Covid-19: Response

Baroness Thornton Excerpts

Tuesday 19th May 2020 Lords Chamber

The Statement was considered in a Virtual Proceeding via video call.

[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.

Covid-19: NHS Contact Tracing App

Baroness Thornton Excerpts

Monday 18th May 2020 Lords Chamber

[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.

Draft Human Tissue (Permitted Material: Exceptions) (England) Regulations 2020

Baroness Thornton Excerpts

Monday 18th May 2020 Lords Chamber

[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: Testing

Baroness Thornton Excerpts

Thursday 14th May 2020 Lords Chamber

[Lord Bethell]

The noble Lord will know that we have set up one of the most ambitious surveys, conducted by the ONS, to study on a weekly basis a large number of viral and serological tests. Those are used by statisticians to understand both the prevalence and the spread of the disease. Figures for that are emerging—we now have three weeks-worth of figures. They are being published regularly and I would be glad to send the noble Lord a link to the relevant data.

[Baroness Thornton (Lab)]

My question is relevant to what has been in the news today concerning antibody testing. PCR testing is the most reliable but most resource-intensive test. Will it ever be sufficiently scalable for widespread regular testing of all key workers and to track clusters of reinfection? Are the Government investigating the potential of increasing the reliability of antibody testing by double testing? Now that a range of tests is being manufactured globally, will the Government publish their assessment of their relative efficacy in testing the two relevant antibodies?

[Lord Bethell]

The noble Baroness is entirely right. PCR testing is an important guide as to who has the virus, and we have made it available to all key workers who exhibit symptoms. However, we are sceptical of whole-population surveys. Double testing might help if there is damage to serological equipment, but the challenges of serological testing are more to do with the blood, and unfortunately people do not change their blood. We are very proud of British universities, which regularly publish assessments of the various serological approaches. That work is under way and continues, and we hope to make more progress on it in the months ahead.

Health Protection (Coronavirus, Restrictions) (England) Regulations 2020

Baroness Thornton Excerpts

Tuesday 12th May 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for his introduction and I thank all noble Lords for the many questions they have raised, which needed to be asked. We all wish these regulations were not necessary, but we also accept that they are. I think the counsel of the noble Baroness, Lady Wheatcroft, is dangerous and potentially fatal and I hope the Government will not heed it. This virus is still among us. It is not defeated, and we need to be cautious and, most of all, clear.

Before getting to the substance of these regulations and the future, it is important to remember that they represent the biggest peacetime restrictions that this country has ever seen and demand full parliamentary monitoring and scrutiny. Parliament put them through at speed, and I wonder whether the Minister agrees that a couple of hours of debate weeks after they were introduced cannot in future be sufficient to provide the level of examination and scrutiny that such sweeping laws require. The Prime Minister’s announcement, the publication of the new strategy, the subsequent debates and discussion and the statement made last night on the BBC by my right honourable friend the leader of the Labour Party, Sir Keir Starmer, all point to the need for greater clarity and significantly better communication. The main point concerns the need to come back to Parliament with yet more amendments to these regulations. Does the Minister anticipate that we will see further revisions to the regulations, and if so, when?

I would like the Minister to address some of the problems caused by the mixed messaging and to try to rectify the somewhat shambolic government communications over the past few days. For example, why have the Government called for people to return to work before the schools are open and not to go to work on public transport? To these Benches, that suggests a serious lack of understanding of ordinary people’s working lives. For the Prime Minister to say that he is sure employers will understand that some of their workforce will have childcare difficulties makes me wonder which planet he and his Ministers inhabit.

Will the Government bring forward further regulations, or even legislation, to provide protection for employees who are faced with the dilemma of employers demanding that they return to work when their children cannot go to school? Furthermore, is a grandparent allowed to look after one child but not two? Who exactly should return to work—as the Prime Minister said, “The next morning” —and how should employers keep their employees safe? The guidance on funerals also needs further clarification. It was championed by my noble friend Lord Kennedy but I feel that there is still considerable variety across the country, with some councils taking awful decisions and causing serious distress to families. Can the Minister ensure that the guidance issued is being followed? My noble friends Lord Kennedy, Lord Campbell-Savours, Lord Hunt and Lady Wilcox asked many questions, which I hope the Minister can answer.

These regulations allow officers to arrest and fine people for breaking the lockdown but, as many noble Lords have said, we know that they have been misinterpreted in some cases, with wrongful cases identified through social media and press reporting. Indeed, the Home Affairs Committee in the Commons voiced

“concern that police were enforcing government advice rather than the letter of the law”,

which is less strict. Parliament’s Joint Committee on Human Rights previously warned that the police may be punishing people “without any legal basis”, causing confusion over the extent of the law. Can the Minister confirm that all criminal charges made under the Act will be duly reviewed to ensure that they are appropriate and compliant? Given the pace at which the new regulations had to be implemented, it is not surprising that there have been early problems and errors, hence the need for a second set of amending regulations.

We all know the damage that this virus is doing to our society and we all know that these measures are needed to limit that damage, but we should not forget their impact. The physical and mental toll is huge, yet virtually everyone has been adhering to these rules in a way that is testament to the resolve and determination of the British people. Like the Minister, I congratulate everyone on their discipline, their thoughtfulness and the protection that they have afforded our NHS.

We acknowledge that this is terribly difficult. We do not want these measures to be in place for a day longer than is absolutely necessary, which is why they must be accompanied by openness, accountability and scrutiny at a greater level than we would ordinarily see. I note that the Chairman of the Secondary Legislation Scrutiny Committee considered a significant number of statutory instruments that make provision, either directly or indirectly, to deal with the coronavirus pandemic. He said:

“Some of these instruments temporarily impose significant and far-reaching restrictions on citizens and businesses, and the Committee noticed the use of a wide variety of different sunset dates and provisions.”


That is absolutely true. We face a very confusing legislative and regulatory framework.

I am also concerned about the monitoring of the Care Act and the other measures in the emergency legislation that we passed just before lockdown. When will we have the opportunity to discuss them in the House?

The three-weekly review of the regulations means that the Secretary of State is legally required to terminate any regulations that are not necessary or proportionate to control the transmission of the virus. Will a statement providing a helpful examination of that requirement follow the review, and will an Oral Statement follow each subsequent review? Can the Minister assure the House that relaxation of the measures and what will happen in the future will be discussed with opposition parties, employers, trade unions and, of course, the public?

That leads me to my next point. The current rules, sweeping as they are, are too numerous. As the Minister said, the next phase will contain a longer list of reasonable excuses to leave home; it is even more important that those rules be clear and consistent. The rules need to be harmonised with the advice, guidelines and all forms of official communication, as most noble Lords said. We do not want people to infer legal authority where there is none or to act outside the law. That is vital to preserve the rule of law. We know that the lockdown was a blunt tool—effective nevertheless—that will change by definition as restrictions ease. There will be a measure of nuance, distinction and variation that requires careful explanation and policing.

In conclusion, we on these Benches do not oppose the regulations, of course, but, given that they represent the most severe restrictions imposed on British liberty in modern history, it is critical that they be subject to continual comprehensive and transparent scrutiny.

Covid-19: Vulnerable Populations

Baroness Thornton Excerpts

Tuesday 12th May 2020 Lords Chamber

[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.

[Baroness Thornton (Lab)]

My Lords, I am pleased to note that today is International Nurses Day. I pay tribute from these Benches to all our nurses, at home and all over the world, for their work and courage in these dark pandemic times. I will ask the Minister about testing in our care homes. On 15 April the Government announced that they were rolling out testing to all care workers. On 28 April they extended this scheme to all staff and residents in care homes. Could the Minister explain why, then, yesterday’s strategy document set a target of 6 June? Which is it? It looks like the Government failed to meet the promise to provide the tests on time and have now moved the goalposts again.

[Lord Bethell]

I share the noble Baroness’s celebration of Florence Nightingale Day, which is an important day for the nursing profession and for all of us. We have made huge progress on testing in care homes in the last three weeks. The new portal was made live on Monday and care homes are now massively supported by satellite care home facilities manned by the Army. I am not sure about the 6 June date of which she speaks, but I reassure the House that care home testing is the number one priority of our testing facilities and is benefiting from the large increase in capacity.

Covid-19: Government Response

Baroness Thornton Excerpts

Wednesday 6th May 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for repeating this Statement. I point out that the Commons took an hour to receive and discuss this update; we are getting 10 minutes. It is almost two weeks since I saw the Minister across this virtual Dispatch Box, which seems a long time in a pandemic. When we went into lockdown in March, he seemed to indicate his enthusiasm for being accountable to the House in lockdown. I regret to say that I do not believe that he or his colleagues have matched that aspiration. I place on record that it is shocking that noble Lords across the House are reduced to submitting vital questions about Covid to a lottery—a ballot of topical questions. That is not serious accountability. Unprecedented times need unprecedented procedures.

I have two questions. First, will the Minister support a proposal that he and his colleagues should come to the House every day and have a Covid-related Question Time, morning or evening, which would discuss the contents of the daily press conference and other urgent matters? Secondly, how does the Minister intend to fulfil his promise to the House that there would be an eight-week review of the Covid emergency legislation? By my reckoning, those eight weeks will be up in two weeks’ time.

[Lord Bethell]

I welcome the noble Baroness’s questions on accountability. However, I remind her that not all Covid-related matters are covered by the department of health; Ministers have been in front of the House every day it has been open, answering questions on Covid, and they have given fulsome and thoughtful answers to questions and scrutiny. I welcome also her question on the eight-week review, which, as she says, is coming up in a fortnight. I will find out how the usual channels wish to mark that occasion in the House, and I would welcome the chance to submit the Government to scrutiny on the matter.

Covid-19: Contact-tracing App

Baroness Thornton Excerpts

Wednesday 6th May 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is entirely right to point to the importance of ensuring that the vulnerable are included. Of course, the app is not the only thing we are depending on. Manual track and trace in the conventional way of using a telephone and speaking to those who test positive will still be a core part of our track-and-trace arrangements. Efforts will be made to reach those who are vulnerable or digitally isolated to ensure that they have details of the provisions for these track-and-trace arrangements.

[Baroness Thornton (Lab)]

My Lords, I would like to follow up on the question asked by the noble Baroness, Lady Lane-Fox, because she has put her finger exactly on how this may not work because either our most vulnerable and poorest communities will not have the technology or there will be problems with language. I would like some more detail from the Minister about exactly how the Government intend to roll this out. Given that it took such a long time to roll out the NHS volunteers system, I feel that we might find ourselves with our most vulnerable and poorest communities disadvantaged.

[Lord Bethell]

The noble Baroness is entirely right to be concerned about the vulnerable and our approach. I completely share those concerns. It is a massive challenge, but that does not stop us embracing the advantages of technology where millions of transactions can be done in a day which could never be done by more manual processes. An enormous amount will be invested in trying to reach out to those who are isolated, vulnerable or digitally excluded to ensure that they have details of our track-and-trace arrangements. Hiring an enormous army of track-and-trace experts has already begun, and details can be seen on my Twitter feed of how volunteers who have the right qualifications can join those efforts.

Covid-19: Social Care Services

Baroness Thornton Excerpts

Thursday 23rd April 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, it is an honour to be winding up this historic debate on behalf of the Labour Benches. It is the first substantial debate to be held in our demi-virtual House.

For two reasons, it is completely appropriate that social and domiciliary care are the subjects of this debate. First, we could only suspect when my noble friend Lady Wheeler proposed this debate how important would be our scrutiny of the effects of Covid-19 on care homes, on domiciliary care, on the 6.5 million carers in our community, and indeed on the elderly and those living with disabilities, whether they are old or young. That has been mentioned by many of my noble friends, including my noble friend Lord Dubs, Lady Pitkeathley, Lord Hunt and Lord Turnberg. Secondly, my noble friend framed this Motion for debate in terms of both the short term and the long term.

I congratulate noble Lords on the brevity and eloquence of their contributions, which were outstanding, but also on their command of the virtual world in which we now operate. I also thank the many organisations that sent briefings to us and gently remind them that a briefing arriving yesterday will have less impact than one that we might have received a week ago.

It is right to separate the short term, where we all wish to work together to mitigate the worst of the crisis, from the long term, where we learn lessons and address with honesty the inertia, political cowardice and long-term cuts that have made it impossible to design and put in place a decent, modern, integrated care system. My noble friend Lady Wheeler and I—the Labour team—have lost count of the number of times we have raised the inadequacies of the Government’s response to the stress experienced on the front line in our social care system over the last five years, with no Green Paper, inadequate budgets and huge cuts to council infrastructure. It would be laughable were it not so awful in its consequences for the most vulnerable in our communities in this pandemic. The fact that in PMQs yesterday the First Secretary of State did not know how many social care workers had lost their lives to Covid-19 tells us all we need to know about the priority that the Government have given social care over many years. That must change.

Finding solutions means that issues are identified by good data, reported honestly and openly, and that all those involved, from care homes, trade associations, charities and trade unions, contribute to finding solutions. The employment and business solutions found by the Chancellor were a result of discussions with many different groups, including the CBI and the TUC. Why has that not been a model for social care during this pandemic? Will the Minister commit the Government to bringing together all the stakeholders in this sector to discuss the future, not just the immediate issues of survival?

Yesterday we learned that the current lockdown is unlikely to end soon. The CMO tells us that the probability of lifting social isolation in the next calendar year is incredibly small. We should be realistic about that. We will have to rely on other social measures which, of course, are very socially disruptive, as everyone is finding out right now. The Chief Medical Officer said that without a “highly effective vaccine” or “highly effective drugs” to treat coronavirus, Britain will have to get used to this new way of life. We do not know exactly what that means, partly because the Government have chosen not to have a national conversation about the best way forward, but to inform us of their decision about ending lockdown at some time—who knows when? We already know that, in the short, medium and indeed long term, the impact will be significant for the communities we are discussing.

I beg the Minister not to talk to us in lofty terms about how hard he and the Government are working—we know and appreciate that—but instead to be honest about the challenge we are facing as a nation and in this sector, and have some discourse about solutions with the communities affected. Perhaps Ministers have had incorrect or incomplete information, but time and again lofty promises and bold assertions have collided with reality. This risks undermining trust in the Government, which is so important at the moment. Levels of trust influence our behaviour. The lessons for our leaders are clear: to have humility to admit they do not know everything; to be authentic in their narrative; to have empathy and provide reassurance for the anxious; to have clarity and consistency of messaging; and above all, to have honesty.

On 9 March I asked the Minister the following question:

“My first question concerns vulnerable people in residential homes and the learning disabled who may be being supported, either by charities or at home by their parents. We need to include these people in the planning.”—[Official Report, 9/3/20; col. 849.]


Social care planning was published five or six weeks later, during which time Covid took hold in our care homes with continuing devastating effect. Only in the last few days have we seen testing offered to residents and staff in these homes, for which we are of course grateful. We are fortunate that the noble Lord, Lord Bethell, is the Minister responsible for testing, which will now be rolled out. Clearly, testing centres which are miles away and can be accessed only by car are inappropriate for residents and many staff. When will this testing, when it is accessible, kick in? What is the timeframe?

We must be honest and say that reports of serious failures have reached us all: vulnerable people denied the care they are entitled to expect, and some even denied life itself. Many with disabilities have expressed how strongly they fear the withdrawal of or reduction in services vital to their well-being, as mentioned by many noble Lords. Not enough has been done to reassure them.

In the short term, we have seen unprecedented action: the Care Act being effectively suspended, with only the protection of the HRA in place, and the injection of literally billions of pounds into the care system, although nobody seems to know exactly where it will end up or whether it is enough.

The loss of hard-won rights in the field of adult care, outlined by the noble Baroness, Lady Grey-Thompson, and others, is a major concern. Service user groups, lawyers and advocacy groups are questioning whether the powers taken are in fact disproportionate to the extent of compromising human rights and are wondering whether these rights will ever be returned after this period of emergency. These are major concerns, and the rhetorical downplaying of the value of low-skilled and low-paid workers has been replaced by treating them as heroes, as many have mentioned.

This really sets up a challenge for the future. It has proved hard in many places to set up proper systems for identifying who is vulnerable and how they can be protected and not fall through any cracks. The lack of good information and the absence of data-sharing are exposed. Market mechanisms, through contracts and regulation, failed to embrace the ability to react in a major crisis. The deep-seated organisational barriers between the different sectors of care and between local authorities and the NHS have been laid bare, despite heroic attempts in many places through local initiatives. We now see, finally, that there has been some recognition of how valuable care staff are, but this must be matched by giving them the pay, conditions, training and equipment they need.

Our current social care model does not work. Integration, despite laudable attempts in Manchester and some imaginative STPs—my own included—is not going anywhere fast. The move to a national well-being strategy avoiding all artificial barriers and tribalism in the NHS and between the NHS and social care is essential.

Labour has set out its vision for a long-term solution. Like everyone else, we will study what we can learn from the crisis and adapt our policies as required—we want to work across parties and nations, and believe that work needs to start sooner rather than later. The NHS and social care must be seen as two sides of the same coin and supported in their efforts to respond to the Covid-19 outbreak. It has never been more important to invest in this critical partnership.

Social care providers and their staff have had to adapt as the crisis evolved and new issues emerged, and are playing a key role in supporting vulnerable people at home and enabling people to return home with appropriate support. This pandemic has laid bare the challenges facing social care and highlights the urgent need for a sustainable, long-term funding solution. This must be a key priority for the Government.

In conclusion, I thank all noble Lords for their contributions to this important debate. I heard a care home manager say in despair on the television last night, “We were not prepared and we are not being led.” She is right. This must change for the short term and the long term.

Covid-19

Baroness Thornton Excerpts

Thursday 23rd April 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for repeating the Statement. I join him and the Government in saying that our thoughts are also with all those who have lost their lives to this horrible virus. I pay tribute to the NHS and social care staff who have lost their lives. I know the Minister agrees that the number of victims who appear to have come from BAME communities is very concerning. Can he confirm reports that BAME people make up 72% of all NHS and carer deaths with Covid-19?

We welcome the announcement of an inquiry. It would be great if the Minister could provide further information about the scope of the inquiry and when it will report its initial findings.

The Minister said he believes that we are now at the peak, but we are nevertheless heading for one of the worst death rates in Europe. The Government have told the public that their response to the pandemic will always be guided by science but, as the Minister will be aware, there are often different views within the scientific community, so I repeat the call that we have made from these Benches in the past that the Government should publish the evidence underpinning their decision to recommend, for example, a seven-day rule for isolation. This is important for public confidence, given that the Government’s advice appears to contradict the advice by the World Health Organization, which advocates a 14-day rule for isolation based on evidence that people can still transmit the virus after 10 days or more.

Despite many questions, it remains unclear why the UK did not participate in some of the European procurement projects. The Chancellor of the Duchy of Lancaster said this was because we missed an email, whereas a senior civil servant at the Foreign Office said in evidence to a Select Committee that it was a political decision, before retracting that comment several hours later. The lack of transparency is deeply unsatisfactory. It would help if the Government published a background briefing so that we could see exactly what happened. We believe that it is necessary to get to the bottom of this situation now to ensure that the UK takes part in any future EU schemes that may help us deliver PPE to those putting their lives at risk on the front line.

The Government have repeatedly said that they are “ramping up”—this is an expression I do not enjoy, and I certainly intend never to use it myself—testing capacity, but the latest statistics show that only 14,629 NHS tests were carried out in the last 24-hour period, eight days before the Health Secretary’s self-imposed deadline to reach 100,000 tests. This is despite testing centres having a capacity of 39,000 checks a day. Why is more than half the country’s testing capacity still going unused when tens of thousands of NHS and social care staff, along with other critical workers, are being forced to self-isolate because they have not been tested? It is very concerning that the number of tests being undertaken is not increasing. Even if the capacity does reach 100,000, that is not the same as access. The latest statistics reveal that the number of tests performed on Tuesday was two-thirds that of the previous day. The Minister needs to tell the House what on earth is going to happen and when we can see the daily increase of tests.

Earlier this week the Health Secretary pledged to test immediately anyone in the social care sector who needed it. While elderly residents can be tested in the homes they live in, staff still have to travel. I learned earlier from the Minister that there are plans in place to change that, so I would like him to explain how soon those alternatives will come on stream.

Testing and contact tracing are vital to managing the UK’s response and easing lockdown restrictions. The new NHS app mentioned is very welcome. Can the Minister set out the timeline for when that will become available?

Finally, will the Minister confirm that the combination of some spare capacity in the NHS and the Government’s view that we now have reached the peak of the virus means that postponed NHS treatments and procedures will resume imminently? Although we understand why some elective treatments were postponed, the delay for many illnesses, including cancer, involves its own risk. It is therefore important that people receive the necessary treatment as soon as possible when it is safe to do so considering the impact of the virus. What support are the Government giving to trusts to help them manage demand amid the ongoing situation and give patients confidence that they will be treated in a Covid-free hospital?

[Baroness Brinton (LD)]

I thank the Minister for repeating the Statement and for his work on testing. We may have some difficult questions for him, but I hope I have the support of the whole House in saying thank you to him and his team for the work they are doing on this difficult area.

I too thank all the staff and volunteers in the NHS and the wider social care sector and other key areas who have been working during this crisis, whether directly on the front line or in supporting families and our children in schools. We send our condolences to the families of the bereaved, and are pleased that many people are recovering, even though we know that, if they have had it badly, it takes time. From these Benches, we echo the concerns about the high percentage of BME deaths, among workers and non-workers alike.

The Statement says that there are 3,000 spare critical care beds, but ITV reports that care home residents now account for up to half of Covid deaths. However, last week the Daily Mail reported that care home residents were still being asked to sign letters to say that they would not go to hospital in the event that they had Covid-19. Will the Minister confirm that these critical care beds in hospital are not spare? There are plenty of people in care homes who could use those beds but they have been put under pressure, no matter how gently, to sign the letters.

It is good to see the Nightingale hospitals coming on board—even if they are empty, for the right reasons. One of the concerns expressed has been about the staffing and the initial request that any patient had to have staff accompanying them from their previous hospital. Can the Minister say that this has now definitely stopped and that staff with appropriate critical care experience are able to be recruited? I gather that this has also been a problem for increasing the number of beds.

There was a good message in the Statement for people to go to their GPs and to use 999 for emergencies, but today there was a report of somebody who had a severe heart attack not being picked up urgently, as heart attacks are still second-level priorities to Covid. As a result of that 20-minute target rate, sadly the patient died. Is there any rebalancing of priorities for ambulances now that we seem to be over the peak of cases?

On equipment and medicines, it is good to hear that there are now just over 10,000 ventilators. Are they full ventilators, or does that include CPAP and BiPAP machines? How many more are to come? There have been some worrying shortages of medicines for those who need to be sedated, and recently we have heard news that there is a problem with kidney dialysis and kidney medicine for people who have come out of intensive care and require long-term support. Is there a shortage of such medicines, what other medicines are at risk and what proposals are there to remedy that problem?

We have spent many hours today talking about PPE. We are still waiting for supplies for everything outside hospitals. On 6 April, Clipper was heralded as being about to solve this problem, but it is still woeful. Until the social care and community sectors get the support they need, they will continue to be worried about the spread of Covid.

The Turkish ambassador has written to various people in the APPG on Turkey, setting out the actual arrangements—as opposed to those reported by the Government—concerning the delay in the package that appeared to get stuck. Turkey actually donated 250,000 pieces of medical protection equipment to us; the rest came through privately. Can the Minister say when the remainder of the consignment due from a Turkish supplier will arrive?

It is good to hear that formal arrangements for testing, tracking and tracing are now under way, but the WHO always puts in a third word alongside “test” and “trace”: “isolate”. Any mention of isolation in the Statement is notable by its absence. Taiwan, South Korea and Hong Kong have all managed to suppress further bursts of Covid because of the arrangements for not just testing and tracing but isolating. It is good to hear that an app will be available, but the Minister will know that there are people with technical experience concerned about whether it is appropriate to use Bluetooth for it, because of security issues. Can the Minister assure the House that this is not the case and that people’s data will be used only for NHS purposes and will absolutely not be able to be used by any providers of the app or beyond? The 18,000 tracers announced by the Secretary of State just before this Statement are a good start, but we will need more for good national coverage. Worryingly, Mr Hancock said a few days ago that all this will be operated centrally. Is that still the case, or will he use the existing trained tracers that there are in local communities, whether environmental health tracers in councils or in local health teams? It seems rather bizarre to try to cover the country on that level.

On shielding, it is good that there is a request to create more volunteers and to celebrate the volunteers, but notable by their absence in the Statement are the many people who have not yet had their letters on shielding and whether any further groupings may have to consider shielding—which I understand is the case.

I congratulate the Government on their progress on test and trace, but confirm that we are extremely concerned about supplies of equipment and medicine and hope that things will be remedied speedily.