Baroness Barker (LD)
I thank the Minister for yet again turning up at the crease to defend what is becoming increasingly indefensible: the poor performance of the NHS Track and Trace system.
The noble Baroness, Lady Thornton, was right to note the admission in this Statement that 16,000 positive results had not been uploaded, and that by yesterday only 51% of those people had been contacted, despite the injection of resources into NHS Track and Trace over the weekend to try to make up the deficit. Given that we know that each person who tests positive is likely to report between four and five contacts, that is potentially 60,000 people who last week were walking around, not self-isolating and possibly infecting others. It is not their fault—they did not know. It is a really significant breach of trust.
In the part of the Statement that I find most curious, the Secretary of State said that the Chief Medical Officer’s analysis of the Government’s assessment of the disease as a result of the new data was that
“its impact has not substantially changed.”
Can the Minister give us further detail about that? The omission of 60,000 people not having any impact does not add up at all. The Secretary of State went on to say that the Joint Biosecurity Centre had confirmed that
“it has not impacted the basis on which decisions about local action were taken last week”.—[Official Report, Commons, 5/10/20; cols. 625-6.]
When will that data come through and when will we be able to see the impact on local areas? As these statements make clear, the virus is beginning to have different impacts in different places. Can the Minister say at what point directors of public health were informed about this breach? Six months in, it is clear that, when local authorities are properly resourced and given correct and timely information, the virus is managed and contained. The major problems come about when decisions are made centrally, poorly communicated and badly executed.
Time and again, it comes back to track and trace, whether it is about a lack of skills and capacity or a lack of foresight. Who could not have foreseen the impact that hundreds of housefuls of students moving around the country in September would have on transmission?
Yesterday when this Statement was debated in another place, speaker after speaker, mostly from the Conservative Benches, got up to complain about the effect of the 10 pm arbitrary cut-off. They explained how well-run businesses, especially in the hospitality sector, will be going to the wall because of continued use of blunt instruments designed nationally and applied over wide geographical areas. How long will it be before the Government realise that local people—local professionals, directors of public health and environmental health officers—have detailed knowledge about businesses in their area, their hygiene ratings, their previous breaches of licensing conditions and where crowds congregate? When we can get decision making to a more local and granular level, we will be better able to protect good businesses without jeopardising public health.
I welcome the announcement of hospital funding for upgrades to A&E departments. We need a greater capacity for A&E. However, could the Minister give the House the definition currently used by this Government of what constitutes a new hospital?
On the Orbis project, we go into this having left a safe and highly effective system of medicines regulation, one where patient safety is paramount. How does the Government propose to withstand the commercial imperatives of American pharmaceutical companies in these circumstances?
The public are getting very worried about the extent to which the Government continue to wing it. It is time for them to bear down on the fundamental flaw in their strategy—thinking that they know best in the centre, above people who are professionals at a local level.
Lord Bethell (Con)
My Lords, I thank the noble Baronesses, Lady Thornton and Lady Barker, for their remarks. The noble Baroness, Lady Thornton, is entirely right about the situation that we face. The latest update, as of 4 o’clock today, is that we have 14,542 daily positives today: 2,833 are in hospital with Covid; of those, 496 are on ventilators, and I am sad to report there were 76 deaths.
These are numbers that make us extremely focused on the challenge of Covid. Earlier today we debated the rule of six, when there was a large amount of challenge about whether such rules on social distancing were really necessary. We were reminded in clear terms about the social impact of separating those who love each other. Here we are talking about the impact on the health of the nation and the threat presented to those who are vulnerable, elderly and have pre-existing conditions. Getting the balance between these two things is extremely challenging, but that is the strategy of the Government—to bear down on the virus while protecting the NHS, education and the economy until we can see a way out through the vaccine, through therapeutic drugs and through mass testing. That is our approach.
I make no bones about it; the errors made over last weekend with the data was extremely regrettable. It undoubtedly causes grave concern among those in Parliament and the general public. I cannot hide from anyone the importance, impact, and severity of the situation. However, I would like to say a few words in mitigation. First, I pay tribute to those at PHE who have pulled together a remarkable system in extremely difficult circumstances, across the length and breadth of the country, integrating many systems into one. I know that that may seem like a trivial challenge and beside the point when we are dealing with a national emergency like this, but these are incredibly complex and difficult tasks. They have involved extremely committed personnel on the technology side of things who have personally checked a huge amount of the numbers. As my noble friend Lady Harding explained, it was through the perseverance of some of those personnel that the mistake was identified.
Between 17 and 23 September, 87,000 were identified through our testing and tracing programme; that is a phenomenal number of contacts where we had the opportunity to intervene and break the chain of transmission. Some 83.7% of those were reached and asked to isolate. I completely appreciate the concerns of those speaking in the Chamber today about the test and trace programme, but those figures are remarkable. That we have set up a system that can intervene in the lives of so many who are carrying coronavirus and can bring to bear such pressure on the disease after such a start as we had at the beginning of the epidemic is a phenomenal achievement. I know that the last thing one wants to be, at this stage of things, is a hollow champion of empty achievement, but that is a hell of a thing for this country to have got to.
There have been questions about the collaboration between the centre and northern leaders, and I cannot hide the fact that there are some quite fruity discussions on the pages of the newspapers and news channels between different community leaders. However, we have to be adult about this and acknowledge that there are different roles for different parts of government. The mayor of a city simply does not have a huge laboratory in which to do tens of thousands of tests a day. The mayor of another city simply does not have a control room filled with PhD analysts who can crunch the numbers and run massive supercomputers with complex algorithms to look at millions and millions of items of data within minutes. These are not the functions of local government, nor will they ever be.
Likewise, the JBC, the Department of Health and Social Care and the Cabinet Office do not have the local knowledge of what is going on on the ground and are not expected to speak a wide range of languages. We do not know what the behaviours are of people on a street-by-street basis. That is the role of local government, and it is through the collaboration of the local and national that we will beat this disease. To try to throw up a false dichotomy and set up test and trace as a scapegoat to blame and punish for the frustrations we all feel about the disease is counter- productive and reveals a shallow understanding of a complex situation.
The noble Baroness, Lady Thornton, said that perhaps care home testing should be sent to hospitals. In many cases, hospitals are involved in care home testing and handle the staff of care homes, but hospitals have to cover their own clinical demands, and pillar 1 is stretched to do the testing of hospital staff and patients. Landing that additional burden is not something that the NHS would welcome.
With regard to the northern leaders and their running commentary on the work of test and trace, I reassure the House that the conversations held in private on a daily—and sometimes hourly—basis have an altogether more collaborative tone. I have been privy to a large number of those conversations; there is a huge amount of expertise on both sides of the conversation, and one should not take too seriously the knockabout commentary in the newspapers and on TV.
The noble Baroness, Lady Barker, asked for an update on contact tracing, and she is entirely right. To have missed a substantial number of contacts during those days was a really big disappointment, but we have moved a huge amount of resources in order to catch up. There has been a phenomenal catch-up already, and I understand that my right honourable friend the Secretary of State will be updating the other place on the progress of that shortly.
I reassure the Chamber, however, that all those who had a positive test were informed promptly. There was no omission in that respect. Therefore, the primary index case, and the person of greatest threat to community transmission, was identified and isolated, and that chain of transmission was shut down.
I will now address the questions about the CMO and the JBC and their analysis of our numbers. I reassure the noble Baroness, Lady Barker, that the integrity of the CMO is unimpeachable; if he judges that the change in numbers has not changed policy, I reassure the Chamber that that is a good judgment that is completely consistent with the way in which we have behaved over the last few weeks.
The noble Baronesses, Lady Thornton and Lady Barker, both asked about Project Orbis. This is a welcome move, enabling the UK to join an international framework to provide concurrent submissions and regulatory views of oncology products, which may allow UK patients to receive earlier access to medicines in the future. I pay tribute to colleagues at the MHRA, who I know have worked really hard on collaborating with American, Canadian and Australian regulators. I am extremely optimistic about the dividends from this collaboration. It augurs, promisingly, similar future collaborations across the health sphere.
The Deputy Speaker (Baroness Pitkeathley) (Lab)
My Lords, we now come to the 30 minutes allocated for Back-Bench questions. I ask that questions and answers be brief, so that I can call the maximum number of speakers.
Lord Craig of Radley (CB) [V]
My Lords, cars can kill, but driving is not banned. Medical treatment reduces the mortality of those badly infected, but will banning work, study and family meetings through lockdowns and crashing the economy be the right strategy for months to come while leaving the more vulnerable to choose which precautions to adopt?
Lord Bethell (Con)
My Lords, I completely sympathise with the observations of the noble Lord. No one wants to see the economy crashed. No one wants to see families separated. Nor do we think that locking up those who are either vulnerable or elderly is a thoughtful or reasonable way to approach this epidemic. What we are seeking is a middle way—a strategy that balances the needs to preserve the economy, education and the NHS with the importance of suppressing the virus and breaking the chains of transmission. That is the approach that we are pursuing today, and it continues to be our strategy going forward.
Baroness Rawlings (Con) [V]
My Lords, the Minister said in the Statement that all people testing positive are required by law to self-isolate. Can he tell the House what the fine is if someone breaks the law? Have all the people who travelled on the train and tube with Ms Ferrier MP been traced and tested? If so, how, and if they tested positive, have they been quarantined?
Lord Bethell (Con)
My Lords, the case of the SNP MP has shocked the nation. I do not want to comment on it in detail. I do not have the details of what after all is a private matter. That is for the police and the House authorities to examine.
However, the principle to which my noble friend refers is very clear and simple. If you are positive, you isolate. If you are contacted by the contact-tracing system, you discuss your recent contacts with the contact tracers, who will coach you and rehearse with you fully the length and proximity of those contacts and will give a thoughtful clinical judgment on which ones need to be subjected to further contact and isolation procedures.
This is absolutely essential to breaking the chains of transmission. It has a huge amount of support among the public and a tremendous amount of compliance, and we are building on the existing compliance with the enforcement regime that we brought in recently. I call upon all members of the public to support this important approach.
Baroness Clark of Kilwinning (Lab)
The Minister will appreciate that the 10 pm curfew, the restrictions already in place in many parts of the country and, indeed, the likely further restrictions that will be brought in, given the levels of Covid, will have a big impact on employment. Other countries are continuing with their furlough scheme, but the scheme that we are introducing to replace it is not as generous. Will the Minister not accept that unless the Government put significant further financial support in place, we will face huge levels of unemployment in this country, with millions of people out of work, an increase in poverty and probably the worst recession that any of us have ever known?
Lord Bethell (Con)
My Lords, the impact of all the restrictions, on the hospitality sector in particular, are particularly acute. I completely recognise the noble Baroness’s point that this touches on the lives of many hard-working people from low-income backgrounds who have casual labour arrangements with the hospitality sector. There are millions of people involved, and this epidemic has hit them particularly hard. That is why we put schemes in place like the furlough scheme.
The Chancellor spoke very movingly this morning on the “Today” programme about his intentions and his determination to ensure that people are protected from the worst outrages of Covid. We are also putting in economic measures to avoid the kind of recession which the noble Baroness describes. The honest truth is that other parts of the economy are doing extremely well. It is an awful shame and sadness that, once again, Covid is hitting the most vulnerable the hardest, and the noble Baroness is quite right to identify the people she does.
Lord Farmer (Con)
My Lords, in the other place yesterday, the Secretary of State was very definite that the virus is transmitted from surfaces. However, this has been recently disproved, for example by Professor Gandhi of the University of California and the microbiologist Emanuel Goldman, who state that while the virus may persist on surfaces, the traces involved are not viably infectious. Will their important new research now be instilled into our response to Covid, so that we can start to move on to “project hope”?
Lord Bethell (Con)
My Lords, I am extremely grateful for my noble friend’s recommendation. It is a source of huge frustration, and amazement to me on some level, that the precise nature of transmission in all cases is not crystal clear. I am not sure that I would completely agree with my noble friend that it has been thoroughly disproved that the disease can never be transmitted from surfaces. In fact, there are others who think that this may actually be a very important vector of transmission. We certainly do not understand the full nature of the way in which aerosol transmission behaves, and it is likely that it is a mixture of them both. That is why we urge the country to comply with the Hands, Face, Space protocols.
Baroness Armstrong of Hill Top (Lab) [V]
My Lords, it is significant that, in what can only be seen as a gloomy Statement, no reference has been made to the most vulnerable, many of whom were in the shielded category. National Voices has been listening to these people over the summer and published its report today. Too many in the most vulnerable category say that they feel, and felt, abandoned. They say, for example, that they want to be:
“given information that is relevant to me, in a way I understand.”
That is what many in the country, around all of this, are actually asking for. If we get it right for the most vulnerable, we might begin to get it right for the rest. When are the Government, after promising that they were going to issue more guidance and support to those shielding, actually going to do that?
Lord Bethell (Con)
My Lords, I am touched by the testimony of the noble Baroness. I pay tribute to the work of National Voices, which has presented an extremely thoughtful and helpful guide and presented the testimony of those who have been under the extremely harsh regimes of shielding. She is entirely right that those who have had to go into the most extreme forms of lockdown depend the most on government guidelines. Those guidelines can be complex, and people can feel confused or lonely and separated because of their status. We have invested a huge amount in local authorities and in charities specifically to reach those groups. It is through that kind of civic and public service support that we can work with those people. It is not properly the role of central government to have individual communications with those who are shielding at home. We rely on our partners, and we have provided an enormous amount of resources to ensure they can do that job properly.
Lord Hamilton of Epsom (Con)
My Lords, if I was diagnosed with coronavirus today and subsequently recovered or showed no symptoms over the next couple of weeks, in 27 days I might get knocked over by a bus and killed, and that would be registered as a Covid-related death. My question to my noble friend is this: why are we including all these deaths that are nothing to do with Covid in the overall statistics that we publish every day?
Lord Bethell (Con)
My Lords, if my noble friend caught Covid today and recovered in two weeks’ time, I would personally celebrate that enormously, as I am sure would others in the Chamber. He is right that we have existing protocols for identifying cause of death, and we approach Covid in exactly the same way we do all other causes of death. This is to help our demographic analysis. Of course, the example that he gives—which is entirely correct—is an extreme example, but it is helpful for us to understand, when we are doing retrospective analysis, who has been touched by Covid in order to explain at a later date where the causes of those deaths may have come from. A death that is not apparently from Covid today may in future have a clearer connection.
Baroness Donaghy (Lab) [V]
I have a question for the Minister and a follow-up to his response about local government. How can the Government prove that public money being spent on test and trace and IT systems fulfils all the requirements of public procurement? I support my noble friend Lady Thornton in her expression of concern. Some years ago, I was a non-exec director at King’s College foundation trust, and the responsibilities of the board for good governance, accountability and proper procedures for public procurement were very clear. I do not have the same feeling for the contracting and other procurement services in the Government today. The Minister says the Government are extremely focused. It feels more like the Mad Hatter’s tea party.
Secondly, the Government’s response to the approach today by council leaders in the north for help, including local test and trace systems, has been made clear by the Minister this evening. Frankly, it was breath-takingly patronising. Will he take the offer from local government seriously?
Lord Bethell (Con)
My Lords, I will tackle those in reverse order. I would not seek to be patronising for a moment. We value the contribution of local leaders enormously, and if I hit the wrong note then I regret that. What I was trying to get across is that the rhetoric in the public media and the realities of the day-to-day conversations between government and local government are not exactly as they might appear. The roles performed by both are complementary, rather than a zero-sum game. It is worth in this Chamber remembering that.
On procurement, the noble Baroness is entirely right; there is a real tension between the absolute requirement to move quickly to meet the challenge of Covid—to stand up facilities and services that did not previously exist—and to move on a national population-wide scale in a way that is not frequently seen in the health system. I can reassure the noble Baroness that a huge amount of work is being done on the auditing, checking and supervision of these contracts. They are not entered into in either a naive or flaky way—quite the opposite. We have put a huge amount of audit and legal resources into striking the right contracts. Cabinet Office colleagues provide a huge amount of analysis and challenge to the way in which these contracts are drafted and in checking against the delivery of the products and services involved.
The Deputy Speaker (Baroness Pitkeathley) (Lab)
The noble Lord, Lord Robathan, has scratched, so I call the noble Baroness, Lady Bennett of Manor Castle.
Baroness Bennett of Manor Castle (GP) [V]
My Lords, questions in your Lordships’ House on this Statement have understandably focused on Covid-19, but the Statement as delivered in the other place is a broad-ranging survey. It starts by talking about treatments for Covid and then shifts to approvals for new cancer treatments; it looks at the expansion of urgent and emergency care; and those mysterious 40 new hospitals appear yet again, as the noble Baroness, Lady Barker, alluded to. In that context, I ask the Minister whether this Statement is sufficiently balanced. If this is a survey, where is the public health element?
Covid has exposed, even more than we recognised before, a deeply unhealthy society with terrible diets, inadequate opportunities for exercise, poverty, stress, and a mental health epidemic. We know from Victorian and early 20th-century times that it is public health measures that really make the difference. In facing up to tackling Covid, surely that is the direction in which we need to be looking. For example, new research today showing the impact of air pollution includes some very stirring suggestions that childhood exposure has an impact on the rates of dementia and Alzheimer’s. My questions to the Minister are these. Are the Government paying enough attention to public health? Is their strategy sufficiently balanced? Are they funding and doing enough on the broad measures that will create the healthier society that is so clearly desperately needed in the time of Covid or at any other time?
Lord Bethell (Con)
In her analysis of the Statement, the noble Baroness is, as ever, inspiring and optimistic. I am extremely grateful for her remarks. The Building Back Better programme will put a vision for public health at the centre of our efforts. We will build on this awful epidemic to ensure that our public health outcomes improve.
Lord Rooker (Lab) [V]
My Lords, the Minister will be pleased to know that I do not intend to ask any questions about the report from the department on testing between 17 September and 23 September. As the noble Baroness, Lady Barker, said, there is a reference in the Statement to the Chief Medical Officer and his analysis. I have a simple, very specific question. On what date, and at what time on that date, did the Chief Medical Officer become aware of the missing data issues? On what date, and at what time on that date, did he issue his analysis? If these answers cannot be given now, I would like a commitment that I will receive a letter with the answers.
Lord Bethell (Con)
I am grateful for the noble Lord’s question. My right honourable friend was very clear. The Chief Medical Officer analysed our assessment of the disease and its impact, and assessed that it had not substantially changed as a result of these data. The Statement from my right honourable friend is crystal clear. I will be glad to send the noble Lord a copy of that Statement if he does not have it.
Lord Balfe (Con)
My Lords, this afternoon’s release from the Office for National Statistics tells us that:
“There were 215 deaths involving … COVID-19 … in England and Wales in the week ending 25 September”.
This remains far below the numbers seen earlier in the pandemic and accounts for just 2.2% of all deaths in the latest week. Our liberties are being trashed and our freedoms removed. When will the Government get down to putting some hope into things? Most people do not know what the rules are, and if they do they are getting round them. I should like a commitment as to when we can open up surgeries and hospitals, and a promise that by Christmas people will be able to visit their elderly relatives in care homes and those who are unfortunate enough to be in hospital. Can we not have a bit of hope, as opposed to this constant gloom?
Lord Bethell (Con)
I hear my noble friend’s frustration, and he is right to call for hope. We all want some hope—we are all feeling exhausted by Covid. But it is ironic that my noble friend mentions the low level of deaths as though that were a bad thing. To me, that number is a source of huge pride, because it shows that we have kept a lid on Covid—our NHS is improving the treatment of people who have Covid and we are winning the battle against Covid. I celebrate that.
Lord Mackenzie of Framwellgate (Non-Afl) [V]
My Lords, it is increasingly apparent that the key to successful test, track and trace is the provision of a speedy test result, without which the whole process is delayed. Sir Paul Nurse of the Crick Institute makes the case for locally based laboratories to do this more efficiently. A similar argument applies to using the skills of local authorities to track and trace contacts. Will the Government reconsider their obsession with a centralised, world-beating system?
Lord Bethell (Con)
I completely endorse the views of Sir Paul Nurse on this and on all matters, wherever I can. The noble Lord is entirely right: speed is critical, which is why we have put major laboratories in regions up and down the country. There are nearly a dozen of them now; they are paired with the pathology networks of the NHS, and our tracking and tracing system works closely with local government. When the large call centre-based tracking and tracing has gaps or when local teams can supplement, augment or complement the work done by the major teams, we seek those opportunities wherever we can.
Lord Hunt of Kings Heath (Lab) [V]
My Lords, I remind the House that I am president of the Health Care Supply Association. I come back to procurement and contracting. Will the Minister respond to the question of my noble friend Lady Thornton about a break clause in the contract with the private suppliers of test and trace? Will he confirm that Public Health England is fully a part of his department, that its staff are officials of his department and that the Secretary of State is fully accountable for its performance?
Lord Bethell (Con)
My Lords, I cannot give a detailed analysis of the thousands of contracts that the test and trace system have gone into, but I reassure the noble Baroness, Lady Thornton, and the noble Lord, Lord Hunt, that these contracts are pragmatic, commercial and thoughtful. The interests of the taxpayers are paramount, and a substantial team of commercial professionals and lawyers from the Department for Health, the NHS and the Cabinet Office is focused on making sure that we get value for money.
The noble Lord, Lord Hunt, is right: PHE is entirely accountable to the Department for Health. I do not know the precise status of the contracts for staff, but they are an important and valued part of the Department for Health’s family, and we work extremely closely together.