Health Protection (Coronavirus, Restrictions) (England) (Amendment) (No. 2) Regulations 2020
Lord Bethell Excerpts(3 years, 10 months ago)
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Lord Bethell
That the Regulations laid before the House on 13 May be approved.
Relevant document: 15th Report from the Secondary Legislation Scrutiny Committee
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
My Lords, the amending regulations we are discussing were made by the Secretary of State on 13 May. These remain an exceptional and necessary package of measures brought forward to protect public health. As noble Lords will be aware, we have been moving—in the phrase of the moment—at pace. The regulations we are debating have been amended two further times since, on 31 May and 12 June. This is an unusual situation, so I will address this early in my speech because I know that it is a cause of concern.
This sequencing has been a necessary consequence of the speed at which the Government have had to respond to the changing impacts of the pandemic on our country. Use of the emergency procedure has rarely been so necessary. It has enabled us to move quickly to bring about essential measures, and to begin a cautious return to normality and to reopen the economy as soon as the science has allowed. In more usual times we would have run the processes in sequence, whereas in Covid time we have to run things in parallel. These are not usual times.
It may feel extraordinary that these processes are so out of synchronicity and there will be those who feel concerned by the situation. However, I believe that the situation has demonstrated that our flexible unwritten constitution is a strength in extraordinary times such as these and that our parliamentary democracy can retain its oversight while bringing about measures necessary to meet these unprecedented circumstances.
Having stood at the Dispatch Box to address such statutory instruments before, I convey my gratitude to noble Lords for their time spent on scrutiny, their thoughtful informal engagement and their continued support through this challenging time. Nevertheless, I assure noble Lords that this expedited process does not set some kind of inappropriate precedent for the future, when we reach a greater state of normality.
As I mentioned, the debate will focus on the second set of amending regulations, which came into force on 13 May. These amendments to the regulations follow the Statement made by the Prime Minister to the other place on 11 May regarding the Government’s road map to ease restrictions over the coming weeks and months. The measures I will outline are a small first step in this plan.
We have now exited phase 1 of recovery and have entered phase 2. Phase 2 involves gradually replacing the current social distancing restrictions with smarter measures that have a greater effect on controlling the pandemic, but at the lowest epidemiological, economic and social cost. Over time we will introduce more localised measures, supported by widespread, accurate monitoring of the disease.
The Health Protection (Coronavirus, Restrictions) (England) Regulations 2020 have been a huge success, thanks to a tremendous public effort to follow the measures that they put in place. The regulations have been instrumental in helping to reduce the rate of infection and avoid overwhelming our NHS. The total numbers of cases and new hospital admissions per day have now slowed significantly. The estimate of R remains between 0.7 and 0.9; crucially, it is below 1. As of 12 June, the estimated average number of people in the community with Covid-19 was 33,000, down from 152,000 between 27 April and 10 May. Public support for, and compliance with, these measures has been extremely positive. Fewer than 16,000 fixed penalty notices have been issued under these regulations—a strikingly small number, considering the massive impact on the behaviours of the nation. I am incredibly proud of our national effort and grateful to fellow parliamentarians, from Westminster and the devolved assemblies, for their support in this process when faced with difficult choices.
The amendments to the regulations that came into force on 13 May were made to reduce the social and economic impact of the measures where it was safe to do so; to ensure continued compliance; and to provide some points of clarity. We are all aware of the substantial cost to our economy that we have had to accept. I am sure noble Lords will be supportive of efforts to protect and restore people’s livelihoods. The Government have been paying close attention to the measures, assessing them to ensure that they continue to be necessary and proportionate. We know that these unprecedented measures have placed a great burden on people, society and business. None of us wants to maintain that burden longer than it is needed to protect the nation and our NHS. The question to be considered each time the regulations are reviewed is whether the restrictions and requirements contained in them remain necessary to prevent, protect against, control and provide a public health response to, the incidence and spread of infection. Each restriction and requirement must be judged by reference to its continuing necessity and be based on the available information at each stage about the effectiveness and impact of the measures. The Government keep their necessity and proportionality under consistent consideration between the formal reviews. Every review and decision is based on the most up-to-date evidence available at the time it is undertaken. Working alongside scientists and experts, we must act swiftly as we develop a better understanding of the virus and how it affects us, clinically, socially and economically.
As I outlined earlier, two further sets of changes to the regulations came into force on 1 June and between 13 June and today. Both sets of amendments will be debated by this House in due course. I am grateful to noble Lords for their continued understanding of the necessity of making such changes quickly, so that we can support people and businesses to begin their recovery from the effects of this terrible virus. There are no easy judgments or choices at this time, and I welcome the scrutiny that this House will rightly exercise on each set of amendments. I look forward to continued engagement and dialogue with noble Lords as further amendments are made in the coming months, in line with the priorities set out in the Government’s recovery strategy. I beg to move.
Lord Bethell [V]
I want to say a profound thank you to noble Lords because this has been an interesting and wide-ranging debate on these important statutory instruments. Despite the unusual sequencing of regulations and debate, I restate the Government’s commitment to working with Parliament in developing the policies that find expression in the legislation we debate in this House.
The amendments we debated today are a cautious step towards returning to normal life. We are beginning to move along the Government’s road map to easing restrictions. We are listening to the scientific evidence and making changes only when we are confident that it is safe to do so. To reassure the noble Lords, Lord Hunt and Lord Scriven, we remain committed to openness and transparency.
Although they do not form part of the specific measures scheduled for debate today, I will address some of the issues highlighted by noble Lords regarding this gradual relaxation. The noble Baronesses, Lady Jolly and Lady Tyler, touched on the crucial issue of social contact. We know that many people are lonely and isolated as a result of lockdown. That is a particularly significant issue for those who live by themselves. We acknowledge that the introduction of support bubbles for single adult households will not help everyone and it will continue to be difficult for those who are not able to benefit from this change. But we cannot risk throwing away the progress that the British public have made. We are focusing today on taking a cautious step to help those who are isolated and living alone, and lone parents who do not have childcare support.
The Government’s recovery strategy has set out an intention to open non-essential retail from 1 June where it is safe to do so and subject to those retailers following Covid-19 secure guidelines. All non-essential retail is now open. To those noble Lords who voiced concern about the economy, this is a significant milestone in our plans to restart the economy. Our non-essential retail task force is considering how the remaining retail environments, such as hair and beauty salons, can reopen safely in line with the phasing ambitions and public health guidance.
The Government completely understand that the impact of the lockdown on the hospitality industry is profound, and I recognise the commercial logic of my noble friend Lord Naseby. But there is no escaping the fact that restaurants and pubs are naturally crowded and require contact between people, which means that they create an infection-rich environment where it is much more difficult to socially distance. That is why we have established a pubs and restaurants task force to consider how these businesses can reopen safely, in line with the road map and scientific advice.
I am grateful to people of all faiths for the patience they have shown during the lockdown, and I am very pleased that we been able to reopen places of worship for individual prayer this week. In response to my noble friend Lady McIntosh, the virus is communicated by the infected person’s airborne droplets, so it is sensible that activities that generate substantial outward breathing, such as singing, should be restricted. However, I reassure my noble friend and the noble Baroness, Lady Uddin, that we hope to be able to reopen places of worship fully when this is supported by the science. I am grateful to the places of worship task force for its continued engagement.
To reassure my noble friend Lord Blencathra, based on the scientific assessment that people generally develop symptoms and cease to be infectious within 14 days, the NHS Test and Trace programme can identify people at risk of infection and, if necessary, advise them to self-isolate. As a result, we can effectively reduce the spread of the virus and maintain transmission at low levels. We have stood up a brand new, large-scale national system at speed and are continuously improving it. We now need everyone to get behind the system, which has the vital function of keeping us all safe.
The noble Baroness, Lady Tyler, was right to focus on social care. The Government have set out a comprehensive action plan to support the adult social care sector in England throughout the coronavirus outbreak, including ramping up testing, overhauling the way PPE is delivered and minimising the spread of the virus, to keep people safe. The social care sector Covid-19 support task force will ensure the delivery of the social care action plan and the care homes intensive support package. This will ensure that concerted and determined action is taken to reduce the risk of transmission of Covid-19 in the sector, for both those who rely on care and support and the social care workforce.
I thank the noble Lord, Lord Campbell-Savours, for his tireless campaigning on the important issue of masks and for his impactful debate last week. The use of masks is particularly relevant for those on public transport. Social distancing remains central to our strategy and is the best way to keep safe. However, on public transport, where it is not possible to follow the guidance consistently, these changes will ensure passengers benefit from the additional protection of face coverings and help keep front-line staff safe. That is why, from today, passengers must wear face coverings when travelling on public transport in England. There are some exceptions for health, age or equality reasons. As my noble friend Lord Blencathra requested, the regulations already do not exempt all disabled people; they just make appropriate provision for those whose disabilities would impact on their ability to wear a face covering. I understand that those who can put on, wear or remove a face covering, including those with disabilities, are required to do so. I remind noble Lords that our regulations have succeeded largely because they are based on consent, rather than mandation. In response to the noble Baroness, Lady Brinton, the Government would like to continue that principle.
The noble Baroness, Lady Finlay of Llandaff, asked about the resilience of our PPE production system. My noble friend Lord Holmes of Richmond and the noble Baroness, Lady Brinton, echoed these concerns. I am pleased to say that we are building up UK manufacturing, with signed contracts to manufacture over 2 billion items of PPE, including face masks, visors, gowns and aprons, through UK-based manufacturers. The noble Lord, Lord Hunt of Kings Heath, raised an important point on borders and quarantine. On 3 June, the Health Protection (Coronavirus, International Travel) (England) Regulations 2020 were introduced. As set out in the Home Secretary’s announcement on 22 May, the regulations introduced measures to gather contact, travel and address information from travellers arriving in England and require international travellers arriving in England to self-isolate for 14 days. The new measures have been in place across the United Kingdom since 8 June. Public health is a devolved matter. The Government are therefore working closely with the devolved Administrations, which have introduced similar provisions, to create a coherent, four-nation approach, for which we are very thankful.
The noble Baronesses, Lady Thornton and Lady Jolly, and my noble friend Lord Naseby speculated as to the effectiveness of the lockdown. I confirm that, between 27 March and 8 June, 15,715 fixed penalty notices were issued by territorial police in England under the new regulations. These are very low volumes when compared with other enforcement data. Over a similar period in a normal year we would expect, on average, nearly 28 times higher. I also confirm to my noble friend that he is entirely correct: this legislation was amended to increase fines, which was designed to deter those who flout the rules. While we allow some more freedom as part of the recovery, we cannot allow that to be jeopardised by a small minority.
The noble Baroness, Lady Brinton, asked an important question about the disproportionate impact on people from BAME backgrounds. I assure her that we are working closely with policing partners to analyse the data. We are clear that nobody should be subject to police enforcement on the basis of race.
I turn now to social distancing, raised by a number of noble Lords including the noble Lords, Lord Hunt and Lord Anderson of Ipswich, my noble friends Lady McIntosh, Lord Holmes and Lord Balfe, and the noble Baroness, Lady Brinton. The Government always prescribe certain things in law and advise others as best practice in guidance. We may not have the laws to enforce the two-metre rule, but we cannot avoid the fact that the scientific assessment is clear: along with handwashing, maintaining robust social distancing is the best way to mitigate the risk of infection. In response to my noble friend Lord Balfe, I say that public support for these common-sense and effective measures remains enormous.
Timing and scrutiny were raised by a number of noble Lords, including eloquently by the noble Lord, Lord Rennard, echoed by the noble Lord, Lord Purvis of Tweed, and the noble Baroness, Lady Thornton. The regulations state that the Secretary of State should revoke restrictions at the earliest opportunity if they are no longer necessary for public health. Parliamentary scrutiny is essential, but we could not justify to the public keeping the restrictions in place for a few extra weeks while we awaited debate. A Statement has been made to this House at the earliest opportunity for each set of amendments, and I assure noble Lords that we will continue with that. In recognition of the importance of transparency in these unprecedented times, SAGE has published the statements and accompanying evidence it has reviewed to demonstrate how the scientific understanding of Covid-19 has evolved.
My noble friend Lady Stroud raised an extremely important issue on abortion. I assure noble Lords that we take issues around abortion extremely seriously. The amendment to the Coronavirus Act included extensive changes allowing nurses and midwives to certify and perform abortions, which went further than the limited coronavirus measures for home use that were eventually introduced. The coronavirus situation was very fast moving. The balance of risks for home use shifted after the debate in a way that made a reconsideration necessary, but the words of the debate were not forgotten.
As we begin to take steps towards normal life, it is vital that all these measures, including the regulations we have debated today, are kept under constant review. In response to the heartfelt and thoughtful points made by the noble Baroness, Lady Jones, and the noble Lord, Lord Scriven, on prior parliamentary authority, I reassure the House that these restrictions have been placed not only on individuals but on society as a whole, and that the Government are maintaining only the restrictions that are necessary and proportionate at any given time. As and when the science supports it, we will introduce further cautious changes in line with the steps outlined in the recovery strategy. As the noble Baroness, Lady Thornton, remarked, this will of course not be the final debate we have on these important matters. The changes to regulations made on 31 May and 12 June will be brought to the House for debate on 25 June.
This is an unusual situation, but I take some comfort from the tone of this debate. While I acknowledge the many serious challenges made to government action, this amendment has not attracted fundamental rebuttal and I think that the rhythm of these amendments, which are moving quickly in response to fast-changing and unpredictable events, has brought a degree of timely scrutiny under difficult circumstances. Therefore I will finish by recording the Government’s continued gratitude to the NHS and care workers, and to all key workers. I am very proud of and grateful to them for their continued hard work and, on behalf of all those in the House, I thank them for the sacrifice which has been so essential in our response to this crisis.
Contact Tracing: Personal Privacy
Lord Bethell Excerpts(3 years, 10 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
My Lords, we have prioritised privacy and security in all stages of the app’s development, working in partnership with experts across government and industry, including the Information Commissioner’s Office and the National Cyber Security Centre. Demonstrating our commitment to transparency, we have published a data protection impact assessment and a privacy notice.
Lord Hain (Lab) [V]
My Lords, there have been numerous failings over the Isle of Wight contact tracing app meeting its promised deadlines, alongside other serious errors in the Government’s track and trace system. Also, the NHS failed to carry out its legal data protection obligations prior to the launch and entered into data-sharing relationships on unnecessarily favourable terms to large companies. Will the Government now give full disclosure on every aspect of how its track and trace currently works, and commit to fully disclose details of any changes to that scheme, including the app, before they are rolled out?
Lord Bethell [V]
My Lords, we have agreed up front to an enormous amount of transparency. We have open source for the code, we have published the data protection impact assessment and the privacy notice, we have committed to publish the privacy and security models, and we have published numerous blogs setting out the approach we are taking. The approach towards the app completely embraces transparency and we will continue down that path.
Baroness Uddin (Non-Afl) [V]
My Lords, in addition to the questions laid before the House by the noble Lord, Lord Hain, can the Minister address the fact that the Covid-19 impact on minority communities has seen pertinent questions about structural discrimination, and inequality is now rightly acknowledged? Does he accept that the deep-seated misgivings about privacy and protection of personal data management within many communities is real? How will the Government work with community leaders, including women’s and faith organisations, to create confidence in the NHSX contact tracing system in areas such as Tower Hamlets, Newham, Hackney and Brent, which have a disproportionate number of deaths, and where access to smartphones and technologies may be limited and this application viewed with scepticism?
Lord Bethell [V]
My Lords, the evidence before me suggests that the British public have an enormous amount of support for the app. Recent research by Johnson and Lubbock partners for ITV showed that 59% of British adults report that they would download the app. We remain committed to reassuring all British people that the app is safe. I take completely on board the noble Baroness’s recommendations to engage with community and faith leaders who may have particular misgivings; it would be worth engaging with them on a particular basis.
Baroness Blackwood of North Oxford (Con) [V]
My Lords, I understand that a second version of the tracing app is now undergoing testing and that, following the outcome of this trial, the plan is to issue the new version to Isle of Wight residents as an update. Is this the case? If so, what are the differences in the information gathered between the first and second versions? Will Isle of Wight residents have to consent to any update or does their original consent include all future updates?
Lord Bethell [V]
My Lords, we are currently assessing the value of a specific Isle of Wight update and whether it would be worth while before we move on to issuing the full app. When we have finished that assessment, I would be glad to answer the questions asked by my noble friend.
Lord Patel (CB) [V]
My Lords, we need the tracking app to succeed. For this to happen, as has already been mentioned, the Government need to make sure that they are honest and transparent with the public to gain their trust. Can the Minister say when the Government will publish the performance data from the Isle of Wight trial? Further, can he confirm that the Government have been following their own code of conduct for data-driven technologies in healthcare and in the development of the app? For example, principle 4 refers to transparency and principle 10 refers to commercial models. Can he tell us what process will determine secondary uses of the data?
Lord Bethell [V]
My Lords, I can confirm that the Government have been following the code of conduct, as the noble Lord suggested. I am also hungry to publish the performance data. I can confirm that, so far, there have been 73,365 users of the Isle of Wight app, 53,490 of whom were on the Isle of Wight. The user experience has been largely benign, and we look forward to publishing fuller technical and user details shortly.
Lord Whitty (Lab) [V]
My Lords, on timing, was the analysis of the Isle of Wight results, particularly as regards privacy, available to Ministers before we started to roll out the system across England? If so, how did that influence the rollout? On the Isle of Wight, were participants told that management of their data would be contracted out to a private company, now in the national context known to be Serco? If so, what was their reaction?
Lord Bethell [V]
My Lords, the greatest insight from the Isle of Wight experiment was that human contact tracing needed to be the first stage of our rollout of the test and trace programme and that, in the sequence of things, the app should come later, when people have got used to the principle of contact tracing. The use of private companies by the Government is commonplace, and we have had no adverse comment on or reaction to that usage.
Lord Scriven (LD) [V]
Ten years is the norm for holding medical research data, so what epidemiological reasons require data from the app uploaded to the NHS central database to be held for 20 years?
Lord Bethell [V]
My Lords, the data that an individual puts on the app is entirely voluntary. No data is held for more than 28 days until somebody takes a test. Once that test has taken place, the individual has the opportunity to upload further data. That data is held for clinical trials and to help us understand the epidemic. There is the opportunity for us to delete all that data at the end of the epidemic, and that assessment will be made at the right time.
Lord Cormack (Con) [V]
My Lords, like many, I pay tribute to my noble friend for his indefatigable hard work over these past weeks, but does he accept that, following the events of three weeks ago, there has been an erosion of public trust and confidence? It has been seen on the beaches and in demonstrations. Further, does he accept that it is absolutely essential that these tests are conducted in such a way that there is total public confidence in their probity? Can he give me an assurance that everything possible will be done to ensure that no vital personal information is misused in any way?
Lord Bethell [V]
My Lords, the test and trace programme will publish data later today; the noble Baroness, Lady Harding, will do the No. 10 presentation. In that presentation, I hope that noble Lords will see an enormous amount of data suggesting that public trust in the test and trace programme is profound, that it has made an enormous amount of progress and that it will be an important part of our arrangements for Covid. I assure my noble friend that the Government’s approach remains that they put privacy at the heart of all of their arrangements and will continue to do so.
Lord Kilclooney (CB)
My Lords, will this tracing application be interconnected with the tracing applications in the other three nations of the United Kingdom? Secondly, since we have a common travel area with the Republic of Ireland, will its tracing application be interconnected with the four nations of the United Kingdom?
Lord Bethell [V]
The noble Lord makes an important point about Ireland. We have regular conversations with the Irish Government about the app that they are working on. It is our aspiration that the two will work together. That has not been confirmed, since neither has been launched yet, as I understand it, but it is very much at the top of our priorities.
The Deputy Speaker (The Earl of Kinnoull) (Non-Afl)
My Lords, the time allowed for this Question has elapsed. Accordingly, we will move on.
Covid-19: Masks
Lord Bethell Excerpts(3 years, 10 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
My Lords, I thank the noble Lord, Lord Campbell-Savours, for raising this important issue. I pay tribute to his passion and perseverance on the issue of masks. I thank all noble Lords who have contributed to this debate for their thoughtful comments, which I will tackle at pace. I apologise if I am unable to namecheck each contributor or address each question as I would have liked.
As we ease lockdown restrictions, the debate on these non-pharmaceutical interventions is key, and I very much welcome the debate and the points raised. As for our strategy, the noble Lord, Lord Campbell of Pittenweem, suggested a Covid-19 defence triad, which I welcome, but our triad, which the Government support, is, first, one of social distancing; secondly, one of hand hygiene; and thirdly, one of isolation. This triad offers the best protection from the spread of the disease. These three measures are our priority and our advice on face coverings does not negate this.
The noble Lord, Lord Campbell-Savours, asked what plans the Government have to review their advice on this issue. Noble Lords will be aware that last week the Government made two announcements on the use of face coverings in specific situations. On 4 June, the Transport Secretary announced that the Government will work with transport operators to make it mandatory for passengers to wear face coverings when using public transport in England from 15 June. On 5 June, the Health Secretary announced that all hospital staff in England will be provided with surgical masks, which they must wear, and that all hospital visitors and outpatients should also wear face coverings from 15 June.
Many noble Lords, including the noble Lord, Lord Bilimoria, and my noble friend Lord Blencathra, provided interesting and well-considered ideas on the exact distance that we need to enforce in our social distancing policy. I assure noble Lords that we will continue to review the evidence on social distancing, and on the question of one or two metres, we will be led by the science and the advice of experts on any changes to this policy.
On 11 May, the Government issued their first set of guidance on the use of face coverings. Informed by the scientific evidence, we advised that, if they can, the public should wear a face covering in enclosed spaces where social distancing is not always possible and where they will come into contact with others they do not normally meet. This announcement and the accompanying guidance from Public Health England came after a careful review of the latest scientific evidence by the Scientific Advisory Group for Emergencies, SAGE. The noble Baroness, Lady Northover, makes an important point about the risk of cannibalising the supply of masks to the NHS.
In reply to my noble friend Lady Anelay, I also commend the work of my noble friend Lord Deighton, who is charged with securing a resilient supply of PPE; the progress that he has made is impressive. I assure the noble Baroness, Lady Northover, and my noble friends Lord Holmes and Lord Bourne that his work, and the hard work across all NHS procurement, has ensured that we are now confident in stocks and sources of supply of PPE to meet the needs in health and social care over the next 90 days. We also continue to pursue contracts for additional stock both to manufacture and to purchase.
My noble friend Lord Balfe and the noble Lords, Lord Skidelsky and Lord Harris, raised the important issue of the distribution and supply of face masks to the general population. Our guidance has been and remains proportionate to this evidence, and we have been clear that a face covering is not the same as a surgical mask or respirator used by healthcare or other workers as PPE. These should continue to be reserved for those who need them to protect against risks in the workplace. I emphasise that it is a considerable challenge for the Government to undertake responsibility for the distribution of masks to the whole population.
In response to the noble Lords, Lord Palmer of Childs Hill and Lord Bilimoria, I want to explain that the principle of “There is little to lose” is not one that we subscribe to. If we support measures that do not work, we create a false sense of security and distract from the measures that really do work.
My noble friend Lord Duncan made a critical point about the hygiene of masks and the danger that they can be a vector for infection. A badly maintained or dirty mask, or a mask that is handled badly, can be a dangerous object that spreads disease. We have published guidance to show people how to properly remove masks and wash them. None the less, the public can and should wear face coverings that they make at home. Accordingly, the Government have provided advice online on how to make these using scarves and other textile items. The advice on face coverings was in addition to the key advice about maintaining social distancing and washing hands regularly, which has proven to be crucial in preventing the spread of this deadly virus. We have been clear that wearing face coverings cannot replace those important practices, and if you are symptomatic then you must self-isolate.
In relation to workers in numerous sectors, including public transport, we advise that they continue to follow the advice of their employers and make sensible workplace adjustments. I welcome the comments by the noble Lord, Lord Skidelsky, on this.
Since that initial advice we have continued to review our position, consider the evolving context in the UK and refine our approach accordingly. However, we should note that, whatever we would like to be the case, the available evidence on the efficacy of face coverings has not moved substantially from the initial advice.
I want to update my noble friends Lord Naseby, Lady McIntosh and Lord Sheikh that in recent days the WHO has updated its advice to encourage the wider use of face coverings in public settings, but it has been clear that
“the widespread use of masks by healthy people … is not yet supported by high quality or direct scientific evidence”.
Evidence from the Scientific Advisory Group for Emergencies suggests that face coverings may help to reduce the risk of transmission if you are suffering from coronavirus but not showing symptoms. SAGE also advised that using cloth masks as a precautionary measure could at least be partially effective in enclosed spaces, such as public transport, where social distancing is not possible.
In continuing to take a risk-based and evidence-led approach to guidance, the Government have continued to adapt our guidance proportionately to the science. In answer to the noble Lord, Lord Purvis, I say that it remains guidance, not law. As lockdown restrictions ease, more people will now come into contact with others and there may be incidences where social distancing is more difficult to maintain consistently. For example, as the noble Baroness, Lady Thornton, mentioned, we expect that more people will leave their homes to make essential journeys, returning to work if they cannot work from home, and some children are returning to school.
While we encourage the public to walk, cycle or drive, this may not always be possible and we can expect the transport network to become increasingly busy. That is why, on 4 June, the Government announced that we will work with transport operators to make it a requirement for passengers to wear face coverings when using public transport in England from 15 June. On board public transport is a space in which it is less easy to socially distance, and people may spend extended periods of time in close contact with others they may not normally meet. The Government remain clear that social distancing and hand hygiene remain the most important ways to guard against the virus, but face coverings may help to prevent individuals who have coronavirus but are not presenting symptoms from spreading it to others.
The noble Lords, Lord Campbell-Savours and Lord Mann, the noble Baroness, Lady Healy, and others shared helpful interventional anecdotes. But the consensus in scientific literature is that the evidence base for the effectiveness of face coverings is inconclusive. Mandatory face covering specifically on public transport is the approach taken in a number of countries, including France, Germany and Italy. Although face coverings are more habitually and widely worn in public in some countries, such as China or Japan, the evidence remains inconclusive around their widespread efficacy in protecting individuals from Covid-19. In answer to my noble friend Lord Blencathra, I say that there is no evidence that these masks are interchangeable with other measures in the triad.
The Government have recognised that, as we bring the overall incidence of Covid-19 down, it is important that we cut down on infections passed on in hospitals. We have noted the evidence that healthcare workers are 10 to 20 times more likely to be Covid-19 positive than the general public. In light of this learning from NHS hospitals and IPC teams, the Government announced on 5 June that all staff in hospitals in England will be provided with surgical masks, which they will be expected to wear from 15 June. NHS staff already wear face masks in clinical areas where they come within two metres of a patient. But this new guidance will apply to everyone working in all areas of hospital, including non-clinical settings. Furthermore, all visitors and out-patients will be expected to wear face coverings at all times. These are measures that some organisations have already started to adopt. We are clear that this will not mean that anyone is denied care. If necessary, a mask will be provided for a patient if they arrive without a face covering.
Detailed guidance on these measures will be published this week to enable hospitals to get stocks and put plans in place; we are confident in the stocks of face masks needed to meet this new demand. We also continue to pursue contracts for additional stock, both through manufacture and purchase. The noble Lord, Lord Campbell-Savours, asked at the start of this debate what plans the Government had to review our advice on face coverings. As I have set out, we continually review these measures, evolving them as we have from 11 May by continuing to follow the evidence and the scientific advice. We will therefore continue to review this latest iteration of advice too. As I have set out, the Government will always look to the scientific evidence and advice we are given in continually reviewing and refining our guidance.
I thank the noble Lord, Lord Campbell-Savours, who has pushed hard on this important issue and rehearsed these important arguments. As the pandemic evolves and the science develops, he will have an impact on our understanding of this important issue.
Covid-19: Cancelled Medical Operations
Lord Bethell Excerpts(3 years, 10 months ago)
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Baroness Kennedy of Cradley
To ask Her Majesty’s Government what assessment they have made of the impact of cancelled medical operations due to the COVID-19 pandemic.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
My Lords, NHS trusts were rightly asked to postpone elective activity to free up capacity to support the response to Covid-19. The latest data shows that there was a 30% reduction in the number of completed admitted patient pathways in March 2020 compared to the same month last year. Data for April is due to be published by NHS England tomorrow. The NHS is safely restoring urgent non-Covid services, catching up on the backlog, and ensuring that surge capacity can be stood up again should it be needed.
Baroness Kennedy of Cradley (Lab) [V]
My Lords, thousands of patients with non-Covid conditions are not getting the treatment they need, and thousands more with life-threatening diseases such as cancer are going undiagnosed every day. Yet we see reports that private facilities, which the Government are paying for, are either empty or hosting only a trickle of NHS patients. Can the noble Lord say how many private beds paid for by the Government are being used by the NHS, and what is the Government’s plan to stop waiting lists hitting 10 million by Christmas?
Lord Bethell [V]
My Lords, I do not have the precise figures which the noble Baroness asked for. However, I reassure the Chamber that the NHS is working hard to ensure that those who need urgent surgery, such as cancer patients, have it, and we have committed a substantial amount to the Help Us, Help You media campaign, which is having an impact in restoring confidence in returning to hospitals.
The Lord Bishop of Carlisle [V]
My Lords, given the disproportionate effect of Covid-19 on those aged over 75 and the likely knock-on effects of cancelled operations, will the Minister take steps to encourage the reintroduction of routine GP health checks among people in this age group which, understandably, have been largely suspended during the pandemic?
Lord Bethell [V]
My Lords, the impact on the over-75s is, as has been described, profound. We have worked hard to try to protect those who are shielding. The reopening of GPs’ surgeries is a priority but, at the moment, we are not encouraging those who are over 75 to make the journey to surgeries that are a potential source of infection. Therefore, we will not be taking the steps the right reverend Prelate described.
Baroness Blackwood of North Oxford (Con) [V]
My Lords, as the waiting lists caused by Covid create huge pressures, harder-to-treat patients must not be left behind. Last month, Eurordis released a survey which included UK rare disease patients and found that nine out of 10 had experienced disruptions in care, while more than half who needed surgery had had it cancelled or postponed. Many rare disease patients are in the shielding group and many have degenerative conditions. Can the Minister set out the plans to improve access to care and communications about care for rare disease patients, and can he please undertake to meet with patient groups about this?
Lord Bethell [V]
The work of my noble friend Lady Blackwood on rare diseases is well known and acknowledged in the House. Those with rare diseases are in exactly in the kind of vulnerable groups that are being hard hit by Covid. They are given particular access to local support systems and they should have access to home testing services if they feel vulnerable to the effects of Covid. Further, I am happy to undertake a commitment to meet with the relevant stakeholder groups to discuss how we could be working harder to support them.
The Deputy Speaker (Baroness Garden of Frognal) (LD)
We do not seem to be able to hear the noble Lord, Lord Patel.
Lord Patel (CB) [V]
My Lords, I have unmuted my microphone and I hope that my voice is coming through. I am sorry for the delay.
As the Minister will know, several million patients are on waiting lists for surgery. Given the increased levels of hygiene safety that will be required, it is inevitable that productivity will be down. This means that there will be a need for the prioritisation of cases. Does he agree that the professional organisations should draw up advisory guidelines for clinicians, rather than leaving it to the individuals?
Lord Bethell [V]
The noble Lord may be interested to know that, frustratingly, waiting lists have gone down rather than up, from 4.42 million in February to 4.32 million in March. This is an indication of people not coming forward for operations that they may need, and it is something that we are keen to address. However, we are putting the decision-making on how to handle the lists into the hands of local clinicians, who will use a combination of clinical need and waiting list times to make their decisions.
Baroness Crawley (Lab) [V]
My Lords, which NHS trusts, following Sir Simon Stevens’ letter to them of 29 April, have made full use of all contracted independent sector hospital capacity, and will the contract between NHS England and the private healthcare sector be renewed at the end of June?
Lord Bethell [V]
The noble Baroness has asked for a very specific figure, which I am afraid I do not have to hand. However, I can assure her that the private healthcare contract has provided us with incredibly valuable surge capacity and we will be looking at how to use that kind of capacity to protect the NHS from a potential surge in the wintertime.
Baroness Jolly (LD) [V]
My Lords, can the Government guarantee that there are safe spaces for all cancer services and ensure that these spaces are Covid-protected? Further, will the Minister update the House on testing numbers and the number and frequency of tests in hospitals and in cancer hubs in England? I understand that he may not have all the figures to hand, but I would be grateful if he could write to me and put a copy of the letter in the Library.
Lord Bethell [V]
The noble Baroness, Lady Jolly, is right to emphasise the importance of safe spaces. Cancer surgery requires a completely hygienic environment for those who have immune challenges. Safe spaces are found for all those who need to have cancer practices. They may not be in absolutely every hospital, but if one hospital cannot make that kind of offer, an adjacent or nearby hospital will be found to provide the kind of safe spaces that are needed to carry out the procedures she described.
Baroness Redfern (Con) [V]
When will treatment begin for post-operative patients who are waiting for chemotherapy, do we have instances where chemotherapies have been halted during their term of treatment, and will these therapies recommence? Do we know whether trusts are beginning to do this?
Lord Bethell [V]
The noble Baroness is entirely right to focus on those who are the most vulnerable. Data for March 2020 shows that cancer referrals began to drop although treatment levels did remain high, with 15,363 patients starting treatment following an urgent referral. That is the highest figure on record in a single month. So, although some treatments may have been cancelled, as she rightly describes, what I would like to convey is that a large number of treatments did continue, and we will be working hard to address any backlog.
Baroness Finlay of Llandaff (CB) [V]
My Lords, following on from a previous question about bed capacity, I declare an interest in that my son was involved in setting up the Nightingale Hospital Excel. What assessment has been made of bed requirements to keep non-surgical care completely separate from surgical care that needs to happen in Covid-light or Covid-free areas, and to ensure the frequent testing of staff, in particular highly skilled trauma surgical staff who may be moving between these two zones, so that they do not themselves become a cause of transmitting infection?
Lord Bethell [V]
I should first like to pay tribute to all those who have been involved in setting up the Nightingale hospitals. People have worked extremely hard to deliver a valuable service to the country. Bed allocation arrangements are made by local trusts and testing within the NHS is now intense. Decisions on the traffic of staff between safe zones and non-safe zones are taken by the local director of infection control.
Baroness Thornton (Lab)
My Lords, it is important that the Minister informs the House about how beds there are in the private sector, how many were occupied, at what cost and whether there will be a renewal. Does the noble Lord share my concern that if there is a second spike of Covid-19, it will lead to further delays in life-saving operations? What contingency arrangements do the Government have in place for this?
Lord Bethell [V]
The noble Baroness is right to raise this concern. The bigger focus is less on the operational restraints, because the NHS has in fact done extremely well to keep the flow of operations going during this period. It is actually on demand. What we are most deeply concerned about is that patients return to hospitals and that their confidence in undertaking procedures is restored. That is why we have put a huge amount of emphasis on the marketing side of things. That is not to understate the importance of the operational side, but it is patient confidence that is our focus at the moment.
The Deputy Speaker
My Lords, the time allowed for this Question has elapsed and I apologise to the noble Lord, Lord Dobbs, and the noble Baroness, Lady Barker, that we have not been able to take their questions.
Exercise Cygnus
Lord Bethell Excerpts(3 years, 10 months ago)
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Lord Hunt of Kings Heath
To ask Her Majesty’s Government what action they took following Exercise Cygnus to prepare the United Kingdom for responding to a major pandemic.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
My Lords, Exercise Cygnus addressed the greatest risk in the National Risk Register of Civil Emergencies: a flu pandemic. All the recommendations from Exercise Cygnus were accepted and taken on board. Many of these proved invaluable for informing the response to Covid, including plans for legislation that would assist in response measures, for bringing back retired clinical staff, for flexing systems beyond normal capacity and for establishing a group of expert advisers on moral, ethical and spiritual issues.
Lord Hunt of Kings Heath (Lab) [V]
My Lords, if the Minister is so confident that the lessons from Exercise Cygnus informed the UK’s preparedness, why was the care sector so neglected? To deal with the surge of NHS patients expected in the event of a pandemic, the exercise identified that extra capacity would be required in care homes. Why was that not heeded and why, as Martin Green, chief executive of Care England, put it, was PPE redirected away from care homes and the NHS given a clear instruction in March to send people to care homes despite no testing for infection being available?
Lord Bethell [V]
My Lords, the Association of Directors of Adult Social Services had strong input into operation Cygnus and its recommendations were taken on board. It was however a trial run for a flu pandemic, not of the kind that Covid produced, and the demands on PPE, the health sector and the care sector were more profound than the flu pandemic trials prepared us for.
Lord Harries of Pentregarth (CB) [V]
The Secretary of State for Health, Mr Hancock, said on 7 May that he had consulted officials and had been assured that all the recommendations had been implemented. However, Martin Green, the chief executive of Care England, is reported as saying:
“It beggars belief. This is a report that made some really clear recommendations that haven’t been implemented.”
How does the Minister reconcile these two totally contradictory stories about whether or not the recommendations were implemented?
Lord Bethell [V]
I assure the noble and right reverend Lord that operation Cygnus happened in 2016 and the recommendations were completed by spring 2018. However, it is possible that nothing could have prepared us for the ferocity of Covid. Operation Cygnus prepared us for a flu pandemic and not for something with the savagery of Covid-19.
Baroness Wheeler (Lab) [V]
The Secretary of State for Health said in relation to Cygnus and the failure to implement key recommendations and warnings on PPE stocks, ventilators, testing and tracing, and scaling up the public health system, that
“everything that was appropriate to do was done.”
To demonstrate this clearly and with evidence, why are the Government not prepared to be open and transparent and to publish the report and recommendations, or to show what action they took on findings of two subsequent major planning exercises with similar warnings: Exercise Iris in 2018, covering a possible pandemic in Scotland, and last year’s crucial national security risk assessment?
Lord Bethell [V]
My Lords, it is necessary for the preparations for such civil emergencies to be made in a confidential fashion so that the unthinkable can be thought and plans can be made in a trusted and benign environment. Publication of these reports is not in the national interest and we do not have plans to publish them in the future.
Baroness Jolly (LD) [V]
My Lords, in the Cygnus report, preparedness, response, plans and capability were found lacking. Local capacity would be outstripped in the areas of excess deaths, social care and the NHS. What findings from the Cygnus report were incorporated into the work for the current pandemic?
Lord Bethell [V]
The noble Baroness is in danger of misrepresenting the situation. The whole point of running a trial such as operation Cygnus is to probe the system and to find weaknesses. That it identified areas for improvement is entirely appropriate and is exactly why we run such projects. As I have explained, the exercise identified key areas where developments were made, and those developments helped us in our preparations for Covid.
Baroness Bennett of Manor Castle (GP) [V]
My Lords, does the Minister agree that Exercise Cygnus warned, and Covid-19 has demonstrated, that we were profoundly unprepared for the pandemic shock that we knew was coming? Does he agree that it demonstrates that a focus on so-called efficiency—that is, profit maximisation for contractors and cost minimisation for Governments under austerity—is incompatible with resilience? The whole model of outsourcing and privatisation is not fit for the 21st-century age of shocks.
Lord Bethell [V]
The noble Baroness will not be at all surprised to learn that I do not agree with her analysis in any way. Operation Cygnus demonstrates that we did have robust systems in a great many areas and I am grateful to it for identifying some areas that we went on to improve. As for working with the private sector, I bear testimony to its enormous contribution to our Covid response. I do not agree with her characterisation of the profit motive.
Baroness Finlay of Llandaff (CB) [V]
My Lords, after operation Cygnus were estimates of the requirements for PPE checked against the 2006 influenza pandemic stockpile, given that this store was found to contain no gowns or visors, and 21 million protective FFP3 masks were missing when the store was opened for the current pandemic?
Lord Bethell [V]
The noble Baroness is right—if I understand her correctly—that the needs of PPE for a flu pandemic were quite different from those for Covid. It is also true that the planning did not anticipate a breakdown in global trade and a failure of the business-as-usual supply of PPE. No one could have imagined that flights would be grounded and factories shut and that the global supply chains for these key and vital products would have ground to a halt in the way that they did.
Lord Clark of Windermere (Lab) [V]
Is it true that Exercise Cygnus reported a shortage of ventilators, critical care beds and PPE in the National Health Service? If so, why were we singularly unprepared in all these spheres three and a half years later, at the beginning of Covid?
Lord Bethell [V]
My Lords, I admit that my briefing is not entirely specific, but it is my impression that operation Cygnus did not address the question of ventilators. One of the distinctive characteristics of Covid was the pneumonia response, which required an unanticipated and dramatic increase in our need for ventilators. That is one of the reasons why there was a global shortage of this key equipment. I have addressed this with the notes I have before me and will be happy to correct it if I have misunderstood.
Baroness Brinton (LD) [V]
The Minister has asserted that my noble friend Lady Jolly misrepresented Cygnus, but she and other noble Lords have quoted from it. The Minister said earlier that “nothing could have prepared us” for something of this severity. Surely the point of pandemic preparation is also to watch what is happening elsewhere, such as in China and Italy in January and February. Why was the government response so slow to adapt to the needs of Covid as it emerged?
Lord Bethell [V]
The noble Baroness conflates two separate matters. The National Risk Register of Civil Emergencies is updated regularly and assesses civil emergency risks with a five-year horizon. The ongoing monitoring of risks in overseas countries is done in a different manner. I was trying to convey to the House that operation Cygnus was a rehearsal for a flu pandemic, not for the kind of virus that Covid proved to be.
The Lord Speaker
My Lords, the time allowed for this Question has elapsed. We will now move to the second Question, in the name of the noble Baroness, Lady Quin.
Covid-19: R Rate and Lockdown Measures
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Baroness Thornton (Lab) [V]
First, will the Minister say what weight the Government attach to the science presented in the figures that the Centre for the Mathematical Modelling of Infectious Diseases at the London School of Hygiene & Tropical Medicine published, which state that R is above one in the south-west and north-west of England? Secondly, the regularly estimated national R rate appears to be a key driver of policy; accurate measurement of R depends on a world-class testing regime, not yet in place; the likelihood is that some geographical areas may have an R close to or above one; and effective local control measures rely on knowing the local R rate. Given all that, when will the system for more accurate measurements of R agreed with the relevant local authorities be available by localities, so that this information can be used to inform and adapt the emerging local planning led by directors of public health?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
The London School of Hygiene & Tropical Medicine’s report is one model of more than a dozen that contribute to the SPI-M committee, which looks at modelling. We value it, but it is not the only model. Regarding the statistical analysis of R, I pay tribute to the Office for National Statistics, which has put in place a massive testing programme to look at prevalence across the country. Hundreds of thousands of tests are done. This is by far the gold standard in terms of understanding prevalence and it feeds in accurate, up-to-date information for the accurate assessment—not modelling—of R0. It is on that work that we depend.
Baroness Brinton (LD) [V]
On 3 June, my noble friend Lord Scriven asked the Minister which body had legal powers to implement a local lockdown. The Minister replied:
“The arrangements for local lockdowns are not fully in place. In fact, the policy around them is in development and a full decision has not been made”.—[Official Report, 3/6/20; col. 1428.]
Five days on, local authorities and directors of public health are reporting publicly that their hands are tied without the postcode data they need or the specific powers for lockdown. When will this vital decision be made so that flare-ups of Covid can be stopped?
Lord Bethell [V]
The work is being undertaken at the moment. Rather than focusing on local lockdowns, we are focusing on local action plans with a wide variety of measures, perhaps including behavioural changes as well as clinical and diagnostic interventions. It is only by working across the piece that local actors, such as local authorities, directors of public health and local infection directors, can implement the right array of measures. That holistic approach is the one we are pursuing.
Lord Crisp (CB) [V]
My Lords, many academics are warning of the likelihood of a second wave of the virus, and there is some evidence that it is already happening in other countries. I appreciate that the Government seek to avoid that, but what is their assessment of the likelihood of a second wave, what lessons have they learned from their first experience of lockdown, and what planning are they doing for a second wave nationally and regionally?
Lord Bethell [V]
The fear of a second wave is profound. We have seen what happened in Singapore and we remain vigilant. However, enormous progress is being made against the epidemic, as the noble Lord will have seen from recent figures. We have put in huge infrastructure to protect ourselves in the winter, which is the moment of greatest anxiety. That includes Europe’s biggest testing programme, stockpiling medicines, upgrading NHS capacity, the recruitment of returning staff to the NHS and—as I mentioned to the noble Baroness, Lady Brinton—the implementation of a local action plan regime which will give teeth to our measures on a local basis.
Lord Robathan (Con) [V]
As my noble friend has admitted, the scientific advice and modelling have been confused, often contradictory and changing as nobody knows a lot about this virus or its progress. Many believe that the virus arrived here as early as November and has swept through the population, often without symptoms. The figures for deaths may be too low or too high because nobody really knows. We have mortgaged this country’s future and our children’s future on uncertain science. The Health Secretary has now described the virus as
“in retreat across the land”.
Will the Government lift all lockdowns now, or as soon as possible, as has happened in New Zealand? Let us all hope the entire lockdown was not a catastrophic error.
Lord Bethell [V]
I share my noble friend’s frustration that this disease has proved a horrid and at times confusing foe, but I testify to the strength of the scientific advice we have been given. We do not expect scientists to agree. We believe that a degree of conflict is the right approach to trying to find the right answer. The role of the CMO and the Government’s chief scientist is to distil the advice of a great many sources into the best possible advice. We expect there to be a dialectic, with some form of conflict. I do not believe that we have made profound mistakes on the science. In fact, I believe that the scientists have been wise and thoughtful in the advice and recommendations that they have given us.
Baroness Pitkeathley (Lab) [V]
The Minister will know from research published yesterday by Carers UK—I declare an interest as a vice-president—that more than 4 million extra people have taken on caring roles at home for family and friends during the pandemic. Following the question asked by the noble Lord, Lord Crisp, I ask: in the event of a second wave, how will the Government ensure that these carers are provided with adequate PPE and access to services?
Lord Bethell [V]
I share the noble Baroness’s tribute to the nation’s carers. This week is Carers Week, and it is quite right that the House pays tribute to the contribution of all those who have looked after loved ones and neighbours in the manner she described so well. Support for carers has been at the front of our minds, but she rightly reminds us that we could do more in a second wave, and we are looking hard at ways of developing that support in the months to come.
Lord Mann (Non-Afl)
What discussions have Ministers had with their German counterparts about the success of the German test and trace system?
Lord Bethell [V]
I have conversations with the German Government, medical authorities and diagnostic industry on a very regular basis. I have a fortnightly call with my counterpart in the German health system. It is true that Germany had a more developed and more local testing facility than the British at the beginning of the epidemic, but since then we have built up our capacity dramatically and we regularly do more tests than our German counterparts at the moment. The testing regime being developed is already delivering fantastic results that match those of many countries.
Lord Bilimoria (CB)
My Lords, given that the R rate is now below one across the UK, will the Minister acknowledge that the risk of infection from reducing social distancing from two metres to one metre goes from 1.3% to 2.6% and that the WHO is recommending one metre as safe? Denmark, France, Singapore, China, Hong Kong and Lithuania have moved to one metre. A pub or restaurant can barely open with a social distancing rule of two metres, being able to operate at only 30%; with one metre, they could operate at over 70%. At one metre, you can have four times as many people in a space as at two metres. It is the difference between being in business and going out of business for the hospitality industry, which employs 3.5 million people, let alone for theatres, cinemas and the university sector. Now that the Government are saying that masks are to be worn on public transport, and given the PPE measures within the sector, does the Minister not agree that we need to get the economy back and working as soon as possible, safely?
Lord Bethell [V]
I completely agree with the noble Lord that we need to get the economy back, and I very much agree with his last word—safely. The CMO’s advice is very clear that social distancing of two metres makes a very big difference compared with one metre. When the time comes to move from two metres to one metre, we will very clear about that moment, and I, for one, will celebrate the reopening of restaurants and pubs, which are a source of great joy and happiness for the nation.
The Deputy Speaker (Lord Duncan of Springbank) (Con)
My Lords, the time allowed for questions has now elapsed.
National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2020
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
My Lords, as expected, this has been a moving debate. Who could not be moved by the powerful testimony from the noble Lord, Lord Hunt of Kings Heath, in moving his Motion and by the many noble Lords who have given such clear accounts from the front line of our social care? I have stood at this Dispatch Box—this virtual Dispatch Box—and heard the fears of noble Lords that the social care sector is in some way overlooked. I want to reassure noble Lords that this is not the case.
The country was put on hold three months ago to protect the most vulnerable, at huge cost to future generations. The protection of care homes remains an important consideration in the ongoing lockdown. I welcome the appointment today of David Pearson, who will be known to many noble Lords, as the chair of the Covid-19 social care support task force. Finally, in planning the future of our healthcare, we will be informed by the experience of the last five months—a time when the social care system was the focus of our attention and the whole of government got to know the sector much better. I do not hide from the fact that the last few months have been tough. We may not have had the social care meltdown that other countries did, but there have been difficult times. As such, I am sure that noble Lords will join me in expressing our gratitude to the hard-working staff across the social care sector, local authorities, charities and the NHS.
We all recognise that many of the lowest paid, many of them BAME, put themselves in harm’s way to look after the most vulnerable. The noble Lord, Lord Sheikh, and the noble Baronesses, Lady Pinnock, Lady Uddin, Lady Sheehan and Lady Jolly, made these points very well. For this sacrifice the country is enormously grateful. In particular, since this is Carers Week, I give special thanks and appreciation to our nation’s carers. The noble Baroness, Lady Brinton, rightly referred to the 6.5 million people in the UK who, as the noble Baroness, Lady Thornton, rightly reminded us, are looking after a family member or friend who has a disability or a mental or physical illness, or who needs extra help as they grow older. These are heroes as much as others on the front line, and we give our thanks.
It was instructive to hear from the noble Baronesses, Lady Pinnock and Lady Jolly, about their thoughts on the potential risks around EU exit and its impact on the recruitment of social care staff. The social care sector is vital to the UK, and our future immigration system will ensure that we have access to the skills and talents that we need after the UK leaves the EU. We are continuing to support employers in their promotion of the EU settlement scheme. EU nationals have until 30 June 2021 to make an application to the settlement scheme, and I strongly encourage them to do so.
The noble Lord, Lord Hunt, introduced this debate by bringing to our attention the recently laid National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2020, which I will outline for the benefit of the House. The FNC exists so that individuals or local authorities do not pay for nursing care that is the responsibility of the NHS. My right honourable friend the Secretary of State for Health and Social Care set a national rate in legislation, and he considers it annually.
Following many representations, including in this House by the noble Baronesses, Lady Thornton and Lady Jolly, and a formal review, we increased the FNC flat rate for 2019-20 to £180.31 per person per week, an increase of £14.75. The higher rate has been increased to £248.06 per person per week, an increase of £20.29. This is an overall uplift of 9% on the rate previously set for the financial year. This is a substantial raise that adds an additional £62.4 million of funding into the sector per year, and I am grateful for the welcome from the noble Lord, Lord Hunt, and the noble Baronesses, Lady Watkins and Lady Pinnock, for this development.
The Government have also uplifted the 2020-21 FNC rate by a further 2%. The regulations being discussed today therefore amend the rates set out in the standing rules to £183.92 per person per week for the flat payment. They also increase the higher payment to £253.02 per person per week.
The noble Lord, Lord Hunt, raised the important issue of efficiency challenges. I confirm that an efficiency rate has not been built into the uplifted rate for 2019-20, nor for the 2020-21 rate; the rate was designed to reflect the average cost of nursing care.
However, we are not here today just to discuss that important but relatively small part of social care funding. I shall spell out a few basic points. The long-term financial stability of social care is an imperative for this Government. We have already acted to ensure that the social care sector is properly funded through the epidemic, with major rounds of finance announced earlier this year. Looking ahead, I reassure the noble Lord, Lord Hunt, that we are committed to reform. The manifesto made that clear and the Secretary of State has invited cross-party talks to resolve the complex issues faced, which is the right place to start the process. I reassure the noble Baroness, Lady Wilcox, whose thoughtful and moving maiden speech on this subject is well remembered on all Benches, that these will take place at the earliest opportunity, given the current circumstances. In answer to the noble Lord, Lord Hunt, and the noble Baroness, Lady Healy, that is when the Government will begin to bring forward a plan for social care for the longer term.
The Government have acted to ensure that adult social care is properly funded. At the last spending review, we announced that an extra £1.5 billion would be made available to local government for adult and children’s social care in 2020-21. This came on top of maintaining £2.5 billion of existing social care grants.
The noble Baronesses, Lady Tyler and Lady Bennett, and the noble Lords, Lord Sheikh and Lord Mann, asked about the significant extra funding that the Government had provided. I confirm that the Government expect local authorities to get the funding that they have received to the front line quickly. Local authorities should take steps to protect providers’ cash flows, including making payments on plan in advance and monitoring the ongoing costs of care. I assure my noble friend Lady Altmann and the noble Baronesses, Lady Pinnock, Lady Brinton and Lady Sheehan, that the future of funding in social care will be set out in the next spending review.
My noble friend Lady Altmann raised the financial stability of care homes. We recognise that Covid-19 is imposing significant pressures on the social care sector. We have now made £3.2 billion available to local authorities so that they can address pressures on local services caused by the pandemic, including in adult social care. In addition, in April we brought forward planned social care grants worth £850 million to further support adult and children’s social care.
The Covid epidemic targeted the old and vulnerable; it had the social care sector in its sights. The noble Baronesses, Lady Barker, Lady Watkins, Lady Sheehan and Lady Healy, raised the question of the protective shield announced by the Secretary of State. I reassure noble Lords that the care home support package published on 15 May and the £600 million adult social care infection-control fund represent the next phase of our response for care homes, using the latest domestic and international evidence brought together by Public Health England and drawing on the insights of care providers. This includes making 1 million tests available for residents and workers in care homes, providing a named clinical lead for every care home, infection-control training, the PPE portal as a temporary emergency top-up route and ensuring that every local authority is carrying out a daily review of data on its care homes. Our help to care homes has meant that most of England’s care homes have had no outbreak at all.
The measures we have brought in have created a tsunami of regulations and guidance as we address this horrible disease, and we have responded to requests for clarification from the front line. We have introduced dozens of new ways of doing things. The 16,000 care homes, which range from the big to the small and are supported by half a dozen business models, face their own HR challenges.
We have sought to move quickly and thoughtfully to bring rapid support to a disparate and decentralised care system and have brought in new resources, technologies, supply chains and even the Special Air Service. I have no doubt that, from the point of view of a care home director, it has felt like a confusing set of measures. Under difficult circumstances, there may be things that could have been done better, but I assure the Chamber that we could not have moved faster or with more commitment. The strength of our social care system is the local routes and the tailored offering of thousands of different homes—I acknowledge the persuasive arguments of my noble friend Lady Wheatcroft —but this diversity makes it challenging to implement novel solutions at pace from the centre. I thank those in central and local government who did their best under difficult conditions.
There can be no doubt that the nation’s health and social care is a major priority for this Government. This extends from the fair funding of NHS-funded nursing care and social care more broadly to comprehensive support during the pandemic and, in time, an ambitious plan for reform. We will work with all interested parties—I thank Age UK and the National Care Forum for their briefings before this debate—to make it the most secure and effective service it has ever been. I conclude by thanking once again those working in the social care sector and other front-line services in these challenging times.
Covid-19: Obese and Overweight People
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, Britain is overweight. For too long, obesity has been a huge cost to the health of the individual, the NHS and the economy. Covid is a wake-up call. Initial evidence suggests that obesity may be associated with a higher rate of positive tests for Covid, of hospitalisation, of admission into intensive care and, I say with great sadness, of death. The Prime Minister spoke movingly of his experience. The Government remain committed to halving childhood obesity by 2030 and we are looking at other ways of making a bigger impact on this national scourge.
Baroness Jenkin of Kennington (Con)
I thank my noble friend for that Answer. Now that Covid has joined diabetes, heart disease and cancer in targeting the obese, I am glad that the Government are finally taking the obesity epidemic seriously. I encourage my noble friend to look at the measures ready now to be implemented, such as chapter 2 of the childhood obesity plan. What advice is being given to people about how to boost their immune systems to improve their general health but also to be ready to combat Covid if it comes for them?
Lord Bethell
My noble friend is recognised for her hard work in this area, and we all admire her championing of healthy living. The CMO’s advice is to focus on weight; that is the best way that you can prepare for winter, for the second spike, to defend yourself against Covid.
Lord Brooke of Alverthorpe (Lab)
My Lords, I welcome the very firm statement from the Minister and I welcome, too, the Prime Minister’s public statement about him accepting personal responsibility for his size. Can the Government, in taking this renewed, stronger position, recognise that the public need to have all the facts that they can about what they are eating and drinking? In many areas, they are left in the dark and therefore cannot make the right choices. On alcohol, for example, drinking has shot up during lockdown, yet people do not know how much sugar there is in alcohol; there is no proper labelling, including on calories. Can the Minister commit to ensuring that, in the review being undertaken, the public will know what choices they have to make and will know the facts about what they are eating and drinking?
Lord Bethell
The noble Lord makes a good case. Chapter 2 of the obesity recommendations makes it very plain that clear labelling and data play a critical and pivotal role in helping people to make choices, but so do interventions on the actual content on the food. We will look at both of those for future options.
Baroness Brinton (LD)
Section 8.3 of yesterday’s PHE review on disparities and Covid demonstrated very clearly that Covid, obesity, hypertension and diabetes type 2 were all severely raised for the BME community. Given that the Minister said in the House yesterday that this review was just the first step in understanding Covid in our BME communities, what urgent guidance is going to our primary care sector to advise our BME communities on what they need to do?
Lord Bethell
The noble Baroness, Lady Brinton, is entirely right. The review has done an excellent job of laying a path for greater understanding of the disease and is informing the PHE response. GPs already have a very clear work plan for advising BME communities on the threat of diabetes, in particular, and on obesity and healthy living for all circumstances. This will be redoubled during the epidemic that we are experiencing.
Lord Robathan (Con)
I welcome the Minister’s statement and indeed the leadership shown by the Prime Minister, but we need to take this further and show leadership from everybody in positions of authority and in politics. I particularly home in on health professionals and teachers because, for too long, there has been, I regret to say, a large number of very overweight people in the NHS and in our schools, setting a very bad example to children and people in hospital. People must be encouraged to take personal responsibility. I am afraid that they know what makes them fat, they need to be told what makes them fat and, dare I say it, they need to be shamed for eating and drinking too much.
Lord Bethell
My noble friend is right that personal responsibility and the leadership of those in areas of responsibility are incredibly important. Shame is not a policy that the Government particularly endorse, but I will confess to personally having a sense that I need to lose a stone in order to be match fit for the winter. I commit to my noble friend to undertake this arduous and difficult task over the next three months and will account to him on what progress I have made.
Baroness Watkins of Tavistock (CB)
My Lords, global scientific data is clear: obesity weakens immune systems, resulting in increased susceptibility to a range of diseases. Covid-19 has shone a light on the effects of being overweight, and I welcome the Government’s concern and intervention for the future. What plans do they have to work with survivors of Covid-19 who are overweight? There is a real risk that many will suffer post-viral fatigue, which will further exacerbate unhealthy lifestyles and could well result in a significant number of subsequent deaths that are in fact associated with the recovery—or non-recovery—period following Covid-19. Will the Government deliver clear and transparent guidance on healthy lifestyles and provide support to overweight people who have survived Covid-19?
Lord Bethell
The noble Baroness is entirely right: there is nothing new to the impact of Covid on those with a high BMI; it is entirely consistent with the impact of other diseases. She is also right that one of the nasty aspects of Covid is its long-term effects, which are not fully understood yet. Evidence suggests that these may be extremely damaging, and it is true that the Prime Minister has spoken about the impact of Covid on him. I have had pneumonia; I know the long-term damage of these kinds of diseases on people. We are looking very hard at offering the kind of support that she describes to those who have been hard hit by Covid.
Baroness Thornton (Lab)
My Lords, as many noble Lords have said, obesity is a significant risk factor in Covid-19. It is critical that we turn the tide on obesity at the earliest opportunity, and this means starting early in life. What steps are the Government taking to implement the measures outlined in chapter 2 of Childhood Obesity: A Plan for Action? Will the Minister commit urgently to restart existing plans to reduce salt, sugar and calories in our everyday foods, extend the soft drinks levy to other sugary and high-calorie foods, limit the advertising of junk food to children and ensure that people are not inundated with promotions for unhealthy food and drink?
Lord Bethell
The noble Baroness is entirely right that chapter 2 outlines an extremely thoughtful roadmap for how to address this issue. It is currently being reconsidered. I cannot make the guarantees she asked for from the Dispatch Box, but I can assure her that we are working hard to see how we can use the example of Covid to make progress on this important agenda.
Baroness Tyler of Enfield (LD)
My Lords, given the Prime Minister’s welcome recent statement that a more interventionist stance is needed to tackle obesity, is the Minister aware of a recent poll by the Obesity Health Alliance showing that 72% of those surveyed supported restrictions on shops promoting unhealthy foods in prominent areas, including checkout areas, and 63% wanted the sugar tax on soft drinks extended to other sugary foods? What plans do the Government have to introduce these measures, working collaboratively with supermarkets and other food retailers?
Lord Bethell
The noble Baroness is entirely right to suggest that Covid might be the infection point—the intervention necessary to wake up the nation to the dangers of obesity. We are keen to use that moment to make progress on this important issue.
Lord Foulkes of Cumnock (Lab Co-op)
My Lords, I declare a very personal interest in this issue: a recent Lancet article raised concerns that obesity is now shifting severe Covid disease to younger ages. Will the Government put in place public messaging not of shame but of sympathy and encouragement to younger adults?
Lord Bethell
The noble Lord is entirely right to raise the issue not only of younger adults but of children. These habits are formed extremely early and are hard to kick; if interventions are to be effective nationwide, they need to be aimed at all parts of society, particularly younger ages, when people pick up the behaviours of a lifetime.
Covid-19: Response
Lord Bethell Excerpts(3 years, 11 months ago)
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Baroness Brinton (LD)
My Lords, I too thank the Minister for the Statement. From these Benches, we send our condolences to the family of Lord Rea; he will be missed. I also repeat the support from the Liberal Democrat Benches for everyone working hard to help contain and reduce Covid-19, from the magnificent front-line staff in the NHS and the care sector to all key workers, whether visible to us or not: we know that you have given your all. We also send our condolences to all those who have seen the death of families and friends over the last four months.
The World Health Organization has insisted repeatedly that no country should start to lift lockdown until Covid-19 is no longer in the community. With the noble Baroness, Lady Harding, confirming that there are still over 8,000 new cases per day, clearly it is still in the community, and WHO also says that lockdown should not be lifted until a full test, trace and isolate process is in competent operation across the country, which it is not.
Can the Minister explain why Ministers took the decision to start the process of lifting lockdown even though the Chief Medical Officer refused to allow the threat level to reduce from four to three? Unlike other European countries, which started lifting lockdown only when the daily death rates were below 10, today the department reports a total of 359 people died in the UK in the last 24 hours. Why was the shielding advice changed over the weekend, and why was no guidance sent out to GPs, care homes and clinical groups? I can confirm, as someone who is shielding, that I still have had no advice, by text, by letter or by telephone, on what I should be doing now that the advice appears to have changed. What can the Minister do to reassure people who are shielding that this is safe advice?
What steps are the Government taking to prepare for flare-ups of cases in our communities, and, worse, an early second wave? Will the care sector be involved in that preparation, given that they appear to have been left to hang out to dry in order to protect the NHS? I understand that unlike hospitals, the care sector has not been approached at all yet.
In the Statement, the Secretary of State refers to the publication of the Public Health England report on disparities and the risks and outcomes of Covid-19. The Runnymede Trust summarised the problems with the report, saying that there were not
“any recommendations on how to save BAME lives.”
What specific guidance is being provided to the NHS and care sectors to protect BAME staff in high-risk Covid-19 areas? Can the Minister comment on the report from the Western General Hospital that BAME locums were disproportionately placed on rotas in coronavirus-intense wards, and that the hospital has experienced a recent and very large spate of cases?
Yesterday, the Office for National Statistics wrote its second letter in four weeks to the Secretary of State, challenging him in the bluntest terms and accusing him of obfuscation and confusion on the number of daily tests carried out. Can the Minister give the House a date when we will be able to see real and consistent data on testing, approved by the ONS, back- dated and adjusted, so that there is no room for any misunderstanding?
I return to the issue I have raised repeatedly with the Minister: the care sector. At the weekly APPG on Adult Social Care update today, we heard again from across the sector that it still faces a number of problems, some of which the noble Baroness, Lady Thornton, outlined. To be clear—before the Minister responds again, saying that this is just anecdotal evidence—we were told that this is happening in a large number of care homes and settings in wide areas right across England. This is not a one-off.
First, a number of CCGs are still pushing care homes to take block-bookings of patients coming out of hospital without having had Covid tests. The Prime Minister and Secretary of State have repeatedly said that this has never happened. It has happened and is still happening. When will it stop?
Secondly, on PPE, the care sector says that the Clipper system is finally starting to be rolled out across the country—a mere eight weeks after your Lordships’ House was told that it was only a handful of days away. However, care homes report that deliveries are still only a portion of their original orders, meaning homes still have to make decisions about rationing. Can the Minister provide a date by which the care sector will receive all the PPE it orders and needs?
Thirdly, the Minister told us that all care homes would be offered tests by 6 June. I repeat my question from two weeks ago as to why some homes are excluded from the portal so that they cannot access tests. These are homes for learning-disabled adults and disabled people under 65. Given the worrying comments on the inequalities data in the PHE report, when will this change?
Fourthly and finally, I echo the points made by the noble Baroness, Lady Thornton, about it being essential for all health sector staff to be able to access repeat testing to keep people safe. While it is true that it is happening for NHS staff, it is not true that our care homes or staff working in the community are able to access regular testing. Can the Minister please provide a date by which staff in care settings will have regular testing? This is vital because there are so many asymptomatic cases. They need parity with the NHS.
I recognise that I have asked a large number of specific questions and hope that, even if the Minister cannot answer them now, he will be able to write to me and others taking part in the Statement. Perhaps he could also answer any of the questions from the noble Baroness, Lady Thornton, if he cannot answer them now.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I start by echoing the words of both noble Baronesses and give thanks for the contribution of Lord Rea to the House. I did not know him well but have read the many testaments to his work. He clearly lived a full life and made a massive contribution to the House, for which we should all be thankful.
I echo the noble Baronesses and give a moment of thought to all those who have had deaths in their family and among their friends. I have lost both an aunt and a godfather to Covid in the last few weeks; my family has not been untouched, and I think—
The Deputy Speaker (Baroness Newlove) (Con)
My Lords, I think we have lost connection. Is the noble Lord, Lord Bethell, back?
Lord Bethell
Yes, I am back. I apologise for my broadband. I was addressing the question of the Prime Minister’s words. I have no doubt that there will be a judgment of history on whether the Government have made every decision correctly and whether every call we have made was right. There will have been mistakes, for which I am happy to put my hand up. But I am proud of the response to Covid, not just from the Government but from everyone involved.
With the leave of the House, I will single out five things. I am proud of the Lighthouse Labs. I am proud of the Nightingale hospitals. I am proud of the fact that the NHS stood up under relentless pressure when so many people thought it would fall over. I am proud of the fact that we ducked the worst effects of the epidemic, which many people forecast might lead to deaths of up to 400,000 people; everything that we know about the disease suggests that those forecasts were quite right and utterly realistic. Of course, the death rate is far too high. I have reiterated my thoughts for anyone who has lost someone and I feel very sad about the number of people who have died. And I am very proud of the scientific response, particularly by our vaccine researchers, who are world-leading in all this.
There has been an amazing collaborative effort by all parts of society, from the SAS to returning nurses, from front-line NHS workers to the private sector. It makes me profoundly sad when I hear people talk so negatively and so angrily about the way this country has responded. I totally put my hands up as a member of the Government for any mistakes that we may have made in our decision-making, but I ask noble Lords to speak a little more positively about this incredibly impressive effort and to remember that, when they speak in a negative way about the response to Covid, they are addressing not just the Government and the Government’s response. They are addressing everyone from postal workers to shop workers, the NHS and everyone who has been involved in this response. Having worked very much at the centre of things, I feel genuine pride in this effort.
The noble Baroness, Lady Thornton, asked about the PHE report. It is important, but it is preliminary research. It does not answer every single question about the complex issue of the differential rates of infection and mortality from this disease. It remains a mystery why some groups are much more profoundly hit, and it is not clear whether the differences are behavioural, social or genetic.
I say to the noble Baroness, Lady Thornton, that it appears that those areas of the NHS with the highest prevalence of infection are not those involving the front-line workers, where the use of PPE has actually protected workers from the worst effects of Covid. It has been among other parts of the hospital—in the canteens, among the porters and among back-room staff—that the prevalence has been highest. That is because infection has often happened where workers have touched each other or socialised. I mention this just to put paid to the idea that there has in any way been an irresponsible attitude, or that the NHS has in any way inadvertently put those with vulnerabilities in harm’s way.
I am not quite sure if I completely understood or heard the precise reference, but I did hear the phrase “structural racism” in the NHS. I react very sceptically towards that phrase and, to be honest, with a profound sense of anger. The NHS is not a racist organisation. This has been raised in previous debates and I reject it wholeheartedly at every level. If I have misunderstood the remarks of the noble Baroness, Lady Thornton, I hope that she will clarify them, but I want to make a clear stand on that point. There is clearly work to be done to understand better why some groups—older people, BAME groups and those who are overweight—have been hit so hard by the disease; that work is ongoing.
The noble Baroness, Lady Thornton, asked about test and trace. I want to be clear about a few things. As my noble friend Lady Harding said at its launch, this is a huge project which has been put together at pace and not every part of it is working immaculately. I admit that there are ragged edges but in essence it is working incredibly well. The people involved are working extremely hard. It is a coherent, thoughtful and, I believe, in many ways a world-beating outfit. I would like to ask anyone who is interested in finding out more about it to let me know and I will be glad to talk them through it or to invite my noble friend Lady Harding to go over the work of the test and trace programme. I genuinely believe that anyone who finds out about its workings cannot help but be impressed by it. I want to make a special testament to the private contractors who have made a contribution to it. I do not agree with people who denigrate those who work in the private sector for doing so—quite the opposite. My experience of working with private contractors who have contributed to the response to Covid has left me extremely proud of them and impressed by the results.
On local engagement, if it was the case that directors of public health, local environmental officers and local infection directors were not engaged, that is no longer true. The joint biosecurity initiative has done a fantastic job of briefing and tying in the local response. Tom Riordan from Leeds, who will be known to many noble Lords, is leading the charge on this. He is doing a fantastic job of working with local groups. Our response to Covid is now more local at every level and, as a result, is much better than it was.
The turnaround time for tests is important and is the focus of the operational priorities of the test and trace programme. Some 85% of the tests carried out through the drive-in centres are now done within 24 hours. The data is shared with GPs, although it is very hard work to tie in the test and trace computer program with the GP computer program, and more work needs to be done on this. I do not hide the fact that we are working extremely hard to bottom out and make more secure the operational arrangements of the test and trace programme. It was a huge infrastructure project which was thrown together very quickly, but I pay my thanks to those who are making extremely rapid progress on it. Perhaps I may share a point with noble Lords. Last weekend, I took a “secret shopper” test. I booked it at 6 pm on Saturday. I took the test at 11 am on Sunday at the Wroughton centre on the edge of Swindon, and I got the result at 6 pm on Monday showing that I had tested negative, of course. It was an extremely easy process. It took me 10 minutes on Saturday and 10 minutes on Sunday. The text I got was very clearly marked as being from the NHS, as it was, and it was a thoroughly professional and easy-to-handle experience. I invite all parties to try to support this important national project rather than denigrating it, because it relies on public trust and we really need the public to believe in it. They will do so only if our leaders support it.
I utterly agree with both noble Baronesses that people need to be able to understand the data—it is a really important project—but perhaps I may share a genuine and honest dilemma. We have sought to publish data as promptly and in as much quantity as we humanly can. The result of that, though, is that it is not all audited and checked and therefore it is often revised. That creates the kind of problems which David Norgrove has quite rightly identified. We are working extremely closely with David to try to close the gap. We are working closely with the Office for National Statistics to ensure that all future data is fully audited, but it is usual in peacetime to take months to iron out these processes before the publication of official data, and data is not published on a daily basis for exactly the reasons identified by both noble Baronesses. We have real and consistent data published by the ONS which is properly audited. That is completely robust data and we try our hardest to make right the data that goes into the daily updates. However, there is a tension between being prompt and being procedural, and we have sought hard to try to hit the right combination of the two.
The noble Baroness, Lady Thornton, asked about shielding. I reassure her that in no way are these announcements made for politically motivated reasons. We have been asked by many groups to address inconsistencies in the shielding arrangements. It is entirely reasonable for the Government to lift the shielding arrangements; that was done at speed and we are working extremely hard to ensure that those who were shielded are informed properly and that GPs and the NHS are part of that process.
Both noble Baronesses, Lady Thornton and Lady Brinton, asked about care homes. I reassure them both that 60,000 tests are carried out per day, and all those homes with outbreaks are being tested and retested. It is too early to tell exactly, but we are well on the way to hitting our 6 June target, and the amount of testing going on in care homes is extremely high.
As regards the anecdotes concerning CCGs being under pressure, as I understand it, to accept elderly people who are coming from hospitals into care homes, I would be very grateful if the noble Baroness, Lady Brinton, would write to me with those examples, because they are shocking, if they are true, and are completely against government policy and the agreed procedures of the NHS. I would be very happy to take up the case if she could give me chapter and verse.
On the future of the NHS, the noble Baroness, Lady Thornton, quite rightly asked what kinds of lessons we have learned. I will share two. First, one of the good things that has come out of the Covid epidemic is that the social care sector, the NHS and the public health sector have worked much more closely together than they have for a long time. We need to learn the lessons of that and figure out ways to ensure that they work even closer than they do right now. As regards the backlog, the Government completely acknowledge the challenge of catching up with the massive amount of procedures and medical work that will need to be done once Covid is under control. We have already made a full and clear commitment to funding the catch-up in that backlog, and we are putting in place the necessary preparations to staff and facilitate the catch-up process.
The noble Baroness, Lady Brinton, asked about the decision on lifting lockdown. It was the right decision and it was entirely consistent with advice from the CMO. The numerical threat level, which is organised by the CMO, is completely independently arranged, and I regard it as a testimony that it has been held at a high level, which shows the scientific independence of that process.
On preventing future flare-ups, I will flag two very important developments. First, I have already mentioned the joint biosecurity centre, which is currently being organised by Tom Hurd, and which is proving to be a really important development in arranging local responses to local flare-ups. These flare-ups may be anything from a school, a business or even, in the Weston case, a whole hospital. Being able to mobilise both the expertise and the analysis, support and data in order to jump on these flare-ups is an essential part of keeping a lid on the epidemic, and I pay tribute to the work of the biosecurity centre.
Secondly, we are working extremely hard to stockpile the necessary medicines and supplies for the winter. Our focus is very much on preparing for the winter in every possible way to prepare the NHS, social care and our public health response. We are using the summer months to mend the roof and ensure that we are in good shape. We very much hope to avoid a second spike, but we are fully aware of and preparing for the threat.
I remind both noble Baronesses that many European countries had more than 50% of their deaths in the social care sector. In fact, a low proportion of deaths in Britain have been in the social care sector, relative to other European countries. I appreciate completely that that is of no interest or value to those who have lost loved ones in the social care sector; I mention it only so that we have a sense of perspective.
On our response to and actions on the threat to BAME workers in the NHS, clear guidance has been sent from the top of the NHS to trusts, asking them to put in local measures that each trust regards as appropriate to protect BAME staff. This is entirely the right response to encourage and allow local trusts and the social care sector to make their own arrangements in their response. We continue to analyse the numbers to understand this problem more fully.
The Deputy Speaker
We now come to the 30 minutes allocated for Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of speakers. I will now pass the chair over to the noble Lord, Lord Haskel.
Lord Bethell
My noble friend makes an incredibly valuable point and I completely share her concerns, but I will share two important points, if I may. First, we cannot avoid the fact that this disease has a 14-day incubation period. It is extremely tough to protect our borders from infection by a disease that may not be detectable, even at our borders, during that period. Secondly, while the peak is raging, additional infection from foreign visitors makes only a marginal difference, whereas at this stage, when we have worked so hard to get the prevalence down and reduce infectiousness, the threat of new infection from foreign visitors is higher. That is an irony that the CMO is fully aware of, but it is entirely right that we have brought in these measures. They are constantly under review. The impact on tourism and other industries is hugely regretted, but to rid the country of Covid they are proportionate.
Lord Patel (CB)
My Lords, I thank the Minister for repeating the Statement. Before I ask my question, let me say this: with the greatest respect to the Minister, if he thinks that no degree of racism exists in the NHS, I suggest that he speaks to those people from ethnic minorities who work in the NHS and see how they feel. I accept his comment that examination of what has happened hitherto is for another day, but we have to examine the current strategy for suppressing the virus, which we have not done successfully. In this regard, the latest initiative is the Government’s test and trace scheme. A great degree of transparency and trust will be required to make this a success. Can I ask the Minister: what matrix will the Government use to demonstrate the success of the project?
Lord Bethell
My Lords, I bow to the experience and wisdom of the noble Lord, Lord Patel, particularly in the matter of racism in the NHS. I would not for a moment suggest that there is no racism at all in the NHS—or any large organisation—and I deeply regret any bad experiences he may have had. The accusation, however, was of structural racism in the NHS, and that is what I push back against. The NHS as an organisation is not racist, and I reject the suggestion that it is.
As for the matrix of success, that is an extremely perceptive question, and a bloody tough one—exactly the kind I would expect from the noble Lord. To summarise, it is to reduce R: if we can get a lid on R0 and stop the index case from spreading the disease to more people, then Test and Trace will have succeeded.
Lord Turnberg (Lab)
My Lords, like the Minister I too went to have my Covid test recently. There was hardly anyone there—lots of testing stations but no customers and no queues. I was in and out in five minutes. I was not surprised, therefore, that while 200,000 tests a day are available, many fewer are being taken up. I ask the noble Lord, therefore, whether the Government will open testing to the wider public and not restrict it to those with symptoms. There are many asymptomatic carriers and we need to know who they are and where they are.
I also reiterate the question about how soon test results will be available in hours rather than days. We can do it, but when will it be rolled out?
Lord Bethell
I can reassure the noble Lord, Lord Turnberg, that all people, of all ages, are currently eligible for testing. I accept that communication about this has not got through to everyone, and we are working very hard to communicate the information widely. A very large marketing campaign to make it clear began earlier today—I saw the adverts when I drove in on the M4 this morning.
I can also tell the noble Lord that because the infection and prevalence rates are so low, we have a machine with spare capacity. That is being used for surveillance and to cleanse the social care sector and the NHS sector through asymptomatic testing. The machine is on standby for the winter, and, as we lift lockdown, to protect society from any rise in the infection rate. The turnaround times are already getting much tighter and in many cases are less than 12 hours.
Baroness Hussein-Ece (LD)
My Lords, the Minister said that the review of disparities in Covid had revealed what we already knew: that those most at risk include minority communities, particularly BAME people. We also already knew that the guidelines for people with inequalities replicate existing inequalities. I am sure that public health directors up and down the country have known about these inequalities, and have published reports about them, for many years. The Minister says that it is a great mystery, but really the report just touches on the inequalities.
Does the Minister understand that those from BAME communities, who disproportionately work in front-line services and the jobs he mentioned, are being hit? They are extremely worried, and very angry at this response. I understand that there cannot be a huge raft of recommendations, but there needs to be more guidance on protecting people, not just in the health service but more generally for those who employ people from BAME communities.
I will give an example from my own community. The Turkish and Turkish-Cypriot communities in this country are around only half a million. We have lost somewhere in the region of 250 people; we have all been touched by this, myself and my community. In Germany, there are 3.5 million Turks, and they have had about 50 deaths. The figures are stark.
On 19 May, I asked the Minister whether he would consider meeting campaigners and health professionals to put in place a proper Covid race equality strategy, for now and beyond. Will he please take that back and agree to meet us, and others, who are determined that we will have a proper response to this terrible virus that is disproportionately impacting on our BAME communities?
Lord Bethell
The noble Baroness is entirely right. These diseases always hit hardest those who are most vulnerable, and the most vulnerable often include those who are poorest, who have existing morbidities and who are vulnerable in some way. She is right that this is an age-old truth; it is as old as history itself.
I was referring to the scientific links between the disease and the death rate. To clear up the point, if I may, the mystery that we do not understand is the biological explanation of why the disease appears to hit some people harder than others. That mystery is being unravelled, but I cannot pretend that we fully understand it at the moment.
As to the noble Baroness’s invitation to meet groups, I remember it well and would be very glad to take it up. I will ask my private office to be in touch to make those arrangements.
The Deputy Speaker (Lord Haskel) (Lab)
The noble Lord, Lord Empey, has withdrawn, so I call the noble Lord, Lord Balfe.
Lord Balfe (Con)
My Lords, I want to go back to the testing centres question. I also had a test, but I had to drive to Stansted from Cambridge. Many people in our community do not have cars and do not drive. What is the Minister doing to make it possible for all major towns to have testing facilities that can be reached either by public transport or on foot?
My second point is more doubtful. Many people do not seem to realise when they should be tested, or, for that matter, how often. If you are tested at the beginning of June, when do you need to be tested again, if at all? What does the test prove, apart from the fact that you do not have the virus? It does not prove that you have had it or will not get it. Will the Minister step up the publicity campaign he just mentioned, so that people can be better informed?
Lord Bethell
I deeply regret that my noble friend had to drive from Cambridge to Stansted. We are working hard to address that and are looking at alternatives. We have now put up more than 100 sites, and I hope very much indeed that there would now be a site nearer him. We have also pioneered at-home testing, which we believe will address his key point, and we are trialling walk-in centres for city centres such as Cambridge.
My noble friend’s last point is entirely right. You should have a test when you show symptoms, but defining the symptoms of any disease, and in particular this disease, is very difficult. We do miss some people who do not show any symptoms, and some people who think that they have the symptoms actually have the symptoms of something else. It is a real dilemma and part of the battle we face against Covid.
Baroness Hollins (CB)
My Lords, the Statement does not address yesterday’s report from the CQC showing more than double the expected number of deaths of people with learning disabilities during lockdown—something we were warned to expect by colleagues in Italy. Will the noble Lord explain what is being done to better protect everyone in this group, including those living in residential care, but also people made vulnerable because of visits by support staff, who often visit more than one person living in the community?
Lord Bethell
I thank the noble Baroness for her question, which I think I understood. If I understand correctly, she is asking about those who live in social care and residential care. I commend the work of Helen Whately, the Social Care Minister, who has been an amazing champion for social and residential care. She holds our feet to the flames daily to ensure that more work is being done. Testing is one area where we have made huge progress. The provision of PPE, raised by the noble Baroness, Lady Brinton, is another, despite everything noble Lords might have read. I pay tribute to my noble friend Lord Deighton, who has brought about a huge amount of manufacturing in the UK. There is, however, more that we can do and we are working as hard as we can.
Baroness Healy of Primrose Hill (Lab)
Could the Minister explain what changed between 12 May, when I asked him what advice could be given to those shielding and was told that they must remain inside until at least the end of June, and last Saturday evening, 30 May, when the advice suddenly changed with no warning and the clinically extremely vulnerable were told that they could go out?
Lord Bethell
The noble Baroness asks a good question. One thing that changed was that there was a large amount of representation from those being shielded that the mental health consequences of their isolation were having a profound effect. There were very touching and moving stories, and the scientific analysis of that was extremely persuasive. We have sought to be flexible, but the advice remains very clear: those who are clinically vulnerable have to take extremely good care of themselves. Even though the prevalence is lower, they have to be aware of the consequences of this awful disease.
Lord McNally (LD)
My Lords, earlier today, a former Prime Minister, Mrs May, intervened at Prime Minister’s Questions to ask about the security of data, including medical data, if there was a no-deal Brexit. The Prime Minister’s reply was the usual “It’ll be all right on the night”. Does the Minister agree that it would be an enormous betrayal if proper systems were not put in place well before the deadline for any departure? The medical and other data that we receive from Europe are an integral part of fighting this disease and should not be put at risk for ideological reasons.
Lord Bethell
I completely agree with the noble Lord. The Prime Minister said that it was down to the negotiating table to sort out this important matter. I will leave it to the negotiators.
Baroness Falkner of Margravine (Non-Afl)
I understand that we have to wait for the data to come through that addresses what underlying health conditions and comorbidities might impact on BME critical care and death rates from Covid, but, to reassure the community while we are waiting for further information, I wonder whether the Minister’s publicity campaign could be very directly targeted at those vulnerable groups to make it very clear that they should avail themselves of the testing capacity available—indeed, that they might even get priority—so that they have some reassurance that, should they have any of the symptoms, they will be seen to as soon as possible?
Lord Bethell
The noble Baroness makes a powerful point. The frustrating truth is that many in the groups and communities of which she speaks take the fewest number of tests. Getting through to these groups is extremely important, so they can seek the clinical help they need if they are suffering from Covid. We have worked extremely hard with our marketing department to ensure that hard-to-reach communities get the marketing messages that will be effective. The noble Baroness provides a really reasonable reminder and I will redouble my efforts to ensure that those marketing messages are focused on the right communities.
Lord Ribeiro (Con)
My Lords, I appreciate that “test, trace and isolate” is in its embryonic phase and that we have yet to learn the lessons of the pilot on the Isle of Wight, but at the height of the pandemic Sir Paul Nurse and other academic researchers offered, in the spirit of Dunkirk, to assist the Government with their “little boats”. Sadly, this approach failed to find favour, with a central approach then being used. Will my noble friend assure me that, as we head to a national rollout of “test, trace and isolate”, the Government will remain open to offers of help from those in the security and medical fields?
In addition, the PHE report identifies worrying outcomes from BAMEs who contracted Covid-19, as others have said, but the analyses did not cover comorbidities such as hypertension, which is common in the Asian and African populations, diabetes or obesity, which was mentioned in 21% of Covid-19 death certificates. Can my noble friend say when these factors will be considered, in order to provide a clearer picture for BAMEs who are at risk of contracting Covid-19 now and when the next wave comes in the winter?
Lord Bethell
My noble friend makes an incredibly perceptive point on the BAME research. He is entirely right that this important aspect of our understanding in relating the ethnic, social and behavioural elements of the response to the disease is essential. The report has not covered all the ground yet: that work is being done at the moment, as I mentioned earlier. Frankly, only when all those elements are linked together will we get a full picture.
Regarding the “little boats”, we absolutely celebrate them. In order to get the industrial-level testing numbers up, it was correct to back big laboratories that could do the automation necessary to achieve that. I am a huge admirer of Sir Paul Nurse and have spoken to him often. The role of laboratories such as his is in connection with their local NHS trusts. Many local laboratories are doing extremely good work with local NHS trusts and we are putting measures in place to facilitate and encourage such connections.
Lord Liddle (Lab)
My question concerns the “track and trace” system. I declare an interest as a county councillor in Cumbria, where we have had severe outbreaks of the virus. A world-beating system was supposed to be in place on 1 June and we were given, as I understand it, less than two weeks’ notice of what the local government involvement in this “track and trace” arrangement would be. Does the Minister think that this has been handled adequately? How does he see the relationship between what is done by local authorities and what is done nationally by the Serco system that is being recruited?
Lord Bethell
I completely understand the noble Lord’s frustration, but I remind him that in Covid time, two weeks is ages. We have been moving so quickly to cover the ground that we have had to stand up very big programmes within a fortnight. He speaks with frustration that there seems hardly enough time to get things organised, but that is the pace at which we have had to move. The prevalence rate is down and the infection rate is down—that is not say we are complacent, but now is the moment when we are bedding in our operations.
The noble Lord is entirely right that our focus and our investment of time is in stitching together the local response, which is, as many noble Peers have said in these discussions, an essential part of our response. As I said earlier, the work of the Serco call centres, of the directors of public health, of Tom Riordan, of local authorities—all these need to be stitched together. It is extremely complex, but that is what the team of my noble friend Lady Harding is doing at the moment.
Viscount Waverley (CB)
Following a previous response by the Minister that touched on politics, will he clarify an issue that is exercising the country at large? Is the response by government to corona led by science or by taking note of science? If the latter, what are examples of choices by government that differ from that of scientific advice?
Lord Bethell
The noble Viscount asks an incredibly broad question, upon which many a treatise could be written. I can best answer by giving my personal experience, which is of being in meetings where the scientists absolutely lead our thinking, where their clinical judgment takes precedence over any lay opinion and where we have been advised by unbelievably impressive and experienced clinicians, epidemiologists and scientists from different groups. My experience is that those voices have been the ones that prevailed in almost every debate. However, not everything can be answered by scientists and there are political decisions to be made. Ultimately, major decisions such as on lockdown, on the strategy for test and trace and on how to run a vaccine strategy are informed by scientists, but politicians have to make big calls. That is the same in every single major national project. I think we have got the balance right. We have tried to put the science, quite rightly, at the heart of the decision-making, and sometimes we have been led into quite politically awkward situations by the good judgment of our scientists. I pay tribute to them and their judgment. My personal experience is that we have listened to and been led by them wherever necessary.
Lord Scriven (LD)
My Lords, I remind the Minister that holding the Government to account for their decisions in no way undermines front-line workers, whose jobs have sometimes been made harder by their decisions. As the Government say that we are moving to local flare-ups, which body has full responsibility and legal powers—now, today—to implement and control a local lockdown?
Lord Bethell
The arrangements for local lockdowns are not fully in place. In fact, the policy around them is in development and a full decision has not been made on what arrangements we will make for lockdowns. The joint biosecurity centre will be absolutely central to those arrangements. It is the hub into which the intelligence on prevalence and infectiousness comes and which pushes that information out into the local area to help advise directors of public health, local authorities and other local services on local arrangements. I believe that it will develop the expertise and the co-ordination role which the noble Lord asks about.
Baroness Bennett of Manor Castle (GP)
My Lords, in answering the question of the noble Lord, Lord Turnberg, the Minister said that a test is available to anyone who wants one, and that this is being advertised on the M4. I am looking right now at the nhs.uk website page headed “Ask for a test to check if you have coronavirus”. Highlighted on that page, it says:
“Please help the NHS by only asking for tests for people who have coronavirus symptoms now.”
Can the Minister explain that? Also on that page, it lists the three symptoms for which it suggests we should have a test. Yet when I go to the Centers for Disease Control and Prevention website—the US body—it lists 11 lots of symptoms, including: fatigue; muscle ache; headache; sore throat; congestion; nausea or vomiting; and diarrhoea. Have the Government considered expanding the list of symptoms, and if they have not, why not?
Lord Bethell
If I was not clear, I hope the noble Baroness will forgive me. The test is open to anyone in the population. It is not restricted to key workers or those who are over five, as it once was. However, the clinical advice is that you should seek a test only if you show symptoms, partly because the test will not necessarily work if you do not have symptoms. That remains the case.
With regard to expanding the list of symptoms, we changed the symptoms about two weeks ago. We have done a huge amount of work to understand the best way of recommending symptoms. This is an amazingly complicated area. A lay person like me would think it was not too difficult to define symptoms for an important disease, but actually it is an extremely contested area. We have broadened it, we keep it under review, and if what we have done is not working well enough, we will update it again.
Baroness Verma (Con)
Does my noble friend not agree that where there are densely populated communities and a greater risk of spreading the coronavirus, testing should take place through booked appointments with their regular GP surgeries? Many of those communities do not know how to access online appointments and come from larger families. They could then also be asked about how they were following the guidelines set down by the Government. My worry is that many communities are not being communicated to and are falling through the gaps. I urge the Minister to take that on board.
Lord Bethell
I agree with my noble friend. It is a grave concern that key communities, particularly those to which she alludes, are not hearing the message and do not have the available resources for booking tests. We are working hard on that. In particular, we are working with GPs to ensure that they have the ability to book tests. They can of course do so on the portal like anyone else, but we are working to create a special prioritised facility for GPs to be able to book tests for their patients. I completely agree with my noble friend’s assessment that in many communities GPs play a trusted role. A practical issue is that many GP surgeries are currently closed, but I welcome the fact that many are now reopening.
The Deputy Speaker (Lord Haskel) (Lab)
My Lords, the time allotted for the Statement is now up. The day’s Virtual Proceedings are now complete and are adjourned.
Hospitals: Patient Safety
Lord Bethell Excerpts(3 years, 11 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, despite Covid-19, the day-to-day health of the nation remains the business of the NHS. That is why the NHS has issued a new operating framework to help hospitals to continue providing essential and emergency care for patients who do not have Covid-19. This guidance is being kept under review. I have placed a copy of the framework in the Library.
Baroness Browning (Con)
Emergency admissions, of which we have seen many, though perhaps not enough, have resulted in people being very afraid of going into hospital, because there has been a lack of information for the general public. For example, what happens at the triage stage, what sort of PPE will people be wearing and how will they be protected? What can the Minister do to reassure the public that they will be safe and, on top of their emergency, will have the absolute minimum chance of getting Covid-19?
Lord Bethell
My Lords, I acknowledge that people’s concerns have led to a decline in attendance at A&E. That is why the NHS is running an “Open for business” media campaign, encouraging all patients in need of urgent or emergency medical care to seek appropriate treatment, including, where appropriate, attendance at A&E.
Lord Clark of Windermere (Lab)
Is the Minister aware that North Cumbria Integrated Care NHS Foundation Trust has confirmed that for five weeks 100 staff working in its operating theatres had to use respiratory face masks that had not been individually fitted, putting patients and staff at risk? The regulatory-fit test had not been applied. Can the Minister look into this and check that all the other trusts in England are not making the same error?
Lord Bethell
The noble Lord raises a question about north Cumbria, which I do not know about specifically, but I reassure him that the arrangements for PPE in hospitals have been made extremely professionally and thoroughly. Billions of items of PPE are available, and training on the fitting, wearing and changing of PPE is provided for all front-line clinical, support and other staff.
The Lord Bishop of London
The report recently published by the Institute for Public Policy Research, Care Fit for Carers, found that half our healthcare workers have said that their mental health has deteriorated since the Covid-19 crisis began. What supplementary provision is being put in place to deal with the mental health needs of NHS staff?
Lord Bethell
My Lords, I acknowledge the expertise of the right reverend Prelate the Bishop of London, who, in a former life, was the Chief Nursing Officer. She raises an important point; the mental health of staff is of enormous and grave concern to the NHS, to the department and to social care. We are investing money in providing additional mental care support and are working closely with the colleges to find out how best we can provide that important support.
Lord Ribeiro (Con)
My Lords, the specialist guidance on the management of non-coronavirus patients needing acute treatment, issued on 20 March, put senior decision-makers at the heart of triaging patients referred for admission. To assist them, what role would testing for Covid-19 play on admission, and what proposals are there to utilise the Nightingale hospitals as a step-down facility for Covid-19 patients, thus reducing their numbers in NHS hospitals and allowing those hospitals to deal with the backlog of cases?
Lord Bethell
My Lords, there was some interruption in hearing my noble friend’s question but, if I understood him correctly, the answer is that all patients are now tested on entry to hospital. Until their test result has arrived, they are treated as though they have Covid-19 and isolated wherever possible.
Baroness Barker (LD)
How will the Government enable hospitals to work on a regional basis, co-operatively, to optimise the use of surgical and radiological resources?
Lord Bethell
I am afraid that at the moment, I cannot give a precise and thorough answer to the perceptive and very detailed question asked by the noble Baroness, but I will be glad to.
Baroness Fall (Con)
We pay tribute to all those doing so much to help Covid-19 sufferers. However, we must not lose sight of others, such as cancer sufferers, who are being adversely affected by being afraid to go for diagnostics, having surgery and treatment cancelled, low supplies of key drugs such as painkillers, and research budgets being hit. Can the Minister reassure the public about this and tell us what he is doing to address these problems?
Lord Bethell
The situation of cancer patients is of grave concern. We have restored all the treatments, surgery and other systems necessary for treating cancer, and we have put in place testing facilities so that those with suppressed immunity can be tested and therefore enter treatment centres with confidence. It is a situation that we maintain under review, and we are working hard to ensure that drugs and painkillers are in ready supply.
Baroness Campbell of Surbiton (CB)
My Lords, there are many specialist units that provide ongoing support and life-saving treatment to people with long-term, complex disabilities. Many of these units have been turned into Covid wards, for example, the National Spinal Injuries Centre at Stoke Mandeville. Will the Minister inform me when these units are likely to return to their original function? What is happening to this cohort of patients in the meantime?
Lord Bethell
My Lords, the NHS chief executive, Sir Simon Stevens, has written to all NHS organisations signalling a change in the phasing of our response to Covid and inviting them to return operations given over to Covid to their previous use wherever possible. I hope very much that this will lower the impact on patients that the noble Baroness described. If she has a specific example in mind, I would be glad to inquire about it.
Baroness Thornton (Lab)
Is the Minister aware that some NHS trusts are diverting 999 and GP emergency admission calls to hospitals other than the nearest hospital to avoid transmitting Covid between patients? Can he tell the House when that will stop? Do the new guidelines allow the Government to provide finer-resolution data on hospital admissions, which will assist understanding of optimal admission, treatment and resource allocation strategies?
Lord Bethell
The noble Baroness speaks about infection control measures regularly undertaken by trusts. Ambulances frequently take patients not to precisely the nearest hospital but to the one best suited to treating the patient. These infection control measures have been extremely effective and will continue for the foreseeable future.
Baroness Jolly (LD)
My Lords, NHS Providers has concerns about the Government’s testing strategy for Covid-19. Will the Minister tell the House when every patient and health and care staff member with suspected Covid-19 symptoms who needs a test will consistently be able to get one within an appropriate turnaround time? When will the updated strategy be published?
Lord Bethell
My Lords, every member of the NHS or social care employee can currently get a test when they present symptoms. They can do that through their employer, directly through the online service or a hotline. The turnaround time in 95% of tests is within 48 hours.
Lord Singh of Wimbledon (CB)
There is a widespread fear of contracting Covid-19 on entering hospital, even where there are Covid and non-Covid zones. What steps can the Government take to reduce this real fear by limiting Covid patients to certain hospitals or by other measures?
Lord Bethell
The noble Lord speaks of a fear that I recognise. It is a sad feature of our times that patients who should be in hospital are anxious about attending because of possible infection with Covid. Different trusts approach this in different ways. Some sites have been deemed Covid-free and are used for, for instance, cancer treatment, whereas larger sites manage differently, perhaps by allocating certain buildings to be Covid-free and others not. We have tried our hardest to reassure the public that they can proceed in the NHS with safety.
The Lord Speaker (Lord Fowler)
My Lords, the time allowed for this Question has elapsed. We now come to the second Oral Question, from the noble Lord, Lord Teverson.