Medicines and Medical Devices Bill

Baroness Barker Excerpts

Committee stage & Committee: 1st sitting (Hansard) & Committee: 1st sitting (Hansard): House of Lords
Monday 19th October 2020 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am glad that the Minister said that he was listening, and his amendments are important, particularly the one that makes the principle of the health and safety of the public the key consideration when making regulations under the parts of the Bill relating to human medicines and medical devices. He will be aware that concern was expressed by patient groups, in particular, about the Bill as originally drafted and the implication of the attractiveness provision. That concern takes us back to our first debate on “whither regulation in future”.

If we are not going to be aligned to the European Medicines Agency and are to plough it alone, the UK pharma industry will be at a huge disadvantage unless the Government offer an incentive. It may be a bung—the debate about state aid is very relevant to that—or much faster regulation. Otherwise, it is very difficult to see why the industry would continue to invest in R&D in this country. Its position could be as vulnerable as is the motor car industry as a result of the bumbling ineptitude of the Government in their Brexit so-called negotiation.

It is not far-fetched, it is a legitimate question to ask what on earth the Government really want from medicines and medical devices regulation. They may have issued all sorts of draft regulations, but we are clueless about what they are actually seeking to do. The MHRA is clearly not allowed to talk to anybody about this. I remember when the MHRA would talk to politicians and debate these things. It has clearly been given an instruction not to talk to anyone. We are absolutely clueless about the future direction of regulation. None the less, the amendments are clearly helpful, and no doubt we will consider them between Committee and Report.

I would, however, like to ask the Minister about Amendment 2 and its relevance to Northern Ireland. I understand that, exceptionally, it will be moved in Grand Committee because legislative consent takes three months to get through, which impacts on the Bill’s process. I understand that, but, as Parts 1 and 2 of the Bill affect Northern Ireland, does that similarly affect any amendment to Part 1 or 2 passed on Report? What is then the impact on Northern Ireland legislation?

Overall, however, most of the amendments are a constructive improvement, but we will obviously consider them further between now and Report.

[Baroness Barker (LD)]

My Lords, we must consider the whole Bill as building the foundations for the future of the medicines and pharmaceutical industry in this country. We do so in the knowledge that we have had a perhaps pre-eminent role in the world in pharmaceutical development because of the coming together of a number of factors—the European medicines regulations and all the conventions to which we are party, plus the existence of the NHS and the potential it offers for clinical research and our long tradition of working in the life sciences and biosciences sector.

The Minister definitely listened at Second Reading to the many voices of concern that perceived the Bill as it came to us as a weakening of the many factors that underpin our success in this area. He understood entirely, I think, that if we were to take away the pre-eminence of the health and safety of the industry, we would fatally undermine the whole basis of the construction of this very important sector for our economy.

The Minister has listened but not quite hard enough. I agree with the noble Lord, Lord Lansley, that Amendment 2 is an improvement, but it still leaves the decision-making on whether something promotes health and safety to the Secretary of State. I much prefer the construction in Amendment 5, to which my noble friend Lady Jolly has added her name.

My main concern in this group is with Amendment 51 on regulation for veterinary medicines. In his introduction, the Minister pointed to the fact that medicines for animals can work back into the food chain and to humans. I understand the interplay between taking into account things that are done to improve human well-being, animal well-being and the environment, but he will understand that, when people see the amendments, it will not be immediately apparent to them that human welfare is pre-eminent in the list. It says that the regulations must promote “one or more” of the three. I agree that the Minister has moved on the first set of amendments, but he has not gone anywhere near far enough on the regulations on veterinary medicines, so we may well need to come back to that at a later stage.

[Lord Patel (CB) [V]]

My Lords, before I start, I should point out that someone is typing with their microphone on, which interferes with the sound, so would they mind turning it off?

The noble and learned Lord, Lord Woolf, said that other legal Members of your Lordships’ House were not able to be present today. That is a pity, because I thought that I had amassed a good legal team in the noble Lord, Lord Pannick, and the noble and learned Lords, Lord Mackay of Clashfern and Lord Judge, to support some of my amendments. I wonder what comments they might have made on what the noble and learned Lord, Lord Woolf, said.

I find myself in support of what the noble Lord, Lord Lansley, said. I would be interested to hear the Minister’s response to the question whether market approval of a device also means that it has therapeutic approval. I know that the noble Lord, Lord Kakkar, has an amendment on the therapeutic values of devices.

I do not find myself in total agreement with what the Government have produced and I do not think that Amendment 2 is satisfactory. Let me try to explain and we will see what the comments are. The amendments are about promoting public safety and insert into Clauses 1, 8 and 12 a new subsection (1A), so that the Secretary of State may only make regulations under those clauses where

“satisfied that they would promote the health and safety of the public.”

However, this is coupled with the insertion of the words “considering whether they would” to replace the start of subsection (2) in each clause. That means that, in the decision on whether the regulations would promote the health and safety of the public, the appropriate authority must have regard to the safety of medicines—or veterinary medicines or medical devices—their availability and the

“attractiveness of the relevant part of the UK as a place”

to conduct clinical trials or supply medicines, or develop or supply veterinary medicines or medical devices. That would be the effect of the amendments. That construction is open to the interpretation that the “attractiveness” of the UK is to be treated as part of what promotes public safety; the Minister might want to comment on that. If so, the amendment would not address the concern—indeed, it would appear to prevent the argument being made—that attractiveness and the safety of medicines and medical devices can sometimes be in conflict and that considerations of attractiveness undermine considerations of safety. This is in line with the Government’s repeated assertion that attractiveness cannot be in conflict with safety. In essence, the amendment appears to make little substantive change.

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[Lord Patel (CB) [V]]

My Lords, I support Amendment 38, in the name of the noble Baroness, Lady Thornton, to which I have added my name. I shall also speak to Amendment 39. I am grateful to the noble Lord, Lord Hunt, who has already spoken, for lending his support. I have listened carefully, and I support what has been said about the issues raised, particularly about whether we remain aligned with the EU trials mechanism or whether we are to be part of that mechanism.

During the EU withdrawal debate this issue was discussed at length. In fact, there was an earlier opportunity for the amendment to be put—as noble Lords may remember, it was widely supported—but I withdrew it, because the then Minister, the noble Lord, Lord Callanan, said that at an appropriate time, when legislation was brought in, the Government would address the issue. By that I supposed he meant that they would address the issue of remaining part of the EU clinical trials regime—but this Bill does not do that.

What options are available to the United Kingdom? One of them, of course, is to remain and participate in the EU clinical trials regime, if that is possible. An alternative is silent participation, as in the EEA model. That would mean that we could not vote, we could not lead projects and we could not raise objections. The third option is to be independent and aligned. The noble Lord, Lord Lansley, referred to that, and I agree with him that the important part of the EU clinical trials regime is its portal—a portal that the UK played a major part in developing—through which companies can apply for clinical trials.

The fourth option is to be independent and divergent: the UK would create a new clinical trials system. There is no time to do that by the end of 2020, but over time the UK could create a new system and build alliances. However, the risks need to be clearly understood, and balanced. Where will the companies go? Will they go where they have a bigger market, and a bigger opportunity, with larger numbers of patients for the trials, or will they conduct their trials in the United Kingdom?

There might be novel ways to approach this, and I understand that the MRHA is discussing and trying to develop a novel way of conducting clinical trials, which might be more attractive to companies. But of course, as we do not know what those are and we are not being told what they are, we cannot comment on them.

Currently, what looks like the best option is to be part of the EU clinical trials mechanism. With clinical trials for rare diseases, it is even more important for the UK to remain aligned with, or to be part of, the EU processes for rare diseases in relation to trials, to the data that will be available, and to medicines—for example, treatments developed for muscular dystrophy and metabolic disorders.

About 3.5 million people in the UK suffer at some point from one of the 7,000 or so rare diseases. The number for which treatment is available is small; hence the great need for collaborative research, data collection and the development of medicines, because a larger population is needed for clinical trials. Companies such as Silence Therapeutics, which the noble Baroness, Lady Thornton, mentioned, use gene silencing technologies for developing novel therapies for rare diseases. Others, such as Sarepta, use gene therapy for developing medicines. Companies such as Gilead Sciences are developing CAR T therapy; it was the first to introduce CAR T therapy for cancers in the United Kingdom. All those companies have said that they would wish to remain in the United Kingdom to do their trials, if the environment was right.

The treatments that will utilise innovative techniques, such as gene silencing, are often used to treat rare diseases that affect a limited number of people, as I said. The number of patients with a rare disease in an individual country such as the UK is likely to be low by definition. However, for clinical trials to work, they require large numbers. Unified and streamlined international processes are essential to ensure that the application authorisation processes of these clinical trials can continue to work both effectively and at pace.

By implementing the clinical trials regulation, the UK can remain eligible for access to the central EU portals and processes for clinical trials, which ensure that clinical trials can recruit enough patients for rare diseases and include submissions, reporting and authorisation requirements and, particularly importantly, inclusion in patient registries. Those were developed as part of the EU-wide MHRA initiative to develop registries for rare diseases.

The UK should also seek to maintain alignment with patient safety and pharmacovigilance standards, as mentioned by the noble Baroness, Lady Thornton, to give patients and clinicians confidence in trials that are conducted in the UK and to support the UK’s ability to host trials that need to take place in multiple countries. Without this level of alignment, it is likely that clinical trials, particularly for innovative treatments such as gene silencing, will not be able to go ahead in the United Kingdom, denying UK patients access to new treatment options at an early stage.

I will end by saying a few words in support of Amendment 125 in the name of the noble Baroness, Lady Jolly. Given the global nature of the Human Medicines Regulations, the UK should be a member of the ICH—the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use. Having recently joined as an observer on Project Orbis and the Access Consortium, the UK can work towards providing a leadership role on global regulatory standards, and it is more likely to do that if it is part of the EU clinical trials mechanism.

[Baroness Barker (LD)]

My Lords, the noble Lord, Lord Hunt of Kings Heath, succinctly set out what we all know: post Brexit, the UK as a market will be significantly less attractive than it was as part of a single regulatory system for the development of medicines and clinical trials. The economics of that are inescapable. However, it is also true, as the noble Lord, Lord Lansley, said, that however much some of us may wish that we continued to be aligned with what will inevitably be a developing clinical trials basis in Europe, it may not be within our gift to do so. However, what we can do, and what all the amendments in this group attempt to do, is encourage the Government to come clean about the extent to which they will seek in future to maintain an ongoing alignment with those clinical trials regulations in Europe.

The noble Lord, Lord Patel, mentioned—as I intend to—the announcement last week of the UK participation in the Orbis trials, which are the new mechanism for fast-tracking cancer treatments, with players from the US, Canada and Australia. I still think that, given the history of this country as a leading player in the life sciences and biosciences fields, and given the amount of investment in research that we have traditionally had and which we must seek to maintain in the NHS and within our universities, if we do not signal at this stage a willingness to keep the regulations in place and ensure that we remain aligned with the European system, we stand to lose a great deal—not least involvement in the clinical trials information system. The Government would be well advised to take some, if not all, of these amendments, which all seek to do the same thing.

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[Lord Kakkar (CB) [V]]

My Lords, I very much support what the noble Lord, Lord Sharkey, has just said. In so doing, I support Amendments 4, 42, 52, 63, 69 and 92 in this group.

It seems counterintuitive at the very least for a Government to come forward with proposals to give a Minister powers using a delegated provision to create new criminal offences and, when challenged, to justify the position by saying, “Well, we will limit the sanction to two years’ imprisonment.” This completely misses the point, as we heard from the noble Lord, Lord Sharkey. There is a clear principle at stake here, which has been well described by the Constitution Committee in its report on this legislation. Very simply, it offends liberty and the functioning of our democracy that a Government can propose to create criminal offences that would deny a citizen their liberty for one day, let alone a maximum of two years, and feel that there should not be proper parliamentary scrutiny in the accepted fashion for the creation of criminal offences. Her Majesty’s Government should think very carefully about what they propose to do here and bring their own amendments beyond the government amendments suggested in this group.

[Baroness Barker (LD)]

My Lords, I just want to add to what my noble friend Lord Sharkey said. This is a matter of principle; from the two reports by the two committees that have been cited and from the Second Reading debate, the Government can be in no doubt about the strength of feeling on it. In the light of those, the Government’s response in the government amendments in this group is, frankly, rather pathetic and not at all acceptable.

The Bill represents an enormous upheaval for one of the critical areas of our industry. The pharmaceutical industry is of immense importance to this country. Apart from anything else, to add criminal offences created through delegated powers by means of a Bill that is so spare and lacking in detail does a huge disservice to people who want to continue to pursue not just high-quality but ethical production of badly needed medicines in this country and within international frameworks. If the best the Government can do is to table the amendments in this group, they do the industry a great disservice.

[Baroness Thornton (Lab)]

I do not think that I need to say much in response to the remarks that were, I think, unanimous in their support for my amendment and the other amendments in the group. The cap on the sentence is not a good enough response by the Government. Earlier in our debates, I made a remark about amendments designed to circumvent; I am afraid that the government amendments before us are exactly that kind of amendment. They will not serve, I am afraid.

Unless the Government are prepared, as I hope they are, to table amendments that actually solve the problems and address the issues raised by the Constitution Committee and the Delegated Powers and Regulatory Reform Committee—they could not have been clearer on this issue: in this country, we do not set up criminal offences and their sentences by delegated legislation—there is nothing more for me to say, other than that I hope the Government will think again.

Health Protection (Coronavirus, Local COVID-19 Alert Level) (Very High) (England) Regulations 2020

Baroness Barker Excerpts

Wednesday 14th October 2020 Lords Chamber

[Baroness Barker (LD)]

My Lords, I welcome the noble Lord, Lord Moylan, to your Lordships’ House. For someone who has extensive experience in railways, he was pleasingly on time, something this House greatly appreciates. He is most welcome.

On these Benches, we have said for several months that assessments of the proportionality of measures must be up to date, based on the latest scientific evidence, and formulated as a result of a precautionary approach to minimising overall loss of life. The Government must be transparent in justifying their decision-making, including in explaining how they have balanced the competing interests and the evidence on which the balancing decision has been made. Today, yet again, they have not done so.

Six months ago, the Secretary of State said that test and trace was the “single most important thing” that we could do to conquer the virus. Then, on 22 September, the Prime Minister made a statement which was, at times, very odd. He said that test and trace had “little or nothing” to do with transmission of the virus. I wondered then what was going on. We now know that on 21 September the SAGE group had advised the Prime Minister that he needed to introduce harsher national restrictions on the spread of the virus. Instead, the Government, or Mr Johnson, decided to ignore that and opt for much lighter measures, such as the rule of six and the 10 pm closure of pubs. And here we are: infection rates are going up, lives are at stake and businesses are in trouble.

It is telling that the scientists who have been advising the Government have been damning about this “world-beating” test and trace system, which is having only a “marginal impact”. We said from the very beginning that the fundamental basis of the Government’s actions was wrong. They believed that they did not have to take into account the expertise in local government, public health and public services such as the police. They could build and introduce their own world-beating tech system. We now have more evidence than we will ever need of how wrong that is. They have just been winging it.

On top of that, we have had confused messaging for six months. Even today, noble Lords could go on to GOV.UK and read an explanation of the three different tiers that is utterly confusing. When will the Government publish the contracts given to companies run by friends of Dominic Cummings and Michael Gove to advise on messaging? Taxpayers appear to be paying a lot of money for old rope.

When the Government are in a corner, they always pray in aid the Joint Biosecurity Centre as the source of the intelligence on which their actions are based. We have now got to a point where they can no longer shield themselves behind that organisation. It is now time for them to release more of that intelligence, so that local directors of public health and environmental health—people who have detailed knowledge of their populations, who know what is about to happen in their areas that could have an impact on the transmission of the virus—have it to work with. Examples are the presence of students in Liverpool and the knowledge that the next three months are the run-up to a holiday season in which people will want to celebrate Christmas and Hanukkah and mark other religions. That is the sort of thing that people on the ground are used to doing and have a great deal of expertise in.

People want a break from gimmicks such as marshals, world-beating bluster, blunt instruments and lockdowns being inflicted on wider and wider areas and impacting on greater numbers of people. When will the Government build on the expertise of local civic leaders and public service professionals, and build resilient public health test, trace and isolate systems that can maintain people in isolation safely for the weeks that will be needed? Only then can we get to a point where we are not merely in another short lockdown, to contain a curve and prevent admission to hospitals, but can begin to build a level of community containment with which we can all live safely live.

It will be no surprise whatever to the noble Lord, Lord Robathan, that we will not be supporting his amendment. We sometimes end up in the same place, but for entirely different reasons. We do believe that there is a role for evidence-based, proportionate restrictions on businesses and individual movement in these dangerous times. If the noble Baroness, Lady Thornton, chooses to test the opinion the House, we will on this occasion support her.

However, all this is immaterial. We need to take some of the money away from this track and trace system which is not working and put those resources into the hands of local professionals, where they can make a real and lasting difference and where we really can begin to beat this virus on a sustainable basis.

Health Protection (Coronavirus, Restrictions) (North East of England) Regulations 2020

Baroness Barker Excerpts

Monday 12th October 2020 Lords Chamber

[Baroness Barker (LD)]

My Lords, hindsight is frequently knocked as the privilege of an Opposition, but provided it is used wisely, it is a very useful tool to bring about informed decision-making in the future. That is what I have felt all these last six months as we have stood up to talk about these different regulations which have come before us, often weeks after they have been implemented. I like to think that at least some of the changes that will come about later today are the result of weeks upon weeks of penetrating questioning in your Lordships’ House of some of the Government’s assumptions. It is worth saying that some of the things that we have said and will continue to say still stand. Herd immunity is a strategy for when a vaccine is available. It is not a strategy for an illness for which there is no vaccine, and that will not change. However, it is also true that back in March we said to the Government, “You must be led and informed in your decision-making by local people—in local authorities, the police and local public services. Those people know how to deal with these sorts of outbreaks, and if we do not learn from them, we will waste a lot of time, money and resources.” Well, here we are today.

I am not in the brigade which has seized on the Barrington declaration and misinterpreted what the WHO has said to try to reject lockdown. There will be an ongoing place for lockdown until such time as we have an effective vaccine. However, there is not a place for reliance on generalised lockdowns in perpetuity, because they are very crude and ineffective, serving only to suppress a virus within a population. However, what we can and should be doing in these repeated regulations is learning from what has happened in different parts of the country to inform things.

We should have listened to the leaders of the local authorities in the north-east who predicted that, after a summer in which young people had been allowed to go out, go abroad and so on, if thousands of them turned up in a university town, they would make a difference to the incidence of infection, even if not to its transmission. We should listen to the public health officials, who tell us that they can see from the rise of infections in the 18 to 25 year-old group a lag but none the less a correlation with people with infections in the over-60 group on whom this has a differential effect. That evidence is there.

We ought not at this stage to rely on such crude geographic interpretations of statistics. I would like to know whether the low number of people infected in Northumberland and County Durham work in Newcastle, and how many of them work in the universities in Newcastle and have contact with students there, so that we can begin to see the patterns of transmission of the infection. That is the important thing that we are not yet learning. We are learning about incidence but we are not being told about transmission. I would like us to have the information to be able to differentiate between different businesses. I guess that transmission of infection is more likely in pubs than in restaurants, at which people sit down—or hotels, for example—and we should be able to make a regulation which differentiates between those different types of venue.

As I say, I am no Florence Nightingale. As noble Lords will know, she was originally a statistician. She was not a nurse; she went to follow the pattern of infection and illness in the Crimea. I am also tempted to say that I am no Dido Harding. What are we doing to get information from households? They are the easiest groups of people to trace. We should be getting differential information per household from all across the country.

I make a plea to the noble Lord for when we are using this information to plan for things. We saw what happened back in March, April and May in care homes. We should now be talking to the civic leaders and care home providers in the north-east and the north-west to make sure that we have no repetition of the daft and dangerous situation in which we had three different systems for ordering PPE, none of which worked.

I want to go back to the councils in the north-west, which my noble friend Lord Greaves mentioned. A few weeks ago, they wrote to the Minister to say that the protocols for the NHS 111 system needed to be looked at and changed. The Minister has told us that NHS 111 will become the primary point of access to the NHS. If we are talking about the NHS in these areas not falling over in the next few months, and as it is the one source of information that the public trust when they have long since lost trust in the Secretary of State for Health, can he assure us that the resources, training and protocols for NHS 111 will be resilient enough to make sure that people all across these areas get access immediately to the services that they need?

Covid-19: Local Restrictions

Baroness Barker Excerpts

Friday 9th October 2020 Lords Chamber

[Lord Bethell (Con)]

Well, I very much welcome the noble Lord’s comments, but I reiterate what I said earlier. As my right honourable friend the Secretary of State for Health and Social Care said on 30 September, for significant national measures with effect for the whole of England or UK-wide we will consult Parliament—and, wherever possible, we will hold votes before such regulations come into force. Of course, we will balance that with ensuring that our response to the virus means that it is delivered with speed when required. We cannot hold up urgent regulations that are needed to control the virus and save lives.

[Baroness Barker (LD)]

What evidence do the Government have that introducing statutory instruments without notice rather than with parliamentary debate and approval is more effective than developing effective local Covid strategies which are understood and adhered to by the population?

Health Protection (Coronavirus, Collection of Contact Details etc and Related Requirements) Regulations 2020

Baroness Barker Excerpts

Wednesday 7th October 2020 Lords Chamber

[Baroness Barker (LD)]

My Lords, we return yet again to the subject of NHS track and trace. In view of our discussion yesterday, it is right for me to put on record with the Minister that we on this side of the House understand entirely the need for local and national action and for those to be complementary. However, they need to be informative of each other; it is not a matter of putting in place centralised top-down systems and not picking up on local data. Only by co-ordinating national and local action will we beat this thing.

We come to these regulations with no regulatory impact assessment. More than that, after three weeks, we have nothing but assertions on the Minister’s part that they are working well and are necessary. The Government are very short on evidence when they come back with repeated requests for regulatory powers. That cannot go on indefinitely. We on this side of the House are quite willing to support actions that are necessary and proportionate—we have been from the very beginning—but frankly, the Minister is trying the patience of the House when he repeatedly requests powers without any evidence to back them up.

I ask the Minister: how many people have not engaged with this process only because they have concerns about the privacy of their data—about it being shared beyond the NHS and local authorities? If people could be absolutely sure of that, there might be far greater uptake. I say that, but I have eaten out only once in the last six months. I happened to be with a group of four people, and I was not the contact person. Had I subsequently tested positive, I would not have known how to go about telling the establishment. If this is going to work to maximum benefit, we ought to look now at how it works in practice and could be made more effective.

On refusal of entry, what evidence do we have so far that that power is being used, how it is being used and who is enforcing it? What evidence is there that it is working? On what basis was the £500 fixed-penalty notice decided, how does it compare to other fees and penalties, and who is in charge of tracking the evidence that that works?

On fixed-penalty notices, Regulation 18(11)(a) states that they can be enforced by “authorised” persons such as

“a constable … a police community support officer”

and

“a person designated by the Secretary of State for the purposes of this regulation.”

Who would that be? Are they the infamous marshals we expect to come riding to our aid any day now, with undefined powers, no skills and no resources?

Finally, when will the Government share the data on the implementation of these regulations? It is great to have three weeks of positive signs, but for these powers, the Government need to tell us a bit more about what is coming. Before the Minister comes back to ask that these powers be extended, will he provide a full statement on their impact for the whole of England?

Covid-19 Update

Baroness Barker Excerpts

Tuesday 6th October 2020 Lords Chamber

[Baroness Thornton (Lab) [V]]

I thank the Minister for this Statement, which was made yesterday in the Commons, and for the one made on Thursday in the Commons. It seems like a good idea to take them both together, since the news about the unreported and untracked positive tests needs urgent scrutiny, and the Minister does not have to suffer double the pain of explaining the very real problems we face with the winter and the second spike.

For example, today, we see another increase in positive tests—14,522 cases reported, with two-thirds of those in the north and north-west. To summarise, we have had people being told to travel hundreds of miles for a test; hundreds of children out of school unable to get a test; tracers sitting idle, watching Netflix; care home tests taking days to be processed; the Minister’s hyperbole, saying this could be a moment of national pride, like the Olympics; and a Prime Minister in a complete muddle over the rules. The Prime Minister seems to be able to learn large chunks of Greek by heart, so why, when he does regional media, could he not at least learn which lockdown rules apply where? It is not much to ask.

The questions from my honourable friends Jonathan Ashworth and Stella Creasy in the Commons yesterday were very pertinent. The reason why they needed to ask what the contractual teams were for the contracts supplying test and trace is that they are not working well and a large amount of public money is being spent on them. Is it not sensible to ask if there is a break clause if goods being purchased with public money are faulty or not working properly, given that they have been sold to us as world-class and planet-beating? What did the Secretary of State say to these questions? Unfortunately, he reverted to the government line of blaming Public Health England. Can we see the terms and conditions and profit margins on all these contracts? Is it true that there is no break clause addressing whether these contracts do what they are supposed to? As the former chair for a few years of the procurement committee of a local CCG, at a very lowly level in the NHS, I can tell the Minister that these are vital questions which have to be asked—questions for which I would expect to be held to account.

Does the Minister agree that transparency would ensure proper governance and accountability for those charged with the stewardship and responsibility of spending public money? Let us examine this for a moment. Is it true that Public Health England’s older version of Excel has a 65,536-row limit, meaning that, in the data transfer from the big CSV file, rows were chopped off? Can the Minister confirm that the data could not be handed over to Public Health England due to the size of the Excel spreadsheet files? Why are critical databases in a national pandemic being hosted on Excel spreadsheets? Is it true that the upgrade to a later version of Excel, which copes with just over 1,000,000 rows, costs about £100? Is this an issue with one particular lighthouse lab or across all the lighthouse labs? Public Health England’s sources say that they report the data when they get it from NHS Test and Trace, so if the information is coming in incomplete, they cannot do their job.

We know that the budget for test and trace is in the region of £10 billion to £12 billion, and it seems to me that an IT audit might have been a good place to start. Was there one? What did it say? We know it is true—so, presumably, does the Secretary of State, who is ultimately responsible for Public Health England—that Public Health England’s budgets were cut by 40%. So, is it the case that Public Health England had no IT upgrades of any kind recently? Given what we know, is it legitimate to ask where all that money has gone?

Why in October, after all the promises of the Prime Minister, the Secretary of State and the noble Baroness, Lady Harding, are we now facing the possibility of 60,000 people unknowingly spreading Covid in their homes and communities, which might account for some of the sudden increases seen today? Have all those people been contacted, traced and isolated?

These are not irrelevant, disloyal or silly questions: they are vital if these matters are to be remedied. They are vital if the Government are to dispel what communities are feeling, described on Sunday by the leader of the Labour Party, Keir Starmer, as

“This deep sense of despondence, anxiety. And actually, what they want is hope.”


We on these Benches want the Government to do that: to give hope. Assuring us that they have everything under control will, however, not work anymore, because it is clearly not true.

Surely, what is needed is transparency and a strategy, expressed with clarity, that everybody understands and supports. It is, furthermore, urgent. Tonight, a group of leaders of the largest councils in the north—Manchester, Leeds, Newcastle and Liverpool—has written to the Prime Minister asking for, among other things, significant local control and support. I beg the Minister not to chant the mantra that test and trace are working closely at local level, because clearly they do not believe that it is. Again, it does not seem to be true. I hope that the Government will respond positively to these councillors.

Yesterday, Jeremy Hunt asked whether responsibility for NHS and care home staff testing should be moved to hospitals and laboratories, and that idea was repeated by the Nobel laureate Paul Nurse, of the Crick Institute, on the radio this morning. The fundamental problem is that there is no strategy: there is a vacuum. That is because there is division in the Cabinet over which strategy should be followed. This needs to be remedied and a clear way forward explained.

Finally, with regard to the part of the Statement concerning treatment: will the Minister clarify whether the establishment of Orbis will be in co-operation and collaboration with EU medicine protocols or in competition with them? Will Parliament scrutinise Orbis, and when?

[Baroness Barker (LD)]

I thank the Minister for yet again turning up at the crease to defend what is becoming increasingly indefensible: the poor performance of the NHS Track and Trace system.

The noble Baroness, Lady Thornton, was right to note the admission in this Statement that 16,000 positive results had not been uploaded, and that by yesterday only 51% of those people had been contacted, despite the injection of resources into NHS Track and Trace over the weekend to try to make up the deficit. Given that we know that each person who tests positive is likely to report between four and five contacts, that is potentially 60,000 people who last week were walking around, not self-isolating and possibly infecting others. It is not their fault—they did not know. It is a really significant breach of trust.

In the part of the Statement that I find most curious, the Secretary of State said that the Chief Medical Officer’s analysis of the Government’s assessment of the disease as a result of the new data was that

“its impact has not substantially changed.”

Can the Minister give us further detail about that? The omission of 60,000 people not having any impact does not add up at all. The Secretary of State went on to say that the Joint Biosecurity Centre had confirmed that

“it has not impacted the basis on which decisions about local action were taken last week”.—[Official Report, Commons, 5/10/20; cols. 625-6.]

When will that data come through and when will we be able to see the impact on local areas? As these statements make clear, the virus is beginning to have different impacts in different places. Can the Minister say at what point directors of public health were informed about this breach? Six months in, it is clear that, when local authorities are properly resourced and given correct and timely information, the virus is managed and contained. The major problems come about when decisions are made centrally, poorly communicated and badly executed.

Time and again, it comes back to track and trace, whether it is about a lack of skills and capacity or a lack of foresight. Who could not have foreseen the impact that hundreds of housefuls of students moving around the country in September would have on transmission?

Yesterday when this Statement was debated in another place, speaker after speaker, mostly from the Conservative Benches, got up to complain about the effect of the 10 pm arbitrary cut-off. They explained how well-run businesses, especially in the hospitality sector, will be going to the wall because of continued use of blunt instruments designed nationally and applied over wide geographical areas. How long will it be before the Government realise that local people—local professionals, directors of public health and environmental health officers—have detailed knowledge about businesses in their area, their hygiene ratings, their previous breaches of licensing conditions and where crowds congregate? When we can get decision making to a more local and granular level, we will be better able to protect good businesses without jeopardising public health.

I welcome the announcement of hospital funding for upgrades to A&E departments. We need a greater capacity for A&E. However, could the Minister give the House the definition currently used by this Government of what constitutes a new hospital?

On the Orbis project, we go into this having left a safe and highly effective system of medicines regulation, one where patient safety is paramount. How does the Government propose to withstand the commercial imperatives of American pharmaceutical companies in these circumstances?

The public are getting very worried about the extent to which the Government continue to wing it. It is time for them to bear down on the fundamental flaw in their strategy—thinking that they know best in the centre, above people who are professionals at a local level.

[Lord Bethell (Con)]

My Lords, I thank the noble Baronesses, Lady Thornton and Lady Barker, for their remarks. The noble Baroness, Lady Thornton, is entirely right about the situation that we face. The latest update, as of 4 o’clock today, is that we have 14,542 daily positives today: 2,833 are in hospital with Covid; of those, 496 are on ventilators, and I am sad to report there were 76 deaths.

These are numbers that make us extremely focused on the challenge of Covid. Earlier today we debated the rule of six, when there was a large amount of challenge about whether such rules on social distancing were really necessary. We were reminded in clear terms about the social impact of separating those who love each other. Here we are talking about the impact on the health of the nation and the threat presented to those who are vulnerable, elderly and have pre-existing conditions. Getting the balance between these two things is extremely challenging, but that is the strategy of the Government—to bear down on the virus while protecting the NHS, education and the economy until we can see a way out through the vaccine, through therapeutic drugs and through mass testing. That is our approach.

I make no bones about it; the errors made over last weekend with the data was extremely regrettable. It undoubtedly causes grave concern among those in Parliament and the general public. I cannot hide from anyone the importance, impact, and severity of the situation. However, I would like to say a few words in mitigation. First, I pay tribute to those at PHE who have pulled together a remarkable system in extremely difficult circumstances, across the length and breadth of the country, integrating many systems into one. I know that that may seem like a trivial challenge and beside the point when we are dealing with a national emergency like this, but these are incredibly complex and difficult tasks. They have involved extremely committed personnel on the technology side of things who have personally checked a huge amount of the numbers. As my noble friend Lady Harding explained, it was through the perseverance of some of those personnel that the mistake was identified.

Between 17 and 23 September, 87,000 were identified through our testing and tracing programme; that is a phenomenal number of contacts where we had the opportunity to intervene and break the chain of transmission. Some 83.7% of those were reached and asked to isolate. I completely appreciate the concerns of those speaking in the Chamber today about the test and trace programme, but those figures are remarkable. That we have set up a system that can intervene in the lives of so many who are carrying coronavirus and can bring to bear such pressure on the disease after such a start as we had at the beginning of the epidemic is a phenomenal achievement. I know that the last thing one wants to be, at this stage of things, is a hollow champion of empty achievement, but that is a hell of a thing for this country to have got to.

There have been questions about the collaboration between the centre and northern leaders, and I cannot hide the fact that there are some quite fruity discussions on the pages of the newspapers and news channels between different community leaders. However, we have to be adult about this and acknowledge that there are different roles for different parts of government. The mayor of a city simply does not have a huge laboratory in which to do tens of thousands of tests a day. The mayor of another city simply does not have a control room filled with PhD analysts who can crunch the numbers and run massive supercomputers with complex algorithms to look at millions and millions of items of data within minutes. These are not the functions of local government, nor will they ever be.

Likewise, the JBC, the Department of Health and Social Care and the Cabinet Office do not have the local knowledge of what is going on on the ground and are not expected to speak a wide range of languages. We do not know what the behaviours are of people on a street-by-street basis. That is the role of local government, and it is through the collaboration of the local and national that we will beat this disease. To try to throw up a false dichotomy and set up test and trace as a scapegoat to blame and punish for the frustrations we all feel about the disease is counter- productive and reveals a shallow understanding of a complex situation.

The noble Baroness, Lady Thornton, said that perhaps care home testing should be sent to hospitals. In many cases, hospitals are involved in care home testing and handle the staff of care homes, but hospitals have to cover their own clinical demands, and pillar 1 is stretched to do the testing of hospital staff and patients. Landing that additional burden is not something that the NHS would welcome.

With regard to the northern leaders and their running commentary on the work of test and trace, I reassure the House that the conversations held in private on a daily—and sometimes hourly—basis have an altogether more collaborative tone. I have been privy to a large number of those conversations; there is a huge amount of expertise on both sides of the conversation, and one should not take too seriously the knockabout commentary in the newspapers and on TV.

The noble Baroness, Lady Barker, asked for an update on contact tracing, and she is entirely right. To have missed a substantial number of contacts during those days was a really big disappointment, but we have moved a huge amount of resources in order to catch up. There has been a phenomenal catch-up already, and I understand that my right honourable friend the Secretary of State will be updating the other place on the progress of that shortly.

I reassure the Chamber, however, that all those who had a positive test were informed promptly. There was no omission in that respect. Therefore, the primary index case, and the person of greatest threat to community transmission, was identified and isolated, and that chain of transmission was shut down.

I will now address the questions about the CMO and the JBC and their analysis of our numbers. I reassure the noble Baroness, Lady Barker, that the integrity of the CMO is unimpeachable; if he judges that the change in numbers has not changed policy, I reassure the Chamber that that is a good judgment that is completely consistent with the way in which we have behaved over the last few weeks.

The noble Baronesses, Lady Thornton and Lady Barker, both asked about Project Orbis. This is a welcome move, enabling the UK to join an international framework to provide concurrent submissions and regulatory views of oncology products, which may allow UK patients to receive earlier access to medicines in the future. I pay tribute to colleagues at the MHRA, who I know have worked really hard on collaborating with American, Canadian and Australian regulators. I am extremely optimistic about the dividends from this collaboration. It augurs, promisingly, similar future collaborations across the health sphere.

Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 4) Regulations 2020

Baroness Barker Excerpts

Tuesday 6th October 2020 Lords Chamber

[Baroness Barker (LD)]

My Lords, on 21 September, the Joint Committee on Human Rights said:

“Assessments of the proportionality of measures must be up-to-date, based on the latest scientific evidence, and formulated as a result of a precautionary approach to minimising overall loss to life. Importantly, the Government must be transparent in justifying its decision-making, including in explaining how it has balanced competing interests and the evidence on which the balancing decision has been made.”


Twice, now, I have asked the Minister: What is the evidence base for this rule of six? I have had unsatisfactory answers.

On 14 September, the noble Lord said that the phenomenon they had noticed was that large groups of people, sometimes in pubs and other places, would seemingly say that they were from two households. It was

“proving to be extremely flexible in the minds of many people. Therefore, putting an integer into the formula makes it much clearer.”—[Official Report, 14/9/20; col. 1002.]

We now have regulations under which it is possible for a person to meet and socialise with 35 people from six households in the course of a week. The public has figured out that that, in public health terms, is an absurdity. It will not work. I am surprised that, during freshers’ week, more students have not got into trouble inadvertently due to the lack of clarity.

Between March and September, Dominic Cummings has, without competitive tendering, paid people and bodies such as Hanbury Strategy £946,000 to

“research public attitudes and behaviours in relation to”

the pandemic. That information is paid for by taxpayers’ money. It is not the property of the Government or the Conservative Party, so I ask the Minister: when will that and similar reports be published so that Members of Parliament can scrutinise the basis on which decisions such as these are being made? We are six months in, and the Prime Minister does not know what we are doing, local authorities do not know what we are doing and the general public are bamboozled by the lack of clarity and consistency. It is time for us to get real about this and stop putting people in danger.

Coronavirus Act 2020: Temporary Provisions

Baroness Barker Excerpts

Monday 28th September 2020 Lords Chamber

[Baroness Barker (LD)]

My Lords, this place is a place of great privilege, but people outside often mistake the privileges we enjoy—they think we get excited about things like robes. The real privilege is to be here on a day when we have excellent maiden speeches such as we have had today, and to welcome new people to take part and bring their experience to our deliberation. You are very welcome.

In March of this year, we sat on these Benches with the noble Lord and we debated this Bill. It came to this House accompanied by reports from the Delegated Powers Committee and the Constitution Committee which, frankly, were excoriating in their criticism. The Constitution Committee said:

“The Bill contains a range of delegated powers. They are broadly framed, include Henry VIII powers, and are often subject to limited or no parliamentary scrutiny.”


The Delegated Powers Committee said:

“Given the speed with which the Government need to act and the significance of the powers needed to address the emergency, we have, on this occasion, chosen mainly to highlight points of concern rather than make definitive recommendations. Whilst in no way resiling from the appropriateness of this exceptional approach, we nonetheless believe that it is important for us to state clearly that, had the country not been in the midst of a developing national emergency, there are powers in this Bill … about which our commentary would have been far more trenchant and our recommendations far more robust.”


This Bill was introduced, in the words of the Government, to save the NHS. We are now in a very different place in terms of our scientific and medical knowledge and society’s behaviour. Back in March, my noble friend Lord Scriven asked the Government—as he has repeatedly—why there was no general power of competence for local government. We said then that local government would be the most important organisation in getting the long-term management of this virus right once the NHS had managed the initial pandemic.

Last Friday, the Government issued the Coronavirus Act analysis. It is a rather amazing document but it is not an analysis. There is no analysis whatever. There is no data at all. It is simply a list of the powers the Government took unto themselves with a small note at the end saying, “We would like to keep them.” That is no longer acceptable. I agree with the noble and learned Lord, Lord Judge, that this legislation must be open to scrutiny. I want to know how many of these powers have been used, when, by whom and how often, and what the effect was. None of that information has come to Parliament for six months. Week after week, noble Lords, such as the noble Baroness, Lady Thornton, sit here, with the regulations long since passed, and ask the Government what has happened—and answer comes there none. That is not acceptable.

Whatever noble Lords choose to do today, I hope that we have set the groundwork here for the debate in the House of Commons next week in which Members of Parliament—who are elected and will have to bear the consequences of their decisions—will challenge the Government to stop behaving in such a cavalier way with Parliament.

It will come as no surprise to noble Lords, least of all the Minister, that I believe that the Government’s approach has been fundamentally flawed. They have often ignored and underestimated the importance of local government and people in local public services. Nobody goes out to clap for environmental health inspectors but they are the people who, in the absence of leadership from central government, built their own call centres and sent out people with experience in investigating outbreaks of ill health and zoonotic illnesses and with the skills to talk to local businesses about what they needed to do to make sure that their businesses remained safe and open. Would that a fraction of the money wasted on some of the national schemes—Covid marshals; I ask you—had been put from the outset behind the people who know about this and have experience.

The noble and learned Lord, Lord Clarke of Nottingham, was quite right to say that there would be a huge amount of good advice in hindsight, but it is not hindsight to say to the Government that abandoning Public Health England in the middle of the worst health crisis we have ever faced was never going to be anything more than an unnecessary and temporary disruption. So, too, it is fair to say that whatever faith the Government have put in their ability to develop apps in ways that other people around the world have chosen not to—and no matter how many people have downloaded them, as the noble Lord, Lord Vaizey, said—understanding what it means in a poor community to sign up for an app that may mean that you cannot go to work, whether or not it is right, is something that local professionals know about. We should work with them more.

We said at the very beginning, back in March, that it was wrong of the Government to make this legislation unamendable. It was always going to be the case that some powers would be needed and some would turn out to be unnecessary, and the situation could not be foreseen. We did not know back then, but might have thought, that we might by now have the vaccine. If we did, that would have changed the whole landscape, but we do not. We also do not know what will happen over the next six months, but we know that we in this Parliament should insist that the Government start listening not just to scientists but to professionals, and using their experience and wisdom not only to craft legislation which has a chance of working in the first place but, when they get it wrong, to admit it and change.

I want to pick up one thing on mental health. The Government brought in legislation that swept away safeguards for people detained under the Mental Health Act. Organisations such as Rethink have talked to people who were detained under the Act during lockdown and they were actually very pleased—they felt very safe and thanked the staff who looked after them. They continued to feel protected. We also know from Rethink that, with the expected upturn in unemployment, we can now say there will be a huge demand for mental health services. The more money that local authorities and health bodies are allowed to put into preventive mental health services, the better. My colleagues in Sutton Council have put a mental health nurse into every school from September because they see the value of that and talked to people who know how these things work on the ground.

Above all else, the reason I have taken this tack is not to glorify local government but because local government not only has the relevant experience but has had a duty throughout this whole thing to keep open basic public services and to enable businesses to stay open and thrive. That is what we must do across the whole country. Noble Lords say that we need to balance health and the economy; without the basic health infrastructure that works and is backed up by very clear, well understood and transparent messages to the public, the economy will always struggle.

I say this to the Government: they should promise now that, within three months, they will bring new and revised legislation which will be the product of discussions that are both cross-party and with people who have clearly not been involved in the making of this, rather than taking and keeping for the next six months a bunch of powers, some of which they do not need and some of which undermine public confidence. We have to get through this together. This Bill is no longer the basis on which to do that.

Covid-19: Medical and Funeral Expenses

Baroness Barker Excerpts

Monday 28th September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the costs of a funeral are indeed a heavy burden on families with little wealth and have to support these payments. The Cabinet Office holds weekly meetings with the funeral industry in order to ensure that measures are in place to support families of the kind my noble friend described. We have put together guidance in order to ensure Covid-compliant funerals at the lowest possible cost, and for those who cannot afford to pay, the DWP has measures in place to make a payment up front for funeral costs in order to support them.

[Baroness Barker (LD)]

My Lords, public health funerals cost on average about £1,500 each. Many local authorities such as Birmingham spend a significant amount on them—almost £1 million in 2019. Local authorities are reporting an increase in demand for public health funerals. Will the Government take that into account in next year’s local government settlement?

[Lord Bethell (Con)]

My Lords, I do take note of the point made by the noble Baroness. This is entirely on our radar screen. We are aware of these additional costs and we will take note of the point that she has made.

Covid-19 Update

Baroness Barker Excerpts

Wednesday 23rd September 2020 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for taking questions on this Statement today. It was noticeable yesterday, and on Monday, that at no point was there any attempt to reveal any scientific basis or evidence for the impact on the spread of the virus of either a 10 pm curfew or going back to working from home if you can. A few weeks ago, we were all being urged to go to the office or workplace if we could. We have certainly not been told what SAGE’s modelling shows as the impact a ban on mixing households indoors would have.

The Government are lacking a clear Covid-management approach. We recognise that the pandemic, and its impact, are complex. The response can be no better than the best compromise, and that should be admitted. Timely policies to rejuvenate the economy will fail if policies to contain the infection fail; we recognise that. In the absence of a vaccine, testing, tracing and isolation is the only response that matters now. Covid infection data should be published, to make it clear to the public where the risks are. The Prime Minister said that more information would be made available. I would like to know that it will and when that might happen.

This leads back to testing, tracing and, importantly, isolating, as every conversation about the containment of Covid-19 does at the moment. Looking back over the last few weeks of growing disquiet, and then serious concern, about not being able to get tests, does the Minister agree that part of the problem—leaving aside the seeming failure of the noble Baroness, Lady Harding, and her operation—is the clear lack of communication about testing? I plead with the Minister not to treat the House to the mantra about the record number of tests and so on. It is completely clear, from MP’s postbags and the media, that “them out there” were under the impression that tests were more widely accessible than they in fact are. Lecturing us on how simple all this is both misses the point and is dangerous.

As far as schools are concerned, I asked a headmaster how things were going. He said: “If they ran a school the way they are running the country, what Ofsted grade would they put on their self-evaluation form?” I thought that was quite a good question. The tone of the Secretary of State and the Prime Minister in their Statements rather gave the impression that the Government were blaming people for breaking the rules and allowing the virus to grow. The reality is that people have done everything that they were asked to do. They have missed birthday celebrations, weddings and funerals; they have, quite rightly, sent their children back to school; they have gone back to their workplace. They have done what they were asked to do. In return, Ministers were supposed to fix test, trace and isolate so that we could return to something like normality.

The mayor of Tower Hamlets, John Biggs, said:

“With cases rising the government is right to bring in stricter restrictions to prevent the transmission of COVID-19. In Tower Hamlets we need to keep each other safe by following these new rules”.


He added:

“Government also needs to ensure adequate testing is available and that there’s continued support for those losing out financially due to these restrictions. The next few months will continue to be challenging—as a community we’ll remain resilient and together can get through this”.


He puts the case extremely well.

The Cabinet Office Minister, Michael Gove, said the 10 pm curfew on pubs in England has been brought in after evidence from places such as Bolton, where the curfew has already been in place for two weeks, suggested it will drive down coronavirus infection rates. However, according to the latest figures released by Public Health England, the infection rate in Bolton has risen again. Does the Minister share my concern that the new regulations may be based on poor evidence? Will the Government review this decision and immediately publish the evidence to allow it to be scrutinised in peer review?

Why is that 10 pm curfew not on all sales of alcohol? For example, you get thrown out of the pub at 10 pm with five of your mates; you go to the off-licence, buy whatever you want and go to somebody’s home. I cannot see the evidence that this will make any difference. I would really like to know.

Returning to tests, can the Minister confirm that only half of all tests have been received in less than 24 hours and will he publish the Pillar 2 data which breaks down how many people asking for those tests were symptomatic and how many were asymptomatic? Many parents report going to walk-in centres with their sick children, when they had no symptoms, and being given a test. Was that a national policy? Has it been abandoned? This is further evidence of confusion.

I welcome what the Minister said about prioritising NHS staff, care workers and teachers, but can he clarify why he has issued guidance to hospital trusts placing restrictions on the number of tests they can carry out? Also, how he will protect care homes? In a previous exchange this afternoon between the Leader of the House and the Leader of the Opposition, my noble friend asked the noble Baroness about domiciliary care. I think she maybe did not understand what was being said—it might have been after a question from the Back Benches. Will people in domiciliary care, going from one home to another doing social care, be given PPE and will the tests available in care homes be available to them? I am trying to put it as simply as I can because it is a very important question.

Will the Minister ensure that no one is discharged into a care home without a Covid test? Given where the virus is, what is his advice to the shielding community? What protections is he putting in place for those from black, Asian and minority-ethnic communities, given that there are disproportionate numbers from those communities in intensive care units even today?

None of us wants to see another lockdown or circuit-break. We will understand if one becomes necessary, but test, trace and isolate should be fixed. The failure of that has left us vulnerable and exposed. It seems to me we must now act with speed to save lives and minimise harm.

[Baroness Barker (LD)]

My Lords, three months ago the Secretary of State said that test and trace was the single most important thing that had to be done to conquer the virus. Yesterday the Prime Minister said it had “little or nothing” to do with the transmission of the virus. These two things cannot both be right. For six months, the problem has been that we have had confused messages, careless use of statistics and a persistent refusal to work with and listen to people who run local public services and know what needs to be communicated to whom and how.

All those are the fundamental reasons we find ourselves in this situation. We still lack an effective and timely track, test and isolate system. In its place and without any evidence base behind them, we have come up with messages which, quite frankly, do not make sense to the general public. The rule of six does not make any practical sense at all, as was very well evidenced today by my noble friend Lord Newby in an earlier interaction with the Leader of the House.

Yesterday, the Prime Minister said the Government now had granular data that enabled them to understand the transmission of the virus. When will that evidence be released? And when will it be released to Members of this House and the other place, who, next week, are going to be asked to renew emergency powers the like of which have never been seen before to this Government? If the Government cannot come up with that evidence—and, I have to say, over the last six months, they have persistently failed to answer any kind of detailed question from Opposition Benches in this House—why on earth should they be trusted to have those powers renewed? When are we going to get the evidence base?

It is helpful, looking at the Secretary of State’s Statement, to see that finally, after repeated questions from these Benches and the Labour Benches, we have got a clearer statement on who is being prioritised for testing and in which area. But, as the noble Baroness, Lady Thornton, said, it is remarkable that there is nothing about black and minority ethnic communities, which we know are at greater risk, and nothing about the important people who work, for example, in domiciliary care, or who work in hospitals but are not medics.

I would like to ask one final question. When will they start listening to local authorities, who are persistently asking, in helpful ways, what they can do to expand the capacity for testing and to make sure that testing is better tied into the rest of the services? We are about to have an app launched, and local authorities are already telling us that there is soft intelligence that people who think they have symptoms but are unable to get a test just give up, and that people whose children are ill give up. It is all well and good for the noble Lord to say, as he did the other day, that they are going to completely redo NHS 111 to make it a more streamlined portal into the NHS, but if people have given up looking for tests long before they should, we are never going to get the data we need to get on top of this.

So I ask, as I did the other day: when they are revamping NHS 111, will they talk to the Royal College of Paediatrics and Child Health about the NHS 111 protocols? I agree with the noble Baroness, Lady Thornton; I think the public are desperate to do the right thing. They have been extraordinarily patient and have listened throughout, giving the Government the benefit of the doubt. But they will not go on doing that indefinitely while the Government continually fail to come up with a decent evidence base for their actions.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, I am extremely grateful to the noble Baroness, Lady Thornton, for correctly characterising our response to the epidemic as “the best compromise possible”. It is a compromise. We have competing demands on our strategy: we have to protect lives and the NHS, but we also have to be conscious of the economy and the livelihoods of people, and we have to look after our students and pupils. The package of measures being put forward by the Government is the best compromise we can make for this moment, and we are unashamed of that compromise.

But the noble Baroness is wrong when she says we do not have a strategy. The strategy is really clear; it is to suppress the virus and protect the economy and education until the vaccine and mass testing are ready. It may not feel like it now, but there are glimpses of sunlight in the distance. The vaccine and mass testing provide a strong opportunity for us to suppress the virus. The strategy that we have put in place, as the Prime Minister rightly described in his address to the nation, is a way to “get through the months” until we have those arms at our disposal.

Both the noble Baroness, Lady Thornton, and the noble Baroness, Lady Barker, talked about the publication of data. I must confess that I have a genuine sense of confusion about that point, because we publish so much data. If there is one thing that this Government have got wrong, it is that we have published too much data too early. Too much has not been audited; too much has been put out as early as possible in our efforts to be transparent. Tomorrow, we will have a REACT survey; we will have an ONS survey; we will have test-and-trace data. There are SAGE minutes; there is NIHR; there is literally data coming out of every organisation of government. It is a fantastically huge amount of data. It is, I confess, extremely difficult to process all of that data all at once. The story it tells does chop and change at an amazingly fast rate—much faster than any experience I have ever had in my life. It is a rollercoaster that the Government have to ride.

I make no apology, however, for the fact that this Government have sought to act swiftly and to bring in measures quickly when the evidence has changed. In the last few weeks we have seen the latest example of that, where the infection rates have clearly lifted quickly in a way that was not expected, and we have had a discussion about that point in previous sessions in the Chamber. We have moved promptly to address the challenge that those worrying and concerning figures have presented to us.

The noble Baroness, Lady Thornton, raised the question of testing. I completely and utterly acknowledge the frustration of anyone who has not been able to get a test for themselves, for their child or for a loved one. It is true that we have more people wanting tests today than we have supply. However, I cannot avoid pointing out that—boy oh boy—we have come a long way since February, when we were doing 2,000 tests a day, to today, when we are doing 240,000 tests a day, and we are well on the way to doing 500,000 tests a day by October. Our aspiration is to do many times that within the near future.

That is not in any way to avoid the fact that I wish that we had more tests today. I want to convey to the House that this Government are 1,000% committed to answering the needs of this country for testing and have put every resource—human, technological, administrative and financial—behind the testing programme in order to deliver that promise.

The noble Baroness, Lady Thornton, raised the question of tone. I completely accept her point that the people of Britain have made a terrific sacrifice. There is no question at all of blaming the people of Britain, but we have to acknowledge that the spread of the virus indicates as a fact within itself that some people are not respecting the principles of social distance, hygiene and isolation, and we have to move in order to shore up the basic principles of this country and, by the way, of any country that is effectively fighting the virus—because, if we do not, the virus will sweep through the country.

I thought that the Prime Minister put that challenge very well, and in a way that a large majority of this Chamber would support. He said that the choice was before us: we could ask those who are vulnerable and older and shielded to simply lock the door and we could turn our backs on them. That is not the choice that this Government have made. They have made a choice to fight the virus at every level, because we love the people whom we care about; and it is a pragmatic choice, because if we find the virus growing in one part of our society, whether that is young people, health workers or the very young, then sure as night follows day, it will sweep through the rest of society.

I turn to the evidence on the curfew. This is a moment where I do not have the science at my fingertips. However, I have been in pubs and clubs after 10 o’clock enough times to know about the proximity and intimacy of late-night drinking, and I know that what happens then is not conducive to social distancing. This is a moment when plain common sense can tell you that a curfew will help to break the chain of transmission among young people. It is, unashamedly, a signal that we cannot go on like this and, in particular, that young people have to change their behaviours because the signs of infection are crystal clear. The prevalence among young people is too high, and we have to turn that corner.

The noble Baroness, Lady Thornton, asked about symptomatic and asymptomatic testing. The honest truth is that it is very difficult to tell; if someone is standing in a testing queue, we do not turn them away. By the way, in order to get a test, people do have to fill in a form, on which they are asked if they are symptomatic. What we do know from closer analysis and questionnaires is that a proportion of testees—between 20% and 25% at current rates—do not meet the strict criteria of our testing. I am grateful to the British public for beginning to show respect for the fact that every test counts, and for helping us direct them at the most needy.

The noble Baroness, Lady Thornton, asked about domiciliary care, an issue that has been raised in this Chamber a few times. I reassure all those in the Chamber, including the noble Baroness, in answer to her specific questions: yes to PPE, yes to testing and, by the way, yes to new guidelines that help minimise contact and the number of patients seen by each itinerant domiciliary worker; and yes to substantial extra funds for the social care system, specifically to help social care avoid relying on people travelling from patient to patient.

The noble Baroness, Lady Barker, asked about our relationships with local authorities and the local teams. I reassure her that we have moved a very, very long way in the last six months and that the picture she paints is understandable but out of date. We have come a huge way to share all of our insight, data, analysis and systems with local authorities, local directors of public health and local infection teams. Decisions on lockdowns now have a protocol whereby they are led by local teams after engagement with local civic groups and brought to the Secretary of State after they have been agreed at a local level.

Substantial sums—billions of pounds—have been given to local authorities to help them afford the kinds of local intervention that they choose to make in order to support the most vulnerable and disadvantaged during the epidemic. Money is given to local authorities for PPE for the people that they decide need it. Community health is being supported within the NHS in order for communities to be given the support they need. Engagement with local civic groups and business leaders is at a level I have never seen in government before.

I will give one example in relation to contact tracing, which the noble Baroness, Lady Barker, specifically asked about. In Leicester, money has been given to the local council for it to commission its own contact tracing, because we recognise that the local authority may well have the insights, cultural connections and sensitivities, and contacts needed for this kind of work. Therefore, we have provided financial and logistical support, and professional advice on how it can fill the gaps. We recognise that a national system cannot do everything, and that we have to be both national and local at the same time.

The noble Baroness, Lady Barker, ended by talking about the public mood and her concerns that people are reaching a state of despair. I completely recognise the exhaustion that many people feel about the state of the epidemic. I particularly recognise the morale within the NHS and social care, where people have worked incredibly hard, often in circumstances and doing tasks that they did not originally sign up for, and the sacrifice that many people have made, whether they work in the healthcare system, are supporting people they love, cannot do the things they want or are isolated and on their own. Of course, lots of people have made massive sacrifices, but I do not recognise the world she describes.

I think the public largely support the steps taken by this Government to suppress the transmission of this virus. After all, it is the virus that is the enemy. In many respects, we have an incredibly united country in fighting that enemy. The way in which the British public have supported the regulations and guidelines, which have had a tough effect on many people’s lives, demonstrates a huge amount of support. No Government —and certainly not this Government—will stretch that beyond what is tolerable. I posit to the Chamber that, to date, that support is still in place, and I remain extremely grateful for it.