Covid-Secure Borders

Ben Spencer Excerpts

Tuesday 15th June 2021 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

We are an island nation, and we rely on our connections with the world for trade. I am sure that many Members would, like me, celebrate and congratulate the Government on the historic trade deal that was agreed today. We rely on our connections to get freight and to meet our friends and family. Many businesses and jobs rely on international travel. In my constituency of Runnymede and Weybridge, it is our lifeblood. We depend on our connections, both domestic and international, for jobs and to support businesses.

I therefore reject the premise of the motion that the Opposition have put forward today. They would have us isolate from the world as if we were some sort of zombie island—or maybe a zombie world, depending on how one views the analogy. For all the reasons that I have put forward, we cannot do so, because we are so dependent on our connections.

Our approach must be proportionate. It must be based on science, not on the false “no risk/high risk” dichotomy that has been presented. Covid is here to stay, and with new variants continuing to evolve, we need a system that is immune to them and that can adapt and evolve as the virus does. The Minister and I have had many discussions about the need for international safety standards and the fact that we can, should and must lead the world in supporting international travel—through whatever means, but fundamentally through the use of science and new technologies.

The Opposition’s proposal is backwards. It is built on a world where there are no vaccines and where there is no testing. Our plans have moved on. We have the science behind us, and our border plans are the foundation for safely bringing back international travel as things develop.

A Plan for the NHS and Social Care

Ben Spencer Excerpts

Wednesday 19th May 2021 Commons Chamber

[Matt Hancock]

Well, it did not actually, because after 2010 we then had to bring waiting lists down, and we brought them down. The 52-week waits came down to just 1,600 before the pandemic, and it is our task and our mission to make sure that we get them down once again. However, this will take time and it will take all the resources that are possible—yes, extra staff, and that is happening; yes, extra capital investment, and that is happening; and yes, extra diagnostics, and that is happening. We have to use all the capacity of everything that we can—north and south, revenue and capital, public and private. What people care about and what our constituents care about is whether they can get the problem fixed, and last year has demonstrated that without doubt. So on the Government side we will use everything in our power to support the NHS. It is only those on the other side of the House who have the ideological divisions, and that just demonstrates once again that we are the party of the NHS.

In March, we committed £7 billion for further funding for healthcare services, including £1 billion to address backlogs from the pandemic, and that has taken our additional funding for covid-19 to £92 billion. We are also helping the NHS to recover medical training, and today I can confirm to the House an additional £30 million for postgraduate medical training. The formula for beating this backlog is looking closely at the demand as we emerge from the pandemic, putting in the right resources to meet this demand and putting in place an ambitious programme of improvement in the NHS.

That brings me to the third thing I want to talk about, which is how we are going to build back better. The Queen’s Speech outlines improvement in almost every area of healthcare, applying vital lessons that we have learned from the pandemic, including from the successful vaccination programme, when the whole health and care system has worked as one in the face of challenge and adversity. The vaccination programme brought a jigsaw of academics, the private sector, volunteers, the NHS, civil servants and many more, and put this together, revealing a bold picture of what is possible in this country when we pull together. That is the spirit and the energy that will underpin our reforms, and all of them have a common thread, which is to improve the health of the nation, based on the principle that prevention is better than cure.

Turning to our health and care Bill, as outlined in Her Majesty’s most Gracious Speech, one of the lessons of the crisis is the importance of integrated working. We knew this before, but it has come right to the front of mind. For years, people in the NHS at all levels have called for stronger integration within the NHS, and between the NHS and others they work so closely with, such as local authorities. The Bill will allow for a more preventive, population health-based approach to how we spend NHS money, helping people to stay healthy in the first place, and that is at the core of our Bill.

The right hon. Member for Leicester South asked about the new integrated care systems. They will bring together decision making at a local level between the NHS and local authorities to ensure that decisions about local health can be taken as locally as possible. The Bill will tackle much of the bureaucracy that makes it harder to do the right thing and free up the system to innovate and embrace technology as a better platform to support staff and patient care.

Her Majesty also set out our commitment to reform adult social care, and we will bring forward proposals this year to give everyone who needs care the dignity and security they deserve. Throughout the pandemic, we have sought to protect the elderly and the most vulnerable, and this will remain our priority as we look to end the care lottery and ensure that people receive high-quality, joined-up care.

This country understands the importance of the NHS and social care, but I also think that there has never been a greater appreciation of the importance of public health. Never have the public been more engaged, and never have we learned quite so much in such a short space of time. We must capture the lessons of the pandemic on how we do public health in this country and put that together with the innovations of the last decade—in data, genomics, population health, science and research.

One of the lessons that we have had to learn quickly is that health security and health promotion each need a single-minded focus. The people who get up in the morning and think about how we increase healthy life expectancy must be different from the people focused on fighting novel pandemic threats. Each is important and each needs dedicated focus. We have split these functions into two purpose-built organisations so that we are better at both.

The new UK Health Security Agency will have a dedicated focus on responding to the current threats, planning for the next pandemic and scanning the horizon for new threats in good times as well as bad. Of course, pandemics do not respect administrative boundaries. The UKHSA’s role is specifically to promote and protect the security of the United Kingdom as a whole.

Next, the job of our new Office for Health Promotion will be to lead national efforts to improve and level up our health—addressing the causes of ill health, not just the symptoms, such as through our plans to tackle obesity and make healthier choices easier and more accessible, and through supporting our colleagues in primary and community care. General practice, after all, is at the forefront of all population health measures and GPs are the bedrock of the NHS. General practice will be central to our levelling up the health of the nation because we know, and they know, that prevention is better than cure. A greater proportion of our efforts will now be directed at preventing people from becoming patients in the first place.

All of that brings me to mental health reforms. To truly level up health and reduce health inequalities, we must level up every part of our health, including mental health. I am determined to see mental ill health treated on a par with physical ill health, and to ensure that support is in place for those struggling with their mental wellbeing. We have provided record levels of funding for mental health services, especially to meet the additional burdens of the pandemic, but we need a better legislative basis—a mental health Act fit for the 21st century.

We are modernising the Mental Health Act to improve services for the most serious mental illnesses and support people so that they can manage their own mental health. The new Act will tackle the disparities and iniquities of our system and improve how people with learning difficulties and autism are supported. Ultimately, it is going to be there for every single one of us if we need it.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

I know that my right hon. Friend shares my passion for legislative reform of the Mental Health Act. We go through this process every 20 years or so. I was wondering whether he could unpack how this will go forward, bearing in mind the need to get the law right while delivering it very quickly so that patients get the benefits.

[Matt Hancock]

My hon. Friend has enormous expertise and wisdom in this area. He is right to make the argument that we need to support everybody’s mental wellbeing, but that we also need a specific focus on very serious mental ill health, much of which has been, in many cases, exacerbated by the privations that have been necessary during the pandemic. He says that this is a process that happens once every 20 years, but it is almost 40 years since we had a new mental health Act. We want to do this with stakeholders on a consensual basis—I am very glad to hear the reiteration of cross-party support just now from the right hon. Member for Leicester South. Our goal is to bring forward a draft Bill in this Session and a Bill potentially in the next Session, so that we ensure it is legislated for during this Parliament. That is a timetable on which we have worked with the many experts who have informed the process, led by Sir Simon Wessley, of course, whose report sparked off this work. I look forward to working on that with him and the Minister with responsibility for mental health, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries).

Coronavirus

Ben Spencer Excerpts

Thursday 25th March 2021 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con) [V]]

This past year has been incredibly difficult for all of us, and I would like to start by paying tribute to the people of Runnymede and Weybridge for their boundless resolve and community spirit, and remembering those who have lost their lives as a result of the pandemic.

Many of my constituents are hurting. The pandemic and lockdown have hit us hard. Many have lost their jobs and many are desperate to see their loved ones. The road map and the fantastic vaccine roll-out bring those most valuable of commodities, certainty and hope—something to look forward to that life will get better. I want to go faster, but I also agree that the need for irreversibility and certainty weighs heavy. I will therefore support the regulations we are voting on today, but I must reiterate that every day we have the restrictions in place they are causing great harm. The Government should move heaven and earth to lift them as soon as possible.

In the brief time I have in this debate, I want to talk about the broader provisions of the road map. As with all discussions on the coronavirus regulations, they are only half the story. We talk a lot about the new normal and the return to normal life after the pandemic. The road map charts out the plan for the lifting of legal restrictions, but not the return to normality. Covid has changed many aspects of life and I have been calling for a long-term plan for living with the virus. I am pleased that the road map starts to tackle that through the four reviews on: large events, covid certification, international travel and social distancing.

Those four reviews will do all the heavy lifting. They are critical to setting out what our post-pandemic covid world—our endemic covid world—will look like after June. When legal restrictions lift, the impact of the recommendations will still be felt. They will have a far longer lasting impact than what we vote on today. They will form the basis of what the new normal will be on a huge range of issues that impact on daily lives, from social distancing requirements in pubs and restaurants to the wearing of face masks, self-isolation and contact tracing.

I ask the Minister, in his closing remarks, to clarify that we will get to debate in the House the outputs of those critical reviews—the Government’s endemic covid road map, as it were—and that we will be able not just to vote on any resulting legislation, but to approve any formal guidance and provisions resulting from it.

Covid-19: Government’s Publication of Contracts

Ben Spencer Excerpts

Tuesday 9th March 2021 Commons Chamber

[Edward Argar]

The right hon. Gentleman highlights quite accurately the 94%, which was cited in the subsequent judgment and the order that flowed from it, of the contracts that were late in publication. We accept that that is a statement of fact. The Department has published 100% of the CANs that it is obliged to publish that are related to this matter. He talked about a percentage that were procured without following a normal competitive tendering process—I think he referred to 58% as the percentage that were procured. That is entirely appropriate under regulation 32, recognising the situation we faced at the time and the priority of this Government to make sure that, at pace, we got the PPE that our frontline needed to keep it safe.

On his final two points, I do not see in the judgments in this case or in any of the other scrutiny of this issue by Committees of this House or other organisations anything that asserts or finds that inappropriate conflicts of interest influenced how these contracts were awarded. I am proud to serve in a Government led by a Prime Minister who leads from the front and has done whatever is necessary to make sure this country gets through this pandemic.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

This time last year, there was a desperate need to secure PPE urgently when, almost overnight, it became one of the most hotly sought-after commodities globally. I congratulate the Department on its Herculean efforts to keep my residents safe and get them the PPE they needed when the shortage hit. Of course, delays to publication are not ideal, and I am glad that the Department is urgently trying to resolve that. Does my hon. Friend agree that, as part of the review into the pandemic, we need to look at how procurement procedures can be improved when responding to a national crisis or, indeed, future pandemics?

[Edward Argar]

I pay tribute to my hon. Friend for his work on this issue; he is a strong and vocal champion for the NHS and those who work in it. The context he sets is absolutely right. I will quote from the summary of the NAO report without making a value judgment on it. It highlighted in paragraph 2:

“Demand for PPE rocketed in England from March…There was also a surge in demand in other countries. At the same time, the global supply of PPE declined as a result of a fall in exports from China (the country that manufactures the most PPE) in February.”

That is a statement of fact, and it highlights the context in which we were operating.

My hon. Friend is right: all Governments should rightly look at what they have done and what lessons they can learn, to ensure that they are well prepared for future events.

NHS Staff Pay

Ben Spencer Excerpts

Monday 8th March 2021 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

I draw the attention of the House to my entry in the Register of Members’ Financial Interests and to the fact that my wife works in the NHS. NHS staff pay is and always will be a highly contentious issue—it was contentious during the junior doctor contract debate and we do not need the back end of a pandemic for it to be so at the moment—because of the mere existence of national pay contracts, pay awards and review bodies. As part of the implementation of the changes proposed in the future of health and care White Paper, will my hon. Friend view alternative models that allow decisions on individual staff pay to be set by local employers, such as NHS trusts themselves, so that they can be best suited to the employees and the services they work for?

[Helen Whately]

I thank my hon. Friend, who makes a really important point. The balance between nationally set pay and local pay has been a point of much debate over the years. There are pros and cons to both ways. We do not want to have trusts competing directly all the time for workforce, but on the other hand there are higher costs of living, for instance, in some areas. That is why there is some flexibility in the system for different levels of pay according to different areas, as he will well know, and some extra support in areas where it is hard to retain staff. I always to listen to his expertise, which I really value.

Covid-19

Ben Spencer Excerpts

Monday 22nd February 2021 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

I welcome the road map announced today, particularly the return to school on 8 March, the clear vision, the refutation of a zero-covid strategy, and the commitment to a steady and irreversible lifting of restrictions. This will bring added certainty and hope to many of my constituents.

Our local roll-out of vaccinations in Runnymede and Weybridge has been fantastic. Vaccination hubs have opened at Chertsey Hall, Egham Hythe and St Peter’s Hospital. Each and every one of our volunteers and staff at these sites are saving lives and getting us all one step closer to the lifting of restrictions. I thank everyone who has worked and continues to work so hard in our vaccination hubs and everyone who helped out or volunteered in the recent surge testing in Egham.

The road map charts a course to lifting the restrictions on the back of the vaccination programme, and it promises that the process will be irreversible, but I hope that the Minister will not think me churlish in asking for another plan—a long-term plan to enable us to live with the virus and support the NHS as it faces the major challenges on the horizon, in particular the coming winter pressures.

It is increasingly clear that covid is a seasonal disease, like other coronaviruses. Winter pressures have plagued the NHS for pretty much every year that I have worked as a doctor, but this autumn and winter will be different. The NHS has reduced hospital capacity as a consequence of social distancing in hospitals, the increased need for infection control measures such as testing and the burden of cleaning and PPE on throughput. Even if the number of patients needing to be hospitalised with covid this winter is radically reduced—and we all hope it will be— the NHS will still face normal winter pressures from diseases such as flu and pneumonia, but with reduced capacity as a result of its covid infection control measures.

I asked my local hospital, St Peter’s, what it needs to increase NHS surge capacity—is it more money, real estate or oxygen? It says that the limiting factor is more trained staff, which I am sure is the case in many of our hospitals. The NHS and our staffing plans were not designed for surge capacity in a pandemic or when recovering from one; why would they be? While the road map focuses on what we need to do to reduce the number of patients who need to be hospitalised, we also need to think of the other side of the equation: how to increase overall NHS hospital capacity—not just surge capacity for covid, but capacity for all care in a post-covid world. While I welcome the announcement of increased nursing applications over the weekend, we need these nurses now. We know that winter pressures are coming later this year. What do we need to do now to prepare us, so that we can live with this virus for the long term, as the road map charts, and prevent any prospect of future restrictions?

Public Health

Ben Spencer Excerpts

Wednesday 30th December 2020 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

Naturally, my constituents and I are disappointed that we were placed in tier 4 and at the short notice of the changes. Of course it is right that in the face of changing facts the Government respond quickly and decisively, and while I regret that we have not been able to debate the tier 4 restrictions sooner, I am glad that Parliament is here now and that we are debating the changes today.

There have been two huge developments in the last fortnight in terms of the pandemic and our response to it. One is the emergence of a new strain of covid that is more infective and that is thwarting some of our measures to contain it, and the other is the development of safe and effective vaccines that can be deployed at pace. I am sure that everyone in the House will celebrate the success of the British science and research that led to the development of the Oxford/AstraZeneca vaccine and of the genomics surveillance that made possible the early discovery of the new variant of covid. It is the Government’s long-term planning that led to our procuring the vaccine in advance, so that we are now best placed to deliver it at pace to our population, and it is science that led to the reduction of the self-isolation time, reducing the impact of infection control measures and making it easier for people to follow them.

However, amidst this positive news, the evidence that the new variant is much more infectious is concerning indeed. It raises serious concerns about the effectiveness of our previous tiers and the individual restrictions in reducing rates of infection and ensuring that they do not spiral out of control and overwhelm NHS capacity—and this is all about NHS capacity. We therefore need to take stock in the context of a rapidly changing situation, with rates increasing in front of us, and urgently research this new variant and the impact of the measures needed to control the rate of infection.

While I am disappointed that my constituency has gone into tier 4, we can all see the pressure that the NHS faces at the moment, we can see the impact of the new variant and we can see our rapidly expanding vaccination programme, which, after today, will really take off. As a doctor, I was always taught to look at every intervention in terms of the risks and the benefits, the costs and the harms. I have been calling for a cost-benefit analysis of the suite of individual restrictions that we and all our constituents have to face. Clearly, the facts that I have just laid out radically shift the cost-benefit ratio faced by our constituents and our country, which we have discussed in this place at length. A change in the facts can, and in his case I believe must, force a change in response.

I support the restrictions that are coming into force, but they will not be without their own harms, which need to be mitigated until the restrictions can be lifted. I wish to talk in particular about uncertainty. I have had many meetings with constituents who work in a range of sectors that are directly impacted by the restrictions. I have spoken to Runnymede and Weybridge’s businesses, publicans and gym owners and to people who work in events, corporate events and weddings—the list goes on—and the message from each is clear: the uncertainty around the restrictions and all the opening and closing is one of the most difficult challenges that they face. My local school leaders tell me that they can prepare and handle anything for the good of their pupils and students; they just need time to put in the contingency planning so that they know where they stand.

Uncertainty is not just harmful for business but detrimental to us all. We need to know, and see, how and how soon we can get out of this situation and when we will be able to see our friends and family again and to reopen those businesses that have shut down. A vaccine is here and about to be scaled up, so as we start to plan for a future when the pandemic is behind us, will my hon. Friend the Minister chart and publish the plan out, detailing in granular detail how many need to be vaccinated and what impact that will have on lifting the restrictions, and show my constituents in Runnymede and Weybridge the road map through the pandemic to the other side and the end of the restrictions that we have brought in to mitigate it?

Covid-19 Update

Ben Spencer Excerpts

Thursday 26th November 2020 Commons Chamber

[Matt Hancock]

Of course we have been engaging with the team who work across London. There is a lot of work to do in London. There are parts of London where cases continue to rise, and we need to get that under control, but there are also parts where they are falling and things are very much going in the right direction. Likewise, there is pressure in some parts of the NHS, but there is a lot of mutual aid within the NHS across London. There is a lot of work to do in London to keep it in tier 2, and I look forward to working with the hon. Lady and other London colleagues on that.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

People living in Runnymede and Weybridge often ask me on what basis we are subject to local tiers and to restrictions, and it is clear that, alongside the data, other factors are taken into account in the two decisions. I thank my right hon. Friend for his response to the question from my hon. Friend the Member for York Outer (Julian Sturdy) that the reasons and the data will be published. Will local hospital bed utilisation be part of the reasons published?

[Matt Hancock]

Yes. There are five indicators that we take into account in deciding on which tier. One is pressure and anticipated pressure on the local NHS, and bed occupancy rates are of course a critical part of that assessment. I know that people are looking for a clear numerical boundary between the different tiers, but because we are looking at five different indicators rather than a single one, there is no automatic figure at which a different tier is triggered. We have to look at all the circumstances, including, for instance, outbreaks. Some cities, on their pure numbers, would be in tier 3, but because an outbreak is specific—for instance, in a school or care home—it is appropriate that they are in tier 2. We have to look at these very localised issues as well, and that is why the engagement with local directors of public health is so important.

Covid-19

Ben Spencer Excerpts

Wednesday 18th November 2020 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

The announcement of the preliminary results of the effectiveness of the Pfizer and Moderna covid vaccines is great news, a ray of hope at a time when we are tired, weary and going through a second lockdown. There are still many questions, but the direction of travel is a good one.

I will talk in a moment about the many challenges ahead, but before then I want to point out that this Government are unrivalled in their support of research and innovation. They have led the world in funding and promoting efforts to find treatments and vaccines, and it is this Government who are already laying down plans to deploy a vaccine. After further analysis and the results from the vaccine trials come good, it will still take some time until we are on the other side of this. Depending who you listen to, life can be back to normal by spring, by summer, by winter, by next year. We simply cannot yet know, and while now we have reason to be optimistic, none of this helps those struggling now.

Lockdowns are incredibly damaging and the lockdown itself will have a cost in lives in the future. We need to think where we will be after six months more of this. The Scientific Advisory Group for Emergencies does not consider the economic impact of its recommendations, which is a substantial limitation. The economic impact will cost lives through diseases generated through poverty. Our public services are built on the back of a strong economy.  Economic damage means less money to invest in medical care and treatment, in community services and in education, again with a cost in lives and quality of life.

Decisions are being made on epidemiological scientific information alone. Although we have been able to see interpreted data—I thank the Government for making experts available—we have been unable to interrogate SAGE and the modellers directly or to see economic impact assessments. The Government’s decision making is rightly based on the science. As any scientist knows, scientists disagree all the time. We need to be able to hold Ministers to account and to interrogate the scientists advising them.

I therefore support calls for a covid commission to take an overall view of all the features of the covid response, but again, that does not help those affected now. We will need to make more difficult decisions over the next few weeks. Lockdowns and restrictions, like all interventions, are a tool—one that has great side effects but, deployed cautiously when necessary, can prevent the NHS from being overwhelmed. Just like in any discussion about a potential treatment with a doctor, before someone consents, they need to know the risks and benefits. That is why we must see clearly the projected harms and benefits before we make any decision.

We are told that there is no alternative, but with potential vaccines around the corner, we will be living with covid and its impact for some time. We cannot simply ask those who are struggling to wait just a bit more, just a bit more, just a bit more, so we need to have now an enduring plan to live with the virus.

Covid-19

Ben Spencer Excerpts

Thursday 22nd October 2020 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

We face a difficult winter. Many areas of England are under heightened restrictions, including Elmbridge, part of which forms part of my constituency. We face the national challenge of a new disease, with a population that is largely unexposed to it and has built no immunity to it through either prior infection or other means, such as vaccination. It spreads easily and quickly, and can make people in high-risk groups, particularly the elderly, seriously ill. It can spiral out of control and overwhelm our health service.

I supported the first lockdown and I support the current restrictions. As an NHS doctor, I say with all my body and soul that we cannot let the NHS be overwhelmed. But lockdowns and restrictions are deeply harmful in themselves. The long-term effects will be profound—a higher burden of disease from poverty, with associated costs in lives; loss of livelihoods; misery and damage from isolation, and reduction in liberties. We need a way out.

My constituents are feeling it—especially those who are now in tier 2 restrictions in Elmbridge—and I pay tribute to them for their resolve. They rightly ask me, “What’s the way out? How does this end? How do we escape the cycle of lockdown?” The current strategy is to suppress until there is a vaccine, but what if there is never a vaccine? As people start to tire of lockdown, increasing coercion and punitive measures are being put in place. On my commute from Runnymede and Weybridge, I travel to Waterloo station, and I have seen the signs there change—from a £100 fine for not wearing a face mask, to £3,000, to £6,000—in the course of a few months. It is inevitable that greater coercion will be needed. When does that stop?

Coercion is illusory. It works briefly, but after a while it fails, unless we take people with us and they own the decision. Of course, in a public health response to an infectious disease, we cannot have a free-for-all, but at the same time, in my constituency, I see people at low risk from covid who ignore the guidance because it will not directly affect them and all they see is harm from restrictions. I see people at high risk ignoring guidance because life is short and they want to see their grandkids. I see people terrified of covid hiding away from the world. Day in, day out, people make decisions about their health risks, such as to smoke or not to smoke—indeed, given that 76,000 people die every year from smoking, probably more people have already died this year from smoking than from covid. People decide whether to put salt on their chips, or not to eat chips. We all make compromises and trade-offs, but rather than the state deciding those trade-offs, we must find a way to let people decide their own.

[Chris Bryant]

Is not the problem that whether I choose to have salt on my chips is a matter for my health, but when I take risks with covid, I take them not just for myself but for everybody else with whom I interact, and for the whole of society?

[Dr Spencer]

I thank the hon. Gentleman for his intervention, and I will come to precisely that point in due course.

I supported the first lockdown, and I support the current restrictions, but we need a way out that works, irrespective of the invention of a vaccine. We need a way out that supports people to take their own decisions and respects free choice but, as the hon. Gentleman said, we must also protect society from an infectious disease. Such a system needs to be sustained for a long time, and those measures will need to be in place for a long time.

It is easy to criticise, but it is more difficult to put forward other options. We therefore need a debate about what a plan B could look like. We started with a national lockdown, but that was too blunt. We rightly moved to targeted measures, which are better, but still not great. The geographical area is too large, and people do not live their lives by local authority boundaries. The next logical step is to shrink the geography further—to the household or individual—and to have a system that allows people to make decisions for themselves regarding their own risks and the people they come across socially or at work.

We must use our testing capabilities in a targeted, risk-based manner, so that those at high risk, should they choose to, can shield and have support to do that. Those at low risk would be able to live their lives more freely, should they choose to do so. At the same time, we must ensure that things do not spiral out of control, with broader measures and restrictions available in reserve if needed. We must invest in our NHS surge capacity, and carry out research into vaccines and treatments.

The challenge, of course, is how we support those at medium risk, or those who live or work with high-risk individuals, and we need to have that debate. Lockdowns are not a cure for covid. They only regulate the pressure on the health service and, important as that is, in time they can, and will, be worse than the disease itself. We need to have that difficult debate and there is no easy solution. While I suggest that we wait for the phase 3 trials of vaccines, which come out imminently, we must start putting flesh on the bones of a plan B, based on individual choice, and consider a pilot in the UK. To get through this pandemic, whatever we do will be difficult. Difficult decisions have to be made, and more difficult decisions remain to be made.