Covid-19: R Rate and Lockdown Measures
Baroness Brinton Excerpts(4 years, 6 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
The London School of Hygiene & Tropical Medicine’s report is one model of more than a dozen that contribute to the SPI-M committee, which looks at modelling. We value it, but it is not the only model. Regarding the statistical analysis of R, I pay tribute to the Office for National Statistics, which has put in place a massive testing programme to look at prevalence across the country. Hundreds of thousands of tests are done. This is by far the gold standard in terms of understanding prevalence and it feeds in accurate, up-to-date information for the accurate assessment—not modelling—of R0. It is on that work that we depend.
Baroness Brinton (LD) [V]
On 3 June, my noble friend Lord Scriven asked the Minister which body had legal powers to implement a local lockdown. The Minister replied:
“The arrangements for local lockdowns are not fully in place. In fact, the policy around them is in development and a full decision has not been made”.—[Official Report, 3/6/20; col. 1428.]
Five days on, local authorities and directors of public health are reporting publicly that their hands are tied without the postcode data they need or the specific powers for lockdown. When will this vital decision be made so that flare-ups of Covid can be stopped?
Lord Bethell [V]
The work is being undertaken at the moment. Rather than focusing on local lockdowns, we are focusing on local action plans with a wide variety of measures, perhaps including behavioural changes as well as clinical and diagnostic interventions. It is only by working across the piece that local actors, such as local authorities, directors of public health and local infection directors, can implement the right array of measures. That holistic approach is the one we are pursuing.
National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2020
Baroness Brinton Excerpts(4 years, 6 months ago)
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Baroness Brinton (LD) [V]
I thank the noble Lord, Lord Hunt, for tabling this Motion. Along with other colleagues, I agree completely with the principles behind regretting these regulations.
I start by praising the care sector—all the homes and ancillary care staff, whether professional or family carers, who during the last two and a half months have done all that they could to care for the most vulnerable in our society, against all the odds. It is important this week, as Carers Week begins, to recognise the unpaid carers, especially the young ones, who have often provided support. I recognise that this is slightly off the topic of the statutory instrument, but it is important to understand the structural problems in our care systems at the moment.
Other noble Lords have outlined how the structural problems started 40 years ago. In 1979, two-thirds of care homes were run by local authorities or were not for profit—now, 84% are run for profit. The noble Baroness, Lady Bennett, outlined how in the mid-1980s things started to change. I can remember as a Cambridgeshire county councillor in the 1990s and early 2000s how the standards changed in care homes at very short notice. Many local authorities, which were not permitted to borrow any capital costs at all, had very regretfully to close down their care homes. That was when the surge started, in about 1995-96, and it continued through the next decade.
We moved as a country towards having a privatised system, but we did not fund it properly. Money for care homes certainly needs to be upgraded. One of the difficulties we face is that, even though we are approving a weekly rate—I know this from experience of my mother’s two and a half years in a care home—the CCG started from a position of arguing, either with the individual and their family or with the local authority, about what the amount should be. Almost standing over my mother’s bed, we had to try and fight back against the CCG representative who did not want to pay anything at all after her second stroke. We need to understand the pressure on families, particularly regarding the way this allowance is used, and recognise that it is not the true picture.
We need also to look at the extra costs that care homes are facing at the moment. Other noble Lords have mentioned that PPE costs have increased. They have not doubled—care homes are now paying five times the amount they were paying in February. We heard that PPE was diverted, and the noble Lord knows, as I have challenged him long enough about this, of concerns about whether Clipper Logistics were going to come on board. Can the Minister confirm the report in the Health Service Journal that the Clipper system is now to be used only for emergencies and is not to be the resource that the care home sector was led to believe it would be? If it is not, where on earth will individual care homes be able to access PPE at the price they used to pay before the pandemic?
Testing has also been a problem over the last few weeks. In order to keep people safe, it was important that everybody, in all care homes, was tested right from the start.
My noble friend Lady Barker and others have talked about that month between mid-March and mid-April, before the Secretary of State announced that care homes could have tests. We heard that last Friday was the date by which everyone in a care home for the elderly would have access to testing. It is good that today, the Government announced that those who have learning or other disabilities can now finally access testing, but care homes for the elderly still desperately need assurances that, as with the NHS, their staff and patients can access regular testing. Can the Minister confirm that this will now happen? Otherwise, there may be a local flare-up which, before we know it, is running rife through certain care homes again.
Many noble Lords have talked today about the importance of treating our care staff well. We know that they have gone way above and beyond the call of duty. Those who have given up life with their families and moved into care homes deserve special credit. I like the idea outlined by the noble Baroness, Lady Wilcox: the Welsh proposal to award £500 to care workers as a bonus for their considerable effort. For them, many of whom are on the absolute minimum wage, it is a significant amount, although it still will not reward them for everything they have done.
At the end of this, we must return to the long overdue Green Paper. I completely agree with all noble Lords who said that it must be cross-party. Dilnot was certainly a good starting point, but the problem with Theresa May’s proposals was that they were Dilnot upside down. I gently remind the Government that it was not the Liberal Democrats or the Labour Party that walked away from the last cross-party arrangements. My party is keen and eager to become involved, whatever we decide for the future. The Green Paper is very much overdue; it must come along quickly. We need to look at everything structural. This should not be just about who pays what for a bed. We need to review the entire system.
Covid-19: Obese and Overweight People
Baroness Brinton Excerpts(4 years, 6 months ago)
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Baroness Brinton (LD)
Section 8.3 of yesterday’s PHE review on disparities and Covid demonstrated very clearly that Covid, obesity, hypertension and diabetes type 2 were all severely raised for the BME community. Given that the Minister said in the House yesterday that this review was just the first step in understanding Covid in our BME communities, what urgent guidance is going to our primary care sector to advise our BME communities on what they need to do?
Lord Bethell
The noble Baroness, Lady Brinton, is entirely right. The review has done an excellent job of laying a path for greater understanding of the disease and is informing the PHE response. GPs already have a very clear work plan for advising BME communities on the threat of diabetes, in particular, and on obesity and healthy living for all circumstances. This will be redoubled during the epidemic that we are experiencing.
Covid-19: Response
Baroness Brinton Excerpts(4 years, 6 months ago)
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Baroness Thornton (Lab)
Before I ask the questions we need to address, I wish to record the deep sadness felt by me and my colleagues at the death of our friend and comrade, Dr Lord Nic Rea, two days ago. Nic was much loved across the House and gave me unstinting support and health advice over many years.
In March, the medical director for England said that keeping the number of coronavirus deaths below 20,000 would be “a good result” for the UK. Therefore, I start by asking whether the Minister agrees with the Prime Minister when he says that he is proud of our efforts in the UK. They have resulted in an ONS figure of 60,000 excess deaths due to Covid-19, even if at present the Government are admitting to only almost 40,000. The UK has 2% of the world’s population and we have had 13% of the deaths from Covid. I suggest to the noble Lord that some humility is required here. We can be as proud as we all are of our NHS, support staff and all key workers but it seems inappropriate to be proud of leading us to where we are today.
I would like to ask about disparities in the risk and outcomes of Covid-19, as covered in the PHE review, which addressed the unequal nature of the risks of this virus. The review reveals that the virus poses a greater risk to those who are older, male and overweight. The risk is also described as “disproportionate” for those of Asian, Caribbean or black ethnicity. It makes no attempt to explain why the risk to BAME groups might be higher.
Yesterday, the Royal College of Nursing released data that supports PHE’s findings. The survey found that for nursing staff working in high-risk environments, including those working in intensive and critical care units, fewer than half—43%—of respondents from a BAME background said that they had enough eye and face protection equipment. This is in contrast to two-thirds—66%—of white British nursing staff who were content. Has the Minister read this report, and what is his view of its findings?
An earlier draft of the PHE review seems to have included responses from the 1,000-plus organisations and individuals that suggested that discrimination and poorer life chances were playing a part in the increased risk of Covid-19 to those with BAME backgrounds. Why was that section omitted? Why was the report published a week late? Is it true that the omitted part included recommendations like that from the Muslim Council of Britain, which stated:
“With high levels of deaths of BAME healthcare workers, and extensive research showing evidence and feelings of structural racism and discrimination in the NHS, PHE should consider exploring this in more detail, and looking into specific measures to put in place to tackle the culture of discrimination and racism”?
Apparently, these words did not survive contact with Matt Hancock’s office over the weekend. Is that true? Does the Minister agree with the Muslim council that the clear statement about the need to introduce change would surely give greater meaning to the statement by the Secretary of State that “black lives matter”?
Moving on, the Prime Minister assured us that by 1 June we would have a world-class track and trace system. I assume that he was misinformed, as crucial parts of the system do not exist and will be in place only at the end of June, which is what the noble Baroness, Lady Harding, says. Furthermore, the fragmented mess of using private contractors has been a disaster. Some recognition is finally being given to the role of expertise and knowledge at the local level and in local authorities, yet even these local experts were not consulted about the system and seem to be in the dark about just how it is supposed to work—just ask any department of public health how confident they are that we have a world-class system. Surely such a system should have the capacity to turn around tests in 24 hours, and we are nowhere near that point.
Over two weeks ago, I asked the Minister a series of simple questions. Who would call me if I tested positive? If the call is from a call centre, how will I know that it is genuine and to be trusted? The deputy at Public Health England seems to think that we would know through the expert questions that the tracer will ask. Clearly, she has never been on the receiving end of skilled online or telephone fraudsters. This is an important question. If it takes over 24 hours to get the test results and the tracing does not start within 48 hours, surely the system of protection will have broken down by then? Would the information, which is held centrally for some years, go to my GP? It is unclear where that data will be stored and what rules will apply. Can the Minister please explain?
An analysis published by Cancer Research UK has outlined that as many as 2.4 million people in the UK have been affected by a backlog in cancer care, waiting for screening, further tests or treatment. That can change only if the staff doing the cancer care, treatment and testing are being tested very frequently, even those without symptoms.
It is very concerning that the Government are refusing to publish information about the reproduction rate per region, the viability of home test kits, the number of people tested daily, and the number of people contacted under the new contact tracing system, to list a few examples. Furthermore, the data that the Government have published has been decried as highly misleading by the head of the UK Statistics Authority. Will the Minister commit to urgently publishing these figures to ensure openness, transparency and public confidence in the Government’s approach?
Does the Minister share the concerns of scientists, including members of SAGE, and public health leaders that the Government’s NHS Test and Trace system was not yet robust enough to quash any resurgence of the virus and should have been “fully working” before lockdown measures were eased? A final comment on “test, track and trace” is that the Cummings saga was bad enough, but we now have the chairman of the UK Statistics Authority making very robust suggestions that government presentation may not be what it seems. Sir David Norgrove has pulled no punches and makes it abundantly clear that he thinks the presentation of testing numbers in England is unacceptable.
On shielding, it is remarkable that the announcement to lift shielding was made during the night at the weekend. There was no notification to GPs, public health officials or those who most recently had been told to shield until the end of June. Can the Minister please tell us what the scientific justification is for that? Apparently, according to my noble friend Lady Armstrong, department officials met many organisations representing patients with long-term conditions last Thursday. There was no mention then that anything would be lifted on Saturday, even though they discussed experiences of lockdown and talked about the way forward. That suggests to me that it was a politically motivated announcement, without any involvement of the relevant clinicians or patient groups. Can the Minister say which clinical groups had supported the announcement on Saturday evening? What preparations were the NHS able to make before the announcement was made? At the beginning of lockdown, shielded people got daily emails from the NHS about how to behave but, since Saturday, I understand that they have received nothing. I think many may feel abandoned —some are our colleagues in the Commons.
We must not make the same mistakes with our shielded citizens as were made with care homes, ignoring the risks to those most vulnerable. The arguments about discharging patients into care homes without them being tested has not abated. What information does the Minister have about current and regular routine testing of care home staff, and even daily tests? There is emerging evidence of higher death rates among those with learning disabilities—yet another emerging tragedy. Does the Minister think that was avoidable? Was a strong shield wrapped around them from the start? I do not think that it was, but maybe the Minister can give us his view.
Finally, we must start thinking about what kind of NHS will emerge after the pandemic is really under control, whenever that might be. How will the system deal with the huge backlogs, such as those for cancer patients and cancelled surgery? I do not expect an answer from the Minister right now, of course, but we need a debate and a discussion. Can we expect a Statement on these matters? If we truly are now going through the worst, can we start planning for the future?
Baroness Brinton (LD)
My Lords, I too thank the Minister for the Statement. From these Benches, we send our condolences to the family of Lord Rea; he will be missed. I also repeat the support from the Liberal Democrat Benches for everyone working hard to help contain and reduce Covid-19, from the magnificent front-line staff in the NHS and the care sector to all key workers, whether visible to us or not: we know that you have given your all. We also send our condolences to all those who have seen the death of families and friends over the last four months.
The World Health Organization has insisted repeatedly that no country should start to lift lockdown until Covid-19 is no longer in the community. With the noble Baroness, Lady Harding, confirming that there are still over 8,000 new cases per day, clearly it is still in the community, and WHO also says that lockdown should not be lifted until a full test, trace and isolate process is in competent operation across the country, which it is not.
Can the Minister explain why Ministers took the decision to start the process of lifting lockdown even though the Chief Medical Officer refused to allow the threat level to reduce from four to three? Unlike other European countries, which started lifting lockdown only when the daily death rates were below 10, today the department reports a total of 359 people died in the UK in the last 24 hours. Why was the shielding advice changed over the weekend, and why was no guidance sent out to GPs, care homes and clinical groups? I can confirm, as someone who is shielding, that I still have had no advice, by text, by letter or by telephone, on what I should be doing now that the advice appears to have changed. What can the Minister do to reassure people who are shielding that this is safe advice?
What steps are the Government taking to prepare for flare-ups of cases in our communities, and, worse, an early second wave? Will the care sector be involved in that preparation, given that they appear to have been left to hang out to dry in order to protect the NHS? I understand that unlike hospitals, the care sector has not been approached at all yet.
In the Statement, the Secretary of State refers to the publication of the Public Health England report on disparities and the risks and outcomes of Covid-19. The Runnymede Trust summarised the problems with the report, saying that there were not
“any recommendations on how to save BAME lives.”
What specific guidance is being provided to the NHS and care sectors to protect BAME staff in high-risk Covid-19 areas? Can the Minister comment on the report from the Western General Hospital that BAME locums were disproportionately placed on rotas in coronavirus-intense wards, and that the hospital has experienced a recent and very large spate of cases?
Yesterday, the Office for National Statistics wrote its second letter in four weeks to the Secretary of State, challenging him in the bluntest terms and accusing him of obfuscation and confusion on the number of daily tests carried out. Can the Minister give the House a date when we will be able to see real and consistent data on testing, approved by the ONS, back- dated and adjusted, so that there is no room for any misunderstanding?
I return to the issue I have raised repeatedly with the Minister: the care sector. At the weekly APPG on Adult Social Care update today, we heard again from across the sector that it still faces a number of problems, some of which the noble Baroness, Lady Thornton, outlined. To be clear—before the Minister responds again, saying that this is just anecdotal evidence—we were told that this is happening in a large number of care homes and settings in wide areas right across England. This is not a one-off.
First, a number of CCGs are still pushing care homes to take block-bookings of patients coming out of hospital without having had Covid tests. The Prime Minister and Secretary of State have repeatedly said that this has never happened. It has happened and is still happening. When will it stop?
Secondly, on PPE, the care sector says that the Clipper system is finally starting to be rolled out across the country—a mere eight weeks after your Lordships’ House was told that it was only a handful of days away. However, care homes report that deliveries are still only a portion of their original orders, meaning homes still have to make decisions about rationing. Can the Minister provide a date by which the care sector will receive all the PPE it orders and needs?
Thirdly, the Minister told us that all care homes would be offered tests by 6 June. I repeat my question from two weeks ago as to why some homes are excluded from the portal so that they cannot access tests. These are homes for learning-disabled adults and disabled people under 65. Given the worrying comments on the inequalities data in the PHE report, when will this change?
Fourthly and finally, I echo the points made by the noble Baroness, Lady Thornton, about it being essential for all health sector staff to be able to access repeat testing to keep people safe. While it is true that it is happening for NHS staff, it is not true that our care homes or staff working in the community are able to access regular testing. Can the Minister please provide a date by which staff in care settings will have regular testing? This is vital because there are so many asymptomatic cases. They need parity with the NHS.
I recognise that I have asked a large number of specific questions and hope that, even if the Minister cannot answer them now, he will be able to write to me and others taking part in the Statement. Perhaps he could also answer any of the questions from the noble Baroness, Lady Thornton, if he cannot answer them now.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I start by echoing the words of both noble Baronesses and give thanks for the contribution of Lord Rea to the House. I did not know him well but have read the many testaments to his work. He clearly lived a full life and made a massive contribution to the House, for which we should all be thankful.
I echo the noble Baronesses and give a moment of thought to all those who have had deaths in their family and among their friends. I have lost both an aunt and a godfather to Covid in the last few weeks; my family has not been untouched, and I think—
Covid-19: Care Homes
Baroness Brinton Excerpts(4 years, 6 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, the issue the noble Baroness raises was recognised in the very early stages. The problem of itinerant staff who move from one resident or patient to another was always going to be one of the most difficult to tackle. They perform an absolutely vital role in the care of non-domiciliary patients. That is why we put more money in to pay for more staff, provided PPE for the staff who were working and continue to upgrade the testing arrangements for both staff and patients, to ensure that they are protected.
Baroness Brinton (LD)
Yesterday, Professor Dame Angela McLean said testing had been prioritised in the NHS over care homes. Today, Justice Secretary Robert Buckland said the Government had prioritised the NHS over care homes as well. Yesterday’s Health and Social Care Select Committee also heard members of the care sector report continuing and widespread problems with PPE—chaotic, unreliable and extremely expensive, with the Clipper system promised two months ago still not rolled out. When will the Government ensure that our care sector gets the urgent priority support outlined in the Government’s social care action plan on 15 April, needed to keep residents and staff safe?
Lord Bethell
The noble Baroness is quite right to focus on the importance of social care, but I think she unfairly characterises the effort made to ensure that social care is protected. The social care action plan announced on 15 April has been enormously important and extremely effective. Also on 15 April, we rolled out outbreak testing for all symptomatic care home staff and residents. We brought in extra funding on 16 April, with £850 million in existing social care grants. There has been new guidance and more money for local authorities, and we have launched a workforce recruitment campaign for care home staff. An enormous amount has been done. Care homes were always vulnerable, and we have sought to put every possible measure in place to protect them.
Covid-19: Response
Baroness Brinton Excerpts(4 years, 6 months ago)
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Baroness Thornton (Lab)
My Lords, I thank the Minister for not repeating the Statement, which I have read.
First, I want to ask about these Covid-19 symptoms: lack of taste and smell. The Minister will know that many healthcare specialists and the World Health Organization were making these warnings eight weeks ago, so can he explain why there has been a time lag in updating the definition?
I start by referring back to the question, on testing and tracing and the NHSX app, which I posed to the Minister yesterday and which he did not answer. I asked him whether it was true that in a Downing Street briefing that morning it was announced that the rollout of the app has been delayed until June. Is that true? When can we expect the rollout? Indeed, will we see the rollout of this app at all? If the Government will not use the app any time soon, does that mean that testing, tracking and isolating have to work smoothly and effectively at local level? That raises many questions.
We on the Benches welcome the wider rollout of testing, of course. Can the Minister update the House on whether the screening of all healthcare workers, whether they are symptomatic or not, has been successfully rolled out? What proportion of healthcare workers have been tested so far? Will they be tested every week? If not, how often? This is important, because it has been reported that 20% of hospital patients got Covid-19 while in hospital for another illness or treatment. So if routine NHS work is to be restarted, patients must be confident that they are in a Covid-free environment.
Can the Minister inform the House of the progress on antibody testing? Are these tests now widely available? If so, for whom? If they are not yet available, when will they be available? I gather from a widely available advertisement that I could have what is said to be a PHE-approved antibody test right now for about 100 quid. Would the results of that test be acceptable if I wished to use it to prove to an employer that I could got to work, go to school or teach at school?
On tracing, we on these Benches have long argued that the safe way to transition out of the lockdown is by having a test, trace and isolation strategy in place. Can the Minister tell us the current median time for test results to be received by someone when the test is carried out by Deloitte and other private sector testing facilities? More crucially, how soon do directors of public health and GPs receive the results of those tests?
Is that how it works: that the test is nationally organised and carried out, and the results are fed back locally? Who are they fed back to, and are those people responsible for tracking and tracing? Are they people the experienced local public health tracers or are they some of the 21,000 tracers who, we are informed, have been recruited? To whom are any or all of them accountable for tracking down people who are infected? As the Minister knows, we on these Benches believe that the Government should have made better use of local public health services. Who will inform people who have been in touch with a person with Covid-19 to isolate? Who is responsible for what happens to those people who must isolate, and for whether their families are supported in doing so? Where does the national call centre delivered by Serco fit in to this system? Can the Minister tell us by what date tracing and tracking services will be operational? Will they be operational by 1 June? I have raised with the Minister the issue of isolation. Why is that not mentioned as one of the key elements of the test-and-trace strategy?
Turning to care homes, I note what the Secretary of State said about social care last week: that he had thrown a “protective ring” around care homes. What constitutes a protective ring? The spread of coronavirus in care homes has become a crisis within a crisis. It was reported by the Guardian on 13 May that during the period coronavirus has been spreading in the UK, there have been as many as 19,938 excess deaths in care homes, well above the figure attributed to coronavirus by the ONS, leaving an urgent question about the causes of these deaths. None of this suggests anything remotely protective.
The reality is that there was no early lockdown of care homes, which was needed, and no early testing of people transferring from hospitals to care homes until mid-April. Prior to 15 April, the Government’s care home advice said:
“Negative tests are not required prior to transfers/admissions into the care home”.
That was not rescinded until mid-April, when the Government eventually issued their care homes strategy. Today, the CQC report says that 36% of care homes have Covid-19. That seems to be a greater proportion than that being admitted by the Government. Weeks later, do we yet have full testing of all residents and care home staff? No wonder Age UK say that this is “too little, too late”. When will they all be routinely tested? What is the date for that?
Turning to the R number, can the Minister guarantee that every easing of restrictions—such as asking children to return to school—is accompanied by a government statement on the expected impact on the R number and the underlying prevalence of the infection? If the R number rises to be greater than one in a region or local area, how will the Government deal with that?
Finally, I want to be clear that we on these Benches are desperate for the Government to succeed in beating this virus. We will and have supported the Government. In return, we expect transparency, as everyone does. Let us see the science. Give us clarity about what people are expected to do, truthfulness when things go wrong, as they inevitably will, accurate communication on all occasions and regular accountability to Parliament. We deserve no less.
Baroness Brinton (LD)
My Lords, I thank the Minister for the Statement. The ONS statistics this morning showed that over 44,000 people have lost their lives, with the Financial Times estimating that the total figure is now well over 60,000 when a percentage of excess deaths is taken into account. From these Benches, we send our sympathies to all bereaved families and friends, and our thanks and support to the amazing front-line staff in the NHS, social care and community sector, and to others in key roles working to save lives and keep people safe.
The Secretary of State began his Statement by talking about flattening the curve, but yesterday an article in the British Medical Journal said:
“What is clear is that the UK’s response so far has neither been well prepared nor remotely adequate … Above all, the response to covid-19 is not about flattening epidemic curves, modelling, or epidemiology. It is about protecting lives and communities most obviously at risk in our unequal society.”
We agree.
I echo the points made by the noble Baroness, Lady Thornton, about the acceptance, at last, by the Government of a third symptom, anosmia, but many other countries have more symptoms. France says that you should self-isolate if you have any symptom on a list of 10. Why do our Government still refuse to increase that list?
The Secretary of State has repeated his claim that he has prioritised testing in care homes, yet he still repeats that testing for everyone in care homes, whether staff or residents, will be only “offered” by 6 June. The Adult Social Care APPG is still hearing of care homes waiting for that “offer” of tests, and of others that have had tests but results still going astray or taking 10 to 14 days to be returned. On that basis, if Ministers are really prioritising care homes, why does the Statement announce testing for members of the public over the age of five now while people at the heart of the firestorm of Covid in care homes still have to wait up to two weeks before being offered a test?
Still on testing, can the Minister tell us the percentage breakdown of PCR testing results versus antibody testing results? If not, can he tell the House when this information will be publicly available? We need as many PCR tests as possible as part of an effective test, trace and isolate programme. How many of those carrying out testing are paid roles versus volunteers? A couple of weeks ago, the Minister told your Lordships’ House that testing would be extended through, among other things, a deal with Boots. Five days ago, Boots had an advertisement seeking volunteer testers taken down after public outrage that a company that had been given a commercial contract with the Government was relying on volunteers to carry out the work. Was using volunteers part of its tender to government? If so, does the Minister approve of companies using volunteers while pocketing public money in a contract?
On tracing, it is encouraging to hear that more than 21,000 tracers have been recruited, but today there are reports of people recruited receiving multiple emails congratulating them on being successful or attending online training that has completely fallen over and failed technically. Can the Minister say what percentage of those 21,000 have received full training and are now working as tracers? Last week, the Secretary of State said that local tracers would be used, whether local health or environmental health tracers, as well as central ones. Can the Minister say how many local tracers—that is, not Serco call-centre tracers or central NHS tracers—there will be from the 21,000?
The Statement asserts that the Government now have all the elements to roll out their scheme of test, track and trace, but I repeat that there is no focus on isolation for those who have to quarantine. Test, trace and isolate is used not just by the WHO but by many countries. What plans are in place to support people isolating, whether at home or in a quarantine unit, once lockdown is lifted? They will feel much more vulnerable at that point, when everyone else is moving back into their normal lives. Experience from Taiwan, Germany and South Korea shows that community health support for those in quarantine is more likely to make it successful. Again, countries that have been successful in containing the virus all had fully operational test, trace and isolate programmes up and running from day one. Given that each new venture the Government have undertaken during this crisis, as outlined in the BMJ article—from expanding PCR tests from a low base to manufacturing ventilators, supplying PPE and now the tracer app—has had a very problematic start, to put it kindly, are the Government starting to run full contact tracing now, using new staff in an area that has sufficient cases of coronavirus, before lockdown starts to be lifted but particularly by 1 June? It would be inappropriate for schools to return and people further to return to work without such a system in place.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I thank the noble Baronesses for their penetrating and searching questions. I will go through them systematically.
First, I want to say a few words, partly in response to the appeal for transparency from the noble Baroness, Lady Thornton, and partly in response to some of the suggestions about the performance of the Government in their response to Covid. I assure the House that the Government approach this epidemic in a spirit of openness and transparency, and we would like to work in partnership with other parties. I simply reject the suggestion, consistent in some of the questions, that the projects undertaken by the Government have in any way been characterised by failure or disappointment.
I bear testimony to the huge achievements of those who have worked extremely hard to throw up remarkable schemes which have been enormously successful and massively mitigated the effect of this disease. The testing network, the ventilators, the lighthouse labs and the nightingale hospitals were all hugely ambitious ventures, greeted with scepticism when launched and accompanied by complaints while being thrown up. But their achievements have been enormous: they have had a huge impact.
I would therefore like to turn around the tone of this debate, to be a little more positive, and celebrate the huge achievements of those who have thrown their heart and soul into the response to coronavirus. I pay tribute to their achievements and to the personal sacrifices many of them have made by giving up their time, and even putting their lives at risk, to conduct these important roles.
Quite reasonably, both noble Baronesses asked whether the Government regard isolation as part of the programme. I can reassure them that isolation is absolutely the key point. The way to stop transmission is for those who have symptoms, and especially those who have tested positive, to shield themselves from the rest of society in order to prevent the spread of the disease. Everything that we do in the test and trace programme is ultimately to promote good behaviours by the British public, so that people who have symptoms will distance themselves from the rest of society, putting a brake on the disease. It is absolutely imperative, and at the heart of all our communications.
I pay tribute to the British public, who have made huge personal sacrifices during this lockdown. The culture of isolation will be an essential part of keeping a lid on the disease. The Government are committed to providing mental health support, and practical and cultural support, for those who are in a state of isolation. I thank both noble Baronesses for throwing a spotlight on that.
I want to convey to the House the enormous complexity of identifying the key symptoms of this disease. By any common sense, it would seem incredibly obvious how to spot Covid, but I have sat in numerous meetings running through the data and know how difficult it is to have a consistent set of symptoms that can be understood clearly and communicated simply to the public. The data on this disease is extremely complex. As I have said to the House before, this disease is a very difficult adversary, as characterised by the way in which symptom checking is so difficult. We have moved to a new and upgraded set of symptoms, and we may well have to move again. However, we are seeking to encourage absolutely anyone who has any symptoms to declare them and seek a test.
Perhaps I may move quickly through the questions put by the noble Baroness, Lady Thornton. I reassure her that the NHSX app is very much part of our plans. The Isle of Wight programme has been enormously successful and take-up rates have been huge. But it did teach us one important lesson: that people wanted to engage with human contact tracing first, and quite reasonably regarded the app as a supplementary and additional automated means of contact tracing. We have therefore changed the emphasis of our communications and plans to put human contact tracing at the beginning of our plans and to regard the app as something that will come later in support.
I reassure the noble Baroness that the testing of NHS and care staff is an absolute priority. Testing by the NHS of both groups is well under way. As announced by the Secretary of State, we are looking carefully at bringing in antibody testing to answer the question from staff who may query whether they have had the disease in the past, and to understand better what the role of immunity might be. The science is not firm; the lessons are not clear; but we need to understand the role of antibody testing and find out how it can help us combat this disease.
I advise the noble Baroness, Lady Thornton, to be very wary of private tests. They vary enormously in quality, as I know through my own experience. The time after having the disease when you take the test impacts enormously on the test and the assumptions one can make about a positive test are not proven. You cannot currently share with an employer any impression that you might have immunity, on the basis of a test.
I reassure both the noble Baronesses that our involvement with local groups in the tracing operation is being energetically promoted. We have appointed Tom Riordan, the chief executive of Leeds City Council, to lead this part of the programme. He is running an excellent programme to work with local authorities, directors of public health, environmental health officers and local resilience forums to ensure that our tracing system is as local as it possibly can be. It cannot all be done locally: some of it is better done digitally, and the highly automated routines of the app are very good. Some of it must be done at scale on a national basis by the massive call centres that we are throwing up, but some of it is best done by local groups. Those processes are being put in place energetically and I thank GPs, local directors of public health and all those who are engaged in them. We will be putting together local Covid plans that will be implemented by the relevant local authorities. These will form an important part of keeping a lid on this contagion.
I also pay tribute to those who are helping to organise the major test centres, including Serco, and those who have stepped up to take roles as contact tracers. They are going through complex training at the moment; it is a challenging task. No one wants to hit the phone and tell someone that they have to isolate; it is a tough message to have to deliver. I have no doubt that there will be problems with this complex and difficult task, but I pay tribute to those involved and express my gratitude to those running the programme.
On care homes, as the noble Baroness, Lady Thornton, rightly described, every death is a source of great sadness. However, I pay tribute to all those who have put their safety on the line by delivering tests in care homes. I reassure the noble Baroness, Lady Brinton, that there is a website where any care home that wants a test can register their interest and get a response promptly. Any care home worker who wants an individual test can access a site where, as a key worker, their test will be prioritised. There should be no reason why any care home or care home worker should wait two weeks, as suggested in the question.
I put my hand up and explained that mistakes were made 10 days ago when, due to problems with our Northern Irish test laboratory, some care home tests were either delayed or voided. That was an enormously regretful situation, but, when you put together an operation of this scale at such pace, some mistakes will be made. We have done an enormous amount to rectify those mistakes. Bringing in the noble Baroness, Lady Harding, to run the operational side of our testing regime is a great step forward.
I will also say a word in defence of the volunteers who are working at our drive-in test centres. These are often furloughed workers who do not need paid employment, but they are spending their time usefully and are often committed and have a sense of public service. I bridle at the thought that they would be sneered at or in any way insulted. The role of Boots in recruiting them is entirely honourable, legal and appropriate for the times we are in, and I very much thank those volunteers who have dedicated their time and risked their personal safety to do this difficult and possibly risky job. It is not appropriate to suggest that there has been public outrage at this arrangement—quite the opposite. The British public support this kind of individual public service.
The recruitment of tracers is going extremely well indeed: 21,000 have been put in place, which is way beyond our initial expectations, and the training is going well.
This programme is developing very quickly. We will seek to make announcements about it later this week and there will be a further rollout next week. I am extremely proud of the achievements that we have made, and I thank everyone who is involved very much indeed.
Care Homes: Covid-19 Testing
Baroness Brinton Excerpts(4 years, 7 months ago)
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Lord Bethell
My Lords, it is not true that the list of priorities did not include care homes. In every epidemic, care homes are always a priority. History has taught us that and we knew it from the beginning. We have focused on them enormously; that is why care homes are a number one priority at the moment. We are determined to reduce the rate of infection so that infection does not leak into the community.
Baroness Brinton (LD)
In a reply during Oral Questions earlier today to my noble friend Lady Barker, the Minister said that test results for the care sector are turned around within 48 hours. Yesterday, care home organisations told the APPG for Adult Social Care that many are not getting any results back—a big black hole—that those which do say that 10 days is not unusual, and that local resilience forums are not being allowed to get the results either. They cannot plan support. While 6 June is three weeks away, the crisis in our homes is now. Given his previous Answer, can the Minister give a date by which all care sector results will be returned within two to three days?
Lord Bethell
I think the noble Baroness casts the situation unfairly. There are undoubtedly cases where test results have taken longer. Last weekend, a laboratory let us down and we had some delays, but I pay tribute to the team who turned around a very difficult situation. By far the vast majority of tests are turned around within our target time, and we are currently trying to reduce that time by using mobile and satellite units to take the tests to residents. That work is showing great and encouraging signs of improvement.
Covid-19: Government Response
Baroness Brinton Excerpts(4 years, 7 months ago)
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Baroness Brinton (LD)
From these Liberal Democrat Benches we echo the points made by the noble Baroness, Lady Thornton. We believe that lockdown should be lifted only using the WHO advice for “test, trace and isolate” to keep people safe. On 23 April, I asked the noble Lord, Lord Bethell, why “isolate” had been dropped from the Government’s slogan. He told your Lordships’ House:
“Turning to track and trace, I confirm that isolation is an absolutely intrinsic part of the track and trace regime: it just does not rhyme so well, so you never put it at the end, but ‘track, trace and isolate’ is the programme.”—[Official Report, 23/4/20; col. 166.]
Today, the Department of Health and Social Care’s Dear Colleague newsletter does not mention “isolate” in the context of lifting lockdown. Can the Minister say what evidence there is of a government plan for isolation, and how will we know that people are isolating, which is absolutely vital if we are to succeed in stopping transmission and keeping people safe? Although testing has increased it has not yet reached a consistent number of 100,000 per day, so what evidence is there for the Prime Minister’s new target of 200,000 per day by the end of May being delivered?
Lord Bethell
The Government’s commitment to isolation is spelled out clearly in guidelines published by Public Health England, and it is promoted every day with the Government’s “stay at home” slogan. On the 200,000-test aspiration, we have put in place a remarkable platform for testing. We have strong partnerships with important companies, we have sourced new supply chains of critical reagent swabs and other supplies that are in short measure, and we are making the logistical arrangements necessary for a massive expansion of testing. I believe that those will take us to whatever is necessary to meet the testing needs of the country.
Covid-19: Personal Protective Equipment
Baroness Brinton Excerpts(4 years, 7 months ago)
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Lord Bethell
My Lords, it is not correct that Turkey was asked to intervene only at the last minute. We have been in constant, daily and regular contact with the Turkish Government. We are grateful to the Turkish Government for their help and involvement and we continue to work with Turkish companies on this order. On the NHS’s requirement, this virus undoubtedly requires much more protection than any other disease that we have encountered. The demand for PPE will continue to rise. We will meet that need through our Make programme and continued strong relationships with foreign providers.
Baroness Brinton (LD)
My Lords, Methodist Homes has reported the deaths of 250 residents and two staff from Covid-19 since the beginning of the outbreak. Last week, it was forced to buy 200,000 face masks for £200,000—five times the going rate. The current government allocation is 300 masks per home per week, when the reality is that they need over 1,000. The system for providing support for our care homes, which are really struggling—they are actually now the focus of the outbreak—is just going from bad to worse. Can the Minister please tell us exactly when homes will receive the PPE that they need?
Lord Bethell
The noble Baroness is entirely right to commend the sacrifice of hard-working care workers who put their safety on the line and put themselves in harm’s way. She is also correct to allude to the challenge for care homes—15,000 of them—that have previously largely looked after their own procurement arrangements. This Covid disease presents an enormous procurement challenge. The Government have stepped up and are helping care homes in many ways. Nearly a billion items of PPE have been distributed in the last six weeks and we will continue our commitment to support care homes.
Covid-19: Social Care Services
Baroness Brinton Excerpts(4 years, 7 months ago)
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Baroness Brinton (LD)
I declare my interest as a vice-chair of the APPG on Social Care and thank the noble Baroness, Lady Wheeler, for securing this vital and highly pertinent debate. So many Members of your Lordships’ House have made moving contributions. On behalf of the Liberal Democrat Benches, I also thank all the staff and volunteers working across the wider social care and community sector. Frequently low paid but definitely not low skilled, these amazing people show us their professionalism and big hearts, day after day.
Back in mid-February, we on these Benches asked the Minister repeatedly about care. On 26 February, the noble Lord, Lord Bethell, said in Hansard that
“we are planning … a massive communications campaign on how to protect people, particularly vulnerable people, in our population.”—[Official Report, 26/2/20; col. 257.]
The evidence of recent weeks shows that those most vulnerable in our communities and care homes have been seriously and tragically let down.
Others have covered plenty of the detail, which is symptomatic of the centralised way in which Whitehall, the Department of Health and Social Care, and the NHS have treated anything not in hospitals as a second or even third order of priority. My noble friend Lord Shipley explained the problems that have arisen since Whitehall took over the supply chain for the social care sector and then decided to create a separate system, known as Clipper, that we were told was due to come online on 6 April, but yesterday discovered is still three to four weeks away from going operational.
Worse, where providers and local resilience forums have ordered their own PPE, it has been confiscated by government and rerouted centrally for hospitals first, leaving community settings high and dry. This includes lorries being stopped at border ports and drivers being rerouted. Consequently, a lack of PPE and a policy of moving patients from hospital into care homes without any testing has meant that Covid-19 has spread rapidly in the social care sector.
I support my noble friend Lady Jolly’s call for clarity on DNRs and echo her concerns about GPs asking disabled and learning-disabled people completely inappropriate questions. It is very clear from the government advice, NICE advice and all good palliative care advice that the way in which this happened was inappropriate. I hope that this DNR factor will be examined as part of any inevitable public inquiry. It seemed to happen in groups. Were CCGs asking GPs to ring their patients and find out whether they wanted to go to hospital? To do it all in one conversation is completely inappropriate. For many disabled people, it was completely inappropriate to even ask them this, if they do not have the clinical frailty that my noble friend Lady Jolly spoke of.
However, the Government’s lack of understanding of the wide range of other disabled people, and extremely fragile people, living within our community extends completely in the opposite direction. As a result, people who have ventilators or tracheostomies, for example, have found that their care support is entitled to only the most simple and flimsy face masks, because they are regarded as exactly the same as the standard care in residential homes. The Government’s PPE for the social care sector is almost always designed for the elderly.
Matt Hancock said last week that health and social care workers should not overuse PPE. The gasp that went through the social care community when he said that could be heard across the country. Most community orders are receiving a tiny fraction of what is ordered and needed. My noble friend Lady Barker summarised well the problem between the department and local government.
Time and again, many noble Lords have talked about testing. Testing in the social care sector has been a real problem, with very few centres where staff can go and be tested. On Sunday, an appalling story came out of a social care worker in Norfolk being asked to go to Sheffield—a five-hour round trip—to be tested. Even their nearest place was a three-hour round trip away. It is all very well saying that more and more centres are opening up, but if they are all drive-through, it becomes impossible for the many staff in the social care sector who do not drive to get to them. I hope that the Minister will be able to explain to us when really accessible testing will be available for all social care staff who need it.
The problems with PPE have demonstrated a perfect storm. At the beginning of this crisis, patients, and especially elderly patients in hospitals who may or may not have had Covid, were being pushed back into local care homes without having been tested, whether they were symptomatic or asymptomatic. At that point, staff in care homes were not able to access tests at all and, as a result, Covid started rushing through many of our care homes. Many of the workforce were already self-isolating, or, because of their symptoms, had removed themselves completely and were unable to work. The criminal lack of PPE means that Covid has had free rein. It is estimated that in London, some 50% of care homes have active cases.
Many noble Lords have talked about the future of social care, and it is absolutely vital that we look at that in the context of today’s debate. My noble friend Lady Northover set out the history of social care reform. I can remember the delight, a decade ago, when all three parties supported the Dilnot review, and the shock when the Conservative Party decided that it did not want to continue with it. As we come to the end of this crisis, we must rapidly review the future of social care, but we must not start again from scratch. There is plenty of evidence to show what needs to be done. Our social care sector was already struggling before this crisis, following cuts to local government and to providers, with many providers having gone out of business and others hanging on perilously by a thread at the moment.
The consequences of all this are visible. The Rainbow Trust supports families with seriously ill children. It has said that the risk of the Covid-19 pandemic has put the provision of social care by charities at a higher risk of ceasing altogether, because many charities depend on fundraising, which has dropped significantly. It says that, in the short term, it is unclear how government departments will divide up the modest funding package of £360 million between the so many charities which are desperately trying to provide for very vulnerable groups of adults and children. It added that, in the long term, it is vital that sustainable funding is established to reduce the vulnerability of vital charitable social care to economic shocks, so that we do not end up in this position again.
The Rainbow Trust would like to ask the Minister to please go back to the Chancellor of the Exchequer. Many charities have had to furlough staff, and those staff have been allowed to work for other charities. But in the medical sector, these staff often have exceptionally specialist skills that cannot be used elsewhere, and, as a result, some of the provision that they are trying to offer cannot be done easily.
My noble friend Lord Campbell of Pittenweem has rightly called for a judge-led public inquiry. It is clear that too many things have been going wrong. We need to recognise the contribution made by our health and social care staff wherever they are, whether in care homes, in the community or in hospices. That is why the Liberal Democrats say that we must have a proper package for them. They must have access to full and proper PPE. Moreover, those who have tragically died as a result of Covid in the line of service need proper death in service benefits. We also think that a daily allowance equivalent to the military deployment allowance should be paid during the lockdown to people who end up putting themselves at risk. Too many are doing that, and they are absolutely serving the nation.