Covid-19: Poverty

Lord Bethell Excerpts

Thursday 27th May 2021 Lords Chamber

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

My Lords, the facts are heartbreaking. Covid, like many diseases, has hit hardest those who are most vulnerable: the poorest, the most disabled and those who work in some of the most difficult jobs. The vaccine rollout and community testing programmes have shown what the country can do, but there is much more to be done. That is why we are publishing a levelling-up White Paper, and health inequalities will be central to that.

[The Lord Bishop of Blackburn]

My Lords, I am grateful to the Minister for his reply and the work that he and colleagues are doing in a fast-changing scene. We know that it is not easy. Does he agree that care for the poorest, most disadvantaged and most vulnerable in the community is one of the signs of a healthy society? Can he be more specific about how equality of opportunity in the levelling-up agenda will be rolled out?

[Lord Bethell (Con)]

My Lords, I can certainly speak for the inequalities we have in health. The right reverend Prelate is entirely right—Covid has been a real reminder of the impact of deprivation and inequality on the population. Those who are disabled are two-and-a-half times more likely to have had some form of life issue with Covid. In terms of deprivation, mortality in the most-deprived neighbourhoods was more than double the rate than in less-deprived neighbourhoods. Those facts are chilling. They are a wake-up call, and we will be working through our levelling-up agenda.

[Baroness Lister of Burtersett (Lab)]

My Lords, as the latest Marmot review made clear, damaging and heartbreaking levels of inequality and poverty, especially child and family poverty, weakened our resilience in the face of Covid. Apart from getting people into paid work, which increasingly is failing to protect from poverty, what is the Government’s anti-poverty strategy?

[Lord Bethell (Con)]

My Lords, I can speak for the health dimension. I should emphasise the work of the office for health promotion. Under the Chief Medical Officer, the OHP will deliver proactive, predictive and personalised preventive strategies. We believe that there is a huge opportunity off the back of Covid to really change the health inequalities of the country, and that is what the OHP will be devoted to doing.

[Baroness Stuart of Edgbaston (Non-Afl) [V]]

My Lords, levelling up is a UK-wide ambition and priority; health and public health are devolved responsibilities. Will the Minister undertake to take a good look at how the various parts of the United Kingdom have dealt with problems that they have faced? For example, Wales appears at the moment to be far more successful in rolling out vaccination than England, Scotland and Northern Ireland. We should not be too proud to learn from each other in order to overcome some of the deep inequalities that have developed over the past years.

[Lord Bethell (Con)]

My Lords, the vaccine race is being contested right across the country, and I take my hats off to all those who are delivering the programme so effectively. We are not too proud to learn from each other. In fact, I pay tribute to, for instance, those in Scotland who have programmes around alcohol and drug use, which are pioneering on a worldwide level. We have to work on this all together, and we will absolutely use the best case studies to apply the best programmes on a countrywide basis.

[Lord Balfe (Con)]

My Lords, I draw attention to my position as a fellow of the Royal Statistical Society. There is an old adage that correlation does not necessarily indicate causation. While it is easy to talk about levels of poverty, there are other factors such as lifestyle and ethnicity, and there will be a need for some multiple regression when studying the consequences. When the committees are inevitably set up to look at the causes and how to deal with those matters, will the Minister make it a priority that a good, well-qualified statistician is included among the members of any committee that is set up?

[Lord Bethell (Con)]

My Lords, I hear my noble friend’s warning very clearly and he is absolutely right. We must not be confused between statistical correlation and causation. However, one thing that has become clear is that in Covid personal health status, particularly obesity, has been a driver of severe illness and mortality. The environments in which people live and work have been a driver of infection. Those two are probably inescapable conclusions and will be central to our levelling-up agenda.

[Baroness Merron (Lab)]

The pandemic has brutally exposed the health inequalities that ran deep in our society even before Covid-19, and it is certainly welcome that the White Paper acknowledges that. However, even the best efforts of an integrated care system can only go so far in preventing ill health. Forthcoming legislation needs to be underpinned by national policy measures and funding to tackle overarching determinants of health. With that in mind, will the Minister comment on why the Queen’s Speech did not contain improved funding for public health, given the Government’s professed commitment to levelling up and building back better?

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right that it cannot be for either the law or the Department of Health to solve a national challenge. That is why the Prime Minister has committed to appointing a cross-ministerial board. It needs the co-ordination and focus of many different departments that handle health, social welfare and the culture of the country to tackle these tricky, long-standing and difficult challenges.

[Baroness Fox of Buckley (Non-Afl)]

Could the Minister add the levelling-up agenda to the arguments for not delaying opening up on 21 June? Overcaution at this stage would be particularly devastating for ordinary working people. Even if the cost-benefit analysis is post hoc, I ask the Minister to start looking now at the health impacts of lockdown, not Covid as such, on the less well off. The health impacts of being confined in overcrowded houses, no gardens for kids and worries about job security are likely to have taken their toll, and we need to learn from what has happened.

[Lord Bethell (Con)]

My Lords, it is a difficult fact that males working in low-skilled elementary occupations, such as security guards, had rates of death more than three times higher than the general population. That illustrates that often those in the most difficult jobs face the greatest threat of infection. The best thing we can do for the economy is to get rid of this virus, for which we need vaccination and testing, and that is the Government’s focus.

[Lord Patel (CB) [V]]

My Lords, following the effects of Covid-19, restoring the nation to good health will require a new social compact, backed by a national cross-departmental health inequality strategy. I am pleased to hear the Minister say that the reduction of health inequality will be in the health Bill, but could he confirm that the legislation will include commitments from other departments and the Government?

[Lord Bethell (Con)]

My Lords, we have provisions for tackling obesity in the health and social care Bill, as the noble Lord knows, but the focus of the cross-ministerial board on health will be to bring together government efforts on not just obesity, but health inequality in the round. The board’s remit has not yet been published, nor has its membership or chairmanship, but I reassure noble Lords that that is coming reasonably soon.

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

So we have to wait for a cross-ministerial board; that will really make a difference. Overall, the Government’s record has been appalling. Improvements in life expectancy, which had been rising steadily since the 1950s, stalled in 2010 when the Conservatives were elected and throughout the subsequent decade. What is more, according to the King’s Fund, real government spending on public health has fallen by 15% in the last six years. That is not new, so why do we have to wait for the so-called levelling-up White Paper and this cross-ministerial thingy? Why can the noble Lord’s department not get on with boosting public health locally, rather than reshuffling the deckchairs nationally by abolishing Public Health England and diluting that focus?

[Lord Bethell (Con)]

I feel inspired by the noble Lord’s passion for the subject, but it is not fair or reasonable to suggest that death rates in the country are driven by the electoral cycle. Far from it—this Government have been extremely committed to the obesity strategy, not least because of the personal story of the Prime Minister. We have not abolished Public Health England; we have redefined it as two organisations, UKHSA and the OHP. The impact of those will be profound.

[Lord Bird (CB)]

Is the Minister aware of the social mobility pledge, which is trying to remove impediments to people applying for highly skilled jobs so that they do not follow the route that their families may have followed into underpaid jobs, where they remain in poverty for ever? I would very much like him to look at this. I support the pledge and many hundreds of businesses are following that example and removing these impediments.

[Lord Bethell (Con)]

The noble Lord speaks movingly about this important issue and social mobility is itself a massive issue for the country. It does not fall directly within the remit of the Department of Health, but the NHS itself can be an enlightened employer in this respect. Many families have seen great advances in their personal development there, and I hope that it has a spirit of meritocracy and opportunity. I would be glad to write to the noble Lord to share with him the kinds of initiatives designed to increase social mobility that there are within the NHS.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, all supplementary questions have been asked.

Covid-19: Variant B.1.617.2

Lord Bethell Excerpts

Wednesday 26th May 2021 Lords Chamber

[Lord Watson of Invergowrie]

To ask Her Majesty’s Government when they will publish data on the spread of the Covid-19 variant B.1.617.2, first identified in India, in schools in this country.

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

My Lords, I pay tribute to the contribution of teachers, pupils and parents in the battle against infections in schools. By the application of hygienic measures, distancing and asymptomatic testing, the spread of the virus has to date been limited. We are very vigilant—we are looking at recent upticks in infection, we react swiftly to outbreaks and we have published variant data twice a week. But we continue to work on ways of having more detailed, setting-specific analysis.

[Lord Watson of Invergowrie (Lab)]

My Lords, the DfE has just published the latest school attendance figures, which showed that the number of pupils in schools in England who had been shown to have Covid-19 had soared by some 33% in the space of a week. Those are national figures, so the increase would have been even greater in the eight hotspot areas. That surely shows the need for the Government to publish the latest data on a local government area basis to ensure that schools have the proper mitigation measures in place for their locality. The second wave of Covid caused immense disruption to children’s education. To ensure there is no repeat of that, will the Government enable secondary schools to carry out lateral flow tests on all pupils in the week following half-term in the hotspot areas?

[Lord Bethell (Con)]

My Lords, there is an enormous amount of data published. I draw the noble Lord’s attention to table 6 in the table test conducted on 28 May 2020, which has an enormous amount of weekly collection data for schools. In that week, 1,967,904 LFTs were taken by schools, and they yielded 1,806 positive results. Those were all examples of where we have cut the chains of transmission. Tests are delivered through a variety of channels, including the community testing channel. Reports on infections in schools are analysed by the tracing programme, and they are then taken through to PHE and JCB. We are looking at ways in which we can aggregate all that schools data into more specific tables. But until we do that, there is already a very large amount of data.

[Baroness Warwick of Undercliffe (Lab) [V]]

My Lords, my noble friend has pointed out that cases are substantially concentrated in school-aged children and young adults, who of course have not yet been vaccinated. Does the Minister agree that it was premature to announce last week that face coverings will no longer be required in secondary school classrooms and communal areas? Does he accept that this policy could drive an increase in infections in our unvaccinated children and young people, as well as in school staff, families and wider communities?

[Lord Bethell (Con)]

I share the noble Baroness’s concern, but I can reassure her on a couple of things. It is, I think, a real tribute to the hard work of parents, teachers and the pupils themselves that the infection rates in schools have been relatively contained, and certainly have not shown the same kinds of behaviours that they did in September of last year. But we remain extremely vigilant, for exactly the reasons the noble Baroness explained. On the question of face coverings, it is a very difficult balance to strike—they are intrusive and disruptive but, on the other hand, they are an effective way of minimising infection. It is an area that we keep a very close watch on.

[Baroness Brinton (LD) [V]]

My Lords, the delayed publication of official Public Health England Covid variant data, which was slipped out during the Eurovision Song Contest results, is bad enough, but can the Minister say whether the Secretary of State for Education has the power to remove official PHE data on cases in schools? If so, what were his grounds for that removal?

[Lord Bethell (Con)]

I really bridle at the suggestion that we run our data publication programme on the basis of the Eurovision Song Contest schedule. That really is not a credible suggestion. There is an issue with positivity rates for some of this data because not every test is registered, and, as a result, it is difficult to draw conclusions about exactly what proportion of tests have become positive. It is for that reason that we are careful about how we present some of the data, and that is behind some of the decisions that have been made about which tables to publish.

[Baroness Blower (Lab)]

My Lords, Deepti Gurdasani, of Queen Mary University, is quoted as saying:

“We know from media reports there are many outbreaks of the so-called ‘India variant’ in schools but there’s no systematic data. In Bolton … it looks like schools are contributing to the rapid spread of the virus”.


She concludes that, in a public health emergency, it is crucial that Public Health England has the public’s trust. Can the Minister say how appearing to censor scientific reports and removing mitigations, such as the wearing of masks in schools, can create and sustain that trust?

[Lord Bethell (Con)]

My Lords, I do not quite recognise the world the noble Baroness describes. In fact, I would say that the work between Public Health England, schools, local authorities and local infection teams has never been stronger, and it has proved to be extremely effective. The noble Baroness is right that schools are often a source of infection, and we remember well what happened in September. In areas such as Bolton, we are very careful to ensure that infection measures are put in place. I do not accept that there is an issue of trust.

[Baroness Masham of Ilton (CB) [V]]

My Lords, are people who have not been vaccinated and who are diabetic being warned about the dangers of the deadly mucormycosis, the black fungus, which is associated with the Indian variant—and now there is a white fungus also? Is the Minister aware that antifungal medication for the treatment of these conditions has run out in India? Can the UK help? There are many children who are diabetic.

[Lord Bethell (Con)]

I have read reports about the fungus the noble Baroness describes, and they are absolutely chilling and a source of grave concern. I am not aware of that being a threat to British public health; I feel sure that Public Health England is watching it extremely carefully. I take note of the noble Baroness’s point about medicine being in short supply. I will be glad to look into it more closely and write to her with more details.

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

Do Ministers accept that more patient choice would help in dealing with problems over spread due to vaccine hesitancy? Having in mind data on vaccine hesitancy in the case of the AstraZeneca vaccine, when will we have a decision on the authorisation of vaccines of a different brand to deal with vaccine brand hesitancy?

[Lord Bethell (Con)]

That has not been the feedback from the public in the round. There are significant issues around the supply of vaccine, and we very much take an approach of getting the vaccine out of the warehouse and into the arms of the public in as speedy a manner as we possibly can. We are not aware of a huge amount of brand prejudice among the public, and that is entirely right, because all the vaccines are effective: that is the view of the MHRA, the JCVI and the British public.

[Lord Hussain (LD)]

My Lords, the latest data published by the Government show that the Indian variant was detected in 151 local authorities in the week ending 15 May, an 18% weekly increase, with 37 areas reporting the variant for the first time. What urgent action are the Government taking in all 151 areas and their neighbours to get on top of this surge in cases?

[Lord Bethell (Con)]

The noble Lord is entirely right, and I am grateful that he has looked at the dashboard as carefully as he clearly has done and drunk deeply from the rich array of data that we have available there. On a more serious point, there are some significant outbreaks—they are listed very clearly on the PHE dashboard—where we have put in place significant outbreak management procedures, including surge vaccination, surge testing and additional communication with the community. But the noble Lord is right that the Indian variant is proving to be extremely competitive with the Kent variant, and we should expect that to start to spread around the country.

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

My Lords, can the noble Lord update the House on the potential vaccination of secondary school children?

[Lord Bethell (Con)]

I am afraid I do not have a specific update for the noble Lord. It is an area that we will be extremely interested in looking at, but there are regulatory processes to be gone through at the MHRA and vaccine policy procedures to be gone through at the JCVI. They will both be looking at that. At the moment, our focus is on getting the vaccine into as many arms as we possibly can, particularly among the high priority groups, but we will turn to that at some point in the future.

[The Lord Speaker (Lord McFall of Alcluith)]

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

Covid-19

Lord Bethell Excerpts

Wednesday 26th May 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, we can probably all agree that the Minister has drawn the short straw today—and not for the first time, I think.

The issue I want to raise on this Question is that the Government took powers in the road map legislation to impose local lockdowns, so I ask the Minister: are any discussions taking place about whether those powers will be activated in those areas? Secondly, we know that a single dose of the vaccine is less effective against this particular variant, so I repeat the question asked earlier: what plans are there to increase vaccination in the areas most affected by the spread of the Covid variant B16172? Will the Government produce a plan with the local directors of public health to roll out the vaccines to everybody in those areas, and consider including bringing forward a second dose for a larger cohort of people?

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

My Lords, the noble Baroness asks two very pertinent questions which slightly answer themselves, in a way—but let me try to update the House on our plans in that area. She is right that we have powers on local lockdowns, but that is not the focus of our thinking at the moment. Local lockdowns are an important tool, but not one that we think is a priority right at this moment. We are focused on the vaccines. It is beyond doubt that this Indian 2 variant particularly hits those who are not properly vaccinated—and by “properly” I mean “have had two doses and two weeks”. Those who have forgone either their first or second dose are particularly vulnerable, and you have only to look at the infection data and, particularly, the hospitalisation data to understand that.

That is why we have rolled out surge vaccination in those areas. What that means is a huge amount of communication, a huge amount of engagement with the communities and the presence of various mobile vaccination units sent directly into the heart of the communities to provide different channels and mediums by which people can step up for their vaccine. The response has been extremely strong and I am touched, as I have said, by the videos of people in some of those communities, particularly in Bolton, where people have queued up for their vaccines. I pay tribute to the DPHs and local authorities that have facilitated that programme.

[Baroness Brinton (LD) [V]]

I echo the gratitude of the noble Baroness, Lady Thornton, to the Minister for his stamina this morning. Can he say whether each of the 121 local authority areas reporting cases of Covid variant B16172 are being given specific extra resources for mass surge test, trace and isolate and arrangements for surge vaccination on top of their planned allocation for this financial year? Can he say when the pilots for extra help with self-isolation will conclude? When would any likely rollout of a proper approach to supporting those who have to self-isolate, including paying their wages, start?

[Lord Bethell (Con)]

My Lords, the noble Baroness alludes to a dilemma that we face. It is not possible to organise surge testing and have pinpoint outbreak management in 120 different areas. That is just too many and our resources do not stretch to that. Many of the outbreaks are substantial clusters. Sorry—let me phrase that better. There is a small number of very substantial clusters in the towns and cities of which noble Lords will be aware. That is where we are focusing the surge testing and surge vaccination. In the other areas, we are working with DPHs to ensure that they know the best way to target the particular behaviours of the India 2. That means that it has very high transmissibility, which requires an extremely quick reaction to school and workplace outbreaks, and within specific communities. That kind of briefing and guidance has been channelled through the Chief Medical Officer’s department and the kinds of infrastructure that I described in my answers to previous questions. The response has been extremely strong and I hope we are making some impact on the spread of the India virus, but we remain extremely vigilant.

[Baroness Hollins (CB)]

My Lords, my question is about the implementation of quarantine regulations. How many travellers have been required to repeat the 10 days required in a designated quarantine hotel for a second 10-day period, with or without a positive Covid test? What appeal arrangements are in place because public guidance does not mention any? Is there any risk of exploitation?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I must admit that I am not aware of a large number of people having to repeat their 10-day isolation, so let me look into that and I should be glad to write to the noble Baroness.

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

My Lords, in the light of the extraordinary personal vendetta that Dominic Cummings is pursuing against the Health Secretary and the Prime Minister, is it not obvious that the Government must now bring forward the official inquiry into the handling of the pandemic promised by the Government so that the public do not have to rely on a partial, self-serving account, fortified by hindsight?

[Lord Bethell (Con)]

I am extremely grateful for my noble friend’s remarks. The inquiry will, as he says, provide an important moment to look at the lessons that we can learn from the response to the pandemic. The Prime Minister has given extremely clear reasons why the timetable is as he described and we should stick to the timetable that he has suggested.

[Baroness Donaghy (Lab) [V]]

My Lords, I understand the Minister saying that he is focusing on the vaccines and surge testing. I even understand his reply to the noble Baroness, Lady Brinton, that one cannot have surge testing in 120 areas. However, I want to go back to the Bedford issue. Despite the director of health, the mayor and the local MP spending nearly a fortnight saying that the Indian variant was just as bad in Bedford as it was in Bolton, the surge testing took place days later. What weight is given to the advice from the local directors of health? There seems to be an imbalance here because it is the Government’s decision rather than that of the local directors. Can the Minister assure us that there is not a change in policy on this? He stated:

“We are … looking to see how we can communicate more effectively with local authorities”.


Actually, the local authorities are communicating effectively with the Minister. Has there been a change of emphasis on this?

[Lord Bethell (Con)]

Let me assure the noble Baroness that there has absolutely not been a change of policy at all. There are clear channels of communication from DPHs and local authorities to the contain secretariat at NHS Test and Trace, which can mobilise the community testing resources. I am not aware of there being a large glitch in the provision of resources to Bedford but I should be happy to look into it, given that it has been mentioned by two noble Lords. I should be glad to write to her to see whether there is anything that we should be improving specifically for the city of Bedford.

[Lord Loomba (CB) [V]]

My Lords, is the Minister aware of the desperate need for second vaccine doses in Nepal? While the majority of the most vulnerable old people have had their first doses, the suspension of exports from India means that they now cannot get second doses and time is running out. Will the UK offer doses to rectify that situation?

[Lord Bethell (Con)]

My Lords, the noble Lord points out an extremely challenging situation, particularly in Nepal, but, frankly, all around the world there is a global pressure on the supply of the vaccine. Britain has contributed enormously to that through COVAX, our financial support and the AstraZeneca vaccine, whereby nearly half a billion vaccines worldwide have been run through the profit-free AstraZeneca process. However, we are aware of the situation in Nepal. My noble friend Lord Lancaster spoke movingly in his debate on the matter in this Chamber and we take note of the particular needs of that country.

[The Deputy Speaker (Lord Russell of Liverpool) (CB)]

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

COVID-19 Variant: Travel Guidance for Local Authorities

Lord Bethell Excerpts

Wednesday 26th May 2021 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government what plans they have to ensure local authorities are informed of new travel guidance on areas where the COVID-19 variant B.1.617.2, first identified in India, is spreading.

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

My Lords, we are always looking to see how we can communicate more effectively with local authorities. We will have discussions with local authority colleagues this week to make sure that everyone is clear what the expectations are and how we can improve communications going forward.

[Baroness Thornton (Lab)]

My Lords, to paraphrase Matt Lucas as the Prime Minister: “Don’t go to work—go to work. If you can stay indoors, go outside. Don’t go outside—go on public transport. Don’t go to work and then—something or other will happen.” It would be laughable if it were not so serious. I have two questions for the Minister. The amended guidance asks people to minimise travel into and out of the eight hotspot areas. The previous version asked them to avoid all non-essential travel. What is the difference between those two things or is it like the amber countries—you can go there but you should not? If the Government want people to heed their advice, guidance or instructions, why were the notices posted on a website during the night without consultation or accompanying dissemination to people and organisations such as public health, councils and mayors? That does not seem the most effective way to communicate with people.

[Lord Bethell (Con)]

My Lords, the characterisation presented by the noble Baroness is unfair. We are trusting people to be responsible and to act with caution and common sense, as they have done throughout this pandemic, and to make decisions on how best to protect themselves and their loved ones. We are seeking to avoid bringing these measures into law and instead are using guidance. The communication of that guidance could have been done better but we are working extremely hard with regional partnership teams, Public Health England, local authorities, JBC colleagues and the incident management teams to ensure that these communications are done in the most effective way possible.

[Baroness Brinton (LD) [V]]

I declare my interest as a vice-president of the Local Government Association. Earlier, on the “Today” programme, Grant Shapps said that it was down to local authorities to disseminate the new travel guidance to their citizens, but local authorities reported that they had not been told about it. Do the Government expect them to develop telepathic skills? What does that say for the way government truly operates as a partner with our councils, directors of public health and local resilience forums, which are dealing brilliantly with this new, rapidly transmissible Covid variant? Are they getting extra resources to cope with the extra burdens on them?

[Lord Bethell (Con)]

No, the noble Baroness will be relieved to know that we are not relying on telepathy. Instead we have regional partnership teams, which include Public Health England regional directors, and Contain and JBC colleagues, working together with local authorities, and these meet on a three-times-a-week basis at the regional team updates. Attendees can include government departments, including the MHCLG, the DfE, particularly REACT, and the No. 10 Cabinet Office task force. It is through this kind of extremely regular and intense collaboration between all the different parties working on this extremely complex pandemic response that we share data, provide guidance and ensure that the communications are done to the best of our ability.

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

I declare an interest as a resident of Bedford borough. Bedford has repeatedly been let down by the failure of government to share information. It did not get information on test results on cases that tested positive with the Indian variant returning through airports, and now there is this communication failure, which it found out about only when the Manchester press phoned it up to tell it that it was on the website. It has been starved of the Pfizer vaccine and now denied the additional boots on the ground that it needs to deal with the crisis, which apparently have all been sent to the red-wall authorities. What ill will do the Government have for Bedford and what is the Minister doing to sort out the important relationship with key local authorities without imposing top-down lockdowns, either clandestinely or publicly?

[Lord Bethell (Con)]

My Lords, I am conscious of having been asked questions about the vaccine, testing and lockdowns in Bedford before. However, I absolutely reassure the noble Baroness that we approach all areas on an absolutely equitable basis, and in fact I pay tribute to the people of Bedford and the local authorities there for their energetic response to this pandemic. We are working extremely hard with all local authorities to give them the effective powers and resources to deal with the pandemic on a local basis. That means that national co-ordination comes second to local implementation and that these communications are sometimes extremely complex. We should not be surprised if sometimes there are differences between how different areas implement those communications.

[Lord Balfe (Con)]

My Lords, is it not time for the department to stop formulating rules that are neither enforced nor obeyed? Instead, if it wants to publish lists, could it not consider publishing a list of the growing waiting lists for treatments for cancer, heart problems and the many other things which are growing out of all proportion to the amount of effort put into constantly talking about Covid?

[Lord Bethell (Con)]

My Lords, my noble friend makes an extremely pertinent point but the two things are inextricably linked. We can get back and address the backlog of operations to which he quite rightly alludes only if we are not fighting the pandemic and if our wards are not full of Covid victims. Only through the right kind of guidance, testing, the vaccine and the behaviours of the public can we contain this virulent virus, a new strain of which has arrived on our shores, and if we do not, our hospitals will be overwhelmed and we will not be able to address the backlog.

[The Lord Bishop of Blackburn]

My Lords, I declare an interest as resident in the area of Blackburn. After the advice last Friday, I was unsure whether I would be entitled to travel to London for duty this week and allowed to return if I did. There might have been people in both places who would have been equally delighted. There is real uncertainty, disquiet and disappointment at the unclear and mixed messages that have been received, especially among communities that are struggling with very high rates of infection. The point is not so much about information being given but about consultation. What will the Minister do to make sure that this debacle does not happen again and that, to hear the local voice, there will be proper consultation with directors of public health, not just information?

[Lord Bethell (Con)]

My Lords, as I sought to explain to the noble Baroness, Lady Brinton, there is a huge amount of consultation with directors of public health. There are meetings on these matters on a daily basis through the chief medical officer, the silver/gold process and the local outbreak teams. However, the right reverend Prelate refers to a serious issue. We are seeking to avoid the kind of legal lockdowns that the public are quite understandably exhausted by and naturally quite resistant to. Therefore our message to the public is that we are asking them to behave in a responsible fashion, to act with caution and to use their common sense, as he had to in his decision about whether to come to London. We are not seeking to legislate on that, and we are asking people to make those decisions for themselves. I completely sympathise with those who find that challenging and who in some cases would prefer to have some certainty. However, that is what people have asked for and it is the right approach to keep the British public on side during this difficult period.

[Baroness Pinnock (LD) [V]]

My Lords, I refer the House to my relevant interests. I live in Kirklees, one of the affected areas. Yesterday, the new guidance on the Government’s website said, “Avoid meeting inside”. Today, the amended site says, “Meet outside where possible”. Perhaps the Minister can help me. Does it mean that, in Kirklees and elsewhere, pubs, cafés and restaurants must turn customers away from service inside? The Minister has just said, “We must use common sense”. Does that mean that council meetings must be held virtually, not face-to-face, which is what the other part of the Government now demand?

[Lord Bethell (Con)]

My Lords, the noble Baroness has given some very good examples of exactly where we are asking the public, and legislatures, to use their common sense. We are saying, “Avoid meeting inside”, but we are not closing the pubs. We also say, “Avoid smoking”, but we do not ban smoking.

[Noble Lords]

Oh!

[Lord Bethell (Con)]

We have not banned smoking; lots of smoking is going on among the British public.

This is where the public have a role to play. They have agency, they are able to make their own decisions and they can make the sensible distinction between meeting inside when they could be meeting outside and making unavoidable decisions of the kind the noble Baroness alluded to.

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

I will have a go now. The latest advice to people in these areas is to minimise travel and use their common sense. If a family have booked a trip away for the weekend, how would the Minister advise them?

[Lord Bethell (Con)]

My Lords, I would ask them to use their common sense. I am a parliamentarian; I am not telling them or legislating for them on that particular decision. They can see the rising infection rates around them, they know for themselves how this disease spreads and we are asking them to make a sensible, reasonable, common-sense decision about whether that journey is necessary. That is not something we are legislating for, it is what we are putting in guidelines, and I think that that, at this stage of the pandemic, is a reasonable response.

[Baroness Bennett of Manor Castle (GP)]

My Lords, given the long, arduous months of confinement suffered by the city of Leicester, compounded by the confusion caused by the apparent secret lockdown, and then the recognition that the city of Leicester should not have been included on the list, according to the figures—that arose as a result of a faulty calculation—can the Minister explain how the error came to be made in the case of the city of Leicester and how it will be avoided in future?

[Lord Bethell (Con)]

My Lords, guidance for people in Bolton and Blackburn with Darwen was published on Friday 14 May. It was then extended on 21 May to Bedford, Burnley, Hounslow, Leicester and North Tyneside. That guidance has now been fine-tuned, in response to feedback from the local directors of public health and, as the noble Baroness will know, the website has been updated. The chronology of that is relatively straightforward. It could have been done better—that I have made plain to the noble Baroness, Lady Thornton—and we are with working directors of public health, local authorities and others to ensure that we get smoother systems for that kind of thing.

[Baroness Merron (Lab)]

My Lords, I share a lot of the concern in the House about the confusion that has been sown. I am somewhat shocked that the Government did not work closely with those who are dealing with Covid in the affected areas, who are at the sharp end: the mayors, public health officials and councils. They are the local experts, and I implore the Minister to work closely with them. Does he accept that what is really needed in the affected areas now is isolation support, enhanced contact tracing and the rollout of vaccine for everybody?

[Lord Bethell (Con)]

My Lords, I completely object to the false premise of the question. I cannot tell you how hard we are working in collaboration with local authorities, directors of public health and the incredible rhythm of regional partnership teams, regional team updates and the huge amount of data and interaction between all parts of government. It is absolutely phenomenal, and the characterisation by the noble Baroness is just not right. Where I completely agree with her is that we are working as hard as we humanly can to get the vaccine out to everyone, we are doing absolutely all we can to spread testing to all areas where there are outbreaks and we are working extremely hard to improve all those systems.

[Baroness Fox of Buckley (Non-Afl)]

Does the noble Lord agree that in one regard, government communication has been brilliantly successful? In Laura Dodsworth’s new book, A State of Fear, she exposes how the nudge unit, behavioural scientists and SPI-B weaponise fear. She quotes the statement:

“The perceived level of personal threat needs to be increased among those who are complacent, using hard-hitting emotional messaging.”


I genuinely want to know: can the Minister explain why the Government are so adept at deploying huge resources to communicate scary messages but seem so inept in communicating the trust and common-sense messaging he has just explained here but did not manage to explain to local people, which is why they are so confused?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I did read that book, and it was based on the premise that the public cannot be trusted and the public cannot make decisions for themselves. That is not the Government’s view.

[The Deputy Speaker (Lord Russell of Liverpool) (CB)]

My Lords, all supplementary questions have been asked.

Heathrow Airport: Border Control Passenger Safety

Lord Bethell Excerpts

Tuesday 25th May 2021 Lords Chamber

[Baroness Randerson]

To ask Her Majesty’s Government what steps they intend to take to improve the safety of passengers queuing at border control points at Heathrow airport.

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

My Lords, Heathrow Airport has extensive measures to ensure the safety and well-being of passengers and we have been working closely with it, Border Force and others to facilitate as smooth and safe a journey as possible for all passengers. In addition, Heathrow will shortly begin a trial in which direct flights from red list countries arrive into a dedicated terminal, helping to focus operational capacity and reduce mixing between passengers from red, amber, and green list countries.

[Baroness Randerson (LD)]

My Lords, there have been three-hour queues at Heathrow with passengers crammed together, yet aviation is flying at only 15% of its capacity and Border Force says that it is working at full strength. This is the latest in a catalogue of errors by the Government in their border policy. Can the Minister tell us why the Government did not properly ensure that passengers were separated out at Heathrow from the start? When will they have the additional fully trained Border Force staff to provide a safe and efficient service?

[Lord Bethell (Con)]

My Lords, I also saw the images circulating last week of queues at Heathrow Airport, and I agree with the noble Baroness that we do not want to see a repeat of those kinds of scenes. However, I do not agree with her analysis. The Managed Quarantine Service has worked extremely well, and I pay tribute to Border Force for its contribution—we have more Border Force staff working today than we did during the 2012 Olympics. It does, unavoidably, take between five and 10 minutes for Border Force personnel to process each passenger; that is an unavoidable bureaucratic burden, but we have taken the necessary steps to ensure safe travel and minimise the circulation of mixed passengers within the terminals.

[Lord Rogan (UUP)]

My Lords, widespread concerns have been raised by travellers arriving at Heathrow, but clearly there are many other border control points in this country. That being the case, can the Minister give a commitment to urgently share the lessons that are being learned at Heathrow with airport authorities in Belfast and Londonderry? As we begin to welcome family, friends and tourists back to Northern Ireland, after the most testing of periods for the Province’s travel and tourism sectors, there is real concern that our relatively low infection rates could take a turn for the worse if common sense and procedures are not followed in all terminals. As the United Kingdom, we simply cannot afford to get this wrong.

[Lord Bethell (Con)]

My Lords, I completely and utterly acknowledge the concerns expressed by the noble Lord and by communities who live proximately to regional airports. As we look to the opening up of more airports, we are enthusiastically and energetically engaged with those communities. I reassure the noble Lord that the systems that we have in place around both red and amber quarantine have extremely tight restrictions on them, and there is no evidence of leakage into the local communities. We are doing our best to communicate that fact to those who are concerned.

[Baroness Altmann (Con)]

My Lords, Heathrow deserves credit for a number of the measures that it has been taking: dedicated channels for red-list arrivals, trialling a separate terminal for arrivals, and escorting people to separate areas. Would my noble friend agree that, if red-list arrivals are required to wait longer than others, there is justification for that? I hope that my noble friend will not consider stopping the opening up of further travel opportunities because of concerns about the spread of new variants in a population that has been so extensively vaccinated already.

[Lord Bethell (Con)]

My Lords, I join my noble friend in paying tribute to Heathrow, which has worked extremely hard, in a collaborative spirit, with the very difficult, challenging and often fast-changing border and quarantine arrangements. As she quite rightly says, its commitment to the red-list terminal pilot is extremely encouraging. However, I am afraid that I cannot give her the reassurance that she seeks on our mission to ensure that variants of concern that might have an impact on the vaccine will not be diligently and ruthlessly excluded from the country. It is our duty to protect the vaccine, and we will take whatever steps are necessary to do that.

[Lord Houghton of Richmond (CB)]

I draw the House’s attention to my relevant interests in the register. It seems to me that the current pandemic will pass but the future threat will not: mass air travel will return and, with it, so will the risk that, once again, it will become the principal vector by which a localised epidemic could become a global pandemic. Therefore, I ask the Minister: what action are the Government taking to find suitable technological solutions that provide early detection of airborne pathogens within aircraft in transit in order to then take measures to avoid the risk of mass cross-contamination in airport terminals? Who in government is the focal point for such activity?

[Lord Bethell (Con)]

My Lords, the noble Lord is right: this is a 21st-century problem that we may well be living with for the rest of our lives. It is absolutely right that we look at the best and latest technology to try to mitigate risk and reduce the impact on the things that we love doing, including global travel. However, the image that he cited is a little far away at the moment, I am afraid: we are struggling to get accurate tests from a gob of spit, let alone from the air in an airport cabin. However, we are meeting with the firms who are investigating these kinds of technologies; that is done through the innovations and partnerships department of test and trace, and we are hopeful that those technologies will emerge.

[Lord Blunkett (Lab)]

My Lords, I draw attention to my interests in the register. It is very welcome that red-list passengers will now be separated, but, the longer the queues, the more likely the infection is to spread. It cannot be right to take 10 minutes per passenger to clear them through the system. Surely we can use the kind of evidence that is being used in other parts of the world, get our act together and, with the help of this excellent Minister and the noble Baroness, Lady Williams, put pressure on the Health Secretary and the Home Secretary to put even more resource in, and, above all, use technology and the experience in the rest of the world to get this right.

[Lord Bethell (Con)]

The noble Lord is entirely right: this is exactly what we have sought to do—namely, to front-end a huge amount of the administrative burden into the passenger landing form through the CMS computer system so that all the bookings, details and testing are pre-prepared before anyone arrives in the terminal. None the less, travel in the days of a pandemic is a complicated affair. Some people are trying to skip out on their responsibilities, and therefore there is an administrative burden. We hope to roll out e-gates for both the amber and red lists, once the red-list terminals are open. This will take a great pressure off the passenger point.

[Baroness Brinton (LD) [V]]

My Lords, how many of the passengers who flew in from India between 2 April and 23 April have now tested positive for Covid? If the Minister does not have the data to hand, please could he write to me with it? Given the guidance—slipped out by Ministers last week—for Hounslow residents to stay at home because of the Indian variant, what advice are the Government giving to all workers at Heathrow, whether they are from Hounslow or not, to keep them safe from Covid?

[Lord Bethell (Con)]

I do not have the statistic that the noble Baroness asked for, but I would be glad to write to her with it. The surge testing and vaccination in areas of VOC outbreak are now in many communities up and down the country that are not correlated with the presence of airports. They are distinct and specific to each of those communities: we work with the local DPH to ensure that the local outbreak plan is tailored to the needs of that community.

[Baroness Nicholson of Winterbourne (Con)]

Can the Minister reassure his noble colleagues that sufficient attention is being paid by the already overworked Heathrow staff to heavily disabled passengers, such as Dr Ros Sinclair, who is a post-polio victim, with all that that implies? Although there is now a distinction between red and amber, highly vulnerable people will none the less suffer if amber lists and disabled passengers are merged. Is there any possibility of entirely separate lanes for those who are disabled?

[Lord Bethell (Con)]

My Lords, I pay tribute to the officials, Heathrow and the carriers for the provisions that they have put in place for those who have exceptional needs for travel. It is a truth that many people travel for health needs, and many must travel in order to address difficult circumstances that they may have. Therefore, it is entirely right that we put in place a system of exemptions and support for those who are either elderly or have some form of disability. My noble friend is entirely right that it is an unfortunate consequence of the administrative burden of red and amber processing at our ports that there are serious delays, and they fall most heavily on the vulnerable.

[The Lord Speaker (Lord McFall of Alcluith)]

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

Covid-19 Internal Review

Lord Bethell Excerpts

Thursday 20th May 2021 Lords Chamber

[Baroness Merron]

To ask Her Majesty’s Government whether they will publish their internal review of the handling of the COVID-19 pandemic.

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

My Lords, I start by welcoming the noble Baroness, Lady Merron, to the Bench; I am very much looking forward to working with her in the months ahead. The Prime Minister confirmed on 12 May that a public inquiry will be established on a statutory basis to consider the Covid-19 pandemic, including the Government’s handling of it. I can confirm that while DHSC officials carried out a routine internal ways-of-working review, this was absolutely for the purpose of providing advice to Ministers only.

[Baroness Merron (Lab)]

My Lords, the National Audit Office report published yesterday both highlighted the need for the Government to learn lessons at speed and advocated greater transparency. Publishing an already completed internal review of the Government’s handling of the Covid-19 crisis would support a plan to contain the threat of new variants, and I urge the Government to do so. I am interested to know whether the Minister can come to agree with me on this. With experts, including SAGE, warning that it is very much in the balance as to whether further restrictions will be lifted in June, given the dramatic rise in Indian Covid-19 variant cases, will the Government learn the lessons and urgently review travel and quarantine arrangements?

[Lord Bethell (Con)]

My Lords, I absolutely agree with the noble Baroness that we are at a pivotal moment in the pandemic; matters are on a knife-edge. There is so much good news about the effect of the vaccine that we should celebrate, but there is enormous jeopardy in the threat posed by variants. That is why we are very much focused on dealing with the pandemic before us. The inquiry promised by the Prime Minister is for spring next year, and until then we will continue to be focused on today’s pandemic.

[Lord Scriven (LD)]

My Lords, Professor Andrew Hayward, a member of SAGE, this morning said that he thinks we are now at the start of the third wave and that more generalised measures will be needed. As an adviser to government is saying that we need to act and plan now, what generalised measures are the Government planning and when will they be announced, so that people and businesses do not have just 24 hours to plan?

[Lord Bethell (Con)]

My Lords, we are enormously grateful for the advice of SAGE, which, as the noble Lord will know, is a very large collection of scientists, many of whom have many different views. The JBC takes their advice into account, and we are absolutely monitoring the situation as closely as we possibly can. We celebrate the transparency with which the very large amount of surveillance data is handled and published for public analysis. Measures are in place on testing, therapeutics and social distancing, but the number one measure is the vaccine. The rollout of the vaccine is what will give this country the protection it needs.

[Lord Robathan (Con)]

My Lords, I reiterate my congratulations to the Government and all those involved in the fantastic success of the vaccine development and rollout programme. This inquiry does not need to be long and drawn out. Will my noble friend confirm that it will look into the accuracy of—and contradictory nature of some of—the scientific advice received over the last year, the appalling scaremongering of some of the media, the validity of political decisions such as lockdowns, and whether the government reaction to the pandemic, and the reaction overall, has been proportionate?

[Lord Bethell (Con)]

My Lords, the Prime Minister promised on 12 May that there will be a statutory inquiry beginning in spring 2022, as my noble friend alluded to. Its chair and terms of reference will be announced before spring 2022, and it will be for the terms of reference and the chair to determine exactly what subjects are looked at.

[Baroness Andrews (Lab) [V]]

My Lords, I ask the Minister to return to the first Question asked by my noble friend—she asked two—which he overlooked. Does the Minister agree that publishing the internal review could strengthen the strategic plan to contain new variants? Does he agree with me that it would certainly raise public trust and that, because of the inordinate delay until next year in starting the public inquiry, it surely makes sense? Even if this is not a public-facing review, it is of such public interest that he should publish the internal review.

[Lord Bethell (Con)]

My Lords, as I said before, there was an internal ways-of-working review into the department’s early response to the pandemic, way before the threat of variants was on the horizon. None the less, it is our commitment to focus on the pandemic and the threat presented to us by its future evolution. That is why we are focused on today’s measures. We will leave reflection on the past to the inquiry.

[Lord Balfe (Con)]

Does the Minister see that we will keep on having variants of this virus and, to an extent, will have to learn to live with it? I am sure people would be much happier if we were to downscale the amount of advice that we get from a variety of often dubious sources. The sooner we can publish an inquiry into it, the better. We must recognise that the Government faced an enormous challenge. Overall, they have come out of it pretty well, and we should not carp.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I am enormously grateful to my noble friend for his comments. I know he has been a vocal critic of some things, and I take his comments in very good measure. On his point on guidance, this is not how the public have presented things to us. They want clear, easy-to-understand guidance. We have learned the importance of publishing in many languages and now regularly publish in 10 spoken languages. The public are in fact hungry for detailed guidance, which is why we have published more than 400 pieces of guidance on GOV.UK, covering everything from funerals, care homes and schools right through to smokers, vapers, houseboat dwellers and singing with children. That is because the public would like to have this kind of advice and recommendation.

[Lord Flight (Con)]

My Lords, I congratulate the noble Lord, Lord Bethell, on how professionally he handles his responsibilities in the Lords. I am sure he will support the Prime Minister’s announcement that a full inquiry will be held next year, beginning in the spring, which will place the state’s actions under the microscope. The existing internal lessons-learned review was an informal exercise, not a public-facing work, which I believe will not be published. It would be wrong to publish it. While there have inevitably been some mistakes, I congratulate the Government and the noble Lord, Lord Bethell, on having got Covid-19 vaccinations moving significantly faster than the EU. I hope he will exceed the speed limit even more.

[Lord Bethell (Con)]

I am enormously grateful for my noble friend’s kind comments. On his point on vaccines, I emphasise the enormous contribution of the whole union behind the vaccine project. It has been a union project to deploy vaccines to every person in the UK at amazing speed and with consistency right across all parts of the union. For that we should be enormously grateful.

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

My Lords, while we all here respect that health is a devolved responsibility, does the Minister not agree with me that one of the problems that arose was the confusion arising from different rules in different parts of the United Kingdom and different messages throughout the United Kingdom? In the inquiry, will the United Kingdom Government talk with the devolved Administrations to make sure that, in future, there is a more co-ordinated response? The virus knows no boundaries.

[Lord Bethell (Con)]

My Lords, the Prime Minister will define the terms of reference and the chair will define how the inquiry deports itself. On the noble Lord’s point about the rules and the suggestion of confusion, I agree that there was a lot of heat and smoke around differences but the truth is that 99% of everything that we did between the different parts of the union was exactly the same. There was a lot of focus on very small differences, but what I celebrate is how much common ground there was in our responses.

[Baroness Altmann (Con)]

My Lords, I echo the congratulations to my noble friend on his dedication to his role, and I welcome the noble Baroness opposite to her position. I join other colleagues in congratulating the Government on their successful rollout of the vaccine, which, from what we can see so far, deals with the variants that have arisen and allows us to open our country back up again after the extraordinary efforts that have been made in connection with the vaccine. In connection with any review, will there be an urgent announcement of an investigation into the way that social care was handled, particularly at the beginning of this, for those people who are so reliant on home care or care homes for their very survival?

[Lord Bethell (Con)]

My Lords, I do not think I need to speculate on this matter; of course social care will form part of the inquiry. It has been an incredibly important part of our response, and we have come a long way in the last 14 or 15 months. I pay tribute to all the people who work in social care, and their leadership, who have done an enormous amount to protect those who live in social care or are supported by it. We as a country have learned a huge amount about how to protect those who are vulnerable and those who are elderly. I also pay enormous tribute to the public, who have made huge sacrifices to protect and save the lives of those who live in social care.

[Baroness Uddin (Non-Afl)]

My Lords, I welcome the noble Baroness, Lady Merron, to her position and look forward to hearing from her. I too pay tribute to the Minister and the Government, including my friend in the other place, Nadhim Zahawi, who has led this very effectively. It is so pleasing to see the uptake of vaccines in all parts of our countries and communities. While we are not privy to any internal findings of the report, does the Minister accept that any current or future review must address the detrimental economic impact on women, people with disabilities and those communities of minority heritage that suffered significant loss of life in the early days? Will such a report also therefore consider whether the lessons of the first wave were learned, and unnecessary deaths and infections subsequently prevented?

[Lord Bethell (Con)]

My Lords, it is not for me to define exactly what the scope of the inquiry will be but the noble Baroness’s points are extremely well made. I emphasise the importance of women. We are in the midst of consultation on the women’s health strategy. It is proving to be an incredibly impactful process and events are being held almost daily. I encourage all noble Lords to submit evidence to the health strategy on any issues that they feel strongly about. This could be a really impactful turning point in the way in which the health of women in this country is massively improved.

[Lord Dobbs (Con)]

Does my noble friend agree that publishing an internal review right now would do nothing less than risking a dodgy dossier, of the sort we have seen before which shed far more confusion than light? Does he not think that the most important use of time right now would be in getting to grips with the anti-vaxxers who are spreading vicious lies, so that we can get on with vaccinating as many people as possible and bringing this country together as quickly as possible?

[Lord Bethell (Con)]

I am extremely grateful to my noble friend for his comments. He is entirely right. The battle against anti-vaxxers has been very successful. We have used a spirit of dialogue with people who have very personal and legitimate questions about a vaccine that requires an injection of fluids into their body. People quite reasonably have detailed questions about its impact. I applaud officials and partners of the Government who have been so effective at conveying the message on the safety and efficacy of the vaccine. It really has demonstrated the power of government and NHS communications at their best.

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

My Lords, I join the chorus of welcome to the noble Baroness, Lady Merron, who referred, as have other Peers, to the National Audit Office report on the handling of the pandemic. Commenting on that, Gareth Davies, the head of the NAO, stressed the need to “learn lessons at speed”. The Minister has often expressed how useful and informative he has found the contributions in your Lordships’ House. Would those contributions not be better informed if Members could absorb and reflect on the findings of the internal review as the country and the world continue to deal with what is, certainly on the global level, a raging and deeply dangerous pandemic?

[Lord Bethell (Con)]

I am enormously grateful to the NAO for the powerful report that it has published. It said many complimentary things about the Government’s handling of the pandemic. I am grateful to noble Lords for the counsel and challenge that they have given here in this Chamber. I point out the vast amount of data and information that we have published, which is at the disposal of the public and parliamentarians. However, confidential advice from officials to Ministers on a means-of-working review is not the kind of thing that I think adds to this sort of debate, and for that reason it is most appropriately kept confidential.

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

My Lords, this morning on BBC News there has been a suggestion that the Indian variant has been due in large part to ineffective track and trace. Would the Minister like to comment on that?

[Lord Bethell (Con)]

My Lords, I do not think that is correct. The noble Baroness is right to ask the question because we should always challenge our systems, but track and trace has really delivered for the country when it comes to the containment of the variants. We were extremely concerned about the Manaus variant. That was why we instigated Project Eagle, an intense application of testing in communities on a very large scale and forensic tracing, putting huge resources into tracking down the movements of those who tested positive with a VOC. We then had the South African variant, which has been successfully contained. We could not have imagined that an Indian VOC of this kind could make its way into this country with such high transmissibility, and I pay tribute to those working in track and trace who have bought us an enormous amount of time so that we can bring in surge testing and surge vaccination to contain and minimise the spread of this variant.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, all supplementary questions have been asked and answered.

Care Homes: Insurance Indemnity

Lord Bethell Excerpts

Wednesday 19th May 2021 Lords Chamber

[Baroness Tyler of Enfield]

To ask Her Majesty’s Government what assessment they have made of the merits of underwriting insurance indemnity for all care homes on an equivalent basis to the National Health Service.

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

My Lords, the differing indemnity and insurance arrangements for the NHS and for care homes reflect the different systems of securing health and adult social care. For the NHS, there are established indemnity schemes, administered by NHS Resolution. In the care sector, providers purchase insurance from commercial insurance markets. This is a requirement of registration with the Care Quality Commission.

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

My Lords, due to Covid, many care homes have found insurance prohibitively expensive, hard or even impossible to find, and that which is available often not covering Covid. Yesterday, I spoke to a care home manager who was told that renewing his existing insurance would cost 880% more than the previous year, and just one Covid claim could result in the care home having to close its doors, causing great distress and disruption to residents and their families. Against this backdrop, can the Minister say what plans the Government have to extend indemnity to all care homes for a reasonable period, not simply the small number now covered as part of the designated care site schemes, to put them on an equal footing with the NHS and ensure that they are able to help the NHS during any third wave? Will the Minister agree to meet me to discuss the options?

[Lord Bethell (Con)]

My Lords, I acknowledge the challenge faced by care homes on the insurance market, but CQC statistics suggest that, in fact, the insurance industry has done an enormous amount to meet the needs of care homes and that many of the pressures on care homes have been the result of Covid outbreaks. We have brought in the designated settings indemnity support, as the noble Baroness knows, and we have given £6 billion to local authorities to support care homes. Putting care homes on the same footing as the NHS would not meet the needs of the care home sector, so that is not something we are looking at currently.

[Baroness Wheeler (Lab)]

My Lords, the Financial Times warned in January that care homes were having to turn away new patients as they struggled and failed to get liability insurance to cover Covid-related claims. There is also huge speculation that a flood of claims is coming as pre-existing claims management companies and many set up purely to deal with Covid-19 cases are vying for business for personal injury claims and compensation for the loss of a loved one. What assessment has the Minister made of the risk that Covid-related litigation poses to the sustainability of the whole social care sector?

[Lord Bethell (Con)]

My Lords, in the year from March 2020, the number of patients has in fact increased from 457,000 to 458,000. The CQC is monitoring the situation extremely closely and its data from the insurance industry suggests that, although there has been some pressure on some companies, there have also been new entrants and the amount of support available to the social care sector is resilient.

[Lord Laming (CB) [V]]

The Minister has a very good understanding that many of the residents in residential care homes are unable, because of their condition, to comprehend the significance of the coronavirus. At this stage in their lives, when they are at their most vulnerable, many have felt that they have been abandoned and are now unloved. Can the Minister tell the House, if the insurance indemnity is not acceptable, what other possibilities are being considered by the Government so as to ensure that the awful experiences of some residents in the past year will never be repeated?

[Lord Bethell (Con)]

My Lords, the noble Lord speaks movingly of the plight of many people in care and I agree with his sentiment—it has been a very difficult year indeed—but we cannot blame the insurance industry for the pressures that have been put on residents. On the specific point about residents receiving visitors, which has, I think, been attributed to problems with insurance, I remind the noble Lord that 82.5% of care homes in England are now able to accommodate residents, compared with 40% at the beginning of March—a very large increase.

[Baroness Walmsley (LD) [V]]

My Lords, the Minister will be aware that the financial viability of many homes has become precarious during the pandemic. What mechanism is in place to monitor the level of premiums and any homes in danger of closing because of this problem? What contingency measures are in place to care for the residents who might lose their homes as a consequence?

[Lord Bethell (Con)]

My Lords, in terms of monitoring, Care Quality Commission data indicates that pressures are being felt by the insurance industry, but these are not translating into reduced capacity, service closures or quality concerns. There is, in fact, a growth in the number of home care agencies since March 2020; for instance, in the east Midlands, there has been a growth in capacity of 9.4%. These are reassuring figures and we are monitoring the situation extremely closely.

[Baroness Greengross (CB) [V]]

My Lords, there are still many inconsistencies between the NHS and social care. Specifically, will the Government ensure that there is a level playing field between the two in terms of insurance and indemnity?

[Lord Bethell (Con)]

My Lords, I do not need to remind the noble Baroness that there are profound inconsistencies between the NHS and social care. They are organised completely differently, and the insurance arrangements reflect that. The noble Baroness is right that we are looking for parity of outcome between the two. That is very much our commitment and this is one area in which we are striving to achieve that.

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

Many care homes felt that they were thrown under a bus early in the pandemic when, without adequate personal protection equipment in place, the Government transferred infected but untested hospital patients into homes and many otherwise healthy residents were lost through no fault of the homes. As future pandemics may happen, is it not a matter of fairness that care homes and hospices should have their indemnity insurance underwritten in the same way as the NHS does?

[Lord Bethell (Con)]

The noble Lord is right to point to provisions for the future and for future pandemics—or any future waves. I reassure him that arrangements are in place to ensure the safe transition of patients and residents from the NHS to care home and back again, but that is not a reason to turn the insurance arrangements of the care home industry on their head. Care homes simply cannot have the kind of risk-pooling arrangements that suit major NHS institutions.

[Baroness Wheatcroft (CB)]

My Lords, huge numbers of care homes are very dangerously financially leveraged, having been bought by private equity over the last decade, when at least £1.7 billion was ploughed into these purchases. Interest payments are heavy and insurance payments going up will add to their burden. Can the Minister assure us that before local authorities pay these privately owned, leveraged care homes, the CQC or some organisation will examine the financial stability of individual homes?

[Lord Bethell (Con)]

My Lords, the financial stability of the care home sector is, as the noble Baroness rightly pointed out, something that we monitor extremely closely. There will, of course, always been new entrants and new departures from such a rich and varied sector. That is not something to be regretted; it brings innovation and new opportunities to the sector. She is right that the potential increase in insurance payments is something that we need to factor in to the finance. That is why we have brought in the designated settlement support scheme and increased the support from local authorities for social care.

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

My Lords, are there any estimates of how many care homes have gone under because of financial difficulties? How many have been closed down?

[Lord Bethell (Con)]

My Lords, I do not have the precise number at my fingertips, but I can reassure the noble Lord that the proportion that has gone under in the last year is not dramatically higher than in previous years. We monitor the situation extremely closely. I am aware of the concerns of noble Lords about the financial position of the social care industry and we are taking very careful measures to ensure that we are on top of the financial monitoring situation.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, all supplementary questions have been asked and we now come to the second Oral Question.

Covid-19 Update

Lord Bethell Excerpts

Tuesday 18th May 2021 Lords Chamber

[Lord Scriven (LD)]

My Lords, I too thank the Minister for coming before the House to deal with this Statement, and also for his work ethic in dealing with Covid-19 over the last 14 months.

From these Benches, we have always said that we will support whatever is proportionate and follows evidence to keep people safe. The more that you delve into the Government’s reason for not including India on the red list at the same time as Pakistan and Bangladesh, the more it feels like a big ball of candyfloss that initially seems tempting but disintegrates on touch. Yesterday, both the Minister and the Secretary of State said that India was not put on the red list at the same time as Pakistan and Bangladesh because of the positivity rate.

Looking at the figures for the two weeks before Bangladesh and Pakistan were put on the red list, the positivity rate for India was 5.1%. For Pakistan, it was slightly higher at 6.2%, yet for Bangladesh it was lower, at 3.7%. The same data—the Government’s test and trace data—shows that in the same two-week period, 50% of all new variants entering the UK, including those of concern, were from India: the largest country by far. Therefore, variants of concern and positivity rates show India to be on a par with, or ahead of, Bangladesh and Pakistan. So what data were the Government actually using, if it was not their own test and trace data? Can the Minister place on the record that data and the raw data which made him, and the Secretary of State, say that India’s positivity rate was three times higher?

Another area of concern is people entering the UK being huddled together at the border with people entering from red-list countries. One needs only to look at the significant Twitter feeds from yesterday of people arriving from green or amber countries, who were spending up to four hours in queues to get over the UK border and having to stand next to and mingle with people entering from red-list countries. Heathrow and Manchester Airports were responding that, despite asking the Government for more border staff to deal with the issue, none had been forthcoming.

This was planned. We knew that international travel was allowed and the Government knew that the traffic-light system was being introduced, so why have the Government not carried out the wishes of the airport operators to ensure that more border staff and more guidance are available to segregate those entering from red-list countries? This is a clear public health crisis at our border, and the Government have not, to date, solved it. So, as a matter of urgency, when will this public health breach right at our borders be solved?

Finally, as variants of concern continue to enter the country and replicate at speed, “isolate, isolate, isolate” becomes vital. Yesterday, the Secretary of State in another place indicated to Munira Wilson MP that the Government were worried that isolation might not be as robust as required, and that some pilots were taking place. Can the Minister outline where they are, what the parameters of the pilots are and when the results will be made public? Also, overwhelming evidence now shows that people on lower salaries must be paid their full wages and given support to ensure that they can comply with full isolation requirements. Will the Government now look at this as a matter of urgency?

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

My Lords, I am enormously grateful for the very detailed and thorough questions from the noble Baroness and the noble Lord, and I am also appreciative of and touched by their kind comments.

The noble Baroness asked about the Indian variant and the uptake of the vaccines. I reassure her that we are doing absolutely everything that we can to ensure that there is a thorough uptake of the vaccine among all communities. She spoke touchingly about the feeling of blame associated with those in hospital who people hear have not taken the vaccine. I hear her comments, but there is no attribution of blame meant in this. It is a simple statement of fact that if you do not take the vaccine that is offered to you, or if you do not take two doses, and you then expose yourself to the virus, that is putting yourself in substantial danger, and it is a clinical observation that many of those who have ended up in hospital with severe disease are those who have not had the vaccine, even though they may have been offered it.

The noble Baroness asked about accessibility. She is entirely right that there are some people to whom we as a healthcare system have not made ourselves accessible enough. During this pandemic we have moved on from using the phrase “hard to reach” and we now think of it in terms of people who find us “hard to access”. She makes a perfectly reasonable observation in that respect, but I reassure her that we have absolutely bent over backwards to do everything we can to put the vaccine in front of all groups in the country, particularly those in areas such as Bolton, which we recognise have in the past been places where we have not got our message across.

I personally am hugely touched by the videos I have seen of people now queueing to have the vaccine. I applaud all community leaders and those who work with communities in Bolton, who have clearly mobilised a huge amount of public sentiment behind the vaccine programme. We are seeing a transformation in the penetration rates among some very important communities.

There is more that we can do. I am open to any suggestions from noble Lords on how we can do better, but I would like to reassure noble Lords that we have strained every sinew in trying to achieve vaccine equity across all groups in the country. That is true not only in Bolton but in Bedford, and I am disturbed to hear that people in Bedford feel they may have somehow been overlooked. I do not believe that is the view of the Vicky Head in Bedford, the DPH, and we have worked extremely closely with her. I assure the noble Baroness that cluster 2, linked to 12 cases in Bedford, was targeted immediately. An MTU went to the community on 8 May, and two community sites were opened up on 10 May. We have absolutely prioritised Bedford, as we have Sefton, Leicester, Nottingham and London—all areas where clusters have broken out. There is absolutely no question of prioritising one area over another. On the availability of the Pfizer vaccine in Bedford, that is news to me. I will be glad to look into that and to write to the noble Baroness accordingly.

On children, as noble Lords will be aware, this is an area in which some of the vaccine companies are making considerable progress in their clinical trials. None is categoric yet. It is too early to have agreed policy in this area, but the noble Baroness makes a very good point. Opening up the Covid vaccine, as we have with the flu vaccine, means that not only are children with some kind of vulnerability, particularly to long Covid, put into a safe place but that the transmissibility of that important age group can be reduced.

I am afraid we cannot know for certain the long-term effect of the vaccine until time has passed, but the CMO’s view is that the indications on the body’s immune system are extremely strong. At this moment it seems the vaccine is working, and our confidence is at a reasonably high point, but we remain vigilant. VoCs could emerge that either reduce the effectiveness of the vaccine or, for instance, effect some kind of decline in protection from the vaccine. That is why we have put in place contingent plans for boosters in the autumn. Those boosters might be of the existing suite of vaccines that are proving extremely effective. We are also looking for VoC vaccines that may be used to supplement the range of immune responses so that they cover any new mutations or variants that may emerge.

I cannot immediately recognise from the Bench the data the noble Lord, Lord Scriven, gave on the India VoCs. I wonder whether it was data that emerged after we made the decisions, because a lot of the sequencing data is retrospective; it takes between a week and 10 days to emerge from the Sanger Institute. That is one of the difficulties in making these decisions, which sometimes seem so clear-cut in retrospect. When you have the data available to you on the day, the decisions are not necessarily quite so apparent.

I do not really recognise the criticisms the noble Lord makes of the red list system. The red list system we have in the UK is an incredibly important shield and is proving extremely effective. Segregation is unbelievably difficult during travel. It is very difficult to segregate amber list and red list passengers on a plane, train or ferry. Within an airport it is very difficult to segregate people, because of the physical proximity. That is why travelling is dangerous, why we tell people not to travel and why, when people do travel, we tell them to isolate. Travelling is dangerous, and that is not news to us or to the people who get on those planes in the first place. The ultimate sanction here is that, particularly as we go into the summer, we tell people: travelling is not for this year. Please stay in this country.

On the isolation pilots the noble Lord referred to, we are running a large amount of work on pilots for isolation generally. If he would like to write to me about the particular pilots he was referring to, I will be glad to give him an update. I am afraid I am not quite clear at this stage which ones he is referring to.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, we now come to the 30 minutes allocated for Back-Bench questions. We do not have that many Back-Bench questioners, but it is still quite good discipline if people keep their questions and answers as brief and relevant as possible.

[Lord Popat (Con) [V]]

My Lords, I thank my noble friend the Minister for his repeat of the Statement. It is indeed welcome news for people and the economy that we are able to move to step 3 in our road map. However, as the Health Secretary said,

“we must be humble in the face of this virus.”—[Official Report, Commons, 17/5/21; col. 424.]

While the UK has had the highest vaccination enthusiasm in the world, does the Minister agree that it is deeply worrying that many people eligible for a vaccine, particularly among vulnerable age groups, have still not had one? This was seen in Bolton, where the majority of the 19 patients admitted to hospital with the new Indian variant, especially people from ethnic-minority communities, have not had a vaccine. What further support can the Government give to promote the better uptake of vaccines among ethnic minorities?

[Lord Bethell (Con)]

My Lords, my noble friend refers to humility and he is right: we have all had to develop a stronger sense of humility in the face of this awful virus and this dreadful pandemic. It has taught us that, despite all our 21st-century healthcare systems, we are all vulnerable to its awful effects. His words are absolutely spot on. I repeat the statistic that 69.4% of adults across the UK have had the vaccine, because the overall story of the vaccine rollout has been one of incredible participation by the British public. Not only have I never been involved in anything quite so successful in my life but there are very few national projects anywhere in the world that have been as successful. I really applaud all communities in every part of Britain for the way in which they have stepped up to the vaccine. My noble friend is right that there are some communities in which those levels are not as high as they should be. That has led to higher transmission among younger people, and in a few cases that has led to severe disease among older people who, frankly, should have taken their vaccine. I urge everyone to step up to their opportunity.

[Baroness Finlay of Llandaff (CB)]

As the Minister, who has worked tirelessly during Covid, knows only too well, an outbreak anywhere can become an outbreak everywhere. Can he tell us how the UK plans to increase vaccine distribution globally through COVAX to control the pandemic and decrease the risk of further variants arising in countries with high rates of infection, particularly as the risk of vaccine-resistant variants will remain high for at least a decade?

[Lord Bethell (Con)]

My Lords, the Tedros principle of us being safe only when we are all safe remains the most profound insight. The noble Baroness is entirely right: we must do more to try to help those in the developing world. The frustrating truth is that the world simply does not have enough capacity for the manufacture of these very complex and tricky substances. We are straining every sinew to try to deliver the 9 billion vaccines we need to deliver worldwide vaccination, but the rate of manufacturing is not as high as any of us would like. I take my hat off in particular to AstraZeneca, which has provided licences for the vaccine worldwide on a no-profit basis, but I also pay tribute to the other vaccine companies, which, despite what one might read in the press, are trying all they can to set up manufacturing sites all around the world. Progress is being made.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I too salute AstraZeneca for its noble efforts. However, I would like to take the Minister back to the SAGE meeting of 13 May, when the Government were warned:

“In the areas where numbers of infections are increasing rapidly … an even faster increase can be expected if measures are relaxed”.


The Government went ahead with relaxing the measures yesterday. I know that Mr Dominic Cummings can perhaps not be regarded as the most reliable of commentators, but was he not right to say that fast, hard and effective action is the best policy for the economy, as opposed to always delaying taking decisive action? When it comes to the next stage, can we be reassured that the decision will not be taken until the evidence in June is fully assessed and evaluated?

[Lord Bethell (Con)]

My Lords, I am a big supporter of the “fast and hard” principle. In our response in Bolton, Bedford, London and elsewhere, we have demonstrated that principle in our handling of the Indian variant. I point out that the use of testing and social distancing measures in schools has been enormously effective. One of the remarkable aspects of the infection rate so far is that transmission levels among school-aged children have not increased in the way that SAGE and others, including myself, once feared. We should take a “glass half-full” moment to applaud that fact. I reassure the noble Lord that we will absolutely make these decisions on the data. Space has been put in between the steps for exactly that reason, and we are not going to rush it.

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

My Lords, could the Minister outline the Government’s plans for test and trace as lockdown is lifted, particularly in areas such as Bolton and Bedford where surge testing is currently being deployed? With former centrally based Public Health England staff being disbanded and senior civil servants returning to their own posts, what financial resources are being passed to the local resilience teams, run by local directors of public health, to operate test and trace, which will be so critical to controlling the spread of the virus alongside the vaccine rollout?

[Lord Bethell (Con)]

My Lords, the outbreak in Bolton, Bedford, London and elsewhere has demonstrated, if that were needed, the paramount importance of keeping resources for test and trace at a critical level, and that is what we have done. Since the national infection rate is lower, there is a much greater emphasis on the kind of surge activity and outbreak management that the noble Baroness describes. Sequencing has proved to be an essential part of that process, and we have brought sequencing from the back of the laboratory to the front line of test and trace operation. Every single positive case is now treated as though it were a VOC, with the same amount of tracing and sequencing that a VOC would have had a few weeks ago. We have the full operation on standby. Should another wave of infections arrive, as it may well do with the relaxing of social distancing, we have the systems in place to be able to deal with it.

[Lord Lancaster of Kimbolton (Con)]

My Lords, I declare my interest as Deputy Colonel Commandant of the Brigade of Gurkhas. The Indian variant is spreading not just across the United Kingdom but across the north Indian plains and into Nepal, a country ill-equipped to deal with such a pandemic. Given the speed of response and support offered to India, I simply ask my noble friend whether the Government will respond positively to Nepal’s request for 2 million doses of vaccine.

[Lord Bethell (Con)]

I am grateful for the briefing on Nepal I had earlier from my noble friend. The scenes that we have seen in north-west India are heart-breaking. Nepal is such a good example of the kind of country that the global community needs to surround and support with vaccine technology that, frankly, is for G7-style countries to help to provide to developing countries. I take my noble friend’s point completely on board. I do not have immediately to hand the statistics about what Britain is doing for Nepal on the vaccine front, but I will be glad to write to him with any data that I can put together.

[Baroness Bull (CB)]

My Lords, I declare my interests as set out in the register. With the move to stage 3 of the road map, university students can now return to campus. Most of them are too young to have received vaccines so students around the country will form a significant cohort of young people undertaking regular and frequent testing as a matter of course. What consideration has been given to the benefits of sustaining PCR testing and sequencing at scale in universities as a way of rapidly identifying and understanding new variants? Will the Government consider providing funding to support that in future?

[Lord Bethell (Con)]

My Lords, I pay tribute to the vice-chancellors and to the universities and colleges of Britain for the way in which they have embraced campus testing. It has been a salutary lesson in what can be done, and it has helped to keep infection rates down on campuses where there has been a small number of returning students to date. That is done mainly through LFD testing. Positive tests then have a complementary PCR test, and the PCR test is automatically sequenced if it is positive. The combination of LFD, PCR and sequencing is the right one for keeping infection rates down, but we tweak the formula as and when best advice comes in.

[Lord Sikka (Lab) [V]]

My Lords, the pandemic has hit the low-paid and the poor the hardest. The Government need to commit to a road map to a better post-Covid society so I invite them to make two pledges. First, at the very least, they need to reduce the NHS waiting lists in England from the present 4.95 million to 2.5 million, which was the case in 2010. Will the Minister pledge to do exactly that by the end of this Parliament or even sooner? If not, why not? Secondly, the poorest 10% of households pay 47.6% of their income in direct and indirect taxes, compared with 33.5% for the richest 10% of households. This condemns millions of people to poor food, housing and health, which is a key reason for deaths during this pandemic. Will the Government pledge to eliminate that injustice by the end of this Parliament?

[Lord Bethell (Con)]

My Lords, I recognise some of the noble Lord’s insights. It is undoubtedly true that the low-paid and the poor have been hardest hit by Covid, both by the infection rates themselves and by the lockdown. That is a frustrating truth that is completely recognised and acknowledged by the Government. It is also true that the low-paid and the poor have health inequalities that have themselves made people more vulnerable to sickness, both from Covid and from the non-Covid diseases that have been exacerbated by limited access to some parts of the NHS. We are absolutely committed to reducing NHS waiting lists—that is an incredibly important part of the “build back better” mantra—but we need to do more to bring a degree of levelling up to all parts of society in order to address the symptoms that the noble Lord rightly describes.

[Baroness Uddin (Non-Afl)]

My Lords, I welcome the remarkable progress of the uptake of the vaccine in all communities, and I thank the Minister for coming to us with this Statement. However, I am sure he will understand that serious questions remain about the Government’s decision not to red-list being a direct cause of this dangerous Indian variant—I am sure that at some point the Government will have to answer fully to Parliament—and that it is not true, even as a clinical assessment, despite the media repeatedly and consistently suggesting this, that the uptake of vaccinations is the responsibility of certain communities. The Minister will appreciate the likely and even inevitable consequences of rising Islamophobia and hate crimes, as has been reported by Tell MAMA. What are the Government going to do to monitor and support local communities to ensure that they do not face such consequences? Also, echoing the noble Baroness, Lady Tyler, what plans and resources are in place to monitor and support compliance as we enter the next phase of the road map?

[Lord Bethell (Con)]

My Lords, I have to be honest with the noble Baroness: I am not sure it is helpful to try to connect healthcare policy decisions with a commentary on hate crime. The people who have not stepped up to the vaccine come from a very wide variety of communities; it is not one single community that has been singled out. We are talking about everyone from migrant workers in the apple yards of Herefordshire, to hard-working off-book sweat-shop labourers in east Leicestershire. In between there are people from many different communities who have not taken advantage of the vaccine opportunity. We are working really closely at NHS level to reassure community leaders and individuals concerned that the vaccine is safe and will provide protection. That is the right conversation to have.

[Lord Bradshaw (LD) [V]]

The bus industry has cleaned up its buses and introduced lots of ventilation, and people are wearing masks. Is there any hope that the amount of social distancing on buses will be reduced in the near future, because there is a lot of unused capacity?

[Lord Bethell (Con)]

My Lords, I pay tribute to the bus industry. Many noble Lords will remember those terrible stories at the beginning of the pandemic about bus drivers having an extremely high incidence of severe disease and even death. But the noble Lord should have hope as there is a really good reason why the buses will one day be full, and that is the vaccine. The vaccine gives us all hope that the kind of life we once had can be revisited, although we have to take some time to ensure that the vaccines are working as well as they should. We have to ensure that booster shots, if needed, are delivered. We have to ensure that the vaccine cuts through to all communities and that hygiene—the social distancing, handwashing and other personal hygiene disciplines which are going to be a long-term commitment by the entire nation—is truly imbedded in everyone’s habits.

[Baroness Verma (Con)]

My Lords, I thank my noble friend for the Statement repeat and congratulate him on the work he has been doing over the last many months. Does he agree that the public health messaging, which has been very good in all communities, should continue because we are going to get many other forms of variant? As the noble Baroness, Lady Finlay, says, this is going to be an ongoing issue, probably for a number of years, and continuous messaging will be key. Will he also tell me, given the recent new variant, what conversations he is having with counterparts from the countries concerned to see how that variant is reacting, what is happening there and whether it is reproducing rapidly or slowly, so that better informed decisions can be made in our own country?

[Lord Bethell (Con)]

My Lords, I am extremely grateful to my noble friend for her insight. She is entirely right; this awful pandemic does have a silver lining, which is that it can be an inflection point for a complete transformation in our public health messaging. The work we are doing on communicating the threat of the variants is one example of that. The next front line will be the flu jab rollout in the autumn, where take-up rates have been okay but not great. I hope that, when the flu jab campaign begins this autumn, a completely different generation and spread of people will step up to that opportunity. We are working extremely hard to use the public mood and sentiment behind preventive medicine to full effect to ensure that the flu jab works, that therefore a much smaller proportion of the population will transmit flu, and that deaths and severe disease from flu will be reduced. That can be the legacy of this awful pandemic.

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

My Lords, I welcome the vigilant focus described in this Statement that has been adopted by the Government, and that the response is being co-ordinated through the UK Health Security Agency. Could the Minister explain how England is working with the other three countries in the UK to ensure that a proactive approach is taken to the new virus variant, that the uptake of vaccines increases, that the monitoring of transmission continues, and to enable early intervention should the number of cases increase? In particular, what data are the Government collecting on the number of people in quarantine hotels testing positive for coronavirus and how many people have absconded from quarantine? Would the Government consider adopting a process similar to the electronic tagging undertaken in South Korea, to more accurately monitor the movement of people in and out of the country at its borders?

[Lord Bethell (Con)]

I am enormously grateful to the noble Baroness for that creative and thoughtful question. The good news is that the number of absconding residents from managed quarantine is minimal; it can be counted on one hand and many of them have been retrieved. The bad news is that the positivity rate in managed quarantine is far too high. I do not have the precise number in front of me and do not want to guess at it, but it is clearly true that far too many people are getting on planes when they are infected and far too many people are catching the disease on their travels. When we think of how to manage any vaccine-evading and highly transmissible variants, we have to look to the red list for secure protection for this country. She asked another question I cannot remember, but I will be glad to write to her about it.

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

I was genuinely excited to be able to attend a Saracens rugby match last night, and I notice from my noble friend’s Twitter feed that he too was out last night enjoying a thoroughly well-deserved visit to Sadler’s Wells. My sincere thanks go to all those who have made this step to normality possible, particularly my noble friend. However, like others, I have concerns about the entry arrangements at airports. While I fully understand the difficulties of segregation and that international travel should be strongly discouraged, does he agree that more should be done to prevent passengers arriving from red, amber and green countries mixing—particularly at airport border entry points with those from red countries, where, as he has just said, there is obviously a high degree of infection?

[Lord Bethell (Con)]

My Lords, I enjoyed the contemporary dance at Sadler’s Wells, which really lifted my heart, but I rather wish I had been at Saracens for that thumping victory and to see my favourite team doing so well after a difficult year. I very clearly hear the concerns of noble Lords about social mixing of amber and red route passengers at airports, and one reads about it in the papers. I reassure noble Lords that the amount of segregation in place in the airports is the focus of both Border Force and the Home Office. We are absolutely doing our best. We are looking at red list terminals, but the practicalities of that when there is a relatively low level of flights are very challenging indeed. I reiterate my point that if you are travelling you are putting yourself at risk, and there is no way we can pretend otherwise. If you are travelling, you should isolate yourself for a substantial amount of time when you touch down in the UK. This question of mingling in airports is, to some extent, a red herring.

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

My Lords, it is clear that the B16172 variant of SARS-CoV-2 is now established in the community, but that only highlights the need to keep out further variants of concern that will inevitably arise around the world as the coronavirus runs rampant. Following the question of the noble Baroness, Lady Watkins of Tavistock, can the Minister reassure me about the security arrangements in quarantine facilities given the number of cases of transmission in New Zealand and Australia, who have long practised quarantine? How often are staff being tested? Are they being paid in ways that mean they do not have to take other jobs, particularly jobs where they may have contact with large numbers of people? Are ventilation systems being checked regularly?

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right to cite the examples of Australia and New Zealand and the challenges they have had with staff manning managed quarantine facilities. I am extremely grateful to officials from both Australia and New Zealand for the very thorough briefings we had when we set up our managed quarantine facilities. We totally took on board their profound insight on that area and that was the number one thing they told us to get right. We focused on it, we have invested in it, and that has worked well to date.

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

My Lords, all questions have been asked and answered.

Health Protection (Coronavirus, Restrictions) (Steps and Local Authority Enforcement Powers) (England) (Amendment) Regulations 2021

Lord Bethell Excerpts

Tuesday 18th May 2021 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 9 April be approved.

Relevant documents: 52nd Report from the Secondary Legislation Scrutiny Committee, Session 2019-21, and 48th Report from the Joint Committee on Statutory Instruments, Session 2019-21 (special attention drawn to the instrument). Considered in Grand Committee on 17 May.

Motion agreed.

Osimertinib Cancer Treatment

Lord Bethell Excerpts

Tuesday 18th May 2021 Lords Chamber

[Lord Moylan]

To ask Her Majesty’s Government whether Osimertinib (Tagrisso), a cancer treatment drug recently approved by the Medical and Healthcare products Regulatory Agency, will be available to residents of Northern Ireland (1) on the same timescale, and (2) with the same ease of access, as in the rest of the United Kingdom.

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

My Lords, the innovative lung cancer drug Tagrisso has recently had its licence expanded to include patients with early-stage lung cancer through Project Orbis. I am pleased to confirm that Tagrisso is currently available to all patients, including in Northern Ireland, at clinical discretion with no delays. The UK Government are committed to supporting parity of access to medicines across all parts of the UK.

[Lord Moylan (Con)]

My Lords, people will be reassured to hear that but the fact of the matter is, surely, that the use of this drug for early treatment of lung cancer remains subject to the approval of the EMA and access at the moment is available on application by clinicians on an individual-case basis, which is not the same ease of access as exists in the rest of the UK. While it may be of some assurance that the EMA is expected to approve the drug’s use for early treatment in the near future, that remains wholly outside the Government’s control. What does that say about the integrity of our National Health Service and for how long can this situation go on?

[Lord Bethell (Con)]

My Lords, we estimate that there are currently just eight patients in Northern Ireland who would benefit from the expanded use of Tagrisso for early-stage disease. Perhaps I may reassure my noble friend that they will all have the same access as in the rest of the United Kingdom without any delay or restraint on that access.

[Baroness Thornton (Lab)]

My Lords, we should all wholeheartedly welcome the news of the agreement to enable early access to Osimertinib for early-stage lung cancer patients in England and I absolutely recognise that it is also available to patients in Northern Ireland. However, early diagnosis is as important as access to treatment. It is therefore deeply concerning that the number of people in England and, presumably, across the UK being seen by a specialist for suspected cancer, following urgent referral from their GP, has dropped dramatically. What steps are the Government taking to bring those waiting lists down? We certainly cannot wait for a reorganisation of the NHS, as proposed this year. Does the noble Lord acknowledge that reorganisations tend to have a chilling effect on the recovery of our NHS?

[Lord Bethell (Con)]

The noble Baroness is entirely right to be concerned about the backlog of oncological diagnostics. It is of grave concern to all of us. That is why the NHS has massively prioritised the tests she described. We are working extremely hard to get through the backlog. GPs are extremely focused on identifying those most at risk and those who are late for their tests are being followed up with great energy and endeavour. I pay tribute particularly to the role of NHS D, which is using the kind of data gains that we made during the pandemic to mobilise all the technology we can to get the right people into tests at the right time.

[Baroness Jolly (LD)]

I am really pleased that this drug can now be used as I understand that it is something of a wonder drug. That is good news. Are there any other drugs that might fall foul of the Northern Ireland protocol? Will the Minister update the House on the current problems in Northern Ireland with over-the-counter medicines such as Strepsils and others that appear to have fallen foul of the protocol?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I am not aware of a Strepsil shortage in Northern Ireland but I would be glad to write to the noble Baroness if I have any information.

[Lord Patel (CB) [V]]

My Lords, can the Minister confirm that the Northern Ireland protocol runs the risk of medicines not being available, that there will be divergence in the availability of medicines—and, importantly, medical devices—because the approval process might be different, and that the Government are due to report in six months on the effect of that divergence?

[Lord Bethell (Con)]

My Lords, we are watchful of the concerns to which the noble Lord refers but it is our hope and aspiration that there will not be the kind of delays or trouble that he explained. The Northern Ireland protocol means that Northern Ireland will stay aligned with EU rules, particularly for this kind of specific cancer medicine, but that does not mean that there need to be any delays. However, we are watching the situation carefully and the report that he described will give a full account of the problems, if there are any.

[Lord Lansley (Con)]

Can my noble friend, in this instance at least, explain the divergence between the MHRA and the European Medicines Agency? On 22 April, the EMA’s Committee for Medicinal Products for Human Use gave a positive opinion under an accelerated assessment, but the EMA has not yet given the new indication of marketing authorisation. What is the potential gap between MHRA authorisation and EMA authorisation?

[Lord Bethell (Con)]

My noble friend is, as ever, all over the detail. It is my understanding that the gap is a matter of weeks rather than there being any clinical divergence in assessment of the evidence. However, I am afraid to say that I would have to leave it to the EMA to think for itself on that.

[Lord Rogan (UUP)]

My Lords, the noble Baroness, Lady Thornton, rightly mentioned waiting lists. According to the most recent statistics, 9% of the population in England are on hospital waiting lists—the highest figure since records began in 2007. In Northern Ireland, the figure is 23% of the population, by far the highest proportion in the four home nations. The drug that we are discussing has been widely used in Northern Ireland to treat mid and late-stage lung cancer until now. Cancer patients in Northern Ireland now feel that they are being placed at greater risk than cancer patients elsewhere in the United Kingdom. Will the Minister confirm that the supply problems that Northern Ireland is facing would not exist if the United Kingdom Government had not agreed to the European Medicines Agency having jurisdiction in Northern Ireland?

[Lord Bethell (Con)]

My Lords, I do not agree with either the basis or detail of the noble Lord’s assertion. There is absolutely no delay or problem of access for this drug. He is entirely right to say that Tagrisso is currently offered to patients across the UK, including Northern Ireland, for mid and late-stage disease and it will now be offered to patients across the UK, including Northern Ireland, on exactly the same terms for early-stage disease.

[Lord Dodds of Duncairn (DUP)]

My Lords, Northern Ireland is subject to EU law when it comes to the single market for goods and medicines because there is a grace period until 31 December 2021. After that, say representatives of the pharmaceutical industry, the supply of 98% of medicines from Great Britain to Northern Ireland is at risk of being discontinued. That is a truly outrageous and scandalous situation. The effects are already being felt. Can the Minister confirm that the Government will take whatever steps are necessary in terms of the protocol to guarantee the continued supply of medicines to Northern Ireland from Great Britain without any further regulation being required?

[Lord Bethell (Con)]

My Lords, I have met with industry on this matter for the past 18 months. I am afraid that the message I get from it is not of the alarmist kind that the noble Lord described—quite the opposite. I pay tribute to the industry for its enormously collaborative sense of partnership and I really do not believe that there is any threat of the kind that the noble Lord described.

[Lord Bruce of Bennachie (LD) [V]]

Speaking from Aberdeenshire, I know that drug approval can differ between Scotland and England. Now that we have left the EU, is it not inevitable that there will be differences in drug approval and timings from time to time? What are the Government doing, having signed the agreement, to opt out of the EMA and negotiate an arrangement that minimises disruption but does not pretend that it cannot happen because that is what they signed up for?

[Lord Bethell (Con)]

My Lords, there will be an occasional moment when there are slight differences between the EMA and MHRA; we are not anticipating them to be huge and, in this case, we are anticipating them to be a matter of weeks while one approval does not quite overlap with another. The UK Government and the MHRA are working closely with the Northern Ireland Executive and all relevant stakeholders to ensure that the supply of medicines to all UK patients, including those in Northern Ireland, remains smooth, seamless and efficient.

[Lord Cormack (Con)]

My Lords, I thank my noble friend for his calm and reassuring Answer, but does he accept that the real problem is the one pointed to by the noble Baroness, Lady Thornton, namely, that of waiting lists? Can we perhaps devise some sort of Nightingale solution to bring forward and have people seen in a special place or special places? The real danger is that people will be diagnosed too late, and then, whatever the drugs, they will die.

[Lord Bethell (Con)]

I endorse my noble friend’s recommendations. He is entirely right that the old method of diagnostics, which relied a lot on patients attending diagnostic appointments in hospital, feels very out of date after the pandemic. I note the review on diagnostics by Professor Sir Mike Richards, which recommended community hubs, and has a huge amount of support within the NHS. We need to build up our diagnostic capability, bring it closer to where people live and make it more approachable so that people get early interventions.

[Baroness Hoey (Non-Afl)]

My Lords, I fear what seems to be a certain complacency in the Department of Health about what will happen in Northern Ireland from next January, when Brussels takes control of medicines coming into Northern Ireland. How can a Conservative and Unionist Party accept that our National Health Service will now be separated out, whatever the good will that my noble friend might express about making sure this does not happen?

[Lord Bethell (Con)]

My Lords, I reject the accusation of complacency. We have worked unbelievably hard with Northern Irish stakeholders, the pharmaceutical industry and EU colleagues to ensure the smooth running of the supply of medicines in Northern Ireland. The facts speak for themselves: so far, they have run extremely smoothly indeed. I reassure the noble Baroness that the UK Government are committed to parity of access to medicines across the UK, including Northern Ireland. Despite different approval routes, we have ensured that all patients have access to medicines at the same time, and we will maintain that commitment.

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

My Lords, will the Minister commit to meet the pharmaceutical industry, otherwise known as PAGB, which I met several weeks ago and which told me about problems that could ensue from 1 January next year in relation to the availability of over-the-counter medicines in Northern Ireland, due to the requirements of the protocol? Will the Minister undertake to meet this organisation to ensure that there are immediate discussions between the UK and the EU to resolve any ongoing difficulties and impediments?

[Lord Bethell (Con)]

I note the point made by the noble Baroness. As I mentioned in relation to the point made by the noble Baroness, Lady Jolly, on this issue, it is not one that I am not aware of, but I would be pleased to meet with the party she described in order to understand it better.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, all supplementary questions have been asked and indeed answered.