-CoV-2 is important? We need more data, despite having sequenced more than 1 million SARS-CoV-2 genomes. The escape of pathogens from labs is not new. Examples are smallpox and anthrax, and also SARS, which escaped from several labs in different countries in 2003. Does the Minister agree that we urgently need to address global regulation of labs that undertake gain of function experiments on pathogens?

[Lord Bethell (Con)]

My Lords, I agree with the noble Lord’s appeal for more data—but, candidly, as I know he knows, it is not just quantity of data that we need; it is the right data. Where we are struggling is in getting genomic sequencing of new mutations from the furthest reaches of the virus’s spread. We need a systematic programme around the world that shares the sequences of new mutations with academics who can study and assess them. Without such a systematic programme we are flying blind. That is why we are working on the new variant assessment platform and other pandemic preparedness projects.

[Baroness Merron (Lab)]

My Lords, scientists are warning that we are in an era of pandemics, and that viruses more deadly, contagious or resistant to antibodies than Covid-19 could emerge. What steps are the Government taking to prepare themselves and the country for the next potential pandemic, and will the Minister commit to ensuring that future pandemic preparedness plans are independently assessed and reported to Parliament?

[Lord Bethell (Con)]

My Lords, I pay tribute to the Chief Scientific Adviser, Sir Patrick Vallance, who is leading the pandemic preparedness work. He is doing an enormous amount both on the international treaties through our G7 chairmanship, and on the internal domestic re-envisaging of our healthcare system. We need to invest more in public health, and we also need the data, the diagnostics and the patient behaviours that support really rigorous tracking down of diseases when they arrive. The noble Baroness is entirely right: pandemics will come, sooner rather than later.

[Lord Jones of Cheltenham (LD) [V]]

Why, within days of becoming Prime Minister in July 2019, did Mr Johnson scrap the Threats, Hazards, Resilience and Contingency Committee, which was set up precisely to ensure that the UK was ready to cope with a pandemic?

[Lord Bethell (Con)]

My Lords, with the greatest of respect to the noble Lord, I am not sure whether the pandemic that just hit us could have been solved by a committee, however august and impressive. We need a national response, and the national response to this pandemic came from the Prime Minister and the top of Government, and involved the entire nation. For that we are enormously grateful.

[Baroness Pidding (Con) [V]]

My Lords, in an article in the Financial Times in May, Sir Patrick Vallance said that the Prime Minister had asked him, ahead of the G7, to pull together relevant experts to start looking at how a future pandemic could be dealt with more swiftly—and, most importantly, on a global basis. Can the Minister advise us what progress has been made on this?

[Lord Bethell (Con)]

My Lords, I attended the presentation by Sir Patrick Vallance at the G7 health track in Oxford in June, which was received extremely well, both by Health Ministers from the G7 countries and by the chief executives of the major pharmaceutical companies that are partners in that work. We are using our chairmanship to nudge it along, and it will cover both the pharmaceutical and the demographic elements of pandemic response. This is an example of where Britain is showing leadership in the world to carve out a clear idea of how we can respond to pandemics better in the future.

[Lord Alton of Liverpool (CB)]

My Lords, I return to the point made by the noble Viscount earlier. Who in the British Government is in direct touch with the US National Institutes of Health, and especially Professor Jesse Bloom, about the deletion of genomic sequences, which he said had no plausible scientific rationale? If it is proven that the virus came from the Wuhan laboratory and that that fact has been concealed by the Chinese Communist Party, does the Minister agree that Magnitsky-style sanctions against individual officials would be the beginnings of an appropriate response by our Government?

[Lord Bethell (Con)]

My Lords, specific official engagement with the investigation is done through PHE, and we have a PHE official sitting on the investigation. That is the right way of conducting a scientific dialogue. The DHSC and FCDO also have extremely active interests in this. As for the tone in which the noble Lord talked about how we should approach this challenge, I say that we have to work in partnership with other countries. There is no way in which we can demonise one country or another in this matter. Partnership is the only way ahead. What we can, I hope, bring to the party is a sense of urgency and a sense of focus.

[The Lord Speaker (Lord McFall of Alcluith)]

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

Hospital Waiting Lists

Lord Bethell Excerpts

Tuesday 29th June 2021 Lords Chamber

[Lord Balfe]

To ask Her Majesty’s Government what assessment they have made of the time needed for waiting lists for hospital treatment to reduce to the levels they stood at on 1 March 2020; and what plans they have regularly to publish data on waiting times for each (1) medical speciality, and (2) geographical region.

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

My Lords, the horrible dividend of this awful pandemic has been the impact on the wider healthcare service. That is, I am afraid, what epidemics do, but we recognised the threat from the beginning and have worked hard to keep open essential NHS services. We have financed the biggest surge in healthcare spending in NHS history, including £1 billion this year to tackle head on the waiting lists and diagnostic backlog so that we can get back as soon as possible.

[Lord Balfe (Con)]

My Lords, that was an interesting statement but it did not answer any of the Question, which is: what is the Government’s estimate of the time needed to get waiting lists back to the state of a year ago and, secondly, what plans do they have to regularly publish data on waiting times for each medical speciality and geographical region? That is the question; would the Minister like to answer?

[Lord Bethell (Con)]

My Lords, waiting lists are published throughout the NHS and I would be very happy to write to my noble friend with details of the web locations for that data. We are working on the forecasts at the moment. It is not possible to forecast precisely when we can back to where we were, but I reassure my noble friend that a huge amount of work is going on to get there as quickly as possible, including 1.8 million diagnostic tests and treatment for 1.1 million patients since April 2021.

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

Even if we get back to where we were in March last year, it will be a status quo in which all the key targets have been missed. When will the Government get back to meeting the targets that they inherited in 2010 with the Liberal Democrats? They have presided over a gradual but disastrous deterioration in overall performance.

[Lord Bethell (Con)]

My Lords, there has been an enormous pandemic, which has, of course, had a huge impact on the healthcare system. During the pandemic, the financial support for the NHS—as well as the system support—has been huge and had a huge impact. We are looking at a backlog and working hard to get through it, but noble Lords should be in no doubt that we are thoroughly committed to getting back to full operational capacity.

[Baroness Brinton (LD) [V]]

My Lords, around 10 million people across the UK are affected by arthritis, and the widespread impact of rheumatology conditions costs the NHS over £10 billion a year. The recent British Society of Rheumatology report, Rheumatology Workforce: A Crisis in Numbers, lays bare the shortage of all multidisciplinary staff, including the consultants, nurse specialists and physiotherapists who are needed to deliver the NICE treatment guidelines. This shortage of staff and funding is already impacting severely on rheumatology waiting lists. Can the Minister say how this funding and workforce gap can be addressed with immediate effect? If he does not have the figures and answer to hand, please can he write to me?

[Lord Bethell (Con)]

The noble Baroness points very well to exactly the kind of challenge that we face at the moment. She is entirely right that conditions such as arthritis and rheumatology require complex combinations and collaboration between many different staff, as well as the application of new and effective treatments and therapies. That is exactly where we are working hard to catch up. I will go back to the apartment, dig out any statistics I can and write to her accordingly.

[Lord Udny-Lister (Con)]

My Lords, waiting lists were too long pre the pandemic and there are now some 6 million people awaiting treatment of one kind or another, many of them in a lot of pain and discomfort. The National Health Service has learned a lot during the pandemic. Will the Minister publish how he intends to speed up the treatment that these people need? Can he also advise whether he routinely uses his private email with his contacts?

[Lord Bethell (Con)]

My Lords, the publication of NHS plans around the catch-up is happening on a regular basis, and there will indeed be further communication from the NHS on this. On the use of private email, I reassure noble Lords that I have read and signed the ministerial code and I seek to uphold it in everything I do.

[Baroness Wheatcroft (CB)]

Specialist surgical hubs have been demonstrated as an effective way of dealing with surgery and would be particularly helpful in dealing with the backlog of cases. Can the Minister say what plans there are for developing specialist surgical hubs, as the Royal College of Surgeons has advocated?

--- Later in debate ---

[Lord Bethell (Con)]

Surgical hubs are exactly the kind of interesting and progressive medical developments that we need to embrace to get through the backlog; in fact, that kind of specialism creates a huge amount of efficiency for the system and a better service for patients. We are working hard to understand how we can use them more effectively, and I would be glad to write to my noble friend with any details we have on the progress that we are making.

[Baroness Thornton (Lab)]

My Lords, the Royal College of Radiologists tells us that 62,000 patients were waiting six weeks or more for a CT or MRI scan, and there may be as many as 45,000 missed cancer diagnoses. There are terrible shortages of skilled staff, fewer scanners than the majority of comparable countries in the OECD—we have half the number in France and a third of the number in Germany—and about a third of our scanners are obsolete or nearing obsoletion. Given the huge waiting list catch-up that the NHS faces, these diagnostic facilities are absolutely vital. Will the Government provide the necessary investment to address this urgent challenge—and in what timescale?

[Lord Bethell (Con)]

I agree with the noble Baroness that diagnostics is one area where this country needs to make further investment. In the 2020 spending review, we ring-fenced £325 million of capital spending to support NHS diagnostics; the funding will be spent on new equipment, digitising NHS imaging and the pathology networks. New capacity is also coming through the new community diagnostic hubs and pathology and imaging networks. This work is critical, and we are working hard to make sure that it is effective.

[Lord Scriven (LD)]

My Lords, data from four major studies shows that disadvantaged groups have faced the greatest disruption to medical care during the pandemic. How are the Government ensuring that these health inequalities are dealt with in reducing the NHS backlog, and what targets have been set to deal with this issue?

[Lord Bethell (Con)]

I completely agree with the noble Lord that the pandemic has illustrated the severe health inequalities that exist across the country as well as the need to address them. The resilience of our health system depends on addressing those who can create the biggest demands on it. There is both a preventive agenda and an agenda for getting through to the communities, to communicate effectively that they can find the treatment they need in their local authority. The Help Us Help You advertising campaign is particularly targeted at the disadvantaged to encourage them to come forward for diagnosis and treatment.

[Baroness Stuart of Edgbaston (Non-Afl)]

My Lords, the original Question requested a breakdown of geographical regions for waiting lists. Workforce shortages will be a continuing problem, and not just for catching up on the waiting lists. Will the Minister recognise the link between training facilities in regions where there are shortages and the ability to fill those vacancies? He will be much more successful in catching up with waiting lists if he pays greater attention to training places, regions and availability.

--- Later in debate ---

[Lord Bethell (Con)]

I completely take on board the noble Baroness’s advice. When it comes to recruitment, it is right that local engagement with local education has to be the way forward. I can report that the recruitment efforts and marketing campaign that we have put in place to recruit 50,000 new nurses, more GPs and more staff across the healthcare system are working extremely well. There is a renewed interest in careers in health—that is one good dividend of this awful pandemic.

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

My Lords, the Government’s £1 billion elective recovery fund is most welcome. Will the Minister support this sum being made available every year until we see light at the end of the tunnel? Can he encourage health authorities to redouble their efforts to get the 40 million people in the UK who are overweight to return to a normal weight and thereby begin to release resources to treat more urgent cases, such as cancer patients?

[Lord Bethell (Con)]

On the elective recovery fund, I cannot make that commitment at the Dispatch Box but I reassure my noble friend that we are in it for the long haul and we recognise that this will be a major project needing major resources. When it comes to the health of the nation, the obesity strategy is a cross-departmental and energetic programme that tackles the issues that my noble friend is concerned about. He is entirely right that the costs of our healthcare system are predetermined by the overall health of the nation, and that is why we encourage people to eat well and lead healthy lives.

[The Lord Speaker (Lord McFall of Alcluith)]

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

Social Care Reform

Lord Bethell Excerpts

Tuesday 29th June 2021 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, in last week’s very powerful debate on social care, noble Lords from across the House made it clear that we cannot build a better future for our country after Covid-19 without transforming social care, but instead of a firm date for the Prime Minister’s clear plan, we had the usual reassurances from the Minister that it was still absolutely under way, we would see some social care foundations in integrated care systems under the NHS and care Bill but that it would still be the “end of the year” before the Prime Minister reveals his clear plan to all.

Over these nearly two wasted years we have had delays and broken promises. Almost 42,000 care home residents have died from Covid-19, 2 million people have applied for support but had their request refused, tens of thousands have had to sell their home to pay for care, millions of families have hit breaking point and staff have been appallingly let down. Even after all the horrors of this pandemic, nine out of 10 councils say that they face care budget cuts this year.

While the Government dither and cancel key meetings and the Prime Minister blocks various funding options, the social care funding crisis deepens. Now we see in the Daily Telegraph that the new Secretary of State considers that we are completely at the wrong stage of Parliament to launch a new social care strategy. What is going on?

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

My Lords, the commitment to publishing a review of social care is absolutely heartfelt. We have delivered on Brexit and the vaccines, and we will deliver on social care. The Prime Minister has made it crystal clear that that will be done by the end of the year; that commitment remains in place. It will require enormous financial commitment by the whole nation at a time when our finances as a nation are extremely stretched. Therefore, it is entirely right that very careful consideration is given to it. It will also involve a very large amount of engagement with other parties and the relevant stakeholders. Again, this is not something that has been rushed. We have just been through the most awful pandemic; it is not possible to do a review of this generational nature at the same time as fighting this awful disease, but we will be true to our commitments and deliver the plan as promised.

[Baroness Brinton (LD) [V]]

My Lords, in last Thursday’s debate on social care and carers, the Minister said

“a plan for reform absolutely is under way. We have before us the building of foundations, which will be laid in the social care measures in the health and care Bill, which will support us in working together”.—[Official Report, 24/6/2021; col. 447.]

Arising from that, is it planned to publish a White Paper or any other consultation document or, as the Minister’s speech implied, will the reforms be published as part of the health and social care Bill without any wider consultation? Given his answer just now to the noble Baroness, Lady Wheeler, will parliamentarians be ask to make decisions on the health and social care Bill without seeing the details of the future social care reforms?

[Lord Bethell (Con)]

My Lords, new legislation will increase integration between health and social care by removing barriers to data-sharing, enabling joint decision-making and putting more power and autonomy into local systems. The noble Baroness is entirely right on that. The Bill has been published and the noble Baroness is very welcome to engage in some of the engagement sessions that I have had on it already. I should be glad to run more, if that would be helpful to her. A White Paper and a public consultation are not planned.

[Lord Lansley (Con)]

My Lords, press reports suggest that the Prime Minister is in favour of including in social care reform the Dilnot commission recommendations that are now a decade old. In doing so, he could bring into force Sections 15 and 16 of the Care Act 2014, which this Parliament passed seven years ago. Will the Government now consider doing exactly that to enable a cap on care costs to be implemented rapidly?

[Lord Bethell (Con)]

My Lords, we are extremely respectful of the Dilnot commission report and the recommendations in it, particularly those highlighted by my noble friend on Sections 15 and 16. It is one of many proposals that we will look at very carefully. We cannot make a commitment to anyone in particular at this stage but, as I said to the noble Baroness, we will put forward a full plan by the end of the year and will remain true to that commitment.

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

Can the Minister assure the House that any proposals on the funding of social care will ensure that working-age disabled people who use care services can access the support that they need to live a full and independent life in the community and that the funding will be sufficient to ensure that they no longer have to pay for it, avoiding inequitable and unfair financial hardship?

[Lord Bethell (Con)]

My Lords, I hear the noble Baroness loud and clear. Indeed, the needs and priorities of those with disability and the role of care for disability and the emphasis on care in the community are things that we hear loud and clear. I am not in a position to make any commitments on finances standing at the Dispatch Box at the moment, but the noble Baroness’s points are heard loud and clearly, and I would be glad to take them back to the department.

[Lord Lilley (Con)]

Does my noble friend agree that it would be better for the state to enable homeowners to insure against the potentially catastrophic risk of social care, rather than diverting billions of pounds desperately needed to pay for the care system for those unable to pay for themselves, instead using those funds to subsidise people, like most Members of your Lordships’ House, who want to pass on to our heirs homes worth hundreds of thousands or even millions of pounds? How would that be levelling up?

[Lord Bethell (Con)]

My Lords, the point made by my noble friend is entirely thoughtful and persuasive. Indeed, there may well be a role for insurance rather than any other mechanism, and it will be one of the options that those who define the policy will look at extremely carefully. The point that he makes about the desire of homeowners to pass on their homes to future generations is completely understandable and human, and one that will take into close consideration.

[Baroness Hollins (CB) [V]]

My Lords, further to my noble friend Lady Campbell’s question, will the Minister commit to mentioning working-age disabled adults every time social care reform is discussed? The needs of older people living in care homes are important, of course, but that is an easier focus for improvement. The real challenge is to improve care and support for disabled adults living in their own homes, including people with learning disabilities and autistic people.

[Lord Bethell (Con)]

I am extremely aware of the point the noble Baroness is making. A very large proportion of those in care are not elderly at all but the young and adult disabled who need some care for some condition, whether physical or mental. Their needs are paramount in these reforms. We will not forget the people the noble Baroness describes; the financial arrangements for supporting them are one of the things we absolutely want to take on in these reforms.

[Lord Rogan (UUP) [V]]

My Lords, as well as declaring that he had a clear plan to fix the crisis in social care, Mr Johnson stressed in his infamous Downing Street speech of July 2019 that he was the Prime Minister of the whole United Kingdom. When the social care plan is finally brought forward, what guarantees can the Minister give to demonstrate that Mr Johnson’s Government value the social care needs of the people of Northern Ireland every bit as highly as those of patients residing in England?

[Lord Bethell (Con)]

My Lords, the noble Lord makes an entirely fair point. The needs of those who reside in Northern Ireland are paramount in our minds. I would be very glad to meet the noble Lord and discuss how their views and needs can be best incorporated in the policies we are developing.

[Baroness Falkner of Margravine (CB) [V]]

My Lords, does the Minister accept that public opinion has shifted, and that the public are now prepared to pay more to ensure that the elderly and vulnerable are properly looked after? Will the Government look at other countries’ attempts to deal with this tricky problem in terms of financial commitment? Japan has a surcharge for people over a certain age—I believe it is between 40 and 45 —and Germany has long had a solidarity tax to pay for particular hypothecated items. Will they at least look at this before the autumn spending review?

[Lord Bethell (Con)]

My Lords, I reassure the noble Baroness that we are looking at foreign parallels. The examples she gives are extremely instructive and thoughtful. I cannot speak for certain on where the public are on this, but I share her sentiments; I think the pandemic has demonstrated that the public are more connected with and thinking more about those in care than ever before in our nation’s history. It is exactly the right moment in terms of public sentiment to address some of these issues. The generosity of spirit towards the elderly living in care could not have been higher than it was during the pandemic. In that matter, I completely agree with the noble Baroness.

[The Senior Deputy Speaker (Lord Gardiner of Kimble) (Non-Afl)]

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

Covid-19 Update

Lord Bethell Excerpts

Tuesday 29th June 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I echo on behalf of these Benches the concerns about the treatment of Professor Chris Whitty. It is totally unacceptable, and it is good news that the police are now investigating this.

Just now, in reply to my question on the Urgent Question, the Minister said that the health and social care Bill has been published. Over the last few minutes I have been searching the web, but I cannot find it— can he help me any further?

Yesterday’s Statement from the new Secretary of State struck an interesting new note. The department is clearly no longer going to be led by data but by dates. Yesterday, 22,868 new cases of Covid were reported. This time last year, when lockdown was finally lifted, daily cases were under 1,000. Even with the high level of vaccinations, this is causing illness and pressures on the NHS—even if it is a different kind of pressure to that of a year ago. On Sunday, Andrew Marr reported on his programme that his own experience of catching Covid had been difficult. He said that, while he had not needed to go to hospital, he was more ill than he had ever imagined possible, and it was not an asymptomatic experience. In the light of this and the reports of growing numbers of people living with long Covid, can the Minister say why data will now clearly not factor into the decisions about 19 July?

On these Benches, we believe that we need to learn to live with this disease, but unlike the Statement from the new Secretary of State, we do not believe that this is just about vaccination, important though that is. This week, Israel has found that, despite early and comprehensive levels of vaccination, the delta variant is ripping through its communities. We have argued since February 2020 that controlling outbreaks is vital. Can I ask the Minister about the provision of test, trace and isolate arrangements moving forward? Specifically, have local directors of public health been given access to emergency funding for the provision of surge testing and tracing and vaccination in their communities? When will the pilots for increased support for those needing to self-isolate be published? We still believe that people should be paid their wages if asked to self-isolate. As that number is considerably fewer than six months ago, it would be not only cheaper for the Treasury but a much more effective way of ensuring that the spread of the virus is reduced.

Usually the Minister agrees with me on the importance of test, trace and isolate, even if we perhaps disagree on how that should be funded and supported. Can he respond to the concerns of the doctors and scientists who are appalled with today’s proposals that company directors will be able to temporarily leave quarantine for business meetings? People are still furious that the Prime Minister delayed adding India to the red list, with the resultant rapid spread of the more transmissible and more serious delta variant. As Professor Christina Pagel says:

“luckily elites don’t get or transmit covid.”


Stephen Reicher, the eminent behavioural scientist, said he was horrified by the

“scandalous misuse of science as a cover for political decisions … which is putting us all at risk.”

When commenting on the DCMS report published on Friday, he said:

“The headlines and the political response isn’t just an exaggeration, they directly contradict what the report says. It warns that the research wasn’t designed to draw any conclusions about the effects of events on transmission and mustn’t be used to do so”.


Yet Ministers and the press are all reporting that these events in the trial had no effect on infections and were safe to reopen.

Yesterday, a No. 10 spokesperson explicitly denied that government Ministers have used private email addresses. They said:

“Both the former health secretary and Lord Bethell understand the rules around personal email usage and only ever conducted government business through their departmental email addresses”.


This is directly contradicted by the Second Permanent Secretary in meeting minutes published by the Sunday Times. Those minutes clearly state that former Health Secretary Matt Hancock

“corresponds only with private office via a gmail account”.

As the Good Law Project has reported, on 19 April 2020, the noble Lord, Lord Feldman, emailed the noble Lord, Lord Bethell, at his private address, about the availability of Covid-19 test kits via a Canadian company, saying:

“Certainly worth contacting … to see if they can help … and the pricing seems competitive.”


Self-evidently, this is government business, and specifically within the portfolio of the noble Lord, Lord Bethell. The noble Lord, Lord Feldman, once co-chair of the Conservative Party, was writing to the Minister at his private email address on government business. In addition, I note that the Minister’s meeting with Abingdon Health on 1 April 2020 was not disclosed on the ministerial meeting schedule.

We note that, unlike the response from the noble Lord, Lord True, on the earlier UQ, it is not possible for the public to access private emails; the Freedom of Information Act specifically excludes it. Not going through the formal government-approved routes, whether for emails or declarations of meetings, gives the impression that perhaps the Minister has something to hide from his dealings with a former chairman of the Conservative Party and the company he was acting for. I note that the company was awarded an £85 million contract after the meeting and the emails.

There has been considerable speculation about the role of Ms Gina Coladangelo as a lobbyist, unpaid adviser to Matt Hancock and then a non-executive director for the Department of Health and Social Care. The press and media have also reported that the Minister gave Ms Coladangelo a parliamentary pass last year. Can he tell the House what personal parliamentary service she provided for him during that period? Does the Minister feel that his position is tenable, given this evidence?

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

My Lords, I am enormously grateful for those extremely thoughtful questions. As ever, I welcome the challenge and scrutiny that the House of Lords always provides on these matters.

I completely endorse what the noble Baronesses, Lady Brinton and Lady Thornton, very thoughtfully said about Chris Whitty. Chris Whitty and JVT are both complete legends, and both have been accosted in public. This is completely unacceptable. We must look at the security of those who serve us so well, and we must somehow address the disrespect that often happens when public figures walk in public. It is a great regret that this has happened.

The noble Baroness, Lady Thornton, asked about nurses’ pay. I repeat to her what my right honourable friend the Secretary of State for Health said yesterday: this absolutely remains a priority. We must have a fair pay settlement. That pay settlement is going through the pay review process at the moment, and we look forward to receiving the output on that.

Both the noble Baronesses, Lady Brinton and Lady Thornton, asked about the basis for the optimism that we have at the moment. I have stood at this Dispatch Box for 18 months as the purveyor of difficult news to the House, and have lived through some very difficult moments in that time. I am acutely aware of the concerns that noble Lords have. I think the questions put were very reasonable and deserve a clear answer, so let me explain why we are a bit more optimistic than I think we ever could have been in the recent past. The case rates are slowing down, for both over and under-60s. Hospital admissions among the over-60s have started to fall, and while there are signs in both measures that the rate of growth is slowing, there is just not enough to fundamentally change our assessment of the risk of delta. In the last two weeks, we have seen case rates fall in both Bolton and Blackburn. That is an incredibly important observation, and one that bears testimony to the effectiveness of the local authorities, test and trace, and all of those who have contributed. It is mainly driven by the under-60 group, but not wholly. Rates among older people are plateauing right across the country at a lower level, and hospitalisations and severe illness are being prevented by people being doubled vaccinated against Covid-19. There are very clear signs that the vaccine is working in lots of ways.

By 19 July, two significant things will have changed that may give us stronger confidence. First, we will have offered a first dose to all adults in the United Kingdom. The NHS states that it can do this by 19 July. We will have also given a second dose to a higher proportion of over-40s, giving them more protection against hospitalisation. Secondly, we will be very close to the school holidays, which start on 26 July, and school-aged children being out of school. This will significantly reduce transmission among the population which is unvaccinated and has driven case growth. Universities should also be out.

We are monitoring the data every day. So far, we have not seen indicators that substantially change our assessment of the four tests. I hear loud and clear what the noble Baroness, Lady Brinton, says about Andrew Marr and his experience. Vaccination is not a panacea. It does not save everyone from any illness at all, but it has a significantly strong effect for us to move on to the next stage.

In terms of the backlog, I assure the noble Baroness, Lady Thornton, that we are putting funds in place to do whatever it takes to get us back to where we began. I cannot give the specific reassurances she asked for on whether specific funds will be extended, but it is our aspiration to work as hard as we can. On GP data, I assure her that the clinical trial progress that we have made on things such as Regeneron in the last few days gives us such a clear inspiration and motivation for ensuring that we get this project right. On trusted research environments, we have demonstrated that we listen and that we will change how we implement the GP data transfer, but our objective remains resolute. We are committed to continuing with this programme of work.

I will give a very clear response to the very important question regarding emails, asked by the noble Baronesses, Lady Brinton and Lady Thornton. I am absolutely rigorous in ensuring that government business is conducted through the correct formal channels. Contracts are negotiated by officials, not by Ministers. Submissions from officials are handled through departmental digital boxes, and that is right. Official decisions are communicated through secure governmental infrastructure.

I have read the Ministerial Code; I have signed it and I will seek to uphold it in everything that I do. The guidelines are clear that it is not wrong for Ministers to have personal email addresses. I have corresponded with a very large number of noble Lords in this Chamber from both my parliamentary address and my personal address. That is right and I will continue to do so. In their enthusiasm, third parties often seek to engage Ministers through whatever means that they can find, including their personal email. That is not the same as using a personal email for formal departmental decision-making. Those who have seen material on the internet should judge it extremely sceptically, because distorted fragments of evidence do not provide sufficient grounds to rush to judgment on how Ministers do their business.

I do not recognise the substance of the comments of the Second Permanent Secretary, as referred to by the noble Baroness, Lady Brinton, and he has indicated to me that he does not recognise the substance of those comments. I completely recognise the comments that were made regarding the meetings with Abingdon Health. The meetings schedule from that week was overlooked because of an administrative oversight. It has now been uploaded to the internet. I will be glad to share a link to that register. On the complaint made by Anneliese Dodds, I have written to the Parliamentary Commissioner for Standards and would be very glad to share that letter with the noble Baronesses, Lady Thornton and Lady Brinton.

I take this post extremely seriously. During the work of the pandemic, many people—officials, Ministers and those in industry—worked extremely hard to address the severe epidemic that we face, and I am extremely proud of how that business was conducted.

[The Senior Deputy Speaker (Lord Gardiner of Kimble) (Non-Afl)]

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

[Lord Haselhurst (Con) [V]]

My Lords, I note the impressive acceleration of the vaccine rollout and its relevance towards taking step 4 on 19 July, at a time when relief at the end of restrictions could lead to lack of caution and a surge in cases. Have the Government assessed whether it might be safer to prioritise those requiring first jabs over those waiting for their second—or, indeed, the opposite?

[Lord Bethell (Con)]

My Lords, the question of prioritisation is one for the Joint Committee on Vaccination and Immunisation. In terms of operational delivery, we have moved to a moment of opening up jabs to all those over 18, and many places do not even require an appointment. Between now and 19 July we are escalating the speed at which we deliver the jab. I encourage all ages to step forward for their first jabs, and those who have an appointment for the second to ensure that they make use of it.

[Lord Patel (CB) [V]]

My Lords, some of the vaccines used in the United Kingdom have been found to be less effective against the beta variant currently spreading in South Africa. What assessment have the Government made of the risk of travellers from South Africa bringing the beta variant to the United Kingdom following the rugby tournament that is taking place there?

[Lord Bethell (Con)]

As ever, the noble Lord is extremely perceptive in his questions, and he is right that as we vaccinate more and more of the population, the risk will become less from highly transmissible mutants and more from those which can somehow escape the vaccine. The South African variant is the one that so far has demonstrated the greatest escapology. For that reason, we are extremely cautious about visitors who may come from areas that have the South Africa variant, including South Africa itself.

[Baroness Donaghy (Lab) [V]]

My Lords, although the Statement is upbeat, it does say that hospitalisation has doubled since May. This will not be solved in three weeks. What would it take to extend beyond 19 July on safety grounds and is the Minister ruling out restrictions this winter? Also, will the proposed top-down reorganisation of the NHS be abandoned?

[Lord Bethell (Con)]

My Lords, hospitalisations have doubled but the vast majority of them are among people who have not been double-vaccinated for plus two weeks. It is very striking, when you look at the list of who is in hospital, how many simply have not been vaccinated. That is why our focus is on seeing through the vaccination programme, particularly getting all those at-risk groups—those over 50—double-vaccinated as soon as possible.

I cannot rule out anything, but I am more optimistic today than I have ever been, and that optimism is grounded on a very careful study of the facts, having sat through the joint biosecurity presentations day in, day out, for months on end. While I cannot be 1000% confident of everything, since this virus has a lot that it can throw at us, I really am hopeful for the future.

[Lord Scriven (LD)]

My Lords, to minimise the need for another national lockdown, effective local test, trace and isolate systems will need to be in place. Therefore, can the Minister explain why, in the test and trace budget, centralised corporate services, which has no front-line test and trace activity, has £931 million more allocated than the localised front-line test, trace and contain allocation? If he does not have those figures to hand, can he please write to me, although not from his personal email address?

[Lord Bethell (Con)]

My Lords, I suspect that I have corresponded with the noble Lord from my personal email address; I am deeply hurt that he does not want to receive any of my emails again, but not entirely surprised. The waiting at test and trace has moved dramatically, as I think the noble Lord knows, from the central supply of testing and tracing services to a much more local model, and that does not always manifest itself in the corporate accounts of the organisation. It manifests itself in both the management and the delivery, and I pay huge tribute to those who are involved in the local implementation. As I said earlier, the way in which the delta virus infection rates, which were skyrocketing at one point, have been turned around in places such as Hounslow, Blackburn with Darwen and other areas of the north-west is phenomenally impressive and is a tribute to the impact of test and trace.

[Lord Farmer (Con)]

My Lords, what has the SIREN study most recently established about the effectiveness of infection-induced antibodies over time? Furthermore, as per my Written Question, answered by the Minister on 2 June 2021, why has not Public Health England or another government-backed health body conducted a review of research on the long-term effects of face mask wearing when clinicians such as Antonio Lazzarino from UCL’s Institute of Epidemiology and Health Care cite deleterious health effects?

[Lord Bethell (Con)]

My Lords, SIREN is one of the most thought-provoking and interesting of all the many studies that we have done. It is a sad fact that we do not understand many of the aspects of the body’s immune system, and that is why we are so committed to that study. It suggests that once you have had the virus, your body’s immune system is extremely strong. The proportion of people who catch it a second time round is incredibly small. That is good news for those who have caught it and for those who have had the vaccine, because if the immune system works well after catching the virus, it probably works well after the vaccine. However, we continue to publish from the SIREN study. On the health impacts of wearing face masks, I am not fully across that, but I will be glad to write to my noble friend with any details that I may have.

[Lord Harries of Pentregarth (CB) [V]]

The Government have been concerned for some time that even though someone is symptom-free and has had both vaccine jabs, there is still some risk that they might pass it on to others. But surely the risk must be minuscule. Have the Government ascertained how minscule the risk is compared with other much more major kinds of risk, and has there been a danger of the Government overcompensating here, particularly with respect to those in that position wanting to enter this country?

[Lord Bethell (Con)]

My Lords, what a perceptive question from the noble and right reverend Lord—he absolutely hits the nail on the head. The honest truth is that we do not have the precise figures on this but the indications are that he is right: the vaccine does not stop you being infected or transmitting it, but it reduces the chances of both those things dramatically. That is one of the reasons why we have kept our foreign travel arrangements under review. It is possible that the effect that he describes may mean that we can look very thoroughly at foreign travel—I think all noble Lords would welcome that.

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

My Lords, I have no doubt about the Minister’s personal integrity but he will recognise that he is part of a Government who are not exactly renowned for their probity or truthfulness. I want to ask him about lateral flow tests. There have been reports that the accuracy of this test, which has been less than 100% in any case, is less still when it comes to the delta variant. Can he say a little more about that, and what discussions are taking place with UK companies, who appear to have developed better models which may be more accurate?

[Lord Bethell (Con)]

My Lords, the noble Lord is entirely right that the Porton Down verification team has looked extremely closely at all lateral flow tests and their sensitivity to the delta variant in particular. There is suggestion and some indication that for very low viral loads, the LFTs are not quite as sensitive, or if they are sensitive, the band is less easy to read. However, for higher viral loads—in other words, the kind of viral loads that the body needs to carry to be infectious—there is no change of sensitivity. Therefore, from that point of view the LFTs continue to perform their original purpose very effectively but we need to keep a very close eye on sensitivity with the new variants.

I pay tribute to all UK companies which are coming forward with LFT, PCR or genomic sequencing tests. I am extremely proud of the progress that the UK diagnostics industry has made. We have extremely high standards and extremely high validation and authorisation protocols through Porton Down. Those standards are very difficult to achieve but we are working extremely closely with UK companies to try to get them over the line so that they can play an important role in our response to the pandemic.

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

My Lords, the Statement places great emphasis on regaining freedoms but has relatively little to say on the specifics of how we learn to live with Covid, as we surely must, given the rising number of new cases and concerns about new variants. Apart from a very brief mention of care workers, there were no other details of how the planned end of restrictions on 19 July will affect care home residents and their families. Can the Minister say what thought is being given to how we learn to live with Covid in care settings and when we can expect to see detailed guidance on this which balances the need for protecting the elderly and vulnerable from infection and improving the quality of their daily lives?

[Lord Bethell (Con)]

My Lords, the noble Baroness’s question is entirely reasonable and I wish I could be more specific on the precise timing. The honest truth is that we look at the data every day; our experience through this pandemic is that our understanding improves every day and therefore the guidance that we provide is often provided at a relatively late stage. It is an unfortunate aspect of this awful pandemic and one that I know noble Lords have commented on with vigour in the past, but it is an unavoidable fact of life. However, the comments made very thoughtfully and persuasively by noble Lords about the conditions in care homes, the restrictions that are put on residents and the pressure that that puts on them and their families have been heard loudly and clearly by all those in the department and across government, and we will seek to address those concerns when the moment is right.

[Lord Lancaster of Kimbolton (Con)]

I remind the House of my interest as Deputy Colonel Commandant Brigade of Gurkhas. According to the Daily Telegraph, 63 unvaccinated Gurkha veterans have now died in Nepal. Had they lived in the UK they would have been vaccinated, but because they left the Army before the law was changed, they have no right of abode here. Under the Armed Forces covenant which we are enshrining in law, we have a duty of care to our veterans, and the differential way in which we are treating our Gurkha veterans from their UK counterparts is a clear breach of that covenant. Just 20,000 vaccines, or less than 3% of a single day’s rollout in the UK, is all that is required. When will those vaccines be made available?

[Lord Bethell (Con)]

My Lords, I pay tribute to the points made by my noble friend and to the persuasive and energetic way in which he made them. Our thoughts go to those in Nepal, who face an awful position; the pandemic there is running extremely hot. I reassure my noble friend that colleagues at both the Department of Health and the FCDO are fully aware of the concerns of the noble Lord and the Nepalese people. We will put in place the kind of vaccination provision programme that we would like to see as soon as we can. Our priority for the moment is the UK. For all the reasons I just described, we must continue the march towards 19 July and get our own people vaccinated. However, my noble friend makes the point well; the sums involved are relatively small and we will seek to address them as soon as we reasonably can.

[The Earl of Clancarty (CB)]

My Lords, there is a growing feeling in the arts that they are being taken for a ride. Up to 60,000 will attend the Euro semis but festivals such as Kendal Calling, with less than half of that capacity, and now WOMAD, have had to cancel because they have no access to the Events Research Programme data or to a government-backed insurance scheme. On top of that, despite the Costello study, our amateur choirs are restricted to six while professional choirs in similar settings are not. For the arts, none of this makes sense.

[Lord Bethell (Con)]

My Lords, I completely understand the noble Earl’s points. On WOMAD, I have a particular interest in that fine festival and I am extremely sad to hear that it has been cancelled, and to have to change my family plans accordingly. I reassure the noble Earl that we have not overlooked the arts at all. They are absolutely paramount in our thoughts. The events research programme is making progress, but it consumes a high number of tests and we simply do not have the capacity, despite the huge investment we have made, for the kinds of figures that would be needed to open up the whole of the arts world at this stage. But I am hopeful that the research we are doing will create the kind of persuasive data necessary to figure out safe ways of reopening the arts, so that we can get back to the life we had as soon as possible.

[Lord Rooker (Lab) [V]]

I welcome the Minister’s openness and transparency about his conduct. I also support what he said about the attacks on Dr Whitty. If there are no arrests before the end of the day, it will just show how useless the Metropolitan Police is under its current leadership. In his Statement, the Secretary of State talked about keeping the NHS safe. What I have not really connected, both from the previous Question and this Statement, is that keeping the NHS safe cannot be done in isolation. The issue of social care and its reform is inexorably linked to keeping the NHS safe, and that point does not seem to be used by Ministers as a serious connection. Finally, without abuse, if this country starts boosters or third jabs later this year when people in countries such as Nepal are still going without vaccinations, it will be a thundering international disgrace.

[Lord Bethell (Con)]

My Lords, I have failed in my mission, because I have sought to convey to the Chamber that we completely understand that the NHS, social care and public health—the three sectors of our healthcare system—are inextricably linked. That is why we are bringing to the House the health and social care Bill that we are. That is why we have already brought about a large number of reforms, including ICSs and the integration of various diagnostic elements, and have sought to bring more parity for social care workers and those in public health. The noble Lord absolutely hits the nail on the head. I completely agree with his point, and that is our guiding star for the future.

[Lord Cormack (Con)]

My Lords, if we are to return to normality on 19 July, as the new Secretary of State has stressed in the other House is his aim, can my noble friend assure me that the question asked by the noble Earl, Lord Clancarty, will be properly and effectively answered by a return to normality with choirs, inside and out? Can he also assure me—and I am sorry to press him on this yet again—that, by the end of August at the latest, all care home workers will have to have been vaccinated?

[Lord Bethell (Con)]

My Lords, I am grateful for the opportunity to address both points. On singing, I have heard loud and clear the points made by many noble Lords, particularly my noble friend Lord Cormack. The right honourable Secretary of State for Health said very clearly yesterday that it was his aspiration that we should return to normal as soon as possible and that he himself would be joining in the singing when it happens. I completely echo that point.

On social care workers, I am advised that we are working as hard as we can to get through the very delicate employment law and the consultations necessary. I know my noble friend would wish that this could all happen a lot more quickly, but the way in which we go about the treatment of our workers needs to respect their human rights, and that is why it is important that we do this in a thoughtful way. It is also necessary to build trust in the vaccine and I do not think that there would be anything gained by in any way pre-empting those processes.

[Lord Hussain (LD)]

My Lords, the hotel quarantine for those returning from red-list countries is having a huge, stressful impact on those using the hotels. I have a couple of examples to share and one or two suggestions to make. The first case is family A from Huddersfield. They went to bury their father in Pakistan. On return, they had huge difficulty booking hotels. At Heathrow Airport some family members were taken to Swindon and others to Camberley, which are about 50 miles apart. They could not be put in the same hotel, for some reason. They have made a formal complaint. I have received a copy of it and I am willing to send it to the Minister as well. It shows the level of dissatisfaction people are feeling.

The second example is from my home town, Luton, where, sadly, a young teenager lost his life in a tragic incident. His father and some other relatives, including somebody who is epileptic, were in Pakistan at the time. On their return, whatever amount of stress they had, they were taken to the hotel straightaway and were not allowed out, other than just coming for the funeral.

The third example—and I would say a more tragic one—is a family who went to Pakistan before it was put on the red list. The father was under stress and there are two disabled children. The mother died there and the children are waiting to come back to the UK—

[Lord Hussain (LD)]

My Lords, the suggestion is, please can those returners be tested and those who are found to be positive asked to quarantine in their own home? To observe their quarantine, they should have some kind of electronic tag instead of being put in expensive hotels and having these terrible experiences.

[Lord Bethell (Con)]

My Lords, the noble Lord’s testimony is very moving and I have no doubt that the red-list system has put a lot of pressure on a lot of families. I personally sign off on these exemptions, and every evening as I go through them and read about the stories people have, it breaks my heart—and I do it with huge regret indeed. However, the noble Lord needs to understand that we put the red-list system in place to protect this country. People simply cannot expect to travel in large family groups as if the pandemic had not happened, and they cannot expect the testing system to work as some kind of barrier to infection. We have tried that. It did not work. The proof is absolutely categoric.

If I may be honest with noble Lords, it is likely, unfortunately, that we will have to live with some red-list countries for some time to come. That is one aspect of the unwinding of this pandemic that is not likely to go away very quickly. I completely take on board the noble Lord’s guidance. If he would like to write to me about the specific examples, I would be happy to correspond with him. However, I would not be levelling with him if I did not make it clear that this is something that we are extremely committed to.

[Baroness Altmann (Con)]

My Lords, I welcome my right honourable friend Sajid Javid to his new role and also offer my public endorsement of the integrity of my noble friend the Minister. I echo the words of this Statement that we must learn to live with Covid, so that our country benefits from the fantastic vaccine success. I fear we have lost perspective on real life. Zero Covid and stopping people being ill with just one disease among the myriad diseases around us all our lives are wholly unreasonable—and indeed unattainable —aims. Can my noble friend comment on when we will take more seriously the mental health damage that lockdown and deprivation of freedom to see all our loved ones is causing, and the importance of trusting the British people to decide for themselves who they need to meet and hug and who—as the noble Earl, Lord Clancarty, and my noble friend Lord Cormack said—they feel safe to sing with?

[Lord Bethell (Con)]

My Lords, I hear my noble friend’s comments loud and clear, and I think that we have hit some kind of inflection point where our focus is now much more on the learning-to-live rather than the saving-life dimension. I say that with unbelievable caution, having, as noble Lords know, been through all sorts of rollercoasters of expectation over the past year. I am extremely hopeful that the vaccine has laid out a clear path out of this pandemic. It is one that is fragile, delicate and could be overturned at any point, but, so far, the vaccine has seemed to be extremely durable.

On the mental health of the nation, I completely agree with my noble friend. It has put huge pressure on families, loved ones and communities. There have been positive benefits—my honourable friend Nadine Dorries spoke movingly about that to the Health and Social Care Committee the week before last. Some families in some communities have been drawn closer together— there is good evidence for that—but, for a great many, there has been a huge amount of pressure. I, for one, look forward very much to some lessening of that burden.

[Lord Taylor of Goss Moor (LD) [V]]

The Minister has just commented that there may be red-list countries for some time to come, and that is clearly correct. That is a reflection of two things. First, many countries, particularly poorer countries, have not been able to vaccinate at our rates—not even close to that. The changes to Covid, which are making its spread both more easy and more dangerous mean that it is ripping through many of those countries and threatens many, many more deaths. Secondly, in doing so, it increases the chances of variants being bred in those countries and ultimately finding their way here—we know from experience that they will find their way here sooner or later. So, while feeling more optimistic about the situation here in the UK, what can we do to further ramp up the effort to support countries around the globe that are struggling to vaccinate their populations, struggling to save lives and, frankly, struggling to stop the creation of new variants that threaten this country?

[Lord Bethell (Con)]

The noble Lord is entirely right: those three things are linked. We cannot live in a world where there is a high infection rate in large parts of it, where new variants prosper and where we cannot travel. That would be inhuman and unpragmatic. I met with the CEOs of the major companies that manufacture the vaccines in Oxford during the G7, and we discussed this point in great detail. It is frustrating, but I also have optimism that the manufacturing capability in the hubs around the world—in the geographical places where populations live—are being built today and, by the middle of next year, there will be a huge amount of vaccine capacity in order to address this problem. It is frustrating that it cannot happen overnight, but vaccine manufacturing capability takes time to build up, as we know only too well. However, those investments are taking place, and I believe that, as a world, we can beat this pandemic together.

[Lord Lansley (Con)]

Notwithstanding the disclosures of the past few days, may I tell my noble friend that I, for one, very much appreciate what Matt Hancock did and the immensity of the effort he put in to combat Covid infection? Step 4 is not a return to normality, so, for example, self-isolation requirements will continue after contact tracing. The Government now have a lot of research to look at whether daily lateral flow tests can replace self-isolation both for schools and for businesses, which are must disrupted by self-isolation. Can my noble friend say when the Government may be able to proceed to allow some schools and businesses to shift to daily lateral flow tests?

[Lord Bethell (Con)]

My noble friend’s comments are very much appreciated and taken on board. On his question about daily lateral flow testing, he is very perceptive and correct. This is an area that we have been exploring for some months, and we are working extremely hard to bottom it out with rigorous clinical trials—clinical trials are difficult to nail down, by their nature, but we have invested substantially in them. He is right that, for schools, for international travel and for contacts—those three things—daily testing may well offer an alternative to 10-day isolation. That would be a huge relief to many in the country, and it is something that we are very focused on delivering.

[Baroness Fox of Buckley (Non-Afl)]

I welcome the change of tone when the new Secretary of State said that the big task ahead is to restore our freedoms—freedoms no Government should ever wish to curtail. Regime change is a bit disruptive, so I ask the Minister: are all the department behind this new approach, because it is in rather stark contrast to the Secretary of State’s predecessor’s more doom-laden, illiberal approach? As we have seen in this debate, there seems some reluctance, at least within Westminster, to allow fellow citizens to embrace freedom.

[Lord Bethell (Con)]

The noble Baroness is quite right to ask the question, but I would say to her that it is not actually the regime that has changed, although the regime has changed; it is that the data has changed. Last Tuesday, I sat through Covid Gold, which is our big set-piece data session—a two-hour deep dive into national and local data. Every week for the past 70 weeks, that has been a very chilling experience where we have looked at the progress of and tactics of this awful virus, and I have often left it with a very heavy heart. Last week, I genuinely felt that we had reached some kind of turning point and, on Friday, when I sat in my kitchen, I felt a great weight beginning to lift off my shoulders for the first time in a very long time. I cannot disguise from your Lordships that there may well be more surprises left in this virus. I cannot promise that I will not be standing at this Dispatch Box giving bad news at some point in future, but, right now, I am more optimistic than I have ever been, and I think that the Statement by my right honourable friend the Secretary of State reflected that.

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

My Lords, the time for questions has now elapsed and, with regrets and apologies to those noble Lords whom I was unable to call, we must move to the next business.

Social Care and the Role of Carers

Lord Bethell Excerpts

Thursday 24th June 2021 Lords Chamber

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

My Lords, I join other voices in congratulating the noble Baroness, Lady Jolly, on securing this debate on a subject that is absolutely at the top of the agenda, both here in the House and more widely. I wish her godspeed in her journey to other climates in the defence sector—I wish her very well in that new brief. I also genuinely commend noble Lords for an enormously moving and persuasive debate, with very personal and thoughtful contributions from all sides of the House.

Any Minister who listened to today’s debate, or to any of the interventions that we have had on social care in the last year, would want to start by paying tribute to carers, both unpaid and paid, for all the work that they do in care homes, people’s homes, day centres and other settings, year after year, during this awful pandemic and, as many noble Lords have noted, in the difficult period in the near future of getting back to normal life. I have heard and completely acknowledge the testimony about the significant personal and structural challenges faced by the sector from those who live and work in it. These challenges were exacerbated and highlighted in the pandemic. I do not pretend that they have not put pressure on the 290,000 who live in care, the 630,000 who depend on care, the 1.5 million who work in care and the many millions of family carers who contribute to care.

I will take a moment to reflect on the huge amount that we have done to provide support, at pace, to the social care sector during the pandemic. As we went into it, there were both strengths and weaknesses across the sector, but we started from a point where the quality and satisfaction with the care sector was high, and there was a range of provision for those who needed care. That point is sometimes lost in a debate such as this. As of March 2020, 84% of all social care settings were rated good or outstanding by the CQC, and 89% of those receiving local authority-funded support were satisfied with it, with 64% saying that they were very or extremely satisfied. The importance of raising this point is to pay tribute to the hard work and dedication of those who work in social care: the social care workforce, the care assistants, the care home managers, the social care workers and the family members, who have all contributed to those incredibly impressive statistics.

I will take a moment to remind my noble friend Lord Astor, and all the many noble Lords who quite understandably questioned our efforts to protect the sector during this awful pandemic, of a few of the things that we did. We published bespoke, tailored guidelines on how to safely provide care and protect those we love during the outbreak; these were used by families, care homes, care providers, domiciliary carers, unpaid carers, local authorities and others. From a standing start, we built up a huge capacity for regular testing: to date, we have sent out more than 35 million PCR swabs and 85 million LFTs to care homes, and we have done more through community testing in the NHS. We set up a massive PPE supply chain, completely from scratch, and through the PPE Portal, we have provided 2.4 billion items of PPE free to providers. As of 30 May 2021, we have provided 440 million items through local resilience forums and local authorities.

We have prioritised health and care workers and older care home residents in the UK vaccines delivery plan, offering vaccines before 15 February to residents in care homes, to older adults and their carers, those over 70, the clinically extremely vulnerable and, very importantly in this debate, front-line health and social care workers on an equal footing. We moved quickly to provide financial support, and have now provided £1.8 billion in specific Covid funding for adult social care. We set up regional assurance teams, and have supported safe discharge with £2.8 billion—a colossal sum—including an extra £594 million announced earlier this year. With this in mind, I very gently challenge the implication made by some noble Lords that, during the pandemic, we overlooked social care, the vulnerable or the elderly.

To address the specific subject that the noble Baroness, Lady Jolly, has raised in this debate, I turn to the social care workforce. The 1.5 million people who make up the paid social care workforce provide an absolutely invaluable service to the nation, working tirelessly to support people of all ages who need care. As the pandemic has made clear, we as a nation are totally indebted to their selfless dedication and compassion. Like other noble Lords, I pay particular tribute to the moving personal testimony of the noble Baroness, Lady Thomas, who spoke so engagingly about her carers. I thought of the carers who looked after my father and other loved ones, and I was really moved by the way in which she spoke about this. As she and the noble Baroness, Lady Cavendish, said, these people may be low paid but they are extremely highly skilled. I want to make sure that all noble Lords pay tribute to them.

What we heard from the noble Baroness, Lady Thomas, and in other very moving personal testimonies, was completely consistent with what I heard in my meeting with Carers UK and Care England earlier this week. They brought other carers, who talked about their very challenging and difficult lives in the last few months, and I found engaging with them extremely moving indeed.

I completely hear the noble Lord, Lord Pendry, who pointed out the impact of the pandemic on those who work in social care. Perhaps I may reassure him that we have taken steps to support social care workers during the pandemic. We identified paid carers as key workers in response and gave them much-needed acknowledgement of their critical role in keeping people safe and supported. Through the infection control fund, we ring-fenced funding for providers to be used for measures such as helping to maintain normal wages of staff who may need to self-isolate.

More recently, in December 2020, we appointed Deborah Sturdy as the chief nurse for adult social care to provide professional leadership to the workforce, delivering clinical and professional advice across the social care sector. Huge thanks are owed to her for that.

I have heard loud and clear the words of noble Lords on parity, education, recognition, career progression and autonomy, points that were extremely well made. To the noble Baronesses, Lady Donaghy and Lady Barker, I completely acknowledge that the well-being and mental health of the social care workforce are paramount and have been under threat during these challenging times. We have invested over £1 million in social care well-being and worked alongside the NHS and other organisations to provide a package of emotional, psychological and practical resources for the workforce in a way that has not been done before and I hope has made a difference.

There are at least 6.5 million unpaid carers—around 10% of the entire population, according to the census. Other noble Lords mentioned other equally impressive figures. As my noble friend Lady Browning and the noble Baroness, Lady Watkins, rightly pointed out, that number is even bigger if we include informal carers. The life of those looking after those with terminal diseases is particularly difficult, as was rightly described by the noble Baroness, Lady Finlay. As she rightly and positively made the case for a carers’ allowance, I should reassure her that the consultation on carers’ leave last year demonstrated huge interest in this area—there were 800 submissions—and we will reply in due course, as per our manifesto commitment on that.

Of those unpaid carers, 23% have high-intensity caring responsibilities of more than 50 hours a week. I clearly heard the personal testimony of noble Lords. I have met some of those carers and acknowledge that their life has been incredibly challenging during the lockdown when day centres and other forms of respite were closed, and when the full burden of care fell heavily on their shoulders—month after month, night after night.

We recognise the impact that the pandemic has had on carers and we responded. Perhaps I may single out four areas. First, there was the provision of free PPE to unpaid carers living separately from the people for whom they care. Secondly, there was funding to charities, such as the £500,000 to the Carers Trust and £122,000 to Carers UK to extend its helpline. Thirdly, we gave them priority for vaccines, which I have mentioned already, with carers being put into cohort six, in line with the JVC advice. Fourthly, we published guidance tailored to carers, enabling them to identify themselves and their needs so that those could be more easily met, with ongoing work to help carers on respite and breaks.

To the noble Lord, Lord Dubs, and my noble friend Lady Browning, I completely acknowledge that the challenge continues as we try to return to normal. Day services in particular have been raised by a great many noble Lords, as well as by Carers UK and carers England. The services provide an important form of respite for carers, and allow people with support to meet others and have a break from their obligations. The noble Baroness, Lady Wheeler, and my noble friend Lord Astor gave moving, precise personal testimony on that and I completely acknowledge the point. I wish to reassure all those noble Lords that we are helping to ensure the safe continuation and restarting of day services. We are working with the Social Care Institute for Excellence to publish guidance. We have undertaken work with ADASS and local authorities to understand the barriers. Specifically in answer to the question of the noble Baroness, Lady Wheeler, there is now a joint ministerial task force between DHSC and MHCLG, working specifically on that initiative.

Moving on to workforce development, perhaps I may reassure the right reverend Prelate the Bishop of Carlisle that I agree with him completely that this is a key element of how we can improve social care. As we come out of this pandemic, it is essential that we make sure that we continue to have a workforce with the right values, skills and knowledge, and with real prospects for career progression, if we are to provide a high-quality service for those with need of care services.

I reassure my noble friend Lord Forsyth that we are continuing to commission and fund a range of training opportunities and other programmes to help recruit people in this sector. To give a couple of examples, we have provided £27 million to expand the Think Ahead programme to train 360 graduates in career switches to become mental health social workers; and there is the workforce development fund, which distributes about £12 million a year for training and qualification at all levels. That has helped almost 3,000 establishments to support more than 14,000 learners in 2018-19. The 2020-21 fund will continue to focus on key sectors.

I can only agree with the noble Lord, Lord Pendry, that Covid-19 has exposed some of the long-term inequalities in our society. Research from PHE and others continues to show those disparities.

To the noble Baronesses, Lady Jolly and Tyler, and my noble friend Lady Altmann, I agree that there have been some home closures, but so far there has been no major overall impact on bed numbers in the care sector. The largest regional loss of beds since March 2020 has been a 1% loss in London. Perhaps I may therefore reassure noble Lords that the Care Quality Commission is closely monitoring the financial health of the largest and most difficult-to-replace adult care providers. This allows the commission to warn local authorities if a provider is likely to fall over.

In response to my noble friend Lady Browning’s call, perhaps I may reassure her that a plan for reform absolutely is under way. We have before us the building of foundations, which will be laid in the social care measures in the health and care Bill, which will support us in working together. It will increase integration, reduce bureaucracy and enhance public confidence in accountability. I reassure the noble Baronesses, Lady Tyler, Lady Hollins and Lady Watkins, that these measures will include a new enhanced assurance framework to improve oversight of how social care is commissioned and delivered to people.

To the noble Lord, Lord Dubs, the measures will help us to get much better data from providers on what is going on at a local level so that we can, as he rightly described, follow the evidence of what works and what does not. The health and care Bill will also introduce a new place for social care in the integrated care systems, which will capture and build on some of the joined-up working that has accelerated in some areas already during the pandemic where local collaboration between health and local government, and between different parts of the NHS, has previously been essential to supporting people. With that in mind, I reassure the noble Baronesses, Lady Hollins and Lady Watkins, that we are developing enhanced assurance frameworks.

To my noble friend Lord Lilley and all those who raised the long-term reform of financing social care, it absolutely remains a government priority and all options are being considered, including those of my noble friend. The Prime Minister will be making an announcement on this before the end of the year. To the noble Baroness, Lady Pitkeathley, I say that boldness will be our watchword.

By way of conclusion, I thank those who have spoken so eloquently on this important topic. I know that noble Lords are all deeply committed to supporting the social care sector and would once again wish to join me in thanking all those on the front line providing care and going the extra mile every day. I am enormously proud of their efforts and immensely grateful to them all. We absolutely must not lose sight of what is important. This means doing our utmost for people who rely on social care and their families. In the words of several noble Lords, bring it on.

Folic Acid

Lord Bethell Excerpts

Wednesday 23rd June 2021 Lords Chamber

[Lord Dodds of Duncairn]

To ask Her Majesty’s Government what progress they have made with the response to their consultation about the fortification of flour with folic acid.

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

My Lords, the administration of folic acid to the bread of the nation to avoid around 500 neural tube defects a year is exactly the sort of preventative health intervention that we are putting at the heart of our health strategy. I am pleased to say that progress is being made, and I thank the devolved Administrations for their engagement in this measure to ensure that we have alignment between the four nations. I reassure noble Lords that this remains a priority for the Government.

[Lord Dodds of Duncairn (DUP)]

My Lords, surely the Government have run out of time and must now announce that they will follow the science and finally act to help to prevent the entirely avoidable numbers of babies born with neural tube defects? Recommendations were to be announced as soon as the recent elections were over, and if we are serious about preventative medicine and health, surely on this issue, where UK research has led the way to many other countries taking action long before now, there really can be no further delay or excuses.

[Lord Bethell (Con)]

My Lords, I entirely agree with the noble Lord that we are committed to following the science and are totally persuaded by it. However, I cannot avoid the fact that there were elections in devolved nations, which have meant that politicians and Secretaries of State in some of those countries were not available to engage with. I am pleased to report to the House that we have made a lot of progress in engaging with the devolved nations. We could not possibly do this policy without their support, buy-in and alignment. Progress is continuing at great pace, and I look forward to returning to the House and updating it at a future date.

[Baroness Kennedy of Cradley (Non-Afl) [V]]

My Lords, in March this year, the noble Lord said that the Government were taking time to create a

“solution that is endorsed by mill owners, paediatricians and all the relevant stakeholders.”—[Official Report, 23/3/21; col. 720.]

Given that the position of UK flour millers is acceptance if the Government decide to introduce mandatory fortification, and given that there is overwhelming support from the medical community, why are the Government dragging their feet and not introducing this measure, when it is proven to reduce neural tube defects in babies? Next month is the 30-year anniversary of when this link was proven. Why are we taking so long to put this measure in place?

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right: medical opinion on this matter has absolutely consolidated around support for it, and the consultation in September 2019 was extremely positive indeed. I am extremely grateful to mill owners, both the large industrial ones, which make a lot of the white flour, and the artisanal mill owners, which had complexities of their own. The engagement with them has been enormously positive, and I cannot see any obstacle on that front. However, there is a machinery of government point that needs to be addressed: we have to work it through the devolved nations and other arm’s-length bodies, and we are doing that at pace.

[Baroness Altmann (Con) [V]]

My Lords, from my noble friend’s responses, the House will be clear that this decision is under way. Could my noble friend give some idea of whether we might expect an announcement before the Summer Recess? We know that hundreds of children being born with spina bifida and anencephaly, which can be so damaging to themselves and their families, could be avoided. The sooner we do this, the sooner we can stop such problems occurring.

[Lord Bethell (Con)]

I agree with my noble friend; she is right that this is a priority. However, it is not within my gift to simply grant a decision on it; it needs to be worked through both industry and government. We are making progress on this. It is a huge national undertaking for us to put substances literally in the bread of the nation. The public deserve to feel confident that that decision has been made thoughtfully and responsibly, and it is entirely right that we take care to dot the “i”s and cross the “t”s.

[Baroness Hayman (CB) [V]]

My Lords, the Government have had an awfully long time to dot the “i”s and cross the “t”s. When the MRC research first came out, my children were the age that my grandchildren are now. Some 80 other countries have moved more speedily than the UK on the evidence provided by the UK-funded MRC research. As well as the noble Lord making progress on this before the Summer Recess, will the Government look at what the barriers were that made us as a country so slow to come to the decision to fortify flour?

[Lord Bethell (Con)]

My Lords, this Government’s progress on this really came to a head in the consultation in September 2019, and we have been on course to implement these measures since then. It is unfortunate that the Covid pandemic intervened at that point and we had to put work on this project on hold until April of this year. Since April, we have had to deal with the elections in the devolved Administrations. That, unfortunately, creates an insuperable barrier to taking the measures through all the necessary checks and alignments. I reassure the noble Baroness that we are totally committed to this policy, we are moving at pace and I look forward to further progress shortly.

[Lord Rooker (Lab) [V]]

I very politely remind the Minister—and it is on the record—that the three devolved Governments were in favour of this policy before the English Government were, so there cannot really be any substance of any delay from the devolved Governments. I know this because, with scientists, I discussed it with some of the Ministers. My other point is that, given that we already fortify with three substances, there cannot be any technical difficulties whatever in the flour mills in adding folic. There should not be any long-term delay of a technical nature, should there?

[Lord Bethell (Con)]

My Lords, I agree with the noble Lord. Can I just take a moment to bear testimony to his patient and determined campaigning on this issue? He has held the Government’s feet to the fire on it, and I am grateful for his focus. He is right that we are hopeful that there should not be any substantive delay with the industry. A huge amount of work has gone on in the consultations and the dialogue we have had, and I am grateful for that. However, the Senedd and Scottish parliamentary elections in May meant that new personnel were at the top of government. We hope that they are as supportive as the noble Lord so rightly pointed out, but there is a process to get the official endorsement that we need to take this forward and we are waiting for that paperwork to come through.

[Baroness Walmsley (LD) [V]]

My Lords, is the Minister aware that 50% of pregnancies are not planned? Therefore, while the Government consult and procrastinate, what communication is being planned with women of childbearing age to tell them that they need to take a folic acid supplement before they start a pregnancy to avoid NTDs in their babies?

[Lord Bethell (Con)]

My Lords, this Minister is very aware—personally extremely aware—of the fact that 50% of pregnancies are not necessarily planned. As the noble Baroness knows very well, that is one of the reasons for this policy and that is why we are so supportive of it. The education that goes to new mums and dads on folic acid is done through GPs, and we are always looking at ways to enhance that. But I think there is no better of way of ensuring that folic acid gets to the right people at the right time than through this measure, and that is why we are supporting it as energetically as we are.

[Baroness Gardner of Parkes (Con) [V]]

My Lords, can the Minister comment on whether the Government have been working with the health authorities in other countries to review the evidence from the more than 80 other countries where folic acid has been mandatorily added to food products?

[Lord Bethell (Con)]

My Lords, it is my understanding that both the Department of Health and Defra have been engaged with other countries on this matter. I will be glad to write to the noble Baroness with any details that we may have on record.

[Baroness Merron (Lab)]

My Lords, I listened to the Minister’s answer where he referred to delays as a result of the Covid pandemic and the elections in the devolved Administrations. While they may be recent issues, this delay well precedes both those important events. As my noble friend Lord Rooker and others have so eloquently expressed, patience on this is long exhausted and parents-to-be cannot be expected to continue to carry such risk. Can the Minister tell the House exactly when babies will be protected? Is the delay that we have seen over decades due to any change in the Government’s position?

[Lord Bethell (Con)]

I absolutely reassure both the noble Baroness and all noble Lords in the Chamber that there is absolutely no equivocation on behalf of the Government in this matter. It is a huge undertaking to put a substance in the food of the nation. It is therefore something that has to be endorsed by all the relevant bodies, including the four nations and other arm’s-length bodies. We have to ensure that we have all the public health sign off and the industry support that we need, and we need to take the public with us. There will be a moment when we need to sell this to the public, and they will have questions and we will need to have a dialogue. When that happens, I would like to have crossed all the “t”s and dotted all the “i”s so that we are in great shape. That is why we are being as thorough as we can. I reassure all noble Lords that there is no question of us going backwards on this.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the time allowed for this Question has elapsed, and we now come to the second Oral Question.

Covid-19: Care Homes

Lord Bethell Excerpts

Thursday 17th June 2021 Lords Chamber

[Lord Scriven]

To ask Her Majesty’s Government (1) on what date, and (2) in which policy document, testing for COVID-19 was offered as a matter of policy to those leaving hospitals and going to care homes.

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

My Lords, the Covid-19 hospital discharge service requirements were published on 19 March 2020. They stipulated that patients’ Covid-19 test results, negative or positive, should be included in their discharge documents. On 15 April, we built on this with the adult social care action plan, including a policy of testing all patients prior to discharge to a care home. I remind noble Lords that the WHO acknowledged the threat of asymptomatic transmission on 9 July 2020.

[Lord Scriven (LD)]

My Lords, last week the Secretary of State said that a policy of testing patients going to care homes was brought in

“as soon as we had those tests available”.

That was in mid-April 2020, and more than 500,000 tests were carried out to mid-April 2020. Only 25,000 would have been required to test all patients being discharged to care homes. Can the Minister explain these figures and the contradiction in the Secretary of State’s statement that they highlight?

[Lord Bethell (Con)]

My Lords, I do not quite understand the noble Lord’s figures. As of 14 March 2020, the seven-day rolling average showed that there were 51,741 discharges a day from hospital, of which 1,123 were from hospitals specifically to care homes. That was at a moment when our testing capacity was 3,000 a day. A month later, on 15 April, the rolling average was 22,000, of which 548 were discharges from hospitals specifically to care homes. By that date, the testing capacity was 38,766.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, we need granular details such as dates and decision-making processes not to play the blame game but because we need to understand precisely how Covid got into care homes. In that context, can the Minister tell us when and why the policy decision was made to make vaccines mandatory for care home staff, going against the Government’s stated opposition to jabs for jobs and against the crucial ethical principle of medical consent? Does the Minister understand that for care home workers, vaccinated and non-vaccinated, this looks like decisively shifting the blame from official culpability for the scandal of how Covid got into homes on to hard-pressed front-line workers?

[Lord Bethell (Con)]

My Lords, we are in the middle of a consultation on mandatory vaccinations for care home staff. One thing I would remind the noble Baroness of is that the vast majority of infections in care homes last year were through staff, not through discharge.

[Lord Balfe (Con)]

I think the question the public want the answer to is why so many people died in care homes. Will there be an inquiry which will try to get to the bottom of that simple fact?

[Lord Bethell (Con)]

My Lords, PHE has published a report on that. It calculates that around 1.6% of the deaths in care homes were directly attributable to discharge. That number is very sad, but it is a relatively low proportion. This will, of course, be a subject covered in the government inquiry that the Prime Minister has already announced.

[Lord Laming (CB) [V]]

My Lords, I feel sure that the Minister will agree that it was extraordinary that, when relatives were prevented from visiting their loved ones in residential care, and many of the residents could not understand why they had been abandoned, at that very time patients were being admitted from hospital without having been tested for this virus.

[Lord Bethell (Con)]

My Lords, I completely sympathise with the point on those in care homes receiving a very tough challenge when they have been prevented from seeing loved ones. We have had to take extremely severe infection control measures, many of which are still in place for the reasons that have been discussed in this Chamber before. But I challenge the noble Lord’s point on testing. We brought in testing when asymptomatic infection was recognised and when the capacity was available.

[Baroness Wheeler (Lab)]

My Lords, can the Minister explain why the Secretary of State continues to justify himself by quoting the seriously underestimated PHE January to October 2020 data assessment on hospital discharges to care homes of 286 Covid deaths? The National Care Forum of care providers has repeatedly made clear how fundamentally flawed and incredibly partial that data is. Only limited numbers of symptomatic patients in hospitals and care homes were tested, and cases not tested before death are not included. Even the chair of the House of Commons Science and Technology Committee has said that relying on this for a full picture of the situation is a stretch of the imagination. We owe it to the people who have died, their relatives and care home providers to have full, accurate and independent information. How is the Minister going to ensure that it is urgently provided, so that we can genuinely learn from what happened?

[Lord Bethell (Con)]

My Lords, I acknowledge the noble Baroness’s concerns, but the PHE report is extremely thorough. I am not aware of it being revised, but if it is, I would be glad to share that information with the noble Baroness.

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

My Lords, respected health commentators and statisticians say that excess deaths—that is, deaths above the expected number—is a more accurate way of looking at the scale of deaths in care homes due to Covid. Care home residents make up just 0.7% of the population. In the first wave of the pandemic, deaths in care homes accounted for 44% of all excess deaths for that period in England and Wales. What does the Minister think this says about the effectiveness of the so-called protective ring thrown around care homes and what lessons have been learned?

[Lord Bethell (Con)]

My Lords, we were never in any doubt from the very beginning that the virus presented a huge threat to care homes. They are where the elderly and the vulnerable are housed, in conditions where it is extremely difficult to enforce infection control and where there is a large amount of intimacy between residents and staff. We knew from the experience of other countries that care homes were very likely to be an area where infection and severe illness, and potentially death, would be highly prevalent. There is no doubt that care homes suffered the brunt of this virus, and for that matter I am extremely sad indeed. Noble Lords should realise that we put every measure in place that we humanly could have done. We gave a huge amount of resources, including £2.8 billion via the NHS specifically to support enhanced discharge processes and the implementation of the discharge to assess model.

[Baroness Altmann (Con)]

My Lords, I apologise to my noble friend for adding to the burden that he bears in answering this question. I know he cares deeply about this situation. However, it is important for lessons to be learned, so that we have no similar experience in future. The letter sent by the NHS to care homes on 15 April 2020 states:

“Where a test result is still awaited, the patient will be discharged … pending the result ... This new testing requirement must not hold up a timely discharge”.


I do not believe any of this was a deliberate attempt to infect care homes, but I do believe that care homes need infection control and that there was a lack of follow-up for patients who were discharged positive.

[Lord Bethell (Con)]

My Lords, I am grateful for the tone of the question, but its assumption is, I am afraid, quite wrong. Before April 2020, there was very little evidence and no scientific consensus whatever that asymptomatic transmission posed any risk. For example, the World Health Organization said on 2 April:

“to date, there has been no documented asymptomatic transmission.”

My noble friend may remember that differently. They were very difficult times, and we made decisions on very limited information. We made the best decisions we could have done under the circumstances.

[Lord Dubs (Lab) [V]]

My Lords, as late as March last year there was clear evidence coming from Italy about people dying in nursing and care homes there. Surely if we had been half-awake we would have realised that what was happening in Italy was a solemn warning to us, and we should have acted accordingly. Why did we not do so?

--- Later in debate ---

[Lord Bethell (Con)]

I saw the images the noble Lord refers to and was shocked and moved by them. That is why we moved massively, including, in March, announcing £594 million in order to support care homes, and massively supporting them through the NHS. We did an enormous amount from the beginning. The effects on care homes have been profound and are extremely sad, but I am afraid to say that this presumption that we either did not enough or took the wrong advice is not supported by the facts.

[Baroness Meacher (CB)]

My Lords, let us focus on what government can do now. My concern is that the Government are overcompensating for the very high early death rate in care homes, for whatever reason, by imposing wildly disproportionate controls over double-jabbed, tested visitors. For example, they have to wear PPE and social distance, as we know, and there is no hugging—thus wrecking the final months for these people in care homes. I ask again: will our excellent Minister—I mean that; he is an excellent Minister—put to the Prime Minister the risks and benefits of scrapping these controls?

[Lord Bethell (Con)]

My Lords, I am extremely sympathetic to the noble Baroness’s point and conscious of her specific point that we could be in danger of over- reaching or in some way emotionally overcompensating for perceived mistakes in the past. We are conscious of that possibility, but I would like to reassure the noble Baroness that it is not the case. The decisions we have made on infection control and on visiting in care homes are tough—they are hard—but in recent weeks there have been outbreaks in care homes in London and Bolton in which vaccinated residents have caught the disease and had serious symptoms. That is something we are extremely wary of. When the vaccination has reached a higher proportion of the population and R is below 1, we will be in a position to change these policies. We will do so at pace and as quickly as we reasonably can, but until that moment arrives we have to take these tough decisions.

[The Lord Speaker (Lord McFall of Alcluith)]

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