Grand Committee
Living in a COVID World: A Long-term Approach to Resilience and Wellbeing (COVID-19 Committee Report)
(12 months ago)
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Baroness Lane-Fox of Soho
That this House takes note of the Report from the COVID-19 Committee Living in a COVID World: A Long-term Approach to Resilience and Wellbeing (3rd Report, Session 2021–22, HL Paper 117).
Baroness Lane-Fox of Soho (CB)
My Lords, I will start with some thanks. First, I thank the team that helped us during our committee; it was patient beyond belief, especially with the novice chair. I thank the Whips’ Office for a protracted process of finding a date to debate our various reports; I am delighted that we have managed to do so today. Most importantly, I thank the members of my committee, a few of whom are in the Room, and many wish they could have been. They all contributed with incredible kindness and care to what was and still is a complicated subject.
The central contention in our work is that, because of Covid, the state needed somewhat of a reset. I will return to that theme in my remarks. We felt that, because of the incredible acceleration of some trends and the emergence of others due to Covid, as well as the trends that we saw in sharper relief during Covid, there were multiple angles from which we should rethink our approach to resilience, well-being and long-term planning.
We did many pieces of work in our committee, starting with a large data-gathering exercise. To be completely honest, it had a mixed reception among colleagues, but we were intent on making sure that, at a time when the world was feeling very anxious, we involved the communities of people most affected by what was happening and did not just start from our own perspective here—not in this building or our own home offices but our own views about how people might feel.
We did a huge call for evidence that went out to the world, and 4,000 pieces of evidence were submitted to us. We received everything from poems to pictures, and writing from children, grown-ups and academics. We worked alongside POST, which did some brilliant work for us, looking at some of the academic work emerging during that time. That was one of the first things we attempted to do, and it certainly put us right into the thick of what different communities were feeling about what was happening. We then went on to look at a hybrid world, families and children, and towns and cities, and then wrapped it together in our last piece of work, about the resilience of our entire communities, which we are debating today. I will focus on each of those in turn.
I was a member of the Joint Committee on the National Security Strategy for three years, and resilience in our work meant something quite different from what ended up in the work we are discussing today. In that committee, resilience was about the critical national infrastructure—whether we can protect the water system from biochemical attacks and so on. In the Covid-19 Committee, we worked hard thinking about how we can build the muscle of resilience not just in how central government responds to crises but in how communities build stronger links to each other and to central, charitable and faith organisations; how to make sure that we are measuring the right things to build on resilience, looking at not just economic growth but all the factors that impact people’s lives; and how we can think about a different planning cycle. So often, short-term thinking is the enemy of good thinking.
I will take each of those in turn, starting with resilience at a local level. In our call for evidence, we looked at multiple different communities of people and engaged with lots of different peoples’ experiences of what was at that point an extreme lockdown. We were all in lockdown while we were doing the majority of our work. We found a huge number of different things, but what was clear in every one of our evidence sessions —and among pretty much every group of experts we talked to—was that, through Covid, inequalities were being seen, which people had not realised were quite so deep; that inequalities were being exaggerated by Covid, which it had not been appreciated were so deep; and that the trend into more inequalities was accelerating because of Covid; all of which was very alarming. We heard from people who were making the choice, quite literally, between getting data to be able to function in a lockdown and buying food. We heard from people whose children were not learning to speak because they had not seen other people, or who were having to deal with a parent with a deep mental health issue. The stories were countless and very affecting, as noble Lords would imagine. We all felt strongly that, unless we recognise and see for ever the inequalities that we experienced during Covid, we will have done the country a disservice by not paying full attention to them. So, one part of resilience is recognising, understanding and acting upon those inequalities.
Another part of resilience is building social cohesion. We saw again that, in multiple parts of our communities, there were amazing examples of social cohesion and people looking after each other. We are not just talking about standing on the doorstep banging pots and pans for nurses, but real care, filling the gaps where services had had to stop. However, we also saw that there were communities where that was not the case; very often, that was linked to deep deprivation and socioeconomic issues. So, yet again, inequality was affecting both the ability for communities to come together and their resilience.
Something else that we found, which perhaps seems unsurprising now but was a little more novel—and we were perhaps a little more naive about—two or three years ago, was around information flows and how that had affected inequalities and the ability for communities to be resilient. We looked at how communities were getting information, how information spread and how communities were affected by information. One thing that I have reflected on since we finished our work is how, if we were starting the work now, we would certainly be more alarmed by this particular point, as the launch of generative AI has changed the game yet again with regard to the information systems that we all live within. Even two or three years ago, we were concerned by how much the resilience that we are able to build for the country is affected by the information that different people receive. I would therefore be interested to understand the Government’s response and reflections on our positioning of resilience as not just coming from central organisations but being built at a local level and built around these different aspects of inequality, social capital, social cohesion and information flows.
The next thing that we looked at as part of the bigger picture was moving to more of a measure of well-being from welfare. Well-being can be taken in many different ways, and I am sure that there are many in this Room who are more expert than me on the measurements and academic studies around well-being. At the very basic level, we knew that mental health was deeply affected at the time that Covid hit. Now, Covid is estimated to have impacted the mental health of around 8% of the population, costing the economy £100 billion a year— I am sure that noble Lords will agree that they are very significant numbers.
But we went further than looking at just mental health; we considered how the Government were weighing up trying to save lives, save the economy, save the education system, save the health system and save communities—an unenviable task—and what other measures might be useful in that regard. Our very clear position was that we supported the Government’s move to measure well- being and would urge the Government to go further. The Government have made many nudges towards measuring well-being and we had an adviser on our committee, Nancy Hey, who works at the What Works Centre for Wellbeing—effectively a government agency looking at well-being measurements across society—who helped us to navigate this issue.
I shall press the Minister a little as, as I understand it, she can recount the Government’s spending figures around well-being. Money was supposed to apportioned to each department, but it has still not been given to each department. Only £50,000 was to be given to each of 10 departments to have some measurements around well-being, but, unfortunately, this has not yet been distributed and it looks as though what works well centres might have to close because of the lack of propulsion towards better understanding of well-being. This is a shame when it felt as though there was some real cohesion and non-party-political coalescing around well-being and how valuable it could be, especially, I reinforce, when weighing up the unenviable task of saving lives and the economy and the systems that we all operate in alongside that.
We looked at inequalities and well-being and spent time thinking about long-term thinking. The political cycle is no one’s friend, especially in the past two years. We felt very strongly that, in order to be well-equipped against potential future crises, we need more long-term thinking at the centre of government, and that is why I am delighted that the noble Baroness, Lady Neville-Rolfe, is responding to us today. We recommended that there should be somebody in the Cabinet Office looking at long-term thinking and bringing together a multi- disciplinary approach to help departments navigate beyond some of the difficult complexities of their political masters. We appreciate that this is a complex subject, but it is fundamental if we are going to be able to address future crises that we are inevitably going to face.
Those are the three planks on which our work was formed: inequalities, well-being and long-term thinking. On all of them, we believe that refocusing and re- emphasising could help build our national resilience in a new way and help us as we inevitably face future crises.
As I stand here now and look back 18 months to when we finished this last report, I think there are some things that we got pretty right. There was a report just this morning from Ernst & Young and coincidentally the TUC has published a report looking at the interactions between humans and digital in the provision of services. One of the things that we looked at for a long time was how that might play out in future. We said very clearly that we thought technology was not the answer for all services. It was gratifying to see this morning that those reports come out in the same place. I think that in some things we were looking in the right direction. However, in some things I think we slightly underegged the challenges we would end up in. In our towns and cities report, which we are not debating today, we looked at future of the high street and local businesses. I stand here as president of the British Chambers of Commerce and I am somewhat anxious about the number of businesses that will be forced to close their doors over the next year. I am sure many members of the committee heard the upset owner of Wilko, which went bankrupt yesterday, blaming Covid for a lot of its troubles. I think we may have underestimated the impact on our high streets and local businesses of the residual tail of the Covid challenges.
Inevitably, with a committee set up three months into a pandemic looking at its long-term implications there will be some challenges. We were challenged by differing views of how to execute our work—who should be brought into it and different ideas about what the future might hold—but I am 100% certain that we were not in any disagreement about the scale and importance of what we were facing. We had absolute cohesion around four ideas. We saw new inequalities, new trends being created, an acceleration of certain trends and a deepening of others. It is very important that we do not lose sight of that in the face of some of the other things we are looking at now.
I am much struck that we are debating this report alongside the financial statement in the Chamber next door—I quite appreciate that many Members may wish that they were there instead. These issues are completely interrelated, yet it somehow feels as though we have disconnected them. The spending choices being debated in the Chamber are a direct result of some of the decisions made through Covid. It is important to make sure that, as we face the significant headwinds of a rapidly intensifying climate crisis, wars on multiple fronts and a cost of living crisis that people are feeling so keenly, we do not lose sight of the impact that Covid had on many people’s lives in this country.
I look forward to the Minister’s response and reflections on the themes and thoughts in our report.
The Deputy Chairman of Committees (Lord Lexden) (Con)
My Lords, I think there may have been a little confusion about the speakers’ list. For the convenience of the Committee, let us hear from the noble Lord, Lord Alderdice, next.
Lord Alderdice (LD)
My Lords, I will say a word of appreciation on my and the whole committee’s behalf to our chair, who went to enormous lengths to try to make sure that we had the resources, time and staff that we needed. As she has done, I thank them as well. This was not an easy time to produce a substantial report. All of us, the country as a whole and the world community faced all sorts of challenges, but I think we produced something that will be useful, as long as we take it and build on it.
We can learn lessons, but the question is whether we learn the right lessons. A couple of days ago, my wife was talking to a friend in our local village, who realised that she probably had Covid. She did a test and the two red stripes came up, so it was absolutely clear. She then said, “What are the rules for what I do?” As a doctor, I would say that in a situation like this the question is not what the rules are but how you do the right thing for your health and that of those around you. If you have Covid, it is absolutely clear: keep yourself away from others, to protect yourself and them. However, the lesson that this friend had learned from the experience of Covid was not that we should take those reasonable precautions but that we should check out the Government’s current rules. Of course, there are no rules at the moment, because they have understandably left that to the side. For me, the importance of that experience was that we must learn not just lessons but the right lessons, as we might end up learning not necessarily the right ones.
One problem with the way we think in situations of existential threat is that we do not weigh up cost-benefit analysis. The parts of your brain that you use in situations of relative stability—quite literally; you can do fMRI studies of this—are those that weigh up cost and benefit, but the parts that you use when under existential threat operate on the basis of rules that you have previously imbibed. They may or may not be suitable to the situation you are in and the challenges you face. This was one of the many problems we faced in this situation that we could generalise to other situations, including current situations of violence and war. In such circumstances, people do not necessarily weigh up the wisest things to do; they react off how they feel and the rules that they have learned previously.
These changes and challenges are a real problem for the way that we govern. For example, there are some suggestions in our report that we should have more devolution in how we operate. As a good liberal, I entirely agree with that proposition, but I do not agree that that solves all the problems or that it is the only thing.
There are many problems in your Lordships’ House occasioned not just by Covid but by some other developments—for example, the development of digital. The speed with which these changes are taking place is something our whole legislative process simply cannot keep up with. If you begin to develop an idea to address some kind of problem with new technology, then you put out a discussion paper, produce some consultations and then start taking it through the parliamentary process and eventually start putting in some regulations, by the time you have done all of that it has all moved on to another problem. There are very real problems with the whole structure and way we operate and govern. We need to find some way of addressing that. This committee’s report adverts to it but does not study it in detail; it was not the committee to produce answers to those questions. If there is a place where those questions ought to be considered, it is in your Lordships’ House, and I hope we have an opportunity to do that.
There are some things that changed at the time quite remarkably and quickly, and for the better. Noble Lords will all recall that it took no time at all to get through a very thick Bill on Covid at the start, with all the things we had to do and make sure of. As we rushed through all of it—obviously there was a time imperative—I went to the clerk at the end of Third Reading and asked how long it was going to take us to get Royal Assent. He said, “Oh, about half an hour”, and I said “How is that possible? She”—because it was she then—“is out at Windsor Castle”. “Ah”, they said, “she’s agreed to sign it digitally”. I thought to myself, outside of Covid, how many decades of discussion it would have taken to do something like that. But Her Majesty simply decided—quite wisely and sensibly, as she often did—to just do it; she did it, and it was absolutely the right thing to do. There have been helpful advances during Covid that might not have happened or would not have happened so quickly had it not been for the exigencies of the circumstances. That was perhaps one of the more delightful examples.
There were some other examples that were not so encouraging and reassuring. There were some things we had to do at the time but have to find a way back from. I will refer to two medical papers and a book. The first is a paper published in the BMJ in 2021 about face-to-face GP consultations. It says:
“The latest NHS England letter to general practices states that face-to-face appointments should be offered at patient request, which is a U-turn on the previous policy of total virtual triage during the pandemic and”—
this is important—
“potentially conflates patient preference and clinical appropriateness”.
Sometimes the patient will want something that is not appropriate, or vice versa. Those two requirements were not reflected in the revised recommendation. In addition, it said that
“the rapid shift to physical closure of surgeries, digital appointments, and virtual or form-based online triage presented challenges for marginalised patient groups, who already face major barriers to accessing primary care”.
Some of you will have heard of a report from the BMJ, reported in various newspapers today, on how it is quite clear that there are major problems and disadvantages. People’s healthcare is not being as well addressed as it ought to be. I think any of us who have tried to make a GP appointment in many areas—not in every area; there is quite a variation—will know that you are having to wait up until midnight to go online because all the appointments are sorted before then. You then have to go through a completely inappropriate questionnaire on all sorts of things, which leads to completely the wrong outcome. We have to understand that some things had to be done in the emergency situation, but we also have to go back and look at them again in the light of the new circumstances and try to see if they are still appropriate—if ever they were.
It must be said that sometimes we have to pay particular attention to the individual requirements of a patient. A book was published shortly after all this called Psychoanalysis and Covidian Life, which I thought was a marvellous title. It had therapists from various parts of the world talking about their experience and their work. There was one very interesting chapter entitled “Where does the analyst live?”, where the psycho- analyst described how she
“continued her work with a very young autistic girl using mobile phones”,
which she would not necessarily have tried to do previously. This form of communication actually made clinical progress much more possible than face-to-face work, because of the nature of this girl’s disorder. It seemed a really interesting example of how real clinical advances actually were able to result from the challenges of Covidian life. So it is not all bad news—there have been positive and good things happening.
But there were also serious downsides, not least in terms of performance of government. For example, there were lots of strategies and papers produced well in advance of all this about all the kinds of things that we should have available—lots of PPE and lots of ways of operating and so on. The problem was that, when we were not in the middle of a pandemic, they were not actually done. They were all agreed and all on paper, and people had responsibilities for them, but they said, “The budget’s tight at the moment, and I just hope it doesn’t happen on my watch”. When eventually the problem did arise, all the strategies had been prepared but had not been implemented. So when we get a response from government that says that it has this plan, this plan and this plan, it is good to hear that there are plans, but it is not enough. How can we be confident that, faced with another pandemic, or one of the many other frightening circumstances that we are likely to face, things are actually in order and not just there on paper? To say “on paper” is a little bit old hat, really—“digitally available”, perhaps one should say.
In that regard, I want to speak to the Government’s response. I find it disappointing, on a number of fronts. To refer to a few of the recommendations, recommendation 5, for example, is about the problems of disinformation, misinformation and people being misled. Quite rightly, it points up that there are rules that need to be adhered to and developed, but nothing is said about the fact that leading public figures sometimes make misrepresentations that confuse people and create problems. There is nothing in it about how public figures need to be responsible in how they react to things. It is not just a question of rules.
In recommendations 7 and 9, we say that there is an importance to having some redundancy of provision in public services—in other words, that hospital beds are not 100% full, or even 98% full because, if you do that and something happens, you get all the problems that you have seen with people being unable to get into hospital because there is no built-in redundancy. I remember that, when my wife and I came into the health service and started working, we were talking with her father, who was a bank manager, and explained about the staffing system—that, at best, we would have 100% of the staff places filled. He said, “That’s crazy. In the bank, we have an extra 15% to 20% of staff, because you always know that some people will be off ill or off training, and some people will be doing other things”. I told him that we did not even have the 100%, never mind 120%. So there needs to be more built-in redundancy. The notion that the highest level of efficiency is making sure that there is absolutely nothing wasted means that, when it comes to a crisis, you have absolutely no possibility of addressing it properly. However, the Government’s response to the recommendation goes through all the things that the Cabinet Office says, and so on. I get the sense with that response, as with a lot of the others, that they were cut and pasted from some other document, because there is absolutely no reference at all to the specific recommendation for redundancy.
Then we come to the question of continuing professional development—for example in recommendations 19 and 20, where the report talks about
“preparing teachers and medical professionals to deliver online”.
So again, from somewhere or other, there are a number of paragraphs in response about the continuing professional development of teachers, but nothing about medical people and nothing about their development online. Again, it just looks as if something has been cut and pasted from somewhere else. This is really not the kind of response that we would hope to get to a report that we took quite a lot of time to prepare, and which many organisations from around the country contributed to.
There are some pieces of progress. The one I would refer to under recommendation 21 is the NHS app, which has been rather good and has made a lot of things available to people. It is, say the Government,
“a simple and secure way for people in England”—
it is quite true that it does not apply to everybody in the United Kingdom—
“to access a range of NHS services”.
People can look up their test results and make appointments, and so on. So that is an advance. It is not that I just want to be critical of everything; if there are areas of progress, let us recognise them and recommend them. However, let us just also understand that our NHS, on which we are so dependent, simply is not working at the moment, and we need to try to address that.
I have already taken up far more time than I ought to have. That is because we felt quite passionate about all this and therefore felt pretty disappointed when the response that we got back from government did not pay attention to the recommendations that we had made.
Lord Patel (CB)
My Lords, I am pleased to be able to take part in this debate today. I was not a member of the Covid-19 Committee, but I congratulate its chair, the noble Baroness, Lady Lane-Fox of Soho, and her committee on producing an excellent report to address issues on future resilience and, importantly, the well-being of people post pandemic. I also congratulate the noble Baroness on the brilliant way in which she presented her report.
My very brief comments relate to how the pandemic changed and accelerated the use of digital media in healthcare, with online consultations and treatment being widely used now. Paragraph 74 of the report highlights—as the noble Lord, Lord Alderdice, mentioned —the lack of training of health professionals in conducting online consultations. The report rightly points to the need for approving and evaluating online health interventions. Your Lordships may have read the report in the Telegraph today, which points out the problems that have occurred because that was not done in the first place.
In paragraph 75, the report alludes to the possible widening of health inequalities. That is an important point, because we know that people from lower socioeconomic groups already have lower life expectancy and spend a fewer number of years that are disease-free compared to people who are better off, and significantly so. As the report points out, the shift to online delivery of healthcare is likely to deepen the inequalities in health outcomes, emphasising further the need for evaluation. It is estimated that nearly 16% of people do not have the means or ability to be able to take part in digital consultations.
In my view, the report rightly recommends the need for training and continuous professional development of healthcare professionals to deliver online healthcare—in fact, I would go further, in that their competency to do so should also be measured and ascertained. I am pleased that the General Medical Council and the royal colleges, particularly the RCGP, are now beginning to establish training courses for doctors for online consultations and their assessment of the courses.
During the Covid-19 pandemic, patients benefited from remote consultations by GPs—we should accept that—and restrictions in travel because of the lockdown benefited older patients, those at risk of infections, patients who were immunocompromised and those patients suffering from long-term conditions. It might not have been the perfect outcome for them, but it was a way to manage the pandemic. The benefits were thought to be so great that it prompted the then Secretary of State, Matt Hancock, to call for all consultations in the future to be remote except in exceptional circumstances —that was rather too forward-thinking and probably inappropriate. Overall, during the pandemic emergency, online consultations were seen to be beneficial. Only later did the unintended consequences of missed cancer diagnoses and increased prescribing of antibiotics become apparent. Antibiotics prescribing went up by nearly 36%, although we are in fact trying to reduce the prescribing of antibiotics. Again, today’s detailed report in newspapers and the BMJ points to that.
Now with the pandemic under some control, it is important to evaluate what this immense change in technology-driven healthcare means, especially for patient outcomes, safety and equity. It is the last that concerns me most. With the arrival of better data, health records and generative AI, some people think that we have arrived at a tipping point in the use of technology in healthcare. As the report rightly points out, the rapid introduction of a data-driven and digital healthcare may not only make deeper the current huge health inequalities that exist but exclude people who are not able to make best use of technology. To mitigate this, the Government need to ensure that policies are in place that take a more inclusive approach to digital healthcare.
There are several key challenges that will need to be addressed, as highlighted by the report by the Health Foundation and the Ada Lovelace Institute. Policies that focus on key challenges include: digital exclusion and access to healthcare; developing clear metrics for monitoring inequalities in health outcomes in data-driven systems; addressing the lack of public confidence in data use and protection; the lack of social context in data, as the report correctly points out; appropriate communication across all healthcare professionals throughout the data pipeline; and much more. A survey of public attitudes to health technology showed that the public are on the whole supportive of it, particularly when technology enables them to manage their conditions better and to connect more easily with the NHS. Currently, that does not happen with GP appointments, as highlighted by the noble Lord, Lord Alderdice. The public are less happy when technology comes between them and the clinicians. In this context, the report’s recommendations in relation to the patient’s right of access to online healthcare seems appropriate.
A long-term approach to resilience and the well-being of people in vulnerable groups post the pandemic and the rapid introduction of data-driven health system runs the risk of widening inequalities. That is my key worry. The inequalities that already exist in healthcare and outcomes will become worse. To mitigate that requires policies across government departments. I hope the Minister will agree.
The Lord Bishop of London
My Lords, I declare my interests as set out in the register. First, it is a pleasure to be participating in an important debate on this report. I thank all those involved in the committee, particularly the chair, for all the work they have done. This report rightly encourages us to increase our understanding of the lessons we can learn from the pandemic and to act on them in having a long-term view of the future.
This is a crucial topic. I support the noble Baroness, Lady Lane-Fox, in her view that our electoral system does not naturally lend itself to having a long-term view of the future. I shall focus today on recommendations 1 and 2. They are, in fact, interconnected. Those topics are first, inequalities, following the noble Lord, Lord Patel, particularly in health, and, secondly, community engagement.
Health inequalities have been a focus of many of my contributions in your Lordships’ House, and I welcome the understanding that the report demonstrates of why addressing them is so important. It says:
“The pandemic has shown that national level resilience is undermined by financial inequalities and health inequalities, which are often exacerbated by racial injustice”.
The moral argument for reducing health inequalities is an important one which continues to motivate me. However, the pragmatic argument is also shown here. If we are starkly unequal in our health, we as a society are more vulnerable to health and other challenges that we face. There is also an economic argument: improving the health of a population and reducing inequalities increases the ability of the population to contribute economically.
I do not need to impress on noble Lords the seriousness of the health inequalities we face. The gaping differences in life expectancy and healthy life expectancy persist. The trends in health inequalities were further exacerbated by the pandemic, as already mentioned. The Beyond the Data report, written by Professor Kevin Fenton and Public Health England in 2020, highlighted that during the pandemic some ethnic groups were more likely to be exposed to Covid-19 and, once infected, were more likely to contract a serious infection and die.
In their response to recommendation 1 of the Covid-19 Committee’s report, the Government pointed to the levelling-up White Paper and promised a White Paper on health disparities. I was and remain disappointed that the critical work that has been done on both these pieces of work has not been brought forward. In the absence of this, will the Minister tell us what the Government are doing to prioritise reducing health inequalities, especially since the report lays out so well why doing so is key to our preparedness and resilience as a country?
Secondly, the report places a heavy focus on sustained and long-term engagement with communities. This is an extremely welcome and important part of what is required for resilience. Recommendation 2 of the report is a call for
“Renewed efforts to build trusted relationships between the state and all groups within society, including racial and religious groups, young people, disabled people and others”.
In their response to this, the Government said that they are already acting to build trust in local communities. As an example, they said,
“the government established vaccination centres in 50 religious venues, worked with ethnic minority celebrities & influencers”,
and so on. Although I commend the setting up of vaccination clinics in these spaces, this is not a means of gaining trust but the fruit of trust.
After the worst of the pandemic, I convened a health inequalities action group to examine the role that faith groups had played in the pandemic and the role they could play in reducing health inequalities across London in the long term. During the town hall events that were held as part of our work, we heard stories of faith groups stepping in to promote health-seeking behaviour and provide for their communities during the pandemic. We heard that faith leaders hold the trust of their communities, often much more than government or other civic bodies. The Government’s health inequalities strategy, Core20PLUS5, shows us the importance of “plus”, that is, those who are not thought of by or engaged with public services.
There is a faith group in every community. Professor Fenton’s Beyond the Data report explains that faith leaders often have the understanding and trust of their communities. This trust is key. As the adage goes, “Change happens at the speed of trust”. However, in our work on inequalities, we found that since the vaccination centres were set up during the pandemic, the Government are no longer engaging with the health-promoting work that faith groups do and would like to do. The relationship has not been sustained, and I fear that the value of faith leaders is not recognised, certainly in respect of the significant difference that could be made within health inequalities. Faith leaders continue not to be regularly consulted at a local level and the truth is that there is some work to do to equip local leaders and faith leaders with the tools of engagement. It is in these sustained relationships that our interconnectedness and resilience is realised.
I just want to mention social prescribing. This is another key way that faith groups can be involved in the health of our community, especially in light of the report’s emphasis on well-being. There is an understanding of not just physical or mental well-being in many faith groups, but also of our well-being as whole people with social, emotional and spiritual needs, all of which contribute to health and, I believe, the resilience of our communities. At the heart of the report is our understanding of our mutuality and interconnectedness, which is key to our public health and well-being. In the light of this, will the Minister say what efforts the Government are making systematically to engage with faith groups and maintain relationships with them? What assessment have they made of the key role faith groups can and already play in public health?
Before I finish, I would like to mention the nod in the report to the long-term funding of public services. The Government’s response to recommendations 24 and 25 was to highlight the 10-year mental health plan which, at the time, was in consultation. Of course, that is no longer happening, in favour of the major conditions strategy. There also remain a number of questions about the major conditions strategy in the absence of the health disparities White Paper. I also suggest that spending on public health services does not feel like a long-term investment as things stand.
To conclude, I warmly welcome this report and its recommendations. I hope that we will hear from the Minister about the Government’s ongoing response to this and their efforts to build and hold relationships across difference for a more resilient society.
Baroness Coussins (CB)
My Lords, I declare my interests, which may not at first appear relevant, but I aim to explain exactly why they are. I co-chair the All-Party Parliamentary Group on Modern Languages and am vice-president of the Chartered Institute of Linguists.
Since this report was published, back in March 2022, the independent public inquiry chaired by the noble and learned Baroness, Lady Hallett, has been set up and its work is still in progress. However, while the inquiry chaired by my noble friend Lady Lane-Fox was in action, several issues relating to languages began to emerge. By the time the inquiry chaired by the noble and learned Baroness, Lady Hallett, started, the APPG on modern languages had assembled sufficient evidence and constructive recommendations to make a submission to that inquiry.
What we said in that submission fits perfectly with the approach and conclusions of the report being debated in terms of resilience, well-being and inclusiveness and, indeed, of the Government’s statement in their response that:
“The government puts fairness at the centre of its policies”.
The response also acknowledges that there are barriers faced by different groups. I hope therefore that the Minister, when she replies, will be able to respond positively to the points and recommendations I will be outlining, as well as to the report itself.
I will flag up the language issues which emerged relating to the impact of Covid on three things: health, education and justice. On health, there are three key points. The first is that the absence or delay of provision of public health messaging in languages other than English may have been a contributing factor to the disproportionate levels of infection and death among some black and ethnic minority communities. The 2023 report by the Race Equality Foundation, UCL and Doctors of the World stated that after two years black and minority ethnic groups were still three to five times more likely than white British adults to be unvaccinated. Alarm among health professionals was widespread as early as April 2020, yet there was an apparent lack of preparedness to provide effective translations. There was also a disconnect between what was claimed to be happening and what was observed to be delivered. For example, in June 2020, Public Health England stated that the 119 phone line offered translations in more than 200 languages and that the Covid-19 App was available in 12 languages.
At the same time, however, the Cabinet Office stated that its strategy for communications in other languages was confined to only nine core languages, with some other information in an additional five. Yet a BBC report found that translation of guidance was delayed for weeks, resulting in some multilingual communities such as Bradford reporting severe confusion, with apparent links to risky behaviour, outbreaks and extended lockdown periods.
In October 2020, the Government’s quarterly report on Covid inequalities talked of improving public health communication for so-called hard-to-reach groups, including people from ethnic minority backgrounds, but strangely also included a footnote which said:
“Translation into foreign languages is discouraged except in extraordinary circumstances because it conflicts with the government’s approach to integration”.
It was also unclear whether information in the right languages, or up-to-date information at all, was available via the Migrant Help service to asylum seekers, which was especially problematic because of inherent risk factors such as hygiene in shared accommodation, difficulty in observing social distancing and the high turnover of people in asylum facilities and refugee centres. Advice and information were available in 12 languages in May 2020, but by June none of the updated guidance on symptoms, for example, was available in translation.
There was also a significant disparity between the Government’s response to the needs of British Sign Language users, as compared with the needs of people who speak little or no English. The former are covered by the AIS, the accessible information standard, but the latter are not—I had not heard of the AIS before either. The APPG agrees with the call from Healthwatch England that the AIS should be amended as part of better preparedness and inclusiveness in future emergency responses.
The second health issue concerns the use of public service interpreters and languages services in NHS Test and Trace. Test and trace operated primarily as an English-only service, despite apparent arrangements to make language services available. The National Audit Office reported that no equality assessment had been carried out by June 2020, but that test and trace had stated that its call centres offered a language interpreter service—a claim that was repeated by Ministers in Parliament. In contrast, a Sky News report in June 2020 reported that DHSC claims that translations were available in up to 130 languages were “brazen” and “bizarre”.
Local government appeared to be no more consistent, publishing advice—in English—that non-English speakers should dial 119 or use the Covid app if they needed to contact NHS Test and Trace in another language. The function of test and trace, as I understand it, was meant to be contacting people proactively, so putting the onus on them to contact the service for information in another language was never really likely to be effective.
The third health issue also concerns public service interpreters working in the NHS. Most are freelance and many complained that no one was taking responsibility for providing them with PPE. The Government funded the provision of 250,000 clear face masks for British Sign Language interpreters, but no equivalent provision was made for spoken-word interpreters. In answers to Oral and Written Questions that I asked, the noble Lord, Lord Bethell said, in July 2020, that individual hospitals were responsible for providing the interpreters with PPE, and, in December, he said that GP practices had a similar obligation. Nevertheless, many public service interpreters found that, in practice, they were expected to turn up having procured their own PPE. The APPG believes that if the provision of language services were included in the accessible information standard, which I mentioned earlier, this kind of support and equipment would in future be more easily identified and forthcoming.
I turn briefly to issues in education that had, and continue to have, an adverse impact on the social well-being of individuals and the economic well-being of the UK. Covid severely exacerbated many existing problems with the teaching and learning of modern languages. This is important because language skills have been shown to be linked to better employment prospects, international relations, security, soft power, social inclusion and, yes, even health. In summary, the impact of Covid was, first, to deprive pupils studying for GCSE or A-level in lesser-taught languages at supplementary schools of the opportunity to take their exams and gain their qualifications, because the system introduced due to Covid of centre-assessed grades awarded by mainstream schools did not apply to them. Official guidance was often unhelpful, and many pupils were charged high fees as private candidates instead. This was systematic inequality and discrimination against bilingual children and those with English as an additional language. The Government, Ofqual, awarding bodies and others need to sort this out in advance of any future comparable emergency.
Secondly, the pandemic produced some unclear and damaging messaging on the mainstream curriculum from the DfE. The guidance for schools published in July 2020 included a list of subjects to be taught in primary schools which omitted modern languages despite it being a statutory key stage 2 subject. The APPG almost immediately began to receive reports from stakeholders that schools were using this guidance as a reason to ditch language teaching altogether. By January 2021, one in five primary schools had suspended language teaching, blaming the pandemic. Following clarification from Ministers, languages remained statutory, but it was left to subject associations, unions and teacher groups to reassure teachers. Both schools and universities suffered by being forced to scale back or drop altogether their international experiences, such as exchanges, trips and the year abroad as part of a degree course. Oral exams were scrapped from GCSEs in 2021. Together with the loss of international experience, this reduced the appeal of a language choice at either A-level or university. The pandemic’s impact on language provision disproportionately affected deprived areas. If the Government are serious about levelling up, language teaching would be a good place to start.
Finally, Covid had an adverse impact on the administration of justice, because lockdown measures prompted a large shift towards remote court hearings, which required the use of public service interpreters in virtual proceedings. A series of major reports found significant concerns about the suitability of remote interpreting, including misunderstandings, delays, poorly performing technology and missed verbal and non-verbal cues. The APPG recommends that the MoJ should caution against any systematic trend towards more widespread use of this practice until and unless the right lessons have been learned from the Covid experience. Guidance on best practice has been provided to the MoJ by the Chartered Institute of Linguists and the Association of Translation Companies. The same concerns and caution also apply to the suitability of remote interpreting in healthcare settings.
I look forward to hearing the Minister’s comments on all these issues.
Lord Robathan (Con)
My Lords, I shall of course be brief because I am speaking in the gap. I thank the noble Baroness, Lady Lane-Fox, and her committee for producing this report. I congratulate her on it. Unbelievably, it is now two years ago that they finished it, and things have changed since. I might not agree with everything in it, but I will concentrate on what I think is the most important issue. Sadly, the noble and learned Baroness, Lady Hallett, has yet to reach this in her inquiry—I suspect that she wonders why on earth she ever took on the job.
The most important issue is whether the so-called cure was worse than the disease. Nobody doubts that Covid was an extremely unpleasant disease and that it kills people—but, frankly, not many people under the age of 60 unless they had some underlying health conditions. In the lead-up to March 2020, we heard from Messrs Whitty and Vallance that we needed herd immunity and to shield the elderly, who were vulnerable, and other vulnerable people with underlying health conditions.
As we heard, huge damage has been done to mental health and education—what good did closing all the schools do?—and other health issues were caused, such as undetected cancers. We heard from the noble Lord, Lord Patel, about some of those. Of course, we now have higher death rates in other fields than we had from Covid.
We have saddled our children and grandchildren with the most enormous debt around their necks for decades to come. We have crashed the UK economy, as I think everybody knows; the noble Baroness, Lady Lane-Fox, referred to the cost of living crisis, which is closely related to the failures of policy during the coronavirus pandemic. I should say on behalf of the Government, although I do not always defend them, that the Opposition, both Labour and the Liberal Democrats, were hounding the Government to go further and further.
Lockdown was an absolute disaster. The noble Lord, Lord Alderdice, mentioned cost-benefit analysis. I had a debate on that to try to get the Government to give us one, but answer came there none. The heart of the matter is whether the Government knew best. I have always felt that the gentleman in Whitehall never knows best. I was derided and insulted for asking that question and for challenging lockdown policies. Therefore, before I sit down, I ask the Minister and anybody else who wishes to answer: who now thinks that lockdown policies were a good idea?
Lord Allan of Hallam (LD)
My Lords, I am extremely grateful to the committee for a thought-provoking report. My comments will reflect reactions to some of the recommendations within it.
I start with recommendation 1, not just logically because it is at the beginning but also because it is significant. It identifies the importance when looking at health issues of considering both the population and each individual within it. Our state of health at any moment reflects each individual’s life story. It is a combination of their genetic inheritance with socio- economic factors, their professional role—in Covid, certain jobs brought with them a different risk than other jobs—long-term health conditions, the language they speak, as the noble Baroness, Lady Coussins, pointed out, dire lifestyle factors and just a dose of good old-fashioned good or bad luck. All those factors affected each individual’s experience of Covid, and no two individuals had the same experience: both in their literal health experience, whether they were likely to suffer ill health and perhaps even death, and in their experience of lockdown and their professional and personal lives.
Covid hit people differently, and some of those differences turn out to be predictable—not the luck factors, but for some of those other factors we can say, “That tells us that your experience of a particular disease or health outcome will be different”. The report pulled that out and said that socioeconomic factors will have an impact over time, not just for Covid but for other diseases. Now that we have that awareness, it is important that we do not let it slip and just go back to thinking of the population as a whole, because those population-based statistics mask all those critical individual life experiences. We need to plan to minimise population risk and be acutely sensitive to whether we have exaggerated risks within certain segments of the population that could and should be addressed by health and other broader public policies.
The Government’s response talks about the work of the Office for Health Improvement and Disparities, and that is a useful approach. However, it is useful only if it continues this focus on the individual rather than masking those individual outcomes in the broad statistical outcomes that it is seeking. The proof of the learning will be in whether we understand future crises and respond much more quickly to those differential individual risks. I hope the Minister will be able to talk about that.
The second recommendation that jumped out at me as really insightful was recommendation 3, on local capabilities. It is important to reflect on that. I would have said that there was already enough evidence to suggest that we did not make sufficient use of local public health services; we brought everything to the centre very quickly and left people on the ground in public health services feeling that there was no role for them, and we did not take advantage of what they could offer. As we get output from the various inquiries that are going on, we will dig into that some more, particularly on the test and trace programme, which the noble Baroness, Lady Coussins, touched on. We have to be really honest about the difference when we brought something centrally and the impact that that had on demotivating local programmes.
The noble Lord, Lord Alderdice, talked about the rules and people’s immediate reaction. I thought about that as I reflected on the experience—I do not know whether anyone else had this experience—of people from centralised test and trace ringing up people in your household to tell them about your Covid, which you had already told them about because that is what people do. I learned that the best way to do test and trace was to WhatsApp all the people I knew when I had a positive test result, because that was the quickest way to get to them. Again, 10 days later somebody would phone to tell you something that you had already dealt with. The phrase “common sense” gets bandied around, but people are sensible and those very local responses were often super useful. In some ways, they were disempowered by bringing everything into the centre.
What was telling about the Scottish and Welsh experience was that people were looking to local leaders. That happened to a certain extent with some of the English regions, but it left me thinking about how much more we could have had of that if we had said that there was a role for local council leaders and others and asked them to stand up, be visible and give the advice about WhatsApping all your friends if you got a positive test result. We could have seen the impact of that, rather than getting a call from an impersonal call centre in a language that you did not even understand. As the report highlights, there was a huge opportunity to do so much more through local institutions.
We are now starting to see certain elements of the dysfunction going on in central government. Back in the day, I was a representative in Sheffield from the minority party, because most politicians in Sheffield had been Labour since time immemorial. I found in a local situation that those local loyalties far outweighed party loyalty, and we would work together very effectively. The right reverend Prelate the Bishop of London talked about faith leaders—there was a real sense that we all had to help Sheffield, whatever our religion or party. It felt to me that we could have drawn on much more of that, but people were disempowered because it was all going back to those press conferences in London and people from there telling you what you should do.
Local knowledge is also critical but was missed. If you want to know where you should put a testing centre which people will find easy to get to, you ask people in the area. There were people sitting here in Whitehall saying, “The testing centre should go there”, because it looks good on the map—but if you asked anyone locally, they would have told you that no one ever wanted to go down that street, for whatever local reason. We missed all those opportunities. I hope the Minister can at least give us some indication that any future planning will be much more sensitive to and take advantage of the fact that we have amazing local structures that can be utilised in such a crisis.
On recommendations 7 and 9 on long-term planning and efficiency, what happened around procurement is a stark example of why that is needed. We saw the best and worst in the pandemic: we saw people pitching in for the public interest, but we also saw blatant profiteering. As the noble Lord, Lord Alderdice, pointed out, part of it is the redundancy question. If you have taken everything down to the bone, you have made yourself more vulnerable to those who will come along and sell you something, because you have to buy it at any price. There was no cushion there, and cushions matter if you want to insulate yourself against that kind of situation.
This is also about planning and advance frameworks for procurement and staffing. Whether it is procuring equipment or staffing, this is squarely in the domain of the Cabinet Office and it could be thinking now about how we avoid that, whether it is a health emergency or any other situation where we have an urgent need to procure people and stuff in the public interest. How do we make sure that we do not expose ourselves to that profiteering? I think that I am safe in this environment to use this reference, but there will always be Private Walkers—that famous figure, the spiv from “Dad’s Army”, for those who are not of that generation. There will always be somebody. Since time immemorial, there have always been people who will take advantage, but we can do things to protect ourselves against that. Part of that might be the Cabinet Office thinking about what kind of profit limits would be appropriate. People can make profit, that is fine—we want them to be creative and think of new solutions—but there should be limits to that, which is something that could be thought about ahead of time.
Transparency rules would be helpful. We are told that a lot of those contracts were commercial, so it is now really difficult to unpick that and to understand whether people were profiteering or just charging a fair mark-up, which would have been fine. If they delivered the goods and charged a fair mark-up, we are okay, but if they were putting on an excess mark-up because they knew that they could take advantage, they were being Private Walkers. We need to know that and be able to dig into it. That area is really significant, and I hope that the Minister will be able to say that this is a priority for the Cabinet Office.
The last set of recommendations that jumped out at me are 16 and 17, on online activity generally, and 21 and 22, on digital health in particular. We had a huge, forced learning process. My noble friend Lord Alderdice talked about our late Queen, who also had to learn; she was forced into the situation of learning how to do digital signing. During that crisis, all of us were forced to do things digitally. The technology held up remarkably well, in fact. I was quite surprised—I think the noble Baroness, Lady Lane-Fox, who has a lot of experience, may have shared my surprise. I thought that we would break the internet with that massive usage, but we did not. However, because the technology held up quite well, in some ways it masked a whole bunch of social questions that we were not asking. The real questions were not necessarily the technological ones, other than for those who did not have access at all. For most people who had access, there were a range of social questions that, in some ways, were much more significant than the technology.
Any parent whose children went through Covid—mine did—will certainly recognise that the impact was significant, even where the technology worked perfectly and even where the schools were good. It was not zero impact. Mine still talk about it; they were not in exam years but it is still relevant to their experience of education today and how they feel about education.
There is also a risk that the debate becomes binary; it is either all offline or all online—whether that is health, education or work. My noble friend Lord Alderdice and the noble Lord, Lord Patel, referred to GP consultations, and there is almost this sense that we need to move everything online or we need to get everything offline, when the world is much more complicated than that. The reality is that it is about individuals who have individual needs and individual preferences. There will be some children who struggle in school social settings—and always have done. A lot of them were absent from school, and online is a wonderful bonus. I can remember going back and dealing with children who were persistently truant from school, and were truant because they genuinely struggled. Online may be a better solution for those individuals. There are other children who really struggle by not being in school, for whom online is a terrible experience. We need, again, to recognise that. It is hard for those who are delivering education—it is much harder than a single model—but, if we want to respond to people’s needs, we need to think about how we are going to do that.
In the healthcare sector, there are many people who will benefit from virtual wards—another development that has come out of all this—and who would rather be at home than in a hospital setting. There will be others, however, for whom being in hospital is essential—often for socioeconomic factors—and at home they just would not get the care that they need. It is not one size fits all. It is not all virtual or all in hospital; it is about reflecting the individual circumstances. The Government’s response to the report talks about the need for new medical systems to be approved by the MHRA. That is right but, again, the risk is that we focus on the technology. Approving the technology as suitable for home use is one thing, but approving the protocols that decide when you use the technology versus when you use in-person is a whole other set of questions that we need to address.
I am grateful to the committee for a very comprehensive report with so much thought-provoking content. I have touched on a few points but I read the other reports with great interest and will learn a lot from them. If we can learn these lessons, we can be better equipped for future crises of all kinds that we are going to face. It will be deeply disappointing if we hit another crisis and do not do better. There is no excuse for not doing better if we take on board these lessons. I am grateful to the committee for giving us the opportunity to focus on the kind of things that we could do to achieve that better outcome.
Baroness Merron (Lab)
My Lords, I thank the noble Baroness, Lady Lane-Fox, for introducing this important debate. I particularly welcomed the focus of the committee’s report on the need for a reset, as she said, which focuses on resilience, well-being and long-term planning. I certainly share the view that all those things are needed. I hope that the Minister will find today’s debate helpful in looking forward in all those areas. I am also grateful to the noble Baroness, Lady Lane-Fox, for chairing the committee and acknowledge with thanks the contribution of everyone on the committee, including those who are present today. As the noble Lord, Lord Alderdice, said, this was not an easy time for the committee to be doing its work, so we should pay particular tribute to the members of the committee for that. I shall particularly mention one committee member, my noble friend Lord Elder, who sadly passed away recently. I am sure we all hold him in our thoughts today, and may his memory be for a blessing.
This is an interesting and important report on so many levels, not least because it makes observations and recommendations that I believe are legitimate not just when we are in crisis but when we are in the day to day. Time after time in the Chamber and outside we hear calls—I have made them myself—for joined-up government with the structures and systems to support it. I am therefore very much looking forward to hearing from the Minister, and as she is a Cabinet Office Minister, as I used to be, I will be very interested to hear from her what ongoing assessment is being made of the effectiveness or otherwise of cross-government working because, as she will know, it is only by keeping this under constant review that improvements can be made. As the report says, the pandemic was a wake-up call pointing to the need for a drastic overhaul of the approach to resilience and preparedness to be ready to face future disasters whenever and whatever they may present as.
The report states:
“It is now clear that we will never be entirely free of COVID-19 and that post-pandemic the world will be very different. Instead, we must adapt our lives”.
For some of us, that is easier than it is for others. While much of the country may be living with Covid-19, there are some 2 million people who are living restricted lives or are now in their fourth year of total shielding. Many of them are unable to make antibodies to Covid-19 and therefore the current vaccines do not serve them. This, coupled with their underlying conditions, places them at heightened risk. A recent study showed that while 4% of the population is immunocompromised, 28% of ICU admissions and 25% of deaths come from this section of the population. This is a taking a huge toll, not just on the individuals themselves but on their families, households and communities.
Can the Minister say what steps are being taken to improve the situation for those who are immuno- compromised and what they might look forward to in the future, in particular in terms of vaccinations and the appropriate medications to assist them? Perhaps the Minister could also inform noble Lords about the plans for those who are suffering the debilitating effects of long Covid—another continuing matter for so many.
I note that the Government did not respond to the report as a whole, but only to each individual recommendation. In my view, as other noble Lords have said, the Government were mostly setting out what they believe they are already doing. I feel that was something of a missed opportunity. There are some specifics that I would like to deal with: first, the underpinning issue of resilience and all that goes with it; and, secondly, some of the specific health aspects, which other noble Lords have referred to.
We have learned so much from the past few years about what it means to be a resilient society. I acknowledge that there has been progress since the publication of this report and the government response. I am sure the Minister will be advising us of this. I am glad that there has been progress because I felt somewhat overwhelmed by the sense that there was little appetite in the government response for reflection on the recommendations and for actually wanting to make improvements. Since then, however, we have seen other developments. I welcome the establishment of the Resilience Directorate and the appointment of Mary Jones, who I wish well in her endeavours leading on this.
In addition, the UK Government Resilience Framework promises a direction of travel which incorporates prevention, preparedness, response and recovery, no matter what the disaster. All these were called for in the report, so perhaps there has been some reflection since the Government responded. I am aware that the provision of vital data has also been improved. I ask the Minister: how can the data that is being used by Ministers in times of crisis also be deployed at a local level? The Minister will have heard the calls in this debate and the report for better support to localities. Does the Minister agree that the Government’s assessment of reasonable worst-case scenarios should be shared as a matter of course with local resilience forums? What plans are there for continuing core funding for LRFs?
In an Answer to a Question put to the Minister by my noble friend Lord Harris on 4 September, the noble Baroness confirmed that, in the resilience framework, it is set out that the Government have a “commitment to publishing” annual statements
“to Parliament on civil contingencies risk and performance on resilience”.
The Minister also stated that:
“Both Houses will be updated in due course regarding the timing, form and content of the statement”.
I am not aware that this update has been provided, but perhaps the Minister will confirm whether I am correct and, if so, why it is not yet forthcoming. It was also confirmed in the Answer to that Question that the Government’s intention, which was given by the Deputy Prime Minister,
“is to publish the first statement during this calendar year”.—[Official Report, 4/9/23; col. 195.]
That would happen, with both Houses being given the opportunity to scrutinise it. Clearly, there is not much of the year left. Perhaps the Minister could indicate when the first statement will be published and, if we do not see it this year, the reasons for the delay.
We are discussing this report while the Covid inquiry continues apace. Can the Minister therefore say whether and how this report might be considered alongside it? I pay tribute to all those who have worked tirelessly no matter what the emergency—in this case, the pandemic—from local councils through to the emergency services, NHS workers, carers, civil society and so many more. This begs the question of how their voices will be heard so that their experience and professionalism can inform the future.
I turn to some of the health specifics in the report. The right reverend Prelate the Bishop of London rightly referred to recommendation 1 and the fact that the government response promised a health disparities White Paper, yet we have been told that that will not happen. Many of us have pushed on this point in the Chamber. The pandemic pulled back the curtain on the fact that there are deep health inequalities in our country. The right reverend Prelate made the very good point that a more equal society strengthens our resilience. In other words, it is not an either/or but a necessity in achieving the required resilience.
The noble Baroness, Lady Coussins, spoke about a different inequality in the provision of information. How can we expect people to work with us and protect themselves, their families and their communities if they do not have access to information simply because it is not available in their language? That seems a real basic.
On health inequalities, as I am sure the Minister is very aware, living well is best captured in health policy by the concept of healthy life expectancy—the amount of time that an average person can expect to live without a major health condition. Evidence shows that the UK is no longer making progress in this regard. The poorest 60 to 64 year-olds have the same level of bad health as the richest 90 year-olds. That is a waste of 30 healthy years for those who are poorer. The impact of poverty on health means that people who live in different parts of the country have very different chances of living well. A girl born and brought up in Blackpool can expect to live well until she is 54, whereas a girl born and brought up in Winchester can expect to live healthily until she is 66. Resilience relies on those health inequalities being dealt with.
On GPs and recommendation 21, the government response is more than somewhat rosy. On access to GPs, the statistics from a recent global study by the Economist show that just one in three in the UK say that they can secure an appointment with their doctor within 24 hours. The global average is 67%—that makes the UK less responsive than Rwanda. Nearly one in five patients in the UK say that they have to wait longer than a week to see their GP. The reality of accessing general practice is not as the Government put it but at an all-time low. The noble Lord, Lord Patel, referred to media reports on the challenge of remote consultations. I say to the noble Lord, Lord Allan of Hallam, that it is absolutely not an either/or, but the noble Lord, Lord Patel, raised the right point; some people—the report talks about the very young, those with existing conditions and the elderly—may be more excluded from the benefits of remote access than others. We cannot just ignore that. What work are the Government doing to ensure that remote access brings benefits to all and does not exacerbate inequalities?
I finish by saying that the reform of the Mental Health Act could have been included in the Government’s legislative programme. The committee’s report refers to the importance of well-being and strong mental health, and a revised and strengthened Mental Health Act would have been a tremendous contribution to that. Sadly, the Government missed that opportunity, and it might be that the Minister can shed some light on when we can perhaps see some progress in this regard.
This has been a very valuable debate but, as ever with such reports, perhaps more questions are raised than the Government have hitherto answered. I hope that the Minister will take the debate in the spirit in which it is intended and perhaps use the insight of noble Lords to take us forward and to make us more resilient and prepared and to get us ready in the long term.
The Minister of State, Cabinet Office (Baroness Neville- Rolfe) (Con)
My Lords, I join all those who congratulated the noble Baroness, Lady Lane-Fox, on her speech and on the work that she did in chairing this committee. She brings a thoughtfulness and a knowledge of digital way beyond most of us, which has made this report a very special piece of work and has allowed her to pioneer new methods of data-gathering, which I think will be used elsewhere. I thank all noble Lords for their interesting contributions today, despite the rival attraction. It is good to see so many noble Lords here, including the noble Lord, Lord Alderdice, who was right to emphasise cost-benefit and the speed of change. My noble friend Lady Fraser of Craigmaddie was here earlier.
Of course, two years have elapsed since the report was printed, but the good news is that that means that we can take advantage of what has been achieved since then and celebrate the fact, as we should, that we are no longer tied down by Covid and, in my case at least, that NHS vaccinations for the most vulnerable and elderly groups continue to help in protecting so many of us, especially in this House.
The COVID-19 Committee’s insightful piece of work in its Living in a COVID World: A Long-term Approach to Resilience and Wellbeing report rightly highlights the importance of building resilience to ensure that we are equipped for future crises. That is where I would like to start, not least since it fits in with my responsibilities at the Cabinet Office. We have made substantial progress on resilience. Earlier this year, we debated the UK Government’s new resilience framework which sets out the Government’s plan to strengthen the systems that underpin our response to a range of risks. The Resilience Directorate, in the Cabinet Office, works across government to ensure that the UK is better placed to prepare for, respond to and recover from risks and hazards—extreme weather, terrorism, pandemics and so on. I thank the noble Baroness, Lady Merron, for her kind words about Mary Jones. We will be publishing an update on resilience shortly—we stand by that promise—and look forward to debating this matter further with the noble Baroness and with other colleagues, such as the expert, the noble Lord, Lord Harris, who I was pleased to see in his place earlier.
As part of the commitments made in the resilience framework, we are establishing new ways of identifying and assessing chronic risks to the UK, the continuous challenges facing the UK, generally over a longer timeframe. This complements the national security risk assessment and sets out the most serious acute risks to the UK. The Government’s national risk register, the external version of the classified risk assessment, was published in August. It is specifically aimed at risk professionals and practitioners across society who benefit from having more information about risks. It is the most transparent version yet, which I am pleased about, and it helps to develop a shared understanding of preparedness for risks facing the UK. Our whole-of-society approach, which picks out what several noble Lords have said this evening, is important to building the resilient society that the right reverend Prelate the Bishop of London emphasised very rightly.
Chapter 2 of the committee’s report outlines the challenges we face, such as the digital and tech revolution, demography and the response to climate change, although it perhaps underplays the economic problems we all face as a result of the enormous cost of seeing Britain through the pandemic. A prosperous economy makes it easier to cope with Covid legacies in health, education and the other areas identified today. Alongside the longer-term forward thinking of the Resilience Directorate, we remain committed to learning from the Covid-19 pandemic, building on the reset mentioned by the noble Baroness, Lady Merron. Today’s debate has been very helpful.
The noble Baroness, Lady Lane-Fox, was right to commend the work of local communities during the pandemic and their role in resilience. I remember what a brilliant job my local village volunteers did during the pandemic. They delivered drugs and donated food to some of the poorest in our area and prioritising deliveries to those with a safeguarding risk. We must build on that joint endeavour. Although the UK Government have a central role in assessing and planning for risks, the local level is the foundation of the UK’s resilience. The many local resilience forums in England, Scotland and Wales, as well as the emergency preparedness groups in Northern Ireland, play a critical role in bringing together local responders, such as the emergency services, to plan for risks.
It was interesting to be taken back by the noble Lord, Lord Allan of Hallam, to all the exchanges on testing, the location of testing sites and the local endeavour that included faith groups. We have learned from those experiences in our planning and the way that we will approach things going forward.
The right reverend Prelate also highlighted the importance of local faith leaders in lots of different ways. The Government recognise the importance of such figures. Indeed, we worked closely with them during the pandemic in developing guidance, using places of work safely and working with a diverse and dispersed network of community champions. Community champions were found to strengthen regional capacities to deal with Covid-19, while the community vaccine champions programme found that religious minority groups aware of CVC-funded activities were significantly more likely to have booster vaccinations.
The pandemic was an unprecedented event that I hope will not be repeated. Everyone had to do their best and often make difficult decisions where there was no blueprint. I was on the Back Benches at the time, but I think the degree of uncertainty in such crises may have faded from memory. All such crises have unexpected features. For example, it was not unreasonable to prepare for a flu epidemic like the one which killed so many, particularly young people, in the 20th century. It is not possible to have a plan for everything, as is rather suggested in the report with the call for a “just in case” model. This would be very expensive and we would be unlikely to get it right, but I agree that we must focus more on prevention and take a more whole- of-society approach to risk management. To pick up the point made by the noble Lord, Lord Alderdice, there has to be some surge capacity. That happened during Covid in many different areas of government. We have to be careful not always to focus on the negative.
Looking back, there will be decisions that we got right but also important lessons to be learned for the future, and that is why we set up the Covid-19 inquiry. My noble friend Lord Robathan questioned the Government’s decision to lock down. The inquiry was commissioned to consider decisions such as that and it will report its conclusions, which we will consider in due course. We need to learn the lessons of Covid in a spirit of transparency and candour, and there are many conflicting views.
Progress on the inquiry is well under way—as we all hear on the radio all the time—and much of the focus is on issues identified in the committee’s report that we are discussing today. Public hearings for module 1 are focused on pandemic preparedness and resilience. Module 2 hearings, going on at the moment, are focused on core decision-making and will conclude on 14 December. Future modules will focus on healthcare systems, vaccines and therapeutics, and government procurement—I note the points made by the noble Lord, Lord Allan. Our new Procurement Act has of course made many changes in the light of the difficulties of Covid, including strengthening the existing legal duties in respect of conflicts of interest and introducing greater transparency requirements, which I think we all welcome.
On levelling up, many of the committee’s recommendations focus on how the Government can and should deliver their commitments to levelling up. Our White Paper published in February 2022 recognised that not every person in every part of the UK shares in the UK’s success, which is why the White Paper outlined 12 ambitious missions to level up the UK, some of which we have touched on today. A number of the recommendations relate to transforming our approach to devolution and giving more power to local government. The White Paper set an objective that every part of England seeking a devolution deal should get one by 2030. In December 2022, we announced five new deals, which will bring devolution to over 51% of the English population. A further four new devolution deals were announced in the Autumn Statement.
The noble Baroness, Lady Lane-Fox, emphasised the significance of well-being. Well-being is an important consideration for the Government when making spending and policy decisions. She raised the issue of funding for well-being; I understand that departments across government have worked with and provided funding to the What Works Centre for Wellbeing and others to date. We will continue to explore how best to measure well-being and deliver improvements across the UK. The Treasury’s Green Book sets out how to appraise policies, programmes and projects and requires all social, economic and environmental benefits and costs to be considered in appraisal. Further, the noble Baroness will be aware of the ONS well-being index and the national well-being dashboard. This intelligent use of data measures well-being across the country in a number of areas and can be a useful tool for practitioners.
Perhaps even more important in this area, however, is the Government’s progress on reducing inflation and promoting growth through measures announced in the Autumn Statement, as this is the best way to support the sustainability of public spending in areas such as well-being. In this year’s local government finance settlement, the most deprived areas will receive 17% more per dwelling than the least deprived areas.
I have not gone through the local government issues; they were dealt with but nobody has raised them today. However, I am happy to talk to people if they want me to. Noble Lords will know that I am always very keen to make sure that local government contributions are appreciated and funded.
On health, the pandemic placed an unprecedented level of demand on NHS services. The NHS has since been provided with record levels of staffing and funding to tackle waiting lists. NHS England achieved its target of virtually eliminating waiting times of two years or more for elective procedures in July 2022, and waits of 18 months have been reduced by over 90% in the last two years. Additionally, as part of the first-ever long-term workforce plan, record numbers of doctors, nurses, dentists and other healthcare staff will be trained in England, backed by over £2.4 billion of funding for additional education and training places.
On increasing access to healthcare services, the NHS app—which noble Lords mentioned approvingly—and the NHS website are delivering a proactive, personalised digital NHS experience for patients and their carers. This has come on a lot since the noble Baroness, Lady Lane-Fox, and I worked together on this in the Cabinet Office. However, as the noble Lord, Lord Patel, pointed out, this is not an easy area. As he said, the public are generally supportive of these measures but less happy when technology comes between them and the clinicians. Like him, I believe that online consultations, although useful, can be overdone.
Of course, GP practices are individual businesses with partners. Many are outstanding and some face more challenges. I have certainly seen how the appointments system has been digitalised in recent years. That has freed up GP surgeries. The report today in the Telegraph examined 95 cases; of course, any serious incident of the kind referred to is one too many. However, NHS guidance and clinical training incorporate red-flag symptoms that would prompt a GP or practice staff to move to a face-to-face appointment. Even more importantly, patients also have a right to request a face-to-face appointment whenever they deem it necessary and practices should comply with that, unless there are good reasons to the contrary such as a particularly infectious disease.
The right reverend Prelate the Bishop of London rightly set out the importance of tackling health inequalities. This is one of the 12 missions set out in the levelling-up White Paper. The major conditions strategy, which the Government intend to publish in early 2024, will explore how we can tackle the key drivers of ill health in England to improve healthy life expectancy, as well as reduce pressure on the NHS and reduce ill health and related labour market inactivity. We are also tackling health disparities through interventions such as the NHS’s Core20PLUS5 programme, which focuses on improving physical and mental health outcomes in the poorest 20% of the population.
We know the pandemic has had and will continue to have an impact on mental health and the well-being of many people. That is why we are investing £2.3 billion of additional funding per year by March 2024 compared with 2018. This funding will expand mental health services in England so that 2 million more people can receive NHS-funded mental health support. We are also continuing to roll out mental health support teams in schools and colleges across England.
Probably the most worrying effect of the pandemic has been on schoolchildren and infants. There is a question as to whether we got school closures right. We acted swiftly in helping our children recover from the impact of the pandemic and have made available almost £5 billion for ambitious multiyear programmes to support education recovery. We are training more early years staff in the latest teaching for communication and language, maths and personal and social development. A number of other important interventions were touched on in the report, such as the Nuffield early language intervention programme, which has played an important role in improving reception-age children’s language and communication skills following Covid-19.
Finally, let me turn to digital transformation. The Covid-19 pandemic had one advantage. It ushered in a revolution in digital ways of working for all of us, which would otherwise have taken decades. The noble Lord, Lord Alderdice, gave us some telling examples—notably changing decades of practice by the late Queen. Schools and public services rose to the challenge remarkably. However, the pandemic brought into stark reality the need to make digital innovation accessible to all.
As the committee found, the nature of digital inclusion is cross-cutting and the onus sits on every government department to support its service users to tackle digital exclusion. We now have a new department, DSIT, focusing more strongly on such matters and much going on elsewhere. Across government, the Cabinet Office is playing its part with the Central Digital and Data Office and our new AI directorate, which is driving the adoption of new technologies in the public sector, making services more accessible and improving productivity and value for money. This is a very important part of the revolution.
The noble Baroness, Lady Lane-Fox, was right to raise the importance of long-term thinking. The Government have clearly made long-term decisions for a brighter future, such as setting up the Covid inquiry to learn lessons from the pandemic, the levelling-up White Paper and the long-term plan laid out by Rishi Sunak in October. Of course, we welcome the recommendations of committees.
I particularly identify the Select Committee on Risk Assessment and Risk Planning, chaired by my noble friend Lord Arbuthnot, which encouraged the Government to think ahead, particularly on resilience. It is a very good example of the influence of critical thinking in this House, as is the report that we are discussing today. Long-term thinking implemented by a cross-departmental approach is also important. I think that the noble Baroness, Lady Merron, was saying that. That is why I volunteered, somewhat reluctantly, to take part in this debate, and why her experience in the department is important to the debate. Being able to look right across the board has been a very good aspect of this report and this debate.
I thank the noble Baroness, Lady Coussins, for her arresting and wide-ranging speech on the importance of language skills and interpretation in health inequalities and injustice. I completely agree on the importance of languages in schools. It is not an area of mine, but I echo everything that she said. I would add that primary care providers should ensure that patients have access to translation and British Sign Language services as required to support consent, mental capacity and clinical assessments. Primary care providers can request support for reasonable additional costs from their local commissioner, which will assess whether claims for such costs are reasonable and represent value for money. That is an example of where we are thinking about the point that she was making, although her speech was wide-ranging, and I look forward to reviewing it again.
I have tried to answer where I can. Clearly, I do not deal with some of these issues on a daily basis. In particular, I shall have to write to the noble Baroness, Lady Merron, on the issue of the immunocompromised. I say in concluding that we share many of the sentiments of the committee’s report. We agree that the Government and the country must learn lessons from the Covid-19 pandemic. I hope that I have shown that progress is being made on many of the difficult issues that were highlighted by the report. My special thanks to the chair and the committee and to those who gave evidence—many people in very difficult circumstances—as well as to the clerk and to his or her team and noble Lords who took part in the debate today.
Baroness Lane-Fox of Soho (CB)
I thank all noble Lords who have taken part in the debate. It has been incredibly interesting to hear about some substantial areas of coalition, particularly around health inequalities and disparities. I have been surprised at how many noble Lords have homed in on that issue specifically. Perhaps surprised is the wrong word; I was pleased. As always, they brought such incredible depth of expertise to that topic. I hope that the Government will listen to the expertise that has been displayed today. I was particularly struck by the intervention of the noble Baroness, Lady Coussins, on the link between health, language and education and the incredible complexity of getting these issues right in the face of such a crisis, so I thank her very much for her contribution. There were some very powerful words from the right reverend Prelate the Bishop of London around the effect of place, as well as on the issues of health disparities, economic inequalities and so forth.
As always when I stand in this chamber, I am humbled by the experience of the people in the Room. It is an example of why everybody should have been on this committee. I thank the members here to speak with me today, and I thank the Government for their response.