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.

Covid-19: Medically Vulnerable People

Baroness Thornton Excerpts

Wednesday 22nd April 2020 Lords Chamber

[Lord Bethell]

I completely agree with the noble Lord’s concerns, both about those who are clinically vulnerable and about the potential for a rise in non-Covid excess deaths. The second is a matter of extreme concern. The example of those with cancer who are going to hospital to have operations is a very good and clear example. These matters are very much at the highest level of the Government’s mind.

[Baroness Thornton (Lab)]

I thank the Minister. According to media reports, those who are particularly vulnerable to the virus could be advised to remain shielded for up to 18 months, or until a vaccine has been developed. Can the Minister confirm whether these reports are true? Secondly, the Government have recruited 700,000 NHS volunteers to support those who are vulnerable or shielded. Most of them seem to have been processed but many have been given nothing to do as yet, when there clearly is need. Will the Minister tell me how quickly that issue will be resolved?

[Lord Bethell]

The noble Baroness is entirely right. The prospect of long-term shielding for those most vulnerable is of deep concern. That is why we are pressing so hard on the disease, through the lockdown, to try to get R as low as possible. We will be putting in track-and-tracing measures to ensure that R can be held down and those in lockdown can be freed from their confinement. In terms of volunteers, the response has been incredible. It takes time to turn around all the offers of help that we have, but we are moving extremely quickly to do that.

Covid-19: Removal of Restrictions

Baroness Thornton Excerpts

Tuesday 21st April 2020 Lords Chamber

[Lord Bethell]

The noble Lord is right that the British public have been incredibly diligent, and I commend all those who have followed the guidelines to stay at home for the impact they have had on the infection rate and the mortality rate. However, we cannot fool ourselves into thinking that the epidemic is over. We have to be clear with, and level with, the public that any changes in the guidelines are some way off, and that they will be presented to the public when our understanding of the medium-term strategy is clear.

[Baroness Thornton (Lab)]

My Lords, I thank the noble Lord for the answer that he has just given, but it still begs the question of why the Government are treating the British public as if they were children. I am sure that it would be possible for them to share their thinking, even at this stage. My question concerns testing. Professor Paul Nurse, director of the Francis Crick Institute, said on 19 March about the way to deliver vital testing at scale:

“Institutes like ours are coming together with a Dunkirk spirit—small boats that collectively can have a huge impact on the national endeavour.”


Does the Minister agree with that approach? Can he tell the House when the Government will be able to utilise all the laboratory capacity, which will ensure mass testing and tracing, and will speed up the likelihood of an exit from the current lockdown?

[Lord Bethell]

The noble Baroness is entirely right. I have spoken to Paul Nurse and commend the Crick Institute on the work it has done to build up the remarkable capacity of 2,000 tests a day. However, there are practical issues with the “Dunkirk spirit”. There are enormous logistical challenges in getting swabs and serology to laboratories. There are logistical problems with them registering the correct patient details and then getting the responses back. We have made substantial advances—the Crick Institute has been a pioneer in this—in bringing industrial levels of organisation both to the very large number of tests done each day and to the logistical backbone necessary to process those results.

Coronavirus Bill

Baroness Thornton Excerpts

3rd reading & 3rd reading (Hansard) & 3rd reading (Hansard): House of Lords
Wednesday 25th March 2020 Lords Chamber

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

My Lords, I offer profound thanks to all concerned. I thank the Bill team, who have put together a balanced, thoughtful Bill in an amazingly fast turnaround. I thank my own team at the Department of Health for their enormous support. I thank the team in the Leader’s office and Whips Office who have worked to manage a remarkable programme in order to pass the Bill. I thank those in other parties who have worked in a collaborative, positive and supportive way during the whole process. I thank those who work in Parliament and in the House of Lords who are here today at considerable risk to themselves; they have displayed amazing commitment to this remarkable organisation by being here. I beg to move.

[Baroness Thornton (Lab)]

My Lords, on behalf of these Benches, I thank the Minister for the way he has conducted the Bill. It has been a perfect exercise in consultation and work across the House. I thank not just the parties but other noble Lords who have taken part in this Bill for co-operating and working together in a way that has allowed us to scrutinise it as best we possibly could. I think we raised every issue that we could during its passage. It is important to have those things on the record because, as we move forward, we will need to know that we have asked those questions, and the Government will need to address them.

I thank my team, particularly my noble and learned friend Lord Falconer, who got drawn into this about a week ago, and my noble friend Lady Wheeler. I also thank the people in the office, who of course do all the work. In our case, that is Rhian Copple, who has done a brilliant job in keeping us informed and on the go.

I thank all my noble friends and noble Lords who are not here, but who gave us their views and have been patient. I know that they would have wanted to be here.

[Baroness Barker (LD)]

My Lords, from these Benches I too thank the Minister, the Bill team and all the civil servants who have worked with them for the collaborative and inclusive way that they have conducted the Bill through this House. I thank Members on other Benches for their immense understanding and patience as at times we have had to rattle through some very difficult issues that normally, in other circumstances, we would not have dealt with in that way.

Coronavirus Bill

Baroness Thornton Excerpts

2nd reading & 2nd reading (Hansard - continued) & 2nd reading (Hansard - continued): House of Lords
Tuesday 24th March 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, we are living in a strange and frightening time. I congratulate all noble Lords on their speeches and questions today. I refer to my interests as listed in the register, including the fact that I am a member of a clinical commissioning group until the 31st of this month, when it will be abolished and absorbed.

As always, our thoughts have to be with those who have lost loved ones to this virus. Also, all of us would praise, as we have done today, the extraordinary efforts of our NHS staff and other dedicated public servants. We are for ever in their debt. My nephew, Oliver Carr, is a newly qualified first-year doctor at the Royal Free Hospital here in London. I cannot stress enough how proud we are of Oliver, but we are also, like thousands of families everywhere with loved ones working in our NHS today, very concerned for his safety.

Today, we are being asked to make decisions of a magnitude that we would never have dreamed of a few weeks ago. None of us came here to put on to the statute book powers that would curtail so many basic freedoms which our forebears had fought so hard to put in place and which we take for granted. As my honourable friend Jonathan Ashworth said yesterday:

“This virus spreads rapidly, exploits ambivalence, thrives on inequality”.


I shall speak about health and social care. My noble and learned friend Lord Falconer covered justice and dealt with the aspects relating to coroners—I am very pleased to say—as well as the sunset clauses. Also, I shall not refer to education, because, between them, my noble friends Lady Blackstone and Lord Watson covered the waterfront on the educational questions that need to be asked with regard to the Bill.

The reference in last night’s statement by the Prime Minister to the fact that social isolation and distancing must be enforced was welcome. It was necessary because too many people were not following the advice. I think that we all watched with incredulity and horror the pictures at the weekend of bustling markets and packed Tube trains, beaches and parks, so I am afraid that the public health message was not heard loud and clear, and we now have to see whether it will be.

Everyone who should be at home, must be, and they must work from home. I am afraid that that includes your Lordships. There are six or seven speakers in this debate, including on our Benches, who should not really be with us. They are breaking the Government’s guidelines—now, instructions—and they endanger themselves, which is really worrying. I hate to say this but I know that they are here because most of their friends, including me, would not dare tell them not to be, and they have a contribution to make. However, it does not reflect well on this House after the magnificent example that has been set by the Lord Speaker. Hundreds of our colleagues are not here and have been sending messages to us, for which we are all grateful. They have been giving us advice, as many of us have mentioned.

I happen to think that Parliament must continue to sit as best it can. We must hold the Government to account, not least because, as many noble Lords have said, inevitably this Bill will have its flaws. Normally, we would have pointed those out over a period of months. It does not adequately cover some very serious areas which we have discussed today, not least the homeless, the self-employed and renters. Therefore, although I feel that the emergency powers, while draconian, are needed, that does not mean that the Government cannot regularly be held accountable. As the Minister said, the powers should be only in the context of this virus.

Turning to the health and social care workforce, one thing that we certainly now know unambiguously, as a result of this pandemic, is that nobody can be unaware of the importance of care workers in our community. There is definitely awareness of social care. It has to be accepted and of course properly funded.

The next few months will present a different level of challenge for the NHS and anyone working in the caring professions. We know that an increasing number of people will become ill and some will require medical treatment in hospital. The additional patient volumes will place enormous pressure on all sectors of our health and social care system. There will be pressures from increased absence by staff who are unwell and self-isolating in their households, so testing is absolutely vital, as is adequate PPE.

I will divert slightly from discussing the health and social care workforce. Several noble Lords mentioned the police, including the noble Baroness, Lady Barker, and the noble Lord, Lord Adebowale. If we are putting on the statute book, as we have been and will do, things that mean that you might be breaking the law if you go out or do something you should not be doing that might involve our police, what protection are we giving them? I will read on to the record what a female police officer has said in a message I have received:

“We need masks for every officer and prisoner, at least four washable masks for police officers: one to use, one to have in the bag for three days to decontaminate before washing, and two to change during the shift. Shower facilities for police officers—there are not enough showers. Gloves. Where do we take prisoners who are symptomatic? Where do we take people in a domestic situation? What happens to child contact arrangement orders? Can a person on bail not sign for bail who is self-isolating? What’s the process for breach of bail? What about registered sex offenders? Do they have to tell us if they intend to be at a different address? They have to attend police stations and register where they are. What do they do if they are symptomatic and away from home?”


She goes on, including on serving warrants and all the issues that our police have to face on a daily basis and which will increase. The Bill does not address those issues, but the Government absolutely have to address them.

The Bill includes provisions for regulators to register suitable healthcare professionals, such as nurses, midwives and paramedics, as well as social workers, including those who have recently retired or are on career breaks. To facilitate the return of experienced staff, we understand that rules that prevent retired NHS professionals working for more than 16 hours a week and which affect their pension entitlement have been suspended. However, procedures must be in place to ensure that background checks and other measures are fast-tracked. We must ensure that the well-being of these people is prioritised.

The Government will also be registering final-year nursing and medical students who are near the end of their training. These students have to be supported, supervised and properly remunerated. I absolutely back what the noble Baroness, Lady Watkins, said about the debt that nurses face.

We recognise that it will be appropriate and necessary for doctors, nurses and other registered health professionals to work outside of the usual scope of their practice and specialisms, and that a far wider range of staff than usual will be involved in directly supporting Covid-19 patients with respiratory needs. The Bill includes indemnity provisions for those undertaking these services. However, it is vital that NHS staff working outside their usual scope of practice are trained in how to care for vulnerable patients. Can the Minister outline what training will be available, what it will entail and how many staff will need to be trained to use ventilators?

We also recognise that health staff will need to depart, possibly significantly, from established procedures to care for patients in highly challenging but timebound situations at the peak of an epidemic. Can the Minister advise what guidance will be issued to assist clinical staff to make these calls? Can he assure the House that they will be kept under constant review?

I echo and support the words of the noble Lord, Lord Adebowale, about the importance of support for social enterprises. That is based on the role and importance that they have in the delivery of social care in this country. Can the Minister commit that he and his colleagues will meet with Social Enterprise UK and its colleagues to discuss this matter urgently?

The Bill also includes provisions for drafting in volunteers, which noble Lords have discussed, but we have to recognise that people with disabilities and chronic conditions often have some of the most complex care needs. It is very unlikely that volunteers will be able to provide the care that they need. We need reassurances that these people will continue to receive the appropriate care they need from professionals.

The Bill will allow NHS providers to delay undertaking the assessment process for NHS continuing healthcare for individuals being discharged from hospital until after the outbreak has ended. We understand that this will allow hospitals to discharge all in-patients who are clinically fit to leave without delay. Sir Simon Stevens has advised that this will potentially free up 15,000 acute beds. However, it is important that these measures are brought into operation for only the shortest possible time at the peak of the outbreak. The increased burden on social care services, already creaking before the pandemic, means that they will simply not be able to cope. We are concerned that the sector will be unable to cope. It is understandably a great worry for existing service users, who will know how dependent they are on the social care they receive daily.

There is huge concern about how domiciliary social care will cope during the crisis. It really is the front line of social care, with dedicated but low-paid care workers providing vital personal care services, visiting people in their homes daily, moving from client to client and providing the link with the outside world for people who depend on them, particularly if they are without family and care support. Can the Minister reassure us, for example, that the 15-minute visits will be extended to make sure that there is adequate time for a care worker to take the effective Covid-19 precautions as well as seeing to people’s needs, reassuring them and addressing any problems? What guidance has been issued on this?

Finally on social care, the risk to care and nursing homes with older people living in them cannot be overstated. There is a huge responsibility on managers and staff to keep the virus out. Does the Minister anticipate that care workers will be required to self-isolate with residents in the event of a quarantine or lockdown? I think it is obvious: if the pandemic takes hold in a care home, that care home could account for all the acute beds in that area, so it is a very serious problem indeed.

The noble Baroness, Lady Barker, covered the waterfront on mental health issues. On the powers to detain and treat patients who need urgent treatment under the Mental Health Act, to be exercised using one doctor’s opinion rather than two if that proves impractical or would result in unhelpful delay, can the Minister just clarify for us what the thresholds are for impracticality and unhelpful delay? I think that was the only question the noble Baroness did not ask on this.

On deprivation of liberty, I echo what the noble Baroness, Lady Barker, said. Also, pressure on care homes is already significant. The legislation—which the Minister was not involved in getting through the House, but many of us here were—is being carried through now, so this really increases the pressure on care home managers.

One of the side-effects of the Government’s Bill will possibly be to reduce access to terminations. I agree with the noble Baroness, Lady Barker, that this is a problem. The Minister and the Government really need to address that.

On supporting the public over domestic violence and abuse, the evidence suggests that domestic violence may increase during this time and that children are particularly vulnerable. What are the Government doing to recognise this? Are they improving funding to this sector? Are they considering the most vulnerable, including ensuring immediate funding as well as replacement income for refuges that have already had to close?

Turning to renters, it is clear that nobody should have to lose their home because of the virus and its impact. The Government have acknowledged that with their action on mortgage holidays, yet have failed to protect those in the rented sector. Despite suggestions otherwise, we believe that the Bill fails to legislate for a ban on evictions. I hope that the Minister can confirm that the Government intend to amend the Bill to this effect or to introduce further primary legislation. There seems to be an overwhelming case here. Some 20 million people in England rent, 6 million of whom have no savings whatever, so they are particularly vulnerable if they lose their job or have their hours cut as a result of this virus. Last week, Shelter estimated that 50,000 households could face eviction through the courts in the next six months, thereby creating yet another crisis. We therefore remain extremely concerned that a three-month pause on evictions will defer this crisis only to the end of that period because landlords will then demand the total arrears of three months’ rent from many tenants who may not have been able to work at all and certainly will not be able to pay.

I turn now to the homeless. The Government need to address the specific question of people who have no recourse to public funds. As noble Lords will know, people experiencing homelessness, particularly those who are rough sleeping, are especially vulnerable in this outbreak. They are three times more likely to experience chronic health conditions, including asthma and COPD, and many are unable to access healthcare or housing because they have no recourse to public funding and benefit restrictions. These people include those on appeals whose rights are exhausted, EU and EEA migrants, people with existing visas, those whose status is not regularised, domestic workers and other migrant workers, as well as the victims of trafficking and torture, so it is critical that this is resolved. It is in everyone’s interests that it should be resolved—if we have people on our streets who are either infected or infectious, that will put yet more strain on the NHS.

On income support, we need income protection for those in precarious forms of employment. Apart from anything else, it would stop them packing Tube trains. One reason the Tube is packed is that many people in very low-paid jobs have to get to work. Like other noble Lords, we remain concerned that the Bill fails to give many people the financial support they need to get through this crisis. They should not be expected to make the choice between their health and hardship. Several noble Lords have talked about the self-employed and they are absolutely right to do so. The Government need to look at the position of the self-employed in a generous way. The Government should also act now to assist millions of people through the universal credit scheme by increasing it, suspending sanctions and scrapping the five-week wait for the first payment. We await to hear what the Chancellor will announce on this as a matter of urgency.

The issue of food is important. Stockpiling is clearly taking place and it is happening because people are not reassured that there is enough food to go around. The most vulnerable are losing out, so the Government have to take this very seriously. We understand that military personnel might be brought in to help with food chain logistics. Can the noble Lord explain what their role would be? Additionally on our food supply, by this summer we will need some 80,000 seasonal workers to pick fruit and vegetables, so we will have to train a reliable workforce for that.

The noble Baroness, Lady Grey-Thompson, covered the issues affecting the lives of disabled people. The Government’s plans in the Bill for this crisis will roll back 30 years of progress for disabled people. While we may tolerate this for a short period, we cannot tolerate it for very long. All the years that we fought for disabled people’s right to social care are being eroded and undermined, along with their civil liberties and right to support. We need to put the noble Lord on notice that, particularly in this House, we will tolerate this for as short a period as possible.

I want to say a word about food banks, which are suffering from, or are in danger of suffering from, shortages. Here I pay tribute to some of our major retailers, the Co-op in particular, for ensuring that deliveries to FareShare schemes are going through. Today I saw a message from the manager of a Boots shop, complimenting the staff on dealing with a totally unacceptable level of abuse. Apparently, it happens particularly when they run out of Calpol. Such scenes are being repeated over and again in our shops and supermarkets, so I pay tribute to all their staff and managers, who are doing very hard jobs, along with other shopkeepers and indeed our farmers.

In conclusion, as my noble and learned friend Lord Falconer said in his opening speech from these Benches, we lend our support to the Government to put this legislation on to the statute book without delay, but not without comment or scrutiny. This is just the beginning of the challenges of the crisis facing our nation and our democracy.

Covid-19: Critical Care Capacity

Baroness Thornton Excerpts

Monday 23rd March 2020 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government, in the light of Northwick Park Hospital’s declaration of a “critical incident” and an increasing number of patients across the UK with Covid-19, what steps are they taking to increase critical care capacity in the NHS.

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

My Lords, Covid-19 is the major challenge of our generation. This Government’s priority is to protect life, which is why we are taking urgent action significantly to increase care-bed capacity throughout the NHS, including freeing up almost a third of existing beds. Yesterday, the Government announced a major deal with independent hospitals. That will add to the NHS’s pandemic response 8,000 hospital beds, 1,200 more ventilators and a significant front-line staff number of 10,000 nurses, 700 doctors and 8,000 other clinical staff.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. It is of course incredibly worrying that, at this stage in the pandemic, Northwick Park Hospital was forced to declare a critical incident over the weekend. That means that it ran out of critical care beds and had to ask neighbouring hospitals to take its Covid-19 patients. It is likely to be two weeks before we may see a steadying of the spread as a result of social distancing measures. If one hospital is already finding itself in such a position, then more might do so in the coming weeks and months. As the Minister said, it is urgent to expand capacity by increasing the number of intensive care beds and ventilators available. Will the Minister detail how many ICU beds and ventilators the Government aim to have in place by the end of the two-week period, at which we hope infection rates will reflect the new measures?

Also, the House may be aware that a fit and healthy 36 year-old nurse is now on a ventilator in Walsall Manor Hospital, having contracted Covid-19. Are the Government confident that the supply of personal protective equipment is no longer an issue after an increase in delivery in recent days and that there are plans to further increase the production of such equipment?

[Lord Bethell]

My Lords, the decision by Northwick Park was entirely welcome, because we welcome the realism and practicality on the part of the management in seeking help when it is needed. We are moving at pace to address the issues around PPE, and I can confirm that there is a massive amount going into the system as we speak. We currently have 3,700 critical care beds; total usage is currently 2,428, of which 237 are Covid-19 related; and our ambition is to increase this dramatically to perhaps 30,000 in time for the crisis arriving in full.

Covid-19: Helplines

Baroness Thornton Excerpts

Thursday 19th March 2020 Lords Chamber

[Lord Bethell]

The noble Lord, Lord Alderdice, is entirely right: one of the features of this virus is its extremely unpredictable nature. The way in which it reacts in different people at different times is extraordinarily diverse. Some people appear to be completely knocked out by it; some have the lightest possible symptoms. There seems to be an alignment with age. We are all enormously thankful that the young and very young seem to be blessed by having the light symptoms. We are all extremely concerned about the old, but it is not even as simple or as linear as that. A huge investment is being put into understanding the virus better. I am pleased to report to the Chamber that international co-operation on that is extensive and positive, and that British researchers are at the leading edge of pulling together that data.

[Baroness Thornton (Lab)]

My Lords, this is a question on co-ordination. Yesterday, I saw the script that 111 is using right now; it was perfectly intelligible and sensible. However, it was out of step with what was on Public Health England’s website. I am sure that is a timing issue but it is rather important, because it will increase anxiety. Moreover, the digital exclusion of the elderly and vulnerable is a really serious problem because suggesting to people that they should go online in the first instance is entirely inappropriate for people who can manage a phone, but that is about it. Many of us are probably related to people in that position, so having plans to deal with that—as suggested by the noble Baroness, Lady Watkins—is very important.

[Lord Bethell]

The noble Baroness, Lady Thornton, is right that the Government have moved incredibly quickly, particularly in the last two weeks. The pace of the virus has been faster than initially expected. The response by some of our international partners has in part conditioned our response, and we are working extremely hard to ensure that all parts of the machine keep up with each other. There will inevitably be occasional glitches, but I pay tribute to the NHS, Public Health England and, in fact, the entire Whitehall machine for moving incredibly quickly and, under the circumstances, demonstrating a relatively high level of consistency in the advice as policy has changed.

Contraceptives and Hormone Replacement Therapy Drugs

Baroness Thornton Excerpts

Wednesday 18th March 2020 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government what assessment they have made of the shortage of supply of (1) contraceptives, and (2) hormone replacement therapy drugs, in the United Kingdom, and when they expect that the normal supply of these products will resume.

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

My Lords, we are aware of ongoing supply issues with some HRT drugs and a limited number of contraceptives. We are sympathetic to those affected. I am pleased to say that the supply situation for HRT started to improve at the end of February and continues to improve during this time. However, we will work closely with all suppliers and share relevant information on availability to the NHS on a regular basis to ensure that patients can access the medicines they need.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. I am very happy that things are improving, because a number of HRT medications and contraceptives remain unavailable until the end of this year, some patients have been told, or until they do not know when. I understand that some of the shortages are triggered by supply problems in China, with some of the components of the popular HRT patches being increasingly in demand for other types of treatment that, in their turn, have become scarce. Of course, one guesses that further disruption in China in the wake of the coronavirus will affect the production and supply of prescription drugs. Does the Minister share my concern that online pharmacies are exploiting desperate women by charging up to four times NHS prices for HRT and contraception?

[Lord Bethell]

The noble Baroness, Lady Thornton, is entirely right that supply problems persist. The NHS looks after 11,000 drugs and at any one time around 100 or 150 have supply problems. It is a great frustration to those concerned and we are cognisant that HRT has been a persistent problem for more than a year. However, the outlook is positive. I reassure the House that Covid-19 has not had an impact on the supply of HRT. We do not envisage there being a connection or a problem. I share the noble Baroness’s concerns that online pharmacies might take advantage of the situation, but it is a marketplace: it provides choice and is regulated.

Covid-19 Update

Baroness Thornton Excerpts

Monday 16th March 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I am very grateful to the Minister for repeating the Statement made by the Secretary of State in another place today. Our thoughts are of course with those affected by coronavirus and the families of the 35 people who have died in the UK and the British citizens who have died overseas.

We understand that the Government’s commitment to ensure the UK’s response to the Covid-19 pandemic is driven by evidence and science, but the Minister must have realised that the public are confused and concerned about the advice that has been given, especially when Governments around the world appear to be receiving and giving their citizens different advice. Surely the answer to this lies with the Government publishing the scientific advice and modelling behind their coronavirus action plan, which would enable experts to analyse, peer review and stress test it.

The Covid-19 pandemic is a global problem that requires Governments to work together. Can the Minister confirm that the UK has access to the evidence and data collected by other affected countries? Does he agree that a global response would give more public confidence? I am not suggesting that the UK is not doing the right thing from our point of view, but it is very important that the public understand why we are doing the things we are doing.

We welcome the update that the Government have already increased the number of tests to 5,000 a day and hope to double this to 10,000. Experts have advised that the most effective way to prevent infections and save lives is breaking the chain of transmission. To do that, you have to test and isolate. The head of the World Health Organization has implored Governments to “test, test, test” and check every suspected case, warning that Governments cannot fight the pandemic blindfolded. Therefore, we are concerned by the Government’s decision that only patients who require hospital admission will be tested for coronavirus. This will mean that only a subset of cases, the most severe, will be identified and we will not know how widespread the infection really is. If our approach is to be science-led, surely data is the key.

The Minister will be aware that NHS workers have also expressed concern about this policy, given that it could lead to staff who do not have coronavirus needlessly self-isolating for seven or 14 days, which would put a further strain on NHS staffing. It could also lead to asymptomatic staff with coronavirus treating frail and vulnerable patients, putting them at further risk. Indeed, there is a petition calling for the prioritisation of testing for NHS staff which currently has over 15,000 signatures. Does the Minister agree that mass testing will allow for valuable insights into the behaviour of this virus? Once testing capacity is increased, will the Government reinstate testing for those suspected of having the virus, prioritising NHS workers, including the cleaners, porters and other essential staff who are needed to keep a hospital running and who play a vital role in infection control? If the Government want to keep key workers at work, they have to make testing available to them. That applies to not only nurses and doctors but teachers and head teachers. It is a nonsense not to do so. Will the Government make tests available to key workers?

Public anxiety has been heightened by Britain seeming to take weaker measures than other countries, confusion over things such as herd immunity and anonymous speculative briefing to the media from government sources. It is unimpressive for the Secretary of State to publish a newspaper article updating us on Covid-19 behind a paywall. It does not smack of a firm communication strategy led by the need for clarity, honesty and reassurance. The Government must provide clear and transparent communication to the public about the steps they are taking to mitigate the impact of this outbreak. This is especially important as the coronavirus curve enters a steeper trajectory, with advice changing rapidly. Just today, the advice has changed for those displaying symptoms to stay at home for 14 days rather that seven. Can the Minister advise us on why the length of time has increased?

We certainly welcome the decision to introduce daily briefings to keep the public informed about what action is being taken to fight the spread of this virus, when certain protocols will be implemented and, perhaps most importantly, why. Will the Government commit to providing clearer guidance for people, including specifying the conditions that may indicate that someone is more susceptible to the effects of Covid-19? The phrase “underlying health conditions” is far too vague and misleading to be helpful, and may cause unnecessary panic and confusion. The NHS website is providing information but I am concerned about how those who are digitally excluded will access it, especially now that they are being advised to socially distance themselves. Will the Government launch a dedicated coronavirus telephone advice line for people? This would be an important source of up-to-date information for many people and would help to alleviate pressure on the 111 service.

Many low and middle-income families will be severely hit by a reduction in income if workplaces shut and they have to take time off sick or need money to respond to the crisis. This morning, Virgin Atlantic asked staff to take eight weeks of unpaid leave over the next three months to help the airline to cope during the pandemic, but that means that those staff will not be eligible for sick pay.

The Prime Minister has now advised everyone to stop non-essential contact with other people by working from home where possible and avoiding pubs, clubs and theatres. Experts have warned that this could push 14 million people who live in poverty into hunger and homelessness, which is why we on these Benches call on the Government to bring forward a package of emergency financial security measures to give people the security and confidence that they need to follow public health advice as part of our collective national endeavour.

The Government have confirmed that the NHS has insufficient ventilators to cope with the number of people who may be admitted to hospital. We certainly welcome the announcement that car makers and defence contractors will be asked to switch production to make medical equipment a national priority. Can the Minister confirm whether it is true that the European Union has passed a regulation so that medical equipment can be exported outside the EU only with special regulatory authority? If true, that would cut us off from a huge number of ventilator manufacturers. What action are the Government taking to increase the number of medical staff who will be trained to deal with respiratory care?

[Baroness Brinton (LD)]

I too thank the Secretary of State and the Minister for the Statement. I also thank the Prime Minister, the Chief Medical Officer and the Chief Scientific Adviser for the press conference earlier, which laid out the new advice that we will have to take into account. I will come to this at the end of my comments, but I note in particular the advice to people over 70 and with underlying health conditions; I have been asking in your Lordships’ House for specific advice for about six weeks now—at last, it is here. A couple of points of clarification would be useful but it is extremely helpful.

I also thank all NHS and social care staff, public health officials in our local communities and other public servants who are all now working above and beyond even the emergency duty. We on these Benches recognise them across the country in everything they do. Our thoughts are with those who are currently ill and the families of those who have died.

I will not repeat much of what the noble Baroness, Lady Thornton, said, but I want to make the point that the past week has seen a big sea change in attitude among not just the public but many experts who may not be epidemiologists but certainly have an understanding of modelling. It is important to keep them onside by making sure that the modelling is published; I echo the concerns that that has not happened yet, although I note that Chris Whitty said that it would become available in due course.

I share the horror at the Daily Telegraph article being behind a paywall. Notably, some of the largest American newspapers are making every single article on coronavirus free so that the public can access it; I wonder whether we could encourage our newspapers to do the same.

On testing, which seems to be the big issue of the day, I had an email from a friend who has been in a hospital in London with a severe case of coronavirus. That person is recovering now, but it was noticeable that there was an astonishing lack of knowledge on the part of paramedics, NHS 111 and others that breathing difficulties were a symptom. It was assumed that she was having a panic attack, although she had never had one in her life before. It was clear that A&E was completely overwhelmed. There was not enough protective equipment, and the doctor who saw her said that when doctors themselves became sick at their hospitals they were told to self-isolate for seven days but were not being tested, so they did not know whether they were immune or infectious.

The doctor concerned was desperate, and said that testing seemed to be happening only in care homes and in hospital outbreaks. The whole system had been overwhelmed. According to the Health Service Journal, the Department of Health and Social Care has said that the regime is set up to provide testing, but at the moment it is unclear how it will be applied. More and more of the people we are asking to go on to the front line are feeling very exposed.

Moving on to some workforce issues, various airline companies have announced that they are in real trouble; I think everybody understands why. And they are not alone. From these Benches, I express real concern about the Prime Minister’s announcement today, in which he encouraged people not to go to clubs, cinemas, restaurants and theatres. That is likely to mean that many of those businesses will not be able to claim on their insurance, as they could if this was an instruction, as opposed to a guide. Can the Minister tell us why the Prime Minister used that framing? It will cause serious problems for many small businesses.

As for other money issues, it is reported that there is a very large drop in donations to food banks. What will the Government do to ensure that the many thousands of people who rely on food banks will continue to get the support they need, when most people are no longer dropping two or three items into the boxes as they leave the supermarket?

There was some debate recently, involving the House of Commons Library, about sanctions for those attending jobcentres. According to the Library report, Will Quince MP had said that there would be discretion, and that people would not be sanctioned as long as they let the jobcentre know before the appointment. There are two problems there. First, if someone is sick they may not be able to call in and spend the hours it takes on the phone to do that. Secondly, if staff at the DWP are ill, there may not be enough people available to take those messages. Surely during this crisis—the Prime Minister has made it plain how severe it is—sanctions should be stopped for everybody.

Finally, on the advice to the over-70s, I am grateful that Chris Whitty said this afternoon that anybody, adult or child, with an underlying condition, including anybody who had had to have a flu jab, should consider taking action, especially if they have respiratory problems. Can the Minister confirm that and make it clear? I understand that the message about flu jabs has just come down from the website, so I am concerned that there will be confusion. There is no doubt about people who are immunosuppressed, but will he please reassure people who use inhalers—that is certainly one of the categories on the Department of Health and Social Care website—that they will be included?

Coronavirus

Baroness Thornton Excerpts

Thursday 12th March 2020 Lords Chamber

[Baroness Thornton (Lab)]

I am grateful to the Minister for repeating the Commons Statement and updating the House this morning. I repeat my noble friend Lady Wheeler’s congratulations to him on his—slightly overdue —promotion to Minister.

Our thoughts and condolences are with the loved ones of the eight people who have, sadly, lost their lives because of this virus. Of course we also join the noble Lord in giving our best wishes to the Parliamentary Under-Secretary of State and to her staff in her department, private office and parliamentary offices, who I am sure will be worried as well. We are now learning that there may be another Health Minister and a couple of MPs self-isolating right now. I also thank the Lord Speaker for keeping us so well informed throughout.

I declare my interest as a member of a local CCG and a health and well-being committee, as in the register. Can the Minister explain what the advice is for those who work on this estate, feel ill and present symptoms, but have not, as far as they are aware, been in contact with the Parliamentary Under-Secretary, for example, or one of the MPs? Should they be tested as a matter of routine?

I also thank the Minister for the advice he has provided on the operation of Parliament. It is quite right that we continue to raise issues on behalf of the public, hold our Government to account, and send a message that we are here to both support and question. We welcome the opportunity to discuss emergency legislation, and I look forward to the Minister inviting a cross-party group of us, as we would normally have in this house, to participate in those discussions in due course.

The Minister knows that we support the actions of the Chief Medical Officer and strongly agree that we must be guided by the science. However, I press the Minister further on the epidemiology and latest medical advice about whether we should move from the containment to the delay stage and adopt further social distancing strategies. What is his response to those who suggest—the editor-in-chief of the Lancet, for example, and others in the global science community—that we are not following the epidemiology in the way we might and are placing too much emphasis on behavioural science?

There are countries taking different approaches across the world. Last night, Atlético Madrid fans arrived—and, as it turned out, celebrated—in Liverpool at a game which would not have been held in Madrid due to social distancing procedures. Can the noble Lord please explain the thinking about why we are not taking more stringent social distancing measures? I have gathered from social media, literally just now, that the Republic of Ireland has decided to close its schools.

We welcome the extra funding for the NHS and social care announced as part of the Covid-19 response fund in the Budget. It is, of course, what we all expected to happen. Are representatives of the Local Government Association and the social care organisations at the table when emergency measures and expenditure are discussed? How will this money be allocated and what will happen when it is depleted? The NHS is seeking to scale up the number of intensive care beds sevenfold. At some point, the fund will need topping up and I hope we will not have to wait until the spending review process in the summer.

The Minister knows that on these Benches we are keen to be supportive, but it is hugely disappointing and astonishing that we still have no clarity on public health funding. I spoke to a director of public health yesterday, and asked if they have their funding agreement, which starts in April. They do not. This is a matter of extreme urgency, so I ask yet again: when will the directors of public health responsible for the coronavirus multi-agency responses know what their allocations will be for the financial year starting in April?

We need to do all we can to support NHS and social care staff, so may I specifically ask about care homes? The NHS Confederation has called for the suspension of Care Quality Commission inspections. Care homes face huge challenges protecting their frail, elderly residents, and chronic staff shortages will be exacerbated by absences if staff contract the virus or need self-isolation. Does the Minister agree, given the circumstances, that the NHS Confederation’s request to suspend those inspections and scale them back is sensible?

I want to ask the Government two more questions. First, do they recognise the burden and risk that the pandemic poses to our charitable and voluntary sectors? Not only will they be expected to deliver support and care during the next few months, but many will see a massive reduction in their income. At the local level, community organisations that care and cater for many different groups, or run cultural, art and community events are all at risk. They will not be able to undertake normal fundraising events, runs, collections and so on. Has any consideration been given to the effect on this important part of our civic infrastructure and how best it can be helped to survive this too?

Secondly, in my work as a member of a CCG, I have picked up reports that communications at the moment may not be working as well as they might be. They seem to be working from the centre down but, at the local level in boroughs and towns, it is the GPs and people working at the front line who need to be absolutely clear about what is expected of them. There are numerous and growing reports that the 111 service is struggling, with delays in responding to emails and organising testing, as well as very long delays in answering the phone. I therefore raise again with the Minister that we need more clarity, more communication and greater accuracy, which I hope is going to happen very soon.

Covid-19 is now an official pandemic as designated by the World Health Organization, and we all have to do as much as we can to help to contain this virus and stop its spread. The Government have our continued co-operation because public health, well-being and safety must come first.

[Baroness Brinton (LD)]

My Lords, I echo the thanks of the Official Opposition to the team for the briefings with Chris Whitty, and indeed for the communications from the Lord Speaker and other staff in the House to keep not only Peers aware of what is going on but the wider staff in Parliament. That is absolutely vital and reassuring.

I want to pick up on the point that has been raised about whether we are in delay or not and the difficulties over the past three or four days, where both Chris Whitty and his deputy CMO have said publicly that effectively we are in delay. We know that this is a transition, not a drop-dead moment—