Covid-19: BAME NHS Staff
Baroness Finlay of Llandaff Excerpts(4 years, 6 months ago)
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Baroness Finlay of Llandaff (CB)
Given the association that there seems to be between a wide range of factors, are these being centrally collated? Are the Government producing guidance on, for example, vitamin D supplementation in the event of deficiency being detected, so that the national results are rapidly rolled out, and those cases where risk is discovered can be managed and supported?
Lord Bethell
I reassure the noble Baroness that the data is being centrally aggregated. ONS has published figures on ethnicity and the CMO and PHE are both scrutinising them. On their list of issues to consider is the role of vitamin D, where the evidence is interesting but unproven.
Covid-19: Testing
Baroness Finlay of Llandaff Excerpts(4 years, 6 months ago)
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Lord Bethell
My Lords, workplace testing for not just Peers but all workers is an important part of our return-to-work strategy. We need to work with employers of all kinds and the diagnostics industry to put in solutions so that people can go back to work with confidence that they are not infectious and that the person sitting next to them is not infected.
Baroness Finlay of Llandaff (CB)
My Lords, what national policy control mechanisms will be used to monitor and report on false negatives and false positives as testing is rolled out to complement a contact tracing app?
Lord Bethell
I did not hear all the question, but I think I understand what the noble Baroness is asking. The truth is that, however strong the sensitivity of the machines, false negatives and false positives are an inevitable part of the testing process. However, PHE conducts extremely thorough validation processes so that these are kept to a minimum and we will use algorithms to ensure that rogue test results are picked up as soon as possible.
Covid-19: Vulnerable Populations
Baroness Finlay of Llandaff Excerpts(4 years, 6 months ago)
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Lord Bethell
My Lords, mental health advice is very clearly available, most of all from GOV.UK/coronavirus, where there is a huge amount of practical and pastoral advice, and access to resources.
Baroness Finlay of Llandaff (CB)
My Lords, I declare that I am an honorary fellow of the Royal College of Emergency Medicine. How will the Government ensure that emergency departments never again become the crowded places that they were, which act as a source of nosocomial infection—hospital-acquired infection—for the vulnerable and those caring for them, especially child carers, who might present with acute injuries, particularly once they are out and undertaking more activities?
Lord Bethell
My Lords, a strange and peculiar feature of the epidemic has been that accident and emergency wards are, surprisingly, below normal capacity since people have sought to avoid them because of the obvious threat of the disease. That said, nosocomial infection is of grave concern. It is an inevitable and frequent feature of any epidemic, but we are applying new ways of working and seeking to section off those with the disease to ensure that the infection does not spread in our hospitals and from there into the community.
Health Protection (Coronavirus, Restrictions) (England) Regulations 2020
Baroness Finlay of Llandaff Excerpts(4 years, 6 months ago)
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Baroness Finlay of Llandaff (CB)
My Lords, I declare an interest as chair of the National Mental Capacity Forum. I want to highlight the tension between public health measures and protection of an individual’s rights, as defined through the Mental Capacity Act.
Those with learning difficulties, dementia and brain injury through disease or trauma often also have conditions that make them vulnerable to Covid, yet society has come to realise that the vulnerable are valuable—they enrich our lives. It has been difficult to explain to them why, and which, restrictions were needed, and it is now even less clear which parts of the guidance are statutory requirements. Is there now a need for a personalised app that tailors legally-apt guidance to the risk factors of a person and those in their household?
Going forward, people with capacity impairments will need more support to adapt to the lessening of the restrictions that were imposed for public health measures. The lockdown routines, creatively structured to keep people mentally and physically well, will change again as “isolation” becomes a nuanced word. Simply saying “use common sense” will not be enough. It will be hard work supporting those who are vulnerable as they adapt to widening and changing physical freedoms. Tasks such as keeping a 2-metre distance must be learned, using bank cards instead of cash makes people more vulnerable to fraud and exploitation, keeping a face mask on is difficult, and some have lost physical strength through decreased activity. The very vulnerable, and those with physical care needs, have carers coming and going. The plan of test, trace and isolate will keep them safe only if testing is rapidly and easily available, for both the person and those who care.
Will public health plans require that all testing facilities are local to the person and get results out rapidly? Which national external quality assurance systems are commissioned labs required to adhere to? Are false positives from RNA contamination, and false negatives from specimen decay in transit or from error-prone gene tests, being detected through audits? Unless those supporting the vulnerable are maintained virus-free, our second wave may be worse than the first.
Covid-19
Baroness Finlay of Llandaff Excerpts(4 years, 7 months ago)
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Lord Bethell
I entirely agree with the sentiments and intent of my noble friend’s point. It occurs to me that we should perhaps set up some kind of advertising or promotion of this. I will take that point back to the department.
Lord Balfe (Con)
In the Statement, the Minister referred to the need for people who have other medical needs to still contact their GP. In Cambridge, where I live, the opticians, chiropodists, dentists and surgeries are all closed, with different fierce notices on their doors. When the isolation requirements are lifted, could the Government make it a priority to get these vital medical services open again and get doctors back into surgeries, not at the end of the telephone? Perhaps we could at least teach them that Zoom exists.
Lord Bethell
I reassure my noble friend Lord Balfe that the amount of video treatment being given by doctors has gone through the roof. During this epidemic, we have seen the medical trade and patients embrace a huge amount of digital technology. We are working with the colleges to try to get all the services of the medical profession open at this time and the response has been largely positive.
Lord Dobbs (Con)
Minister, are prisoners in our prison system participating in the manufacture of PPE? Does the crisis not represent an opportunity for many prisoners to not only contribute but move towards some rehabilitation?
Lord Sheikh (Con)
My Lords, my noble friend the Minister referred to the fact that the number of deaths that have occurred as a result of coronavirus stand at 18,738. The BAME community represents about 14% of the UK population, but unfortunately accounts for about 35% of all coronavirus patients in intensive care. The number of people in the BAME community who have contracted coronavirus and died as result is disproportionately high.
My noble friend might perhaps recall that I talked about the burial of Muslims when the Coronavirus Bill was discussed in your Lordships’ House. The Muslim community has got together, and burials are taking place in very difficult circumstances. However, I have been told by leaders of the community that the availability of land for burials should be kept under review and that a system should be provided if the land issue becomes a major problem and burials cannot take place. Secondly, the Government should consider providing additional funds to local authorities, which are dealing with very difficult circumstances. They are stretched to the limit and need additional resources for burials and cremations. Will the Minister comment on those two points?
The Deputy Speaker
Minister, if you could be very brief, we might be able to fit in the noble and learned Lord, Lord Woolf.
Lord Bethell
I am very grateful for my noble friend’s helpful update, but I remind him that these arrangements are conducted by local authorities. The question that he asks is best answered by those local authorities.
Lord Bethell
I thank the noble and learned Lord. Will he please express my and the Government’s profound thanks to his secretary for their contribution? I hope it is proving to be rewarding to him or her personally and impactful to the causes in which he or she serves.
The Deputy Speaker
My Lords, the time allotted for the Statement is now up. I thank all noble Lords for being concise, in particular the Minister for his very concise answers.
Covid-19: Social Care Services
Baroness Finlay of Llandaff Excerpts(4 years, 7 months ago)
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Baroness Finlay of Llandaff (CB)
My Lords, I thank the noble Baroness, Lady Wheeler, for this essential debate. This pandemic has become a palliative care emergency. I declare my role as vice-president of Hospice UK and Marie Curie. Care sector staff are providing extensive end-of-life care. They are skilled, compassionate and motivated, but low paid and, until now, unnoticed and unappreciated in society. Yet the mark of a civilised society is the way it cares for its vulnerable. The care sector is a bedrock of such a society.
Some of the most vulnerable can be difficult to care for. The Mental Capacity Act framework supports delivery of essential care and treatment, but safeguarding is harder. Covid guidance on the deprivation of liberty safeguards, DoLS, needs to cover greater responsibility for care staff while reducing bureaucracy.
Chairing the National Mental Capacity Forum, an interest that I declare, I see the care sector adapt with enthusiasm and profound caring to the challenges. Yet the care home staff feel abandoned. Personal protective equipment and weekly testing for all care home staff and residents are critical in controlling cross-infection. When will this happen? Staff from minority populations seem at higher risk of serious or fatal Covid-19. They are not deserting—far from it—but showing humanity and compassion in care. As a nurse said:
“I’m like a policeman who is facing a terrorist attack … ready to face it, but what will happen to our family? … That’s the only worry I have.”
Who is responsible for staff death-in-service financial support?
Dying residents need medication for symptom control. For care homes, without easy and rapid access to medicines, why has the repurposing of medicines not yet been approved? I tabled Questions on it on 7 April. Draft guidance was produced on 14 April and issued in Northern Ireland on 20 April. Why not England and Wales? Has every clinical commissioning group been instructed to achieve integration with its social care providers in the long term? Is it time to develop nursing home medicine to support social care delivery as a distinct discipline, and to fully integrate health and social care? It should have happened a long time ago; it must happen now.
Baroness Watkins of Tavistock (CB)
My Lords, I welcome this debate and thank the noble Baroness, Lady Wheeler, for securing it. It is clear from yesterday’s NHS Providers briefing that the social care sectors, including hospices, care homes and domiciliary providers, are beginning to consider closing to new admissions or taking on new people for support in the community. This is due to worries about the need for PPE to protect residents and staff from cross-infection by Covid-19. As of 13 April, nearly one-sixth of care homes reported expected outbreaks of Covid-19. This means that many care homes do not have enough staff. Other noble Lords have spoken eloquently on this issue, but it means that it would be very difficult to discharge people from hospital care if either care homes cannot give short-term care or domiciliary care cannot be organised.
The shortage of PPE is more extensive, serious and difficult to overcome in some places than others. It appears that care homes which are members of large chains are beginning to find solutions to short-term procurement. However, even these larger companies are extremely concerned about the increased costs of PPE. It is therefore almost impossible for small domiciliary care providers supporting vulnerable children, people with mental health problems and older people in their own homes to purchase the necessary PPE in a timely and cost-effective manner. Can the Minister explain the Government’s approach to these providers, and how the Government intend to make access to PPE available through either national or local procurement and delivery in a cost-effective manner?
If social care is to be successful and sustainable in taking on new clients, as well as providing high-quality care to those who receive it, we must reduce the feelings of fear about employment and the right to remain among carers from overseas. The Government’s new post-Brexit immigration scheme is based on treating health and social care workers differently. The Home Office’s plan will enable doctors and nurses to apply for fast-track NHS visas, but care workers will have to apply to come under the points-based system. Nearly a fifth of all care workers in this country come from overseas. Many of them may choose to return home in the next year, yet the Home Secretary does not at the moment see a need to apply a fast-track system for care workers. Please can the Minister comment on this approach and inform the House whether it is to be reviewed?
I also have to ask, as other noble Lords have: will the Government consider scrapping the £400-a-year NHS surcharge for health and social care workers? If we are to recruit and retain our workers, doing so is vital at this point in our history.
The Deputy Speaker (Baroness Finlay of Llandaff) (CB)
I ask the noble Baroness, Lady Warwick of Undercliffe, to stop sharing her screen by clicking the box with an arrow in the command bar, please. I call on the noble Lord, Lord Turnberg, to speak next.
Lord Turnberg (Non-Afl)
My Lords, I want to raise three questions with the Minister. None of them is entirely novel since they concern testing, how we treat care home staff and the logistics of government control. Those who are gifted with hindsight can see clearly now where the Government have gone wrong. But you do not need to have much of a retrospect-a-scope to know that we have been extraordinarily slow in recognising that care homes were ticking time bombs, full of closely gathered and extremely vulnerable elderly people, being looked after by carers who had long been the most underappreciated and undersupported of health workers. One might have thought that this combination was a disaster waiting to happen but, rather than getting into the blame, we must look at what is needed now.
First, in order to get a much firmer grip the Government should appoint a Minister or, better still, a well-respected authority to oversee the logistics of providing protection to care home residents and staff. Whoever is appointed should have that as his or her sole responsibility. It is no good dissipating responsibilities between different parts of the Government. It should be one person with no other responsibilities, focused entirely on co-ordinating the response and reporting regularly to Ministers. Is this already happening and, if not, can it be undertaken sometime soon?
Secondly, it is now clear that we seem to have more capacity to test people for the virus than people able to access the tests. The reasons why care workers and residents cannot do so have been well rehearsed in the debate so far, and the answer is obvious: we must take the test to those who need it. I hear that the Government intend to set up a system of mobile testing units, which can go around care homes and elsewhere, and that the Army will be involved. That is a step in the right direction, but can the Minister say how quickly that can be scaled up? Why do we need the Army when taking samples from staff and residents requires only about an hour or so of training, and we have a huge number of volunteers ready to help?
Thirdly and finally, we have been debating in this Chamber—for ever, it seems—the parlous position of care home staff: how underappreciated, poorly paid and unregulated they are. Several noble Lords, including my noble friends Lord Hain, Lord Hunt, Lady Pitkeathley and Lady Wheeler, talked about the terrible position they are in. The coronavirus is now transforming our neglect of them into a form of hero worship. We must take advantage of this new-found recognition to change the way we show our appreciation as we come out of these horrible times. Whatever we do, we must recognise that a majority of our care homes are in the private sector, where they have long struggled to keep their head above water. We must include them in the rescue. Local authorities need support now. I ask the Minister: when the Government at long last come to their review of social care, will they put the conditions of care workers right at its heart?
The Deputy Speaker
I apologise, but I ask the noble Baroness, Lady Warwick of Undercliffe, to close the box that has a small cross on it, in the middle of the command bar. If she could do that, that would help, as the screen is distracting for others.
Lord Farmer (Con)
My Lords, I, too, congratulate the noble Baroness, Lady Wheeler, on initiating this important and well-timed debate. I will speak today about children’s social care and how supporting those on the edge of it can prevent this crisis from being the tipping point when they become looked after by the state. First, however, we should acknowledge the families who are flourishing now that they are no longer in the time famine of normal life, even though money and space are tight. Many children are enjoying being with their fathers, for example.
On those in social care, the Government are consulting on reforms to the use of unregulated care homes which include banning this provision for under-16s and introducing national quality standards. In these strange times, young people currently in such accommodation are out of the sight of social workers and others, who have high case loads. I have heard that these professionals are seeing only the highest-need families face to face. Some have adapted well and are catching up with young people directly, for example through WhatsApp, but such flexibility might be patchy. Can the Minister inform me whether a national assessment has been made of the welfare of those in unregulated accommodation during this crisis?
More broadly, the Government have committed to reviewing the care system. For the system to be sustainable going forwards, this review requires what I call the prevention pipeline. It should establish how we can best prevent, first, children from coming into care in the first place and, secondly, the care system from being a runway into educational underachievement, unemployment, criminality and prison, early parenthood, addiction and poor physical and mental health.
Early family support is essential to prevent children from tipping across care thresholds. Many local authorities have set up family hubs where families with children of any age can access help. I have set up the Family Hubs Network, which has held several virtual round tables with providers, who report that hubs have come into their own in this pandemic. They are offering food, maternity appointments, a rich programme of online family support and more. I understand that the DfE is leading on family hubs, but can the Minister inform me whether and how it is supporting their spread?
The Deputy Speaker
I call the noble Baroness, Lady Blower. She is not here. We will move on to the noble Lord, Lord Addington.
Covid-19: Extent of Infection
Baroness Finlay of Llandaff Excerpts(4 years, 7 months ago)
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Lord Bethell
My noble friend is entirely right. Fitness and the Covid epidemic are closely connected. The Secretary of State for Health has made it clear that a daily walk should be part of everyone’s lockdown arrangements and we are ambitious to make fitness and diet part of the agenda as we leave the Covid lockdown.
Baroness Finlay of Llandaff (CB)
I thank the Minister for being open to communicating with us during the period before Parliament resumed. What assessment have the Government made of combining repeat virus detection with those risk factors that the Intensive Care National Audit & Research Centre’s contemporaneous data has shown are associated with particularly poor outcomes—I refer particularly to high body mass index, indicating obesity—and how will this inform the lockdown exit strategy?
Lord Bethell
The noble Baroness speaks of anecdotes of which we are very aware. We are conscious of the stories coming particularly from America about a seeming correlation, if not a causation, between obesity and Covid mortality. Clinical trials and data on this are in short supply. The CMO has not made a declaration on it. But I share her instinct that there is a strong connection. As the noble Lord, Lord Moynihan, suggested, fitness and diet will be important parts of our post-lockdown experience.
Coronavirus
Baroness Finlay of Llandaff Excerpts(4 years, 8 months ago)
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Lord Bethell
The noble Lord is entirely right. The CMO’s effort is now to identify those groups who require the greatest priority of assistance. We are not sure, and the CMO has not declared, at exactly what age that should start. He is considering publication of the exact details of the priorities in future. It seems that it is not necessarily gender-specific but that the state of your immune system is the key driver. In some areas, of course, men have very bad habits when it comes to things such as drinking and smoking. The CMO has made it clear that if you want to do one thing to avoid getting the virus, it is giving up smoking.
Baroness Finlay of Llandaff (CB)
Will the Government give specific guidance on deferring or cancelling gatherings of clinicians and other healthcare professionals at conferences and examinations required for career progression, and specifically ask the regulators to allow alternative routes of registration and validation?
Lord Bethell
The noble Baroness asks an important question about trying to keep our clinical staff healthy and fit. That is one of the biggest priorities in an epidemic such as this, because the pressures on the NHS are made worse if clinical staff are themselves poorly. At this stage the CMO has not decided that the cancellation of conferences or major events is proportionate, but that remains one of the options laid out in our CV plan. If necessary, provisions for videoconferencing and alternative ways of attending training will be considered and put in place.
Health Protection (Coronavirus) Regulations 2020
Baroness Finlay of Llandaff Excerpts(4 years, 8 months ago)
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Lord Campbell-Savours (Lab)
My Lords, as I understand it, this is the first opportunity that we have had, outside of UQs and Statements, to fully debate this whole issue. I want to speak at a little greater length on this matter because I think that we are entering a crisis which perhaps we have underestimated at this stage.
As I understand it, these regulations apply where the Secretary of State makes a declaration that the incidence or transmission of coronavirus constitutes a serious and imminent threat to public health, and that the incidence of coronavirus is at such a point that the measures outlined may reasonably be considered as an effective means of preventing the further transmission of coronavirus. I will argue in my contribution that, prior to the use of regulations, advice should be given in the form of information—far more information than is available at the moment to the public—to help individuals avoid contamination and infection.
Before I start, I need to declare an interest. Some years ago, I had surgery on my lung to remove a tumour, leaving me with half a lung and with COPD on the remaining two lobes. As a result, I have major breathing difficulties. I also want to make it clear that I am not speaking only on behalf of myself; I approach this whole debate as one among the many hundreds of thousands who are in the vulnerable group described as “persons with pre-existing conditions”. Before moving to the thrust of my case—on the provision of information, which is what I want to concentrate on—I want to make three points.
First, the use of the terms coronavirus and Covid-19 is unhelpful and confusing. We need single-term terminology in the public debate. Secondly, repeating the statement that masks are of little value and are no defence, which we hear repeatedly on television, is irresponsible. Masks protect others from infection by those who are unaware that they are carriers. If they are so ineffective, why are doctors, nurses, health assistants, virus-testing personnel, ambulancemen, laboratory assistants, research chemists, health professionals generally and even undertakers worldwide all wearing masks, as can be seen on every television screen in the country, every day and every night on every new bulletin?
Thirdly, I am curious about the statistics on mortality rates, particularly among the elderly. The way this debate is being presented, it is as if 1%, 2% or 3% of those who are stricken with this condition may die, but that confuses groups of people, including the elderly and the young. I understand that the real figure for people in the 70 to 80-plus age group is appropriately 15%, which is substantially more. We need clarification on that.
In my view, the public should ignore the advice on masks and follow the practice of health professionals. I understand that this mistaken advice is being given to avoid panic among the wider population. It will do the reverse, as such advice emphasises in the public mind the distinction between the no-panic case from government and the reality of the practice of healthcare professionals on the ground in the real world that they can see on television every evening.
I turn to the provision of information. The best way to secure public co-operation in the avoidance of infection is to provide authoritative information. That is the story behind the calls for freedom of information legislation in the late 1980s. I was at the heart of that debate in the Commons, and our mantra was “information influences conduct”. To avoid infection, we need information from authoritative sources that is regularly updated as more information is made available to government. When the public have confidence in the scale of transparency and the source of the information, individuals are more likely to act responsibly. Apart from providing information, the state can do only so much, as is the case with the National Health Service and local authorities. The less information it provides, the less it will influence conduct. The less it provides, the more the fake news merchants will dominate the debate and the more they will influence public reaction and conduct. Inadequate and confused messages from government will lead only to a mix of panic on one hand and resigned inertia on the other. We need more than “Wash your hands, cough and dispose and do not touch your face”. It is simply not enough. If you provide more information, the public will make far more realistic assessments of the actions that they need to take. The terms contain, delay, research and mitigate are important, but they are meaningless to Joe Public. In fact the public will not even know what they mean. As contain morphs into delay and further morphing goes on, the message will become even more confused and obscure. The public want authoritative messages and updated and detailed information on where the dangers lie, in particular to elderly groups.
I have spoken to a number of people in my former constituency over the past week, and I will now set out what I believe the public want to learn and know. These are questions being asked by the vulnerable groups; they want authoritative information and answers.
We are told that the research money has been increased to £40 million. Reuters put out a very interesting article the other day. It reported:
“A global coalition set up to fight epidemic diseases issued a call on Friday for $2 billion … to support the development of a vaccine against the new coronavirus that is causing COVID-19 infections around the world. Describing the outbreak as an ‘unprecedented threat in terms of its global impact’, the Coalition for Epidemic Preparedness Innovations (CEPI) said that while containment measures would help slow the spread, a vaccine was key to longer-term control … ‘It is critical that we ... invest in the development of a vaccine that will prevent people from getting sick.’ … But on Friday it said these funds would be fully allocated by the end of March. ‘Without immediate additional financial contributions the vaccine programs we have begun will not be able to progress and ultimately will not deliver the vaccines that the world needs’.”
Those were the comments of Mr Hatchett, CEPI’s chief executive. On Friday, the British Government announced another £20 million of additional funding. The total is now £40 million or £50 million; I am not absolutely sure about the final figure. The point is that the budget is insufficient. What pressure are we putting on other countries to contribute to this budget to make sure that it meets the demands of those people who believe that it is necessary if a vaccine can be found in the foreseeable future?
Further, is the virus affected by temperature? We read all sorts of things on the internet. If so, at what temperature is it destroyed? That is the first question on my list of questions about the detail.
Should a vulnerable, at-risk person use public transport, be it a train, Tube train or taxi? The public are asking these questions. Should the elderly be using these facilities?
Can the virus survive any of the following circumstances: a hot drink; water; fruit juice; milk; beer or wine; a drink with a high alcohol content; an ice cream; a burger; takeaway food; or a restaurant meal? In each case, what is the lifespan of the virus? Again, the public are asking these questions, each of which should be answered separately.
What general information do we have on the lifespan of the virus? Can a fish, bird, animal or any other species catch the virus? The internet is full of explanations from people who cannot be described as authoritative sources for this information. Of course, the reference behind that is to pets. To what extent can a pet potentially be dangerous?
Can disposable polyurethane gloves be reused following washing? If so, in what fluids? Tens of millions of them are being sold on the internet. The question is, will they be effective if they are used more than once in contaminated circumstances? Will they wash in hot water? I know that these questions may seem naive to some but they are the kind of questions being asked by the general public.
Can a pair of gloves, whether they be made of fabric, leather, plastic or another daily wear material, pass on the virus? If so, can the gloves be decontaminated and reused? Can a simple face mask made of plastic be used repeatedly? Can it be washed for reuse? Is there a difference in terms of efficacy between a single-fabric face mask and a filter mask? I have two such masks here. The question is, are they in any way of use in the circumstances I described at the beginning of my contribution?
What antiviral substances are effective in killing the virus? Also, what substances are ineffective? Is there a base alcohol requirement in any decontaminant? Can the virus survive on any of the following inanimate items and, if so, for how long? Again, we have seen material on the internet, but we have nothing authoritatively on whether and how long the virus can survive on: a light switch; a newspaper; a piece of correspondence; a letter; a fabric, such as clothing; furniture; metal items; glass; a milk bottle; a plastic container; a piece of china; cutlery; a coin; a bank note; plastic packaging on food; a cash machine; a computer; a mobile phone keypad; a handle; handles on public transport, such as on a Tube train; a handkerchief; a toilet seat; a toilet chain; a towel; or a petrol pump nozzle. There is no authoritative information on these items, and we are getting into a dangerous period.
I have listed some of the items that I have been asked about—and there are more. The public will want clear advice and individual answers that identify the likelihood of contamination for each listed item and, crucially, the length of time that the virus could survive under such inanimate item headings.
What advice can be given on the possible contamination of food, such as cold meat, cooked fish and poultry, raw meat and fish, fresh vegetables and salads, fruit, cheese, and spreads, including butter? It might be that the process of vacuum packing affects contamination one way or another—who knows?
Will the Government publish the stats on the age of persons, which I referred to before, who fall under the following categories: in hospital care and deceased—which I referred to before?
Finally, is Worldometer a good source of information? It seems to be the primary source for the public of information on this matter on the internet.
In conclusion, I fully understand that to some, many of my questions may appear to be simplistic, naive and an indicator of my own ignorance. Such criticism is of no concern to me. These questions will stand the test of time. There are 67 million people in the United Kingdom, and these are the kinds of questions many of them are already asking on the internet and in public meetings. We are Parliament and it is our role to secure answers on these from the Government. I do not expect answers to them today, but only after they have been fully considered. I hope that they are made public and are widely circulated to counter misinformation. I can only repeat that, when the public are told the full truth and given the full information in an authoritative form, they will respond positively and constructively. Until that happens, there will be nothing but panic, confusion, upset, frustration and, in some cases, dangerous indifference, particularly among the elderly and the vulnerable groups, who are the focus of my contribution today.
Baroness Finlay of Llandaff (CB)
My Lords, first, I apologise to the Committee that I came in late. The business proceeded slightly faster than I realised, but I am most grateful to noble Lords for allowing me to intervene briefly.
The comments made by the noble Lord, Lord Campbell-Savours, clearly illustrated the need for messaging out to the public. One of the difficulties is that the answers to many of his questions are just not known scientifically. It is a range of probabilities only; the way the virus behaves on different surfaces and with different substances is different. The infectivity may vary with the viral load to the individual as well as the individual’s own immune system. That makes it really complicated in terms of defining. You cannot give a false sense of security to people by saying, “Well, you are fit and well, and your immune system is okay”, because those people may become very ill, particularly if they have a large viral load. We saw that with the Chinese doctor who initially highlighted the problem. Tragically, he died.
I take this opportunity to ask a few questions. This order refers to Public Health England but we have devolved Administrations, and Public Health Wales and Public Health Scotland operate differently. Some aspects of this statutory instrument concern the police and justice, yet the Ministry of Justice and its overarching responsibilities are not devolved, so there is a difficult interface between the devolved and non-devolved competencies. Can the Minister provide some reassurance on the daily round-table consultations that are going on to make sure that decision-making is absolutely seamless and that the devolved Governments are taking forward—and, I hope, mirroring—such legislation so that we do not end up with different systems operating across what are effectively artificial borders? In areas such as Shropshire, there is a huge amount of cross-border flow between England and Wales. Linked to that, can the Minister clarify that equipment, and its distribution to where it is needed, is also part of the consideration of the protection of the public so that we do not have an outcry if one part of the country cannot access equipment as well as another?
Testing is difficult: it is a complex and finite resource, and it takes some hours to run the test. A lot of the public do not understand that it is not like a pregnancy test; it is not a quick dip and a quick answer. With such a finite resource, will the Minister clarify where the governance sits for the management of negative results? One of my anxieties is that people may have a false sense of security from a negative result, because they may get the infection the day after it and subsequently become positive. Although it is helpful to confirm positive cases, a negative result does not mean that you are not going to get the coronavirus infection further down the road.
Linked to the cross-border issues, can the Minister also confirm that the use of beds and the availability of things such as ITU beds and ECMO are being considered across the whole country? I worry that difficult decisions are going to have to be made and it will be very important to have clear standards against which to make them. If it looks as if we are becoming like Italy, that will certainly more than stretch services to the limit; it will take them beyond it.
Will we need additional statutory instruments for the reregistration of people with healthcare professional qualifications of any sort? If so, when will we see them? I was rather hoping that it might be today. This relates to my earlier question about registration on specialist registers. Is the GMC working to find alternative ways of putting those who have completed training on the specialist register without bringing them all together in an exam hall, which seems to be an unwise move when their competencies have already been assessed through training?
That concludes my questions, but I thank the Minister for his clarity, for explaining things really well, for answering questions on the Floor of the House and for answering unanswerable questions with such honesty. It is terribly important that he and those advising him try to be very clear and open about the things that we do not know.
Lord Bethell
My Lords, I will start by talking about two matters that are not central to the regulations but which are important pieces of context. I thank the noble Lord, Lord Campbell-Savours, for his incredibly candid and heartfelt comments, which none of us here could help but be moved by. I would also like to express sympathy for his personal situation. We all know friends, relatives and people who are in a vulnerable position. While the CMO’s advice is that for a lot of us the virus does not present a huge risk, for some people it does. That cannot but be on their mind and we think about them a lot, so I am grateful to the noble Lord for bringing that message of seriousness and his personal testimony.
I will also address directly the noble Lord’s questions. I am afraid that I cannot answer the important technical questions he asked; I am grateful for his appreciation of that fact. However, I reassure the Committee that our approach is to seek to be as transparent as we possibly can be. In answer to the noble Lord’s question, there is a daily update on the PHE website, where all the figures that we know and can prove are published—they go up at 1.45 pm every afternoon. That is a serious matter, and we are looking at ways of making that a more easily accessible dashboard with a deeper set of numbers that you can look at locally; we could then publish as reasonable and proportionate an amount of figures as possible while keeping secure the anonymity of those involved.
The other part of our approach comes very much from the spirit of the CMO himself, whom many of your Lordships will have met. He is an enlightened character who is extremely committed to evidence-based policy recommendations. We all plague him with questions much along the same lines as those the noble Lord, Lord Campbell-Savours, asked, seeking from him reassurances about particular technical questions. He is able to speculate and to say, “Maybe this or maybe that, but I can’t give you any clear reassurance on that because there is no data on it”.
One of the things about trying to preserve the pact with the public that our decision-making is supported by evidence is to avoid going into the kind of tempting speculation that the situation draws you into. There is temptation there, but, as a cardinal rule, we have to apply a self-restraining ordinance on trying to give people the answers and the speculation that, emotionally, they naturally want. The questions of the noble Lord, Lord Campbell-Savours, are exactly right, and I reassure him that battalions of scientists are trying to get to the bottom of those answers. Lots of evidence is being worked up, and I believe that answers to many of those questions will be forthcoming. However, until they have the sign-off from the scientists, it is not right for us to indulge in speculation. That is the foundation of our approach, which I mentioned earlier. Although it is incredibly frustrating, from a public policy point of view it is the right approach. However, I will try to address just a couple of the questions that the noble Lord asked, without falling into my self-defined bear trap.
The noble Lord, Lord Campbell-Savours, asked about masks. Broadly speaking, except for the most comprehensive hazmat suits that cover you from head to toe, masks are mainly used to limit the number of germs that you emit rather than that you consume. I think we are all interested in the work going on in Taiwan, where all schoolchildren wear masks, not to protect them from the germs but to try to stop them infecting the people next to them. That is an interesting insight, but it is not the approach that the CMO has recommended.
On the delicate issue of mortality rates, I completely sympathise with the noble Lord’s point that there is wild speculation on these numbers, and it would be fantastic to have a more reliable set of figures. I will say only that it is extremely difficult to know mortality rates, because you simply do not know how many people have the virus in the first place. Large numbers of people are infected and infectious but completely asymptomatic and never go near a test kit, so we cannot know what the mortality rate is at any age. I recommend that the noble Lord treats all mortality rates data with great suspicion. It is not the way we are guiding ourselves.
Lord Bethell
I understand the point and will take it back to the department.
The noble Baroness, Lady Finlay, asked about testing. She is entirely right to focus on that, because we are at the stage of the cycle when questions about testing are very much on our minds. She asked where we were focusing our testing. The most important area for testing is those people who are most vulnerable but who might have the virus. She is entirely right that someone who tests negative today may well test positive tomorrow. Where that is most dangerous is within hospitals. Hospitals are centres of infection. It is one reason why, if you phone 111, they recommend that you do not go to your hospital or your GP. Therefore, testing within hospitals is where we are focusing our resources.
I reassure the noble Baroness, Lady Finlay, that we are moving incredibly quickly to increase capacity of ECMO beds. There will be a huge amount of pressure —we cannot hide that—but those most in need are being prioritised. Training is going on to support those with the technical knowledge of how to run the equipment and purchasing is going on to create new kit.
On reregistration of clinical professionals, all the concerns raised in Committee and in the Chamber about the provenance of people seeking to reregister are fully understood. Provision is being made to make sure that criminal record checks and competence checks are in place. However, these remain incredibly valuable and skilled people who can support us, so we are determined to mobilise them if possible.
Baroness Finlay of Llandaff
I referred to difficult decisions possibly being made. Can the Minister reassure the Committee that the Government are working with the heads of all the royal colleges—particularly their ethics committees—to make sure that unified guidance is going out to commissions across all the disciplines? Unfortunately, the different colleges have at times a tendency to work in their own silo, but this will be across all of them. It will have to go across the professions, rather than across the individual trusts and internal organisations. Therefore, a round table or regular consultation with them to make sure they all give the same messages is important, and it would reassure the public.
Lord Bethell
The noble Baroness, Lady Finlay, makes an important point. The CMO currently has a weekly call with all the presidents or relevant members of the royal colleges, and there is an incredibly energetic interface between officials at PHE and the colleges. New guidance is being drafted at the moment. As our understanding of the epidemic increases so the CMO’s certainty and confidence about the advice he is giving will be clearer. We are therefore seeking to publish really good guidance for employers, voluntary organisations and all the groups who need it. The CMO also works closely with the CMOs of the other three nations, and I understand that is an incredibly healthy and productive relationship. It has served very well to ensure that the devolved authorities are fully involved in decision-making and that there is transparency on key issues such as ethics, which the noble Baroness was right to mention.
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Baroness Finlay of Llandaff Excerpts(4 years, 9 months ago)
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Baroness Blackwood of North Oxford
The noble Lord is quite right that each of us has a role to play in preventing the spread of infection. At this point, the advice is that, if you have travelled from any of the infected areas or have been part of the contact tracing, you should self-isolate. Should you have any of the symptoms associated with coronavirus—a cough, fever or shortness of breath—you should stay indoors and call 111, even if the symptoms are mild. Outside the question of whether you have had any contact or travelled to the affected areas, the advice from the Chief Medical Officer is that effective handwashing and the “Catch It, Bin It, Kill It” concept—to use tissues when you sneeze or cough and to throw those tissues away—is the most effective way of limiting the passing on of infection, and each and every one of us has a role to play in doing that. However, I am happy to pass on to the House authorities the point the noble Lord has made and ask for communications to be sent from Public Health England with the most up-to-date information.
Baroness Finlay of Llandaff (CB)
My Lords, I thank the Minister for bringing the update to the House. Among all those people to whom we owe a debt, we should particularly single out the chief medical officers, led by Chris Whitty, who is an epidemiologist and therefore has an in-depth understanding of the science. We should also thank the owners and crew of, and all those on board, the “Diamond Princess”—a British-owned vessel—who are working with the Japanese authorities and doing all they can to contain the outbreak that has occurred there.
One of the difficulties—this was alluded to by the noble Baroness, Lady McIntosh, who is not in her place at the moment—is that in the early stages this is like the common manifestation of any other viral disease. Therefore, self-isolation and being responsible by staying away from people is everyone’s responsibility with all such infections. Unfortunately, some turn out to be coronavirus. Are the diagnostic kits for Covid-19, which I think is now its official name, available to adequate numbers of hospital laboratories which are under public health supervision? Are those diagnostic kits available across all four nations of the United Kingdom? Are they linked to Colindale so that there is good co-ordination of the way in which the diagnostic procedures are undertaken?
Baroness Blackwood of North Oxford
The noble Baroness is quite right. We are aware that there are British nationals on board the “Diamond Princess” in Japan and that six more people have tested positive for coronavirus, none of whom is a British national. We have offered consular assistance to those British nationals—we have been in touch with the “Diamond Princess”—including one who is in hospital. We obviously pay tribute to the work being done in trying to contain the situation there. I identify myself with the thanks and tribute paid to the work of the CMOs, who are doing an extraordinary job right now to make sure that the UK is prepared.
We are one of the first countries in the world to have an effective test; it is working well. Now that the protocols have been sent to the devolved Administrations, testing centres in Glasgow, Edinburgh, Cardiff and Belfast have started testing already. Labs in Cambridge, Bristol and Manchester have started testing today and Birmingham, Newcastle and Southampton will come online shortly. I hope that reassures the House about the capability already available within the NHS.