Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) Regulations 2020
(3 years, 6 months ago)
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Lord Bethell
That the Regulations laid before the House on 28 September be approved.
Relevant document: Special attention drawn to the instrument by the Secondary Legislation Scrutiny Committee, 29th Report.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, this instrument sets out the regulations on the legal duty to stay at home and self-isolate for people who test positive for Covid-19 and their contacts who are told to self-isolate by NHS Test and Trace, which came into force on 28 September. The principle of self-isolation is a key component of our strategy to break the chain of transmission, which in turn stops the spread of the virus, protects individuals and local communities and avoids further societal and economic restrictions. The legal requirement in this statutory instrument is to make it crystal clear to the public—more than any marketing, published guidelines or televised Downing Street presentation possibly could—that people who are infectious or potentially so should stay at home and self-isolate. Providing this clarity about the right thing to do is an essential step to securing a more normal way of life and supporting the economy.
On the scientific substantiation for this strategy, perhaps I may reassure noble Lords that SAGE has advised that ensuring that infected individuals and their close contacts isolate is a vital tool in controlling transmission. Faced with the current rising incidence levels, it is the right time to provide this clarity. Positive cases have increased sharply, with seven times as many cases compared with the end of August. Since it was launched on 28 May, 290,034 people have tested positive and have had their cases transferred to NHS Test and Trace. Some 1,198,151 contacts have been identified and 82% of those for whom contacts have been given have been reached and told to self-isolate. These are astonishing figures. The most recent weekly statistics for 8 to 14 October show that 101,494 people tested positive during that week at least once, an increase of 12% compared with the previous week. I cannot emphasise enough how important it is that those people should self-isolate when instructed.
We are naturally concerned about compliance levels. We cannot knock on 1 million doors every day for 10 days for each person when they are isolated, so we cannot be certain about compliance levels. However, there is enough evidence to suggest that it is not good enough and we have a programme in place of measures to improve it. The first is to increase public understanding of the importance of self-isolation in stopping the spread of the virus. We have put in place a comprehensive media campaign to explain what test and trace is, why it is important and what the public need to do when they are told to self-isolate.
I thank the Secondary Legislation Scrutiny Committee for its important review of this SI and its impact on the public’s understanding, and I acknowledge the committee’s comments on the importance of that. However, I point out that the SI is part of a broad effort to simplify and clarify the rules, which includes the introduction of local alert levels in England and the rule of six.
Secondly, we are supporting people to self-isolate by providing assistance to those who may have practical difficulties in self-isolating. NHS Test and Trace will check with individuals who test positive and their contacts to reinforce the importance of self-isolation. They will ensure that they have access to any support needed. Since 28 September, contact tracers have made around 35,000 to 50,000 calls a day to people who are self-isolating.
The £500 test and trace support payment has been introduced to ensure that people on low incomes self-isolate when they test positive or are identified as a contact, and to encourage more people to get tested. Eligible individuals receive an up-front, one-off payment of £500. This is on top of any benefits and statutory sick pay that they may currently receive. The Government set a deadline of 12 October for local authorities to be ready to administer the test and trace support payment scheme.
Local authorities are now making payments to people on low incomes to support them to self-isolate. We are monitoring the situation to ensure that national coverage is in place. I acknowledge that a small number of local authorities are experiencing technical difficulties in administering the scheme, as we would expect with a programme set up so quickly. We are supporting them to resolve these issues as soon as possible. In addition to the support payment, local authorities will focus on the principle of encouraging, educating and supporting self-compliance.
Thirdly, we are introducing fixed penalty notices for those who do not follow the rules to send a clear message about the seriousness of not self-isolating. Penalties and offences were designed in conjunction with legal colleagues, consulting previous precedents. During this process, the Department of Health and Social Care worked closely with the Home Office, the National Police Chiefs’ Council and the Government Legal Department to agree the memorandum of understanding. The Information Commissioner’s Office has also advised on the process of information sharing involved to ensure data is shared appropriately and proportionately. BEIS and MHCLG also supported the decision-making around enforcement methods and processes. Fines start at £1,000 and may increase up to £10,000 for repeat offenders. For more serious breaches, fines start at £4,000, increasing up to £10,000.
We have needed to use emergency powers to introduce these regulations so that we can respond quickly to the increased threat posed by Covid. The urgency in this case arises from the increasing rate of diagnosed positive cases at the time of making the instrument. The Secretary of State for Health and Social Care keeps the necessity of regulations under consideration between formal review points. We are committed to ensuring that these measures are in place only for as long as necessary.
The requirement on people who are notified to self-isolate plays a key role in slowing or preventing the spread of the virus. The regulations will protect individuals and their loved ones. They will help to ensure that we keep the virus under control. For that reason, I beg to move.
Lord Rooker (Lab) [V]
My Lords, the message was “clarity”; that is a joke. There are no less than five ways to calculate the period of time for self-isolation in the regulations: at Regulation 3(3)(a), Regulation 3(3)(b), Regulation 3(4)(a)i, Regulation 3(4)(a)ii and Regulation 3(4)(b). Who makes the calculation? If you slip up, potentially more than once, as the Minister indicated, there could be a fine of up to £10,000. This is completely unacceptable.
Why is there no mention of exercise as a reason for leaving the place of self-isolation? Exercise is a requirement to maintain physical and mental health. You cannot just isolate away if there is no prospect of exercise at all. Are the BMA and SAGE fully on board with this aspect of the regulations?
I do not accept that the police should be involved in the first place. Environmental health officers are perfectly capable and would have more trust in the locality if they were tasked with this role. In effect, the Government are starting to lose the trust of the people. I repeat: who makes the calculation of the time period for self-isolation?
Baroness Jolly (LD) [V]
My Lords, when an individual self-isolates, the whole household is impacted too. What financial support might be available? Does enforced self-isolation mean that the individual is entitled to statutory sick pay? In Germany they would get full pay. If the rest of the family have to isolate too, are they entitled to any financial support to supplement their loss of income? Who gives guidance to the Covid-affected individual as to what they may and may not do, and where to find help and support? Are there arrangements for non-English speakers? What about caring responsibilities?
What other criteria might there be to extend the isolation if a family member shows signs, is tested and found positive? Does that then become a family lockdown? Are those family members expected to quarantine for two weeks?
Could the Minister clarify paragraph 6.7 of the Explanatory Memorandum? It states that adults who have been notified other than through the app that they are positive should self-isolate “for a specified period”. What is the contact: by phone, in person, by letter or by email? Of course, some parts of the countryside have no mobile coverage. I have no signal at home, but I am not aware that I have indicated my preferred method of communication.
Not everyone has the app. Could the Minister tell us what proportion of the adult population has downloaded it? A recent report suggests that many people may use a phone only to text and chat. What assumptions has the test and trace team made in this regard? What proportion of the general population are regular IT users who can handle this way of information dissemination?
Has the Department of Health and Social Care done any analysis of the effectiveness of test and trace? It certainly got off to a bumpy start, but could the Minister tell the House whether there are any plans to carry out a review so that it could be improved for a possible second or subsequent wave?
Baroness Meacher (CB) [V]
My Lords, I begin by thanking our hard-working Minister for a very helpful meeting we had recently about parents of school-age children who had been required to self-isolate for months because of their exceptional vulnerability to Covid-19. These same parents are now required not to self-isolate, despite their exceptional vulnerability, but rather to send their children to school as normal. I declare an interest in this issue: one of my daughters was in the shielding group and received a text every day saying, “Do not leave your house”.
These regulations deal with the situation where a child tests positive for coronavirus or comes into close contact with someone who has tested positive. We are told in Regulation 2(3)(a)(i) that the child in question must then self-isolate in their home. This means that a child of an exceptionally vulnerable parent who contracts coronavirus has to remain isolated in the house of the exceptionally vulnerable parent. It is hard to think of anything more completely unreasonable.
I emphasise that the Minister, whom I greatly respect, is not responsible for this state of affairs. I raise this concern more by way of a follow-up to our helpful meeting to offer an alternative solution to these very vulnerable parents. Germany ensured that children could attend school safely without presenting a risk to their families. The main interventions included face coverings in classrooms, handwashing and an effective testing regime. Saliva tests that produce results in 15 minutes now exist. Does the Minister yet know how much longer vulnerable parents will have to wait for every school to have weekly testing of their pupils using the saliva test? If he cannot answer this question today, perhaps his officials could write to me.
Baroness Rawlings (Con) [V]
My Lords, I thank the Minister for presenting so clearly this vital regulation. I am sure that your Lordships agree that it would be wrong not to self-isolate as instructed, and wrong not to make disobedience a serious offence. However, what is the government procedure for contacting the general public if a person who is already infected with Covid-19 does not self-isolate but travels on public transport, obviously spreading it? As the noble Baroness, Lady Jolly, asked, how do the Government contact anyone who could have been close to the diseased person, and make it public? Is PHE responsible if it does not contact the relevant public? Is it fined? After all, we all want to save lives.
Lord Hunt of Kings Heath (Lab) [V]
My Lords, we have just two minutes each to debate these important regulations, which create large fines and come at the same time as the agreement reached with the police for the handing over of the personal information of individuals notified to isolate. This is a travesty of parliamentary scrutiny. I simply do not understand why we could not have debated these regulations before they came into force.
On clarity, as the Minister said, I am extremely sympathetic to the argument of Big Brother Watch, and of my noble friend Lord Rooker, that the sheer complexity of the regulations means that the period of time that a person must isolate for is not immediately evident and requires very careful reading of the regulations —not a good basis for public trust.
Added to this is the concern expressed by the Secondary Legislation Scrutiny Committee that those without the app, who may be poorer or more elderly, could be more likely to be contacted by traditional track and trace, and therefore more liable to be fined. Can the Minister comment on this?
Finally, a fascinating report, recently published by the Nuffield Council on Bioethics, asked some searching questions about the values which inform the most recent decisions on Covid-19 restrictions, and the challenging trade-offs between different rights and interests. It asked what support is to be given to those in the parts of society asked to bear the greatest burden in the Covid-19 response, arguing that the state has a duty to ensure that they are supported to do so. I hope that the Minister might be prepared to look at its work.
Baroness Walmsley (LD) [V]
My Lords, I agree with the noble Lord, Lord Rooker, about the difficulty posed by the complexity of these regulations, and with the noble Lord, Lord Hunt. Poorer people, without a smartphone that supports the NHS app, are more likely to be fined if they fail to isolate than those who have the app. This is because, without the app, the only way that they can be asked to self-isolate is by test and trace or a council official. If those with the app who learn that they have had a contact are not subsequently contacted by test and trace and asked to self-isolate, nobody will be able to enforce the penalty if they do not.
Given the poor record of NHS Test and Trace in contacting those who have tested positive and their contacts, that would leave an awful lot of people not self-isolating and not liable for a penalty if they do not. I am concerned that these penalties may deter people from taking a test. Also, a person who tests positive may be quite reluctant to disclose any contact who they predict is not likely to be able to self-isolate, in case they expose them to the possibility of a big fine.
Like the noble Lord, Lord Hunt, I am also concerned about the disclosure that the police will be given the details of people who have been asked to self-isolate. The BMA and the Chief Medical Officer have expressed concerns that this could also deter people from getting a test, and this would apply in particular to those who feel that they cannot afford not to go to work. Why is it necessary to involve the police? This is a disclosure of health information and an invasion of privacy. If the police are informed, what guidance and training are they given about how to approach the person concerned? Will they initially explain why self-isolation is important and direct them to support before using the big hammer of a fine?
Lord Loomba (CB) [V]
My Lords, the Secondary Legislation Scrutiny Committee has drawn these regulations to the attention of the House due to their potentially discriminatory nature. This is because the regulations do not apply to people who use the NHS app. The committee believes—and I agree—that the elderly and the poor are less likely to use the NHS app, as it only works on newer, more sophisticated phones, and therefore they are more likely to be contacted by the normal test and trace team. This means that there is the potential for more poorer or elderly people to end up being fined than people who are informed by the app but who do not go on to get a test.
My second point is that a swathe of coronavirus regulations is coming into force, amid numerous reports of the public being confused and not understanding what is the law and what is guidance, and what applies to them in their situation. With these regulations, we have another instance of the potential to confuse, precisely because these regulations mandate people to self-isolate if they are told to do so by NHS Test and Trace team or by an official, but not if they are informed by the NHS app.
Baroness Jones of Moulsecoomb (GP) [V]
My Lords, I think it is obvious that most people agree that self-isolation when you have a communicable disease is a good idea if you can possibly do it—so most people will of course obey the instruction. But for those people who do not, I fear that the Government have only themselves to blame. There is far too much confusion. We have had six or seven months of advice and laws and regulations, and police activity, with the police themselves being very confused. The Government must urgently tidy up all that so that we can be clear about what we all need to do.
Secondly, the Government urged people to go back to work, which was a pretty stupid thing to do while the pandemic was still very active among us. Thirdly, they encouraged people to “eat out to help out”—while of course at the same time abandoning hungry school- children. So the Government have only themselves to blame, because there is confusion around these regulations.
In an earlier question-and-answer session, the Minister suggested that I give him some ideas for an economic recovery for Britain: a long-term plan so that we do not just lurch from crisis to crisis. I am more than happy to set up a meeting with Green Party economists, and in particular our professor of economics, Molly Scott Cato. I will be in touch with the Minister’s office to do that as soon as this debate is finished.
Lord Moynihan (Con)
I will follow the noble Lord, Lord Rooker, and his emphasis on the importance of exercise, and the noble Baroness, Lady Meacher, on the critical importance of children in isolation. Will the Minister tell us what public health advice concerning physical well-being and mental health is being given to the young, who are often traumatised by having not just to stay home but to self-isolate as a result of these regulations?
The outstanding work done in this area by YoungMinds is worthy of national distribution by the Government. Its four pillars—“staying connected”, “staying calm”, “dealing with stressful situations at home” and “helplines and resources”—are critical. Guidance on mindfulness, social media, physical activity at home, and unfollowing or muting accounts that create anxiety, is important. We need a national information campaign to back these regulations, including advice on exercise at home and staying as mentally and physically fit as possible.
Joe Wicks led the way earlier this year, and the Government should fund such fitness programmes as the nights draw in. As test and trace increases its reach, this work for innately gregarious young people during these difficult days is essential. It is young people who are shouldering the lion’s share of the burden of this crisis, while the average age of someone dying from Covid remains above 82. When isolation is over and rejoining wider society is permitted, I repeat my plea to the Government to reclassify gyms, pools and leisure centres as essential services and to keep them open.
Baroness Massey of Darwen (Lab) [V]
My Lords, individuals will be required to isolate for specified periods in specified places. This implies that such periods will vary. On what does that depend? Failure to isolate will incur a fine ranging from £1,000 to £10,000. That is quite a range. What criteria will determine the amount of a fine? It is not clear, even among professionals, such as the police.
The virus is now evident among younger people, such as students. They may be asymptomatic but infectious. How will any proposed system of isolation work for them? Handing out massive fines to students having parties may be a deterrent, but would it not be better to persuade and involve young people in behaving differently than to deal out punishment? We have powerful examples of working with young people to change health behaviour, perhaps the most striking being the highly successful teenage pregnancy strategy, introduced in 2000. Why do the Government not build on good practice?
I agree with the noble Lord, Lord Moynihan. Mental health charities and services warn of serious and expensive consequences if mental health in isolation is not given more attention. Will the Minister say whether mental health services, which were underequipped before Covid, will be expanded, with more staffing and resources, including helplines, which are already dealing with huge increases in demand?
What about older people in isolation? They may be suffering loneliness and stress. I recognise and admire the efforts made by local communities through phone calls and practical help. Will local authorities have the resources to check that elderly people do not fall through the net? Most importantly, if the Government continue to hand out confusing information without strategies to involve individuals and communities—strategies best funded to be carried out at local level—the objective of defeating Covid will be more difficult.
Baroness Bowles of Berkhamsted (LD) [V]
My Lords, I understand why these regulations have been made and share many of the concerns of other noble Lords. The first point that has to be made is that it all depends on the effectiveness of test and trace.
One of the effects of the measures extending to employers is that there is a flurry of circulars from lawyers and other employment advisers with good, simple explanations of what can and cannot be done, and that should have a reinforcing effect on compliance, with more checks via line managers and information to employees. It also opens the door to cross-checking—for example, if one person reports in as self-isolating and another, who might have been expected to be in similar circumstances, does not. In that context, I understand that whistleblowing legislation would cover this instrument in the event that there are instances of reporting by employees either on other employees or on businesses, and that whistleblowing protections must apply. Will the Minister confirm that? There have been reports of threats of redundancy if employees do not turn up to work. This instrument may deter threats, but unfortunately it may not deter redundancies where loss of workers is the last loss of business income that the employer can withstand, especially if several employees are affected at once.
Finally, with regard to enforcement, local authorities could nominate Covid marshals or possibly security guards, similar to those used at Manchester Metropolitan University before there was a legal basis. What kind of training safeguards would be in place, especially around the use of reasonable force?
Lord Bilimoria (CB) [V]
My Lords, with millions of people and many thousands of businesses in tier 2 and tier 3 areas, the support measures announced today by the Chancellor will bring a huge sigh of relief to many, especially those in the hospitality sector. However, it is no exaggeration to say that successful, affordable mass testing could transform the way we live and work in the months ahead. The Minister has worked very hard in this area. Will he give us an update on the 20 million 15-minute antigen tests that have now been procured and are being deployed around the country?
The Prime Minister, the Health Secretary, the Transport Secretary and even the Minister have consistently used Public Health England’s 7% figure to reject calls for the introduction of airport testing. By contrast, 30 other countries are now implementing airport testing on arrival. Some have gone further to test after five days of quarantine to reduce the number of asymptomatic carriers who might be missed. Today, the Daily Telegraph reported that
“Oxera and Edge Health, said the 7 per cent figure was ‘significantly understated’ because it excluded not only travellers who might have symptoms but also those whose viral load could be detected … ‘If all infected passengers (including detectable symptomatic passengers) who attempted to enter the UK population but were prevented from doing so were to be included in the estimate, this estimate would be 63 per cent.’”
That is nine times 7%. They also said that the public health report was based on a modelling exercise and did not take into account
“‘real-world’ evidence from … airport testing regimes such as Jersey, where only a tiny fraction of arrivals tested positive without any onward community transmission.”
Will the Minister explain why we cannot implement airport testing, which will help our tourism industry, business, airports and airlines, which have suffered so much through this pandemic?
Lord Adonis (Lab)
My Lords, the isolation of school pupils is a crucial issue, and the Minister kindly agreed to address five questions which I posed on Tuesday. First, will the Government undertake in England not to follow Wales and close all secondary schools as part of any revised tier 3 or circuit-break arrangements? Secondly, will the Government codify advice to schools on best practice and the definition of bubbles with a view, where infections are identified, to only groups who sit together being sent home rather than whole classes and year groups, as is often happening at the moment? Thirdly, will Ofsted give best practice guidance on what constitutes adequate online learning where pupils are sent home, including live instruction and interactive learning? Fourthly, where pupils are sent home and do not have the necessary IT equipment or wi-fi, will the Minister undertake that schools can apply for laptops for pupils who do not have them up-front under the Government’s scheme without having to wait until pupils are actually sent home so that learning can start immediately? Fifthly, where pupils, by the nature of their home circumstances, do not have wi-fi, will the Government set out to schools what they should do, where possible, to provide it, including the provision of financial support?
Baroness Uddin (Non-Afl)
My Lords, regardless of the statistics the Minister has suggested on the number of those reached for self-isolation, communities with large minority communities remain unaware of government regulations and, most importantly, the unnecessary punitive fines. Some of the latest statistics suggest that more than 60% of close contacts of those who are Covid-positive have not been reached. Are statistics available for their profile, including their ethnic backgrounds? What assessment has been made of the reasons for the evident and serious gap in trust in the Government’s management of their communications with the public? Needless to say, their resistance to engaging with the leaders of Manchester will not have filled ordinary citizens with great confidence, and any clarity is in the messaging that the Government will not accept any scrutiny or dissent.
These are emotionally testing times for us all. Problems with mental health and well-being are also at pandemic level and, regardless of government funding strategies, why are respected national and local statutory and voluntary organisations struggling to access essential funds to provide assessments, counselling and other support, while many people end up in A&E? What urgent consideration and resources have been allocated to national and local children’s organisations to support individuals and families before they reach crisis point?
Under emergency modes, we have overlooked social divisions as communities become ever more segregated, with more vulnerable families increasingly detached from those who have and those who remain at the margin of inadequate, unequal access to financial, educational, digital and emotional support. Now is the time to reach out for better management of this pandemic. The politically biased attention given to local leaders is unbecoming of this Government leading a national and global pandemic.
Lord Bourne of Aberystwyth (Con) [V]
My Lords, it is a pleasure to follow the noble Baroness, Lady Uddin.
I applaud the work ethic of my noble friend and thank him very much for setting out the regulations. I certainly support the intent behind them, but they are, of course, dependent for their efficacy on several factors.
The first important factor relates to clarity. As other noble Lords have said, these regulations are not a model of clarity. Can my noble friend say something about getting some simple messages across to people, so that those affected by these regulations are in a position to understand them? At the moment, it is very difficult to do so.
A second factor relating to the efficacy of the regulations is whether people will obey them. Can my noble friend say what discussions there have been with the police about their implementation and about resources?
Also very material is the extent to which the regulations are being used. My noble friend referred to the importance of fixed penalty notices. How many have been levied so far? That is a very important consideration. Have they been used at all? It would be good to hear something on that.
Another factor relating to their efficacy is, as the noble Baroness, Lady Massey of Darwen, said, test and trace. The national Covid-19 app does not require people to self-isolate. Why on earth not? We were told that this app was going to be world beating. I wonder in what respect it has been. According to SAGE, it is making only a marginal difference. It is not tracing nearly enough people and is not being used as effectively as it might be. Perhaps I may ask my noble friend, as I have done previously, about the importance of using local public health teams throughout the country to improve traceability.
I approve of the rationale behind the regulations, but many questions need to be answered.
Baroness Finlay of Llandaff (CB) [V]
My Lords, these regulations read as punitive. Currently, around 18% of people self-isolate after developing symptoms, but only 11% of people in contact with them quarantine for 14 days. It seems that one in 10 with Covid is a high spreader, inadvertently passing the virus to around 80% of the subsequent cases. Containing these outbreaks requires very rapid testing and tracing, because in two and a half days each will have doubled in size.
Non-adherence is associated with men, younger age groups, having a dependent child at home, lower socio- economic grade, greater hardship during the pandemic and working in a key sector. We hear of those who cannot miss work for financial reasons, whose housing makes self-isolation impossible, whose caring responsibilities mean that self-isolation would cause disproportionate suffering for others, whose mental health and welfare are deteriorating, or whose cognitive difficulties mean that they cannot understand why they are being punished by being kept away from the activities and people they depend on.
Crippling fines and a police record will only disincentivise people to seek testing and disclose their contacts. The criteria behind the instruction to self-isolate are not transparent and there is no appeal mechanism for those who feel they have been inappropriately instructed. That runs counter to the principles of co-production and the findings from the CORSAIR study, which showed that practical support and financial reimbursement, with targeted messaging and clear policies, are likely to improve adherence. Punitive measures set up blame and division, not supportive collaboration. Any instruction must help people understand the benefit to them and those they care for, not jeopardise health by driving people to conceal their symptoms I am sure that is a risk that our hard-working Minister recognises and does not want to take.
Lord Hain (Lab) [V]
My Lords, it is a pleasure to follow my noble friend Lady Finlay of Llandaff and to agree with the thrust of her remarks.
Can the Minister respond to the interview given to last Sunday’s Observer by Graham Medley, a member of SAGE, the Government’s Scientific Advisory Group for Emergencies, and chair of its sub-committee on modelling? He argued that a massive expansion of testing will still leave Britain struggling to keep Covid-19 infections under control unless the system can inform people within 24 hours that they are positive. Ministers are fond of quoting rising figures on numbers tested, but surely returning test results within 24 hours is as critical as capacity in a successful test and trace system. Graham Medley said that, if necessary, capacity should be curbed in favour of speed.
The latest figures show significant delays in the test and trace system. In the first week of October, just 33% of tests conducted at regional test sites were returned within 24 hours. The figures were 24% for local walk-in sites and 42% for mobile testing sites. The number of home-testing kits received within 48 hours was a measly16%. Graham Medley told the Observer:
“The length of time it takes to get the test result is critical for the contact-tracing. And so there has to be a potential compromise between the volume of testing done and the ability to return the result, ideally within 24 hours … Suppose you could treble the number of tests you did, but only at the expense of returning them in a longer period of time, then that’s not really going to work. The volume is important, but only if it can be done promptly.”
Surely the system is still a shambles. Almost 250,000 contacts of people who tested positive in England had not been reached by tracers since the end of May. And that has still not improved very much.
Lord Naseby (Con)
My Lords, frankly, I do not see why this particular SI could not have been tabled earlier, in September. We had the break in August. I hope that my noble friend on the Front Bench will answer the case regarding children put by the noble Baroness, Lady Meacher, and pay particular attention to the plea from the noble Lord, Lord Bilimoria, for this country, remembering that we are an exporter and that we have to export to succeed.
One of the main problems hampering Her Majesty’s Government in making sensible decisions is the lack of timely data. We were talking about isolation; now, everybody has to have a test. I checked the figures over the weekend. Fewer than a third of the test results have been coming back within 48 hours, but last Sunday, the figure was only 16%. Frankly, that is hopeless. We have now had six months’ experience, and nothing seems to have improved on that front. It is not acceptable. It is important to publish—ideally, weekly—not just the number of cases and tests but the percentage of people who test positive. That makes it possible to tell how much of the increase is due to more testing.
Last week, I mentioned what was happening with reporting the number of deaths. Also important is the primary cause of death on the death certificate for those who have had Covid. The number of deaths between 10 August and 7 October was precisely 43, in 60 days. Even on a macro scale, we are not out of line with what normally happens at this time of the year.
The weekly and monthly mandated data of the Secondary Uses Service, the repository for healthcare data in England, shows a dramatic reduction in respiratory condition admissions compared to normal. We have seven Nightingale hospitals, with £220 million having been spent on them. What on earth are we using them for?
Lord Desai (Lab) [V]
My Lords, there are various things to say here. First, whenever we make regulations, I guess that we have to assume that people are the same, depending on their age, gender or profession—but they are different. Even among the elderly, there is a great difference among BAME people, some of whom live in crowded surroundings and are not easily reachable by modern technology. It is assumed that everybody has a smartphone or is accessible via wi-fi or some other device. We have to look after people in a way that recognises that different circumstances require separate agencies to reach them.
We also have to be clear about whether we are taking these measures to slow down the spread of infection or to try to reduce mortality. As I said the other day, we have to be clear about whether our objective is to reduce mortality or to reduce infection. If it is to reduce mortality, we need only to reach the affected person quickly and give them notice that, having tested positive, they are in danger and ought to do something about it.
We have to be quite sure that local community agencies, mosques, temples and corner shops are used to reach people who might be in danger. Lastly, there ought to be a single source that people can reach to give them clarity about the rules, because right now there is no single source that people can go to.
Lord McColl of Dulwich (Con) [V]
My Lords, these regulations also stress the importance of personal responsibility. A recent survey indicated low levels of adherence to self-isolation guidance, at 18%. The study was conducted by a range of bodies, including Public Health England and academic institutions. Will the Government publish that figure and emphasise that people must play their part in correcting it?
These regulations are, of course, an essential part of preventive medicine. Many countries with a high incidence of Covid also have a high prevalence of malfunctioning immune systems. Why do the majority of these citizens have immune systems that do not work effectively? It is simply because their immune systems have been poisoned by cytokines, which leak out of the excessive number of fat cells. The majority of people in these countries with a high Covid incidence are obese. Covid and obesity is a dangerous and often fatal combination, and we need an all-out nationwide campaign to reduce the obesity epidemic before we are overwhelmed by the next pandemic. Would the Minister agree?
Baroness Altmann (Con)
I thank my noble friend, for whose stamina, good humour and diligence I have enormous respect, for introducing these regulations. He certainly received the hospital pass. He says that the aim of this SI is to make it crystal clear to the public that people should stay at home and self-isolate but, as the noble Lords, Lord Rooker and Lord Hunt, and the noble Baroness, Lady Meacher, and others have said, for how long? Should it be for 14 days or 10 days, and from when—five days before what? It is convoluted. This SI is part of a broad effort to simplify and clarify the rules, but they have ended up being highly confusing, with huge fines.
With such penalties, it is particularly regrettable that there has been no proper parliamentary scrutiny of these measures. They were not debated in the Commons, even though they were announced about a week before they came into force, and we are now debating them well after commencement. The SI states, for example, that parents are responsible for ensuring that children under 18 self-isolate. Can my noble friend confirm that a parent could be fined thousands of pounds if their rebellious 16 year-old persistently sneaks out of the house to go to the gym? What advice does the Government have for effective restraints or solitary confinement methods for individual homes?
I recognise that my noble friend believes that these measures are designed to protect individuals and their loved ones, but isolation itself costs lives. Psychological damage, collapsing cancer tests and other treatments, and the lack of exercise, as my noble friend Lord Moynihan, has said, have already caused thousands of deaths as a direct or indirect result of lockdown. The poorest groups are the hardest hit, as the Secondary Legislation Scrutiny Committee warns, including so many of the young.
Baroness Ritchie of Downpatrick (Non-Afl) [V]
My Lords, I take this opportunity to thank the Minister for his explanation of the regulations. It is always a pleasure to follow the noble Baroness, Lady Altmann.
There is no doubt that there is confusion around the intent of these regulations and the issue of self-isolation, which of itself, notwithstanding the rigours of this pandemic and its impact on the wider community in the level of cases, is very penalising and punitive. To withdraw from society has its own associated health issues outside the pandemic.
The Secondary Legislation Scrutiny Committee has been particularly instructive about the whole area of test and trace. It highlighted the fact that those using the NHS Test and Trace app did so anonymously and would not be liable for the self-isolation requirements unless they took a test or were otherwise notified by an official. In such circumstances, it is believed that people may now avoid doing so and could avoid the connected fines for not self-isolating. In contrast, it is believed that those without the app, such as those in lower income categories or elderly people, are more likely to be contacted by traditional track and trace and more liable to fines. Has the Minister a solution to that state of affairs?
In the Minister’s earlier comments, he referred to a vaccine and said that there were something like six contracts and four platforms. Is he able to specify a date or timescale when the vaccine will become available, because that would deal with the issue of self-isolation in itself?
Baroness McIntosh of Pickering (Con) [V]
It is a pleasure to follow the noble Baroness and to join others in congratulating my noble friend on his stamina and energy in pressing these regulations.
I ask my noble friend to address a number of practical problems and limitations with the app and the track and trace system. On a practical issue, how can we advise people who are working away from home to self-isolate at home, which may be some distance away, without putting others at risk? This is a perennial problem and normally flagged up when it is a high-profile individual who is deemed to have fallen foul of the rules.
I want to address the issue of the app not necessarily updating sufficiently. It has also come to the attention of many that it drains the battery enormously, which is a disincentive to those who are using their mobile phone for other purposes during the course of the day to rely on the app, because they simply do not have enough battery usage left.
I know that there has been a lot of criticism of consultants being paid £7,000 a day, but I would like to understand what particular role the consultants played to justify what seems like an extraordinarily high fee. I welcome the fact that we are now using unqualified people to work track and trace; presumably they have been trained up at high speed. This is very welcome, and I wonder why we have not been using them earlier. I welcome this opportunity to address these issues and ask my noble friend as far as possible to find solutions to the issues that I have identified here.
Lord Scriven (LD)
I, too, pay tribute from these Benches to the Minister’s work ethic in coming forward with these continuous regulations. I want to hit on that—and no one else in the debate so far really has done. On these Benches, we accept that in a public health crisis proportionate, evidence-based and reasonable restrictions on people are required to prevent the public health threat getting out of control. However, as many noble Lords have said, when you have an emergency pushing through legislation, some huge unintended consequences come from how the statutory instrument is written.
I have to challenge the Minister. At the beginning, he said that there was a need for emergency legislation. No, there is not. There is for certain things, but self-isolation during a public health threat is not something that you cannot foresee. This should have been proper, primary legislation. Many noble Lords have raised very detailed and reasonable questions through the debate about the time, the implication for children, and the implication in terms of the app or non-app. These points could have been teased out so that when these provisions gained Royal Assent and became law, many of these issues would have been ironed out.
This House has to stand up more each time the Government say that they need emergency legislation. I accept that some will be needed, but self-isolation during a public health crisis can be foreseen and legislated for. It has on a number of previous occasions, so I completely reject this as needing to be emergency legislation. You cannot police yourself out of a public health crisis by the approach of pushing through and accepting emergency legislation.
I want to raise a couple of things within the regulations which no one else has mentioned so far. Many noble Lords have mentioned issues, but there is one to do with enforcement. The regulations talk about “reasonable force”; I think my noble friend Lady Bowles mentioned this. But which people are allowed to carry out “reasonable force”? Part 3 of this instrument refers specifically, in Regulation 10(6), to
“(a) a constable … (b) a police community support officer”
and
“(c) a person designated by the Secretary of State for the purposes of this regulation”.
Over and above a constable and a police community support officer, what type of person would the Secretary of State designate? Sub-paragraph (d) refers to
“an officer designated by the relevant local authority for the purposes of this regulation”.
Is that any officer of a local authority? Could it be a director of finance, a refuse collector or a traffic warden?
The way that this is written is serious: the powers that the Government have given to a local authority—I declare my interest as a vice-president of the Local Government Association—are far too wide. Whether the intent is reasonable or not, should my reading of the provision be that any local government officer can use reasonable force to take somebody off the street, if they refuse to go to a house and do not self-isolate? This is why emergency regulation has to stop. It is serious and goes wide.
I will move away and look at the bigger picture. These Benches do not believe, and nor do I, that we can police our way out of a public health threat and crisis. There needs to be far more carrot and less stick. The countries getting this right, such as Taiwan and Germany, are putting far more carrot into the system. In Germany, you get paid your wage to stay at home; you are seen to be doing it in the national interest. Many people will not go for a test and self-isolate, because you will self-isolate only those who have actually had the test and feel secure financially, with support to do so. Why can the Minister and the Government not look at a proper support package, so that people will do the right thing? Many people want to do the right thing, and many are doing so. Some want to do so but fear what it means for putting food on the table to feed their children. This is a serious issue and it needs to be addressed.
In Germany, there are Covid support teams which provide social, economic and mental health support. This is seen not as punitive but as a support mechanism, with regular knocking on doors for people who have self-isolated. I understand the Minister will say that local government has been given money, but it is paltry compared to what is needed to support properly somebody in isolation who does not have the means to provide things. As I say, the intention is correct, but these regulations raise many questions. I hope the Minister can answer them because self-isolation is an important part of dealing with the public health threat.
Lord Touhig (Lab) [V]
My Lords, I thank the Minister for introducing this instrument, although I must put on record my concern that we are only now able to debate these regulations, almost four weeks after they came into effect. Moreover, it is simply unacceptable that this instrument came into force a mere seven hours after it was laid on a Sunday evening. Given that it contains significant requirements and penalties for individuals and employers, a lead time would have been reasonable to communicate these changes to the public and encourage compliance.
The Government say that these regulations are necessary precisely because there have been low levels of compliance. A study commissioned by the Government found that just 18% of people who had symptoms went into isolation. Why was this evidence not included in the Explanatory Memorandum? Is it because the Government are embarrassed by their record? The low levels of compliance must be viewed in the context of the failure of the Government’s test and trace system. The most recent weekly statistics show that only two-thirds of people who tested positive were transferred to the contact tracing system. How can we possibly expect people to self-isolate if they are not contacted?
It beggars belief that what was called Britain’s world-beating app, costing tens of millions of pounds, was finally rolled out months later than promised and is unable to operate on phones more than five years old. This world-beating app cannot accept all coronavirus test codes; it struggles to calculate distances and does not require people to self-isolate. Can the Minister explain why the app, a vital tool in the fight to contain coronavirus, is not part of these regulations?
While I understand the data and privacy concerns, the Government appear to have no qualms about sharing information obtained through the contact-tracing programme with the police—a point made by a number of colleagues. The Secondary Legislation Scrutiny Committee pointed out that those informed by the app could avoid being fined for failing to self-isolate if they do not follow up the notification by applying for a test. Who would know? A number of colleagues today have also made that point. Does the Minister accept that excluding app users is ineffective and discriminatory? It is discriminatory because those who do not have access to the app are more likely to be identified by track and trace, and to be fined.
The Government have said that people on low incomes who cannot work from home and have lost income will be eligible for a new £500 test and trace support payment. With around 4 million people in receipt of benefits in England expected to be eligible for this payment, we welcome this support, however belated its introduction was. However, the Health Minister, Helen Whately, said that only 60 people had received a £500 payment as of last week—60 out of a potential 4 million people. How many people have applied and how many are awaiting a decision for this compensation and support? This is important because these regulations require our fellow citizens to act and do the right thing. The effective delivery of financial support where it is needed is therefore vital to ensure that no one is pushed into poverty for doing the right thing.
Lord Bethell (Con)
My Lords, I am enormously grateful for a debate that shed a huge amount of light on an issue which acutely illustrates the delicate task that we and a lot of liberal democracies face in fighting Covid: on the one hand, balancing the preservation of life and the difficult public health measures necessary to protect it with, on the other, our liberty and freedoms, the livelihoods we need and the love of family and friends that we enjoy. I believe that these measures do strike the right balance, but this debate has rightly raised important questions about whether we have hit exactly the right point. I will address a few of those.
I reassure all noble Lords that these measures in no way seek to instigate some kind of mass fining or punishment regime. They are about supporting the principle of isolation, to ensure that there is absolute clarity about its meaning and the requirements expected of people, and to give the authorities the powers to enforce these—if absolutely necessary and only in the most extreme circumstances—when they have been most overtly breached.
We recognise that the people who are breaching isolation have not respected a clear and simple public health message in the first place. It is, therefore, not our policy to believe that they would necessarily be motivated by the threat of a fine. Instead, we seek to support people in a number of important ways and to educate them on the importance of isolation. We remain committed to the principle of consent, wherever possible, and we believe in the good nature and good intentions of the British public. That support has been enhanced by a payment of £500. The noble Lord, Lord Touhig, asked about the number of payments. Those payments are being made by local authorities and we are putting in place the measures necessary to count the number being made.
A number of noble Lords asked about the precise nature of isolation: how long should you isolate for; what is isolation; what are the requirements of those who have been asked to isolate? In the last five months, we have taken a large number of genuinely complex measures through the Chamber. This is not one of them. The protocols around isolation are clearly spelled out. If anyone needs to, they can look at GOV.UK/coronavirus or google “Do I need to isolate?” They will see, spelled out in very clear terms, the timing of the isolation, what is required when you isolate and the support you get when you do. I take with a large pinch of salt the suggestion that this is not clear.
What is definitely true is that isolation is a big challenge. For those in casual work, it may have a massive impact on their income. For those with families to support, it hits their ability to look after them. I do not doubt that it is an onerous obligation, but it is a necessary one, because there is no other way of breaking the chain of transmission. If those with the disease travel in our community and share the virus with those they love or pass by, we will never contain it. If people adhere to isolation, the regime of local lockdowns and of hands, face, space, stands a chance of being effective. We believe that it is effective on the great majority of occasions and we applaud the British public for their adherence.
We have sought not to make these measures draconian. There are exemptions for travelling for food and medical emergencies and for other reasons. As I said, there is support from NHS volunteers, statutory sick pay and discretionary payments from local authorities.
A number of noble Lords raised the impact on the elderly, and I hear their concerns loud and clear. It is without doubt that the Covid regime puts a huge emphasis on digital communication, whether that is getting information from websites or the app itself, which is available on 89% of phones. The elderly undoubtedly have a larger proportion of the older phones or have not updated their technology recently. However, the lack of the app does not necessarily mean that you are somehow excluded from the isolation protocols. The 111 telephone facility is enormously helpful and has proved hugely successful. We have given local authorities special support to reach out to the elderly to ensure that they have both the necessary support under isolation and the information to understand the protocols.
A number of noble Lords mentioned the impact on children. The impact on their mental health is enormous, which is why we are supporting local authorities and charities with funds. The noble Baroness, Lady Meacher, asked about testing in schools. I reassure her that we have, today, started a large set of pilots, first in Stoke and then in a number of schools up and down the country, to try to use testing in a much smarter way in order to keep schools open.
The noble Baroness, Lady Altmann, mentioned the pressure on families and the discipline needed in schools. She made her point very well: it is my personal lived experience and I have no doubts about that pressure. However, I cannot avoid the fact that containing this virus does require us to stop the chain of transmission, in children as well as everyone else.
The noble Lord, Lord Adonis, asked a number of pertinent, thoughtful and detailed questions. I will be happy to write to him with answers to some of them. I reassure him that, although the Welsh may have closed secondary schools, it is very much our intention to keep the schools in England open. On inspecting online learning, on 6 October Ofsted published the first of a new series of briefings looking at how schools are managing pupils’ return, including online learning. The Department for Education has made available an initial 250,000 additional laptops and tablets for children who need them. On wi-fi, the department has delivered over 50,000 4G wireless routers to support disadvantaged children in accessing remote education and vital support services.
There were a number of other detailed questions that I will be glad to write to noble Lords about. The noble Lord, Lord Hain, made a number of points, not all of which I completely agree with, but he is absolutely right that there is a balance to strike between speed and quantity. We have massively increased quantity and will continue to do so, but we have a case to answer on the turnaround time of our tests. The noble Lord is right that turnaround time is very important.
In conclusion, the noble Baroness, Lady Jones, set me a challenge about what we can do to “build back better”. Those were not her words but the Prime Minister’s, but they capture rather well her intention regarding the investment needed to address the levelling-up agenda and the damage done by Covid. I am afraid that I do not run the Treasury, so I cannot necessarily meet with her economists.
However, there are a number of resonant themes in the healthcare sector regarding the way in which Covid will actually lead to improvements in our healthcare system if we take the right measures now to capture that progress. I get reports from the front line about an enormous culture of collaboration between different parts of the healthcare system, which is refreshing and impressive. That is exemplified by the sharing of data. Although we have not changed the guidelines or rules on data sharing, we have hugely encouraged it, which has helped with treatment and therapeutics. The renaissance in the diagnostics and pathology professions, and the investment in a large amount of diagnostic kit, is going to have a huge impact on early interventions in disease. The investment and progress we have made in vaccines and therapeutics demonstrates Britain’s leadership role in and the value of science, and illustrates the huge return on the British taxpayer’s investment in science. It is a sign of how we should take things from here.