The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I am grateful for the questions from the noble Baroness, Lady Thornton. If the noble Baroness, Lady Jolly, returns, I shall be happy to answer her questions, too.
The noble Baroness, Lady Thornton, asked a lot about the testing programme. Let me reassure her with some statistics about last week’s processes. Some 1,892,000 test were done in the week from 1 to 7 October—I repeat, 1,892,000 tests. That is a colossal number, and the vast majority of them were done promptly, accurately, and to the satisfaction of those involved. Of those, 89,874 results were positive, which is a substantial increase of 64% compared to the previous week. That is 89,874 people who would not have had a test six months ago, because we simply did not have the capacity, the knowhow or the systems to do that.
The number of people transferred to the test and trace programme since the beginning of August has increased by 10 times; 67,511 were reached, of whom 57,000 provided details of one or more close contacts. In other words, 67,511 people were taken out of the chain of transmission and asked to isolate, were provided with a financial supplement to care for them and were phoned—sometimes many times, it would appear but, generally, once or twice a week—in a pastoral call to ensure that they had access to local authority, charity and financial support. Of those non-complex cases, 55.9% were reached within 24 hours. That is not good enough, and we need to work on it more, but 55.9% is enough to make a serious impact on the progress of this virus. Without the test and trace programme, we really would not be match fit to combat this virus at all.
The story that the noble Baroness told of her friends was distressing. Anybody who has had the virus will know that it is a miserable affair. For the entire family to have had it is very sad, and my feelings are sincere when I say that I am sorry to hear about her friends who have had coronavirus. But the guidance is relatively straightforward. You are to isolate for 14 days from the original infection. That would have been the advice that they had on the telephone and, if their app said otherwise, the telephone supersedes anything that the technology might have told them.
On getting tests at all, I acknowledge that the general public are not at the top of the priority list right now. The top priority is to protect clinicians and NHS workers, as well as those in hospital care who have the threat of nosocomial infection. Secondly comes social care—protecting those who are vulnerable and live either in residential or domiciliary care. Those people are at the top of the list. We are building our capacity dramatically; we are on course to hit our ambition of 500,000 tests per day by the end of October, and many more beyond that.
The tests that the noble Baroness, Lady Thornton, described are incredibly impressive. The saliva testing is much easier to use, and the LAMP testing is phenomenally accurate. The capacity for those LAMP tests to be rolled out across social care and hospitals is enormous, and we are investing considerably in that.
The noble Baroness, Lady Thornton, also asked about Manchester, and there the situation is distressing. I cannot hide the fact that the increase in prevalence in Manchester is a source of enormous sadness, but I reassure her that the extra measures that have been taken there have been accompanied by the offer of extremely generous financial measures.
Those financial measures have been accepted by Lancashire and by Blackpool—but not, it seems so far, by Manchester. We hope very much indeed that Manchester will remain at the table. The negotiations being undertaken by the Government are generous and open hearted. We have already made available £465 million to help local authorities implement and enforce restrictions. Greater Manchester will definitely receive £22 million of this, and we will continue to work with the Greater Manchester councils to ensure that testing and local contact tracing are allocated in the right way. We will continue with those negotiations. The negotiations with Manchester were entirely proportionate to the support that we have given to the Liverpool City Region and to Lancashire, and it is a source of enormous regret that the mayor decided to reject it.
The Deputy Speaker (Baroness Henig) (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.
Lord Lansley (Con)
My Lords, the figures today for the number of cases and deaths are deeply worrying. It is a 20% increase in the week in the number of cases and, of course, the number of cases that we have seen in recent weeks is now tragically leading to a much-increased number of deaths, so there are no grounds for complacency. However, as I think we all understand, this is a marathon, not a sprint, and there is an inevitable tension in the question of how far businesses can be shut down on a permanent basis—and we want to avoid that.
I put it to the Minister that to support businesses that are Covid-secure and keeping open, we need compensating measures to try to limit the transmission in social circumstances. Would the Government consider extending the advice across England that, when indoors, people should mix only in their own household and social bubble, and that the rule of six, while continuing to apply, is not sufficient indoors? We need to limit the mixing of households indoors.
Lord Bethell (Con)
My Lords, my noble friend’s observation is entirely right. In Manchester alone there have been more coronavirus infections already in October than in July, August and September combined. The average daily hospital admissions in Greater Manchester are now higher than they were on 26 March, and there are now more Covid-19 patients in Greater Manchester hospitals than in the whole of the south-west and the south-east combined. These are illustrative of one region but it is a story that has already played out in others, and we naturally fear that it will play out in others in the future.
My noble friend’s advice on the mixing of households is very perceptive. One thing with that we cannot do anything about is the kind of infection that the noble Baroness, Lady Thornton, described among her friends, where it spreads within a household. That is something that no household can reasonably fight against. However, stopping the spread of disease between different households is something that we can lean into. It requires an enormous amount of social distancing and a return to the kind of lockdown measures that we had at the beginning of this year. That is something that we are extremely anxious to avoid because it has enormous social impact, it is disruptive to our way of life, and it has an economic impact because it has implications on social distancing and on some businesses. Still, my noble friend is entirely right that that is exactly the kind of area that we will need to look at if we are to contain the spread of the virus.
The Lord Bishop of London
My Lords, from my background as a former Chief Nursing Officer, I am aware of the difficult decisions that Her Majesty’s Government are required to make, as well as of the importance at this specific time of good public health action. However, I have heard the concerns expressed by my colleagues in the north-east and the north-west of England, including some of my right reverend friends in your Lordships’ House: Covid-19 is disproportionately affecting the vulnerable and, unfortunately, so are the restrictions. There are significant concerns about their compliance with regulations that they do not feel are fair. The Government have frequently made assertions about public health behaviour and science without publishing the evidence or properly engaging with people in the communities affected. The interventions may well be right but the implementation seems to be failing. The Government must genuinely engage with, listen to and learn from people affected at a local level. Without such local buy-in, public health actions will not happen.
There is also some concern that the restrictions are impacting on those least able to manage the health and economic impact. There are concerns that movement into tier 3 will continue to exacerbate matters such as child poverty, deprivation, economic and health inequalities and poor mental health. If the perception is allowed to grow that certain sections of the economy or society can be allowed to bear the substantive weight of fresh regulations without levels of financial support, the consensus will not hold. Will the Minister reassure your Lordships’ House that, as areas move to tier 3, local voices will be listened to and everything will be done to ensure that the risk to the most vulnerable is minimised?
As I have already said in your Lordships’ House, the local public health nurse can inform top-down rules with local experience. What is being done to ensure that when the ring-fencing of funding that was passed to local government for public health comes to an end at the end of this financial year, it does not lead to further disinvestment in public health?
Lastly, faith communities, like public health nurses, are part of local populations and areas, and should be used more as experts to help leverage insights that they gain on the ground to support the public health action and interventions needed. I again encourage the Government not to neglect the whole-system approach to public health, as we work together on the challenge of Covid-19.
Lord Bethell (Con)
The right reverend Prelate puts it extremely well. We completely recognise that not only does the virus attack the most vulnerable, but those who are least fortunate bear the huge brunt of the lockdown and the measures needed to crack down on the virus. In these matters, I emphasise that it is worth stepping back and reminding ourselves that the Government are not the source of the problem; the virus is. All the Government can do is take measures to save lives, protect our healthcare service and keep our schools open. In that way, it is not right to demonise central government for taking measures.
Central government can take measures to help protect the vulnerable, and I acknowledge the right reverend Prelate’s point on this. I reassure her that we have put in place the Job Support Scheme to ensure that those affected by business closure are still paid; we have made £465 million available to help local authorities implement and enforce restrictions; we have provided £1 billion of extra funding to local authorities across the country; and we are committed to working with local authorities to allocate testing and tracing locally.
On the message the Government deliver, I recognise the phenomenon described by the right reverend Prelate, but I reassure her that there is no intent by government to make an association between poor behaviours and results. The data is there. We have published every piece of data we can and, to an extent, it does not lie. It is an uncomfortable truth, but some communities have consistently higher prevalence and infection rates. There is some responsibility on those communities to address the causes of that. It is an intent shared by government, local authorities, communities and individuals. There is no avoiding the fact that you cannot pin responsibility on any one of those four pillars.
Lastly, the right reverend Prelate is entirely right that faith communities pay an important role. I pay testimony to those faith communities in cities such as Leicester and Bolton, which have worked with us to great effect. We continue to put our relations with faith communities at the centre of our outreach to communities.
Baroness Andrews (Lab) [V]
My Lords, is the Minister aware that, today, a highly respected member of SAGE, Professor Stephen Reicher, said that the three-tier system is
“the worst of all worlds … where there is no sense of clarity. There is a growing sense of inequity and resistance”?
Wales has decided to go for a circuit break, with the situation deteriorating, and a poll suggests that public opinion is very much moving towards recognising that this is necessary and will support it. What evidence can the Minister provide to show Professor Reicher that he is wrong?
Lord Bethell (Con)
The noble Baroness makes her point well, but I will defend the three-tier system. It is an important mechanism to avoid a national lock- down, which is our objective. It was designed in close collaboration with local authorities and stakeholder groups. It has proved effective in a number of areas, and there is evidence of infection rates coming down where local lockdowns have been effective. But I completely agree with her analysis of public opinion. There is a growing sentiment that decisive action may be necessary, and an enormous amount of support, despite what one reads in the newspapers, for decisive action by the Government to restrict the spread of this virus.
Lord Rooker (Lab) [V]
I will change the subject. Early in the Statement yesterday, the Secretary of State referred to the shortening of the wait for cancer treatment since the long waits in July. I support the Secretary of State in thanking all the cancer teams working so hard, and indeed single out the staff of Hereford County Hospital in charge of my treatment, which started in Christmas week last year. Can the Minister confirm that the two-week cancer diagnosis plan is still functioning, and will he do more to encourage people to attend their GP, as I did, not guessing what was wrong? They do not have to be uncertain or have a suspicion, but if they know something might be wrong, the GP and the specialist will find it out. People need to be encouraged to do that and not be put off by the pressures on the NHS from the virus.
Lord Bethell (Con)
My Lords, I am enormously pleased to hear that the noble Lord’s cancer treatment has progressed so well. Like him, I pay tribute to those at the Hereford County Hospital who participated in his treatment, and in fact to all those who have maintained an incredibly high level of cancer treatments through the difficulties of the pandemic. Broadly, cancer treatments were maintained at around 85% of their normal practice during the summer months, and the restart has come on a long way. In July 2020, 87.8% of patients saw a cancer specialist within two weeks following a referral from their GP, and 94.5% of patients received treatment within 31 days of a decision to treat. However, I completely agree with the noble Lord’s analysis: more could be done. That is why we are backing the Help Us, Help You campaign, which is a very high-profile marketing campaign, to try to drive up attendance rates and ensure that no one is put off by fear of hospitals or GP surgeries when they have a tell-tale sign, and that they go and get the referral that they need.
Baroness Pidding (Con) [V]
My Lords, we have clear evidence that obesity is a real hazard with regard to Covid-19. Tackling obesity and promoting the benefits of exercise, both for our physical and mental well-being, are quite rightly priorities of this Government, both now during this pandemic and beyond. Does my noble friend the Minister agree that we need to do all we can to ensure that gyms remain open as long as they can operate in a Covid-safe environment? Can he also confirm my understanding that we have two regions that are both currently in tier 3 with differing restrictions: Merseyside where gyms are closed, and Lancashire where gyms are open? Surely we need clarity of message.
Lord Bethell (Con)
My noble friend illustrates the complexity of trying to work with local authorities and the impact of giving local authorities the discretion to make decisions on their own. In this area, in tier 3, we gave discretion to local authorities on their gyms. Merseyside decided to close its gyms and Lancashire did not. It is entirely appropriate for them to make their own assessment. I confess to feeling a real and genuine dilemma when it comes to gyms. My noble friend is entirely right that activity is important, particularly at a time of lockdown. However, medical advice on hygiene is that the spray from exertion and sweaty bodies is very difficult to contain, even in a well-meaning and well-managed gym. That is why we have given local authorities that choice and why we keep the matter under review.
Lord Dubs (Lab) [V]
My Lords, I have two brief questions. Somebody I know received the following message on their mobile phone:
“Possible COVID-19 exposure. Verifying exposure info. The app has accessed the date, duration and signal strength of this exposure.”
Can the Minister say what this means? Is the recipient supposed to do anything about it or is this some maverick message? My second question is on a different point. Does the Minister agree that there are people in this country who are too apprehensive about the possible quarantine to go abroad and so have to quarantine on their return to this country? Could we not adopt the system, which certainly seems to be working in Germany, that we offer testing for people arriving from areas where they are liable to be quarantined, possibly testing them two or three days later? That means they would not have to be in quarantine for two weeks and risk losing their job, and so on. Could we not adopt that simple expedient?
Lord Bethell (Con)
I reassure the noble Lord that his friend’s notification came from a new feature of Apple phones called “Exposure Notifications Express”. This is something that we have worked hard to incorporate in the existing app. I slightly suspect that, if she has a new version of the NHS app, she will not receive these notifications any more. We are grateful to Apple for enabling its phones to work in developing countries, but there has been some turbulence with our own app, which we think we have resolved.
On quarantines, I say that, as a follower of these debates, the noble Lord will know that the CMO’s view is that testing on arrival will capture only 7% of infections, and it is very difficult to apply quarantines to get people to commit to staying longer. However, we are committed to running pilots to try to open the kinds of schemes that he describes, and I would be happy to report back on their development.
Baroness Wheatcroft (Non-Afl) [V]
My Lords, at the beginning of this debate, the Minister gave a very spirited defence of the test and trace system. This morning, my daughter and her 15 month-old daughter were tested, and it was very efficiently done, but they were told that they should expect results in two to three days’ time. The Minister mentioned 24 hours; what timetable are the Government trying to operate on for test and trace because, clearly, if there are two days that are fallow, an awful lot of people risk being infected?
I will also address the issue of gyms. The noble Baroness, Lady Thornton, talked about the lack of clarity at the beginning of this debate. If people are to stick to the rules, they need clarity. I do not understand why gyms are open at all, quite honestly. It seems to me—as the Minister indicated—that they are potential hotbeds for coronavirus. However, we are told that discretion is given to local authorities to decide what they do and do not allow. I recall that Manchester was absolutely determined that it would like to stop alcohol sales at the same time that, if not sooner than, pubs were forced to close, but it was not given discretion over that. I would be grateful if the Minister could explain when local authorities do and do not have discretion.
I also wonder whether the Minister could tell the House the position on travel to work. Office workers are told to work from home if it is possible for them not to work from the office, but there does not seem to be a ruling that says, “Do not go to work in an office unless you absolutely have to”. What counts as essential? What instructions are the Government giving to civil servants about whether they should travel to work? We are told that gatherings that are “reasonably necessary” can take place in office environments with no limit on the numbers involved. In the circumstances, that seems crazy. If the Minister could clarify the position, I would be grateful.
Lord Bethell (Con)
I reassure the noble Baroness that 24 hours is our objective, and it is clear that a 24-hour target is right. Having swift turnaround is conducive to effectiveness, and that is what we are trying to do. There has been a very large increase in demand in the last 11 weeks, which has put pressure on our operations and pushed back some of our turnaround times. We are working extremely hard to address that; new capacity is coming on-stream all the time, and we are hopeful that that can be turned around very quickly.
The noble Baroness is entirely right to raise her point on clarity, which is very similar to those raised by others, including the right reverend Prelate. There is a really important balance that we have to get right here because to have communal buy-in to our measures, we need to somehow mobilise leaders that people trust, from their faith community, their local community or other leadership groups that they subscribe to.
However, to give people a role in the decision-making about what measures are to take place in one area or another, there will be an uneven application of regulations—what happens in one place will not be the same in another. We have made a commitment to a partnership between national and local government, and we are trying to manage that complex partnership at the moment. As noble Lords know from the discussions in the other place and our conversations with Manchester, this is an extremely bumpy affair and it does not always work out well.
However, we are committed to doing this precisely for the reasons the noble Baroness described: to have buy-in, we need to mobilise all the country and all the people who are respected by those who adhere to the rules. That is why we take the approach we do. It means that gyms will be open in Lancashire but not in Merseyside. It is argued that this is a complexity that the British public can handle. It also takes us into very public conversations about funding, the allocation of resources and the establishment of new testing facilities. We believe it is worth the administrative and political effort to try to do that. There are also delays to the implementation of some of the restrictions. The British public will form their own judgment on their politicians and whether that is worth their while. These are the prices and friction costs to the local/national partnership that we are committed to, which has been advocated on the Benches of this Chamber for many months.
Baroness Bennett of Manor Castle (GP) [V]
My Lords, the noble Lord, Lord Lansley, referred to the risk of mixing indoors. From the housing department, the noble Lord, Lord Greenhalgh, today kindly answered a Written Question from me about ventilation standards in building regulations in the light of Covid-19. It referred to the most recent SAGE paper on aerosol transmission, dated 22 July. The science on aerosol transmission has moved on a great deal since then. The noble Lord indicated that a new paper is being prepared by the SAGE Environmental and Modelling group. I note that German schools, for example, have strict conditions about opening windows regularly, even in the coldest conditions. Is the Minister confident that the current strength of advice on levels of ventilation, particularly to businesses where people are mixing, either retail premises, offices, or gyms, as we have been discussing, and to schools, is adequate?
Lord Bethell (Con)
The noble Baroness is right to raise questions about the way in which the disease is transmitted. We have put a huge amount of effort into studying it. I pay tribute to the epidemiologists who have crafted sophisticated models and have sought to test them in practical ways in order to establish, for good, the really important questions of how one person’s conversation, breathing and spoken word might transmit the disease to another person either through the air or on surfaces. Understanding that is absolutely essential in order for us to put in place the right kinds of Covid safety measures. However, at this stage it is an imprecise science. For instance, there is some evidence that transmission from hygiene and surfaces can play a very important role, perhaps meaning that we have to invest more thought and commitment in cleaning measures. The guidelines we have for workplace and school testing reflect the very best provable standards according to scientific evidence. We continue to invest in these important epidemiological insights, and I welcome very much the contribution of the scientists on SAGE and all those who continue to try to gain a better understanding of this issue.
Lord Hunt of Kings Heath (Lab) [V]
My Lords, in the first Statement that we are debating, the Secretary of State spoke about the strategy being to suppress the virus and support the economy and the NHS. He did not specifically mention the vaccine programme, although clearly it is an important part of our approach. Although the Government have secured early access to, I think, over 300 million doses, there will not be enough for the entire population to receive them immediately. The Joint Committee on Vaccination and Immunisation has published interim advice on a prioritisation programme. Will the Government follow that advice, and can the Minister say more about what work is being undertaken to encourage a high uptake?
Lord Bethell (Con)
I thank the noble Lord for his interest. The JCVI is, as he described, the agency responsible for giving advice on the prioritisation plan. Our policy is to follow that advice, and I pay tribute to those on the panel for the hard work they are putting into that. The interim advice is extremely thoughtful and follows the best values and standards of this country. We are putting a lot of work into trying to raise adoption rates of the vaccine. We face a challenge from those who would like to query the science or have some form of national or commercial vested interest in undermining confidence in the vaccine. We are putting a lot of work into mitigating that risk. That is not work that I would like to discuss at the Dispatch Box but I would be very glad to share some of it privately at a later date.