Covid-19 Vaccine Roll-out

Rachael Maskell Excerpts

Tuesday 8th December 2020 Commons Chamber

[Matt Hancock]

Some of the stories we have heard this morning have been really heart-warming, of people being able to have the confidence to do the things that in normal life we take for granted. I heard the story that my hon. Friend refers to and it was truly charming. I look forward to seeing the roll-out in Carshalton and Wallington, and then I look forward to building a new hospital in Sutton for his constituents.

[Rachael Maskell (York Central) (Lab/Co-op)]

Huge demands are being placed on our NHS staff and they are being asked to step up yet again today, so we thank them for all their efforts. Let me ask about one thing the Secretary of State could help with: instead of every vaccine being individually prescribed, he could issue a patient group directive. Is that in his plan? Will he be doing it?

Childhood Cancers: Research

Rachael Maskell Excerpts

Monday 7th December 2020 Westminster Hall

[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Mundell. I thank all hon. Members for the way they have spoken so movingly. I put on the record my thanks to Chris Copland, from my constituency, who helped me prepare for the debate, and to all the petitioners, who obviously signed the petition wanting to see real change in the life chances of children.

Grace did not lose her battle with cancer. The truth is that Grace’s battle was lost before she was even given a chance to fight. The battle was lost by the lack of research into the No. 1 medical cause of death of children in the UK: childhood cancer. I was struck by the words of Dr Jen Kelly, who told me of her little girl, Grace, and how she died in her arms, just four and a quarter years old, of a rhabdoid tumour. I am grateful to her for sharing the story of her little girl, Grace, with me. She continues to fundraise and champion the cause of all children.

Every year, 1,900 children receive the devastating news that they have cancer. Parents have to equip themselves to deal with that, often without the information that they need at that time being readily available. For Grace’s family, the time was too short, and they were simply told to do research on the internet. They have used the legacy of Grace to turn that around for other parents.

Just two weeks ago, many of us spoke in this place about the opportunity to extend research in certain medical areas. The Association of Medical Research Charities called on the Government to establish a life sciences-charity partnership fund. I listened intently to the Chancellor’s statement and was sorry that no announcement was made. Cancer Research UK alone has had to cut its research budget by £44 million this year due to covid. Charities have also lost £10 billion to date, and this year is not getting any easier for them. However, today marks the start of UK Charity Week, with its slogan, “What will you be doing?”. I put that question to the Minister, because this week again provides an opportunity for action. It is worth recalling that, for every £1 spent on childhood cancer, there is a potential £3 return, not to mention the human benefit that this brings.

There is an opportunity for us to go further. We trail behind our European counterparts in early diagnosis. A prime goal of at least catching up with all European countries would be a first step.

We also need to ensure that we are part of that global community of research, and that we play our role in leading that. Before the closure of talks with the EU, we need to make sure that opportunities to participate with other European countries are not diminished at this time but accelerated. There is hope on the horizon. There has been much discussion about Horizon research funding over the years. This new round, which is coming over the horizon, is very much related to cancer, and discussions are certainly taking place about the role it can play in advancing research into paediatric cancers. I trust that the Minister will tell us how she is participating in that debate in order to make what all of us have called for today a reality for the families who desperately need that help.

Coronavirus Vaccine

Rachael Maskell Excerpts

Wednesday 2nd December 2020 Commons Chamber

[Matt Hancock]

I enjoyed the conversations that I had with my hon. Friend on the approach to the Division Lobby. I can confirm that the answer to his question is yes.

[Rachael Maskell (York Central) (Lab/Co-op)]

I also congratulate the scientific community on their achievements today. But will the Secretary of State look with precision at the York model of delivering contact tracing? It has been a phenomenal story. Precision of contact tracing interviews has reduced the rate right down. They need the information on day one, not after 48 hours, which is being held back, but they also need to ensure that they get payment and support for people isolating. It works, so will the Secretary of State now follow that model?

[Matt Hancock]

We will not only follow the model; we will promote it. The link between the local authority and the national system in York has indeed had the effect that the hon. Member rightly describes, and the teamwork between the two has meant that the figures in York—I was looking at them this morning—are coming right down. I pay tribute to everybody in York. It is an example of the national and local systems working together. We have to get the case rates right down all the way across North Yorkshire—indeed, everywhere in Yorkshire—and I am sure that we can.

NHS Dentistry and Oral Health Inequalities

Rachael Maskell Excerpts

Wednesday 25th November 2020 Westminster Hall

[Judith Cummins]

The single most important thing that the Government can do is reform the dental health contract with a view to more prevention.

During the initial period of lockdown, between March and June, all routine dental care in England was paused and urgent dental care hubs were set up to provide emergency treatment to patients. That period of closure has clearly led to an enormous backlog of patients requiring treatment. The British Dental Association estimates that in April and May only about 2% of patients were able to access dental care, compared with last year, and that between March and October 19 million appointments were lost. One local Bradford dentist told me:

“Our phones are ringing hot with new patients who have no dentist access, which has certainly been made worse by this year’s lockdown. On top of this we are facing significant staffing pressures, due to increased triage requirements and the need to thoroughly clean the practice between patients.”

Just yesterday, I was contacted by one of my constituents who has been trying to get a dental appointment for five months and is living with gum disease and toothache. That is simply unacceptable.

[Rachael Maskell (York Central) (Lab/Co-op)]

I am grateful to my hon. Friend for securing this debate and for all her campaigning work on dentistry services. In York, it is really challenging to get registered with an NHS dentist, let alone access their services. One of the things that has exacerbated that during the pandemic is access to personal protective equipment for people who are overseeing our oral health. Does my hon. Friend believe, as I do, that oral health has not been seen as an equal partner in the provision of healthcare? We seriously have to address that, including access to PPE.

[Judith Cummins]

I certainly agree with my hon. Friend about access to PPE and the fact that dentistry is very much seen as the Cinderella service of the NHS.

Clearing the backlog will be a considerable challenge. Even in the best of circumstances it would take years, but unfortunately we are not in the best of circumstances. As people who have tried to get dental appointments since June know, dentists are operating with considerably reduced capacity. About 70% of practices are operating at less than half their pre-pandemic capacity. The primary reason for that is the requirement for a period of fallow time after each appointment to allow any aerosols that may have been produced by treatments such as drilling or even scale and polish to settle, and then for a long deep clean to take place. The fallow period can be for up to one hour.

In October, the number of NHS treatments carried out was a third the level of the year before. In the BDA’s members survey published earlier this month, 87% of dentists in England cited fallow time as a top barrier to increasing patient access. That could be significant reduced. The number of patients seen could be increased by installing high-capacity ventilation equipment. However, the price of such equipment and ventilation is estimated to start at about £10,000, and the cost is considerably more for larger practices with a high number of surgeries.

The British Dental Association members survey shows that the majority of dental practices in England are not currently in a financial position to afford such an outlay for investment. However, the practices least likely to have had the appropriate equipment tend to serve the most deprived communities, and are also the least likely to be able to afford that investment, increasing oral health inequalities further. That vicious cycle of underinvestment in our most deprived communities feeds inequalities in health outcomes.

--- Later in debate ---

[Jo Churchill]

I believe that the workforce, more broadly, is something we must look at properly in the round.

Aerosol-generating procedures present a high risk, as I said, and under initial guidance issued by Public Health England, infection control required that rooms should be rested for up to an hour, as the hon. Member for Bradford South said, to allow the airborne spray to settle. NHS dental practices were allowed to start offering services from 8 June providing that they had appropriate PPE and infection prevention and control measures in place.

In response to the hon. Member for York Central (Rachael Maskell) I would say that all NHS dentists can access the portal. Registration is voluntary, and 5,500—equating to about 81% of all NHS dentists—have signed up, and 50 million items of personal protective equipment have been dispensed. Making sure that our frontline services have what they require is vital, but the e-portal is being used, and I urge the remaining dentists to sign up.

There are more than 6,000 NHS practices in England that should now be offering face-to-face care, in other than exceptional circumstances. Guidance to practices has made it clear that during the difficult period they should prioritise care for vulnerable groups and then address the delayed routine check-ups; but that remains a challenge.

I recognise the comments that the hon. Member for Bradford South made about expectant mothers; I have asked my officials to look at that at speed, and I will come back to her on that. I am determined that we mitigate widening oral health inequalities as much as we can during this difficult period because, as we have alluded to, we know we had a problem beforehand.

NHSEI is keeping more than 600 urgent dental centres stood up to provide additional capacity in the system. My hon. Friend the Member for North Cornwall said he has problems too—and we have them across the country—so making sure that we have that universal coverage with UDCs is important. I must put on record my gratitude to dentists, dental nurses, technicians and all the team, because this has been a really difficult period. Dentists and their staff have kept vital care going through the initial peak, both remotely and in frontline urgent dental centres; many also volunteered to be deployed if needed on the frontline of covid services, and their contribution was very much appreciated.

It is important to ensure that NHS dentists are financially supported as businesses. NHSEI has continued to pay dental contracts in full, minus the running costs for downtime in the initial lockdown, whatever the volume of service to be delivered, and NHS dentists holding NHS contracts have welcomed that support. However, I am mindful that that support was for NHS dentists, and there are challenges in the private sector—and many practices are a mixture of both.

The focus now is on increasing dental provision as fast and as safely as possible. Key work has been done to establish ways to reduce room resting times, and that advice has been made available to the profession. I regularly meet with the chief dental officer, the BDA and other stakeholders, because it is vital that we keep looking at how we can get volumes up. That also means updating the existing dental infection prevention and control guidance, but it does not solve the challenge of delivering dental care at volume through the pandemic. It is an important step forward, but part of the problem is the variability in the estate, as the hon. Member for Bradford South alluded to—the different sizes of practices, where they are located, and so on. NHSEI is in discussion with the profession and is taking clinical advice on the expectations for delivery of services to the end of March.

I met the BDA and other dental stakeholders last week to progress conversations further, and I heard those messages. The challenge is to make sure that we can get the optimal amount of care for our constituents and patients while safely ensuring that dental teams can be protected, but we do need to see increased provision. I am keen to understand what further work can be done to solve the challenges in dentistry and how it faces the pandemic, and I have asked officials and NHSEI to look at potential solutions, including testing, increased use of ventilation and the financing thereof.

I understand the constraints under which the profession is operating and how vital services are. We know without doubt that oral health inequalities are likely to have increased over the period of the pandemic and NHSEI is working hard to ensure that caring for vulnerable communities is prioritised. Poor oral health can have a devastating impact on somebody’s quality of life, particularly a child’s, and dental disease is entirely preventable. In the Green Paper published in 2019 we committed to looking at those barriers, to fluoridation and to consulting on rolling out supervised tooth-brushing schemes in more preschool and primary settings. We are working as hard as we can to make sure we hit the consultation dates, but there are challenges.

[Rachael Maskell]

Will the Minister give way?

[Jo Churchill]

I am all but out of time.

Sugar plays a crucial role as well, and dental professions are important in healthcare more broadly: diet, spotting oral cancers, diabetes and so on. NHS England is working on a number of key initiatives to reduce inequalities for children, the elderly and the frail. I know that all dentists seek to put prevention at the heart of what they do, recognising that good oral hygiene and diet are the foundation of a lifetime of good oral health.

Through more flexible commissioning, dentists can be partially remunerated for carrying out initiatives such as outreach to schools, care homes and other settings—the homeless are often very compromised with their teeth as well. I hope that provides some reassurance that we are determined to tackle both the long and short-term issues with dental access and the continuing and very concerning inequalities around health, and I am happy to continue this conversation informally.

Question put and agreed to.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 17th November 2020 Commons Chamber

[Matt Hancock]

Yes, I do, and so does the Prime Minister. We feel very strongly about this. It is so important that we have the work across the country to tackle obesity; this has only been made more urgent because we know of the link between obesity and the risk of dying from covid. I look forward to working with my hon. Friend and others to make this happen.

[Rachael Maskell (York Central) (Lab/Co-op)]

York’s contact tracing work has proved to be incredibly effective, not just in its reach but in persuading people to isolate. However, it is not getting data through until around day five, when people are having a test, and it could be so much more effective if it had that data on day one. Will the Secretary of State look at York being a pilot for having immediate access to the data and the resources necessary to get on top of this virus and lock it down?

[Matt Hancock]

I am happy to work with the hon. Lady and the director of public health in York, and obviously with NHS Test and Trace, to make sure that the link-up is as effective as possible.

Dementia: Covid-19

Rachael Maskell Excerpts

Thursday 12th November 2020 Westminster Hall

[Rachael Maskell (York Central) (Lab/Co-op)]

I thank my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) for the way she set out so many of the complexities in this debate. We know that the intersection between dementia and covid is complex and that there are multifaceted challenges. I am sure we will not touch on them all in today’s debate.

I thank the Alzheimer’s Society, which is supporting people with dementia day and night through this crisis. I echo its call, and that of the Association of Medical Research Charities, for a significant and separate fund to be set up—a life sciences-charity partnership fund—to continue medical research through this time. We know that those charities’ funding has been massively hit and that they need support. I trust that the Minister will feed that back to the Chancellor ahead of the autumn statement that we are expecting.

We know that 27% of the people who have died had dementia. There is a correlation with older people, because of the resilience they have, but the figure is also disproportionate within that age population. Research is therefore absolutely necessary in order to understand what is happening. From my own clinical background, I have considered the impacts that dementia has on people with respiratory conditions, and there are certainly issues that need to be looked at in greater detail. I believe that that has mitigated against opportunity for people with dementia and created inequality. For instance, people with respiratory conditions often find it hard to comply with some of the treatment processes: positioning, secretion clearance from the lungs, and the ability to follow complex instructions such as huffing, coughing and taking deep breaths. When not under instruction, they are certainly not able to do that.

We have also seen environmental challenges to healthcare. At the beginning, we saw no PPE and barrier nursing, which have been well debated. As was said in this Chamber yesterday, 39% of people with dementia live in care homes, and 70% of care home residents have dementia. That environment, in itself, has become unsafe, but it has also become a place of isolation, which has a real impact.

There is a big question around the efficacy of access to healthcare. We know that there was a reduction in referrals to healthcare, which meant drugs not being administered, as well as no therapy, physio or secretion clearance, as I indicated. That could well have raised the number of people who had covid and who died from covid. We therefore need to look at the human rights of individuals with dementia.

When we consider the psychological, emotional and cognitive impacts of separation and isolation, which have been articulated so well in this debate, we know that harm has been caused. I therefore ask the Minister to look at the report of the all-party parliamentary group on ageing and older people, which looks at a commission on the human rights of older people, and to look at the work that has been done in Wales on having a commission and a commissioner to look at those issues. That is a way of ensuring that older people are part of the debate. That will include many people with dementia, although I appreciate that some people with dementia are younger.

That would be a way of putting protections in place, and of ensuring that we care for the carers. This is the point that I want to end on. We know that the majority of carers are saying that they are exhausted, they are anxious, they are having sleeping problems, they are depressed. They are not part of the conversation at the moment, and we need to bring them into it. Many are lonely and struggling at this time. We need to care for those carers as they not only take on more and more responsibilities, but provide vital care day in, day out.

Family Visits in Health and Social Care Settings: Covid-19

Rachael Maskell Excerpts

Wednesday 11th November 2020 Westminster Hall

[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Ms McVey. I should say to the hon. Member for Beaconsfield (Joy Morrissey) that I was really moved by the way she opened the debate, particularly the way she described Jamie’s story. It will be imprinted on my mind and, I am sure, on the minds of all hon. Members present.

When things do not add up, I ask questions. During the first lockdown, I had to jump through hoops just to obtain data to find out what was actually happening in our care homes. I spoke to managers, the local authority, relatives, staff and whistleblowers, then I put the jigsaw together. In the vast majority of care homes, residents were kept safe, and I thank the staff for their extraordinary work and for the ends that they went to in order to care for the residents. However, some care homes stood out. In the first period, around half of covid-related deaths in York were in care homes. Discharging patients into care homes—something I pleaded with the local authority not to do—seeded the infection. It then spread with the lack of PPE and no training in barrier nursing.

However, there was another conclusion to my inquiry: care homes became closed environments. One thing that we know about closed environments is that they are also unsafe. We have heard so many times in this place about the bitter experience of that. The plethora of informal inspectors were not there—GPs, community pharmacists and other professionals. They did not go in and see for themselves. Families did not go in either.

Families notice things. They notice if mum cannot reach a cup of tea, is looking unwell, has not eaten or is confused, and they notice if dad is slightly more unsteady on his feet, upset or withdrawn. But they were not there do that. However, one family noticed the eerie silence at one care home. Having been told that everything was fine, they learned that 15 people had died over a fortnight. They were not informed of the risk, only that the deaths had occurred. By the time it came to their deathbed visits, of course, it was all too late. During a deathbed visit to their mum, who had been fine, they found her emaciated, as if she had not eaten since their last visit in previous weeks. On another visit, they noticed that mum’s mobile was uncharged. On another, she had a fractured pelvis on discharge. That is why visits must occur; if they do not, these things go unnoticed.

It was whistleblowers who informed me that, at one care home, people contracted covid but their death certificates with marked with their underlying health condition. Covid was not put on the death certificate, because there were fears of reputational damage to the care home. The staff’s concerns were dismissed, and they were bullied. Even when the CQC came at my calling, they were shifted out of sight or moved to other shifts. Families would have noticed such issues.

Families must be proactively communicated with at all times and supplied with the information that they need to make care choices. As one relative said,

“We would have brought mum home had I known there was covid. It took her life.”

I am sure we were all distressed to see a nurse who went to take her 97-year-old mum home being arrested for doing what any of us would do in those circumstances. Families must visit and must have the choice where care is provided.

A constituent wrote to me this week, having celebrated his 60th wedding anniversary in September. He and his wife are both in their 80s and were told they could not visit. He said:

“When your whole existence is dedicated to the love you have for one another, it tells you something is very wrong.”

A distressed daughter told me this week that her father “couldn’t visit mum”. What are we doing to people? This is just so wrong. People are separated because our care system does not allow spouses to join their life partners unless they pay extortionate fees that they cannot afford.

I urge the Minister to look at that issue in the care sector. Not only must we give choice around visiting, but it must become a human right for older people. Visits can be facilitated with dedication and focus, PPE supply, and lateral flow testing to open up more opportunities and create safe spaces. We need to ensure that indemnity insurance does not prohibit the care home sector from pursuing that.

On the vaccine, the most vulnerable and those wishing to visit them must be prioritised. We must also ensure that there are clear and easy routes for staff, residents and relatives to raise any concerns they may have. We all know that we need to look into the eyes of those we love—hold them, and know that they are safe.

Coronavirus Regulations: Assisted Deaths Abroad

Rachael Maskell Excerpts

Thursday 5th November 2020 Commons Chamber

[Matt Hancock]

I would be happy to have that meeting with Mr Conway. I have spoken to others in the same circumstances who have made the case strongly. The compassion of the case cannot be overstated. I also respect the fact that many hon. Members, as has been reflected today, have deeply held views. We should make sure that the conversation happens; that there is, rightly, a debate about the topic, as there is in many other countries right now; and that it is conducted in an evidence-based, sensible and compassionate way.

[Rachael Maskell (York Central) (Lab/Co-op)]

Clearly, we are debating the most sensitive of issues, and we need more investment in the research and practice of palliative care. I ask the Health Secretary what additional resources will come forward, because at the end of October the grant funding for covid-19 and hospices came to an end. Of course, we are entering a further period of lockdown in which charity shops will be shut and fundraising opportunities will come to an end. Hospices need resourcing now, so what additional support will he bring forward?

[Matt Hancock]

The hon. Lady is absolutely right to raise that issue. We provided more than £150 million of extra funding to hospices during the first peak. Locally, many clinical commissioning groups fund their local hospice and contribute to that support, but we always keep it under review, because hospices are such an important part of the provision of end-of-life care.

Covid-19

Rachael Maskell Excerpts

Monday 2nd November 2020 Commons Chamber

[Matt Hancock]

Of course, self-isolation following contact or following a positive test, or in quarantine from abroad, is absolutely critical, and we have brought in measures to improve self-isolation, such as the £500 payment and strengthening the enforcement around it, and we are always looking for what we can do to strengthen self-isolation; the Prime Minister was absolutely right in what he said earlier, and there is a huge amount of work under way on it.

[Rachael Maskell (York Central) (Lab/Co-op)]

Two weeks ago, I asked the Health Secretary about the button that was meant to be on the app to release a reference code for people to claim the £500. The Health Secretary specifically came to the Dispatch Box to say that they just needed to press that button. That button does not exist—it did not exist then and it still does not exist today—so why did he make that intervention and how is he going to rectify the situation so people can claim that £500?

[Matt Hancock]

Yes, the button is coming; it is in development. The hon. Member for Twickenham (Munira Wilson), who made the previous intervention, also spoke about the app. There was an upgrade to the app towards the end of last week, and I want to put on record my thanks to the app team, who have done such a great job in improving the app by, as the hon. Member for Twickenham said, improving the targeting so that more people are targeted and more people get the message. The app is also now getting fewer false positives so people can have more confidence that if they are contacted by the app and told to isolate, they need to do so. The button will come.

--- Later in debate ---

[Rachael Maskell (York Central) (Lab/Co-op)]

If we had had a short circuit break at the beginning of autumn, fewer people would have been sick and fewer people would have died. The reality now is that we face a long, harsh lockdown at the very time people need support. I am worried about the loneliness those long dark nights will bring and the impact on people’s mental health. It is damaging not only for people, but for our economy.

I want to suggest two things that could make a difference over the lockdown period we will have to endure. They could make the difference that turns the tide and ultimately saves lives. The first suggestion is local contact tracing. I present it to the Minister with evidence for why we need localised test analysis and contact tracing. On testing, the delay in getting results is far too long. The local resilience forum in North Yorkshire said that after 24 hours, only 16% of tests are returned; after 48 hours, 60% are returned, and after 72 hours, 96% are returned. That is too long to wait to lock down the virus. If we could process those tests locally—test locally and process locally—we could have the results overnight. The University of York Aptima, a local laboratory, has the capability to do that in York. We need some seed funding from the Government, then we can process more than 6,000 tests a day in our city alone.

The evidence on contact tracing is clear. We have heard this evening that Serco turns round only 48% of contact tracing. City of York is already at 83% and had they had more effective data, which they could if they ran the system, they believe they could get to 100%. Indeed, last Wednesday, they did. The difference is stark. A quick response is key to getting on top of the virus—testing quickly, contact tracing quickly and isolating the virus quickly, as opposed to isolating people and the economy. The evidence is clear and I hope that the Government will respond to the suggestion of a localised system of public health.

Just over a week ago, the case rate in York was 307.2 per 100,000 cases. Since we have been doing our own contact tracing, it has fallen to 189.4 per 100,000 cases. That is the evidence the Government need to hold on to to recognise that local contact tracing is effective. It delivers, it saves lives and it will ultimately see off this virus with some of the other measures mentioned.

Secondly, as we unlock the economy, I want to suggest a new approach. When we deal with public health in workplaces, we give workplaces the all clear and certify that they are safe. If a work or community environment is covid secure and certified to be so, it should remain open. As we just heard with the golf example, they do not carry the risk of the virus. If those places are not secure, improvement notices should be issued and venues should remain closed. That is a simple, public health approach, which will make a difference without harming the economy further.

Those are two simple suggestions that can turn the ship around and make the ultimate difference. We need to do that because we cannot risk the NHS, we cannot risk our economy further and ultimately, we cannot risk lives. I trust that the Minister will respond positively this evening.

Covid-19

Rachael Maskell Excerpts

Thursday 22nd October 2020 Commons Chamber

[Jonathan Ashworth]

I am truly grateful for that reassurance, because the Secretary of State will understand that many people in those areas will be concerned and Members will want to get their points of view on the record on that front.

The virus has caused a pandemic because it exploits ambivalence and takes advantage of our human vulnerabilities. It undermines our biological defences and spreads through human social behaviour and clustering. We know that people with long-term chronic conditions in particular are vulnerable, and we know that there is a greater burden of illness in our more disadvantaged areas, which covid cruelly exaggerates. We know that as we entered this crisis, we had less resilience as a society. We entered with life expectancy falling for some of the poorest and stalling nationwide, and life expectancy is a summary of our overall health.

In the past 10 years, the amount of life in good health has decreased for men and women. Our child mortality rates are some of the worst in Europe, and poor health and chronic illness leave communities acutely vulnerable to disease, so it should come as no surprise to any of us that some of the boroughs currently fighting the most virulent fires are some of the very poorest in our country, with the very worst life expectancy.

I welcome the progress being made on diagnostics, therapeutics and vaccinations, which the Secretary of State has updated us on today. We welcome the expanding of mass testing, including the saliva testing and the lateral flow testing. I hope, by the way, that the Secretary of State will invest in our great universities, which are developing some of this saliva-based testing, because they will need the equipment and the labs to process it. He will probably need to invest in robotics and artificial intelligence to do some of that, because there are not enough staff to do it at the moment, and I hope that is part of his agenda. As well as all that, because the virus is now endemic, we will need a health inequalities strategy to get on top of this virus for the long term.

In the immediate term, we also need to adjust our behaviours to bring infection rates down, which is why I have supported the difficult restrictions that the Secretary of State has had to impose, and it is why we are saying we need clarity all the time from Government. But people also want to know that there is light at the end of the tunnel, because it is still not clear to families in Bury, Heywood and Penistone and all those other places that have been put under lockdown in recent days how they will escape it.

We still do not know whether the restrictions across the north will be lifted when the national R falls below 1 or when local regionalised R values fall below 1. We still do not know whether restrictions will be lifted across the north when hospital admissions stabilise. Yesterday, the Prime Minister said that decisions are

“based on a number of things including the R—also, of course, rates of infection, rates of admission to hospital and other data.”—[Official Report, 21 October 2020; Vol. 682, c. 1053.]

He did not tell us what that other data is. Perhaps the Minister responding to the debate can outline how an area in the north in tier 3 gets out of those restrictions. I know that the areas will be reviewed every four weeks, but what are the criteria to inform those reviews?

I represent Leicester, where we are in tier 2, but we have been in a version of restrictions for 114 days. We went directly from national lockdown to local lockdown. In fact, we endured tougher restrictions than those currently designated for tier 3. Our hospitality closed, our non-essential retail closed and—I did not agree with this—our schools closed as well. All those measures together did help to bring infections down in Leicester to about 55 per 100,000—to be frank, many Members would bite your hand off for 55 per 100,000 now—and even at 55 per 100,000 we remained in a version of lockdown.

Now, months later, after all the sacrifice we took in Leicester—after months with our businesses closed, with the mental health impact of people not being able to see their loved ones and families denied the opportunity to visit a care home to see their grandmother or mother—our infection rates in Leicester are 219 per 100,000. The Secretary of State will therefore have to forgive me when I express some scepticism that his approach will work and suppress the virus to the levels sufficient to bring the R value down, because although the early restrictions in Leicester did have an impact, after months we are still under restrictions with infection rates over 200 per 100,000.

The Secretary of State updated us on the situation we are in. He has been good at updating the House repeatedly; I have no criticism of him at all on that front. The growth rate in the virus is slower than in March—it is more muted, thanks to the great sacrifices of the British people, with hand hygiene, social distancing and everything we are doing—but it is not plateauing. We are dealing with an autumn resurgence, and for all the heat and fallout we have had across the House this week, the truth is that the virus is at worrying levels everywhere. The national R is between 1.3 and 1.5. The R across the south-east is between 1.3 and 1.5, across the south-west between 1.3 and 1.6, and across the east of England between 1.3 and 1.5.

Of course, admissions to critical care are currently concentrated in the north and the midlands, but while at this stage in the first wave those admissions to critical care were beginning to come down, they are continuing to go up. It is right that improvements in care mean that people are less likely to die. That is a good thing, and we all celebrate that, but general and acute beds are filling up with covid patients across the north and across the midlands.

We know that the Prime Minister has rejected a circuit break for now—he does not rule it out indefinitely. We think he should have taken advantage of next week’s half term. He decided not to do that. But we should remind ourselves that SAGE advised the circuit break on 21 September. A month later, on 21 October, we had these grim statistics: 191 deaths; 996 hospital admissions; 6,431 in hospital; 629 on ventilation; 26,688 tested positive; and 249,978 cases in the past 14 days. Many will ask how much of that could have been avoided, had the Prime Minister gone along with SAGE’s advice a month ago.

Today, the Chancellor said in his statement that we have to find a balance between saving lives and protecting livelihoods, but I do not believe that the two are in conflict. It is not a trade-off. Actually, I do not believe the Secretary of State thinks it is a trade off—the tone of his remarks was very different from that of the Chancellor earlier. Saving lives and protecting livelihoods go hand in hand. I worry that the approach the Government are currently taking—while understandable, because nobody wants to be in a lockdown, and none of these decisions are easy or do not have negative consequences; I think we are all mature enough across the House to appreciate and understand that—means that there will, by necessity, have to be tougher, deeper action in the weeks to come, not only in autumn. Winter has not hit us yet.

Professor John Edmunds of the London School of Hygiene said yesterday in one of the Select Committees that

“there’s no way we come out of this wave now without counting our deaths in the tens of thousands…I think we are looking at quite a bleak situation unless we take action…I don’t think we should be taking action just specifically in the highest risk areas, but I think we need to take action everywhere”.

A similar sentiment was expressed by Sir Jeremy Farrar, who is also on SAGE. For balance, Professor Van-Tam said at the press conference this week that he disagreed, but also that

“we may have to push on the pedal a little harder”

to get it under control.

I know the Secretary of State is a decent man. He has been very good throughout this crisis in talking to me privately; one would expect a Secretary of State and a shadow Secretary of State to have those discussions. Whenever I have asked for briefings, all the way back to January, he has ensured that the chief medical officer would give me confidential briefings, as I am sure that every Member across the House would understand and appreciate. So I know he is a decent man. I know he is not playing games or anything like that. I know that these are difficult judgment calls of extraordinary gravity. I know there is no easy solution. Everything has trade-offs; everything has negative consequences. But we also know that unless we take decisive action, the consequences could be even worse. No one should pretend to the House that that is not the case. There is a worry that by not taking action now, we will, in the words of Professor David Hunter, an epidemiologist at Oxford,

“all wind up in tier 3 eventually.”

According to Times Radio yesterday, Government sources were telling it that the Government are now planning a three-week circuit break next month across all tier 2 and tier 3 areas. If that is the case, then the Government should probably level with us so that we can all start preparing for it.

This is not just about minimising harm and deaths from covid. As the Secretary of State said in responding to questions from my hon. Friends, we have a huge responsibility and duty to minimise harm and deaths from non-covid conditions as well. We have to avoid the situation that we were in in the spring, when the immense lockdown, which was actually a number of different interventions all at once, meant that to build surge capacity in the national health service, we had to cancel elective operations to free up general and acute beds, and much important diagnostics work and treatment got delayed. That has left us with a situation today where 110,000 people are waiting beyond 12 months for treatment, compared with just 1,600 in January; 3 million people are waiting for breast, bowel or cervical screening, and more people are waiting for treatment.

My worry is that we will end up building a greater backlog in treatment if we do not act. General and acute beds are filling up. We have a number of hospitals cancelling electives already. Bradford has just suspended non-urgent surgery. Birmingham is talking about suspending non-urgent surgery. It is happening in Nottingham. We know that Merseyside is under considerable pressure; the Secretary of State outlined it. It has just been revealed in the Health Service Journal that we are heading into this winter with 2,000 fewer beds than we had last winter. Today the Royal College of Emergency Medicine has warned that over half of A&Es across the country are caring for patients in corridors due to the lack of beds—and we are not even in winter yet. Our overcrowded A&Es are not ideal at the best of times, but during a covid pandemic it is obviously highly dangerous to be treating patients in corridors of A&Es. The president of the royal college, Katherine Henderson, has pointed out that this situation

“will put more lives at risk than it ever did before.”

If the Government really want to drive down infections, suppress the virus and ensure that general and acute beds are not overwhelmed and more operations are not cancelled, then they have to seriously consider what steps they need to take to go further. Unless the Secretary of State or the Minister is going to get up at the end of this debate and say, “Actually, we’re going to do a circuit breaker over half-term next week”, I accept that the Government have probably missed that window of opportunity now, but at some point they will have to take further action.

We could have avoided much of this if test and trace had been more effective. The Secretary of State is spending £12 billion on this programme. Twelve billion pounds is a colossal amount of money. Some of it is going on consultants who earn £7,000 a day, but where on earth is the rest going? We are throwing around figures in this covid debate, and we are becoming quite complacent and relaxed about them, but £12 billion is an extraordinary amount of money; we could probably run the NHS for a month or so on that. We learn today that the system is contacting only 59.6% of contacts, which is the equivalent of failing to contact 101,000 people. That is not world beating; it is a world-beating shambles. I really hope that the Government look at stripping all the failing private outsourcing firms, such as Serco, of these contracts and putting local public health teams in charge. That would be much more effective.

[Rachael Maskell (York Central) (Lab/Co-op)]

I want to pick up a point about the app. It is telling people to self-isolate, but it does not give them the code that they need for the process, so they cannot claim their £500. That is creating chaos across local authorities. Does my hon. Friend agree that the Government need to get on top of this quickly?

[Jonathan Ashworth]

Absolutely. There have been problems with the app. When I am in Leicester, it tells me that I am in an area that is both medium and high alert. Leicester has been under lockdown for 100 days, so how can the app say that in the part of Leicester where I live?