Baroness Brinton (LD) [V]
My Lords, first, on behalf of the Lib Dem Benches, I once again pay tribute to all of those who are helping to curb the coronavirus pandemic, whether in the front line or behind the scenes, and especially in Leicester. We know that there are many unsung heroes who continue to work long hours in stressful and ever-changing environments. Secondly, on behalf of these Benches, and in memory of the outstanding report by William Beveridge, I extend our congratulations to the NHS on its birthday, and note that of the five evil giants, many are still present in those most affected by Covid.
If the Minister is unable to answer all the questions asked, will he write to noble Lords with an answer? I hope that I can speak for other Members of your Lordships’ House when I say that we understand that the nature of a pandemic means that there are many questions to raise, but to repeatedly not have answers from Ministers is disappointing.
On that note, I ask the Minister for the fifth time in just over two weeks what the problem is with ensuring that every local council and director of public health has full test and tracing data as it becomes available. Over the past three weeks, it has become clear that full data has not been provided, and directors of public health, council leaders and mayors have all had to beg for data so that they can intervene early to prevent further cases, hospital admissions and deaths. Information is being dribbled out and it appears that pillar 2 testing lies at the root of the problem.
Stella Creasy MP asked a Written Question in the Commons, which was replied to by Minister Nadine Dorries on 11 June. It states:
“The contract with Deloitte does not require the company to report positive cases to Public Health England and local authorities.”
Does that remain the case, or has the contract now been varied to ensure that that information is made available immediately to key partners? The issue of why any such contract should not require positive cases to be reported is quite extraordinary but for another day; however, with low transmission, tracing pillar 2 cases is absolutely critical. Are all local authorities and directors of public health now getting full data, including pillar 2 data immediately so that they can prepare for small or larger local outbreaks? That is important because there are reports from across England of areas with increasing cases—indeed, as the noble Baroness, Lady Thornton, said, Sky News reported this morning that 35 other local authority areas may face locking down if their cases do not reduce quickly.
That raises an issue about the powers of local lockdown. It was rather strange to hear Matt Hancock saying on Monday evening that he would bring forward legislation for local lockdown, but this morning on Sky News he said that he would rather not do that by legislation but by consent. So I put what I hope is a hypothetical case to the Minister. If this Saturday a number of Leicester residents get in their cars, what powers to the police have to prevent them from going to Loughborough, Derby or Sheffield to be able to go into a pub? Clearly, at the moment, local authorities do not currently have the powers to stop them: their powers relate only to single buildings. But if the Secretary of State believed on Monday that there needed to be legislation, why not today?
This feels very much like policy by press release, and local legislation enforcers, whether they are police or local authorities, need to know what powers they have as a matter of extreme urgency. I also ask again, why will Ministers not give the powers of local lockdown to local authorities and directors of public health, obviously working with Public Health England, the NHS and Ministers? For any final decision to rest with the Secretary of State inevitably slows down processes, as we have seen in the Leicester case over the past three weeks. Above all, we must keep people safe.
Finally, will the Minister inform the House whether there is sufficient supply of PPE in Leicester and other areas where cases are increasing for hospitals, primary care, care homes and care in the community? The Health Service Journal reports today that there is still much panic buying of PPE, with some orders costing 10 times the amount that would have been paid before March.
This Saturday marks the lifting of lockdown for most of England except for those of us shielding and the people of Leicester. Will the Minister ensure that the wider public will remain safe with the increases in cases in at least 35 other local authority areas? Will the Government move much more quickly to ensure that public safety is guaranteed?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I thank the noble Baronesses, Lady Thornton and Lady Brinton, for their thoughtful questions. To answer directly, it is extremely important that we are currently here debating the outbreak in Leicester, because in a way it is a tribute to the success of the hygiene, isolation and social distancing strategy that has borne so heavily down on this disease that we are now in the position of focusing on those rock pools of the epidemic that have been left behind by the tide of this disease going out. But I completely accept the importance of this outbreak management. That is where the Government’s focus is centred.
I reassure both noble Baronesses that the data that local authorities and local directors of public health require is being given to them and access is being provided. All local authorities were issued with data-sharing agreements to access personally identifiable local testing data on 22 June. After signing those data-sharing agreements, the first local authorities accessed the data on 24 June. Leicester accessed it with its log-in details on 25 June. An enormous amount of progress is being made in an area that is now very much our focus. Local authorities, public health directors and infection control teams have worked hard in the past few weeks knuckling down on those lockdowns that did not get away, on the local outbursts that were well managed and that have not hit the headlines and that are now falling lines on the epidemiological graph.
The noble Baroness, Lady Brinton, asked about the legal aspect. I reassure her that the lockdown in Leicester is being carried out under the Public Health (Control of Disease) Act 1984 at the request of the local authority as the provisions of that Act require. Therefore, regulations will not be brought to this House. The Secretary of State and the Government have sought to manage the epidemic through the consent of the people, not through making things mandatory. That has been our consistent approach because trust and collaboration are at the heart of this country’s response and we do not believe that making things mandatory through regulation will be as effective. However, if regulations are necessary, we will bring them to bear in order to protect lives and save the NHS.
I pay tribute to the British people for their enormous collaboration and the huge sacrifice that many have made in order to put in social distancing and other necessary measures. I pay tribute to the shops, pubs, churches and other venues that are working so hard in order to apply the necessary regulations for reopening on 4 July, which will be an incredibly important but worrying experiment in opening up our society.
On further lockdowns around the country, none is currently planned. Our profound hope is that none will be necessary. Our severe fear is that they will be, because epidemiological experience suggests that a virus that has a doubling rate of two or three days very quickly spirals out of control in geographical focal points. But we remain incredibly vigilant, and the focus of our effort is to use the necessary data to identify outbreaks when they happen and to move epidemiological resources into place in order to deal with those outbreaks.
On further data, we hope to make announcements shortly in order to get the most local data open to the dashboards available to local authorities and public health officials in the very near future.
The noble Baroness, Lady Thornton, asked about the involvement of the Mayor of Leicester in decision-making in Leicester. I reassure the noble Baroness that he was very much at the heart of all the analysis, the meetings with PHE, the gold meetings of the JBC and the process of agreeing the lockdown arrangements. That is entirely right and proper for such a situation.
The noble Baroness, Lady Brinton, asked about PPE in social care. I reassure both noble Baronesses that the measures in place to manage imports and the manufacture of the necessary domestic PPE have proved to have a huge yield and at the moment our RAG rating is extremely positive on PPE for all aspects of the healthcare system.
The Deputy Speaker (Lord Faulkner of Worcester) (Lab)
We now come to the 30 minutes allocated for Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of speakers.
Baroness Pidding (Con) [V]
My Lords, as we have sadly seen in Leicester, it is clear that this virus still lives in our communities. We know that testing is key in helping to keep the pandemic under control. Does the Minister agree that anyone who has been in close contact with someone testing positive for coronavirus should be able to get a test, whether they have symptoms or not? At present, this is not the case. In Buckinghamshire, for example, there is only one testing facility that offers this.
Lord Bethell
I reassure my noble friend that anyone who has reason to believe that they may have been infected by the virus is eligible for the test. The resources we have put into testing are now enormous. There are nearly 300,000 tests a day. Those in Buckinghamshire who are too far away from the drive-in testing facility should apply for an at-home testing kit.
Lord Patel (CB) [V]
My Lords, I agree with much of what the noble Baronesses, Lady Thornton and Lady Brinton, had to say. In response to them, the Minister said the dashboard will provide data about the infection rate to local authorities and local healthcare. If that is so, I welcome it. Does that mean a change in policy towards greater involvement of local public health directors in managing this pandemic?
Lord Bethell
To be clear to the noble Lord, the dashboard was made available on 22 June. It has a very large amount of local information, including information from 111, hospitals and the test and trace programme. The analysis of the data will be enhanced using the latest technology in order to give the most granular information possible. Those enhancements will be rolled out very shortly.
The Lord Bishop of Coventry
My Lords, the Minister said that data required by local authorities is given to them, but I am told by the leader of Coventry City Council and our director of public health that, although data sharing has improved over the past two weeks, it still comes from different sources and does not include data on workplaces and other settings that people regularly visit or, as we have heard, on ethnicity. Can the Minister provide further assurances that local authorities will be supplied with the full data that they need to respond to local outbreaks in a streamlined form and at an early point?
Lord Bethell
The right reverend Prelate is right that bringing together data from a very large number of sources is a challenge. One could include social media data, digital tracking data, hospital data and 111 data. We are working on systems that bring all the possible data one could imagine to one place at the joint biosecurity centre. We have made huge strides on that, but there is work to be done, and we are very much focused on it.
Lord Bach (Lab) [V]
My Lords, I declare my interest as the elected police and crime commissioner for Leicestershire and Rutland. I want to make it clear that I agree with the decision the Government have taken. The data makes it clear that it is necessary at the present time. This is primarily a health matter, but the excellent Leicestershire Police will be expected to play its part. It will do so proportionately and reasonably in the British tradition of policing by consent. The police may well incur extra costs in policing this matter. Will the Minister today make a promise that any extra costs the force incurs will be met fully by the Government?
Lord Bethell
My Lords, it is beyond my brief to comment on Home Office funding for the police force, but I emphasise that funding has been put in place— £300 million—for local authorities specifically to cover outbreak management and further funds are being looked at to cover this area.
Lord Hussain (LD) [V]
My Lords, around half of Leicester’s residents are black and minority ethnic. Given that the Public Health England report COVID-19: Review of Disparities in Risks and Outcomes shows that BAME people are more likely to suffer from the disease seriously and to die from it, what can the Minister do to ensure that specific advice is given as a matter of urgency to BAME residents?
Lord Bethell
The noble Lord is right to raise the question of marketing and communications to BAME audiences. We are looking at it very closely, because there is a natural concern about the regular epidemiological phenomenon that those who do not feel in the mainstream of society are sometimes the hardest to reach. We are focused in both our communications and our marketing on working with the groups that most fairly represent BAME communities to ensure that the message gets through. I would welcome any recommendations or suggestions from him on how we can do that better.
Baroness Verma (Con) [V]
My Lords, I declare my interest, as listed in the register, as a social care provider in Leicester. I am currently in Leicester and I have listened to noble Lords very carefully. Perhaps I may quickly pick up on a number of points. We in Leicester consistently pointed out to our local authorities and to the mayor and his councillors that they should look at areas where we believed there would be peaks in outbreaks of the virus, particularly in factories. We were totally ignored. We have raised the communications issue over and again, and we have been totally ignored. Now that the data is coming in and is being shared properly, will my noble friend confirm that there will be strong and swift enforcement in areas where we know that breaches have gone on, are going on and continue to go on, so that other parts of the community stay well protected?
Lord Bethell
My noble friend points to the crux of the matter, which is that the correct response to such a local outbreak requires careful collaboration between PHE, with its expertise, insight and data, and local leaders, who have local insight, regulatory muscle and influence. Her account of talking to the mayor and raising these issues is very important and interesting. All I can say is that we are now focused on making sure that PHE and the local authorities in Leicester work together very closely. We have learned lessons in this area. Certainly, outbreaks in some other towns and cities have been handled with a higher degree of collaboration at an early stage.
Baroness Watkins of Tavistock (CB) [V]
My Lords, I declare my interests as outlined in the register. The Statement makes no mention of day centres, many of which are lifelines for carers who have had little or no respite during the UK-wide lockdown. They support people with long-term conditions, including learning disabilities, dementia and severe, enduring mental illness. In the event of local restrictions associated with Covid-19 hotspots, how will such centres be affected? With the increasing stigma associated with working in areas with high Covid-19 rates, many agency staff are refusing to work in certain care homes. Can the Minister explain what safeguards around care and treatments, including access to higher levels of healthcare and specialist services, are being planned to ensure that care home residents will not be adversely affected by further restrictions associated with high localised infection rates?
Lord Bethell
It is my understanding that many day centres will be reopened, although they will have to undergo a very careful risk assessment and, depending on the physical layout, may not be able to open at full capacity. However, I am happy to check that point and reply to the noble Baroness in detail. The issue of agency staff is a big problem, particularly where the staff are itinerant, but I remind her that we are embarked on a massive recruitment programme for the social care sector, including a large recruitment marketing campaign. That is bearing fruit and we are filling spaces very quickly.
Lord Turnberg (Lab) [V]
My Lords, when will the Government begin to make the test available to the whole population and not just to those with symptoms, so that we can discover the 80% of asymptomatic carriers? If there is a lack of capacity, why not use private and university labs around the country, as is the case at the Francis Crick Institute in London?
Lord Bethell
My Lords, there is very wide access to tests. Anyone who wants a test can apply for one today and, in almost any location in the country, will get one this afternoon. Whole-population testing is not the Government’s strategy, because testing at this level of prevalence would throw up more danger of wrong results than positive results. In terms of private and university labs, I absolutely pay tribute to the Crick, the University of Birmingham, the University of Cambridge and all other university and private labs that have contributed to the test and trace programme.
Baroness Pinnock (LD) [V]
I am a councillor in Cleckheaton, where there was a significant outbreak in a meat-processing factory, with 165 positive cases identified. The Secretary of State has, rightly, praised the local response. However, the national testing response has been described as “shambolic”, and it hindered an effective local response. What has been learned from the incident? Apart from belatedly sorting data-sharing, how will government actions change as a result?
Lord Bethell
The noble Baroness talks of an incident that I do not know the details of, but I do not deny that we are on a learning curve. We will publish new guidelines tomorrow on our local outbreak response; we are publishing guidelines on the opening of venues for 4 July; and we are working extremely hard to stitch together much better relations between the centre, where a lot of the data inevitably ends up in a big system, and the insight of local actors in local PHE, local infection, NHS and local authority bodies. This has been happening for many weeks and we have already made huge progress, but there is still more to do.
Lord Ribeiro (Con) [V]
My Lords, the noble Lord, Lord Hussain, referred to the risks for the BAME population. The PHE report found that those of Bangladeshi ethnicity were at twice the risk of death compared with people of white British ethnicity. That, of course, is particularly relevant in relation to Leicester. The PHE follow-up report, Beyond the Data: Understanding the Impact of COVID-19 on BAME Groups, which came out last month, identified long-standing inequalities exacerbated by Covid-19. Occupation, population density, the use of public transport, housing conditions and the risk to key workers are all factors in acquiring Covid-19. What actions will the Government take to address the seven recommendations in the report?
Lord Bethell
My Lords, we take the PHE report extremely seriously but there is still work to do in understanding how the disease affects different groups, including ethnicities. Some effects are behavioural, such as obesity; some are social, such as population density, to which my noble friend alluded; and some might be genetic. It is not clear which of those three is the main driver and what the balance is between the three. We are investing a large amount in medical and clinical research to understand that dilemma. In the meantime, we are prioritising the safeguarding of BAME workers in the NHS who might be at risk and in need of specific treatment.
Baroness Falkner of Margravine (Non-Afl) [V]
My Lords, what specific plans do the Government have to host people in Leicester who test positive for Covid-19 in hotels to isolate them from multigenerational households and to keep the other members of the family safe?
Lord Bethell
The noble Baroness asks a sensible question. It is, however, an unfortunate truth that, by the time someone tests positive, it is likely that they may have infected other members of their household. So, our current guidelines are that anyone who tests positive should isolate themselves with all other members of their household for 14 days, thereby containing the virus and breaking the chain of transmission.
Baroness Hollins (CB) [V]
My Lords, are services that care for people with learning disabilities—a group with an even higher death rate than the over-65s—being provided with home testing kits? I hear of services that are having difficulty getting access to them. Secondly, what proportion of people completing a home test fail to register their test online and therefore do not receive their test result?
Lord Bethell
My Lords, home testing by those with learning difficulties should be a straightforward matter. Anyone seeking a home testing kit can apply for one online; we have a large supply and there is no capacity issue. The registration of home testing kits is improving all the time; we are working through a checklist of things to get that rate higher. At-home testing is a hugely valuable resource for specifically the reason that the noble Baroness alluded to, and to get the geographical spread we need if we are to make testing available to everyone in the country.
Lord Dubs (Lab) [V]
We have frequently been told that the key figure to look at is the R figure. Will the Minister confirm that whereas after lockdown the national R figure was 0.84, it is now 0.94—so we are on a bit of a knife edge? Secondly, can he explain why the R figure is not released locally at the same time as the national figure is released?
Lord Bethell
The noble Lord is right that the R figure is important, but in many ways, at this stage of the epidemic, the prevalence figure—the total number of people who carry the disease—is more meaningful. A higher R on a smaller prevalence is less worrying than a smaller R on a higher prevalence. As to having regional Rs, the data to date has not been strong enough for that to be a reliable figure. However, we are working towards that situation and I can envisage a moment when it would happen.
Baroness Sheehan (LD) [V]
Can the Minister say categorically that there will be enough properly equipped staff and support staff across all departments in local hospitals in Leicester to cope with the upcoming spike in admissions? What are the plans if local hospital capacity is breached? Will the Minister categorically assure the House that there will be no transfers from hospitals into care homes as a consequence of the projected spike in admissions?
Lord Bethell
I pay tribute to the NHS in the Leicester area, which has done magnificently. I understand that the facilities there are extremely resilient. In Leicester, as in many other places, a major source of concern is the spread of the disease among younger, working-age people, particularly those in their 20s and 30s, many of whom are not showing symptoms—are not touched negatively by the disease and may be socialising—but become infectious to their parents and grandparents. That is the cycle that we have seen in places such as Texas where, after the Easter break, young people led to a large outbreak of the disease. At this stage, hospitals are not facing the pressure, but we are leaning into the disease to prevent the cycle from heading that way.
Lord Polak (Con)
Sadly, social media is rife with speculation about local lockdowns. People are naturally anxious and often pass on the speculation, which can make matters worse. Can my noble friend the Minister tell the House what he is doing to combat fake news and false data, so that the Government’s messaging can be heard loud and clear?
Lord Bethell
My Lords, we have an energetic fake news and rebuttal team at the Department for Health—which I regard as an enormous shame. It is a waste of our time and indicates how dangerous speculation and false information of this nature can be. I have noticed in today’s social media a large amount of extremely irresponsible recycling of fake news by those who, frankly, should have known better. I urge all influencers, whether from the worlds of media, politics, health or other parts of society, to think carefully before recycling fake news and speculation on outbreaks in a way that wastes the time of public health officials and creates anxiety among the public.
Viscount Waverley (CB) [V]
My Lords, moving beyond the unfortunate Leicester situation, is it the case that Covid is mutating at such speed that it will diminish the effectiveness of a vaccine, and does it therefore follow that emphasis would best be placed on a cure?
Lord Bethell
The noble Lord stretches my scientific expertise to the limit, but my understanding from the CMO is that a distinctive feature of this virus is its surprising lack of mutation. It has proved to be an extremely sturdy and consistent virus. While many viruses get less deadly but more infectious, this one has remained pretty much the same. Cures for coronaviruses, particularly those that hit the lungs, are extremely rare and difficult to track down. I am advised that a vaccine is the quickest and most effective route, and I am extremely pleased that, in Imperial and Oxford, Britain has two of the leading vaccine candidates.
Lord Campbell-Savours (Lab) [V]
My Lords, last week I raised the issue of the report by the German IZA Institute of Labor Economics entitled Face Masks Considerably Reduce COVID-19 Cases in Germany: A Synthetic Control Method Approach. I had asked that the Minister arrange a fully considered response to me in a letter on the report’s findings. On that occasion, the Minister, who is always courteous, failed, probably inadvertently, to give me that assurance. Can I now have that assurance please?
Lord Bethell
My Lords, I remember the incident well and I intended no discourtesy whatever. I reassure the noble Lord that I left the Chamber and instructed my officials to draft that letter; on leaving today, I will chase it down and ensure that it goes to him speedily.
Baroness Tyler of Enfield (LD) [V]
My Lords, local lockdown plans in Leicester and elsewhere are vital to ensure that a proper place-based response takes full account of existing health inequalities. At an all-party group meeting yesterday, Sir Michael Marmot explained that Covid-19 has exposed existing inequalities in society and amplified them, with Covid-19 mortality rates closely linked to health inequalities and deprivation more widely. Does the Minister agree that, before the Summer Recess, your Lordships’ House must have a full debate on tackling inequality before a second wave hits us, with a sharp focus on the disproportionate impact on specific groups, particularly the BAME community?
Lord Bethell
My Lords, it is beyond my reach to instruct the House on its debates, but I would entirely agree with the noble Baroness that one of the saddest and most challenging aspects of Covid is that it hits society where it is weakest. It has undoubtedly hit those with health issues the hardest and has exacerbated health inequalities. It is my sincere hope that this Covid epidemic will be an inflection point, when this country embraces a strong public health agenda and addresses those health inequalities with energy.
Lord McColl of Dulwich (Con) [V]
Does the Minister agree that the reason why so many people in the United Kingdom and the United States have suffered from Covid-19 is that the majority of people in both countries are obese? Covid-19 and obesity is a lethal combination. We urgently need a nationwide campaign to reduce the obesity epidemic—to persuade people to put fewer calories into their mouth before the next pandemic arrives to affect even more people.
Lord Bethell
The noble Lord overstates his case a bit—it is 28% of Britons who are obese—but his point is very well made. We have undoubtedly been challenged as a nation because too many of us are overweight, and I say this with a degree of personal humility. As I said in my previous answer, there is a significant opportunity for this country to regard Covid as a massive warning shot and a potential inflection point where we address overeating and, as a nation, embrace the opportunity to get fit and lose some weight.
Lord Wood of Anfield (Lab) [V]
My Lords, on Monday the Mayor of Leicester said:
“It was only last Thursday that we finally got some of the data we need but we’re still not getting all of it.”
Is he mistaken, Minister?
Lord Bethell
Yes, the mayor is mistaken. He has been presented with all the data that we had. He has sat down with public health officials and been through that data, which has been re-presented to him on several occasions. I am pleased to say that he has finally come round to the lockdown measures that we have recommended.
Lord Bradshaw (LD) [V]
My Lords, currently we are dealing with coronavirus problems, but another problem is approaching us: we are telling people not to use public transport but, at the same time, we are filling our cities with cars, pollution and congestion. Can I be assured that all the health issues are taken into account in deciding how many people can travel on buses?
Lord Bethell
The noble Lord raises a significant challenge that has emerged from Covid: our profound reliance on public transport to keep our major cities and, candidly, much of our economy going. The idea that we can quickly return to packed tubes and crowded buses feels unlikely at this stage, but the answer is a difficult one to imagine, not least our need to get nurses and doctors to the front line of their hospitals and care provision. The health agenda on this is extremely important, and the noble Lord can rely on the Department of Health and Social Care to pursue it with energy.
Lord Singh of Wimbledon (CB) [V]
My Lords, it is important for children, particularly vulnerable children and those of key workers, to get back to school as soon as possible. Will the Government consider a shift system, whereby the day is divided into shorter hours with smaller class sizes to ensure maximum safety and maximum education?
Lord Bethell
The noble Lord is entirely right. I have four children, all of whom have returned to school this week, and they are all attending smaller classes for smaller amounts of time on different days of the week. As a parenting challenge this is considerable, but it has meant that they have returned to both the social and disciplinary aspects of school. I embrace this development and entirely agree with the noble Lord’s prioritising of this important subject.
Lord Lansley (Con) [V]
My Lords, will my noble friend the Minister commit the Government to maintaining their financial support for the Covid-19 volunteer testing network? He will know the important work that it is doing.
Lord Bethell
My noble friend is right to raise this important subject. I know the volunteer testing network; I value it enormously and am extremely grateful for its support. I am currently looking into its funding, and I would be glad to write to my noble friend to provide a clearer answer on that.
Lord Foulkes of Cumnock (Lab Co-op) [V]
The Minister graphically described Leicester as a rock pool while the tide of the pandemic goes out, but tides have a strange habit of coming back in again. The Government have decreed that all the pubs in England will open on a Saturday—4 July. As my noble friend Lady Thornton said, that has been described as another New Year’s Eve, and of course it is followed by a Sunday. What plans do the Government, and particularly the Department of Health, have to respond to any problems that may arise after this rather early New Year’s Eve?
Lord Bethell
The noble Lord is right to be concerned. I think we are all concerned about the unlockdown because we want to return to opening the economy and society, but we are naturally anxious about the consequences. I have met the leaders of pubs, clubs and others in the hospitality industry, and I am working extremely closely with them to put in systems with which we can record those who attend those venues to support our tracing efforts—and to provide a subliminal message to all those who attend that they are at a place of risk and have to behave with some common sense. I am extremely hopeful that the experiment will be a success, but we should not be under any illusion: if the tide returns and the experiment does not work out, we will have no hesitation in suspending the experiment and going back to closing the pubs if necessary.