Baroness Jolly (LD) [V]
I support the points made by the noble Baroness, Lady Thornton, on lockdown; she and I have repeated them regularly in these debates, and yet there is no change. My points will be around vaccines, acute hospitals and their staffing, and Christmas. I thank the Minister for repeating the Statement and join him in welcoming the news about vaccines. Anyone in need of a real feelgood story should watch last night’s “Panorama” programme about the development of the Oxford team’s AstraZeneca vaccine.
How confident is the Minister of 100% vaccine coverage, for those that are entitled, by Easter 2021? This is a lot of people, and we are not certain of all vaccines being available by that time. Could he explain to the House what determines who receives the AstraZeneca vaccine and who the Pfizer—or indeed any other vaccine that may come along? Is he confident that the new vaccines will be effective against the new variant that is emerging?
Can the Minister give us a statement about acute hospitals in tier 3 areas? At the moment, it looks as though the rise in cases in the London area and the south-east is almost matched by the rise in hospital admissions—they are just a percentage point apart. Are the Government confident in London’s hospital capacity? We know that, in some areas, there are Nightingale hospitals; is the NHS intending to bring them into use if necessary? Are there the clinical and other staff to run them?
For many of us, an in-person Christmas may not be possible. We need to look at the impacts that Thanksgiving had on the US Covid-19 figures and assess our risk. Many of my contemporaries have decided not to travel to celebrate with friends and family, and our children have told us that this is what we are going to do as well, so it looks as if many will be resorting to whatever is their favourite conferencing software to catch up with family.
Finally, will the Minister outline the Government’s communication strategy for Christmas? Clear messaging is imperative but many of the public who have been interviewed are unclear. Will ads be used in newspapers, broadcasts and online social media? Christmas is 10 days away, and people would appreciate a clear steer from the Government. This needs urgent and professional communications attention.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
My Lords, I am extremely grateful for the clear and thoughtful questioning from the noble Baronesses, Lady Thornton and Lady Jolly. Both of them are right: we are seeing a sharp rise in south Wales, London and parts of the east and south-east of England, which is making us rethink some of our approach to Christmas. We have seen a sharp rise in the virus across London, Kent, parts of Essex and Hertfordshire, and reports of a new variant. We saw the evidence of this starting in the 15 to 19 year-old age group and we have taken swift and decisive action but, unfortunately, more may be necessary. We know that this rise will be mirrored in hospital admissions, and it takes only a few doubling times to put pressure on the NHS. The noble Baroness, Lady Jolly, is absolutely right to question whether we have the resources in place to see such doubling take place over time. This is a trend we are seeing all over Europe, in countries such as Sweden, where nearly all the intensive care in Stockholm is currently in use, and even in Germany, where tougher new restrictions were announced over the weekend.
It is entirely natural that we look very closely at the Christmas relaxation, but I am not in a position to share any update on that this evening. The noble Baroness, Lady Thornton, asked: what is the Secretary of State’s plan to keep us safe? We have plans, and I will be glad to share them with noble Lords. However, may I just say a word about personal responsibility? The noble Baroness, Lady Thornton, put it well: it is up to each and every one of us to decide whether we will take a minimalist or maximalist interpretation of the rules. At the end of the day, it is a personal decision on what kind of risk approach one will take to Christmas. The SAGE advice has been published and it is clear. It does not make very comfortable reading for those of us with elderly relations who have been looking forward to seeing us, but it clearly states that we should be looking to spend time at Christmas with as few people as possible for as short a time as possible and, wherever possible, outside instead of inside. I am afraid to say that that will be what a responsible Christmas looks like for everyone. It is not something that the Secretary of State can ordain; it is, unfortunately, what the spread of the virus requires.
I acknowledge—the noble Baroness, Lady Thornton alluded to this—that the tier 3 regimes, particularly in the north of England, have had a profound impact. The behaviours of people in the tier 3 areas have been considerably amended, and that has seen a sharp reduction in the infection rates in those areas. It demonstrates that restraint works, and I take a moment to applaud all those who have played a role in that achievement.
On the vaccine, I will be very happy to provide an update on the special cases that the noble Baronesses alluded to. Both the case for unpaid carers and the case for the terminally ill are powerful, and we are listening carefully to them as they are made. However, the JCVI has put in its priority decision and that is what we are working to at the moment. Any further complications or refinements to that create profound operational challenges, but we are listening very sensitively to the case being made for the special cases.
I share the tribute of the noble Baroness, Lady Jolly, to the AstraZeneca team. The “Panorama” programme last night was a tonic for the soul during these difficult times, and I would recommend it to everyone.
As to the new variant to which the noble Baroness, Lady Jolly, alluded, the preliminary scientific judgment is that it does not at the moment show any evidence that it will escape either the vaccine or any other therapeutics that are targeted at Covid. That is always the natural concern in these circumstances; we are studying it very carefully indeed and will, of course, update the House if any changes do emerge. However, the new variant, which has been correlated with higher levels of transmissibility in Kent, does remind us that the threat of Covid is undiminished and we must remain committed to the restrictions in place to contain this horrible virus.
The Deputy Speaker (Baroness Morris of Bolton) (Con)
My Lords, we now come to the 30 minutes allocated for Back-Bench questions.
Lord Patel (CB) [V]
My Lords, we know that all viruses evolve and, while we do not yet know whether the genomic variant identified is more infectious, we do know that the transmission rate of the virus is rising exponentially. By the way, the Minister just said that the new variant correlates with increases in infection; the word “correlates” suggests cause and effect that has not yet been proven. Can the Minister tell us what scientific matrix the Government will use over the next week to make the political decision on whether to ease or otherwise the current restrictions, going forward to Christmas and beyond?
Lord Bethell (Con) [V]
My Lords, I am extremely grateful to the noble Lord, Lord Patel, for his description of affairs, which, as ever, is as thoughtful as we would hope. However, I clarify and disagree with him in that correlation and causation are not the same things. I chose my words extremely carefully: there is a correlation with higher transmissibility, but there is no evidence that this is caused by the variant; I want to be crystal clear about that. I pay tribute to colleagues at the Sanger and at COG, the genomics collective that is doing the work on tracking down the science of the new variant. Their insight is profound and they will be playing into the decisions about whether any judgment on the variant should play a role in the decisions about any future restrictions.
Lord Hayward (Con)
My Lords, does my noble friend the Minister accept what I deem to be the position in relation to the younger generation: that they are suffering from lockdown fatigue and are not responding to government messages? I suggest that, rather than having government Ministers and some scientists conveying the message of the importance of acting responsibly, they consider along with Jonathan Van-Tam somebody like Marcus Rashford, Rio Ferdinand or Harry Kane to convey the message that we are failing to get across? In association with that and the comments that have been made elsewhere, can the Minister tell us whether he has any information, in light of the FDA’s announcement, as to whether the Moderna vaccine will be recognised in this country in the near future?
Lord Bethell (Con) [V]
My Lords, I feel the point that my noble friend makes extremely personally. I am currently isolating with a 14 year-old; like many 14 year-olds, he and his friends never demonstrate any symptoms of Covid whatever and yet it would seem that they are carriers and vectors of the infection. The recent explosion in transmission in London and the south-east was led and probably caused by the 14 to 18-year-old age group, even though almost all of them are completely asymptomatic. We have worked with celebrities and opinion leaders in the youth groups to try to get this message across, but I point my noble friend to the announcement today of a very large increase in the use of asymptomatic testing in schools in the new year, as an indication of our commitment to ensuring that transmission among asymptomatic young people is contained.
Lord Winston (Lab) [V]
I thank the noble Lord for repeating the Statement. I concur with what the noble Baroness, Lady Thornton, said from the Front Bench. We know from the history of plagues that they occur through travel. This happened in the 1340s and again in the 1660s with the plague of London. Now we are seeing people travelling to London, which is a massive hub of travel; they come to the airport, they do not leave a phone number or address—they are not required to do so—and tests at the airport are voluntary. Many people go missing and are not followed up by a proper track. When they get tested, they pay for it, so it is entirely voluntary. Does the noble Lord feel that these arrangements are sufficient, given that so many people travel to London and that there is a risk of this plague continuing just as they have done historically?
Lord Bethell (Con) [V]
I am grateful for the noble Lord’s insight. He is right that travel is the friend of the virus. Many of the growths in transmission have been associated with it; one thinks of the ski resort holidays at the beginning, the spring break migrations in America and other examples. I reassure him that, while he is right to question the arrangements around our airports and transport hubs, we have brought in a much more strenuous test to release programme which is much more realistic than the previous isolation programme. The procedures around the passenger location ports have been tightened up and the enforcement and tracking arrangements for passengers have been supplemented. There is now a very strong body of evidence to suggest that passengers are abiding by the testing programme. As he may know, private tests were launched yesterday, and their uptake has been incredibly impressive.
Baroness Hollins (CB) [V]
My Lords, 200,000 people are on their GP’s learning disability register and get the flu jab on the same terms as over-65s, but only one in 10 of this group has been prioritised for vaccination. My research 25 years ago found that these people were 58 times more likely to die before the age of 50 in ordinary times, and PHE research found a death rate 30 times higher for 18 to 34 year-olds with learning disabilities than for others of the same age during the first wave. To require them to wait until their chronological age group is eligible seems discriminatory. Will the Minister commit to look at this again?
Lord Bethell (Con) [V]
I completely acknowledge the correlation between mortality and learning difficulties that the noble Baroness alludes to. PHE has looked at this in respect of Covid very closely. That evidence played into the JCVI prioritisation process; it landed on age as the main determinant for that process but continues to review this based on evidence. The noble Baroness makes a good case, but I reassure her that the JCVI has looked at all this evidence very closely.
Lord Robathan (Con)
My Lords, during all these restrictions and over the lockdown we had for one month, which ended on 2 December, we have been told that the Government are following the science—the “unstoppable force of science”, to quote the Secretary of State in yesterday’s Statement. However, in late September SAGE recommended circuit breakers of two to three weeks, which Wales imposed for 17 days until 9 November; it now has coronavirus rates that are nearly three times those of England. What confidence does the Minister have in the scientific advice he is given?
Lord Bethell (Con) [V]
My Lords, the restrictions in England have never been based on a two-week circuit breaker. It was not a policy that the DHSC supported.
The Deputy Speaker (Baroness Watkins of Tavistock) (CB)
The noble Baroness, Lady Blower, has withdrawn, so I call the noble and gallant Lord, Lord Craig of Radley.
Lord Craig of Radley (CB) [V]
My Lords, the Statement refers to a new variant of the virus. Is this the only variant, or are others being found overseas? Porton Down is working to discover whether the current vaccines will remain effective. When does it hope to report? I declare an interest: I was vaccinated in the Fakenham medical centre in Norfolk this morning—a very efficient and reassuring experience—which had 365 planned for today.
Lord Bethell (Con) [V]
I massively congratulate the noble and gallant Lord on his vaccination this morning. I am extremely proud of that moment and glad that he has taken a step towards safety. It is a fantastic piece of news, which we should all celebrate.
On the noble and gallant Lord’s question on the variant, there are dozens—possibly hundreds—of variants, some of which are minimal and insignificant. The one that has been thrown up in Kent is being singled out only because it correlates with an increase in transmissions in Kent. It is not certain whether this is because of the variant or because of behaviours in Kent, but naturally we are worried about it. I am not a biologist, but I am assured by the biologists that the new variant does not seem to show any attributes that would mean that it could escape the vaccine. Naturally, we are looking at it very closely and hope to have an answer to his question shortly.
Lord Randall of Uxbridge (Con) [V]
My Lords, the Government are between a rock and a hard place with regard to the Christmas arrangements. If it is decided that circumstances now dictate a change, does my noble friend agree that it is imperative that the public are given as much notice as possible of any changes?
Lord Bethell (Con) [V]
My Lords, we always seek to give the public as much notice as possible. But I accept that one of the most frustrating aspects of this pandemic has been that the virus does not behave as predicted, and that the response to restrictions and policies by the public has not always turned out exactly as we planned. It is therefore sometimes true that our policies need to change at short notice. This is incredibly challenging for the public—I do not duck that point in any way—and I am extremely grateful to the public for their forbearance under the circumstances.
Lord Mackenzie of Framwellgate (Non-Afl) [V]
My Lords, I can fully understand the necessity for additional measures announced by the Health Secretary in another place yesterday in light of the statistics. It is not just Covid deaths likely to increase but, of course, the deaths from diagnostics not being carried out on potential cancer and stroke patients—not to mention the pain and misery being inflicted on patients who have to postpone elective life-altering surgery. Is there not now a powerful case for the Government to consider reversing the superspreader travel festivities bonanza during the five days of Christmas which, as night follows day, will inevitably lead to more infections, hospital admissions and deaths, as has happened in America following Thanksgiving?
Finally, having heard the Minister’s considered responses this evening, am I right to feel a little more optimistic?
Lord Bethell (Con) [V]
My Lords, the noble Lord, Lord Mackenzie, makes a powerful case. There is undoubtedly a dilemma about what we should do in the approach to Christmas. The country does deserve a break, because it has done so much this year to contain the virus, and yet the consequences of too much social mingling are harsh, as he rightly describes. I reassure him that we have done a huge amount to restart elective surgery and other diagnostics and to get the NHS working as hard as we possibly can. It is our objective to ensure that the non-Covid death rate is not affected by the Covid response.
Lord Campbell-Savours (Lab) [V]
My Lords, can I return to the issue of masks, which I have been pushing since February? With London in lockdown, a new variant and the prospect of an explosion in transmission in the new year, why not, in this rapidly developing crisis, adopt a vigorous belt-and-braces approach, follow worldwide mandatory practice and require mask wearing in all public places outside the home? Why not ban the use of valved masks, apart from in clinical settings? They protect only the wearer. Now is the time for really tough decisions; there is a big crisis that confronts us.
Lord Bethell (Con) [V]
My Lords, I pay tribute to the campaign and advocacy by the noble Lord, Lord Campbell-Savours, on masks. He has moved the needle on this subject. I would argue, perhaps, that there is a huge amount of mask-wearing, particularly in public places; certainly in shops, on transport and even in the House of Lords, mask-wearing has become mandatory. So, he has already come a long way. We continue to review additional options in this area. His point on valve masks is extremely well made and is one that I have made to the relevant officials.
Baroness Finlay of Llandaff (CB) [V]
My Lords, I declare that I chair the National Mental Capacity Forum. I ask the Minister to express thanks to staff in his department as they continue to work with us and the Ministry of Justice to run a rapid-response webinar on Friday, requested from primary care leads yesterday, following their pilot, to support primary care as vaccination is rolled out to care homes, where many residents have seriously impaired capacity. We aim to disseminate the latest guidance and ensure appropriate information to support understanding for consent to vaccination, including easy-read and pictorial versions of information.
Lord Bethell (Con) [V]
I am enormously grateful for the work that the noble Baroness, Lady Finlay, and the National Mental Capacity Forum have done during the pandemic. The issue of mental capacity and consent has been addressed in official guidance that the NHS and others have issued to medical professionals who will administer the Covid vaccine in care homes. I understand that officials at the DHSE and the MoJ are supporting the forum with the webinar planned for this Friday, and I am absolutely delighted to reaffirm the Government’s support for the forum’s work on these important areas.
Baroness Verma (Con)
Will my noble friend do a communications strategy or campaign to debunk the idea that the vaccines have animal content? There are messages going around on social media that would stop people from minority communities, in particular, from having the vaccine if it did have animal content.
Lord Bethell (Con) [V]
I thank my noble friend for providing this opportunity to scotch that unhelpful rumour. I confirm that there are absolutely no animal components in the vaccine. That point has been endorsed by the British Islamic Medical Association, members of which issued a fatwa earlier this year confirming that the vaccine was halal. My noble friend is right that there are stories on social media that are extremely distracting. We engage with sympathy with those who are concerned about the vaccine, but these stories are completely wrong, and I would like to put them to bed.
Lord Hunt of Kings Heath (Lab) [V]
May I continue on the theme of vaccines? Has the Minister seen the very recent survey by King’s College and Ipsos MORI, which found that 46% of all 16 to 34 year-olds say that they have seen or heard messages discouraging the public from getting the vaccine? Alarmingly, 27% of them believe that the real purpose of a mass vaccine programme against coronavirus is to track and control the population. Social media is playing such an important role in vaccine disinformation. Is the Minister really satisfied that all is being done to combat it?
Lord Bethell (Con) [V]
My Lords, the noble Lord, Lord Hunt, is right to be concerned. Some of the data we have on public attitudes is of extreme concern and the statistics he has referred to show exactly why we have focused on this area as much as we have. We have worked extremely closely with social media platforms to try to minimise the availability of this material, and we have a large communications programme to engage with those concerned about taking the vaccine. I reassure him that our experience to date has been that when those who are considering taking the vaccine reach the moment of decision, their confidence increases, and I am hopeful that that will continue.
Baroness Stuart of Edgbaston (Non-Afl)
My Lords, in the Statement made in the other place, reference was made to notification to the World Health Organization about the new variant. The Statement went on to say:
“Public Health England is working hard to continue its expert analysis at Porton Down.”—[Official Report, Commons, 14/12/20; col. 23.]
I invite the Minister to make it absolutely clear that the work done at Porton Down is on behalf of the whole United Kingdom, not only Public Health England, and that any of the vaccinations which have been procured are procured on behalf of the whole United Kingdom. He may also want to say how the vaccines are to be distributed.
Lord Bethell (Con) [V]
The noble Baroness is entirely right. The vaccine is a great success story for the union and for the United Kingdom. We have had a four-nation approach and the distribution of the vaccine shows the union at its best. She is right to say that the work done at Porton Down is on behalf of all the nations of the United Kingdom and that the communication to the WHO was on behalf of the whole country. That communication demonstrates that our approach to the vaccine is to put transparency first and that we have moved extremely quickly to share this insight with our colleagues overseas.
Viscount Waverley (CB) [V]
My Lords, I am reliably informed that only two of the 14 passengers in a carriage on the 5.48 am Southeastern train from Gravesend to the London terminus this morning were wearing masks, so clearly the message is not getting through. Adding to the words that the Minister offered to the remarks of the noble Lord, Lord Winston, on the challenges that have appeared this morning of the long- awaited test release scheme, I ask: why not resolve this in part by passengers obtaining a test evidencing a negative result within 72 hours of travel into the UK? Further, if they have received a vaccination abroad or a negative test result abroad, will official confirmation from an appropriate authority from abroad be acceptable to the United Kingdom?
Lord Bethell (Con) [V]
If I have heard the question correctly, that is exactly how the test release scheme works. Travellers are invited to sign the appropriate forms and after some days they can be released from isolation early by taking tests. That scheme has been signed off by the Chief Medical Officer and data from the test is transmitted to Public Health England. We currently have a UK-only testing regime and we do not take tests from overseas, but we are keeping the scheme under review.
Lord Balfe (Con)
My Lords, it appears that it is among younger people where the spread is now concentrated. What is the severity of the infection? It has been put to me that it is not that severe and that, indeed, many younger people are saying that they have to learn to live with it. I do not think that things are helped by the harsh rhetoric of “4,000 deaths a day” and so on. It just goes over people’s heads. They are saying, “This is not believable. They are going on about it, but it doesn’t matter.” Instead of using punitive terms, could the Minister go for more of a nudge theory, as put forward by David Cameron, and try to persuade people that it is in the interests of everyone to do certain things, rather than terrify them all the time—because that is not working?
Lord Bethell (Con) [V]
My noble friend Lord Balfe is entirely right to say that the symptoms in young people are zero in many cases. There are issues of both saliency and believability among many young people who think that this is a disease that simply does not touch their lives. It is understandable that they may think it implausible that they could be carrying the disease. However, the statistics are crystal clear. When looking at the heat maps, you can see easily how infections grow among the young and then graduate through the demographics until they hit older people, and then hospital admissions rise. I am extremely sympathetic to young people and why they find this idea a challenge to believe in, but we have to hit home with this message—otherwise, we will not be able to contain the disease.
Baroness Bennett of Manor Castle (GP)
My Lords, my question follows that asked earlier by the noble Lord, Lord Young of Cookham, to the noble Baroness, Lady Stedman-Scott. It referred to how some local authorities have run out of funds to give the £500 payment for people to self-isolate, when they would not otherwise be able to financially. In response, the noble Baroness said that there is only a fixed envelope of money, suggesting that no more would be provided to those local authorities. As Health Minister, would the noble Lord agree with me that, whatever tier people are living in, they have to be able to self-isolate and feed themselves, pay their rent, et cetera? Do people not need that £500 in every part of the country, without there being a postcode lottery?
Lord Bethell (Con) [V]
My Lords, the noble Baroness is entirely right: the whole purpose of the isolation payments and the idea behind them is the recognition that people who are being asked to self-isolate, particularly if they come from a low-income household, to which the isolation payment is targeted, need financial support to fulfil their civic obligations. That is why we put the scheme in place. It is true that it has been tremendously successful in some areas. We continue to review whether that fund needs to be topped up.
The Deputy Speaker (Baroness Watkins of Tavistock) (CB)
The noble Lord, Lord Rooker, and the noble Baroness, Lady Fox of Buckley, have withdrawn, so I call the noble Lord, Lord Singh of Wimbledon.
Lord Singh of Wimbledon (CB) [V]
My Lords, the Statement rightly emphasises the need for swift and decisive action to control the deadly virus, which is increasingly affecting schoolchildren. Yet, when a few schools in London planned to close a few days before the end of term but to continue with internet classes, they were threatened with legal action. Does the Minister agree that, while children’s education is important, their health and that of their parents and grandparents should also be considered before rushing to legal threats?
Lord Bethell (Con) [V]
The noble Lord makes his point well, but I respectfully disagree. One of the great challenges from closing schools is that young people then socialise and spread the disease much further and wider than they would if they stayed at school. This has been demonstrated time and again around the world. Also, to keep our hospitals open and our businesses and education systems going, and to stop deprivation from accelerating, it is desperately important to keep schools open. That is why, today, we announced the rollout of a much greater and enhanced asymptomatic testing regime for schools, in the new year, which will see bubble and teacher testing, so that schools can remain open.
Baroness Uddin (Non-Afl) [V]
My Lords, in the light of the British Medical Journal’s formal joint letter with the Health Service Journal, I hope that the Minister will reconsider the Christmas relaxation of the rules. The point I wish to make really echoes those of my noble friends Lady Verma and Lord Hunt. It is about the scepticism around medicine within some sections of the communities—in particular within Bangladeshi communities, where disproportionate numbers of deaths and infections have occurred. In the light of many noble Lords raising questions about communication issues, will the Minister urgently meet me and some of the local specialist media to consider reviewing the messaging that targets some of these communities?
Lord Bethell (Con) [V]
I completely accept the point made by the noble Baroness. It is incredibly frustrating that the exact communities which have often seen some of the highest mortality rates are also those which are sceptical about the vaccine. This is one of our biggest challenges; it has been for months and will continue to be so. I pay tribute to colleagues at the Department of Health and the Cabinet Office who have done a huge amount in working with specialist media—radio, magazines and online forums—to target exactly these communities. They have used advertising and direct engagement with the presenters to put the message across, often in local languages, and this has proved increasingly effective.
The Deputy Speaker (Baroness Watkins of Tavistock) (CB)
My Lords, all speakers have been called.