The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I shall repeat a Statement made by my right honourable friend the Secretary of State yesterday evening in the other place on coronavirus. In the repeat, I will use the most up-to-date figures, which have changed since last night. The Statement is as follows:
“Mr Speaker, this afternoon, the World Health Organization declared coronavirus a global pandemic. I have spoken to the Leader of the House and we have had discussions; we have resolved that we will keep Parliament open. Of course, in some ways, the House may have to function differently, but the ability to hold the Government to account and to legislate are as vital in a time of emergency as in normal times. Our democracy is the foundation of our way of life.
Turning to the advice that is being provided to Parliament, I start by welcoming the way in which you, Mr Speaker, are working with the Government. I know how seriously you take the well-being of all Members and staff in Parliament, and the Government will continue to work closely with you, the Lord Speaker and the authorities in both Houses in the coming days and weeks. As the Leader of the House said in business questions last week:
“The public will expect Parliament to sit, and to get on with its job ... Our approach will be guided by the best scientific evidence and medical advice, and we will take all necessary measures to deal with this outbreak.”—[Official Report, Commons, 5/3/20; col. 984.]
Mr Speaker, I know that you are committed to providing as much information to Members and staff as possible and to taking any action that is required. A cross-parliamentary group of senior managers meets daily to plan the response to Covid-19 and ensure business continuity, with close input from the Government. It is essential that the parliamentary authorities continue to work closely with the Government and in line with medical advice, and I commit us to that endeavour. Both Houses are conscious of our national role at this time, and by basing decisions on the very best public health advice, we can be confident that we are doing the best we can to respond to this virus.
Around the world, the number infected is rising. Here at home, as of today, 456 people in the UK have tested positive and eight people are now, sadly, confirmed to have died. The positive cases of course include my honourable friend the Member for Mid Bedfordshire. She has done exactly the right thing in following the official advice to self-isolate, and I know the whole House will wish her well as she recovers. Public Health England has world-class expertise in contact tracing, which it initiated as soon as her case was confirmed. It will contact anyone whom it thinks may need testing. This will include only those who have had close contact. The advice of the Chief Medical Officer is that close contact is defined as being within two metres of someone who has active symptoms for more than 15 minutes. Those who have not been in close contact with my honourable friend since Thursday have no cause for concern in this case, and anyone who has concerns should seek guidance from Public Health England. I also know that my honourable friend wants me to pass on her thanks to officials at Public Health England and the NHS, who have been brilliant throughout.
Of course, a Member of the House and Health Minister testing positive has brought this issue home to us all, and I know that the public will be concerned that coronavirus has now been deemed a global pandemic. The official advice is clear: people should go to NHS 111 online or call NHS 111 if they think that they have symptoms of coronavirus, notably a cough and fever. Of course, the best way to minimise the risk to yourself and others is regularly to wash your hands.
Earlier today, I chaired a meeting of COBRA. Our response will be built on the bedrock of science. It is clear that we will need legislation to ensure the best possible response, and I can tell the House that I have invited the Official Opposition to meet with me first thing tomorrow to discuss the proposed emergency Bill that we will set out before the House next week. In addition to the measures that my right honourable friend the Chancellor set out in the Budget earlier, the Bill will include measures to help the national effort to keep vital public services running, to support business and to help everyone play their part.
Adult social care will be at the front line of our response, with social care providers looking after many of the most vulnerable in society. We are working closely with the sector to make sure that it is ready. Tomorrow, the Prime Minister will chair a further meeting of COBRA to decide what further measures may be necessary.
We will do the right thing at the right time. I know how worrying this is. I know that people have deep concerns. I know that everyone will play their part in this national effort to defeat the virus. The best way to beat it is for us to work together. We will do whatever it takes. We will give the NHS whatever it needs. We will do all that we can to keep people safe and get through this together, as a Parliament and as a nation. I commend this Statement to the House.”
My Lords, that concludes the Statement.
Baroness Brinton
I apologise for using an inappropriate term. None the less, even yesterday the Secretary of State said that we were not in delay. I recognise that things are moving very fast, but it is worrying that the Government keep saying that they are following the clinical advice yet there seem to be some differences in this. That matters in the light of what is happening elsewhere in Europe. Whether we close schools is obviously down to the advice of Chris Whitty, who is an epi- demiologist. He has been clear that there are disadvantages as well as advantages. What we are concerned about is that it is beginning to feel as though the professional advice is differing slightly from the political advice.
I am very pleased that the Government have responded to the WHO news about moving to a pandemic, and this morning’s letter from Chris Whitty to all doctors is extremely helpful in setting out their roles in being flexible and having to do things differently. But we know that the Italians have struggled with the number of hospital beds in ITU, and of ECMO beds, ventilators and other specialist equipment. By the way, it is really good that China is now helping Italy out. Learning as a global community from one outbreak area onwards is excellent.
However, the data paints a worrying picture. Japan and Korea top the OECD table for hospital beds per thousand at 13 and 12; Italy has 3.2 and the UK 2.5. What is happening to ensure that we have the ITU beds and ventilators that will be needed for the more severe cases which, as the news from Italy has shown, has been very problematic? Last night, a former public health director, Professor John Ashton, said on “Newsnight”:
“We’ve got a complacent attitude … We’ve wasted a month. If this now spreads the way it looks as though it’s likely to spread, there will not be enough hospital beds and people will have to be nursed at home.”
I am afraid that there are still holes in the advice and action, especially in social care. I shall repeat the concern that yesterday no extra money was provided in the baseline Budget for social care. Also, while the Secretary of State made it clear that social care is being included in the emergency coronavirus grant, that is for adult social care only. I repeat the question that I and my colleagues in another place keep on asking: what about the most vulnerable children who are often on ventilators or, if not, they end up on ventilators if they get even a cold? If there is no extra resource for them, that is a real problem. Many parents are hearing that everything is about care for the elderly. Children may be asymptomatic, but these children will not be, so it is vital that they are given support. If the Minister cannot answer that now, I would be really grateful for a reply outside.
The Secretary of State talked in the Statement about everyone working together. As we move into the delay section, we already know that directors of public health, councils and other key stakeholders such as CCGs are doing fantastic work, but—as many of us know that communication between Public Health England and the directors of public health has been a problem—can the Minister reassure the House that those lines of communication are working effectively and being monitored by senior people in both the NHS and government?
I echo the points about the announcement of the public health grant. That is the Secretary of State for Health and Social Care’s responsibility. We are only a fortnight away from the new financial year. It is ridiculous that we do not have the details.
Will the Government relax appraisal and re-registration requirements during Covid so that we are fighting the virus and the specialists are not having to fill in paper the whole time?
Finally, where is the personal protective equipment for social care? It will undoubtedly be needed, not just in care homes but for those being nursed at home.
Lord Bethell
My Lords, I thank the noble Baronesses for those excellent questions. I will take them at some pace, because there were a lot of extremely worthwhile questions and I will try to answer them as best I can.
The noble Baroness, Lady Thornton, asked about advice. I would like to explain to the Chamber the effectiveness of the contact tracing that Public Health England has put in place. Nadine Dorries shared her diary with Public Health England officials. They have gone through an extremely thorough contact-tracing process and have identified those individuals most at risk. It is a feature of our strategy for dealing with this virus that we have put contact tracing very much at the heart of what we do. It has proved an extremely effective measure. I understand from the Chief Medical Officer that more than half of those positively identified as carrying the virus in the UK have been identified through contact tracing, which is an indication of how thorough that process is and how effective it has been.
For those who remain concerned, the guidance from 111 is that it is those who show symptoms who should present themselves for a test. Those who have been in proximity but are not currently showing symptoms should use common sense and isolate if they feel like it, but that is not the positive guidance from 111.
The noble Baronesses, Lady Thornton and Lady Brinton, both asked about containment and delay. The truth is that we are in a transition period. The CMO’s advice is that the virus will almost inevitably spread through the British population, but the testing statistics speak for themselves. On 11 March 2020, 27,476 tests had taken place and only 456 had tested positive. The simple arithmetic of that is that if you are ill and feeling poorly at the moment, you probably do not have coronavirus. We are still at the tail end of the winter flu cycle; many germs are still in circulation. As yet, although coronavirus has been identified in many places in the country, it is not turning up in a very high incidence or proportion of those tested.
We are not complacent about this; we take it very seriously indeed. We can see the storm on the horizon, but the question of timing is incredibly delicate. I understand the frustration and concern in this Chamber, the media and the general public that not enough is being done, but the science, modelling and guidance from those who study epidemics are clear that we have to get the timing right. When we do, we will move emphatically, clearly and in a focused way, but we have to get that choice right.
The noble Baroness, Lady Thornton, specifically mentioned schools. The evidence suggests that, thankfully, children are not strongly affected by this virus, if at all. It is not currently clear whether those who are infected are infectious. There are strong signs that if they are infectious, they are not very infectious. There needs to be a degree of sense when it comes to the infection. In the balance between the social and economic effects of closing schools and taking mums and dads out of the workplace versus the safety of the children, particularly the effects on clinical and care workers, the opinion of the Chief Medical Officer and those who advise him is that closing schools is not the correct option in the UK today.
The noble Baroness, Lady Thornton, asked about the LGA and social care associations. I will reassure her on two fronts. They are very much engaged in all our preparations. Money is very much on the table and the resources that they need to combat this virus will be there to top up their budgets. The same is true on public health funding: the CMO is actively engaged with directors of public health to ensure that they have the resources they need.
The noble Baroness also asked about inspections for care homes and recent submissions by those who run care homes. I assure the House that we are listening to all those organisations that have concerns about inspection regimes and meeting legal requirements when physical resources and resources of people and time are under huge pressure. We hear their concerns loud and clear and will be making realistic provisions about those inspections and legal requirements.
The noble Baroness asked about the charitable sector. I hear its concerns but hope that this incident will be a massive opportunity for communities to come together and for the charitable sector to play an important role in providing support in care and to clinical staff. Funding for the sector is being looked at by DCMS. I have been updated by the Minister concerned, who assures me that their plans are progressing and that engagement is happening in a very serious way.
The noble Baroness also asked about CCGs and shared her anecdotes about the pressures on CCGs. Let me be absolutely clear: pressure is inevitable. There will be huge pressures on the people and the resources at every level, particularly in front-line and primary care, but we are working extremely hard to ensure that they have the physical manpower and administrative resources that they need to meet the challenge. For example, the noble Baroness, Lady Brinton, asked about PPE suits. They are being delivered, if not this week then next week. We have listened to the concerns of CCGs about the provision of suitable protection resources, and deliveries are happening as we speak. I hope that the recent letter from the CMO provides the kind of clear guidance that CCGs have been looking for.
In terms of registration documentation, the noble Baroness, Lady Brinton, asked about those returning to work. It is a primary concern of ours, because the current arrangements for those seeking to return to work in front-line clinical roles are clunky and administratively onerous. The process takes a long time and is completely unsuitable for the challenge we have ahead. That is one of the important measures that we will be addressing in the week ahead.
Specialist beds are our primary concern. The experiences of China and Italy make it crystal clear that those who have severe respiratory responses to the virus are creating the greatest demand on resources and are at the greatest risk. We are doing everything we can to convert existing resources into relevant, suitable provisions for those who will need respiratory help, and we are working hard with the oxygen manufacturers and providers to ensure that we have the kit and the personnel to answer that need.
Both the noble Baronesses, Lady Brinton and Lady Thornton, asked about social care. I reassure the House that the financial provisions outlined by the Chancellor yesterday will include all aspects of social care, including those relating to children and the most vulnerable in society. Directors of public health will be included in decisions about how those financial resources are allocated.
Lord O'Shaughnessy (Con)
My Lords, I am grateful to my noble friend for repeating that Statement and providing that reassurance. We all respect that this is an incredibly difficult and finely balanced decision, and, to some degree, we all need to trust in the process and those who are leading it. We have great scientists who are doing so.
Will my noble friend do two things? First, can he talk a little about the welcome funding that was in the Budget yesterday to support the economy and the health system through this outbreak? What exactly will that be spent on and what can be spent quickly to good effect? Secondly, to pick up an issue that was raised by the noble Baroness, Lady Thornton, but was also mentioned yesterday about capacity in the system, particularly in care homes, I am very worried about vulnerable people who require domiciliary care whose workers might get sick. Who will care for those people? We may need to think completely out of the box in how we do this. Can we stand up a volunteer army of post-infected people who have DBS checks to take on these kinds of responsibilities? Going about things in the ordinary way will not deal with the consequences of this crisis when it really hits. I would be grateful if my noble friend could expand on some of the plans the Government are making for these consequential impacts, which are not to do with the virus, but are very much to do with the impact on the health system.
Lord Bethell
I thank my noble friend for those questions. In terms of funding, the Treasury has provided immediately a £5 billion contingency fund to ensure that not only the NHS but local authorities have the resources necessary for both clinical and social care. The kinds of items that the money can immediately be spent on include boosting staffing, particularly in the NHS, which might include re-employing retired doctors and nurses and recruiting and offering compensation to volunteers who agree to help provide health and social care services full-time for the period of surge.
The precise arrangements for how that volunteering army can be put together will have to wait until we have the legal provisions for that army because there are important questions of indemnity, legal registration and DBS checks, all of which have been raised in this Chamber previously and which we take very seriously. But it would be premature to describe plans that are being worked on at the moment until we have tabled the sorts of legal requirements that we will need.
Funding will also ensure that we have the right drugs, supplies and equipment. Lastly, there will inevitably be a backlog of care after the virus has passed. We are conscious that this backlog will put a long-lasting strain on our medical and social care arrangements, and we are putting in the resources today to ensure that the backlog can be addressed in the future.
Lord Judge (CB)
My Lords, for those of us who are trying to plan next week, when will the Minister be in a position to let us know when the proposed emergency legislation, and in particular the Bill, will be able to be examined; in other words, when will we see a draft that we can look at and reflect on?
Lord Bethell
The noble and learned Lord asks a very reasonable question. I reassure him that the Leader of the House will make a Statement to that effect and she will outline the schedule for the publication. That will be for the Leader’s Office to decide.
Lord Blunkett (Lab)
My Lords, I commend the Government for the measured approach they are taking and the Minister for his helpful responses this morning. I chair the Sheffield City Partnership board; it will be partnership at local level that will deliver, as the noble Lord, Lord O’Shaughnessy, described, the civil effort that all of us will need to put in. Will the Minister indicate now whether he has taken on board the questions raised about the public health grant and about some of the money from the £5 billion that he mentioned going into facilitating local government—which has been severely damaged over the last 10 years—to provide the capacity to co-ordinate, as it did with the floods, the partnership approach needed at local level?
Lord Bethell
My Lords, I reassure the noble Lord, Lord Blunkett, that local authorities will undoubtedly provide a huge amount of the response to the coronavirus, not only in social care but in supporting business, giving pastoral care to those who are vulnerable and left alone and providing the community cohesion that we will need to get through a very difficult time for society. Extremely generous funding has been put in. That money is trickling through the system and I know that my colleagues at the Treasury are working hard to ensure that everyone has the information they need.
The Lord Bishop of Portsmouth
My Lords, in thanking the Minister, may I ask him whether he can give any information on the precautions and particular challenges in prisons, where, for instance, social distancing, isolation and provision of hospital services will be difficult to achieve?
Lord Bethell
The right reverend Prelate is entirely right to raise the question of prisons. Prisons provide an enormous challenge when it comes to the virus. The idea of prisoners living in prisons while the virus passes through such a tight-knit community concerns us enormously. I reassure him that the Ministry of Justice is looking into this carefully. It is using the experience in Italy and in China to understand how to provide for this in a humane and responsible way that preserves the security of our communities. It will publish advice on that shortly.
Baroness Jolly (LD)
My Lords, I declare my interest in the register. I was pleased to hear that the Secretary of State had included social care in the Statement. Could the Minister clarify what support will be offered to providers of social care to vulnerable adults with a learning disability?
Lord Bethell
The noble Baroness is entirely right to ask about a specific group. As yet, I do not have a clear answer on the exact demographic that she describes, but I reassure her that our understanding is that this will hit hardest the most vulnerable in our society. The entire focus of our provisions is therefore to make sure that the most vulnerable are looked after best.
Lord Forsyth of Drumlean (Con)
My Lords, yesterday I asked my noble friend whether he would give guidance to employers on the standards of deep clean required to enable people to return to premises. He indicated that he thought that the CMO did not think that this was necessary and that such advice would be “red herrings or distracting”. I read in the newspapers today that, sadly, a case was identified in the Treasury, which arranged a deep clean overnight so that people could return to work. Speaking as an employer with buildings where continuing services are important to consumers, customers and others, as well as to maintaining employment, we would like to carry out a deep clean every night, so that, if a case was identified, the premises would be safe, but we do not know what standard of deep clean is required. Frankly, asking a cleaning company what it would recommend does not seem the basis on which best to protect not just the staff of the building but also the businesses. May I reiterate the plea for some guidance? If that is not possible, perhaps we could be told what the Treasury decided.
Lord Bethell
I thank my noble friend for his question on deep cleaning. I reassure him that no one is suggesting that the best efforts of any employer to protect the welfare of their staff is in any way irrelevant or undervalued. Cleaning is an important response to this virus and those who decide to put resources into cleaning their premises are entirely to be lauded. There is clear guidance on the PHE website. I have put that guidance in the Library and would be happy to arrange for it to be emailed.
Let me try to explain the nub of the question. The CMO has not put the daily deep cleaning of offices or any work premises at the top of his priorities. The reason for that is that it takes only one person to touch a doorknob at 7 am for that doorknob to be contagious for the rest of the day, whereas a pair of hands can be cleaned many times a day. If you do the arithmetic of how the virus is spread—as the modelling professionals do at SAGE—constant handwashing, which we bang on and on about, is the most effective way of preventing the virus spreading. When that no longer proves an effective measure, the CMO will undoubtedly change the guidance and publish that guidance widely.
Lord Harris of Haringey (Lab)
My Lords, I am slightly surprised by that answer. I was not going to ask about this but, none the less, I will. Surely, what the noble Lord, Lord Forsyth, is asking is: if an employer wants to go above and beyond the current minimum level of requirement, where can they get guidance? That seems quite important. The question I would like to ask the Minister is this: obviously, we wish Nadine Dorries all the best for her recovery, but is the line by which she acquired the virus yet clear? If it is not possible to answer that, of those people who have been confirmed to have the virus, in how many cases is the route by which they acquired it known? If that route is not known, clearly this is much more endemic than has previously been said.
Lord Bethell
My Lords, not wishing to return to question of deep cleaning too many times, I just reassure the noble Lord that the published guidance is very clear. It says that this virus can be cleaned with conventional soaps and conventional detergents, of the kind already freely available and used by cleaning companies. There is nothing technically challenging about the cleaning of offices, homes or hands in the case of this virus. It is just about thoroughness. That guidance exists. If it would be helpful, I would be happy to share it with noble Lords in this Chamber.
It is not possible to discuss Nadine Dorries’s case in detail. On community contagion, which is the nub of the question, we have reached the stage where the origin of every positive case is not known. In other words, there are people who have picked up the virus for whom no simple explanation can be given for where they got it. Therefore, the CMO has stated clearly, including in briefings to noble Lords, that his opinion is that the virus is present in the community but, as I explained, that the levels of positive testing suggest that it is not very prevalent. The CMO in his briefing estimated that between 5,000 and 10,000 people had the virus earlier this week. Those are the kinds of proportions we are talking about at this time.
Lord Campbell of Pittenweem (LD)
With respect to the Minister’s answer on the management of intensive care facilities, is that management being done by health boards, regionally or centrally? In particular, is regard being given to it being done on a United Kingdom- wide basis? I have in mind that, if there is a problem in Newcastle, Edinburgh might be recruited to assist with that and vice versa. Is this being approached on a UK-wide basis or rather more narrowly?
Lord Bethell
I reassure the noble Lord that this is a whole-health family challenge. I thank all my colleagues, in every part of the NHS, PHE and all the arms-length bodies, who have been involved in the response. Yes, the guidance and direction are coming from the top, and the expertise is coming from the scientists who advise and guide us, but it has been up to individual managers at every level of the NHS to step up to this challenge. The response has been formidable, impressive and reassuring. I wanted to take a moment to bear testimony to that response.
Regarding the devolved nations, the four CMOs are working incredibly well together. It is reassuring to see how closely their response has been tied. It has been a whole-country, UK-wide response and there is a lot of consistency across the different nations.
Lord Pickles (Con)
My Lords, may I ask about the unintended consequences of President Trump’s announcement last night? As my noble friend will be aware, a considerable amount of commercial cargo is carried on passenger flights, including medicine and vital medical equipment, plus time-sensitive exports. While our European neighbours will bear the brunt of the announcement, it will undoubtedly have a knock-on effect on supplies to the United Kingdom. What discussions are the Government planning with airlines to ensure these vital medicines and medical supplies come through?
Lord Bethell
The supply of medicines is of concern. We have built substantial stockpiles of all medicines that we feel we need. We are working through what the implications of President Trump’s declaration might be. My understanding is that we are presently very confident about the secure supply of medicines.
Lord Layard (Lab)
My Lords, if we look abroad, especially to Japan and China, it is clearly not as inevitable as the Government assume that this disease will become widely spread through the population. Extraordinarily, in Hubei province, the epicentre of the disease, the proportion of the population who caught it was 0.1%. So how can we be hearing our experts talking about up to 80% of our population being affected? This cannot be right; it is based entirely on the assumption that our approach will be very passive. Can the Minister assure me that we will move to a really stringent regime next week?
Lord Bethell
The noble Lord asks a question that is on the minds of a lot of people who have been reading into the subject. The concern of the CMO is that if you bring intense social behaviour restrictions to bear on a population, you can temporarily suppress the spread of the virus. If you ask the entire population to stay at home, and close down every business, public space and event, you can suppress circulation. However, the moment you lift those restrictions, the virus spreads with a vengeance. It is often the most vulnerable who are then hit with a second peak, which can take out the provisions needed to support them. That is the CMO’s primary concern. The Government’s objective is to manage the situation so that the virus spreads in as limited a way as possible, and is spread out over time to allow medical and social care resources to be given to those who need support.
Lord Trefgarne (Con)
My Lords, my noble friend referred to the inevitable increased level of activity in the National Health Service. What success has been achieved in recalling recently retired NHS staff to help?
Lord Bethell
The recruitment of recently retired staff requires some changes to legislation, which are being studied at the moment. We look forward to bringing them to the House in the near future. I am happy to update the House on those provisions, once we have made further progress.
Lord Foulkes of Cumnock (Lab Co-op)
My Lords, I welcome the decision of the Government, and the meetings of the joint commissions, that Parliament should continue to operate properly in our democratic society—not least, as the noble and learned Lord, Lord Judge, said, so that we can deal with the draft legislation for this emergency. But has any assessment been made of potential dangers from the large groups of visitors, from many countries, who wander around—and are taken around—this building? That might create dangers that put the question of our sitting in doubt.
Lord Bethell
The noble Lord’s point has been raised with me by staff of the Palace, who are concerned about this. It is not for me, I am afraid, to answer this question; it is for the officers of the House. I know they are looking at this matter and are being advised by the Chief Medical Officer.
Lord Forsyth of Drumlean
My Lords, I return to the question of deep cleaning. My noble friend says that the advice is clear. Could he confirm that, if an employer arranges for all surfaces within their premises to be treated, that will be sufficient to allow staff to come back into the building safely?
Lord Bethell
My noble friend clearly feels passionately about the subject. I am not personally in a position to provide the reassurance he seeks, but I will try to find the information for him. I will share with him the regulations as they stand.