Health Protection (Coronavirus, Restrictions) (Steps etc.) (England) (Revocation and Amendment) Regulations 2021

Lord Bethell Excerpts

Wednesday 15th September 2021 Lords Chamber

Tabled by

[Lord Bethell]

That the Regulations laid before the House on 15 July and 19 July be approved.

Relevant document: 11th Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 14 September.

[Baroness Chisholm of Owlpen (Con)]

My Lords, on behalf of my noble friend Lord Bethell and with the leave of the House, I beg to move the three statutory instruments in his name en bloc.

NHS: Hospital Visiting

Lord Bethell Excerpts

Wednesday 15th September 2021 Lords Chamber

[Lord Farmer]

To ask Her Majesty’s Government what steps they are taking to ensure visiting arrangements in all NHS hospitals resume as soon as possible.

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

My Lords, we absolutely recognise the importance of people’s ability to visit their loved ones. Over the pandemic, NHS guidance advised all NHS hospitals to welcome visiting in a Covid-secure way. Now that we are not in a national lockdown, visiting arrangements are set out locally by NHS trusts and other NHS bodies. The health, safety and well-being of patients, staff and communities remains the priority, but careful visiting policies remain appropriate to ensure safe hospital visits.

[Lord Farmer (Con)]

My Lords, I thank the Minister for his Answer. Do the Government collect statistics on the number of in-patients whose mental well-being deteriorates during their stay in hospital? Also, what assessment, if any, has been made of the impact of visits on patients’ mental well-being and recovery?

[Lord Bethell (Con)]

My noble friend raises an important question. Mental well-being is affected by visiting. We know that particularly from social care, where this has been a particularly onerous problem for those in care and their loved ones. I am not aware of any statistics being assessed but I will look into it and write to him. He makes an extremely important point. We do, however, take statistics on nosocomial infection. I am afraid that is a massive issue, which we must balance at the same time.

[Lord Hunt of Kings Heath (Lab)]

My Lords, of course I understand the reason for very great care in relation to infection control in our hospitals, but it is notable that a press release by NHS England in July, at the time of the announcement of a reduction in restrictions by the Government, said that hospital visiting guidance is set to remain in place for all staff and visitors. The concern is that the health service will never change this guidance. Surely there should be some review of the general guidance, given what is happening in society as a whole and the autumn and winter plan that the Government announced yesterday.

[Lord Bethell (Con)]

My Lords, we brought in harsh guidance at the early stage of the pandemic. That was lifted quickly, for exactly the reasons the noble Lord gave, and we keep the current restrictions under review all the time. But it is up to local trusts to put the right infection control measures in place. Although we have some guidance in place, it encourages visiting, for the reasons the noble Lord points out, and we leave it to trusts to make the ultimate decisions.

[Lord Shinkwin (Con)]

My Lords, I will always remember how my spirits rose the moment my mother appeared at the entrance to the children’s ward when, as a child, I was confined to bed with yet another fracture. Given that the isolation of lockdown has highlighted the importance of human contact to good mental health, I ask my noble friend how the Government are advising hospital trusts on taking the mental health of visitors and those they are visiting into account.

[Lord Bethell (Con)]

What a touching piece of testimony from my noble friend. The feelings he had as a child are felt by a great number of people, not only those in hospital and social care but their loved ones. We are mindful of the impact of visiting on the mental health and the good feeling of those in hospital. Visiting was suspended on 4 April last year, but that suspension was lifted on 5 June. Since then, we have sought wherever possible to put careful visiting policies in place. In October last year, the number of visitors was limited to one family contact or somebody important to the patient; since then, we have made huge strides in trying to lift those restrictions wherever we can. It is left to trusts to implement exactly those restrictions that are suitable to maintain infection control in their area.

[Baroness Brinton (LD) [V]]

My Lords, in his Answer to the noble Lord, Lord Farmer, the Minister said it was vital to keep hospitals safe from Covid infections. There are now over 8,400 Covid patients in hospital with around 1,000 daily admissions and rising. SAGE is concerned that, in a month, there could be 8,000 patients a day. Paragraph 36 of yesterday’s autumn and winter plan says that the UK HSA is reviewing easing specific infection prevention and control and social distancing to better manage activity. Can the Minister give assurances that this will not happen while cases in hospital continue to increase at this rate?

[Lord Bethell (Con)]

We are trying to have visiting policies that are proportionate to the situation. To reassure the noble Baroness, as she probably knows, the number of visitors at the bedside is currently limited to one close family contact and somebody important to the patient. Those are the guidelines we have in place. As I said, we leave it to trusts to run their own infection control measures. She is entirely right that the potential for nosocomial infections within hospitals, which was such a serious feature of the pandemic last year, is one that we are extremely wary of and careful about.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

As a Christian minister who has visited the sick for over 50 years, I believe that a vital part of the healing process of any patient is not only the care given by medical professionals, but the individual’s peace of mind. That healing is greatly enhanced by the visit of a family friend or loved one. One of the tragedies of the Covid pandemic was that many had to die without the touch of a loved one’s hand or tender words of comfort and love, as they were about to pass away. Will the Minister do everything he can to change that situation?

[Lord Bethell (Con)]

My Lords, the noble Lord makes an incredibly powerful point. I agree with him. The point about visitors to the dying was one of the most poignant and hurtful aspects of the pandemic. The stories I have heard personally and in the Chamber on that point have been some of the most moving I have heard in the entire year. He is right that being ill is horrible; being ill and away from the people you love is doubly horrible. We are trying our hardest. Infections in hospitals cost a lot of lives last year. We are mindful of that damage. Another area where we are very mindful is maternity units, where to prevent post-birth depression it is really important that partners are there. We have put in allowances for all partners to be at scans and at the birth, but we are working to try to balance these two competing difficulties.

[Baroness Greengross (CB)]

My Lords, have the Government considered using vacant hospital land owned by the NHS or unused buildings near NHS hospitals for patient accommodation while rehabilitating, rather than having long stays in medical wards? Have the Government considered the benefits for patients and families? Visiting may be safer and more suitable in this type of accommodation compared with visiting medical wards.

[Lord Bethell (Con)]

The noble Baroness’s point is entirely right. The focus on hospitals puts huge pressure on hospital administrators to have safe, contagion-free environments. That makes visiting extremely difficult. That is why we are trying to move as much care and diagnostics as we can back into the community, where we have smaller hubs and visiting is much more accessible. Some of that can be done on vacant NHS land. There are also opportunities on the high street, which is not as occupied as it used to be, for those kinds of services. We have £3.3 billion available for discharge. If we have safe, quick discharge, that also achieves the same objective.

[Lord Flight (Con)]

My Lords, I question the wisdom of seeking to restore all visiting arrangements as soon as possible. For the time, surely visitor resource priority should go to those who are seriously ill, whether with Covid or other serious illness. Visiting should be limited, for the time being, both for the seriously ill and for limited slots of groups of limited size.

[Lord Bethell (Con)]

My Lords, it is a question of balance. We certainly have to be extremely careful about people visiting those with Covid because of the obvious contagiousness of that disease. As I said, the guidance is currently to limit the size of groups to one close family member, but we are mindful of the mental health impact of that, so trusts are trying to get the right balance between contagion control and the mental health implications of people being ill and alone in hospital.

[Baroness Thornton (Lab)]

It is very nice to see the Minister in his place; I wish him good luck right now. May I say how much we welcome the measures relating to visits in care home premises from 16 August? Welcoming anyone into care homes poses risks and it is important that those risks are managed and mitigated. In the face of the winter plans that have been announced, is there any expectation that there will be a review of these guidelines for care homes under plan A or plan B?

[Lord Bethell (Con)]

My Lords, I am pleased to say that 91% of care homes in England have been able to accommodate residents receiving visitors, compared to 40% in March. That is huge progress and answers a very large amount of concern that I have heard here in the Chamber. It is our objective not to change or review these measures. We want to try to keep care homes open to visiting in a safe way, as we do presently. If it becomes necessary, though, we will take the steps to protect life.

Covid-19

Lord Bethell Excerpts

Wednesday 15th September 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, the publication of the 33-page Covid Autumn and Winter Plan, including plans A and B, rightly talks about the need to resume life as normally as is possible while Covid is still around, but to move into restrictions faster if cases surge and the NHS is pressured. The World Health Organization’s special envoy on Covid, Dr David Nabarro, has said that the UK is right to find a way to live with the virus. However, he added:

“Speed is of the essence. We’ve been through this before and we know, as a result of past experience, that acting quickly and acting quite robustly is the way you get on top of this virus, then life can go on. Whereas if you’re a bit slower, then it can build up and become very heavy and hospitals fill up, and then you have to take all sorts of emergency action.”


Why does the Statement talk about the vital importance of mitigations, such as meeting outdoors where possible, ensuring ventilation if inside and wearing face coverings? Why are there no clearer, repeated messages for the general public about all these vital interventions, especially what we can all do now to slow down the increase in cases and hospital admissions?

At the No. 10 press conference on Monday, Professor Chris Whitty said:

“Anybody who believes that the big risk of Covid is all in the past and it’s too late to make a difference has not understood where we are going to head as we go into autumn and winter.”


He is right to be concerned. The seven-day rolling figure for daily hospital admissions is now around 1,000, with an average of 8,400 Covid patients in hospital beds. These numbers are considerably greater than they were this time last year. SAGE is very concerned that, as rules are further relaxed and people start coming back into work, the number of Covid patients going into hospital is set to increase substantially. This would put the NHS under real pressure, with perhaps as many as 7,000 admissions a day in six or so weeks, so it says.

The Statement announces the final decision on the booster scheme for those aged over 50, healthcare staff and the clinically extremely vulnerable, following the third dose for the half a million people who are severely clinically vulnerable. We welcome this. However, the World Health Organization reminded us that we should also be providing doses for low-income countries, but I see that the Government are planning only 100 million doses over the next few months. That is a drop in the ocean given that only 2% of the populations of low-income countries have been vaccinated. Will the Government agree to review and increase this number?

We on these Benches welcome the news on 12 to 15 year-olds getting vaccines. We accept that this was a difficult and complex decision, but we are pleased that there finally is one. There was an excellent slot on the “Today” programme this morning, with a group of 12 year-olds asking a paediatrician some questions; he had to look one answer up on Google. I hope that all parents and children will be able to access this sort of information because we know that it makes all the difference in coming to a decision.

However, as the noble Baroness, Lady Thornton, said, anti-vaxxers are causing serious problems. Good on Chris Whitty for what he said about one celebrity who attacked the idea of 12 to 15 year-olds having vaccines. However, today, yet another celebrity attacked him on social media, saying that he should be hanged. That is disgraceful. What are the Government doing about public servants like Professor Whitty being threatened in this way? As importantly, what will the Government do about the disinformation that people are now spreading at school gates, including leaflets with the NHS logo on them?

Ten days ago, Dr Jenny Harries announced that all clinically extremely vulnerable children in England—even those still on chemotherapy—would be removed from the CEV list and expected to return to school as term was starting, regardless of their underlying condition or the fact that there are no masks, bubbles or even, in many schools, proper ventilation. Although it is really important to have all children back in school, this cohort of children is at particular risk. Their consultants and GPs are as bemused as their parents, so why is Jenny Harries’s letter to the parents of these children, explaining why they are being removed from the CEV list, not on either the NHS or UKHSA website? Will the Minister write to me to explain this decision? We are hearing confusion from parents and medics alike.

Finally, last week, I commented on the continuing farce of Ministers U-turning daily on the use of vaccine passports for clubs. It is confusing to keep up with the U-turns on U-turns; I note that the Statement is trying to have it both ways. I suspect that Ministers could do with some new flip-flops.

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

I thank the noble Baronesses, Lady Thornton and Lady Brinton, for such thoughtful questions. I am very pleased to be here to answer questions on both these Statements, and I thank the noble Baroness, Lady Thornton, for her kind remarks earlier.

I too welcome the decision to bring forward the vaccination of children. I reassure the noble Baroness, Lady Thornton, that it will be done in the same way that a large number of other vaccinations are run through the school process. As I am sure she knows, vaccinations for things such as HPV and flu have been done at primary school for some time and there are extremely well-established and thoughtful protocols for handling them. They are handled not by school nurses but by nurses employed by the local authority or on contract by the local CCG to deliver the vaccinations, and the consent forms are handled directly with the parents. There is an extremely well-established process for the very rare occasions where there is a difference of opinion between the child and the parents. It is important that we get that right. I reassure the Chamber that this process for vaccinations has been handled for years. The professionals who deal with such disagreements are extremely well trained and the Gillick principles, which are extremely well known, will be applied to the Covid vaccination. I think all noble Lords agree that that is entirely right. Children aged between 12 and 15 will be provided with information, usually in the form of a leaflet, for their use. The school- age immunisation provider will, prior to vaccination, seek consent for all the vaccination programmes.

The noble Baroness, Lady Thornton, quite rightly raised the question of children being pressured into taking or not taking the vaccine. I reassure her that the school-age vaccination programme and the clinicians involved are very well equipped and are well versed in dealing with vaccines in schools; this will not be a new thing for the schools or professionals involved. Their ability to gain consent and to communicate exactly why the Chief Medical Officer has gone ahead is an important element of the decision to accept the recommendation from the CMO on the back of the JCVI recommendation. The four CMOs have said that it is essential that children and young people aged 12 to 15 and their parents are supported in their decisions, whatever decisions they take, and are not stigmatised for accepting or not accepting the vaccination offer. Individual choice will be respected.

The rollout is starting immediately, at the beginning of next week, and we expect that it will end in schools by the end of November. The advice from Dr June Raine of the MHRA is that the flu and Covid vaccinations can happen contemporaneously—studies have supported that—but that will not necessarily happen in every case. The practicalities of the supply of Covid and flu vaccines are, as noble Lords know, extremely complex, and we do not want to make a complicated situation any worse by trying to force a combination if it is not possible.

The noble Baroness, Lady Thornton, asked about our arrangements for the current winter period and particularly about mandatory masks. I completely understand the concern of noble Lords in the Chamber about making masks mandatory. The noble Baroness, Lady Thornton, referred to it as “light touch”, but our feeling is that it is not light touch to mandate the wearing of masks; in fact, it is an intrusion into people’s life in the most intimate way. That is not to say that it should not happen at all, but we are at a stage of the pandemic where we are trying to move the responsibility for individual choices, such as wearing masks, on to people to take it for themselves. Of course, if the worst happens and we have to move into plan B, we have the legal and influential role to be able to mandate masks, but at this stage it feels proportionate to try to use persuasion rather than mandation.

I remind noble Lords that the messaging around the pandemic is not the only thing we are trying to do right now. In response to the remarks of the noble Baroness, Lady Brinton, about public messaging, I reassure her that I am the Minister who signs off the marketing around Covid and other health messaging. We are currently spending a substantial sum communicating our messages on Covid. The fact that she thinks they do not exist is an example of the public exhaustion that is an inevitable result of 18 months of relentless campaigning on Covid. We have to recognise that the public can hear us only so many times before they start tuning out the message.

There are other very important messages that we have to get through to the public, the most important of which is for those who show symptoms of other diseases to step forward to get their tests, so that we can catch people who are ill with non-Covid diseases. We have a massive backlog of diagnostics; the NHS figure on the expected numbers of people who have diseases such as cancer, and need to be seen by GPs and specialists, is huge. We need to get those messages across to people as well and, while it is not a zero-sum game, to be aware that these messages compete with each other. We are using this moment where there is a pause in the Covid epidemic to try to get people back into the GP surgeries and the diagnostic hubs—back into hospital—to try to catch diseases and reduce the lists. That fightback is extremely important and is one of the reasons why we are focused on the “Help us to help you” messaging.

The noble Baroness, Lady Thornton, asked about testing in schools. I reassure her that we have not only put a huge effort into the double supervised testing which, as she knows, kicked off the school term but are sustaining the support for school testing. There will be a review at the end of September but there are no current plans to end regular testing in schools. We have to ensure that there is value for money and that the testing is effective, but it is extremely well supported by schools. I believe it has made a serious impact on the spread of disease within schools and pay tribute to teachers, headmasters, parents and pupils for the high rates of uptake in schools. Around one-third of all positive cases are tracked down through asymptomatic testing, which is a really good indication of how effective it is at breaking the chains of transmission.

There is a review of our border arrangements in play, and I believe the Secretary of State for Transport will be making a Statement tomorrow. However, I reassure the noble Baroness that we take border control extremely seriously. We are very conscious of the threat from variants of concern. At the same time, however, we have to recognise that vaccination makes a big difference and be proportionate in our border arrangements. We are conscious that although travel is regarded as a voluntary matter, people may have strong family roots or good business reasons. Being able to travel is one of the great joys and loves of people’s lives, so we are seeking to be proportionate and reasonable in our travel arrangements. The Secretary of State will make further announcements on that tomorrow.

On the point made by the noble Baroness, Lady Brinton, on public servants, I could not agree more. The rhetoric that has been directed at public servants such as Chris Whitty and JVT sometimes leaves one feeling quite cold and disappointed at the British public. As she probably knows, we have made arrangements to put a big arm around those people who have been threatened and improve the security arrangements for them. I call on everyone to express support for our public servants, who have a very tough job. They are often communicating unpalatable, difficult truths to the public and challenging some of the assumptions and preconceptions of those who would like life to be slightly different from what it really is.

In particular, I noted the physical attack on the MHRA headquarters in Canary Wharf 10 days ago. Videos of that attack really disturbed me; it was brutal, nasty and ferocious. I pay tribute to the Metropolitan Police, who responded extremely quickly and emphatically, and to professionals at the MHRA who had steady nerves on that Friday afternoon. We cannot operate in a society where differences of opinion about public health policy lead to physical violence on the streets of London. I absolutely condemn those who participate in physical attacks of that nature, along with the kind of violent extremism that calls for people to be hanged. This is no time for that kind of extremism. Those who participate in it are trying to divide society. They really need to move on and find something else to do.

I am extremely pleased to hear what I think was the implicit support of the noble Baroness, Lady Brinton, for the principle of vaccine passports. It is right that we hold such an intimate and strong measure in reserve in case we need it for plan B. The technical and regulatory arrangements for the measures have been put in place but we have held off the implementation because it is not felt that it is needed right now. However, should it be needed either to break the chains of infection and restrain the spread of the virus or to encourage vaccine uptake, which is one of the benefits of such a measure, we will turn to it as part of our plan B measures. That is a proportionate treatment of that potent but very heavy state intervention.

[Baroness Watkins of Tavistock (CB)]

My Lords, I join other noble Lords in congratulating the Government on the last two Statements and the decision to encourage vaccination in 12 to 16 year-olds. However, some teachers who have been very involved in assisting pupils with swabbing are concerned that there might be an expectation that they do inoculations. Can the Minister confirm that that will not be expected of teaching staff? I think he implied that it will not be in his discussion of nurses.

Will the Government seriously consider alternatives to quarantining in hotels by giving individuals the choice to be tagged and remain in one centre if they travel back to the UK? This is particularly important for British citizens working abroad who have been doubly vaccinated.

[Lord Bethell (Con)]

My Lords, I absolutely reassure the noble Baroness that teachers will not be involved in the vaccination programme. I pay tribute to the work that teachers have done in organising pupils and, on occasion, administering the swabs themselves. It has been an impactful programme and we are enormously grateful. There is an established vaccination programme that, as I mentioned, makes use of professional nurses. That is the route we will take in this instance.

When it comes to the MQS programme, the bottom line is that hotel quarantine is extremely effective. It really does stop the spread of the disease as it comes into the country. That is absolutely relevant when we have the threat of variants of concern. We keep the question of tagging in sight. It is a very intrusive measure and we are not convinced that it will necessarily be, in current terms, as effective as hotels, but I take the point the noble Baroness made and will continue to look into it further.

[Lord Faulkner of Worcester (Lab)]

My Lords, there is a great deal in the Minister’s answers and the initial Statements with which I totally agree, particularly his statement about the threats to leading medical figures and leaders of the vaccine movement. Anti-vaxxers are a vile section of our community and I hope everything can be done to stop their activities. I also strongly welcome, as the grandfather of a teenage girl, the decision to vaccinate schoolchildren. She is delighted by that. It means she can go on holiday properly with her parents. It will make a great deal of difference to her and I know she will support it.

However, the aspect of the Minister’s answer with which I was not happy—he will know what I am going to say because I have raised this before, although not for a while in the Chamber—is the wearing of face coverings. The message is confused and the advice being given to the public is not clear. It is not made easier by photographs appearing in the press of the Cabinet sitting around a table close together with not a single face covering in sight, and pictures of at least half the Chamber in the House of Commons where virtually all the Members are unmasked. It is not the same in this House: face coverings are being worn by the great majority on all sides of the Chamber when we are not speaking. We do this not just for our own benefit and that of our immediate neighbours but for the benefit of the staff who work here. That perhaps deserves rather higher consideration in the House of Commons.

The advice being given to travellers is very difficult. Again, I would have liked earlier, much stronger advice. At present, it is mandatory if you are travelling on a Transport for London conveyance—a Tube, tram or bus—to wear a mask, but on other forms of transport, it is advisory. There is great confusion, and it gives rise to resentment among people following what they think is government advice to wear a face covering. Can we have from the Government a bit more clarity on when they believe face coverings should be worn, because I think the public are not clear about it at all?

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[Lord Bethell (Con)]

My Lords, I hear the noble Lord’s points loud and clear. We are seeking to balance the epidemiological, public health practicalities of trying to limit the spread of the disease through mask wearing with accepting the benefits of the vaccine and the limit that puts on hospitalisations and death and trying to restore confidence in the public that we live in a safe environment.

We will be debating in months to come the challenge of trying to get the country back to work and back to economic activity, to get people back into society and back into their communities. It is not that stage right now—we are going into the winter, so naturally our concerns are about hospitalisations and a possible rise in pressure on the NHS—but we must have sight of the exit from this disease. If we have a society where the Government mandate very intimate parts of people’s everyday life and where the impression given to the entire population is that a deadly disease is an imminent threat to them, I am afraid we will run into a problem in trying to get the economy moving and to get society back again.

What we are seeking to do right now is to get that balance right, and it is proportionate. I acknowledge that mask wearing is down, but people are broadly responsible, as the noble Lord rightly pointed out. Central government cannot make every decision in all of society for all time. We need transport providers to make their own decisions, which does mean that it is complicated and that TfL and overground are different. However, it feels like the right approach for right now.

[Baroness Tyler of Enfield (LD)]

My Lords, I make no apology for pursuing the issue of wearing masks and face coverings, because I feel so strongly about it. My personal experience this morning when coming in on the Tube was that more than 50% of people were not wearing a mask; they were close to me. One man actually took his mask off and sneezed over me. The whole experience made me feel very uncomfortable and very anxious.

I contrast this experience with a recent train journey to Scotland. As soon as we crossed the border, there was an announcement making it quite clear that wearing masks was compulsory on the train. Absolutely every person was wearing a mask, and I felt so much more confident.

I do not really understand the explanation that the Minister has given; I listened to it very carefully. I think he said that it is not a light-touch measure, but, to me, it seems extremely light-touch. It costs very little; it protects others; it does not harm the economy, and ultimately it can save lives, so I genuinely do not understand what the problem is. I think it is about being considerate to others and, frankly and bluntly, not being selfish.

I would certainly add my voice to the comments of the noble Lord, Lord Faulkner. By not wearing masks in the Commons Chamber yesterday, many MPs were sending mixed messages and setting an appalling example to the country.

I want to end by asking the Minister a question asked also by my noble friend Lady Brinton about children who are clinically extremely vulnerable being taken out of that category. Can he explain why that is and what is going to happen to those children, and perhaps write to me and my noble friend on it?

[Lord Bethell (Con)]

My Lords, I absolutely applaud the sentiments that the noble Baroness articulated: her sense of responsibility and commitment to the community are generally exactly what we are trying to inculcate in a lot of people. But I just do not agree with her or with the noble Lord, Lord Faulkner, that having a state-mandated direction—accompanied, presumably, by fines and, therefore, court appearances for some—could possibly be described as light touch. It is the most intrusive and intimate of measures. If the circumstances require it, we are prepared to do it. We have done it, and, if necessary, we will do it again. But noble Lords really are missing the mood of the nation if they think that the vast majority of the country is in the same place.

I am afraid to say that this is a question of personal choice at the end of the day. The public health judgment—these decisions were made in participation with public health officials—does not support mandatory mask-wearing for the entire country. I agree that visiting Scotland is a completely different experience; there, policymakers have made a different decision, as they have in some other countries. But when we lifted mandatory mask-wearing on 19 July we saw a very large change in the public’s habit. Why? Because some people find it extremely intrusive and not comfortable at all, and they do not like it or are not prepared to do it. Therefore, at this stage of the pandemic it feels proportionate and right to rely on guidance and inspiration and on the leadership of both our national and civic leaders. If necessary, in plan B we will come back to the mandating of those kinds of measures. At this stage it really does not feel proportionate.

[Baroness Andrews (Lab)]

My Lords, if I may pursue this with the noble Lord, he has used the term “proportionate” on several occasions and has now said that the Government will be prepared to come back to this if they feel that the circumstances require it. It is worth reminding the House that the term “light touch” was not used by my noble friend Lady Thornton but by Sir Patrick Vallance.

I have several questions for the Minister. First, when will the circumstances be such that the Government will agree that “proportionate” is no longer the key and that action will need to be taken to require masks to be mandatory and people to stay at home? That is what the SAGE advice is suggesting. Secondly, exactly why have the Government not taken the advice of their own advisers in this respect, given the circumstances, which have been well described across the Chamber, of increases in the number of hospitalisations and the number of infections? Thirdly, what does the Minister think is likely to be the worst-case scenario this winter and the key risks, given that the Government have, on two or three occasions over the last 18 months, not followed the advice to act swiftly and urgently and according to the advice that they have been given? Why is it so difficult to take that advice and act on it now? It appears that we have not learned the lessons about the necessity for early intervention to stop things getting worse.

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[Lord Bethell (Con)]

I am very grateful for the questions and I will take them one at a time. I am enormously grateful for the advice of SAGE; the work it does is invaluable. However, it is not regarded as the key medical adviser to the Government—that is the role of the CMO, who advises the Government on medical matters.

On the circumstances for moving to plan B, that is a reasonable question. We do not have a specific formula or algorithm, because it is extremely uncertain how things will play out. Undoubtedly, pressure on the NHS is one of the biggest drivers of that decision, and if we were to see a spike in hospitalisations, severe disease and deaths, and beds being used up and capacity being drawn down to an extreme level, that would be one of the key drivers. But we have to also look at variants of concern, other diseases and the state of the NHS in the fightback, as well as at the flu epidemic that may or may not come. Therefore, I cannot give an easy and simple answer to that question—there is not a “four tests” type of answer to it—but we are looking at it extremely carefully.

On the criticism on speed, I remind the noble Baroness that, at the beginning of this year, the Government laid out a very clear steps process, whereby we left the last round of regulations. That was extremely well considered; there were at least five weeks between each step, and it was done in a proportionate and empirically based manner, and I think noble Lords would recognise that it was a thoughtful and reasonable way of doing things. To characterise the Government’s approach this year as being behind the curve is not reasonable. As I said, we are trying to accept the risks that we have in front of us, and Covid is only one of them: there are other pressures on the NHS, including the huge catch-up that we need to do, and the possibility of flu and other epidemics on the horizon. We cannot just focus entirely on this.

[Viscount Waverley (CB)]

My Lords, quite rightly the Minister is in popular demand this evening. This is nothing against Boots the Chemists, which by the by does an excellent job, but with not shy of 2,000 eligible candidates on the parliamentary estate, could not the testing facilities on the estate be designated as official testing areas for flying purposes and for any other reason that tests are required? Furthermore, notwithstanding the announcement to which the Minister referred, which may or may not address this point, why, oh why, do we need day 2 testing, having had a valid test 48 hours prior to arrival in the UK from, for example, the continent?

If the Minister is minded, given that I do not think that another noble Lord is going to ask a question, could he possibly also say a word about the issue of mixing and matching booster vaccination types? Can the flu jab, to which the Minister referred, be taken at booster stage?

[Lord Bethell (Con)]

Like the noble Viscount, I pay tribute not just to Boots—an excellent chemist—but all the other pharmacies, which have contributed so much in this epidemic in looking after the communities that they serve, not only in trying to provide essential services during lockdown but in their contribution to the vaccine rollout programme. It really has been a demonstration of the enormous amount of value in big and small chains and community pharmacists across the board.

As for the testing provisions here on the estate, those are of course LFD asymptomatic testing provisions, and for flying purposes you need a PCR test, so I am not quite sure whether it would necessarily read across directly.

[Viscount Waverley (CB)]

My Lords, just from first-hand experience— Sorry, I apologise for intervening.

[Lord Bethell (Con)]

It is an interesting and creative idea, and certainly one that would be worth looking at.

On day 2 testing, I recognise that it is inconvenient to do the follow-up testing if you are travelling but, for the protection of this country, it is an important part of our border public health measures.

The pre-flight testing regime is helpful; it catches some disease, but in no way could it be thought of as a reliable barrier to infection into the country. I am afraid that there is simply, as I am sure noble Lords know, too much variance in the quality of that testing regime, to put it politely. Our estimate is that it catches between 10% and 20% of disease, but we know from our own testing in this country that it certainly does not catch all of it. In fact, most people will not travel if they are blazingly ill, so almost all travel infection is asymptomatic. That is why we look to day 2 testing, because it has the benefit of catching those people who might either have asymptomatic disease or are incubating the disease and would not be caught even by a PCR test.

The day 2 test is an effective way of catching those with the disease; it is an essential part of our surveillance. We would not know how much disease was coming into the country, what VOCs were coming into the country or which countries had disease, because so few have sophisticated testing, let alone genomic sequencing. It is literally the only way we know what is coming into this country and where the threats are from around the world. That is why it has played such an important part in our testing regime to date. The Secretary of State for Transport will be making announcements tomorrow and I look forward to his update on that.

On mixing and matching, one of a great many surprising medical outcomes from this disease is the idea that you might have one vaccine one day and another one three months later. When that was first posited to me, and when I first made that suggestion in this House, it was greeted with surprise and with some concern, but actually they somehow provoke different parts of the immune system, they somehow complement each other and there is strong and growing evidence that this is a very effective and complementary way of administering programmes. They work for different types of people in different ways, and different mixes and matches complement each other in a strange Rubik’s cube of complicated arithmetic. I would have to leave it to JVT, the deputy CMO, to explain it in more detail if noble Lords would like more information on that.

Health Protection (Coronavirus, Restrictions) (Steps etc.) (England) (Revocation and Amendment) Regulations 2021

Lord Bethell Excerpts

Tuesday 14th September 2021 Grand Committee

Moved by

[Lord Bethell]

That the Grand Committee do consider the Health Protection (Coronavirus, Restrictions) (Steps etc.) (England) (Revocation and Amendment) Regulations 2021

Relevant document: 11th Report from the Secondary Legislation Scrutiny Committee

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

My Lords, these regulations are an important milestone on our journey through the pandemic—and, I hope, beyond. On their introduction, most coronavirus restrictions in England were lifted, so on 19 July we moved to step 4 of the Government’s road map—the final step of our cautious journey out of lockdown.

I do not need to detain your Lordships for very long setting out the content of these regulations. Almost all legal restrictions have been lifted. Businesses across all sectors are able to open again. We can now attend weddings, birthdays and festivals and spend time with our families, friends and loved ones without legal restrictions on social contact. The balance has truly shifted, with most restrictions enforced in law now replaced with guidance.

I am pleased to see that our theatres and the wider entertainment sector are blossoming once again. I know that many of us have enthusiastically welcomed the return of singing in churches and amateur choirs. In the broadest sense, community life has returned, and I do not think we realised quite how much we missed it.

I know that many people may feel nervous, particularly those who are immunocompromised or immunosuppressed. We must all continue to act carefully, respond to the latest guidance and remain cautious to protect ourselves and those around us. That means continuing to follow the Government’s advice on protecting ourselves and others: for example, by getting the vaccine, letting fresh air in if meeting indoors, and getting tested when symptomatic and isolating when necessary.

The pandemic is not over. The virus will remain part of our lives. We are undoubtedly in a better place now than when we embarked on the road map out of lockdown in February this year. This is a testament to the expertise and dedication of all those involved in building our defences against the virus.

We have a toolkit in place for tackling the virus in the months ahead. The Government have set out our plan for managing the virus over these difficult months, and the Secretary of State has recently finished making his Statement in the other place. Our plan A is to continue to build on the progress we have made and manage the virus without the need for restrictions that impact on the lives and livelihoods of citizens.

We are implementing the biggest and most successful vaccination programme the country has ever seen, with more than 48 million people having now received their first vaccine dose. Data shows that the vaccination reduces overall symptomatic disease by 80% to 90%, hospitalisations by more and deaths by around 95%. The vaccination programme has substantially weakened the link between infections and serious illness or disease.

We will continue to bolster the wall of defence provided by vaccines by encouraging take-up and through booster jabs. Extensive planning for a booster vaccination programme is well under way, and the NHS is preparing to start booster doses from next week. Details have emerged during the course of today. This will protect the most vulnerable throughout the winter months and strengthen our wall of defence even further.

Vaccines are now being offered to 16 and 17 year-olds, and the Government have accepted the advice of the four Chief Medical Officers to offer vaccination to all healthy 12 to 15 year-olds. Invitations for vaccinations will begin shortly.

Our test, trace and self-isolate system is another of the key defences in our armour against the virus. We have established the largest network of diagnostic testing facilities in British history. The UK has conducted 274 million Covid tests and reached 15.9 million people who have either tested positive or been in contact with someone who has. I look forward to updating noble Lords further on the test, trace and self-isolate systems when we debate important changes to the self-isolation regs later this afternoon.

--- Later in debate ---

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for introducing this late regulation. As I said to him last week, there is a sort of “Groundhog Day” tendency in having to deal with these things. I would also like to register with the noble Baroness, Lady Barker, that the House needs to address the issue of the noble Baroness, Lady Brinton, being able to access these sessions in the same way that she can access the Chamber. I would even go so far as to say that it is discriminatory that she cannot. As well as that, we are missing her wisdom, words and her representation of her points of view.

The noble Baroness, Lady Barker, and my noble friend Lord Hunt have covered many of the points and have asked many of the questions that need to be asked on this regulation. As noble Lords have said, it triggers the end of most of the lockdown restrictions in England by revoking regulations and amending regulations listed in the schedule from 19 July. I echo what other noble Lords have said. Does the Minister believe that it was premature to remove face mask regulations? I have not yet read the 30-odd page toolkit document in full, so I do not know whether the option is there to reintroduce them as part of the autumn-winter Covid plans. Would that be mandatory?

At the time of lifting the restrictions, from these Benches we opposed and still oppose the decision to remove the requirement to wear a face covering indoors and on public transport. The risk of transmission inside a crowded bus or train will be high. If it is true, as the scientists say, that one in 70 of us in England has Covid, and the capacity of a double decker bus is about 70 and a full Tube train or regular train carriage can carry up to 140 passengers, that would mean that on average one person on a crowded bus and two people on a crowded Tube train will be contagious. They will have Covid, and with little ventilation and no legal requirement to wear a mask.

I travel on public transport all the time—it is how I get to your Lordships’ House and go home—and it is certainly noticeable that mask-wearing, particularly among young men, has fallen. It is true that on the Tube there are marginally more people wearing masks than on the Overground, but the number has fallen. It is very concerning and worrying, and I have got to the point where I have stopped being a mask monitor and offering people masks if they have not got one on, because there are too many of them on the Tube and on trains without masks on.

We supported the removal of restrictions on gatherings, but we thought the Government were going too far and too fast at the time. We were also concerned that the lifting of all the restrictions was confusing to businesses. Has the Minister had feedback about how effective the lifting of those restrictions was? This instrument extended the expiry date of the Health Protection (Coronavirus, Restrictions) (England) (No. 3) Regulations to the end of September to ensure that local authorities retain the power to respond to local serious and imminent public health threats as a result of the spread of coronavirus. Can the Minister confirm whether the Government intend to further extend these provisions? If it is in the winter plan I apologise, but I think we will be discussing that tomorrow or Thursday.

I suspect that the winter plan contains which bits of the Coronavirus Act are being retained and which will be got rid of. However, what worries me is whether in three or four weeks’ time, if infection rates have increased enormously as a result of the schools going back, there will be sufficient powers to deal with that, and sufficient powers if we need to go into further restrictions. The Minister must explain what will happen if the worst happens. The byword throughout the whole pandemic has been “Let’s plan for the worst and hope that we don’t have to use those powers.” If all those powers are being rescinded now, what will we do if there is a new variant further into the winter or we see a spike in the next three or four weeks? We need to know that.

In terms of mask wearing, I went on holiday to Scotland by train and it is true that as we neared the border, there was an announcement that everybody had to wear a mask, and everybody put a mask on. It was not an issue. Like the noble Baroness, Lady McIntosh, I do not regard mask-wearing as an encroachment on my civil liberties. I regard it as something that protects me and with which I protect others. We seem to have lost that message in the wearing of masks. Are the Government going to do anything about that?

[Lord Bethell (Con)]

My Lords, I thank noble Lords very much for an extremely helpful debate, and I very much welcome this return to the Moses Room. It is very nice to be back in the intimate and more conversational style of Committee.

The Secretary of State has been on his feet this afternoon to talk about the toolkit. My understanding is that there will be some kind of Statement repeat, and I look forward very much to going through the toolkit during that. I apologise in advance if I cannot answer every question on that right now, but I would like to tackle a couple of points that were raised. Before I do, I will say a word of appreciation for the contributions of the noble Baroness, Lady Brinton—her presence is highly valued—and for those who organised the virtual House and our current arrangements. It is all a massive compromise and uncomfortable, but I am extremely grateful for the work that has been done to make this return possible. I am hopeful that even more can be done in October.

A number of noble Lords, particularly the noble Lord, Lord Hunt, asked about the booster. The NHS will be rolling out a booster programme to protect those who are most vulnerable to Covid, as we announced previously. It will now be extended to individuals who received vaccination in phase 1 of the programme: that is, JCVI groups 1 to 9. That includes those living in residential care, all adults over 50, front-line health and social care workers, and all those aged between 16 and 40 who have underlying health conditions that put them at a higher risk of severe Covid.

This is very good news. There is very strong evidence that a booster programme such as this can have a very big impact, particularly on those who are immunosuppressed or who live with the immunosuppressed. The JCVI has advised that the booster vaccine programme is offered no earlier than six months after completion of the primary vaccine course, and that will of course affect many people. The vaccination programme has been planning booster vaccinations for some time, which means that the NHS is now in a position to offer booster doses from next week. As most younger adults will have received only their second Covid vaccine dose in late summer, the benefits of booster vaccination in this group will be considered at a later date. I think noble Lords would agree that this is a reasonable and proportionate approach to this complex issue.

Commonwealth Fund Report: NHS Ranking

Lord Bethell Excerpts

Tuesday 14th September 2021 Lords Chamber

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

My Lords, we are very grateful to the Commonwealth Fund, based in America, for its very important report and its updated rankings. I note that the criteria in the report have changed considerably over the years. On the report’s key points, I agree that there is more that we can do on patient equity. The Government have put health inequality at the centre of their agenda, and we are working hard on implementation. On care process—the other key finding of the report—we do not recognise the report’s analysis.

[Baroness Thornton (Lab)]

Well, how convenient. The UK’s drop in rank in the Commonwealth Fund’s five-yearly research into the performance of the world’s wealthiest 11 countries’ healthcare systems from first to fourth still seems to be associated, as the noble Lord has said, with access to care and with equity. This is important because the key differences between the top-performing countries, of which we are still—just—one, and the worst performing healthcare systems, of which the USA is, by a long way, the outlier, concern universal coverage, removal of cost barriers, investment in primary care systems, reducing bureaucratic burdens and investment in social services, particularly for children and working-age adults. Can the Minister explain to the House how the announcement on social care last week and the current NHS reform Bill before Parliament will contribute to the UK’s healthcare performance and ranking in the next five years?

[Lord Bethell (Con)]

My Lords, the noble Baroness half answers her own question. When it comes to universal coverage, I am extremely proud of the NHS and the service that we provide to the British public. There is no other health system like it anywhere in the world. The report makes cogent points on equality, and we have put that at the centre of our agenda, and in the NHS long-term plan, the prevention Green Paper and the newly implemented Office for Health Improvement and Disparities. We are doing that work through the obesity plan, the NHS health checks, the tobacco control plan and the vaccination plan. We are highly committed to this agenda, and we are making an impact.

[Lord Shinkwin (Con)]

My Lords, of course we must protect the NHS and support social care but, given the proposed tax increase, can my noble friend the Minister explain to taxpayers on low incomes how they will know whether their money is well spent?

[Lord Bethell (Con)]

My Lords, we raise taxes with huge hesitation. My noble friend is entirely right to hold the system to account for delivering value for money and to question productivity, but I reassure him that we have one of the most efficient health systems in the world. The money spent by the department on behalf of taxpayers is very wisely invested, and we are extremely grateful to those in social care and the NHS for the incredibly effective way in which they go about their business.

[Baroness Massey of Darwen (Lab)]

My Lords, my noble friend Lady Thornton has asked about the key features which enhance the delivery of healthcare; I am sorry that the Minister was so dismissive of the report. We know that countries differ in how they organise healthcare, and that vulnerable groups in all societies need special attention. What measures will the Government take to ensure that children, for example, especially those identified in the Leadsom report, are given the support that they and their families need to overcome their disadvantage and to thrive?

[Lord Bethell (Con)]

My Lords, I pay tribute to Andrea Leadsom for her report and all those who collaborated in drafting it. The noble Baroness is entirely right that those in the first 1,000 days of their lives are the people we should focus on—that is why we commissioned the report in the first place. We have embraced many of the recommendations and we will continue to see through their implementation.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we will now have a virtual contribution from the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, the report points out that, although the UK is fourth overall in the rankings, we are ninth out of 11 on health outcomes. As the noble Baroness, Lady Thornton, outlined, the top three countries are particularly good at investment in preventive services and primary care, but the report also talks about wider social care, including housing, nutrition, transportation and early years services. All these investments tackle inequity and deprivation, as covered in both the Leadsom report and the Marmot report. Given the Chancellor of the Exchequer’s statement that there is no money for anything other than the NHS and social care, what are the Government proposing to do to address investment in these vital areas?

[Lord Bethell (Con)]

My Lords, we are investing a tremendous amount in preventive care, and I agree with the noble Baroness that this is key to the future—to better and longer lives and, on my noble friend’s point, to increasing the productivity of our healthcare system. I have already mentioned the key components of our preventive agenda and I add to that list the £325 million that we have allocated to the diagnostic fund precisely to catch disease earlier, to give people the treatments they need earlier, and to bring down the cost of our healthcare service.

[Lord Foulkes of Cumnock (Lab Co-op)]

My Lords, is one of the reasons for this decline the fact that we have fewer doctors per head than almost any other country in the OECD? When the Prime Minister announced 6,000 new doctors, did he know that it takes six years to train a doctor? In fact, the numbers have gone down rather than up, so what will the Minister and his colleagues do now to improve the position?

[Lord Bethell (Con)]

My Lords, we are grateful to GPs and doctors for the work that they do. Of course, the way to get more GPs is partly by training them, partly by retaining them, and partly by working with GPs from overseas who come and serve in the NHS. That is how we are meeting our commitments on raising the number of GPs in the NHS.

[Baroness Neville-Rolfe (Con)]

I hope my noble friend has seen recent reports from NHS doctors in the Daily Mail and elsewhere about the slowness of the NHS to embrace obvious change. Does he think that there are sufficient resources such as GPs, hospital doctors, nurses and medical equipment, to allow the new money being made available announced last week—for which, thank you—to be spent effectively, thereby lowering waiting times? I worry that it will just boost pay cheques, as we saw under a previous Administration.

[Lord Bethell (Con)]

My Lords, I take my noble friend’s point: there are hot spots of innovation and change in the NHS, of which we should be proud, but she is right that the NHS is a large organisation and change can be challenging. In particular, I pay tribute to the Office for Life Sciences, the Accelerated Access Collaborative and NHSX—three organisations within the NHS that are driving change. I also pay tribute to the People Plan, which is putting innovation at the centre of the culture within the NHS. I agree with my noble friend that more can be done in this area.

[Lord Davies of Brixton (Lab)]

The report says little about the important area of services for mental health, because of a shortage of comparative data. However, a new measure has been introduced into this report for the first time, dealing with access to counselling and treatment for mental health issues. Is the Minister concerned that the data in the report shows that the UK lags behind the comparators in this important area of mental health?

[Lord Bethell (Con)]

My Lords, I have not studied the report’s comments on mental health but, in the broad terms in which the noble Lord describes the issue, I agree. We are very committed to improving access to mental health in this country—we have invested in it, but there is more to be done. It is an area of our health system that requires more investment, which is why we have committed more money to it.

[Lord Balfe (Con)]

My Lords, reference has been made to healthcare outcomes, where we are nearly at the bottom. It is rather like saying, “Everything went well but the patient died.” One of the functions of the NHS is to provide care but, because it is such a bureaucracy, there is very little competition. Can the Minister look at ways to preserve the NHS which include some sort of built-in incentive to innovate?

[Lord Bethell (Con)]

My Lords, I remind my noble friend that the report looks at 10 countries, so although we are at the bottom, it is bottom of a very small list. There is competition within the NHS—the 2012 Act organised that. My experience of working in healthcare, which has only been for one and a half years, is that collaboration, rather than competition, is the key to productivity. Getting diagnosis and the patient journey right requires a huge number of experts to work together and huge expertise, often in many different organisations. We are keen to use technology and modern techniques to make sure that collaboration is at the heart of the way in which the NHS works.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the time allowed for this Question has elapsed.

Flu Vaccination and Blood Test Cancellations

Lord Bethell Excerpts

Tuesday 14th September 2021 Lords Chamber

[Lord Rooker]

To ask Her Majesty’s Government what assessment they have made of the level of cancellations of influenza vaccinations and routine blood tests.

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

My Lords, I regret to report that there was a shortfall in the supply of blood tubes of around 13% in the last two weeks of August, which led to some disruption. That has been mitigated through use of government stockpiles, importing tubes and changes in practice. Supply has now returned to normal. It is not true that there is a flu vaccine shortage; the delivery from one supplier was delayed by one or two weeks, but this should have no impact on the flu vaccination programme overall. I am pleased to say that we are in regular contact with doctors, and no issues of cancelled appointments have been raised.

[Lord Rooker (Lab)]

What the Minister just said about blood tests is good news for those who have regular serious blood tests. But on the subject of flu jabs, does he recall telling me earlier this year that the flu jabs were made in the UK? They are not imported. The lorry drivers problem is a UK issue, so this is a home-grown issue. The websites this morning are saying that, up and down the country, GP after GP has been thrown into chaos because they are having to cancel appointments that were made weeks ago. I have personal experience of this, because even in Ludlow we are having appointments cancelled. The idea that this is not a problem is not the case. Why has this been allowed to happen? Everything involved is under our control in the UK.

[Lord Bethell (Con)]

My Lords, it is not my understanding that appointments have been cancelled. If the noble Lord has any anecdotes, reports or evidence of that, I would be very grateful if he could send me that material. Seqirus, the company concerned, brings its vaccines in from overseas.

[Baroness McIntosh of Pickering (Con)]

I remind the House of my interest, in working with the Dispensing Doctors’ Association. If my noble friend reads the BMA website for 4 September, he will see that it reports numerous cancellations of appointments for meticulously planned routine flu vaccinations. Obviously, that has caused great disruption. Will he undertake to treat this matter with the utmost urgency, to ensure that GP practices are not left to face the music, and that the Government will do their utmost to roll out the vaccine programme?

--- Later in debate ---

[Lord Bethell (Con)]

As my noble friend knows extremely well because of her close connections with the industry, GPs and pharmacies are responsible for purchasing their own flu vaccines through the seasonal flu vaccination programme, directly from manufacturers or wholesalers. Deliveries are phased and typically take place over a long period from September to November. As I said earlier, the disruption we have had in the supply was from one supplier for one or two weeks. It has not had a meaningful impact on the supply of flu vaccines to this country.

[Baroness Thornton (Lab)]

The Minister and the Government need to catch up with what is going on on the ground. I think almost everyone in your Lordships’ House knows someone who has had their flu vaccine appointment cancelled. There are two such noble Lords over there. I know three people in the House whose flu vaccinations have been cancelled. Perhaps he needs to go back to have another look at this.

The BMA has called for a COBRA meeting on the shortages of test tubes and transport. The Minister might think it is scaremongering, but it actually has a right to be alarmed. First, in these circumstances, if there are further delays and shortages, will he and the Government have a system of prioritisation? Secondly, how will the NHS encourage better take-up of flu vaccination among NHS staff?

[Lord Bethell (Con)]

My Lords, I hear loud and clearly the very obvious feedback from noble Lords about cancelled appointments. It is not the same as the guidance that I have been given, but I will look into it when I get back to the department and will be happy to write to the noble Baroness with an update on them. With regard to test tubes, I reassure her that guidance was issued to the NHS and GPs recommending actions for medical directors, nursing directors, GPs and pathology laboratories. It required refinements that had an impact, but those with an acute need for blood were accommodated and a COBRA meeting was not needed.

[The Deputy Speaker (Lord Brougham and Vaux) (Con)]

I call the noble Baroness, Lady Stuart of Edgbaston.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I had a similar text. I point out that it was about “routine” use. We were able to accommodate acute use through the whole period. However, the noble Baroness makes a good point, so I will look into it and see whether something can be done along those lines.

[Lord Adonis (Lab)]

My Lords, the HGV driver shortage has clearly been exacerbated by Brexit. Will the Minister tell the House what he intends to do about that?

[Lord Bethell (Con)]

I do not quite know how to answer that question. When it comes to test tubes for blood collection and the flu vaccine, I am not sure that there is a Brexit angle and we have it covered.

[Baroness Chakrabarti (Lab)]

My Lords, I cannot be the only Member of your Lordships’ House who is slightly confused by the Minister’s answers in relation to disputes of fact about whether cancellations are even happening, and then perhaps the passing of the buck to GP surgeries. When he writes to my noble friend Lady Thornton, will he place his answer in the Library and not just address the vital issue of fact—and trust—as we head into a very difficult winter, but be clear about the priorities between routine testing and vaccination and the more acute category that he describes?

[Lord Bethell (Con)]

I would be absolutely delighted to put the letter into the Library as requested by the noble Baroness, but please do not think for a moment that I am in any way seeking to pass responsibility. I am pointing out the very clear fact that GPs are responsible for implementing the flu vaccination programme. It is something that they do brilliantly. No other country has a flu vaccination programme with the impact that ours has. GPs are taking on more responsibilities this year with secondary school children being vaccinated. The rate I am expecting for this year will be higher than we have ever seen before.

[Lord Hunt of Kings Heath (Lab)]

My Lords, any delay in blood tests or flu vaccination must have some impact on patient safety. What monitoring are the Government doing to try to measure the impact? Will the Minister ask the Healthcare Safety Investigation Branch to conduct a review?

[Lord Bethell (Con)]

My Lords, my understanding is that patient safety has not been at stake, but the noble Lord makes an extremely good point. I am not sure it is my role to instruct HSIB on this, but I will look into whether investigation is necessary. I reassure him that these shortages have not had a profound impact. We have marshalled the use of the tubes extremely carefully and have pushed back some routine blood-taking. That will have a small impact but we have put in place provision for a catch-up.

[The Deputy Speaker (Lord Brougham and Vaux) (Con)]

We now come to the noble Lord, Lord Young of Norwood Green.

--- Later in debate ---

[Lord Young of Norwood Green (Lab)]

After my unfortunate trans moment, I shall now ask my question in all seriousness. Does the Minister recognise that this winter it is particularly important that we get the maximum number of flu vaccinations in this round? It is important every winter, but this winter somebody contracting flu and then Covid is in serious danger.

[Lord Bethell (Con)]

My Lords, I reassure the noble Lord that we have strained every sinew to deliver the most impactful flu vaccination programme in the history of the country. We have expanded the range of the flu vaccination and the number of vaccinations available. The NHS depends on us keeping people out of beds. That is why we are highly focused on this.

[Lord Brooke of Alverthorpe (Lab)]

Will the Minister answer the question asked by my noble friend Lady Thornton about the BMA’s feeling sufficiently concerned that it suggested a meeting of COBRA? COBRA could have discussions with the Armed Forces and perhaps we could use some of their drivers. There are answers to some of these problems.

[Lord Bethell (Con)]

This is not a driver problem; it is a delivery problem.

[Lord Coaker (Lab)]

Does the Minister not understand the frustration across the Chamber? Every one of us knows that there are problems with routine blood tests and cancellations of flu vaccinations. Everyone would expect the Minister to explain what he is going to do about it—so what is he going to do about it?

[Lord Bethell (Con)]

My Lords, I hear the frustration in the House, particularly on flu vaccinations. Quite clearly the personal experience of those in this Chamber is different from what is being reported to me. I have undertaken to look into it more closely, to write to the noble Baroness and to put that letter into the Library. I think that is an entirely fair and reasonable response and, if I may say so, demonstrates the effectiveness of this Chamber at holding Ministers to account.

Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) Regulations 2021

Lord Bethell Excerpts

Tuesday 14th September 2021 Grand Committee

Moved by

[Lord Bethell]

That the Grand Committee do consider Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) Regulations 2021.

Relevant document: 11th Report from the Secondary Legislation Scrutiny Committee

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

My Lords, over the past few months, the Government have made a concerted effort to bring forth a sense of normality across the country with the easing of restrictions, while maintaining caution with regard to this deadly virus, which clearly has a long way to run. These regulations are a key part of this dual-track effort, significantly reducing the burden of self-isolation while protecting society from the threat of contagion. The main focus of the regs is the isolation protocols, so I begin by reflecting on the crucial role that contact tracing and self-isolation play in fighting the virus.

Since it was established in May 2020, NHS Test and Trace has contacted more than 15 million people who have tested positive for Covid-19 or who have been in contact with a positive case. Tracing—the bedrock of any public health intervention—has improved substantially over the last several months. In October 2020, 60% of close contacts were being reached. In comparison, over the period from 26 August to 1 September, 87.3% of positive cases transferred to NHS Test and Trace were reached, as have 89.5% of their contacts where usable contact details were provided. That is a remarkable achievement.

The public realise the importance of isolation. July’s ONS statistics that show 79% of positive cases reported complying with the self-isolation guidance, alongside 89% of close contacts. That is a terrific response from the public and it has proven a vital weapon in our arsenal against the virus.

What is the impact of this massive financial and societal investment? A recent study from PHE, published today and called the Canna model after the idyllic Scottish western isle, which some noble Lords may have visited, shows that from August last year to this April, test, trace and self-isolation activity reduced the transmission of the virus by between 10% and 28%. The PHE research demonstrates that self-isolation helped to bring R below one at crucial times, reducing the duration and impact of lockdown. Over the full period of the study, the Canna model estimates that isolation due to test, trace and isolate policies prevented between 1.2 million and 2 million secondary cases. The NHS Test and Trace service has also enabled us to identify peaks and troughs in case rates, supporting decisions on when restrictions should be tightened or could be eased.

We recognise that none of this has been easy. The requirement to isolate creates enormous challenges for individuals and their families across the country. A study in March 2021 by the BMJ concluded that offering financial and practical support to individuals who needed to self-isolate would likely improve compliance. We support that view. Since September last year, we have provided councils with £280 million to issue support payments to those who may face financial hardships because of self-isolation. We have also made up to £100 million available between March and September this year for councils to offer practical and emotional support to some of the most vulnerable in our communities, covering over 200,000 people. It is right, though, that we sought to reduce the burden of self-isolation at the earliest opportunity.

The amendments to the self-isolation regulations we are debating balance these factors and provide a significant easing of burden from self-isolation requirements while maintaining vital measures to reduce the spread of the virus. These amendments came into effect on 16 August and allow those who are fully vaccinated to be exempt from self-isolation if they are the close contact of a positive case. Based on the data, we know that the vaccines reduce overall symptoms by between 80% and 90%, hospitalisations by between 90% and 95%, and deaths by around 95%. Therefore, we have adapted our approach to self-isolation to reflect this and ensure we balance the need to slow down the transmission of the disease with the need to get back to normal.

As well as fully vaccinated adults, several other groups have also been exempted from the requirement to self-isolate. The amendment provides an exemption to self-isolation for the close contacts who have taken or are taking part in an MHRA-approved trial for a Covid vaccine. This will ensure that they are not disadvantaged as a result of their personal sacrifice. We recognise also that some groups cannot be fully vaccinated on medical grounds. The amendment therefore includes an exemption for those close contacts who can evidence that they are unable to be vaccinated for medical reasons.

Finally, we have carefully considered the impact on those under the age of 18. There are unqualified harms to children’s educational, emotional and social outcomes as a consequence of self-isolation, as well as of the infection itself. The risk of hospitalisation and intensive care admission in children due to Covid is very low—approximately eight per 100,000 population aged under 18 are admitted to hospital. The incidence of mortality in children as a result of Covid is also extremely low. By balancing these factors, the SI provides an exemption for those close contacts under the age of 18 from self-isolation.

Those who are exempt will be advised to take a PCR test as soon as possible to check whether they have the virus. Though not required to self-isolate, they will be advised to consider other precautions, such as wearing a face covering in enclosed spaces, as well as limiting contact with others, particularly those who are clinically extremely vulnerable. However, it remains the case that if any of these groups develop symptoms they should self-isolate immediately and take a PCR test. Anyone, whether fully vaccinated or not, who goes on to test positive will remain under a legal duty to self-isolate.

Although I sympathise with the burden and the challenges that self-isolation creates, it will continue to play an indispensable role in containing the virus. The Secretary of State said more on this in his Statement earlier on the winter strategy for tackling the virus. While restrictions are easing, we must all continue to adhere to the self-isolation regulations and the guidance if we are to continue protecting our friends, families and communities. I commend these regulations to the Committee.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I very much agree with what the Minister said about the importance of self-isolation. I note that emphasis is given in the winter plan to the importance of isolation in relation to breaking transmissions. The issue I have is that there is a proportion of the population who find self-isolation very difficult, and there are legitimate reasons for that. I have been studying TUC research, which shows that 24% of low-paid workers say they cannot afford to take time off for sickness, as opposed to 6% of high-paid workers. It reckons that only 35% of low-paid workers get full sick pay, as opposed to 80% of high-paid workers, defined as those earning more than £50,000 per annum. Statutory sick pay is only £96.35, less than any other OECD country. It is reckoned that 72% of low-paid workers cannot work from home, compared with 20% of high-paid workers.

--- Later in debate ---

All our local secondary schools opened last week and one had anti-vax parents demonstrating outside it. I do not know whether this is happening elsewhere. They were demonstrating about 12 to 15 year-olds being vaccinated, and that is very worrying. I will leave that with the Minister. It is shocking, but what on earth can we do about it?

[Lord Bethell (Con)]

My Lords, I am enormously grateful for this rich debate. The reflections of noble Lords are shared by the Government in many ways. I will start with the poignant remarks made by the noble Lord, Lord Hunt, on support. We agree that financial support is an important part of the isolation process. It would be inhumane to suggest that someone can somehow live off the generosity of others to support themselves over this difficult period. We have actively promoted the financial support available to people who need to self-isolate, are working with local organisations to extend our reach and continue to improve those arrangements.

Please do not forget that we have already invested £280 million in the test and trace support payment scheme, which has been specifically designed to encourage more people to get tested and to ensure they self-isolate if they are positive. From March this year, we increased the funding available to local authorities to make discretionary payments under the scheme to £20 million a month. This enables a wider range of people to be supported and addresses some of the points made, not unreasonably, by the noble Lord, Lord Hunt, about the availability of funding and how it might touch local authorities’ provision of those payments.

In May, the Government launched nine trail-blazing pilots in England to try different, creative ways to ensure that people stick to self-isolation rules in areas with a higher prevalence. Some individuals have had concerns about their practical ability to self-isolate, either because they did not think they would get support with food delivery or dog walking, or perhaps because of the impact on their mental well-being. Interventions, such as one-to-one buddy support and the provision of practical assistance, aim to support self-isolation.

The programme has provided funding for areas such as Greater Manchester to pilot ways to reach, support and engage with households within 24 hours of a positive test to develop a personalised plan for their self-isolation. In Peterborough, those living in houses of multiple occupancy or in larger multigenerational environments, who are unable to effectively self-isolate and are more likely to increase transmission through household contact, if they have nowhere to go, have had specific projects of support. Our Local-O initiative means that we are improving local tracing techniques to reach those who need to self-isolate quicker. The support payment itself is around £500 a month.

These are the kinds of measures that we have put in place to improve the reach and effect of our support. Of the £280 million we have spent so far, £114 million has covered the cost of the main test and trace support programme, £116 million has been in discretionary payments and £50 million has been in administrative costs. This, in addition to the medicine delivery service launched on 16 March 2021, which has delivered £17.8 million-worth of medicines, has made a huge impact and supported those in isolation, but we continue to review this area.

Many noble Lords made extremely pertinent points on schools. I completely agree that schools and potential infection from them are critical. That is why we brought in twice-weekly asymptomatic testing in secondary schools and colleges, which will continue during September. That programme includes two tests specifically at an asymptomatic testing site three to four days apart for students at schools and colleges on their return. Most of them have just happened and there is a review point at the end of September when we will assess the levels of infection in schools. We are encouraging schools to continue with twice-weekly asymptomatic testing. We very much hope that staff and pupils in secondary schools and further education providers, and staff in primary schools and early years settings, will continue to do testing and we will assess compliance at the end of September.

I hear loud and clear the concerns about ventilation. We have in fact brought in plans in the winter plan on this matter. Changing the ventilation arrangements of our estate of 25,000 schools is itself a mega generational project of hundreds of billions of pounds, so this is not one that we can turn around overnight. The vaccine will certainly have a lot more impact in its immediate efficacy, but we are investing £25 million in around 300,000 CO₂ monitors for schools. That in itself is a terrific initiative and I hope will not only make an impact on the schools involved but give us the learnings to understand how ventilation can be used to stop the spread of the virus.

We will also have trials of high-efficiency particulate-absorbing filter and ultra-violet C air cleaners in 30 Bradford schools, as well as working with stakeholders such as the Rail Delivery Group and the Rail Safety and Standards Board to trial the use of upgraded air filtration devices on passenger rolling stock. I will not pretend to understand the full technicalities of those arrangements, but I am extremely impressed by how quickly officials have moved to address these concerns.

As I said, we are committed to testing in schools and will review it in September. Social distancing remains in place wherever it can, but I am relieved to say that the bubbling arrangements, which were so disruptive in the first half of this year, are now largely in the past.

I know that the noble Baroness, Lady Barker, is extremely concerned about those not registered with GPs. I assure her that I have a regular meeting with the vaccination team to address this specific point. The outreach we do is to marginal groups of all kinds, ranging from Traveller groups who might not be registered with GPs and have a suspicion of the vaccination programme, through to those who may have religious, language or other distinctive qualities that mean they would not normally be captured in a vaccination programme. We have done an enormous amount to reach out to these groups. Vaccination can now happen without being registered. We have turn-up sites and a vaccination can happen at any of our main vaccination centres without full registration. If the noble Baroness would like to know more details of this part of our vaccination programme, I would be very glad to arrange a briefing. I know that it is very much on her mind.

I do not accept the premise that the Government are running an “it’s all over” programme in their communications. The winter programme that we have announced today is extremely proportionate. It relies on the responsibility of individuals. We cannot legislate for every sneeze and splutter in the country for years to come. We have to rely on people. I think the story that the noble Baroness, Lady Thornton, told of her friend and the wedding and the very detailed judgments that we all as individuals have to make is exactly what we all have to live with. The Government do not seek to intervene in those judgments—they are for the noble Baroness and her friend to work out for themselves. That is a proportionate climate for us to proceed in. Of course, should the worst happen, and should we need to, we have a back-up plan—described in the winter plan that we have announced today—where we bring back the awful measures that tied this country down so heavily earlier this year. We are seeking to avoid that.

Lastly, on the local authority funding settlement, there is more work to be done with local authorities—the noble Baroness, Lady Barker, is right. The funding settlement is not finalised yet. Local authorities will continue to play a critical role in public health protection, emergency response and infectious disease control. They will have support through the contain framework, which continues, and through the enhanced support that we offer through test and trace. I think noble Lords are aware of the surge testing, vaccination logistics support and national funding that we have in place in areas where there are major outbreaks. There is also the education contingency framework, which provides schools with additional support. We are totally engaged with local authorities in discussing the practical and financial support that we can offer them.

I think the place we are in has a huge sense of relief, because the vaccination programme is largely working, but also enormous uncertainty. If the CMO were here today and we were to press him to tell us how exactly things are going to play out, he would say that he could not be sure and that he has never faced a moment of such uncertainty in his life. I am sure he speaks with his normal integrity and discretion on that. As a result, we have put in place a proportionate plan for the near future but are ready to bring in other measures if necessary. I think that is the right approach. I beg to move.

Motion agreed.

Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 2) Regulations 2021

Lord Bethell Excerpts

Tuesday 14th September 2021 Grand Committee

Moved by

[Lord Bethell]

That the Grand Committee do consider the Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 2) Regulations 2021.

Relevant document: 11th Report from the Secondary Legislation Scrutiny Committee

Motion agreed.

Social Care: Family Carers

Lord Bethell Excerpts

Monday 13th September 2021 Lords Chamber

[Baroness Wheeler (Lab)]

On behalf of my noble friend, and with her permission, I beg leave to ask the Question standing in her name on the Order Paper.

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

My Lords, we recognise that family carers play a vital role. When we announced an additional £4.5 billion over three years for social care, it included a commitment to take steps to ensure unpaid carers have the support, advice and respite they need. We will publish a White Paper later this year with more detail. The Health and Care Bill also places a duty on integrated care boards to promote the involvement of unpaid carers.

[Baroness Wheeler (Lab)]

My Lords, the Minister has acknowledged that our 1.6 million unpaid carers are reporting high levels of fatigue and stress and are worn out and exhausted by caring during Covid-19. On average, carers have lost 25 hours a month of crucial support over the past 18 months, and 81% are providing more care. Essential daily support services for them and their loved ones are still not up and running in many areas. Was it not therefore reasonable for carers to have expected immediate funding support from the Prime Minister’s health and social care funding announcements last week? The situation is desperate and needs addressing now, not just with more kind words and another “White Paper tomorrow” promise.

[Lord Bethell (Con)]

My Lords, I do acknowledge the pressures on unpaid carers and pay tribute to the incredible contribution they have made during these very difficult 18 months. We are continuing to work with local authorities, in collaboration with ADASS and MHCLG, to support local authorities in meeting their duties, particularly in the area of respite, which the noble Baroness rightly pointed out. We have also made contributions to Carers Trust, Carers UK and to “See, Hear, Respond” services to support unpaid carers. In the long term, our commitment is to social care reform and the financial proposition that we will bring forward in the White Paper.

[Lord Lilley (Con)]

My Lords, would my noble friend confirm that he just said there would be only £1.5 billion a year going to social care from the large increase in national insurance? Can he confirm that nearly half of that will be absorbed by the need to pay for the extension of free social care to those with valuable homes? That means that nothing will be left to help domestic carers.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, the maths that my noble friend has done is a little bit premature. The White Paper will come out later this year; it will spell out the precise financial arrangements, and I am looking forward to that.

[Lord Laming (CB)]

My Lords, the Minister has already indicated an understanding that many carers sacrifice a huge part of their lives in trying to care for a loved one. Many of the community support services that used to be available are no longer available. When these arrangements break down and a crisis occurs, it is understandable that the only option left is to call an ambulance, which places increased pressure on the health service. Will the Minister champion a new approach, which is this: “Protect the NHS by supporting carers”?

[Lord Bethell (Con)]

Yes, I would endorse that sentiment. That has been one of the learnings of the pandemic. It is instinctively true in any case, and the evidence base during the pandemic was quite right. They are interlinked; that is one of the reasons we are bringing forward a Health and Social Care Bill that brings both services much closer together and brings a responsibility on the ICSs to combine health and social care at the same time. Our population-wide measures will try to bring those care responsibilities much closer together, as the noble Lord suggested.

[The Deputy Speaker (Lord Haskel) (Lab)]

My Lords, we will now have a virtual contribution from the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, the Disabled Children’s Partnership reports that parents of disabled children say that two-thirds were not able to access care at home during the pandemic. In the two years prior to the pandemic, large numbers of respite care beds for disabled children had already been shut down. Given that none of the new social care levy is targeted towards disabled children and young people, can the Minister say whether urgent funding will be provided for this vulnerable and too-often forgotten group, where unpaid carers are often on duty 24/7?

[Lord Bethell (Con)]

My Lords, I do recognise the problem: 23% of carers—1.3 million—provide care for 50 hours or more a week. That is an absolutely astonishing figure, and I pay tribute to the contribution they make. The overall contribution by carers is around £56 billion a year. We cannot undervalue that contribution in either emotional, care or financial terms. The precise allocation of funding for this new financial package is not yet confirmed. When it is, I will make sure that the reasonable points the noble Baroness made are heard clearly in the department.

[Lord Hunt of Kings Heath (Lab)]

My Lords, in his first Answer, the Minister mentioned the Health and Care Bill and a more general duty to promote the interests of underpaid carers. Can he tell me why, at the same time, the Government are getting rid of the current provision in law of a carer’s right to an assessment when they take on a new caring role and the right to be consulted on whether they are willing and able to care? It is a crucial right of carers to have a proper assessment. Why is it being taken away?

[Lord Bethell (Con)]

My Lords, I completely agree that the carer’s assessment is the building block of our system. It is incredibly important; we do a lot of work to encourage more carers to get it. I do not know specifically about the point that the noble Lord makes on this additional component, but I would be glad to enter into correspondence with him on it. The broad principle of the importance of the carer’s assessment is one with which I wholeheartedly agree.

[Baroness Tyler of Enfield (LD)]

My Lords, research shows that, pre pandemic, 600 people a day had no choice but to leave work to manage their unpaid caring responsibilities and that, since Covid began, an additional 2.8 million workers now juggle work and unpaid care. Having access to carer’s leave would help millions of carers and support many of them to remain in work alongside their unpaid caring responsibilities. When will the Government publish their response to their consultation on carers’ leave, which closed on 3 August last year?

[Lord Bethell (Con)]

My Lords, I recognise the challenge referred to by the noble Baroness. Some 2.9 million carers are employed; that is more than half of all carers. One can only imagine the pressure that they feel trying to juggle their roles as carers and employees. The consultation has been tied up by the pandemic, but we are keen to get a response out soon. Now that we have announced this package, it makes that all the easier. I very much look forward to bringing the response to the House.

[The Deputy Speaker (Lord Haskel) (Lab)]

My Lords, the noble Lord, Lord Bhatia, was not present in the Chamber so all supplementary Questions have been asked. We will now move on to the next Question.

Covid-19 Update

Lord Bethell Excerpts

Thursday 9th September 2021 Lords Chamber

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

My Lords, I am extremely grateful for such thoughtful questions. I thank the noble Baroness, Lady Thornton, for her kind remarks: I had a very good break, and I hope that both she and the noble Baroness, Lady Brinton, did so too.

We are in a much better place than we were this time last year, but there are still serious challenges on the horizon. I am grateful for the opportunity to address some of those.

The noble Baroness, Lady Thornton, rightly alluded to the important flu vaccine rollout ahead of us. I reassure her that any issues of supply are focused very much on single suppliers, and we have a wide range of people stepping forward to supply us. We will continue an extended vaccination programme for the whole of the 2022 season, and more than 35 million people should be eligible for free seasonal flu vaccines. It will be the biggest flu vaccine rollout that we have ever done, beating, we hope, the record uptakes that we had last year. It will include a continued offer of vaccination to 50 to 64 year-olds and, for the first time, will be extended to additional cohorts in secondary schools so that those in years 7 to 11 will be offered a vaccination. The vaccination rollout is on course and we hope that it will hit all its targets.

While talking about education, I reassure the noble Baroness that asymptomatic testing in secondary schools and colleges will be continued. That includes two tests in person on return, which many have recently done, but there will be a review point at the end of September. Schools will not be responsible for contact tracing of positive cases. As with positive cases in other settings, NHS Test and Trace will work with those cases to identify close contacts. I believe that will lift a severe burden on schools and make life easier both for parents and for pupils.

On ventilation, both the noble Baroness, Lady Brinton, and the noble Baroness, Lady Thornton, are quite right: these are important developments. But we cannot turn around a massive change in the infrastructure of our education system overnight. As autonomous institutions, it is right for providers of education to put in place their plans based on individual circumstances, including allocating their own budgets. None the less, we are putting in place special provision for ventilation in schools where there is an acute need.

To answer the noble Baroness, Lady Brinton, directly, she is right: vaccines are the primary but not the only way out of this pandemic. She will know as well as anyone our remarkable achievements in that space. The noble Baroness, Lady Thornton, asked whether we are therefore planning to have an autumn “firebreak” of lockdowns. The Government are undertaking a review to assess the country’s preparedness for autumn and winter, which will consider whether to continue or strengthen public and business guidance. We may need to take measures to help manage the virus during periods of higher risk, such as autumn. However, we will do everything we can to seek to avoid imposing restrictions that have significant economic, social and health costs. We will do it only as a last resort if absolutely necessary.

Both the noble Baroness, Lady Brinton, and the noble Baroness, Lady Thornton, asked about children’s and young people’s vaccines. As they know, on 3 September we accepted JCVI advice on extending the list of 12 to 15 year-olds with underlying health conditions who can receive the vaccine. That is very good news. It includes children with haematological malignancies, sickle cell disease, type 1 diabetes, congenital heart disease and a number of other conditions. We are now awaiting the CMO’s assessment of the JCVI advice so far and its advice to us on whether the remaining 12 to 15 age group should also receive the vaccine. We look forward to receiving that advice.

Regarding boosters and a third vaccine, on 1 September we accepted JCVI advice on offering a third vaccine dose to individuals with severe immunosuppression. That dose is being given to bring severely immuno-suppressed individuals nearer to the same level of immunity achieved by healthy individuals in two primary doses. Again, this is very good news. Following the publication of interim advice by the JCVI in June, the Government are preparing for a potential booster vaccination programme from September, and I look forward to bringing details of that to the House at a future date.

On the mandation of vaccination in social care, we are enormously grateful for the huge amount of support among social care workers for our vaccination programme. It is true that some—a very small proportion—have not taken up the opportunity for vaccination. We hear the concerns of providers of social care, but, in the round, this has proved to be an effective programme that has delivered a huge amount of reassurance to those who live in social care and has put safety at the forefront of our efforts. That is why we are looking at a consultation on mandatory vaccination for NHS workers, following a public consultation that we recently announced. While many of those working in health and care have taken up the offer, it is crucial that this is consistent across relevant services to safeguard vulnerable people, which is why we are looking further at mandatory vaccination elsewhere.

Testing is still very much an important part of our campaign against the virus. We are supporting the testing programme, but we maintain it under review. On discharge arrangements, there has been generous financial support for discharge provisions from hospitals to schools because, as the noble Baroness, Lady Brinton, rightly pointed out, that is a very important bottleneck that has tied up a large number of hospital beds. As we go into winter, we want to have the best possible arrangements for ensuring that those hospital beds are prioritised for those who need them most.

[Baroness Finlay of Llandaff (CB)]

My Lords, I have some supplementary questions. I am most grateful to the Minister for the update and for yet again appearing before the House. I will pose short questions about three areas.

First, on the public health messaging over asymptomatic carriers, we seem to have had a complete drop-off of mask wearing and of being distance aware. Neither of those impedes the economic viability of any business at all; they are simply social behaviours. People seem to have gone back to the most inappropriate social hugging, which is unnecessary. Yet I do not see any public health messages coming out just to maintain the control measures we had in place before. Could the Minister tell me what the plans are for that?

Secondly, does the noble Lord plan to widen the list of eligible children to ensure that those who have a family member, whether a sibling or parent, who is particularly vulnerable are offered vaccination—this would not be forced but would be an offer to them—rather than being excluded, as they are at the moment, because they themselves are not ill? They may carry quite a large emotional burden, knowing that someone at home could become very ill, despite being double vaccinated.

Thirdly, on preparing for the winter, does the Minister recognise this week’s notice from the Royal College of Emergency Medicine showing that 80% of respondents are not confident in their ability to cope safely in their departments as we go into winter, and that half of the emergency departments are reporting delays of transfer from ambulances into their departments? That compares with a quarter of such departments reporting these delays in October 2020, which would suggest that the whole backlog and silting up has got worse. Can the Minister explain what provision there is to expand bed provision, so that people who arrive in emergency departments and need admission can be moved rapidly into beds to be looked after, rather than having this backlog, which also stops ambulances going to other emergencies while they are stuck outside an emergency department?

[Lord Bethell (Con)]

I thank the noble Baroness for three extremely thoughtful questions. I will dwell on them, if I may, because they are a good opportunity to answer some of the concerns that I know many noble Lords have.

On public health messaging and behaviours, there is a question of perception. If we look closely at the analysis done by our behaviours team, we see that the public remain extremely conservative and restrained. While the noble Baroness’s perception may be that mask wearing and distancing have been given up and that hugging is not where she would like it to be, from the data it appears that the public remain extremely concerned about public transport, going to the shops and attending major events. Therefore, we are in a moment of transition, but roughly speaking we are where we would want to be.

Let us be clear: we are keen to get back to the life we once had, and vaccines are going to be the way that we do that. We want to return to intimacy and to the way in which our community likes to live. Testing, social distancing and the panoply of virus control play a role in that—but we are seeking to step back from those days and, so long as the vaccines work in the way they are working at the moment, we are keen not to disrupt people’s lives as much as we can.

On eligible children, that ball is with the CMO at the moment. I completely hear the noble Baroness; she is entirely right about the emotional burden. I also emphasise the importance of making sure that children get the education they need, while at the same time empathising with their concerns for their loved ones and those with whom they live. It is an awful position for those children and families to be in. That is why the CMO is looking at vaccination for 12 to 16 year-olds and possibly beyond.

On winter preparations, I hear the noble Baroness’s comments about the Royal College of Emergency Medicine. The statistics she gave are a matter of concern, but the medical director of the NHS monitors these questions extremely carefully. We think we are in the position we need to be in to get through this winter. We are on the balls of our feet in case there is either an uptick in the current delta variant or a new variant. A huge amount of investment has gone into the redeployment of NHS beds. The NHS has never had a bigger capacity in terms of its workforce and the number of beds available. The use of ICUs and the management of Covid patients have become much more efficient and productive than they used to be, and we believe that we are in good shape.

[Baroness Donaghy (Lab)]

My Lords, perhaps I could ask the Minister two questions. My first question is the question I asked on the day we broke up in July, about whether there are plans to do booster jabs combined with flu jabs. The Minister was not certain and said he would try to let us know. Has he got more information on that?

My second question is slightly more speculative, but it is something I am very concerned about. BBC news has been extremely conscientious about keeping everybody informed about the Covid rate, the death rate and the number in hospital. Can we have an assurance that no pressure will be put on the BBC by the Government in order to bury the worrying developments that are taking place?

[Lord Bethell (Con)]

I am very grateful to the noble Baroness for asking about the co-administration of the flu and Covid vaccines. I hope very much that I got back to her. If I did not, I shall give her an update now. JCVI’s interim advice is to plan to offer Covid booster vaccines from September 2021 to prolong the protection of the vaccines provided to those who are most vulnerable to the serious effects of Covid ahead of the winter months. This would take place alongside the annual flu vaccination programme. The NHS will continue to follow the guidance given by the JCVI on the co-administration of flu and Covid vaccines—so, yes, they will be co-administered. That is an enormously effective way of delivering the vaccines, and the reach of both programmes is amplified by the other.

On the BBC, I reassure the noble Baroness that no pressure is put on it. If we had an effective pressure mechanism on the BBC, she would certainly be the first to know about it.

[Lord Paddick (LD)]

My Lords, may I take the noble Lord the Minister back to a question about Covid passports that my noble friend Lady Brinton asked and that he did not have time to answer in his first response? I understand both sides of the argument regarding Covid passes, but what I do not understand is the potential exclusion of those properly vaccinated overseas, or indeed anyone double-vaccinated outside England.

In July, the Vaccines Minister, in a Statement in the other place, said that, by the end of that month, those vaccinated overseas could have their vaccinations recorded on the NHS England system and access their Covid pass using the NHS app. Despite the Government promising that this would happen by the end of July, it is still not possible. What do these people do when they are told to self-isolate on arrival into the UK from yellow-listed countries, or when they are excluded from designated premises, if the Government bring in compulsory Covid passes for access to certain types of premises?

[Lord Bethell (Con)]

I am grateful to the noble Lord for raising the point again, and my apologies to the noble Baroness, Lady Brinton, for not addressing her point the first time around. I will just say that, from 19 July, it has been voluntary for organisations to use and implement the Covid pass under step 4. There are some essential settings where certification should not be used, and we have made that plain.

However, the Government are encouraging and supporting businesses and large events to use the Covid pass. The Government intend to make full vaccination a condition of entry to nightclubs and other venues where large crowds gather from the end of September. Work is under way to find a solution for Northern Ireland citizens who have been vaccinated in England but are registered with a GP in Northern Ireland. We are also very close to establishing data flows with the Isle of Man.

To the noble Lord’s point about those who have had their vaccinations overseas, in countries such as Norway, he is entirely right. We are working extremely hard on those processes. I have met with NHSX and NHSD to talk about this matter and I assure him that we are putting every effort into dealing with it. I wish that we had dealt with it by now. It is an extremely complex matter. The validation and verification of vaccines requires an enormous amount of bilateral and multilateral co-ordination, and the approval of different vaccines taken by different people in different locations and the record keeping by overseas countries are things that we have to consider and manage. He is right: when the Covid pass system is brought in, those who have had a vaccine overseas will need special consideration. I reassure him that we are working as hard as we can to resolve that issue.

[Lord Farmer (Con)]

My Lords, perhaps I might bring up the subject of antibodies. All the statements seem to be focused completely on vaccinations, yet there is growing evidence that those people who have had Covid and have had vaccinations are indeed almost super-immune even to variants. There was an article in today’s Telegraph about that. So my first question is, do the Government have any idea how many people have in fact had Covid? There are an awful lot of people who have not had symptoms, have been at home, have had it and have recovered, and the Government have not really been informed about it. Is there knowledge in the Government about this area and, if so, is research being done on the strength of the antibodies of those who have had Covid and is that being taken into account in policy?

[Lord Bethell (Con)]

My noble friend has had an interest in this very important area for some time, and I completely applaud his diligence on it. It is an area that I share an absolute fascination with. We know so much about the vaccines but so little about the body’s immune system. It is incredibly frustrating but it is, I am afraid to say, just one aspect of this pandemic.

To answer the specific question of how many people have had the disease, it is difficult to be precise. Unfortunately, a lot of people have had the disease and never known that they had it. The fact that they have now gone on to have a vaccine means that it is extremely difficult for us to trace whether they have had the disease, because we do it mainly through the counting of antibodies. My noble friend can look on the ONS website, which I am sure he probably has, and he will see that the Venn diagram makes it almost impossible to figure out exactly how many people have had the disease. I can, through correspondence, share with him the various modelling that we have done, but there is not a definitive answer to that question.

I wish it were true that having had the disease and the vaccine together creates some kind of super-immunity, but I am afraid that there is a subset of people who have had both the vaccine and the disease who then go on to have the disease again. I have met a few of those people; they are extremely frustrated, as you can imagine. I am afraid that it does not bode well for thinking that the vaccine presents a concrete and immutable guard against the disease. I am afraid we will be living with the thought of boosters and improvements on the vaccine for some time to come. That is emerging as something we are working on. We are doing a tremendous amount of research on this. I had a meeting earlier with the antibody team, and I reassure my noble friend that we are doing everything we can to understand it better.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I come back to the advice from the JCVI relating to 12 to 15 year-old children who do not suffer the underlying conditions it has set out. I worry about the implications of that being overruled through the process that the Ministers have set up, seeking the advice of the four Chief Medical Officers. The Minister will know that they concluded that some young people, although it would be extremely rare, could suffer from myocarditis with lifelong consequences.

I must ask about the ethical considerations here as to some young people who will be damaged as a result of that decision because 6 million adults are too stupid or ignorant to have the vaccination. That surely is where our focus should be. Could he say something about what the Government are doing? Does he agree that the integrity of the whole vaccine process, not just in relation to Covid, is at stake here? I think that the JCVI should be listened to.

--- Later in debate ---

[Lord Bethell (Con)]

I violently agree with both the noble Lord’s points in spirit. If I may take them in reverse order, he is right that there are people who are not taking the vaccine, and they put the entire community at risk. Vaccination uptake among the under-30s has plateaued at around 60%. I cannot tell him exactly what will get that number up any further. That is why we look at questions such as certification and mandation. These are already in place in many European countries, including France and Italy, where they have taken advantage of certification and mandation in an extremely tough way to drive through vaccination. That example weighs heavily on our minds as we assess those two important opportunities. It is tough, and we will have important debates here in the House of Lords on both of them should they come to pass.

On children, the noble Lord is right that there are profoundly complex epidemiological and ethical issues around child vaccination. Child vaccination has been rolled out in America and in many European countries. Some European countries are looking at vaccinating those aged over three, not just those aged over 12. Why do they do that? It is because children are vectors of infection and drive the disease through their families, schools and communities. He is right that there are very rare examples, but examples none the less, where harm is done to children through the vaccine. Therefore, the assessment of that harm and weighing it up against the harm done by Covid to children, which again is extremely rare but is a statistical occurrence, and the community obligations and the damage done through the spread of the disease is something that ethicists and epidemiologists are looking at right now. We are being extremely careful about the way we do that. We are aware that it might be open to challenge. Therefore, we are dotting the “i”s and crossing the “t”s.