Covid-19: R Rate and Lockdown Measures
Baroness Thornton Excerpts(4 years, 5 months ago)
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Baroness Thornton (Lab) [V]
First, will the Minister say what weight the Government attach to the science presented in the figures that the Centre for the Mathematical Modelling of Infectious Diseases at the London School of Hygiene & Tropical Medicine published, which state that R is above one in the south-west and north-west of England? Secondly, the regularly estimated national R rate appears to be a key driver of policy; accurate measurement of R depends on a world-class testing regime, not yet in place; the likelihood is that some geographical areas may have an R close to or above one; and effective local control measures rely on knowing the local R rate. Given all that, when will the system for more accurate measurements of R agreed with the relevant local authorities be available by localities, so that this information can be used to inform and adapt the emerging local planning led by directors of public health?
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.
National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2020
Baroness Thornton Excerpts(4 years, 5 months ago)
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Baroness Thornton (Lab) [V]
My Lords, I thank all noble Lords who have participated in this debate, and my noble friend Lord Hunt for allowing this small but important statutory instrument to receive full scrutiny. There has been intense scrutiny and there are many questions to be addressed by the Minister. I join other noble Lords in paying tribute to those who work in the care sector for their dedication and courage over recent times. I ask for the indulgence of the House to mark national Carers Week and to pay tribute to and recognise the essential role of family carers, who have received precious little attention so far during this pandemic. Support has been desperately hard to access, and many families feel overwhelmed and pushed to breaking point.
Several noble Lords have said that this sector was in crisis before the pandemic and has been cruelly and badly served by the Government from the outset. As the noble Baroness, Lady Barker, mentioned, some of us were waving warning flags about the need to protect this sector from Covid-19 early in the outbreak. We were told that care homes would not be affected. It took a major campaign and pressure—by the media, by my honourable friend Liz Kendall MP, the shadow Minister for Care and Older People, many organisations such as Age UK, local government, MPs from all parties and your Lordships’ House—for the Government to start recognising the terrible toll and neglect in our care homes.
The notion, repeated by the Secretary of State, that a protective ring was put around our care homes is rather insulting, given the number of deaths and the time and chaos involved in providing PPE and testing. The Minister might advise his right honourable friend the Secretary of State to stop using expressions that are patently wrong and that only serve to deepen the anger and sadness of those families who have lost, and continue to lose, relatives in our care homes.
At some point, there will be an examination of the reasons for the mortality among those in care homes, those with dementia, those with learning disabilities and those in our mental health institutions. What we have to work for is seeing that the transparency and honesty of that examination, and of the price paid, will lead to real reform in our care sector.
The statutory instrument that we are discussing concerns the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 and makes provision for, among other things, NHS-funded nursing care. Several noble Lords have explained what all this means. These regulations amend Regulation 20 of the 2012 regulations and increase the rates for NHS-funded nursing care payment by the NHS Commissioning Board or a clinical commissioning group. Like my noble friend Lord Hunt, I welcome the proposed increase in the FNC rate that the NHS pays to care homes to cover the costs of services that must be carried out by a registered nurse. I repeat his question and echo many of the contributions today in asking: what contribution will this upgrade make to the long-term sustainability of the sector? I commend my noble friend Lady Wilcox on her strong support for reform in the sector.
According to a House of Lords Economic Affairs Committee report, as my noble friend Lady Healy said, 1.4 million older people in England had unmet care needs in 2018. The number of older people and working-age adults requiring care is increasing rapidly, while public funding declined in real terms by 13% between 2009 and 2016. When will the Government respond to that report? When will we see a new proposal for a new model of social care, as mentioned by so many noble Lords tonight? Specifically, given that this SI reached us before the pandemic, what plans do the Government have to put this somewhat battered sector on to a more secure footing in the short and long term? What assessment have they made of the impact that increased care costs resulting from the Covid-19 pandemic has had on the care home fees paid by those who are self-funding or partially self-funding?
Last month, the Health Secretary promised that by 6 June, all residents and care home staff would be tested; today, he said that care homes would only have their tests delivered. This is not good enough. The Government have been too slow to act. Care home residents and staff need to be regularly tested if we are to come to grips with this virus. We need to move swiftly to regular testing of family members, too, so that they can safely visit their loved ones. Ministers should now implement a comprehensive strategy for regularly testing more in care homes, including among the under-65s, and give social care services the priority and resources that they deserve. When will they do so?
Covid-19: Obese and Overweight People
Baroness Thornton Excerpts(4 years, 5 months ago)
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Lord Bethell
The noble Baroness is entirely right: there is nothing new to the impact of Covid on those with a high BMI; it is entirely consistent with the impact of other diseases. She is also right that one of the nasty aspects of Covid is its long-term effects, which are not fully understood yet. Evidence suggests that these may be extremely damaging, and it is true that the Prime Minister has spoken about the impact of Covid on him. I have had pneumonia; I know the long-term damage of these kinds of diseases on people. We are looking very hard at offering the kind of support that she describes to those who have been hard hit by Covid.
Baroness Thornton (Lab)
My Lords, as many noble Lords have said, obesity is a significant risk factor in Covid-19. It is critical that we turn the tide on obesity at the earliest opportunity, and this means starting early in life. What steps are the Government taking to implement the measures outlined in chapter 2 of Childhood Obesity: A Plan for Action? Will the Minister commit urgently to restart existing plans to reduce salt, sugar and calories in our everyday foods, extend the soft drinks levy to other sugary and high-calorie foods, limit the advertising of junk food to children and ensure that people are not inundated with promotions for unhealthy food and drink?
Lord Bethell
The noble Baroness is entirely right that chapter 2 outlines an extremely thoughtful roadmap for how to address this issue. It is currently being reconsidered. I cannot make the guarantees she asked for from the Dispatch Box, but I can assure her that we are working hard to see how we can use the example of Covid to make progress on this important agenda.
Covid-19: Response
Baroness Thornton Excerpts(4 years, 5 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.
Hospitals: Patient Safety
Baroness Thornton Excerpts(4 years, 6 months ago)
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Lord Bethell
My Lords, the NHS chief executive, Sir Simon Stevens, has written to all NHS organisations signalling a change in the phasing of our response to Covid and inviting them to return operations given over to Covid to their previous use wherever possible. I hope very much that this will lower the impact on patients that the noble Baroness described. If she has a specific example in mind, I would be glad to inquire about it.
Baroness Thornton (Lab)
Is the Minister aware that some NHS trusts are diverting 999 and GP emergency admission calls to hospitals other than the nearest hospital to avoid transmitting Covid between patients? Can he tell the House when that will stop? Do the new guidelines allow the Government to provide finer-resolution data on hospital admissions, which will assist understanding of optimal admission, treatment and resource allocation strategies?
Dental Care
Baroness Thornton Excerpts(4 years, 6 months ago)
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Lord Bethell
The arrangements for eye care, similarly, are an extremely delicate matter, because the eye is a potential source of infection, and both workers and patients are at risk through work done by opticians. We are extremely keen to get back to normal, but we put the safety and care of patients and staff first.
Baroness Thornton (Lab)
My question to the Minister is an amalgam of those already asked, and I want to press him on them. Everyone needs dentists to be able to survive this pandemic and to be open to do their job as soon as possible. What financial support might be given to the sector to make that happen? What steps are the Government taking to ensure that there are treatment guidelines and access to PPE?
Lord Bethell
My Lords, I completely endorse the point made by the noble Baroness, Lady Thornton. I lost a front tooth a few weeks ago and I cannot wait for the dentists to reopen because it is both uncomfortable and embarrassing. We are providing enormous financial support through NHS contracts, which we have honoured 100% through the epidemic whether or not dentists are seeing patients. However, we recognise that there is a problem with the private sector, and we are working with colleagues in the Treasury to try to find a solution.
Mental Health Services
Baroness Thornton Excerpts(4 years, 6 months ago)
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Lord Bethell
The noble Baroness is entirely right. I am living with four children who are greatly distressed at losing their friends and not being able to stay in touch in the way they would like. We will undoubtedly need to provide support to schools to cover a list of mental health issues. The Secretary of State for Education is working on plans for that.
Baroness Thornton (Lab)
My Lords, as a nation, a vast number of us have seen our mental health deteriorate during the coronavirus crisis, so the challenges facing our mental health services are even greater than they were before. Surely we need a strategy to take us through the Covid-19 pandemic that takes account of the most welcome promises in the NHS long-term plan and addresses and scrutinises the impact of the pandemic on mental health and learning disability settings, including the impact of the temporary measures in the emergency legislation. Such a strategy must address how and when the DoLS legislation will be rolled out, and when and how the Government will bring forward reforms arising out of the review of the Mental Health Act. Does the Minister agree that these are the key ingredients of such a strategy? When will we see progress in this area?
Lord Bethell
The noble Baroness is right: the Covid epidemic will throw a spotlight on our mental health provision. That provision is already benefiting from an extra £2.3 billion a year by 2023-24. We have already brought forward the 24/7 crisis lines that were due to be delivered in 2023-24, and I think there is a good case for bringing forward other parts of our mental health strategy to address mental health issues during the Covid epidemic. Undoubtedly, we will focus very shortly on ways of doing that.
Covid-19: Response
Baroness Thornton 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.
Draft Human Tissue (Permitted Material: Exceptions) (England) Regulations 2020
Baroness Thornton Excerpts(4 years, 6 months ago)
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Baroness Thornton (Lab)
My Lords, I draw attention to the register of interests and my position as an NED of a hospital trust. I agree with the very important last point made by the noble Baroness, Lady Barker, about the European Union rules and regulations. It would be a great shame if we lost our ability to access or give organs across Europe because the Government had crashed out.
It is a great pleasure and honour to speak in this debate. Of course there are some Covid-related questions to be asked, as anticipated by the Minister, but I confess that it is a relief to undertake some positive legislative work, which is the everyday business of this House.
I do not wish to appear ungracious at a time of great agreement and celebration about this Act and these regulations. However, listening to the Minister’s opening remarks, one might be forgiven for thinking that this was a government Bill, when it was in fact a Private Member’s Bill, brought forward by two of my honourable friends in the Commons. As the noble Baroness, Lady Barker, said, it is a great example of parliamentarians doing their job over quite a long period of time and bringing forward progressive legislation that people really want. That the Government backed this is of course vital, and I congratulate them and the Minister on doing so.
I thank the Minister for his excellent introduction, my noble friend Lord Hunt for his inspiring and thorough speech, and all noble Lords who participated in this debate. I commend my noble friend for taking the legislation through your Lordships’ House and gaining support across the House, as illustrated by the contributions today, for this important and life-enhancing change.
The Organ Donation (Deemed Consent) Act 2019 amended the Human Tissue Act 2004 to allow consent for organ donation from deceased donors to be deemed in specified circumstances. These new arrangements have been referred to as “deemed consent”, but “opt-out” has generally been used in public communication, including in the press. During the passage of the Bill, noble Lords scrutinised effectively how the very sensitive issues dealt with in it and these regulations might be handled, so we are now finally able to agree the final regulations.
I do not intend to rehearse the many moving stories about organ transplants here today. We all understand how important this change is and, as many noble Lord have said, that its effect will save lives and change lives for the better. However, I take this opportunity to further press the Minister about the low level of transplants during the period of lockdown. Just 99 organ transplants were carried out in the UK in April, which is the lowest number for 36 years.
While we understand the need to delay operations given the demands on NHS capacity, as well as the risk to patients of proceeding with a transplant and being heavily immunosuppressed in a hospital environment, the fall in the number of operations is deeply concerning. It will inevitably lead to a backlog of patients needing organ donations and increased waiting times and mortality rates. The data has also shown that just 206 patients were added to the waiting list in April, down from 524 in March, suggesting a delay in assessment that could leave patients waiting even longer for a new organ. This is especially important given that the Covid-19 pandemic has resulted in further pressures on the supply of organs too. Patients who test positive for coronavirus cannot be donors, while the lockdown measures have resulted in a decline in the number of road and industrial accidents so there are fewer organs available for transplantation.
Can the Minister give the House a timetable for when this situation will improve? What steps are the Government taking to ensure that those who may require a transplant are assessed and, if necessary, added to the transplant waiting list during the pandemic? How quickly will transplant operations be back to the level of before the crisis? If we are unfortunate enough to experience another spike in Covid-19 and have to bring back the lockdown, and have more Covid-19 patients in our hospitals, will the NHS—with the experience gained from the last few months—seek to have hospitals which can continue to undertake transplant surgery in a Covid-free and protected environment?
I find myself completely in agreement with the noble Lord, Lord Naseby, and my noble friend Lord Hunt that communication and promotion of these regulations and the new law is now vital. I close by paying tribute to Geoffrey Robinson, the former MP for Coventry North West, Dan Jarvis MP and my noble friend Lord Hunt, who sponsored the Organ Donation (Deemed Consent) Bill on which these regulations are based. The ambition is a big one: to achieve an 80% consent rate in England, which will add at least 280 extra donors a year. This could lead to as many as 700 more transplants a year, which seems a very worthwhile aim.
Covid-19: NHS Contact Tracing App
Baroness Thornton Excerpts(4 years, 6 months ago)
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Lord Bethell
My Lords, ID cards do not form part of the British tradition. We work on a system of consent and we have a very high level of trust in the Government. The app is particularly well suited to a country that has a universal NHS system, and that is one reason why we have designed it in the way that we have.
Baroness Thornton (Lab)
Can the Minister confirm that the national rollout of the NHSX app has now been delayed until June? Does he share my concern that a government spokesperson has said that it is possible for the test and track system to work without an app, and for the lockdown to be relaxed further without a system operating at all? This is deeply worrying, given that the Government have admitted that they should never have stopped track and trace in the early stages of the pandemic and now appear to be reneging on a commitment to make it a priority.
Lord Bethell
My Lords, it is entirely right that test and trace does not need a digital app to be effective. I reassure the House that prevalence levels are reducing across the country, as is the infection rate. It is only because prevalence and infection are reducing to manageable levels that we can even consider reducing the lockdown and maintaining pressure on infection through test and trace. The app brings many benefits of being able to automate millions of transactions a day, but it is not intrinsically necessary, and we believe that it would benefit from being introduced later, rather than earlier, than human-based tracing mechanisms.