Covid-19 Update

Lord Bethell Excerpts

Wednesday 23rd September 2020 Lords Chamber

[Baroness Barker (LD)]

My Lords, three months ago the Secretary of State said that test and trace was the single most important thing that had to be done to conquer the virus. Yesterday the Prime Minister said it had “little or nothing” to do with the transmission of the virus. These two things cannot both be right. For six months, the problem has been that we have had confused messages, careless use of statistics and a persistent refusal to work with and listen to people who run local public services and know what needs to be communicated to whom and how.

All those are the fundamental reasons we find ourselves in this situation. We still lack an effective and timely track, test and isolate system. In its place and without any evidence base behind them, we have come up with messages which, quite frankly, do not make sense to the general public. The rule of six does not make any practical sense at all, as was very well evidenced today by my noble friend Lord Newby in an earlier interaction with the Leader of the House.

Yesterday, the Prime Minister said the Government now had granular data that enabled them to understand the transmission of the virus. When will that evidence be released? And when will it be released to Members of this House and the other place, who, next week, are going to be asked to renew emergency powers the like of which have never been seen before to this Government? If the Government cannot come up with that evidence—and, I have to say, over the last six months, they have persistently failed to answer any kind of detailed question from Opposition Benches in this House—why on earth should they be trusted to have those powers renewed? When are we going to get the evidence base?

It is helpful, looking at the Secretary of State’s Statement, to see that finally, after repeated questions from these Benches and the Labour Benches, we have got a clearer statement on who is being prioritised for testing and in which area. But, as the noble Baroness, Lady Thornton, said, it is remarkable that there is nothing about black and minority ethnic communities, which we know are at greater risk, and nothing about the important people who work, for example, in domiciliary care, or who work in hospitals but are not medics.

I would like to ask one final question. When will they start listening to local authorities, who are persistently asking, in helpful ways, what they can do to expand the capacity for testing and to make sure that testing is better tied into the rest of the services? We are about to have an app launched, and local authorities are already telling us that there is soft intelligence that people who think they have symptoms but are unable to get a test just give up, and that people whose children are ill give up. It is all well and good for the noble Lord to say, as he did the other day, that they are going to completely redo NHS 111 to make it a more streamlined portal into the NHS, but if people have given up looking for tests long before they should, we are never going to get the data we need to get on top of this.

So I ask, as I did the other day: when they are revamping NHS 111, will they talk to the Royal College of Paediatrics and Child Health about the NHS 111 protocols? I agree with the noble Baroness, Lady Thornton; I think the public are desperate to do the right thing. They have been extraordinarily patient and have listened throughout, giving the Government the benefit of the doubt. But they will not go on doing that indefinitely while the Government continually fail to come up with a decent evidence base for their actions.

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

My Lords, I am extremely grateful to the noble Baroness, Lady Thornton, for correctly characterising our response to the epidemic as “the best compromise possible”. It is a compromise. We have competing demands on our strategy: we have to protect lives and the NHS, but we also have to be conscious of the economy and the livelihoods of people, and we have to look after our students and pupils. The package of measures being put forward by the Government is the best compromise we can make for this moment, and we are unashamed of that compromise.

But the noble Baroness is wrong when she says we do not have a strategy. The strategy is really clear; it is to suppress the virus and protect the economy and education until the vaccine and mass testing are ready. It may not feel like it now, but there are glimpses of sunlight in the distance. The vaccine and mass testing provide a strong opportunity for us to suppress the virus. The strategy that we have put in place, as the Prime Minister rightly described in his address to the nation, is a way to “get through the months” until we have those arms at our disposal.

Both the noble Baroness, Lady Thornton, and the noble Baroness, Lady Barker, talked about the publication of data. I must confess that I have a genuine sense of confusion about that point, because we publish so much data. If there is one thing that this Government have got wrong, it is that we have published too much data too early. Too much has not been audited; too much has been put out as early as possible in our efforts to be transparent. Tomorrow, we will have a REACT survey; we will have an ONS survey; we will have test-and-trace data. There are SAGE minutes; there is NIHR; there is literally data coming out of every organisation of government. It is a fantastically huge amount of data. It is, I confess, extremely difficult to process all of that data all at once. The story it tells does chop and change at an amazingly fast rate—much faster than any experience I have ever had in my life. It is a rollercoaster that the Government have to ride.

I make no apology, however, for the fact that this Government have sought to act swiftly and to bring in measures quickly when the evidence has changed. In the last few weeks we have seen the latest example of that, where the infection rates have clearly lifted quickly in a way that was not expected, and we have had a discussion about that point in previous sessions in the Chamber. We have moved promptly to address the challenge that those worrying and concerning figures have presented to us.

The noble Baroness, Lady Thornton, raised the question of testing. I completely and utterly acknowledge the frustration of anyone who has not been able to get a test for themselves, for their child or for a loved one. It is true that we have more people wanting tests today than we have supply. However, I cannot avoid pointing out that—boy oh boy—we have come a long way since February, when we were doing 2,000 tests a day, to today, when we are doing 240,000 tests a day, and we are well on the way to doing 500,000 tests a day by October. Our aspiration is to do many times that within the near future.

That is not in any way to avoid the fact that I wish that we had more tests today. I want to convey to the House that this Government are 1,000% committed to answering the needs of this country for testing and have put every resource—human, technological, administrative and financial—behind the testing programme in order to deliver that promise.

The noble Baroness, Lady Thornton, raised the question of tone. I completely accept her point that the people of Britain have made a terrific sacrifice. There is no question at all of blaming the people of Britain, but we have to acknowledge that the spread of the virus indicates as a fact within itself that some people are not respecting the principles of social distance, hygiene and isolation, and we have to move in order to shore up the basic principles of this country and, by the way, of any country that is effectively fighting the virus—because, if we do not, the virus will sweep through the country.

I thought that the Prime Minister put that challenge very well, and in a way that a large majority of this Chamber would support. He said that the choice was before us: we could ask those who are vulnerable and older and shielded to simply lock the door and we could turn our backs on them. That is not the choice that this Government have made. They have made a choice to fight the virus at every level, because we love the people whom we care about; and it is a pragmatic choice, because if we find the virus growing in one part of our society, whether that is young people, health workers or the very young, then sure as night follows day, it will sweep through the rest of society.

I turn to the evidence on the curfew. This is a moment where I do not have the science at my fingertips. However, I have been in pubs and clubs after 10 o’clock enough times to know about the proximity and intimacy of late-night drinking, and I know that what happens then is not conducive to social distancing. This is a moment when plain common sense can tell you that a curfew will help to break the chain of transmission among young people. It is, unashamedly, a signal that we cannot go on like this and, in particular, that young people have to change their behaviours because the signs of infection are crystal clear. The prevalence among young people is too high, and we have to turn that corner.

The noble Baroness, Lady Thornton, asked about symptomatic and asymptomatic testing. The honest truth is that it is very difficult to tell; if someone is standing in a testing queue, we do not turn them away. By the way, in order to get a test, people do have to fill in a form, on which they are asked if they are symptomatic. What we do know from closer analysis and questionnaires is that a proportion of testees—between 20% and 25% at current rates—do not meet the strict criteria of our testing. I am grateful to the British public for beginning to show respect for the fact that every test counts, and for helping us direct them at the most needy.

The noble Baroness, Lady Thornton, asked about domiciliary care, an issue that has been raised in this Chamber a few times. I reassure all those in the Chamber, including the noble Baroness, in answer to her specific questions: yes to PPE, yes to testing and, by the way, yes to new guidelines that help minimise contact and the number of patients seen by each itinerant domiciliary worker; and yes to substantial extra funds for the social care system, specifically to help social care avoid relying on people travelling from patient to patient.

The noble Baroness, Lady Barker, asked about our relationships with local authorities and the local teams. I reassure her that we have moved a very, very long way in the last six months and that the picture she paints is understandable but out of date. We have come a huge way to share all of our insight, data, analysis and systems with local authorities, local directors of public health and local infection teams. Decisions on lockdowns now have a protocol whereby they are led by local teams after engagement with local civic groups and brought to the Secretary of State after they have been agreed at a local level.

Substantial sums—billions of pounds—have been given to local authorities to help them afford the kinds of local intervention that they choose to make in order to support the most vulnerable and disadvantaged during the epidemic. Money is given to local authorities for PPE for the people that they decide need it. Community health is being supported within the NHS in order for communities to be given the support they need. Engagement with local civic groups and business leaders is at a level I have never seen in government before.

I will give one example in relation to contact tracing, which the noble Baroness, Lady Barker, specifically asked about. In Leicester, money has been given to the local council for it to commission its own contact tracing, because we recognise that the local authority may well have the insights, cultural connections and sensitivities, and contacts needed for this kind of work. Therefore, we have provided financial and logistical support, and professional advice on how it can fill the gaps. We recognise that a national system cannot do everything, and that we have to be both national and local at the same time.

The noble Baroness, Lady Barker, ended by talking about the public mood and her concerns that people are reaching a state of despair. I completely recognise the exhaustion that many people feel about the state of the epidemic. I particularly recognise the morale within the NHS and social care, where people have worked incredibly hard, often in circumstances and doing tasks that they did not originally sign up for, and the sacrifice that many people have made, whether they work in the healthcare system, are supporting people they love, cannot do the things they want or are isolated and on their own. Of course, lots of people have made massive sacrifices, but I do not recognise the world she describes.

I think the public largely support the steps taken by this Government to suppress the transmission of this virus. After all, it is the virus that is the enemy. In many respects, we have an incredibly united country in fighting that enemy. The way in which the British public have supported the regulations and guidelines, which have had a tough effect on many people’s lives, demonstrates a huge amount of support. No Government —and certainly not this Government—will stretch that beyond what is tolerable. I posit to the Chamber that, to date, that support is still in place, and I remain extremely grateful for it.

[The Deputy Speaker (Baroness Pitkeathley) (Lab)]

My Lords, we now come to the 30 minutes allocated for Back-Bench questions. As ever, I ask that the questions and answers be brief, so that I can call the maximum number of speakers.

[Baroness Watkins of Tavistock (CB)]

My Lords, I thank the Minister for coming to take questions on this Statement. I will ask about two issues. If he cannot answer me now, could he kindly write with information? My main concern is people who are still going to work and caring for people who are Covid positive. Based on the highest prediction of need, how many days’ worth of PPE stock does the UK currently have in store for the NHS and voluntary and independent-sector providers of health and social care, including care homes and domiciliary services? How rapidly can stocks be replenished? What proportion is produced and manufactured in the UK? Have we tested the distribution systems and are they satisfactory?

My second question is in relation to vaccination. Vaccination will obviously be really important, but what are we doing now to support the Prime Minister’s approach, declared in August 2019, that we will increase MMR vaccination rates, among other needs, so that all people are protected as far as possible against other infections during the rise of Covid?

[Lord Bethell (Con)]

My Lords, the noble Baroness asked about PPE, which is naturally a concern as we go into winter. I assure her that the NHS has 15-day, 45-day and 90-day plans for the supply of PPE to the NHS and the independent sector. Roughly half of that comes from British sources. The distribution mechanisms have been radically overhauled and tested, and have proved to be utterly modernised.

We are working extremely hard on the deployment of a Covid vaccination. She rightly mentions other vaccinations. I assure her that we have 30 million doses of the flu vaccination. As she rightly points out, there appears to be a strong link between having flu today, Covid tomorrow and problems with a combination of both at a later date.

[Lord Hamilton of Epsom (Con)]

Sweden did not go for a total lockdown, as we did in this country. Although there is some evidence that its number of infections is going up at the moment, it still has far fewer deaths from Covid per 100,000 than we do. On top of that, its economy is supposed to be declining by about 5.5%, while ours will decline by at least double that. Does my noble friend think there are any lessons to be learned from Sweden?

My second question is about herd immunity. We started this whole process of dealing with coronavirus by talking about herd immunity. We then seemed to completely desert that idea and did not think it held any promise. Where do we stand now on herd immunity?

[Lord Bethell (Con)]

My Lords, it is with sadness that I note that the infection rate in Sweden is inching up, and with regret that I note that Stockholm is bringing in many lockdown measures similar to those in the UK. The noble Lord is right that Sweden has had a distinctive approach, but it is not as distinctive as would appear. Many of the same regulations that we have had here have been applied in Sweden. One area where Sweden has shown leadership is in compliance among the public. When regulations have been brought in, there have been extremely high levels of compliance, and therefore the optics are different from the reality. This Government have never supported a herd immunity strategy.

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, I remind the House of my presidency of the Health Care Supply Association. I want to ask the Minister about testing. He will be aware that the medicine supply chain rose to the huge challenge presented partly because, early on, pharmaceutical wholesale staff were classified as key workers. That gave them access to priority testing, but on Monday the Government issued a revised list that excludes those pharmaceutical wholesale staff. The Healthcare Distribution Association has reported to me that there are already delays in staff accessing these tests. It is very concerned that, if this continues, it will have a very detrimental effect on the supply of medicines to hospitals and pharmacies. Would the Minister be prepared to take this away, look at it and see whether they could be added back to the priority list?

[Lord Bethell (Con)]

The noble Lord makes an extremely good point. I am grateful to him for alerting me to this question in advance. We take the contribution of pharmacists to the battle against Covid extremely seriously. I am not sure, right now, why pharmacists have been taken off the list and I would be glad to look into the matter and respond to him shortly.

[Lord Greaves (LD)]

My Lords, turning to the new proposals affecting people advised to self-isolate, on the one hand, an isolation payment of £500 is being offered, which is an incentive; on the other, there is a new legal duty, the enforcement of which could result in some quite swingeing fines if people do not do it. It is a two-sided thing. I have two questions about this. First, what involvement will local authorities have in this process? Will it all be done centrally or locally—like the payments in the pilot areas—or will it be both together? Secondly, there is obviously a lot of scope for disputes about this—about individuals and how they are treated and so on. What documentation will be involved? It is rather more than simply getting a telephone call and being asked to do something. It is an offer of quite a bit of money, and it is an instruction to do things. Will they be sent pieces of paper or will it be done by email or whatever? Will there be documentation to back all this up?

[Lord Bethell (Con)]

My Lords, implementation of both the payment and the legal sanctions will run their course through exactly the same channels as any other social care payment or the implementation of any other social duty. That will be led by local authorities, as it would be with any other social penalty. The police will be involved. The courts will be involved. Appeal processes will be involved. We hope that there will not be many sanctions, and that the payments will make a big difference to isolation protocols.

[Baroness Chalker of Wallasey (Con) [V]]

My Lords, I ask the Minister whether the Government have considered better ways of communicating the data to the public. One of the things that many of us have found, in talking the issues through with the general public, is that they simply do not understand the limitations of data analysis, which inevitably will be part of the whole story. Therefore, particularly when it concerns younger people, we should be trying to explain the data better than by giving the absolute numbers that always seem to come over. Inevitably, those who think they are not affected disregard the data. An improvement here would help with people’s agreement to isolate and to take preventive measures to stop the continued transmission of Covid-19.

[Lord Bethell (Con)]

My Lords, I have said on other occasions that we publish a lot of data, and I would be glad to share a full list of our data sources with my noble friend. To put a different perspective on the point she makes, the biggest challenge we have is to persuade people that their personal health is not a private matter that affects only them; it is a public matter that affects the people they love, the people they are standing next to and everyone else. This is particularly challenging for young people, quite understandably. Young people may have very few symptoms or none at all. They may carry the disease without any personal implications whatever but are vectors of disease who carry it to the vulnerable, ill or elderly. Persuading the country that their health is a public matter is our number one priority. My belief is that we are making great progress, but there is some way to go.

[Baroness Finlay of Llandaff (CB) [V]]

To break the chain of transmission, people must isolate if carrying the virus. Therefore, people have to understand that a negative test means only that they were not carrying the virus at the time the test was taken. The new contact tracing app being launched tomorrow has the potential to interrupt the transmission of the virus, but in order for it to work, a large proportion of the population will need to download and use it. Is it true that only just over half the mobile phones currently in circulation in the UK are compatible with the new app?

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right that a test today only proves that you have not got it this morning; it does not necessarily prove that you might not have it in a couple of days’ time, when you go and see your loved ones. However, she is not correct on two points concerning the app. First, all the epidemiological data suggests that even small numbers of downloads—even two people, but certainly 10% of the population—can make a difference. Our aspiration is much higher than that, but it is not true that a large proportion of the population needs to use it for it to be effective. Nor is it true that that it works on only half the phones: our belief is that it will work on a very large majority of phones.

If I may take a moment, I shall use it to advertise the “Distance Aware” badge sponsored by the noble Baroness. It is a really good device for encouraging people who are near those who are shielding to respect the social distancing rules.

[Lord Rooker (Lab) [V]]

Again, I take the Minister to his own department’s weekly statistics for test and trace for the latest week, 3 to 9 September. He said on Monday that I did not understand the chart on page 8. Has he now read the annexe on page 37, which states, in table 1, in bold, that the number of people tested under pillar 1 and pillar 2 was 571,400? This amounts to 81,628 per day. So, can he now tell us the date on which more than 100,000 people were tested?

[Lord Bethell (Con)]

My Lords, I can confirm that in the week to 22 September, in pillars 1 and 2, 188,865 tests were taken during each of those days.

[Lord Bradshaw (LD) [V]]

The noble Lord may know of my interest in public transport. Since the wearing of masks has been mandated by law, is he satisfied now that everything possible is being done to make the use of public transport safe for people?

[Lord Bethell (Con)]

My Lords, I recognise the expertise of the noble Lord on public transport. It is my observation that the public have come a long way on mask wearing. When I was on the Tube this morning, absolutely everyone, including small children, was wearing a mask. That is huge progress. Yes, there is more that could be done, and we have brought in fines and support for isolation, but I pay tribute to the public attitudes that have moved a long way in this matter.

[Baroness Verma (Con)]

My Lords, first, I thank the Minister for all the work that he and the Government have done in Leicester. The many millions that have been spent have been hugely helpful to our communities there. However, given yesterday’s Statement by the Prime Minister about increased restrictions, my concerns relate to the mental and physical well-being of women and girls, in particular, in the densely populated areas of Leicester, as they will not be able to go out and get the right amount of exercise or make good choices when it comes to eating. Will my noble friend assist me in trying to get those messages across to people in communities such as mine in Leicester, where the messaging is so important? If the restrictions are extended, those communities will suffer far worse outcomes, and for much longer

[Lord Bethell (Con)]

My Lords, I recognise that this epidemic has hit women hard—it really has—particularly in high-density areas such as Leicester where women and girls do not have access to the kind of exercise and space that they need in order to lead fulfilled lives. We have given substantial funds to the authorities in all cities, including Leicester. I greatly encourage those authorities, including the ones in Leicester, to think about how they can help women and girls to access the space and exercise that they need to fulfil their lives during this difficult period.

[Viscount Waverley (CB) [V]]

[Inaudible] the presence of the noble Lord, Lord Hunt, perhaps I may refer the Minister to his response to me when he presented a Covid update on 14 September, and indeed as he has confirmed today. On what calculation does he anticipate that

“we are looking at making up to half of our PPE requirements in the UK.”—[Official Report, 14/9/20; col. 1007.]?

Why do the Government have their sights on only 50%, and what plans do they have to increase national production? Is it suggested that this is the sum total of our manufacturing prowess?

[Lord Bethell (Con)]

Absolutely not, my Lords. I pay tribute to British manufacturers, which have come an enormous distance—everyone from high-end manufacturers such as Burberry to those which once made recycled bin bags and have now turned their factories over to producing aprons and other important PPE articles. I pay tribute to my noble friend Lord Deighton, who has done an enormous amount to generate interest among British manufacturers of all kinds in order to support British PPE production. However, we have to have a balance to this. Some specialist goods, such as gloves, are best made elsewhere, but having the capacity and expertise to make 50% of our PPE means that we now have a route to making it all if necessary.

[The Deputy Speaker (Baroness Pitkeathley) (Lab)]

The last question is from the noble Baroness, Lady McIntosh of Pickering.

[Baroness McIntosh of Pickering (Con) [V]]

My Lords, I am delighted to hear that there are 30 million doses of flu vaccine. I remind the House of my interest with the Dispensing Doctors’ Association. How and when will the flu vaccine reach doctors’ and GPs’ surgeries? My noble friend will be aware that PPE will presumably have to be worn for the dispensing of each dose of flu vaccine, which means that the vaccination will be administered at a loss to dispensing doctors and others. That does not seem sustainable. Is that an issue that my noble friend will be able to address?

[Lord Bethell (Con)]

My Lords, flu vaccines are being distributed right now. I know that because I had mine yesterday. The person who gave me the vaccine was not in PPE and in fact spoke very movingly about the way in which walk-in methods are being used to make administering the vaccine as easy and quick as possible, removing all barriers to the public. When I asked him about the commercial practicalities, he gave me an encouraging update on the financial settlement for the distribution of vaccines by pharmacists. I am led to believe that there will be a huge amount of interest by pharmacists in distributing as many flu vaccines as they can.

House adjourned at 6.45 pm.