Baroness Brinton (LD) [V]
My Lords, I add my tributes from these Benches to all those who continue to work well above and beyond the call of duty in all areas to do with managing the Covid pandemic. This includes the vaccination teams, the invisible workers—the scientists working in labs and all those who we do not see on a daily basis—as well as our overtired doctors, nurses and other clinical healthcare workers, and those in social care who are still taking remarkable precautions.
It is worth noting despite the reduction in cases, hospital cases and deaths that daily cases are still double the level that they were at the lifting of lockdown 1, so it is good that the Government are not speeding things up. We need to continue to move carefully and steadily, as later parts of the Statement talking about the India and South African variants give cause for some concern. It is also reassuring to see that uptake of the vaccine is excellent. However, the Statement is silent on when all adults will have been offered the second vaccine. That is important because, as scientists constantly remind us, two doses are needed. Focusing only on the first vaccine is giving the vast majority of the public overconfidence about protection. If people want to go on holiday, one dose of the vaccine will not be enough, whether that holiday is in the UK or abroad.
That leads also to those who are immune-suppressed and to those under 18, because until all are safe, none are safe. Can the Minister say if there is any news on the OCTAVE clinical trials on the ability of those who are immune-suppressed to make and retain antibodies? Those formerly shielding—including me—still need to avoid mixing with people. They are still waiting for news to see if they can relax, even after two doses of the vaccine.
What is the news for children? I understood that the trials on over-12s had been halted following the blood clot issue with the AstraZeneca vaccine. Is that still the case? What are the long-term plans to ensure that our under-12s and, indeed, our under-18s are safe? The Statement says that:
“The vaccine is our way out of this pandemic”.
Not on its own, it is not. We must continue to test, trace and isolate to keep people safe. The Government are to be applauded for the large number of lateral flow tests because they are useful, but they are not as effective as PCR tests for really tracking the virus.
Had I not been unable to do so, I would have loved to have been at Wembley on Sunday supporting my team, which, sadly, lost to Leicester. I would have been delighted to have been part of a testing arrangement to see what happens, but other fans have said that they were only asked to be tested in advance and that there is no testing afterwards. Is that correct? In other words, how detailed is this testing for moving back into normal life going to be?
I am a member of the All-Party Group on Coronavirus, and this morning we heard from scientists who are bemused that immediate contacts of those who test positive are still not routinely PCR tested, which all the countries with a truly effective test and trace system operate. That is vital with the high percentage of people with Covid still having no symptoms, so they would believe that there is no reason for them to be tested, and it is particularly important with the information about the spread of the variants from South Africa and India.
I have family who live in Wandsworth. This time last week, as the announcement about mass testing across Lambeth and Wandsworth was made, we were told that everyone in those areas would be publicly informed. Three days later, not only had my son heard nothing, but he walked past a newly set up testing site a few hundred metres from his house, went in, and discovered that he did need to be tested. So, he and my daughter-in-law had their tests. It transpires that the only notification from Wandsworth Council before the weekend was a tweet, with none of the mechanisms used elsewhere such as texts via GPs, posters up in the street, word of mouth, or even leaflets. How on earth can that be real surge testing if only a small percentage of the population see a handful of tweets?
On the India variant, scientists also told the APPG this morning that the estimated figure of 103 cases was considerably lower than the likely number of cases circulating because only 10% to 15% of positive lateral-flow swabs are sent on to laboratories where they are scanned for variants. This might mean that the actual number is 10 to 20 times the official estimate. This brings us full circle, back to test, trace and isolate. Even with vaccines, it is vital to have an effective test, trace and isolate system to keep people safe. As the noble Baroness, Lady Thornton, outlined, adding India to the red list but giving people three-and-a-half days’ notice before implementing it, means that a large number of cases are likely to slip into the country. Even if they are caught through positive testing, we are unlikely to have a real sense of the actual number of cases.
This follows on from the concern that we from these Benches have had about successful self-isolation and quarantining for a year. The APPG heard evidence this morning that demonstrated that arrangements at our borders, particularly in airports, are not Covid safe, either for travellers or staff, and they risk becoming breeding grounds. This now needs to include effectively separately passengers who arrive from red-list countries from those who arrive from others, and ensuring that all quarantine rules are observed. We heard evidence that people were leaving their quarantine hotels early, and that others, quarantining at home because they did not come from red-list countries, were being forced to use public transport to get to testing centres for their day eight tests. Worse, border staff are discovering around 100 fake Covid test certificates daily, and there are probably many more. If that does not signify a real worrying standard for the possibility of vaccine passports, I do not know what does. When will a proper test, trace and isolate system be put in place that includes immediate contacts and more lateral-flow tests being tested for variants, along with vital, proper, paid arrangements for self-isolation, including quarantining and proper separation in the transport arrangements for those coming from abroad?
Finally, I will spend just one minute on Greensill. It is not just Greensill: we need desperately to see full publication of all meetings and correspondence—informal and formal—that Ministers have had regarding all contracts, whether it is payday loans, PPE or testing arrangements. This also includes the new quarantining partners; the Health Secretary said on Monday that two have already been sacked, having been in place only for a short time. It is vital that the smell-test on all these contracts is evident and sure.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I am enormously grateful to both the noble Baronesses, Lady Brinton and Lady Thornton, for such thoughtful questions. I totally and utterly endorse both with regard to their massive thanks to NHS staff, to the vaccinators and, in particular, I echo the words of the noble Baroness, Lady Brinton, who thanked the invisible workers. I am acutely and particularly aware of the lab technicians, many of whom have worked unbelievably hard in difficult circumstances, often located far from their homes, supporting our laboratories up and down the country. There are many other categories of invisible workers in our healthcare system and they deserve our huge thanks.
I am as concerned as the noble Baronesses about the threat of variants of concern. It is an absolutely frustrating and anxiety-making fact, that we simply do not know a huge amount about what the impact of these variants will be on transmissibility, severity and escapology. We are throwing absolutely everything we have got at this to try to understand the features of this disease. However, it is true that while we can study them in a mathematical or computer-generated model, we get only so far with that. We can study them on the workbench and get a little bit further, we can stick them in a tube with some serum from someone who has had a vaccine, and maybe figure out a bit more, but it is only when we have the real-world data of how the vaccines have worked in real life when put up against the virus that we can accurately conclude what the impact will be. Therefore, only the passage of time will give us the critical data we need to go forward.
In the meantime, we are standing up a huge international effort to try to understand the variants that are emerging around the world. The noble Baroness, Lady Thornton, asked me about global co-ordination. Britain is absolutely playing its role; it is using its chairmanship of the G7 to full effect. As noble Lords are, I am sure, fully aware, we have a world-leading facility in genomic sequencing. We have made a massive, open-hearted offer to the world to sequence the genomes of any variants of concern, from any country in the world, through the newly launched New Variant Assessment Platform. We are working to set up hubs to develop expertise in that capacity around the world. We are working extremely closely with multi-laterals such as the WHO, with the relevant major trusts such as the Gates and Rockefeller foundations and the Wellcome Trust, and with individual countries, to provide the insight, the fast-turnaround analysis and the assessment of new variants as they turn up.
Within our own country, it is concerning that variants have made landfall, but I reassure noble Lords that we have put in place remarkably diligent efforts to close down any spread of variants of concern when they have occurred, whether they are from India, Brazil or South Africa. It is a fact that the Operation Eagle process, which is supported by local authorities, DPHs, test and trace and by the JBC, has so far—touch wood—proved to be extremely effective at closing down community spread. We have numbers of the variants in the UK but a very large proportion of them are known to be related to travel and they have not yet created clusters of infection of the kind that might cause concern. The MQS—Managed Quarantine Service—has played an absolutely critical role. I pay tribute to the MQS team, who are at this very moment putting in place arrangements for managed quarantine for flights with travellers from India. They have put in place the necessary pre-testing, the hotels and the assessment.
While I hear, loud and clear, the concerns raised by the noble Baroness, Lady Brinton, about that process, I reassure her that her list of concerns is quite different from the operational notes that I am given every day. The truth is that it has kept a lid on any spread of VOCs in the UK to date. On Wandsworth, I pay tribute to the enormous civic response to our concerns around the cluster there. I recognise the concerns of the relative of the noble Baroness, Lady Brinton, in that area, but there has been an absolutely massive news and community-marketing promotion of the home testing, pharmacy testing, MTUs and ATSs in Wandsworth. Very few people indeed cannot have heard of the arrangements that are in place.
With regard to the OCTAVE clinical trials, that is of grave concern to all those who have immunosuppressed circumstances. We are working extremely hard with Birmingham University, with Professor Paul Moss, to understand more about the response of those with immunity issues. It is a frustrating fact that those with pre-existing immunity issues are likely to be the ones who have the lowest and least response to the vaccine. We are trying to understand as best we can how that can be supplemented. As noble Lords may know, we have already invested considerably in new arrangements for therapeutics and antivirals that we believe will support those with immunosuppressed conditions. I would be glad to write to the noble Baroness about our arrangement for vaccines for the under-12s.
If there are any other questions that I have not had time to answer, I would be glad to write to the noble Baronesses with full answers.
The Deputy Speaker (Lord Duncan of Springbank) (Con)
My Lords, we now come to the 30 minutes for Back-Bench questions. I ask that noble Lords keep their questions as short as they can.
Baroness Jenkin of Kennington (Con) [V]
What plans are being put in place for flu and Covid vaccine booster shots for the winter?
Lord Bethell (Con)
I am extremely grateful for that perceptive question. We are looking, at this very moment, at our arrangements for the autumn. For the flu vaccine, we hope to double down on our hugely successful efforts from last autumn. We hope to build on the experience of the Covid vaccine to ensure that a much wider range of people have the vaccine, so that we can deal with those who might head towards severe illness, and to stop transmission. When it comes to the Covid vaccine, we are beginning to try to understand whether a booster shot will or will not be necessary to address the threat of VOCs. As I said earlier, we are still at a stage where we do not have the full science at our disposal but, if necessary, we will roll out a vaccine booster programme in the autumn.
Lord Singh of Wimbledon (CB) [V]
My Lords, India being placed on the red list will cause real hardship to many UK citizens with close family ties in the subcontinent. Does the Minister agree that, while this has necessitated the cancellation of the Prime Minister’s visit to India, it will also have prevented him bringing back a virulent strain of the virus Modi-us bigotus, which attacks and can seriously harm a country’s entire democratic immune system?
Lord Bethell (Con)
My Lords, our thoughts are with the people of India at a time when they are fighting the disease in very difficult circumstances. I acknowledge that, for families in the UK with family and business ties with India, the arrangements under the red list are extremely inconvenient, and we are doing it only because it is absolutely necessary.
The Lord Bishop of London
I am sure the Minister knows that those from deprived communities are more likely to catch Covid-19, be admitted to ITU and to die from the disease. They are also less likely to take up a vaccination. Could the Minister update us on action by the Government to ensure that Covid-19 does not continue to be a disease of poverty?
Lord Bethell (Con)
The right reverend Prelate hits the nail on the head. It is extremely sad, frustrating and hard to acknowledge the fact that those who live in deprivation are often those who are hardest hit by this awful disease. We have worked extremely hard to get the vaccine, and testing and tracing, into those communities and to support them with whatever education and community support we can. But the fact remains that this country has an unequal health outcome for too many families, and it is part of our levelling-up agenda that we try to address that. The obesity strategy is one way in which that we can do that, but there are a great many others that we need to look at.
Lord Sikka (Lab) [V]
My Lords, 4.7 million people in England are waiting for routine operations and procedures. Some 388,000 have been on waiting lists for more than a year. Even with the extra £7 billion a year, it is estimated that it will take five years to clear the backlog. Can I urge the Government to declare an NHS emergency, equivalent to that of Covid-19, provide additional resources to the NHS, and inform the House of the targets they will set for reducing the waiting list?
Lord Bethell (Con)
The noble Lord is right that the backlog is a grave issue, and we are fighting as hard as we can to address it. The big guns of the NHS are moving from Covid to addressing the backlog, but we should not overstate its threat either. Large parts of the NHS remained open all the way through Covid, and I pay tribute to those in the NHS who worked extremely hard to ensure that many elective procedures and much diagnosis continued. We do them and their reputations no favours if we imply that the NHS was in any way doing less than it should have done to work through Covid. But the noble Lord is right; this is a grave issue, and we take it extremely seriously.
Lord Scriven (LD)
My Lords, overwhelming evidence now exists that lower-paid people are less likely to take a test, self-isolate or isolate for the full period, due to not being able to afford to do so. What extra support will the Government now put in place to deal with this Achilles heel of the test, trace and isolate system?
Lord Bethell (Con)
My Lords, we put in place a considerable amount of support for those on low wages, including the furlough scheme, and a huge amount of economic support. It is true that those on low wages have wage pressure put on their lives, but we have statutory sick pay for those who are sick and out of work, and we have a huge amount of investment in local government and in charities, which also provide support for those who live in deprivation.
Lord Sarfraz (Con) [V]
My Lords, I join other noble Lords in thanking my noble friend the Minister for just how hard he has worked and for all that his department has achieved over the last year. Will he tell us what plans there are for the development of new vaccines in response to new variants?
Lord Bethell (Con)
My Lords, all the major vaccine companies are already looking at tweaking their existing vaccines, or developing new ones, in response to the new variants. AstraZeneca, for instance, has been working on that for some months. It is not clear, at this stage, whether we will have to start again on the vaccine programme or simply arrange new booster shots, or whether the existing vaccines will, in fact, run the full course. It is unbelievably frustrating to be in this hiatus of short knowledge—that is where we are at the moment—but please be reassured that this Government are investing absolutely everything necessary to ensure that vaccines will be available for whatever comes down the track.
Lord Rooker (Lab) [V]
I can confirm what the Minister said about other services in the NHS. The staff at the Macmillan Renton Unit at Hereford County Hospital were working flat out this morning when I went for one of my check-ups. I have two brief questions for the Minister, one of which follows on from what the noble Baroness, Lady Jenkin, said, in a way. First, there was a reference in the Statement to the flu issue. I understand that our flu jabs have always been made in India, which will be more than occupied producing Covid vaccines for itself and others in the next few months, so where are the UK flu jabs for the forthcoming season later this year coming from? Secondly—if I cannot have an answer now, I would like a letter—who is responsible for maintaining and monitoring the shelf life of the PPE that we have?
Lord Bethell (Con)
My Lords, I join the noble Lord in commending the people who work at Macmillan and all the other important diagnostic centres that have remained committed to their work throughout Covid under extremely difficult circumstances, delivering hugely important healthcare services. The noble Lord is stretching my knowledge of vaccination with this question, but it is my understanding that most of our flu jabs are grown in eggs in East Anglia and we do not rely on Indian supplies for the flu jab. This may seem like an extraordinary fact, and I doubt it, even as I stand here at the Dispatch Box, but I would be glad to write to him to confirm the point.
Baroness Tyler of Enfield (LD) [V]
My Lords, I welcome the Government’s consultation on whether vaccines should be required for care staff working with older adults. To make this easier, could the Minister say what plans the Government have to ensure that care staff are paid for time spent being vaccinated, particularly if they have to come in when not on shift or have to take time off because of any short-term reaction to the jab? Also, are the Government prepared to support care homes financially to enable staff who cannot have the vaccine for clinical or other specified reasons to be redeployed to non-front-line work?
Lord Bethell (Con)
My Lords, the vaccine is typically seen as personal medical hygiene. I am not sure if arrangements have been made for people to be paid while they get vaccinated, but I would be glad to write to the noble Baroness to confirm that. She makes an extremely sensible point about redeployment; I do not know the precise details, but would be glad to write to her.
Lord Sharpe of Epsom (Con)
My Lords, one of the very few positives to come out of the pandemic is that the spotlight has shone on the superb life sciences sector in this country. For example, 47% of all global genomic sequencing is conducted in the UK. Could my noble friend the Minister elaborate on any future collaboration plans between the Government and the sector and how we intend to continue to grow our world-leading position in this space?
Lord Bethell (Con)
My noble friend is entirely right: life sciences is a huge national strength. It was a quiet industry that people did not speak of much; now it is centre stage. Post Brexit, the role of the MHRA, as one of the world’s leading regulators, is something of which we can be enormously proud as a country. It is also making a lot of businesses think that the UK should very much be the focus of their investment, going forward. BEIS and the DHSC are working together very closely, through the Office for Life Sciences, to ensure that the message is heard loud and clear, around the world, that Britain is the right place to invest.
Baroness Verma (Con)
My Lords, will my noble friend the Minister tell me what plans are in place to monitor the work being done to ensure that cities such as Leicester, which was in the longest lockdown ever, do not go backwards now that people are being vaccinated? How will they monitor that? Could my noble friend also tell me what is being done to encourage people into the social care sector? There is an enormous demand for care workers, and yet we do not seem able to fill those gaps.
Lord Bethell (Con)
My noble friend is right: the people of Leicester have done a terrific job at getting the rate down. It was once 571 per 100,000, and on 15 April it was 74 per 100,000. This is a huge achievement, but I am afraid that behind that lie some concerns. Nationally, we are at 26 per 100,000, but 23 local authorities have cases above 50, and Leicester is one of them. In some areas of the country, the virus is proving extremely resilient. That is partly due to the deprivation referred to by the right reverend Prelate and the noble Lord, Lord Scriven, and partly due to the cultural and practical habits of those involved. We are working really hard to try to address those knotty problems, and I welcome the civic engagement of all who live there.
Lord Robathan (Con)
My Lords, last week, the Prime Minister said that the lockdown has been doing
“the bulk of the work in reducing”—
—infections, then Simon Stevens said that
“'Vaccines are successfully reducing hospitalisations and deaths”.
Around the world, lockdowns are not being as successful as one might have imagined, so could my noble friend say whether it is the Government’s opinion that the reduction of deaths and serious cases is down to the lockdown or to the amazing success of vaccinations? Secondly, is what I read true—and it may be completely untrue—that the average age of death from Covid is higher than average life expectancy?
Lord Bethell (Con)
My noble friend is quite wrong if he is seeking to imply that there is any doubt about lockdowns working. Lockdowns work incredibly well because they put space between people. The science behind lockdowns is very simple and incontrovertible. That is the learning of the last year, and those who seek to cast doubt on it, time and again, session after session, do us no favours at all. We are at a moment in the cycle of the disease when the weight is being lifted by the lockdown and by the vaccine—it is somewhere between the two. I cannot call it, and Sir Simon Stevens and the Prime Minister cannot call it—it is somewhere between the two. But we should be in no doubt: if there is a variant of concern that makes landfall in the UK and threatens the success of the vaccine, we will be back in lockdown. We should be extremely careful to avoid that eventuality.
Lord Mackenzie of Framwellgate (Non-Afl) [V]
My Lords, I join the Minister in thanking all those involved in the vaccination programme. I was surprised that the Secretary of State in another place did not mention in his Statement the important topic of Covid passports. It is reported that Michael Gove, who is in charge of the Whitehall study into their use, is visiting Israel and is a big fan of its use of the “green pass” scheme for entry to venues including gyms, swimming pools, restaurants, theatres, cinemas and the like. Putting to one side whether such a system would be discriminatory, can the Minister explain whether it would include, as well as evidence of vaccination, recent proof of a test or of having had Covid recently? Also, does the vaccination, or recovery from Covid, nullify the chance of reinfection and therefore of becoming a vector?
Lord Bethell (Con)
My Lords, the Cabinet Office is reviewing whether Covid status certification could play a role in reopening our economy, reducing restrictions on social contact and improving safety. That work is under way. The noble Lord refers to the importance of social justice and civic rights, and he is entirely right to do so; those are exactly the kinds of issues that the Cabinet Office is weighing up. We need to look at everything that the technical toolkit can provide us with to fight this virus and any others that may emerge from the back of the bat cave. We are trying to avoid the kind of social, health and economic impacts that these 21st-century pandemics have on our country. Technology such as Covid certificates can provide an important defence mechanism.
Lord Cormack (Con)
My Lords, my noble friend knows that I have repeatedly raised the subject of care home workers. I am grateful for his responses and for the letter that I have had from our honourable friend Nadhim Zahawi in the other place. However, in that letter, the Minister for vaccines acknowledges the vulnerability of people in care homes and that they can be a source of spreading the virus. I urge that an early decision is made to ensure that care home workers, who attend to the most intimate needs of their often extremely frail patients, are vaccinated. To compel them to be vaccinated may seem a bit draconian, but, if we are concerned about the containment of these viruses and their spread, surely being vaccinated is not too high a price to ask care home workers to pay.
Lord Bethell (Con)
My Lords, I hear the message from my noble friend loud and clear. Vaccination rates among care home workers in some communities are just not high enough. The Government have acknowledged that point, and that is why we have launched the consultation. We must be fair to the social care workers who work so hard, looking after those we love and care about. We have put this consultation in place to understand the most thoughtful, fair and meaningful way to go about this knotty problem. The consultation is moving as quickly as it can, and I assure my noble friend that everything is being done to expedite this matter.
Lord Balfe (Con)
My Lords, as the Minister will know, I have been a little doubtful about the amount of effort that has gone into this particular exercise. NHS waiting lists have gone through the roof in the last year, and the amount of care being given has dropped substantially. There is now a huge backlog. What plans do the Government have to get the NHS open again? Surgeries are still closed; hospitals are still closed; doctors are still seeing people only on videos. There is no reason now why surgeries should not start to be opened, and no reason why hospitals, apart from looking after their own convenience, should not start to cut the waiting lists back. I ask the Minister whether one of the very able people who are looking after the Covid programme could be diverted to getting the NHS back into action.
Lord Bethell (Con)
My Lords, I completely recognise my noble friend’s concerns, but I reassure him that surgeries simply are not closed, and if he has any examples of those he thinks are closed, I would be grateful if he would write to me. Hospitals are not closed and if he has any examples, I would be grateful if he would write to me. In fact, the NHS has for months done a huge amount not only to be wide, wide open, but to grow in its capacity quite dramatically. It is an inevitable, predictable, sad but frustrating fact that the impact of the coronavirus pandemic, like every other pandemic, is the hit or the follow-on effect on all the other procedures that are needed from a healthcare system. We have diverted a huge amount of capacity from Covid to ordinary, business-as-usual care; we are doing a huge amount to address the backlog and we will continue to move the resources accordingly, but we have to keep provision in place for those who, I am afraid to say, are still in hospital with Covid, and we are aware that the threat remains on the horizon.
Lord McColl of Dulwich (Con) [V]
My Lords, in addition to the great success of the vaccination campaign, at last it is now accepted that the high mortality from Covid in the UK, and in many other countries, is due to the high prevalence of obesity. The high Covid mortality is not the fault of politicians, civil servants or scientists. Does the Minister agree that what we now need is for everyone to unite to support the Prime Minister’s campaign to reduce obesity in order to promote a healthier nation and reduce the mortality from any future pandemics?
Lord Bethell (Con)
My Lords, the post-mortem is not fully written. When it is, the causes of our relatively high mortality rate will undoubtedly be complex and a number of factors will have played a role, but the noble Lord is right that obesity will definitely be on the list. This country is too heavy in comparison even to our European partners. We are one of the heaviest countries in the whole of Europe and if you are overweight, I am afraid to say that the brutal truth is that your heart is having to work too hard, your lungs are having to work too hard, your immune system is run down and the ability of your organs to fight disease is greatly reduced. That is one of the reasons why a very large number of people have really struggled in hospital to fight this disease. If you are carrying an obesity-related illness, such as diabetes or some other major affliction, you really are in no shape to fight off one of the major diseases.
The resilience of this country depends on it getting fitter. That is why we have focused on the obesity strategy that we have, and we will be building on it further. The noble Lord is entirely right that this challenge is well recognised by the Prime Minister from the top, from his own personal experience and his acknowledged fight with the disease last year. It is recognised by the whole of government and by the NHS and our healthcare system.