Covid-19: Brazilian Variant

Lord Bethell Excerpts

Tuesday 2nd March 2021 Lords Chamber

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

My Lords, the challenge we have is uncertainty. Genomic sequencing data links the Brazilian variant to the South African variant, the so-called E484K mutation. We also acknowledge that there are anecdotes from Manaus on transmissibility, but none of this is clear cut. We are working towards getting the concrete data necessary to make a confident assessment of this mutation. Therefore, we are taking a precautionary approach and we are committed to limiting its spread by all means at our disposal.

[Baroness Thornton (Lab)]

I thank the Minister. According to a report by the World Health Organization, the P1 variant that originated in Brazil has been found in at least 15 countries which are not on the Government’s red list, meaning that arrivals from those countries are currently exempt from the hotel quarantine policy. Virologists have warned that the Government’s red list is at risk of becoming out of date at any time because of the time it takes to sequence coronavirus cases. Indeed, these six cases date back to 11 and 12 February. In the light of these facts, and given concerns that the Brazilian variant may be more transmissible and might be resistant to existing vaccines, will the Government review the red list and take urgent action to introduce a comprehensive hotel quarantine system that applies to all UK arrivals?

[Lord Bethell (Con)]

The noble Baroness is entirely right: this is not the first case of P1 in Europe. As of 11 February, P1 has been identified in 17 countries, with 200 cases reported globally. In the EU, 30 cases have been identified in five countries and areas. We keep the red list under permanent review and have an ongoing process of keeping it up to date. The fact that we have a red list and a managed quarantine programme makes further expansion of the red list possible. It puts our borders and our vaccine under a programme where we can control things, which is to be applauded.

[Baroness Jolly (LD) [V]]

How confident are the Government that our vaccines will cope with the Brazilian variant of the Covid virus and that the passenger from Brazil, who is somewhere in south Gloucestershire, will be traced? What measures are now in place to ensure that an incoming passenger is not lost again?

[Lord Bethell (Con)]

We are uncertain on the vaccine. There is a huge amount of speculation, but I would recommend that noble Lords take it with a pinch of salt because we cannot know for sure how the virus will behave with those who have been vaccinated until we have much better and clearer data. Regarding the current managed quarantine arrangements, I pay tribute to the teams which have stood up the system extremely quickly and well. The south Gloucestershire and Aberdeen arrangements have been incredibly impressive. It is extremely frustrating to all concerned that one person did not fill in the form and slipped through the net. But overall, the programme has shown itself to be extremely robust and we have an enormous amount of confidence in it.

[Lord Balfe (Con)]

My Lords, we seem to be devoting a huge amount of state resources to chasing one person with a mutating virus at a time when the National Health Service is on the point of collapse. Waiting lists are going up and we are in a terrible mess. Will the Government accept that viruses mutate and that we need a strategy to deal with that? Constantly locking people up and extending the list of countries so that you can put more and more people into hotels is a self-defeating policy.

[Lord Bethell (Con)]

The vaccine is absolutely central to our strategy. It is an approach that has proved enormously popular, and I think I speak for a large number of people when I say that defending the vaccine has to be our number one priority. If there were a highly transmissible vaccine-escaping mutation, it would take us back to the beginning of this whole pandemic. That is why we have put in place red list countries and managed quarantine. That is why we are committed to Operation Eagle and the efforts to track down those bringing variants of concern into this country.

[Lord Patel (CB) [V]]

My Lords, the scientists are concerned about the P1 Brazilian variant because of three mutations, one of which is common to other variants, making it more transmissible. One of the others is referred to as the “escape mutation”, which may bypass some vaccine-induced immunity. Does the Minister agree that, apart from the measures the Government are taking of trace, track and isolate and surge testing—which I thoroughly approve of—it is important to continue genomic sequencing, at scale, of Covid cases to detect variants that may arise and to monitor and study post-vaccine immune response? That would enable us to modify the vaccines to boost the immune response and deal with the variants.

[Lord Bethell (Con)]

The noble Lord is entirely right. Our commitment to genomic sequencing, which has lasted for years, has put Britain in great shape to be able to do the sequencing necessary to track these variants. We are doing more sequencing than any other country. But as the noble Lord knows, this is detective work, and it is extremely complex. While the 484K mutation might be the significant change in both the Brazil and South African variants, it might be one of a great many other mutations in its genomic characteristics. This is the detective work we are doing. I am afraid that it will take some time to get to the bottom of it, and it needs to be complemented by field studies into how the mutation reacts in real life, as well as with antibodies. The combination of immunology, virology, biology and real-world clinical study will give us the insight that we need.

[Lord Winston (Lab) [V]]

My Lords, with due respect to the Minister, I wonder if a pinch of salt is quite the right treatment for some of these variants of the Covid virus. It is not just the Brazilian and other different variants. For example, in addition to Siqueira’s paper, which has just been published from Brazil in the last couple of weeks, the paper from Bogota shows numerous variants which are not quite the same. Some of these may be rather more virulent, and it is possible that they may even cause reinfection—it is certainly not very clear. The point is this: surely we need to be very cautious indeed about our airports and whether the list we have is sufficient. At what stage do we decide that we need to take much firmer action with all incoming passengers to the United Kingdom, making certain that they are properly tracked and traced?

[Lord Bethell (Con)]

The noble Lord is entirely right. Things are happening around the world which are causing a great deal of anxiety. Stories of possible reinfection in South Africa are extremely concerning and the huge spike in infections in South America has not been properly explained. It is possible that there are a number of mutations, and mutations of mutations, there. The truth is that we do not have the genomic or immunological data that we need to fully understand what is going on. That is why we have taken a precautionary approach, as the noble Lord recommends. We have instituted both managed quarantine and a red list which we keep under review. If we feel it necessary to extend that list, we will do so.

[Lord Scriven (LD) [V]]

My Lords, tracing new variants will be key in the next phase of this public health challenge. So why does the £22 billion test and trace system not have an individual identifier on each test posted to homes, along with an integrated database? This way, every test could be traced back to an individual, regardless of where the test was sent from, or even if a person incorrectly filled in a form.

[Lord Bethell (Con)]

I endorse the noble Lord’s observation that tracing is important. I pay tribute to the Operation Eagle team. The noble Lord will note that the South African variant, which made landfall in the UK, is currently being contained through the immense work of this team. They are throwing a blanket over communities and doing a huge amount of forensic, detective work in tracing variants. As to his specific point, it is possible for someone to walk up to a testing station, take the test, be handed a form and not fill it in. We are trying to understand if those were the circumstances in this case.

[Lord Flight (Con)]

My Lords, are there risks that the Brazilian variant may not provide adequate protection against reinfection and that vaccinations are less effective against this strain? It carries the same mutation as the Kent variation, which is rated 70% more transmissible than previous strains.

[Lord Bethell (Con)]

My noble friend is stretching my immunological skills to the limit. The Brazilian variant has a number of mutations. It is not clear to us whether those are mutations of transmissibility, vaccine-escape mutations or reinfection mutations, and therefore which we should focus on. All are possible and we are keeping a careful eye on this. An enormous amount of investment and research is going into understanding this more carefully.

[Lord Empey (UUP) [V]]

My Lords, is my noble friend aware that Brazilian companies have a significant footprint in both parts of the island of Ireland? Given that there is a common travel area between the two, what discussions has he had with the Government of Ireland about this? How is it proposed to deal with inflows of people from Brazil who might be able to travel freely throughout these islands?

[Lord Bethell (Con)]

I am grateful to the noble Lord for flagging the Brazilian connection with Ireland, which I did not know about. I reassure him that there is an enormous amount of collaboration between Whitehall and Dublin on this matter. There are strong links on the managed quarantine programme within Ireland in order to close the “Dublin backdoor”, as it is sometimes called. I pay tribute to colleagues in Dublin for their collaborative approach. We do not currently have a five nations unified approach, but it is of interest. We are definitely keen to ensure that there is no backdoor entrance for VOCs through Dublin, or in the other direction.

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

My Lords, given the inevitability of variants and that some will evade antibody responses, what plans do the Government have for unified messaging, across the whole of the UK, that long-term distancing, mask-wearing and other measures are essential, and to tell the public that this is not like flu and we need to live differently?

[Lord Bethell (Con)]

The noble Baroness is entirely right, which is why the Prime Minister struck such a cautious tone when he unveiled the road map. We are not through this yet. A substantial proportion of the country is vaccinated, but we have to protect the vaccine. For those who have not been vaccinated, there are risks, and that is why we still have in force a “do not travel” alert and why we are maintaining marketing and communications at every level on the restrictions that are still in place.

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

My Lords, to come back to my noble friend Lady Thornton’s Question, the Minister will know that, at the SAGE meeting on 21 January, there were warnings that geographically targeted bans cannot be relied upon to stop the importation of new variants, partly because of indirect travel. He has just said that he does not want a backdoor entrance through Ireland. But what are the Government going to do about indirect travel, which is a clear route into this country to avoid the current quarantine rules?

[Lord Bethell (Con)]

Those who travel to the UK must fill in a passenger locator form. On the PLF they have to state whether they have been in a red list country. We also share an enormous amount of information with the aviation industry to cover people’s previous travel, and therefore it is not as easy as the noble Lord might think to take a hop and a skip into Britain through a third country, as has been proved by those who have travelled from Brazil and been caught by the red list. However, his point is well made, which is I why I reinforce what I said earlier: we keep the red list under review and, if it proves necessary to extend the countries on that list, we shall do so to protect the vaccine.

[Lord Cormack (Con)]

My Lords, at the outset, my noble friend said that the Government wanted to use all means at their disposal to combat the spread of all the variants and mutations. I refer to a point I made last week. One means at the Government’s disposal is to ensure that all those who work in care homes are vaccinated. It is quite wrong that they can refuse it and then attend to the most intimate needs of their patients

[Lord Bethell (Con)]

My Lords, I remind my noble friend that we have some mandatory vaccination already in place in the health service; those who perform operations and other intimate health interventions are required to have hepatitis and other vaccinations, for instance, so there is a precedent for what he talks about. However, it is a huge step, which impacts people’s personal liberty and choices, to make vaccination mandatory for more than a million social care workers. My noble friend makes a persuasive argument, which is why the Cabinet Office is looking at exactly this sort of matter; there is a strong public health argument for mandatory vaccination. Given that we have not rolled out vaccination across the whole population yet, it is premature to make that decision today, but we are considering it carefully.

[The Deputy Speaker (Baroness Fookes) (Con)]

My Lords, the time allowed for this Question has now elapsed. I apologise to those Members whom I was not able to call.

Independent Medicines and Medical Devices Safety Review: Sodium Valproate

Lord Bethell Excerpts

Tuesday 2nd March 2021 Lords Chamber

[Lord O'Shaughnessy]

To ask Her Majesty’s Government, further to the report by the Independent Medicines and Medical Devices Safety Review First Do No Harm, published on 8 July 2020, what plans they have to bring forward a redress scheme for women and families who have been harmed by sodium valproate.

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

My Lords, the Government plan to respond further to the Cumberlege review later this year, as I committed in my recent Written Ministerial Statement. In the meantime, we are carefully considering the recommendation regarding a redress scheme for those harmed by sodium valproate, and measures are in place to limit the prescribing of this drug.

[Lord O'Shaughnessy (Con)]

I am grateful to my noble friend for his Answer. Since my noble friend Lady Cumberlege published her landmark review, another 150 babies have been born suffering harm from in utero exposure to sodium valproate, to add to the 18,000 children—18,000, my Lords—who have been harmed in this way since the 1970s. These children belong to families whose lives have been turned upside down, and who often cannot afford the costs of caring for their damaged children. They need and deserve a redress scheme now. Why can the Government not move faster?

[Lord Bethell (Con)]

My Lords, I pay tribute to those who have put together the valproate registry scheme that became live on 11 February. My noble friend is entirely right. There are 22,095 people on the registry; 462 of them had 490 conceptions, and 180 women were prescribed in a month when they were pregnant. A redress scheme is not necessarily the correct solution to this problem. We are considering it extremely carefully, and when we publish our overall response to the Cumberlege review we will include our considered response to the redress suggestion

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

My Lords, the noble Baroness, Lady Cumberlege, concluded in her report that the system still did not know how to minimise the risk of future babies being damaged, despite 27,000 women of childbearing age currently taking valproate in the United Kingdom. In view of that, does it not make the case for a redress scheme absolutely persuasive?

[Lord Bethell (Con)]

My Lords, I will leave it to the response to the Cumberlege review to make the decision on the redress scheme. In the meantime, our focus is on a regime ensuring that those who take this important drug have the right advice to prevent them becoming pregnant. I emphasise that specialists review the treatment and ensure that an annual risk acknowledgment form is signed by the prescriber and the patient. This is an important measure ensuring that all those who take this potentially life-changing drug acknowledge and understand the implications of becoming pregnant.

[Baroness Cumberlege (Con) [V]]

My Lords, in our report we suggested that every pregnant woman who is on sodium valproate should be warned by her GP of the potential harm to her unborn child. Can my noble friend please tell me how many of the women exposed to this danger have been notified, and what the plans are to ensure that in future they are told? What incentive is given to GPs through the quality outcomes framework to ensure that they carry out this very important duty?

[Lord Bethell (Con)]

My Lords, as I explained a moment ago, there is an annual risk acknowledgment form signed by the prescriber and the patient, and that is shared with the patient’s GP. GPs should check that the patient has signed an up-to-date annual risk acknowledgment form each time a repeat prescription is issued. We have instituted a valproate safety implementation group that analyses, along with the MHRA, compliance with this plan. We acknowledge the review’s recommendation to introduce an indicator on safe prescribing in pregnancy for future iterations of the quality outcomes framework, and we will respond on that with the rest of the response to the review.

[Baroness Jolly (LD) [V]]

My Lords, redress is important, but so too is patient support. Could the Government confirm that they are considering the recommendation that a network of support centres should be set up to support those women who have been affected by Primodos, sodium valproate or vaginal mesh?

[Lord Bethell (Con)]

My Lords, I completely acknowledge the noble Baroness’s point. Support is incredibly important and our hearts go out to all those who have been hit by any of the three conditions covered by the review. We are absolutely looking at those recommendations to see how they may be implemented to provide the support that the noble Baroness rightly points out.

[Baroness Wyld (Con)]

My Lords, could my noble friend please update the House on the timetable for the appointment of the patient safety commissioner, one of the key recommendations that I am delighted the Government accepted? I understand that that requires new regulations, and the Government have rightly said that we ought to take time to find the best and widest possible field, but surely that just underlines the urgency of the need to get going with this.

[Lord Bethell (Con)]

As my noble friend rightly acknowledges, the everyday workings of the commissioner require some work. That work is being finalised and regulations will be made setting out further details about the appointment and operation of the commissioner—for example, the terms of office, the finances and other support for the commissioner. Officials are now working with legal and appointment colleagues to firm up time- lines and begin both the regulations and the appointment process for the commissioner.

[Baroness Masham of Ilton (CB) [V]]

My Lords, is the Minister aware that, when his noble friend Lord O’Shaughnessy was the Minister, the noble Lord realised the harm that some women had suffered from taking sodium valproate when pregnant? The noble Lord’s support has been inspirational and has given hope to these victims. Will the noble Lord, Lord Bethell, in his position as Minister now, bring forward a much-needed redress scheme for these women and children who have been let down?

[Lord Bethell (Con)]

I am grateful to the noble Baroness for her tribute to my noble friend Lord O’Shaughnessy, who has done an enormous service to us all by championing this cause, both as a Minister, when he moved this review and made a huge impact, and since then with his patient and thoughtful advocacy of this important cause. He speaks very movingly and thoughtfully, and we are greatly influenced by his persuasion on this subject. The noble Baroness should be reassured that we are absolutely looking at the recommendations for a redress agency, and we will come back with considered thoughts on it when we answer the review in the round. Until then, I welcome all thoughts and advocacy on the subject.

[Baroness Thornton (Lab)]

I have two points. First, last summer only 41% of the respondents taking valproate said that they had signed an annual risk acknowledgment form, so I would like the Minister to reflect on the fact that some GPs are not doing the job that they should be in terms of protecting women. Secondly, those affected by thalidomide and contaminated blood have a redress scheme, but it took years for that to happen. We simply cannot wait years for this to happen for those suffering from the effects of sodium valproate.

[Lord Bethell (Con)]

My Lords, I welcome the noble Baroness’s point on the proportion of those who say they have filled in the form. Phase 1 of the registry is a helpful collection of statistics, but we are putting in place phase 2, which will help us to understand exactly how many patients who are taking sodium valproate have actually filled in the form. That will give us the concrete reassurance that we seek on this matter. I recognise that there are redress payments for thalidomide and contaminated blood, but redress payments are not necessarily suitable for every single misfortune that happens in the medical world. However, we will look very carefully at the case for sodium valproate and I take the noble Baroness’s comments on board.

[Lord Jones of Cheltenham (LD) [V]]

Research from Konkuk University in South Korea has suggested that disabilities caused by the compound could cause autism spectrum disorder transgenerationally—in other words, afflict successive generations within families. What is the Government’s view?

[Lord Bethell (Con)]

I am grateful to the noble Lord for raising that study. It is not one that I am aware of, and I am keen to go back to the department to find out whether it has done any analysis of it. I will write to the noble Lord with a response.

[Lord Singh of Wimbledon (CB) [V]]

My Lords, the report First Do No Harm underlines the hurt and devastation that can result from not making patients aware of the possible side-effects of drugs. The harm done by giving sodium valproate during pregnancy cannot be undone, and generous support should be provided. Does the Minister agree that, while the appointment of a patient safety commissioner is a move in the right direction, that in itself underlines the importance of keeping patients fully informed of possible side-effects and listening to their concerns?

[Lord Bethell (Con)]

The noble Lord puts it extremely well and I totally agree with the thrust of his point. For patients to have the right information about the risks of the medicines that they are prescribed is essential. However, if I may stray into a different subject, there is also patient choice. For many patients, sodium valproate provides an incredibly valuable relief from epilepsy and mental illness. It is a drug that continues to be prescribed because some have no choice and there is no valid alternative to the drug. The number of people being newly prescribed the drug—new starters—is down dramatically from previous years, but for some it really is an important part of their therapy. The decisions that they make are personal ones, and we should respect those.

[The Deputy Speaker (Lord Bates) (Con)]

With apologies to the noble Baroness, Lady Browning, the time allowed for this Question has now elapsed.

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

Lord Bethell Excerpts

Monday 1st March 2021 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 29 January be approved.

Relevant document: 45th Report from the Secondary Legislation Scrutiny Committee

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

My Lords, this regulation covers important aspects of the enforcement of isolation. Noble Lords will recognise that isolation is the key tool that most effectively breaks the chain of transmission; if those who are asked to isolate do so, we can beat this awful virus, but if they do not, the cost is measured in lives, the economy and our society. Huge resources are expended on identifying those with the disease, and their contacts.

So many are asymptomatic that the instruction to isolate can strike some as tough. No one likes measures that restrict people like this. I did not join the House thinking that I would stand here like this, and I am sure that many noble Lords will rightly reflect on the costs to liberty of such regulations. However, I would not be before your Lordships now if I did not believe that they were absolutely necessary. If those with the disease, and their contacts, do not isolate, and instead spread the disease in the community, then we are wasting the country’s resources in fighting this disease, because this disease is so virulent that we cannot rely on most people abiding by the guidelines most of the time. We need much higher adherence than that to beat the disease, or else we will be living with a high infection rate, giving the disease the circumstances to mutate and potentially evade the vaccines, so that we are back at the beginning.

These regulations cover detailed aspects of data sharing between test and trace and our police forces. This is a delicate area, because we must be very careful about data being shared between a testing body and an enforcement body. That is why these regulations are so detailed and why we are taking so much time to get them right. The data sharing of these regulations is operationalised by a memorandum of understanding between the National Police Chiefs’ Council and the Department for Health and Social Care. Conscious of the importance of getting this relationship right and retaining public trust in the system, we have sought to give clear legal underpinnings with these regulations. We worked very hard to get this right in the regulations in September, we refined them in January, and we continue to work hard to get this right.

This instrument makes changes to the original regulations from September. These regulations introduced for the first time the legal requirement to self-isolate for individuals who have been notified to do so by test and trace. They provided for some very basic details to be shared by test and trace to the police, specifically name, contact details, the date on which they were told to self-isolate and the end date of the self-isolation period. Non-adherence to those regulations became punishable by a fixed penalty notice ranging from £1,000 to £10,000. Failure to pay could result in court action and conviction.

The amendments that we are discussing today address the data sharing that is required to make those FPNs enforceable. For the police to issue FPNs, in addition to the information covered in the September regulations, they need some very basic extra information about the suspected brief, including, first, evidence to prove that the individual is supposed to be self-isolating—either a test result or a contact connection—and evidence that a person has received a notification from test and trace.

Secondly, there are some further items of contextual information that are needed by the police to help them reasonably manage their engagement with a potential offender. For instance, they need to know if that person might have a disability, so that they can take the right approach. At the other end of the spectrum, they need to know if that person has been threatening or abusive. These amendments allow the minimum necessary information to be shared with the police to ensure that they have confidence with the individual who has been notified and issued with an FPN if necessary.

I have spoken previously of our intention to publish the MoU and I reiterate that. We will publish it shortly, once these loose ends are tidied up.

I will say a word about how all this works in practice. The process deployed since the regulations first came into force protects individual privacy and is only activated by a specific police inquiry. The amendment to the regulations on 29 January does not change that. These additional data points may only be shared,

“for the purpose of the prevention, investigation, detection or prosecution of offences”.

The police receive details of a potential breach, mostly from the public, and will assess this information. Where confirmation is needed that the individual has a legal duty to self-isolate, a specific request is made to test and trace. On receipt, test and trace will check its records and confirm to the police that the individual has been notified. The police do not have access to the test and trace database and that will remain so. The police will then decide whether to contact the individual and, having interviewed them, whether the FPN should apply. To meet the evidentiary test necessary to issue an FPN, the police need to have the same level of certainty of the facts as they do for bringing a prosecution in a court of law. The changes being debated today provide that certainty. Without the additional information, the police would have found it much more difficult to issue an FPN.

We will continue to support people to do the right thing, both through the test and trace support payment scheme and through supporting councils to provide practical help for those struggling to self-isolate. In this country, we rely on the principle of the consent of the people, rather than the threat of imprisonment, for the application of lockdown measures. However, as has been noted by noble Lords in many debates, there must be consequences for those who break the law. The police have a role in upholding and enforcing these regulations. We must ensure that they have the tools—the data—necessary to do so. The urgency of this amendment stems from the feedback received from the police that that additional information was needed.

SI 97 also makes changes to the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) Regulations 2020. It introduces a higher fixed penalty notice to persons aged 18 and over for participating in gatherings of more than 15 people in a private dwelling, educational accommodation or an indoor rave. This new, larger FPN will support wider efforts to improve compliance with regulations during this stage of the restrictions and thereby help to lower transmission rates further.

Taken together, these amendments demonstrate our willingness to take tough action against the most serious breaches of the rules. We also understand that it is crucial to take steps to allow people to return to a more normal way of life. The most effective way of doing this is by continuing to reduce the transmission of the virus while we deliver our vaccination programme. I commend these regulations to the House.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I start by thanking the Secondary Legislation Scrutiny Committee for its work in looking at this legislation. I also echo the words of the noble Baroness, Lady Thornton, and thank all those noble Lords who have shown huge commitment in following these regulations. I completely confess that it is a tough gig, and I am enormously grateful to those who have shown the stamina, forbearance and determination to stick with it. If anyone has any questions, please do not hesitate to contact me directly.

I also echo the thanks of my noble friend Lord Blencathra, the noble Lord, Lord Bilimoria, and others on the vaccine. It is absolutely right that the rollout of it is impressive, but it is also right that we have to remain cautious because of the very large number of people who have not been vaccinated, and we also must be cautious about whether variants may affect the vaccine. That is why we remain determined to get these regulations right.

I shall start by tackling the MoU, which is the most delicate of the subjects raised by noble Lords. We are trying to get this right; when it comes to the data, we took a minimalist approach. The MoU and the regulations we have laid so far have covered the smallest amount of data that we thought could be effective. We are slowly ensuring that the police have the clarity that they need—the noble Lord, Lord Clark, spoke eloquently on this point—and we are adding to it carefully. The moment that we have an MoU that we think is publishable, I assure noble Lords that we will publish it.

It is absolutely crystal clear that the data covered by the MoU may only be used in the

“prevention, investigation, detection or prosecution”

of these specific offences, and it may not be used elsewhere. The data itself is held on the management of police information—MoPI—system and taken off the moment it is no longer needed. This SI will be rescinded in September this year, unless it is rolled over, in which case a debate will be necessary. To the noble Baroness, Lady Thornton, I say that this does not apply to the isolation app because it does not tell us who the person is who has it on their phone—because of its privacy settings.

Noble Lords spoke very eloquently and with such thought on the absolutely critical issue of compliance, and we are very focused on trying to get it right. I completely and utterly disagree with my noble friend Lord Balfe and his very sweeping and uncomfortable generalisations. I believe that most people in this country want to do the right thing, whether they live in a council house, fly by NetJets or anywhere in between; that is what we have seen from the British public.

Several noble Lords asked about the number of FPNs. We have had 42,675—roughly 4,000 a month—in the entire epidemic. That is a very small number, considering that it is not the approach of this Government to try and get compliance with these regulations by enforcement—we have not done that. We have sought to appeal to people’s civic pride and their feelings towards their neighbours and loved ones, and that appeal has largely worked.

However, my noble friend Lady Wheatcroft did speak about consistency and clarity when it comes to the law. One of the things that I have learned during this epidemic is that putting things into law has the benefit of making them clearer: it means you take out the bugs and reduce the amount of flexibility, and that is of enormous help to those who are trying to live their lives by the law and contribute to the well-being of others. In this matter, I completely agree with the sentiments expressed by my noble friends Lady Wheatcroft and Lady Stroud.

A number of noble Lords spoke about deterrence, and we are very alive to this danger: the idea that you may put enforcement measures in place that deter people from taking tests. This has not been our experience to date, but I take on board the comments last week of the noble Baroness, Lady Finlay, and others who have spoken about the dangers of this. This is why we have not put enforcement at the heart of our approach in terms of trying to implement isolation; instead, we have appealed to people’s better nature.

We are doing a very large amount of marketing around isolation during the unlockdown that starts on March 8, and we are making a huge effort to roll out hundreds of millions of tests in the community testing programme, through schools, workplaces, the community testing programme and elsewhere. At the heart of that investment is an appeal to people’s better nature, which, we believe, will make a huge difference. If you look around the world at those who have effectively applied isolation protocols, you see that you need a combination of four things: civic buy-in, a degree of carrot, clarity and the presence of a little bit of stick—that is our approach.

On carrot, I completely take on board the comments of the noble Baronesses, Lady Thornton and Lady Brinton, the noble Lord, Lord Scriven, and others. However, I do not agree with the suggestion posited: we have, in fact, done an enormous amount to support those who are feeling the pinch. We have a very broad furlough scheme and a payment for testing; local authorities have billions of pounds in order to support local schemes. Those who need it have the support necessary for them to comply with isolation.

On a slightly detached note, I want to say a word about the use of data, which has been brought up by a number of noble Lords. We are seeing a revolution in the use of data through Covid, and we are extremely ambitious about this. The use of the NHS number has been massively increased through vaccination, so that everyone who has a vaccine now knows their NHS number, if they did not know it before. Many of them have used the NHS login to reach the website. The Covid app, with 20 million downloads, has been one of the most successful digital health interventions in the world. I pay huge tribute to the IT teams at NHS Digital, NHSX and NHS Test and Trace who have done an enormous amount to produce billions of data points on the testing, tracing and support of those with clinical needs.

We envisage a complete inflection point on the use of diagnostics by the British public. We are hopeful that this experience will lead people to be much more engaged with their patient records, that they will download the logins and apps necessary to stay in touch with their records, and that they will take a much more proactive approach to consumer diagnostics. That, I hope, will be one of the positive dividends of this awful pandemic.

A number of Peers have asked about borders and the Brazilian variant. We have a debate on this tomorrow so I will limit my comments. However, I stress that the managed quarantine process has been an enormous success. It is extremely frustrating that although there was one person did the right thing and stepped forward for a test, their details were not properly captured. We are trying to understand exactly how that happened. But overall, the South African variant is on the decline, and it speaks volumes that families in south Gloucestershire and in Scotland have done the right thing and isolated so that those outbreaks have been contained. I pay tribute to the Project Eagle team, to NHS Test and Trace and to the borders team who have worked so hard to make that happen.

Finally, on the subject of raves, which several noble Lords have raised, including my noble friend Lord Bourne, and the noble Baronesses, Lady Wheatcroft and Lady Thornton, there is a definition in the law book. It is a gathering on land in the open air with music that includes sounds which are wholly or dominantly characterised by the emission of a succession of repetitive beats, causing serious distress to the inhabitants of the locality. That used to be my life.

Perhaps I can give a legal and a cultural explanation for these measures. The legal explanation is that there has been a lacuna in the law. While small and large gatherings were covered by other regulations, gatherings of under 15 in a house were not. My noble friend Lord Bourne will of course remember the origins of the phrase “house music”; it refers to the period after the closure of discotheques when people gathered to listen to loud music in their home, creating house parties which themselves generated the genre of music now known as house music. That is what is happening, and it often arises at times of economic decline. I beg to move.

Motion agreed.

Covid Contracts: Judicial Review

Lord Bethell Excerpts

Monday 1st March 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, a year ago, Parliament gave the Government huge power so they could act quickly in the face of the pandemic. Unfortunately, growing evidence suggests that Ministers have taken advantage of these powers to the disadvantage of the taxpayer and to the cost of health workers and patients. The NAO report in November revealed that the Government set up fast-track systems for billions of pounds of contracts for people personally known to Ministers, Peers and MPs. They found that suppliers with links to politicians were 10 times more likely to be awarded contracts than those who had applied to the department in the normal way.

It looks like there is more to be explored here: not just a case of “delayed paperwork” as the Health Secretary has claimed but serious procurement rule breaches. Will the Government urgently publish the names of all companies awarded public contracts through the VIP lane and how much they were paid? What steps are the Government taking to recover millions of pounds of public money from companies which failed meet their contractual obligations?

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

My Lords, I am grateful for the question from the noble Baroness, Lady Thornton. During those hectic days, more than 15,000 suppliers approached us. Many of them were credible, but many sadly were not. It was entirely right and the best practice to have a high-priority lane to triage and prioritise those who were the most credible. A sample of 232 suppliers in that lane reveals that 144 came from Ministers, 21 from officials, 33 from MPs and 31 Members of the House of Lords not in the Government—including many who chose to write to me personally with the names of recommendations. I am enormously grateful to those who got in touch.

[Baroness Brinton (LD) [V]]

My Lords, the Prime Minister said last Monday in the House of Commons that

“the contracts are there on the record for everybody to see.”—[Official Report, Commons, 22/2/21; col 638.]

However, the evidence questions that statement. Can the Minister say how many PPE contracts entered into in the first wave of the pandemic, up to the end of June, remain unpublished? If the number is not to hand, please will he undertake to write to me with it?

[Lord Bethell (Con)]

From memory, it is my understanding that 99% of the contracts are published and 1% are outstanding. I am happy to check that and confirm it to the noble Baroness.

[Lord Robathan (Con)]

My Lords, it is fair to say that I have not been uncritical of some of the Government’s approach to this virus crisis and, of course, it is important that the Government follow proper procedures and are beyond reproach in their procurement policy. However, in relation to the judgment, did the judicial review find any impropriety in the behaviour of the Government, or was it a question of straining every sinew to deliver essential equipment to front-line workers, as the Government were urged to do by Rachel Reeves down at the other end?

[Lord Bethell (Con)]

My noble friend puts it extremely well. The judge said

“the overall picture shows the Secretary of State moving close to complete compliance. The evidence as a whole suggests that the backlog arose largely in the first few months of the pandemic and that officials began to bear down on it during the autumn of 2020”.

The judgment was entirely about the timing of the publication; it had nothing to do with the awarding of the contracts themselves. From that point of view, it is a ringing endorsement of the actions of officials in this matter.

[Baroness Meacher (CB) [V]]

My Lords, I strongly support the Secretary of State’s decision to prioritise saving patients’ lives, albeit that the contractual process appears to have breached the rules. Does the Minister agree that the real problem was the failure of Governments over the preceding 10 years to give proper attention to preparations for a pandemic which everybody knew could be around the corner? Can the Minister assure us that this failure will not be repeated, and systems are in place to ensure proper preparation in future?

[Lord Bethell (Con)]

My Lords, it is not for me to do the post-match analysis; that will be for those in the future. I reassure the noble Baroness that we have 32 billion units of PPE procured, including 19 billion purchased by the DHSC, 10 billion purchased by SSCL and 2.5 billion manufactured by our brilliant UK companies. We have 120 days of PPE ahead of us, and I can very confidently say that we are in great shape for anything the pandemic may throw at us.

[Lord Wood of Anfield (Lab)]

I declare an interest as director of the Good Law Project, which brought the action against the Government. Can the Minister clear up a confusion about this judicial review? In the wake of losing it, Matt Hancock, the Health Secretary, refused to apologise and said that dealing with the pandemic meant that breaching the legal obligation to publish within 30 days was “the right thing to do”. However, the case revealed emails showing that civil servants’ serious concerns that

“we are in legal breach”

were overridden in order

“to allow No.10 SpAds … enough time to be sighted and given full opportunity to comment”.

Why would the desire of No. 10 to provide comment on the mere publication of a contract legitimise a legal breach? Can the Minister explain the inconsistency between these facts and the Health Secretary’s professed explanation?

--- Later in debate ---

[Lord Bethell (Con)]

The right honourable Secretary of State for Health and Social Care put it extremely well. For those of us who were there at the time, the priority was saving lives, not publishing contracts or focusing on anything other than the protection of those who work and live in care.

[Lord Scriven (LD) [V]]

My Lords, 25 million masks that could not be used were supplied by a pest control firm in a £59 million deal, while a Mauritius hedge fund got £252 million, and, again, the face masks could not be used. There was also a £70 million contract with a Florida jeweller for gowns that could not be used. Will the Minister commit to a judge-led public inquiry into the handling of such PPE procurement?

[Lord Bethell (Con)]

As the noble Lord knows, I cannot comment on some of those cases specifically because they are subject to legal action at the moment. However, in broad strokes, I say that there were a lot of people who stepped forward to help us in our time of need; I do not condemn them. Some of them came not from the PPE industry but from others. I am extremely grateful to all those who stepped forward to help us when we needed it.

[Lord Harris of Haringey (Lab) [V]]

The Minister is on very thin ice. He is following Machiavelli’s teachings that the ends justify the means. He should be careful— this is the same argument that led to French aristocrats being guillotined after the revolution, to Stalin’s terror and to the blackshirts of Kristallnacht. Does he accept that the Government and Ministers have to obey the law? If he thinks that this case was trivial, where does he draw the line? Contracts to cronies? Clearly not—not until No. 10 spads have been “sighted”. Proroguing Parliament illegally? Clearly not. Interning vaccine refusers? Where is the line?

[Lord Bethell (Con)]

I am enormously grateful for the colourful character of that question. However, the noble Lord makes a serious point. We do respect the law, which is why we have published the contracts. The case found that we had published them 17 days late. Any reasonable person faced with a huge pandemic would think that a 17-day delay is a perfectly reasonable price to pay for saving lives. The noble Lord asked me about the price we are willing to pay and the reasons for standing out on this: saving lives is what this delay was about.

[Lord Mackenzie of Framwellgate (Non-Afl) [V]]

My Lords, at the beginning of this pandemic, I—like many Members of this House, I suspect—was approached by various suppliers and manufacturers asking how they could assist in supplying, or even making, PPE, ventilators and the like. Indeed, an appeal was made by the Health Secretary to this end. Of course, the difficulty was knowing who to contact. To assist in a similar future crisis, would the Government consider providing a direct hotline to deal efficiently with a large number of calls from people responding with help—rather like what Crimestoppers provides for police appeals?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, the noble Lord puts it extremely well, and he takes me right back to those days. I remember making a public call for help with diagnostics, and an NHSBSA call centre was overwhelmed by 5,500 calls in a week—triaging them took nearly a month. The noble Lord is entirely right: getting through all of those who sought to help was an enormously difficult task, and those who proved to be effective assistants were not always the obvious ones. I could share anecdotes of surprising people who came forward and gave tremendous help, while those who you would think could help simply did not have what we needed. Those were extremely complicated times, and I pay enormous tribute to the officials who saw us through them.

[Lord Wallace of Saltaire (LD) [V]]

My Lords, the Minister has been explaining how the centre was overwhelmed by the number of offers. In the early stages, why was it not dealt with by a greater degree of local decision-making and autonomy? Local authorities and hospital trusts were bypassed in this, as in a number of other areas, such as test and trace. Would it not have been much better to have allowed small companies and local authorities to bargain with each other about these offers in the first place?

[Lord Bethell (Con)]

That is a reasonable question, and, in fact, that was our starting point: the noble Lord will remember that, at the beginning of all of this, we supplied PPE to 252 NHS trusts and no one else—everyone else sorted out their own PPE. The reason we had to change was that this was a global crisis: borders were shut, factories closed down and every country in the world was desperate for PPE. There was no facility for a procurement manager at an NHS trust, let alone a small social care home in the West Country; those avenues were all shut. That is why it took a massive national effort to secure PPE. We now have a portal that supplies more than 50,000 different NHS and social care units; as I explained earlier, we have an enormous stockpile to secure that. This has been one of the big learnings of the pandemic: in order to have resilient supply chains, there needs to be some national muscle to make sure that it works properly.

[The Deputy Speaker (Lord Alderdice) (LD)]

My Lords, the time allowed for this Question has elapsed; I regret that we were not able to reach everyone on the list.

Covid-19: Vaccination Programme

Lord Bethell Excerpts

Wednesday 24th February 2021 Lords Chamber

[Baroness Walmsley]

To ask Her Majesty’s Government what assessment they have made of the progress of the COVID-19 vaccination programme towards meeting its (1) delivery targets, and (2) objectives.

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

My Lords, the vaccine deployment programme is proceeding at pace, for which I give profound thanks on behalf of all noble Lords. We have offered a Covid vaccine to 15 million of the top four priority cohorts, hitting our 15 February delivery target. We remain on track to achieve our objective of offering a vaccine to all priority cohorts by 15 April and all adults by the end of July.

[Baroness Walmsley (LD) [V]]

My Lords, the vaccine programme certainly is going well, but there is evidence that some groups are being left behind. One such group is housebound people. Although they cannot leave their homes, carers and family come in, which opens them up to infection. Why does NHS England not record the number of housebound patients who have received the vaccination? What is being done to speed up their vaccination? The other group is people in poor areas and demographics. What is being done to correct this?

[Lord Bethell (Con)]

My Lords, we were alert to the issue of housebound priority cohorts from the very beginning, which is why we have put in place mobile vaccine units. We work closely with community pharmacists and GPs in order to take the vaccine to housebound individuals. While we do not report on them publicly, I understand from the front line that the progress of that has gone extremely well.

The issue of areas of deprivation is really troubling. It is often those areas where the disease is most prevalent and where the vaccine rollout has been the slowest. We are working extremely hard with local community groups, faith groups, marketing experts and influencers to get the message through to the right people and to take the vaccine delivery into the right contexts.

[Lord Reid of Cardowan (Lab) [V]]

My Lords, the vaccination programme has been one bright spot in what has otherwise been a less than illustrious handling of the pandemic, but the number of daily doses administered on Monday fell significantly, week on week, for the fifth day running. Can the Minister explain why? Can he further explain the apparent discrepancy between the vaccination rate in London and other regions of the country? It appears that some regions have a rate 50% higher than London. What are the reasons for that and what is being done to narrow the gap?

[Lord Bethell (Con)]

My Lords, I do not agree with the noble Lord’s analysis. We are sometimes constrained by supply, but I am reassured that we will hit the targets that I articulated. London has a younger demographic, which is why the rollout percentages can seem lower than in other areas.

[Baroness Ritchie of Downpatrick (Non-Afl) [V]]

My Lords, will the Minister outline the Government’s strategy to address those areas and people who are reluctant to take up the vaccine? Those of us who have had it know that it is the passport to our freedom.

[Lord Bethell (Con)]

My Lords, we have an extremely sophisticated and energetic programme in this regard. Let me flag that the most important influencers in anyone’s decision on whether to take the vaccine are the people whom they know and love. The best way to encourage vaccine uptake is to take the vaccine yourself.

[Lord Hamilton of Epsom (Con)]

My right honourable friend the Prime Minister said in his Statement that decisions would be led by data, not dates. In the same Statement, he said that step 2 would be no earlier than 12 April, step 3 no earlier than 17 May and step 4 no earlier than 21 June. This morning, the Daily Telegraph reported that the 21 June date may be brought forward if the data continues to show that coronavirus is being well dealt with. What is leading the Government’s decisions? Is it dates or data?

[Lord Bethell (Con)]

My Lords, I recommend that my noble friend and the Daily Telegraph look at the large amount of conditional material that the Prime Minister articulated in his Statement. There were no firm dates. He made it clear that data would drive decisions and he made a lot of his indicative programme remarks reliant on passing the four key tests that he laid out very clearly in his programme.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, at Monday’s Downing Street press conference, Professor Chris Whitty expressed his view that front-line health and care workers had what he termed a “professional responsibility” to get vaccinated to reduce the risk that Covid poses to patients and care home residents. With studies indicating that in many care homes well in excess of 30% of care workers have not yet taken up the vaccine, what plans do the Government have to make getting vaccinated a condition of employment?

[Lord Bethell (Con)]

My Lords, the Chief Medical Officer was entirely right. As the noble Baroness probably knows, there are already important requirements on health care workers who, for instance, do surgery or are in certain risky clinical situations to have the right vaccines, hepatitis being one in particular. Having up-to-date vaccines is a condition of engagement for some medical staff. The noble Baroness is right to raise the question of social care. We are looking at the right policy in that area. We want to tread carefully and to take social care workers with us. We are aware of the risks in social care, but we do not want to provide barriers for employment. Getting that decision right will be one of the most important things that we do.

[Lord Cormack (Con) [V]]

My Lords, I would like to follow on from that. My friend has a 99 year-old mother in a care home and she is naturally very glad at the prospect of more frequent and slightly less distanced visits. She has not held her mother’s hand for over a year. She is deeply concerned that some of the care workers in the home, who have to attend to some of her mother’s most intimate needs, have declined vaccination. Should not the rule in care homes be, in the words of a recent Times leader, “no jab, no job”?

[Lord Bethell (Con)]

My noble friend puts it very bluntly. At this stage of the rollout, when the vaccine has not been made available to everyone, it is too early to make that kind of decision. However, he makes the case well and I hear it loud and clear.

[Baroness Hollins (CB) [V]]

My Lords, I welcome today’s announcement that all people with a learning disability on their GP learning disability register will now be included in group 6. However, we know that these registers are incomplete. How will the Government and the NHS ensure that those in England not currently on the register can be added so that they can be offered a vaccine too? Will the Minister confirm that family carers and home carers will be offered vaccination at the same time?

[Lord Bethell (Con)]

We have to work with what we have. The existing register, while not perfect, is the tool that we have for our task. GPs had been encouraged to update registers in advance of the vaccine, as we had several months of knowing that it was coming. I understand that considerable work has gone into that. With regard to carers, my understanding is that they are not currently included in the clarification that came out today, but I am happy to confirm that point with her.

[Baroness Thornton (Lab)]

My Lords, we all want our children back at school on 8 March, and the Government need to do everything possible to keep children learning, with testing systems that work, ventilation and the use of Nightingale classrooms. The Government missed the opportunity to vaccinate teachers at half-term, so I ask the Minister to explain why, if our children are to be back at school on 8 March. When will teachers and support staff be a priority for vaccination?

[Lord Bethell (Con)]

My Lords, teachers are a priority in as much as they are on the prioritisation list along with other key workers, but the honest assessment of the JCVI is that teachers are not at accelerated risk of increased sickness or hospitalisation over any other member of the public. We are enormously grateful to the teaching profession for the role it is playing in getting schools back and in testing but, in terms of sickness and mortality, teachers are in the right place in the JCVI prioritisation.

[Baroness Jolly (LD) [V]]

My Lords, NHS England has told GPs to use their clinical discretion on vaccines for adults with a learning disability—although I am pleased that the Minister says that this is no longer the case. What percentage of adults with a learning disability have been called for their first jab and, if it is not 100% at this stage, why not?

[Lord Bethell (Con)]

I do not have the precise figure to hand. Those in group 4 will include those with Down’s syndrome and other CEVs; those with severe or profound learning disabilities will be in group 6. As we know, group 4 has had an extremely high conversion rate and, although I do not think it is exactly 100%, it will be an astonishingly high amount and, if those figures are available, I should be glad to write to the noble Baroness with them.

[The Lord Speaker (Lord Fowler)]

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

Future of Health and Care

Lord Bethell Excerpts

Tuesday 23rd February 2021 Lords Chamber

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

My Lords, I thank the two noble Baronesses enormously for those thoughtful and helpful questions. We are at a very early stage in the process of this important legislation, and the questions from both the noble Baronesses, Lady Brinton and Lady Thornton, are extremely helpful and make a good challenge. I will attempt to answer them as best as I can.

I reassure the noble Baroness, Lady Thornton, that we have all read the debates around the Lansley Bill carefully and learned an enormous amount from them. We greatly look forward to reminiscences from all those who were there in those days. There are some things that the Lansley Bill did that left an important and lasting legacy, and it would be wrong to overlook those. The establishment of Healthwatch and a focus on outcomes was a cultural inflection point in the history of the NHS. The overall importance of commissioning will not be lost in any changes introduced by this Bill. Lastly, this Bill massively builds on the establishment of NHS England in its measures. These are some examples of where the Lansley reforms made huge advances.

However, as the noble Baroness, Lady Thornton, rightly pointed out, some of those reforms have had their day and it is now important to move on to the next round, building on those reforms while fine-tuning some of them. One of the most important areas of development is around collaboration. By that, I mean that the challenge of modern healthcare is to bring a huge amount of expertise and extremely complex resource to bear on individual patient challenges. The sheer complexity of some of the treatments and therapeutics that can benefit the patient requires not just simple clinical analysis by an individual but teams across many disciplines, sites and, sometimes, institutions. It is the bringing together of that huge amount of collaboration that the Bill focuses on.

The noble Baroness is right that we face massive challenges in the period ahead. The vaccination programme is absorbing a huge amount of resource. There is a tremendous backlog in almost every area of the NHS and getting through it is a great challenge. NHS staff themselves are tired and exhausted; they deserve a break. This should not hold us back from doing exactly what the NHS had planned to do before the Covid epidemic, what stakeholders in the NHS repeatedly tell us that they want to do and what the huge amount of engagement that we have done tells us is right to do. I remind her that the core of the White Paper is the proposals made by the NHS to the Government in September 2019 to help the NHS deliver its long-term plan.

NHS England and NHS Improvement carried out a huge engagement process before making those recommendations. That exercise had over 190,000 written responses from individuals and organisations representing different parts of the health and social care system. Those recommendations were supported and endorsed by key leaders across that system, including NHS Providers, UNISON, Healthwatch, the Local Government Association, the Royal College of Nursing and many others. The recommendations made by NHSEI also built on recommendations made by the Health and Social Care Select Committee in June 2019.

The Bill will have been thought about and prepared for over many years. It is the thoughtful application of important reforms and therefore deserves the close analysis and support of noble Lords. There are tremendous benefits to patients. The noble Baroness, Lady Thornton, specifically asked what the tangible benefits are, and I will pull out three in particular.

First, there are some specific public health measures in the Bill. As the noble Baroness, Lady Brinton, rightly raised—I will come back to it, in a moment—public health is central to the outcomes of the Bill. Fluoridation is the iconic measure, but a thick red thread of public health runs throughout the Bill. Secondly, the constitution of the Healthcare Safety Investigation Branch—HSIB—will, with statutory muscle, bring about the important investigatory element to promote the patient safety agenda, which my noble friend Lady Cumberlege wrote about in her report. Thirdly, the bringing together of GP and social care services into integrated care systems will bring much closer the decisions about patients which often cross barriers that, I am afraid, are huge obstacles to effective care today.

I will address the question of social care directly because the noble Baronesses, Lady Brinton and Lady Thornton, challenged me on this point: why have we not in the Bill brought about a wholesale financial rebooting of adult social care? The measures on adult social care in the Bill are just one aspect of a wider reform agenda. Our wider objectives for social care are to enable an affordable, high-quality and sustainable adult social care system that meets people’s needs while, supporting health and care in joined-up services around people. The Prime Minister has been crystal clear about his agenda for reform. A broad range of options are being explored on how best to accomplish these reforms and we want to ensure we get that reform right. Engagement with the sector and the public will be an important part of that.

We are still considering a number of funding reform options. However, the leading options, such as a cap and floor, are already provisions in the Care Act so they require only secondary legislation to enact. For this reason, we do not require anything on charging reform to be included in the Bill. However, the Bill should be considered as an important paving stone to wholesale social care reform.

I entirely agree with the noble Baroness, Lady Brinton, that culture is important. We are absolutely committed to putting social care in exactly the same hierarchy as the NHS. We believe that local authorities have a central role in the provision of social care; that is envisaged to remain the same. The noble Baroness, Lady Thornton, asked specifically: who will sit on the boards? That is exactly the kind of question that I look forward to debating here in the House and engaging on with noble Lords.

The noble Baroness, Lady Thornton, asked about competition, and she and the noble Baroness, Lady Brinton, raised deep-seated and heartfelt concerns about cronyism and corruption. I take those concerns very seriously. Huge amounts of taxpayers’ and voters’ money have been employed during the pandemic in the fight against Covid, and very large sums of money were spent on PPE in circumstances where there was a huge rush and difficult arrangements were being put in place. However, I remind both noble Baronesses that when they attack the Government and make accusations of cronyism, chumocracy and corruption but have no foundation for those attacks, they are interpreted as attacks on the very NHS and social care staff who have worked extremely hard to procure the right services and products, who have the interests of patients in mind, and who are working so hard to save lives. Attacks on the integrity of the system are extremely damaging to their morale and the integrity of that system. I kindly ask the noble Baronesses, Lady Thornton and Lady Brinton, who have made these attacks repeatedly over the last few months, to think very carefully about the way in which they make these accusations.

In particular, I will address the question raised by the noble Baroness, Lady Brinton, of PPE being taken from lorries that was destined for social care and sent instead to the NHS. If she indeed has evidence that such a thing happened, I would be very grateful if she would write to me. But if she does not, I would be extremely grateful if she did not raise this anecdote again, because it is a damaging image which hurts very much those who work in social care and the NHS, and is not necessarily fit for a debate such as today’s.

In terms of the PPE contracts that were the subject of a recent action in the law courts, I will repeat the sentiments expressed by my right honourable friend the Secretary of State for Health. Every waking moment of every day for everyone involved in the procurement of PPE was dedicated to getting the right kit to people on the front line to save their lives. If the paperwork was done two weeks late, that is an entirely proportionate and reasonable consequence of a very difficult situation, and seeking to make political capital out of an administrative oversight does not seem at all proportionate to the situation.

This is an extremely exciting Bill we have before us. I very much look forward to debating it in this Chamber. I am extremely grateful to the noble Baronesses, Lady Brinton and Lady Thornton, for their questions.

[The Deputy Speaker (Lord Bates) (Con)]

My Lords, we now come to the 20 minutes allocated for Back-Bench questions. I ask that questions and answers be brief so that I can call a maximum number of the 16 speakers who have asked to ask questions in response to this Statement.

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, I declare my interests as outlined in the register and broadly welcome this paper. I particularly applaud the removal of the need for competitive tendering and the introduction of the discharge to assess model, which I and many other professionals have long advocated. However, could the Minister explain why such extensive powers are planned for the Secretary of State prior to the reforms of social care coming before Parliament? Why can they not come concurrently? He has partly just explained that, but it would be much better if we waited and did the two things together. Section 5.153 of the White Paper is designed to widen the scope of Section 60 of the Health Act 1999 to provide further powers enabling the Secretary of State to

“make a large number of changes to the professional regulatory landscape through secondary legislation.”

I seek assurance that there will be ample opportunity to debate this latter issue during the passage of the Bill.

[Lord Bethell (Con)]

I am extremely grateful to the noble Baroness, Lady Watkins, for her generous remarks on competitive tendering and discharge to assess. These are examples of where we have listened to stakeholders and those in the NHS who have called for changes. In terms of the powers given to the Secretary of State and the link with social care, it is worth remembering that this Bill is a stepping stone towards other changes. Changes to social care funding can take place largely without any legislative change; they can be introduced by secondary legislation. Changes to the funding model in social care are a matter for a very large engagement process that will include other parties, as the Prime Minister has outlined, and will include very considerable engagement with stakeholders.

In the meantime, we are seeking to correct an overreach in the seclusion and mandation of the NHS to give the Secretary of State the kinds of powers that are reasonable in a parliamentary democracy in the governance of such a large and important national institution. Those powers are to be used with restraint and a degree of circumscription, but they rebalance the political geography of the NHS to give it full accountability. As such, they give the kind of authority the Secretary of State needs to institute the kinds of social care reforms I know the noble Baroness, Lady Watkins, is interested in.

[Baroness Neville-Rolfe (Con) [V]]

While the costs of reorganisation are certain, the expected benefits may or may not be realised. The fate of the Lansley reforms is a lesson for us all. The country will judge the performance of the NHS over the coming decade in the light of this truth. Will the Minister specify objectives against which the new reforms can be assessed?

[Lord Bethell (Con)]

My Lords, the objectives outlined in the White Paper are reasonably clear. The four headline objectives are to make it easier for different people in the system to join up to find ways to address complex issues, to remove unnecessary bureaucracy, to empower local leaders to make the best decisions for the populations they serve and to facilitate a range of other improvements held back by existing legislation.

This is a large Bill with a very large number of measures. It is not, and does not pretend to be, unified by a single thought or held together by an ideology or motivation of any particular philosophy. It is the application of a very large number of recommendations that have come out of a huge engagement with the NHS family, patients and other stakeholders. As such, it is a pragmatic, thoughtful and restrained approach to an important piece of legislative housekeeping of this much-loved healthcare institution.

[Baroness Pitkeathley (Lab) [V]]

My Lords, I share the concerns of my noble friend Lady Thornton about these proposals, but I take issue tonight with one particular assertion in the Statement that health and social care are

“part of the same ecosystem.”—[Official Report, Commons, 11/2/21; col. 506.]

As far as patients are concerned, this has never been the case as healthcare is free at the point of use whereas social care is and always has been charged for. In a debate in your Lordships’ House on 28 January, to which the Minister replied, virtually every speaker from all sides of the House said that this is the anomaly which must be addressed. Will the Minister add to his previous remarks about money and charging issues and assure the House that the Government will address this issue in the long-promised reforms of social care and recognise that warm words about integration and collaboration are simply not enough?

[Lord Bethell (Con)]

The noble Baroness is right that there are distinctive qualities to social care and medical care, but the lived experience of most patients and residents is that those living in social care are very often heavy consumers of the NHS. As far as most of them are concerned, the support and treatment they are given needs to be much more closely linked. For instance, it is a strange anomaly that many living in residential social care have a completely different budget and sometimes completely different staff providing their medical treatment and their care treatment. This is not a functional distinction that we are seeking to overturn; what we are seeking is to get those teams of people and the decisions made about the care of individuals working much more closely together. We are not seeking to introduce a revolution in the funding of social care, and the financing of social care by local authorities and private individuals will continue, but we would like to see the distinction between social care and NHS medical care become more seamless, more joined up and, therefore, more effective.

[Lord Kakkar (CB) [V]]

My Lords, I draw attention to my registered interests. The justification for any reorganisation of the health and care system must be to improve patient and population outcomes. The current system, which has been unable to deliver the benefits of integrated care, is heavily regulated on the basis of distinct institutional boundaries and care settings. How do Her Majesty’s Government propose to address the regulatory impediment to the successful delivery of integrated care as part of the proposed reorganisation?

[Lord Bethell (Con)]

My Lords, the noble Lord is entirely right that the regulation of both clinical care and social care is critical and key not only to good performance by both sectors but to the way in which they work together. That is why we will look at the CQC and its role in social care regulation. We will seek to enhance the way in which the CQC can look deeply into social care to set higher standards and to ensure that, when it comes to integrated care, social care is stepping up to the challenge as best it can.

[Lord Grade of Yarmouth (Con) [V]]

My Lords, the front line of social and community care—indeed the whole of the NHS—begins with local pharmacies, which, as the Government well know, are in dire financial straits, closing down at a rate of four or five every week. I ask my noble friend the Minister: is it the Government’s policy to wait until these vital community services have all gone bankrupt before they act?

[Lord Bethell (Con)]

My Lords, I start by paying an enormous tribute to the 11,251 community pharmacies for the work they do day in, day out, and in particular their contribution to the vaccine rollout. I remind my noble friend that £370 million has been made available by the Government in increased advance payments to support community pharmacies with cash-flow pressures caused by the pandemic. The community pharmacy contractual framework—the five-year deal—commits £2.5 billion annually to the sector. Non-monetary support has also been provided in recent months, such as the removal of some administrative tasks, flexibility in opening hours, support through the pharmacy quality scheme, and the delayed introduction of new services. I am afraid I do not quite recognise the figures my noble friend cited on the closure of pharmacies, but if he would like to write to me, I would be very glad to look into them more closely.

[Lord Brooke of Alverthorpe (Lab) [V]]

My Lords, the White Paper refers to the NHS problems with obesity. I make no apology for introducing this topic, because obesity is one of the major underlying causes of Covid deaths, but it is rarely raised in the direct communication between the Prime Minister and Professor Whitty and the population in the No. 10 conferences. As World Obesity Day approaches on 4 March, will the Minister speak to the Prime Minister or Professor Whitty and see if we could have this fundamental topic raised as an indicator that this is where cost savings can be achieved and we can get better health, if we work on it?

[Lord Bethell (Con)]

The noble Lord is entirely right: obesity is not only a major issue, it is specifically cited in the Bill, where we have clear measures to try to address it. I do not need to raise it with the Prime Minister or the CMO because they both take it incredibly seriously. The Prime Minister has spoken movingly about his own challenge when he caught Covid—the five stone by which he feels he was overweight, the impact that had on his life chances, and how close to death he came because of obesity when he went into hospital. That was a metaphor for the whole country, and that is why we have launched a major obesity strategy in respect of marketing and advertising. It is why we remain committed to the obesity strategy, and more measures will be rolled out during the course of the year. I am extremely grateful to the noble Lord for reminding me about World Obesity Day on 4 March, which we will be marking very seriously with a publicity campaign.

[Lord Scriven (LD) [V]]

My Lords, nearly 75% of NHS expenditure goes on hospital and ambulatory care. Will the Minister explain how the proposed reforms will, in reality, lead to the redirecting of significant hospital sunk costs into ill health prevention and improving population health outcomes, as implied in the White Paper?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, we are putting considerable resources into hospital rebuilding, with 40 hospitals being built over the course of the Parliament; that is a major investment programme. The investment in population health comes out of different budgets. We are looking at how we will use ICSs to bring population health and responsibility for the outcomes of popular age and health metrics much more closely to GPs and hospitals. This oversight needs to be corrected, and it is one of the primary objectives of this Bill.

[Lord Naseby (Con) [V]]

My Lords, speaking as the husband of a former full-time GP, I ask whether the Minister is aware that neither general practice nor community care are meeting patients’ needs today and they require a total review. Also, is it fully understood by government that there is insufficient capacity in our current hospitals and that we need to build more? Having said that, I say that the vaccination programme is brilliant—and I place on record my sincere thanks, from the bottom of my heart, to the NHS staff at Bedford Hospital for saving my wife’s life.

[Lord Bethell (Con)]

I will indeed share my noble friend’s tribute to the vaccination programme and to Bedford Hospital for saving Lady Naseby’s life, for which we are all enormously grateful. However, I would probably leave his company on his remarks on GPs; they are extremely effective in the service they provide to their local communities. The patient satisfaction surveys do not support his contention that there is a massive gap there.

We are committing to building new hospitals in order to expand our capacity, but the essence of the measures in this Bill is more about prevention, population health and supporting better outcomes for the kind of public health measures around things such as obesity that ensure that people do not have to spend their time in hospital when they feel ill and, instead, have an early-stage intervention.

[Lord Curry of Kirkharle (CB) [V]]

My Lords, my interests are recorded in the register. This White Paper and proposed Bill are extremely welcome and long overdue, and I very much support the direction of travel. I have been curious and interested to read that reducing unnecessary bureaucracy in the process of change is a key plank of the White Paper. I am interested in how the Minister expects this to be achieved; as a former chair of the Better Regulation Executive, I know how difficult this is. Will there by some form of oversight to ensure that this does take place, and some way of monitoring that fact as well?

[Lord Bethell (Con)]

My Lords, the noble Lord makes a very wise observation. The challenge of reducing bureaucracy has confounded many Ministers in the past, and I would not want to suggest in any way that this is an easy challenge. However, it is our belief that, by getting those involved in primary, secondary and social care, and in public health, working more closely together in integrated care systems, with a culture of collaboration and clearer accountability for the outcomes of the populations in their areas, we can reduce the friction of paperwork, duplication and oversight that has cost the health system dearly, and can build a more effective way of providing healthcare services for individual populations.

[Baroness Armstrong of Hill Top (Lab) [V]]

My Lords, much of the laudable ambition of this White Paper is in the integration of the two sectors, but the truth is that you cannot have integration of health and social care without parity of esteem. With a social care system that the Government themselves have called dysfunctional, we know, certainly from all the evidence of Covid, that there is no such equality between the two structures. The legislation to implement this White Paper—I fear the Minister has it ready, considering the number of times he has talked about a Bill tonight—should not come before the desperately needed reform of social care.

The Secretary of State voted for the Lansley reforms more than 20 times in the Commons and they are what he now wants to undo. Unless this integration becomes a real possibility through dealing with social care first, this will look and feel like a vanity project for the Secretary of State. I therefore ask the Minister to assure us that we will know what will happen in social care before he brings a Bill on structural change of the National Health Service to this Chamber.

[Lord Bethell (Con)]

My Lords, I agree with the noble Baroness that there is a challenge around parity of status. The pandemic has vividly brought alive the challenging circumstances of those who work and live in social care. It is a tremendous tribute to the British people that they have given the lives of the elderly and the vulnerable such a high priority by putting the life of the country on hold to protect the health of the vulnerable and elderly, and that they have thought carefully and thoughtfully about those who live in either residential or domiciliary social care, for instance. It has brought alive for the whole nation the circumstances of those who live in social care.

I have heard loud and clear those in this House who have made the case for those who work in social care, often in low-paid roles but with a huge amount of responsibility and a massive task ahead of them, to receive better training, have clearer career paths, and, as the noble Baroness rightly points out, have a higher status. However, I do not agree with her that the sequence should be financial reform followed by structural reform. With this Bill, we are trying to put in the correct structural circumstances for social care so that it has parity with the NHS and a collaborative jigsaw fit with those in clinical and public health roles. Therefore, when the financial reforms are put in place, they will be done most effectively and with the largest impact.

[The Deputy Speaker (Lord Bates) (Con)]

My Lords, I am afraid that the time allowed for Back-Bench questions has now expired, with apologies to the noble Lord, Lord Vaizey, and the noble Baronesses, Lady Barker, Lady Stuart, Lady Donaghy and Lady Jolly, that I was not able to call them.

Food-related Crime

Lord Bethell Excerpts

Monday 22nd February 2021 Lords Chamber

[Lord Rooker]

To ask Her Majesty’s Government what assessment they have made of (1) the level of food-related crime, and (2) the resources available to address such crime.

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

My Lords, food crime is of rising importance to the public, our trade, our farmers and our climate. That is why the Food Standards Agency constituted the National Food Crime Unit in 2014; why the National Food Crime Unit published its assessment in September; and why Ministers have a dialogue with the NFCU, industry and the police about increasing its powers.

[Lord Rooker (Lab) [V]]

My Lords, does the Minister accept that the National Food Crime Unit is operating against organised crime with its hands tied? Investigations are being hampered. Does the Minister agree that investigation powers should be strengthened to include powers to collect the necessary evidence to a higher standard? In other words, will the Government agree that the Police and Criminal Evidence Act powers should be granted to the National Food Crime Unit? The National Police Chiefs’ Council agrees to this to remove the burden from local police forces, which actually agree that food crime is not a high priority.

[Lord Bethell (Con)]

The noble Lord entirely has a point. I completely agree with him that the National Food Crime Unit has a formidable task ahead of it and that its investigatory powers could be enhanced and its impact improved. That is the view of the Government, industry and the police, and that is why we are committed to the dialogue, first suggested by the Kenworthy review, on the enhancement to which the noble Lord refers.

[Baroness Jones of Moulsecoomb (GP)]

One of the food crimes I am told is increasing is that of stealing market-ready lambs. The people stealing them do not just load them on to a trailer and take them away—they butcher them in the fields and leave the debris, guts, blood and heads. I wonder whether the police have enough powers to deal with that particular crime, which is increasing.

[Lord Bethell (Con)]

The noble Baroness is entirely right: this is a very distressing crime. I was pleased to note the convictions and custodial sentences in March last year under Operation Stock, led by Northamptonshire Police, of three men for a string of such offences in the Midlands. The NFCU remains alert to the entry of meat from these offences into the food chain and works with policing rural crime networks to actively counter this practice.

[The Earl of Caithness (Con)]

My Lords, the better the NFCU does, the more cases will be reported to it. Could my noble friend tell me what the budget for the NFCU will be over the next three years? Could he also confirm, as the opportunity for reporting to the NFCU improves, whether there is enough anonymity for people, particularly those within the food business, to be able to make complaints without exposing themselves to retribution by criminal gangs?

[Lord Bethell (Con)]

My Lords, the NFCU’s head count is just over 80 staff in England, Wales and Northern Ireland, and its budget is £5.7 million. The NFCU has an anonymous reporting route available via the phone and the FSA website, and it welcomes contact from public-spirited people within the industry on wrongdoing. The unit also encourages engagement with industry through more overt routes, and I particularly thank the Food Industry Intelligence Network, whose members share over 50,000 anonymised authenticity sampling results with the unit each year.

[Baroness Meacher (CB) [V]]

My Lords, in the 1970s I wrote a book based on a survey on the consequences of benefit withdrawal and found that, typically, claimants were driven to crime. Have Her Majesty’s Government undertaken any recent research into the consequences of the very low universal credit rates, the sanctions regime and the deductions taken from benefits to repay loans early on in the claim? If not, would the Minister be good enough to ask the DWP to undertake such research into the crime effects—if you like—of the benefits system?

[Lord Bethell (Con)]

My Lords, I bow to the noble Baroness’s great expertise on the correlation between poverty and crime. But that makes no excuse for the kind of crimes we are talking about here. Many are either brutal—as the noble Baroness, Lady Jones, referred to—or crimes of fraud, for which there is no excuse.

[Lord Clark of Windermere (Lab) [V]]

My Lords, I am encouraged by the Minister’s response today, and I am sure that many Members of the House will wish him well in persuading his colleagues to give more power to the NFCU. As he does so, will he ensure that the new system is integrated completely with the more established direct farm-related food regulations and crimes?

[Lord Bethell (Con)]

My Lords, the NFCU has done an enormous amount in working with stakeholders. Although it is a relatively small unit, with just 80 individuals, it works extremely closely with trading standards officers in local authorities and with policing authorities up and down the country. It leverages its expertise, and we hope to be able to augment that expertise with investigatory powers so that it can relieve police forces from some of the application of justice in this area.

[Baroness Bakewell of Hardington Mandeville (LD) [V]]

My Lords, a steady supply of nutritious food is essential, not only for those recovering from Covid but for those who are struggling due to losing their job or having been furloughed. Queues at food banks are extensive. Food crime is very serious, so can the Minister provide assurance that it will not affect the supply of food to those who are most in need?

[Lord Bethell (Con)]

My Lords, the focus of the unit tends to be on either food that is unfit for human consumption, such as in the horsemeat scandal of 2013, which the noble Baroness will remember, or on the passing off of low-quality food with a higher-quality label. It is not involved in addressing the theft of food. However, I agree with the noble Baroness that getting good-quality food to all the population is a priority, and that is one of the Government’s priorities.

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

My Lords, I applaud the work of the National Food Crime Unit. The main function of the Food Standards Agency is food safety and surveillance. We are currently in the midst of a salmonella outbreak through the import of chicken nuggets from Poland. Does my noble friend share my concern that this raises serious issues about the food safety and surveillance system and why this outbreak was perhaps not detected during the import of this meat into the UK?

[Lord Bethell (Con)]

My Lords, I am across the recent outbreak of chicken nugget salmonella poisoning across the UK. However, I point to the work of the European distribution fraud unit, which is very much focused on this kind of cross-border food crime. I will take back to the department the noble Baroness’s recommendation and will write to her if there is any update that I can provide her with.

[Baroness Thornton (Lab)]

I will be very quick because I am very keen that the noble Lord, Lord Krebs, is able to get in on this Question. Can the Minister commit to briefing parliamentary counsel to advise and bring forward these changes, and when can that happen? We on these Benches would welcome this commitment and would give appropriate support to the resulting legislative process.

[Lord Bethell (Con)]

I am enormously grateful to the noble Baroness for her support in this matter. I reassure her that we are focused and working on it, and I will bring forward an update as soon as I reasonably can.

[Lord Krebs (CB) [V]]

My Lords, detecting food crime often depends on trading standards officers and public analysts. Does the Minister consider that the current number of trading standards officers and public analysts is adequate to give the public confidence that food crime is being detected in a timely and comprehensive way? Could he also tell us what progress has been made on detecting honey fraud? It is estimated that about 15% of honey on sale in Europe is adulterated, and it is now over a year since Defra held a seminar on detection methods.

[Lord Bethell (Con)]

The noble Lord undoubtedly knows that, since January 2021, the FSA has been running a 12-month pilot of the new model of working with local authorities on trading standards in order to improve the work between the FSA and trading standards to address any gaps there may be in that collaboration. On the noble Lord’s question about honey fraud, I completely endorse his shock and outrage that the honey that we buy in the supermarket may be adulterated. It is sometimes said that there is 10 times the amount of manuka honey on sale than could ever be possibly made by the bees of New Zealand. There are challenges on nuclear magnetic resonance spectroscopy allocations, as the noble Lord undoubtedly knows. We are working extremely hard with both Defra and the Laboratory of the Government Chemist to put pressure on international authorities to align the data needed in order to investigate honey more closely.

[The Lord Speaker (Lord Fowler)]

My Lords, the time allowed for this Question has elapsed. That brings Question Time to an end.

Dentists: Covid-19

Lord Bethell Excerpts

Thursday 11th February 2021 Lords Chamber

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government what steps they are taking to enable dentists to reduce any backlog of patients requiring dental treatment as a result of the restrictions to address the COVID-19 pandemic.

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

My Lords, an increase in dental activity has been made possible by updated infection prevention and control guidance. NHS England and NHS Improvement have set a 45% activity target for January to March 2021, with the main aims being to increase patient access and reduce backlogs in patient care. PPE is being provided free of charge to NHS dental practices to support the provision of services, and we are looking at what role pre-appointment testing could play.

[Baroness Gardner of Parkes (Con) [V]]

I thank the Minister for that Answer. Is he aware of the problem of dealing with the essential time gaps required for cleaning and sterilising between patient appointments where the dental practice has only one surgery that can be used for treatments? A significant time is required for this between patients, which means fewer patients can be treated. The BDA has had reports of tests of a very effective ventilation system which could be used to enable many more treatments to take place in the working day. It costs about £10,000 to install. After the closure of surgeries for a considerable time, the operators of national health dental surgeries are not in a position to fund this. Will the Government provide either the funding or the necessary equipment to NHS dental practices?

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right; ventilation is a key issue. I took my daughter to the dentist this morning, and there were indeed long gaps between each appointment. I am not aware of the ventilation system she alludes to, but if the BDA would like to write to me, I would be happy to have a closer look at it.

[Baroness Warwick of Undercliffe (Lab) [V]]

My Lords, can I follow up on the Minister’s point about the new activity target imposed on dentists to reduce the backlog? It seems to have had the reverse effect. It has resulted in one of the biggest dental chains in the country instructing its dentists to focus on band 1 check- ups and reduce urgent treatments to meet the targets, reducing access for those who need it most. Other practices are reported to be doing the same. What assessment have the Government made of the impact of this target on patients who need urgent and complex treatment? Dentists have continued working, like doctors, nurses and other health professionals, in a high-risk environment during the pandemic. But their contribution seems to have been ignored. Can the Minister confirm the Government’s appreciation of the commitment of dentists and their staff during this pandemic?

[Lord Bethell (Con)]

I join the noble Baroness in paying tribute to dentists. As of 18 December, 88% of NHS dental practices were open, and that is a huge tribute to the hard work, determination and skills of dentists. She is right that they offer a spread of services; more triaging is going on, and that has successfully made a big contribution to getting through the lists. As of 13 January, 6.9 million dental patients have been triaged on the AAA service—advice, analgesics and antibiotics—but urgent dental care centres, of which there are 695, have picked up the difficult and time-consuming work for those who have an emergency need.

[Baroness Walmsley (LD) [V]]

My Lords, do the Government plan to continue to enforce activity targets in the next financial year? The new contract is only seven weeks away, and those in the profession has heard nothing about the basis on which they will be paid next year. When do the Government plan, at last, to deliver wider NHS dental contract reform, which they committed to in 2010? The issue keeps being kicked into the long grass.

[Lord Bethell (Con)]

My Lords, I would like to reassure the noble Baroness that officials are working extremely closely with the dental profession on the arrangements for the new practice. It will not be a complete renegotiation of the full contract, but we are looking at what arrangements should be in place for 2021-22. And as I said before, I pay tribute to the hard work of dentists. Activity targets are a useful way of getting a focus on increasing the throughput of dentistry. We have a big backlog, and that is one way we can try to increase the velocity of dental appointments.

[Lord McColl of Dulwich (Con) [V]]

My Lords, in order to deal with this backlog, should we not rely on the good sense of dentists to prioritise their patients—for instance, to treat those with pain and infection with antibiotics, then deal with the less urgent problems? Would the Minister consider the fairer solution adopted by Scotland and Northern Ireland, where new activity targets are half those of England?

[Lord Bethell (Con)]

My Lords, the Chief Dental Officer has looked at the activity targets and done extensive modelling to ensure that they are fair and safe. The noble Lord is entirely right that some dental support can be done in absence through things such as antibiotics. But it is important that face-to-face appointments are increased, otherwise, we will have a generation of people whose teeth are not in great shape, which will cost the country dearly.

[Baroness Masham of Ilton (CB) [V]]

My Lords, is the Minister aware that should people with gum disease and swollen gums get Covid-19, they are many times more likely to die, having ended up in intensive care or on a ventilator? Would the Minister agree that oral care, which goes hand in glove with dentistry, is vital for reducing the risk of severe Covid-19 outcomes and is an important part of patient safety and the prevention of ill health?

[Lord Bethell (Con)]

My Lords, I confess that I did not know about that association. I am not sure whether it is correlation or causation, but I completely support the noble Baroness’s observation that oral hygiene is critical, and we should put the steps in place to improve the oral hygiene of the nation.

[Baroness Thornton (Lab)]

I think the Minister needs to go back to the drawing board, because the new NHS activity target is basically forcing dentists to choose between check-ups and helping those in pain. That cannot be right. It can only increase health inequalities, let alone deal with the gigantic pandemic backlog. In secondary care, there is the particular problem of patients needing general anaesthetic for their dental treatment. These are mostly children and learning-disabled adults. There was already a waiting list of a year before the pandemic. Could the Minister inform the House how many patients are on this waiting list now? If the Minister does not have this information, could he please write to me? Do the Government have a plan to reduce this awful, and obviously very painful, waiting list?

[Lord Bethell (Con)]

My Lords, I do not necessarily accept the dichotomy the noble Baroness refers to. I think it is reasonable for dentists to triage patients between those who can be treated with either advice, analgesics or antibiotics, and therefore do not need face-to-face contact, and those who need to be prioritised to, for example, the urgent dental care centres. I commend the dental profession for making good choices in that area. With regard to the treatment of children using anaesthetics, those are not statistics I have to hand, but I would be glad to write to the noble Baroness with whatever information we have.

[Baroness Jolly (LD) [V]]

My Lords, when I inquired, none of the dentists in north and east Cornwall was able to offer an appointment for NHS dentistry, so I know to my cost that private treatment is expensive. Would the Minister tell the people of Cornwall, whose earnings are below both regional and national averages, what should be done about this lack of NHS dentists in remote areas, leaving patients untreated, in pain and often resorting to self-care?

[Lord Bethell (Con)]

My Lords, as I said earlier, 88% of NHS dentists are open. I was at an NHS dentist earlier today, and I pay tribute to all those dentists that are open. I do not know the specific situation in north and east Cornwall, but those in acute pain have access to the 695 urgent dental care centres, which are around England. I have enormous sympathy for those who have painful teeth, and I urge them to hunt down an appointment at one of those centres, where the service is excellent.

[Lord Rogan (UUP) [V]]

My Lords, official statistics show that the number of patients seen by general dental service dentists in Northern Ireland fell from 163,537 last February to just 8,825 in June, but rose again to 49,059 in September. With many of the current Covid restrictions having been put back in place since then, what discussions have UK Ministers had with their counterparts in Northern Ireland and the other devolved regions to encourage people to visit their dentist rather than suffer pain at home?

[Lord Bethell (Con)]

My Lords, I am grateful for that account of the Northern Ireland statistics, which tell a very similar story to those in other parts of the United Kingdom. The noble Lord is entirely right that those statistics tell a story of the massive challenge dentists face in order to increase the number of appointments per day. We are looking at a number of measures to try to improve that, including ventilation, which was referred to earlier by the noble Baroness. Testing is another option we are looking at. We are trying to put in place the kind of pre-appointment and point-of-care testing that can protect both the employees of dental practices and their patients. I hope that will help accelerate improvement in this area.

[The Lord Speaker (Lord Fowler)]

My Lords, I regret that the time allowed for this Question has elapsed. We now come to the third Oral Question.

Covid-19

Lord Bethell Excerpts

Thursday 11th February 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, the Minister is right to say that it looks as if the corner has been turned on cases, and even on hospitalisations, in this most recent surge. I too, like the noble Baroness, Lady Thornton, look forward to actually seeing the quarantine regulations being laid in Parliament. We keep asking for sight of them as early as possible. We have known that this quarantine arrangement was coming in—leaks started in December.

The BMA and other medical groups are concerned that those without GPs must have access to the vaccine. Last week, the Government announced that undocumented migrants can register with GPs for a Covid vaccine without fear of being prosecuted by the Home Office. This is good news, as we need everyone possible in the country to be vaccinated, to keep us all safe. However, the law currently requires the NHS to report those without a defined migration status. This amnesty announcement, based on the suspension of so-called immigration data sharing between the health service and the Government, is temporary, only during the pandemic. What safeguards are there that this data will not be shared after the pandemic is over? A temporary amnesty will not encourage people to come forward if their data can later be shared.

According to Ministry of Justice data, 2,400 Covid-positive cases were recorded in prisons in December—a rise of 70% in a single month. Given that the Government have a legal duty to provide equivalent healthcare to those in prison, can the Minister explain why prisoners in priority groups 1 to 4 started to be vaccinated only from 29 January?

Will the Minister answer a question I asked earlier this week without a response? There have been number of reports of Sitel and other call centre contractors having their contracts reduced by government and immediately sacking track and trace staff because, as a Sitel manager said,

“At this point in time as a business we need to reduce the number of agents because we have done our jobs.”


Can the Minister please confirm or deny that the Government have asked for track and trace staff numbers to be reduced? Do the Government still believe that test, trace and isolate remains a vital part of coming out of this pandemic, or are they totally relying on the vaccine? Everything that the scientists and doctors are telling us is that we will have to continue to take all precautions, such as “hands, face, space”, and will also need all the protection tools, such as test, trace and isolate, for some time to come, otherwise we will be hurtling towards yet more cases, hospitalisations and deaths.

That brings me to borders. On 22 January last year, alongside the noble Baroness, Lady Thornton, I asked the Minister’s predecessor what steps were being taken to monitor flights from places where Covid-19 had been confirmed or was suspected. I have repeatedly raised worries that the UK was not following either the World Health Organization advice or the actions of the CDC in America, which has resulted in many cases coming into the UK from China and the Far East and, during February, through those returning from skiing holidays in Italy, France and Austria. Every step of the way, the Government have been too slow in making arrangements to monitor passengers, whether placing them in quarantine at home or, as is now proposed, in quarantine hotels.

Some countries have learned through experience that early action at borders is vital. South Korea, Australia and New Zealand are notable examples. Taiwan should be a role model for us all. It began monitoring passengers arriving as early as 31 December 2019, and shortly afterwards created formal quarantining, both at home and in hotels, with electronic monitoring by health teams. Its Government’s clear communication with its people, providing the carrot of a support package for anyone quarantining, as well as the stick of substantial fines, has meant that a country of 23 million people had, in 2020, fewer than 800 cases, with only seven deaths. One city alone has 3,000 hotel rooms reserved for quarantining; the Government here are proposing 4,000 for the whole of the UK. And the fines in Taiwan are not small, at up to 300,000 New Taiwanese dollars—about £7,500—with one businessman who breached quarantine seven times in three days fined more than £26,000.

Taiwan’s approach is as much about self-isolation as it is about quarantine for those coming from abroad, and the view of the Taiwanese public is that everyone should do their civic duty, helped by the clarity of messaging from the Government and their medical experts. So it is a shame that our Government’s key message is all about the maximum prison sentence. We need as much of the carrot in our approach, rewarding people for self-isolation, preferably by paying their wages and by supporting them with care calls and delivering shopping and medicines, most of which has been notable by its absence to date.

Two things are clear from the worries over the new variants. The UK public want to do their duty. The vast majority of people are complying with lockdown. They also understand that the nature of Covid-19 is changing, and that new variants mean we must change the way we live too. So will the Government please make the changes that we on these Benches have asked for, for over a year, regarding borders? Otherwise, we risk losing all the progress made with vaccinations, we risk children not returning to school, and we risk further and substantial damage to our economy.

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

My Lords, I am enormously grateful for the questions from the two noble Baronesses. By way of introduction, both the noble Baronesses are entirely right that the variants of concern have been a massive game-changer and the reason for this profound inflection point in our approach to border control. Having invested so much in vaccine deployment, having got it right so emphatically, having been ahead of the world in the identification, development, purchase and now deployment of vaccines, and having got so many people who were at threat of sickness and death into a position of safety, it seems entirely right that we now protect the country from mutations that might escape the vaccine by taking tough measures on the border.

That is different from the situation of a year ago: we had comparable infection rates and were all facing the same virus, which did not seem to mutate for months on end. At that point, the priority was to keep our borders open in order to keep the flow of goods, medicines and essential supplies in the planes, trains and boats that are necessary to support Great Britain. But the variants of concern have completely changed that view. That is why we brought in this new, robust and emphatic regime. It depends, in very large part, on existing legislation, but I reassure noble Lords that our plans are to bring in new regulations, where necessary, at the earliest moment. I hope that that will be very soon.

The noble Baroness, Lady Thornton, asked about international surveillance. That is an important part of our overall plan. In Britain, as noble Lords know, we have the most advanced investment in genomic sequencing anywhere in the world, by far. We are hugely investing in a great dash on capacity, turnaround times, accuracy and the geographic distribution of that surveillance in the UK. But we are also investing in international systems. We have made an open-hearted, big and generous offer to the countries of the world to do genomic sequencing for them, wherever necessary. If anyone wants to send their specimens to the UK, to the Sanger at Cambridge, we will do that for them. We are sending machines, often from Oxford Nanopore, the British diagnostic company, to diagnostic centres in countries that have some genomic capability, to enhance their testing and speed up their turnaround times.

The noble Baroness, Lady Thornton, asked about the enhanced measures we are putting in place to check when people arrive in the UK. I can reassure her massively, because the system for the passenger landing form has been digitised and hugely enhanced. We have dramatically increased the amount of validation of the data put into the PLF. The pretesting certificates are linked directly to the PLF, and we are working on linking it to the hotel booking and testing forms. We are also putting in enhanced surveillance of those isolating at home, which includes phone calls, SMSs and an increased investment in police time to follow up where there may be suspicion of a breach. We are also making a crystal-clear communication to those who have access to private jet travel that we will not tolerate those who have the resources to pay the fines but feel that they can, or want to, get around these measures.

The application of the hotel quarantine measures to all countries—both red list and amber—is something that we keep under review. There is a rolling review of the red list, and we are putting in place the necessary infrastructure, should it be required, for a blanket hotel quarantine protocol on all travellers to the UK.

The noble Baroness, Lady Brinton, kind of answered the question on the number of hotels, for which I am enormously grateful. We have currently booked 16 hotels with 4,600 rooms. However, I reassure her that this is an on-call framework, and we will have access to a massively increased number of hotel rooms if that should prove necessary.

But I have to be clear: the signal from the British Government and the instruction from the Home Office and the Department of Health and Social Care is that there should be no need to travel other than under the most exceptional circumstances. We are not trying to encourage anyone to travel, and we expect the number of people travelling to and from the UK to remain at a low level for the foreseeable future. For those who are currently overseas and seek to return but are experiencing some hardship because they were not expecting, did not plan for and cannot afford the considerable cost of the hotel quarantine, we will publish schemes to spread the payment of that to help people out.

Regarding the legislation, the noble Baroness, Lady Thornton, made a big point of saying that a sentence of 10 years was too long for a breach of contract. I remind her that Section 1 of the Fraud Act 2006 creates a general offence of fraud and introduces a number of ways of committing it, including fraud by false representation and fraud by failure to disclose information. Committing fraud is a very serious offence. Not everyone who commits their first fraud will get a custodial sentence, but if people repeatedly breach these restrictions or put the lives of others at risk, it will be up to either the magistrates’ court or, ultimately, the Crown Court to decide on the sentence. The maximum sentence is 10 years and it is quite right that it should be. The noble Baroness, Lady Brinton, made a very good point when she referred to Taiwan, which I shall mention in a moment.

The noble Baroness, Lady Brinton, asked about the data flows on undocumented migrants and the temporary amnesty. I reassure her that it is absolutely our intention to get everyone in the UK vaccinated, whatever their status. We are completely status blind when it comes to distribution of the vaccine, but we need to know who you are before we inject you with drugs—that is a basic clinical need and one that we cannot avoid.

She asked specific questions about the flow of data and whether this would be a temporary amnesty or would last longer. I do not have access to the precise answer to that question but am happy to commit to write to her on that important point.

The noble Baroness asked about prisons. She is entirely right to be concerned. We have had a terrific track record on protecting prisoners from this disease over the year, but she is right that in recent weeks epidemics have emerged in prisons. We are working incredibly hard to deploy a very large amount of testing and, where necessary, implementing isolation, and the vaccine has been rolled out to those who are qualified.

Turning to Sitel managers, I assure the noble Baroness, Lady Brinton, that we are enormously thankful to all those who have contributed to the tracing operation. We balance the workload between a variety of providers, and Sitel is just one of several that we have. There is no question of our backing off from our tracing operations—quite the opposite. Test, trace and isolate remains an important part of our armoury and it only increases. In recent times, we have doubled up on our commitment to the Lighthouse labs, which have proved cost-effective, accurate and fast. The genomics turnaround in tracking variants of concern has been remarkably efficient. On tracing and VOCs, Project Eagle is working extremely well and I saw incredibly impressive numbers on that this morning. Pharmacovigilance around the vaccine is being supported by test and trace, and the creation of the NIHP is apace.

Finally, the noble Baroness, Lady Brinton, mentioned Taiwan. Given that I am married to a Taiwanese wife, I can absolutely bear testimony to the remarkable achievement of that island nation. Taiwan was hard hit in 2003 by SARS, a time I remember well, since my Christmas was cancelled. It learned the lesson and applied important measures. The island has the advantage of social cohesion, but both the stick and the carrot were thoughtfully used, as the noble Baroness rightly pointed out. It created a green list country with a remarkably low level of infection and death, and that is a lesson we can all learn from.

The public are doing their duty and absolutely understand the threat of variants of concern. It is incredibly impressive and I am optimistic for the future.

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

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.

[Lord Patel (CB) [V]]

My Lords, I support the government plans for travel quarantine to reduce the risk of importing new variants of SARS-CoV-2 that may be more contagious and get around vaccine-induced immunity. Both Australian and New Zealand studies have shown that, despite testing prior to flights, the risk of transmitting the virus on flights, particularly long-haul flights, remains as shown by the New Zealand study. My question relates to airline crew, particularly on long-haul flights. What measures do the Government plan against the risk of transmission from an infected crew member?

[Lord Bethell (Con)]

The noble Lord is, as ever, cutting to the chase. The role of hotel staff, transport to and from airports and the flight crew themselves is incredibly important. As the noble Lord probably knows, the outbreak in Melbourne that hit Australia hard was caused in part by the bus drivers from the airport to hotels becoming vectors of infection. That created an unfortunate outbreak, which was hit extremely hard with a long lockdown to squeeze out the outbreak. We are putting in all the right, responsible measures to segregate crew, keep them apart from the rest of the population and ensure that they are, wherever possible, vaccinated against the virus so that they cannot be vectors of transmission.

[Lord Moynihan (Con) [V]]

My Lords, having flagged up the quarantine restrictions, tens of thousands of people from around the world have been returning to the UK in advance of Monday’s deadline to avoid unaffordable costs in hotel bills. This is resulting in many connecting flights across the UK being unexpectedly packed. I understand that this is leading to large numbers of passengers, on arrival at major UK satellite airports, waiting shoulder to shoulder around baggage carousels for their luggage, without airline or baggage-handling staff in evidence, no social distancing and a serious risk of exhausted passengers with low resistance being prone to Covid infection. Will my noble friend the Minister consult colleagues and ensure rigorous application of all social distancing restrictions around all domestic baggage carousels over the remaining three days and beyond?

[Lord Bethell (Con)]

My Lords, I am grateful for the question but my information is slightly different from that articulated by my noble friend. Passengers overseas have heard the message loud and clear, and there has not been, as far as I understand, the kind of rush that he describes. In fact, there has been a lot of sensible behaviour by passengers. We are grateful to London Heathrow, London Gatwick, London City, Birmingham and Farnborough, which to date are the authorised red list airports and have put in place exactly the kind of social distancing measures around transit from the aircraft to the PCP, from the PCP to the baggage hall, and from the baggage hall to the transport to the hotel. A huge amount of thought has been put into the personnel, signage and arrangements to ensure that that is done in a way that applies the best possible hygiene measures.

[Lord Winston (Lab) [V]]

My Lords, the Minister knows that I have great respect for him, but I want to put a slightly colder note into this debate, which also reflects on the debate about the previous Statement. We have heard a lot of hugely optimistic and very confident statements from Members of the House and the Secretary of State. It strikes me that we must be a bit more cautious. As the Minister knows, the one country that has conducted more vaccinations than us, proportionate to the population, is Israel. It has also had a complete lockdown of airports, so that there is no ingress at all into the country. Yet puzzlingly, and not even the Israelis can explain this, the infection rate has not gone nearly as well as predicted or expected. Can he comment on that?

Furthermore, what does the Minister intend that the Government should do with regard to poor students returning, as they need to, for their exams? These students are deeply needed by the country and, if they have a good experience here, they were support us in the future when they are adults and working. I would be very grateful for his answer.

[Lord Bethell (Con)]

The noble Lord is right to cite the example of Israel. It is indeed extremely worrying. I touched upon this point when replying to my noble friend Lord Hamilton on the previous Statement. Undoubtedly the fear is that you vaccinate a large proportion of your most vulnerable population but those who have not been vaccinated—mainly the young—feel a licence to go out and socialise and create an enormous problem by spreading the disease on a large scale among the wider population. As I alluded to in my earlier answer, we currently have an infection rate of between 1% and 2%, It is not impossible that it could rise to 10% or 20%. Should that happen with the kind of proportions of people who then end up being hospitalised whatever their age, or suffering from long-term impacts of the disease, we would have a very big problem on our hands. That is why the Government are moving cautiously. I strike an optimistic tone in my answers, but I am extremely cautious and considered in my approach to policy, as are the Government.

[Baroness Sheehan (LD) [V]]

My Lords, hotel quarantine measures, albeit late and incomplete, are nevertheless welcome—better late than never. However, as things stand, mankind cannot outpace the mutating virus without a global vaccine plan in place. When do the Government think that the time will be right to call for a leader’s summit to develop a global collaborative effort to deal with this pandemic?

[Lord Bethell (Con)]

My Lords, I completely agree with the noble Baroness. As I said earlier, we are not safe until we are all safe. That is an absolute axiom. It will soon become a cheesy remark but that does not make it any less true. Britain is totally committed to the principle of global distribution of the vaccine. We are extremely proud of AstraZeneca, which has a profit-free approach to the intellectual property around the vaccine. It is quite possible that as a cheap, easily administered and portable vaccine, it may become the common global standard for vaccination. It is my hope that it will be rolled out globally, and that it is updated as necessary, as mutations and variants of concern begin to affect it. Britain is very committed to CEPI, Gavi and ACT. These are the major financial commitments that the world has joined in to get the vaccine to the developing world, and we are using our chairmanship of the G7 to champion that agenda.

[Lord Harris of Haringey (Lab) [V]]

The variants of concern are already here, so self-isolation is vital for those who test positive in the community, yet many fail to do so because they will lose wages. Four million people in the UK have had Covid. The NAO says that the Government have spent over £270 billion on the pandemic so far. That is the equivalent of £67,500 per person infected. If that is the cost of each person who is infected by those who do not self-isolate, how low would the R number have to be for it not to be cost effective to pay at least £1,000 to everyone who tests positive, to ensure that they self-isolate?

[Lord Bethell (Con)]

I am grateful for the noble Lord’s fascinating mathematics, but there are other principles at stake here and I am not quite sure that his arithmetic can be leaned upon. One of those principles is personal responsibility. We cannot pay the entire nation a huge wage to stay at home for the entire epidemic; we have neither the cash resources nor the value base to do that. We must look to people to do the right thing. If we do not, we will end up with a country that is dependent on the Exchequer for its money and has the wrong values for the kind of enterprise economy that we need to build to get out of this epidemic.

[Baroness Neville-Rolfe (Con)]

Does the Minister realise that the imposition of a 10-year prison sentence for providing an inaccurate travel history on Covid forms is wholly disproportionate? Existing powers should not be misused for this purpose. Such a measure would require proper reflection and parliamentary debate, and it should therefore be in a new Bill if the Government wish to persist with it. In the meantime, will the Minister amend the present proposals significantly?

[Lord Bethell (Con)]

I do not agree with my noble friend on this in any way—fraud is fraud. If you put people in danger, you deserve to serve the consequences. It will be up to either the magistrate or the Crown Court to determine the sentence. The sentence is laid out in law, not by me or any new measure. Those who put the entire nation at risk by bringing variants of concern into the country should be aware that the courts may take an extremely dim view of their actions.

[Viscount Waverley (CB)]

My Lords, I am going to pass the baton to the next speaker as the points I wished to raise have already been addressed. However, I commend the noble Lord, Lord Bethell, whose performance as a torchbearer at the Dispatch Box is exemplary by anybody’s standards. I have recently been jabbed myself, and the whole vaccination process from start to finish is commendable for being conducted with efficiency and courteousness, making one proud to be a Brit. We will be on to a winner if we replicate that in global Britain.

[Lord Bethell (Con)]

I am extremely grateful for the noble Viscount’s kind remarks. They are rightly directed at those responsible for the deployment of the vaccine. The NHS itself has been a central player in all that, as have our academic colleagues, particularly at Oxford University but also Imperial, as well as others who have contributed. I will take his remarks back to the Department of Health and Social Care. It has been a very tough year, and I am extremely grateful for his remarks.

[Lord Beith (LD) [V]]

My Lords, the Minister is right that there must be a penalty for lying about which countries you have been to in these circumstances, but I am surprised at how confident he is that the Forgery and Counterfeiting Act 1981 is a good tool for this purpose. Some offences under it do not attract a ten-year maximum but a two-year maximum, and it seems unlikely that a court would impose a substantial custodial sentence when comparing this with other offences. Does he not recognise that all the headlines about a 10-year prison sentence undermine credibility in the Government’s strategy at a time when we need to support and encourage it?

[Lord Bethell (Con)]

My Lords, I am enormously grateful for the noble Lord’s legal insight and will leave it to the courts to decide whether he is right or wrong.

[Lord Rooker (Lab) [V]]

My Lords, I endorse what the noble Viscount, Lord Waverley, said, but I would also say that the Minister’s private office must have had an interesting time supporting him in the last few months. I have two very brief points, and I am sorry that they are detailed. Can he tell us how the rich and famous returning home in private aircraft and landing at one of these five airports will be treated? Will they be treated like anybody else? Secondly, while children under 11 are not covered, can he explain how unaccompanied children over 11 will be dealt with in quarantine and what safeguarding facilities and procedures have been put in place?

[Lord Bethell (Con)]

My Lords, we have only one package in hotel quarantine; there is no VIP suite, so those arriving in their Learjets at Farnborough will have to check in with all the rest of us. As for the children, the noble Lord raises an important point. I know that the issue has been discussed and that provisions have been put in place, but I am afraid I do not have the details to hand. I would be glad to write to him with them in due course.

[Baroness Sugg (Con) [V]]

My Lords, the vaccine rollout has been an incredible success. We all look forward to the road map out of lockdown expected later this month that the Minister referred to in the previous debate, and that includes our world-leading aviation sector. I support the measures being taken to protect our population against Covid-19 and now is not the time to reopen our skies but, given that it will take airlines something like three months to prepare for a return to flying, can the Minister give me any reassurance that the aviation sector, which will play a crucial role in our economic recovery from Covid when it is safe to do so, will be included in the forthcoming road map?

[Lord Bethell (Con)]

I completely endorse my noble friend’s comments. I am personally extremely committed to travelling. I would fight for the right to travel and I believe in its value. I am extremely grateful to the airports, the airlines, the hospitality industry and all those involved in travel for the huge contribution they have made to the sum of human wealth and experience. It is heartbreaking that we are having to bring in these measures and it is done with huge regret. The cost and implications for the businesses and employees involved is extremely harsh, and we regret it enormously. It is simply a fact of the fight against this pandemic that it is necessary. I cannot confirm for sure that details of a timetable for airlines will be in the schedule in the week of 22 February, but I assure my noble friend that we are in constant touch with both airlines and airports. Their arguments to us are extremely well made and their plight is understood and sympathised with, and when the time is right we will do everything we can to support the travel industry in getting back to where it once was.

[Lord Oates (LD) [V]]

The Minister told the House in his earlier response to the Front Benches that there was no point in securing our borders before the new variants emerged. Was that not exactly when we should have closed the borders in order to prevent the new variants arriving in our country, rather than shutting them once they had? Why did he suggest that the new variants were unexpected when, as I understand it, mutations were always highly likely, if not inevitable?

[Lord Bethell (Con)]

The virus mutates all the time and minute variations have happened from the very beginning. However, this virus has been unusual in not having profound mutations; it had not changed its seriousness, its transmissibility or its escapology in a meaningful way until the end of last year. Those were not—how shall I put it?—completely unexpected, but they had not been identified before. When they were identified, we changed our tactics, our strategy and our approach. Our determination to keep out variants of concern is manifested in these proposals, and we have moved extremely swiftly to enforce border control as the threat has mounted.

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

My Lords, I want to follow up on that question. The SAGE minutes of 21 January make clear that

“reactive, geographically targeted travel bans cannot be relied upon to stop importation of new variants … due to the time lag between the emergence and identification of variants of concern, and the potential for indirect travel via a third country”.

By confining the quarantine measures to travel from red-list countries, are the Government not ignoring the SAGE warning about indirect travel?

[Lord Bethell (Con)]

My Lords, SAGE is entirely right that we have to be careful about indirect travel. That is why we have introduced a passenger form that requires people to detail all their recent travels. It is why we have attributed to the filling-in of the form very serious enforcement measures, including the potential for a large custodial sentence if it is filled in incorrectly. It is why we are using all the benefits of technology and of airline databases in order to track people’s travel and ensure that they are not in any way misleading us or skipping around borders to get here. The noble Lord is right that this is a very serious matter. This is a 21st-century pandemic and we are determined to use the techniques of the 21st century to keep out variants of concern. Countries such as Taiwan, Iceland, Australia, New Zealand and Singapore have demonstrated that if you use thoughtful 21st-century methods then you can make a big impact on transmission, and that is what we are determined to do.

[Baroness Bennett of Manor Castle (GP) [V]]

In his answer to the noble Lord, Lord Patel, the Minister said that

“the crew are, wherever possible, vaccinated.”

It was not clear from context whether the Minister was referring only to plane and train crews or also to bus drivers and quarantine hotel staff. Is this a change in government policy to prioritise the vaccination of key workers, as the Green Party has been calling for?

[Lord Bethell (Con)]

While I acknowledge the Green Party’s views on this matter, the JCVI has been clear about what prioritisation levels 1 to 4 are. As I said earlier, we will be looking at the other prioritisation lists in time. I am in no way signalling a change in government policy, because that, I am afraid to say, is not in my gift.

[Lord Balfe (Con)]

My Lords, we seem always to be talking about holidaymakers. There is a small amount of legitimate business still being carried out in Europe. A few days ago, the Parliamentary Assembly of the Council of Europe met in Strasbourg under suitable conditions, with no Covid cases reported at the end of that meeting. NATO and the European institutions are also holding a limited number of meetings. Could the Government at least accept that some legitimate business has to go on across frontiers, even at this time? Or are we going to be like the late Markus Wolf of the Stasi and try to do the impossible by closing down the country—and, in the end, discovering it will not work?

[Lord Bethell (Con)]

My noble friend of all people should know that it is an unfortunate comparison to make between the quite legitimate efforts of the Government to keep out killer viruses with those of a nasty East German regime for which I have no sympathy whatever. We have seen that a large amount of business that we previously thought required travel does not require travel. I must admit I am extremely surprised by the news that the Council of Europe thought it was a great idea to get together for a meeting. It is a decision I am querying, and when I get back to the department I will chat to my Foreign Office colleagues to see if that really was a sensible thing to happen.

[Lord Taylor of Goss Moor (LD) [V]]

My Lords, while the Act may have long existed, its attachment to mis-filling out forms certainly has not. It is hard to imagine that at any stage Parliament intended that filling out a form misleadingly, however serious the circumstances, should attract a 10-year sentence. Surely this is something, right or wrong, whatever the principles and whatever the Government might believe is the right thing to do, that should go through Parliament for approval. A 10-year sentence, equivalent to many firearms charges and other serious offences, is surely something that should be subject to parliamentary scrutiny before it is imposed.

[Lord Bethell (Con)]

My Lords, the noble Lord seems to be forgetting that it is not Parliament that is going to be sending people to prison but the courts, and courts are perfectly capable of interpreting the law. They are perfectly capable of assessing the nature and gravity of the offence. I am simply repeating the section of the Act on which people will be prosecuted if they commit a fraud. I am reminding noble Lords and all those thinking about committing fraud on their passenger locator form that the maximum sentence for committing fraud is 10 years, and it will be up to the courts to decide what kind of sentence they apply.

[Lord Robathan (Con) [V]]

My Lords, I first thank the Minister and the Chief Medical Officer Chris Whitty for a very useful session yesterday on Covid-19 therapeutics. I found it extremely informative. I can see the logic and the good sense behind the quarantine policy—but, bearing in mind Lord Acton’s famous dictum, and knowing that no court will send anybody to prison for 10 years for incorrect information being put on a form under the Fraud Act, does my noble friend not realise that the Secretary of State’s crazed, hollow and exaggerated threats about 10 years in jail undermine the whole policy? If he does not agree with that, could he please defend them? Because so far, I am afraid, I find myself agreeing, unusually, with the two Liberal Democrats, the noble Lords, Lord Taylor and Lord Beith.

[Lord Bethell (Con)]

My Lords, I think I have made the point reasonably clearly, but I am happy to make it again: it is up to the courts to decide how long people go to prison for and it is up to Parliament to decide on Acts. The Act is very clear; it was made in 2006, and it is up to the Crown Court to decide for how long someone goes to prison. It is unfortunate that my noble friend described the Secretary of State in those terms. It is the kind of language that does him no credit. These are extremely important measures. They are devised to protect the country and the vaccine from the very serious threat of mutations of the disease, and they are enormously supported by the public.

[Lord Mackenzie of Framwellgate (Non-Afl) [V]]

My Lords, I welcome the tightening of controls to prevent the introduction and spread of new variants of the virus. Will the Minister say whether the policy deals with international travellers who have a stopover for a connecting flight in, say, eight hours or even overnight? Will the road map that the Prime Minister will roll out on 22 February include a flight plan showing how and when the quarantine controls might be lifted, as they are extremely damaging to the travel and holiday sector and to the mental health of the nation, to which the Minister has already referred? Finally, has the Minister yet booked his summer holiday?

[Lord Bethell (Con)]

My Lords, the arrangements for those changing planes in British airports are spelled out in considerable detail. We are not encouraging people to overnight when changing planes. If they overnight, they will be invited to spend 10 days in hotel quarantine, which I think will be a suitable incentive for those who might be thinking of such a travel plan. Those who remain airside will be able to change planes. Those who land in, say, England and are going to end up in Scotland will quarantine in England, and those who fly into Scotland to enter England will quarantine in Scotland. These are the kinds of provisions that we are putting in place to ensure that the quarantine is as effective as possible.

[Lord Randall of Uxbridge (Con) [V]]

My Lords, I completely endorse the praise for my noble friend and, indeed, his private office. I fully support the measures the Government are introducing, and I look forward to discussing them in detail in due course. Would it be possible to consider the confiscation of a passport, at least for UK nationals, for a flagrant and dangerous contravention of the quarantine regulations, perhaps particularly by those who think they can afford the fines, as he mentioned earlier? I seem to recall that we were able to do this for football hooligans.

[Lord Bethell (Con)]

My Lords, I am grateful to my noble friend for that suggestion and I will take it back to the department. I have not heard it suggested. It is not currently in our plans at the moment, but let me try to understand it a little better.

Covid-19 Vaccines Deployment

Lord Bethell Excerpts

Thursday 11th February 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I start by congratulating everyone working in the vaccine sector: the scientists, still working behind the scenes to ensure that there are vaccines that will be effective against the South African and Manaus variants; those involved in the manufacture and supply chain; and all those on the front line, making sure that the vaccines are delivered into arms safely and swiftly by clinicians, with administrators, staff, the military and volunteers helping. A notable reason why the UK has been able to manage this so well has been the expertise of Professor Chris Whitty and our vaccine research community, which has so many years’ experience in epidemics, including the Ebola outbreak in west Africa.

The Joint Committee on Vaccination and Immunisation has also kept our focus on who should be protected first, and the government delivery group, led by Kate Bingham, has also done well. The numbers vaccinated in the top four priority group continues to grow and I, for one, hope that the target for next week will be achieved.

The Statement says:

“We … visited every eligible care home possible with older residents in England and offered vaccinations to all their residents and staff. That means we are currently on track to meet our target of offering a vaccine to the four most vulnerable groups by mid-February.”


However, I still cannot find the actual number and percentage of social care staff vaccinated, whether those working in care homes or domiciliary care staff providing essential support to keep people living in their own homes, so please can the Minister provide the number and percentage of social care staff who have now had their first dose of vaccine? Once again I ask: why are care staff not disaggregated from NHS staff in the published data?

The target of “offering” a vaccine to those in or working in homes is, frankly, no target at all. We know that, after Christmas, an alarming number of cases were diagnosed in care homes, which has resulted in residents and staff being refused vaccine until all cases are over in those homes. With very limited visits by families, the only way that Covid could have come in is, unfortunately, via staff, who probably picked it up from others over the Christmas break. Today, the ONS has said that one-third of all Covid cases in hospital during this pandemic have been over the past month. That is truly shocking.

Was the Prime Minister’s bold statement last year that Christmas should not be cancelled and his encouragement to allow people to mix, against all the expert advice from SAGE and alternative SAGE, worth it? How many deaths will have resulted from those cases, which could have been avoided if that expert advice had been followed earlier?

There are reports of some surgery teams arriving at care homes with enough vaccine only for residents and staff being redirected to large hubs, many miles away. This is unhelpful when staff work shifts and are on low wages, with no access to the transport needed to get to a hub. What is planned to ensure that all care home staff can be vaccinated at their place of work by their local vaccination teams?

Another bit of ONS data this week has shown that there were more than 30,000 Covid-related deaths of disabled people between mid-January and mid-November last year, representing 60% of all Covid-related deaths in that period. I remain concerned that many of those under 70 who are disabled or learning disabled and live in homes are still not on a priority list. We know that those requiring close personal care are at very high risk. The ONS data proves that. When will the Government add them to the top four priority lists?

The opening of large hubs is welcome, but they must not replace very local access to vaccines, whether through GP surgeries or local pharmacies. Worrying reports are emerging of GPs running out of supplies and being told that the large vaccine hubs are being prioritised over them. I thank the Minister for the excellent briefing that MPs and Peers had earlier this week on vaccines and possible treatments for Covid-19. The Statement says:

“This trial will look at whether different vaccines can be safely used for a two-dose regime in the future to support a more flexible programme of immunisation.”


It goes on:

“I want to reinforce that this is a year-long study, and there are no current plans to change our existing vaccination programme, which will continue to use the same doses.”


However, the green book on the vaccination programmes states:

“For individuals who started the schedule and who attend for a vaccination at a site where the same vaccine is not available … it is reasonable … to offer a single dose of the locally available product”


to complete the schedule. If safety has not yet been established, why does the green book say that potentially unsafe dosing regimes can go ahead?

The Minister is correct to say that no one is safe until the whole world is safe, and it is good that the UK has made a commitment of £548 million to COVAX with match funding to provide 1 billion doses of vaccine this year to developing countries. I hope that the Prime Minister will use his chairing of the G7 to encourage other countries to donate their share to make this happen. The examples of the South African and Manaus variants are a wake-up call to all of us that we must work as a global community to protect all people and the world’s economies from Covid-19.

[Lord Bethell (Con)]

My Lords, I am enormously grateful for the thoughtful questions from the noble Baronesses. They are entirely right to applaud the progress of the vaccine. I start by sharing some pretty formidable statistics on that. An absolutely remarkable 95.6% of those aged 75 to 79 have received their first dose. I have never seen a government statistic quite like that. It is an astonishing figure. Such a very large proportion of a target population have come forward, have been efficiently vaccinated and are now protected from the worse effects of this awful disease. It is an enormous success story. Of those over 80 years old, 91.3% have received their first dose and 74% of 70 to 74 year-olds have received their first dose. Up to 9 February, an astonishing 13,580,298 people received their vaccine. These are extraordinary figures. It will have a huge impact not just on the personal lives of those who have been vaccinated and their families but on the workings of the entire NHS. It is a massive game-changer and will dramatically reduce the amount of hospitalisation for and deaths from Covid. We are determined to take full advantage as a country of this enormous success story.

We are enormously pleased with the WHO readout on the AstraZeneca vaccine. It is exactly what we hoped for and what we understood from the clinical trials of the vaccine, and it is pleasing to see worldwide recognition that a 12-week gap between the two doses is the right approach and that the AstraZeneca vaccine is good for over 65 year-olds. I greatly thank those at the WHO who have done that. We are completely committed to the vaccine rollout and we will not take our foot off the pedal in any way.

I completely understand the point of those who are concerned about the impact of the lockdown. The noble Baroness alluded to the words of Charles Walker, who is entirely right that the lockdown has a huge impact on the economy, the public mood and particularly on those who cannot make it to school. However, the approach we are taking—a slow and steady approach of not rushing into anything—is exactly the one that will pay the greatest dividends for the economy. It is hugely supported by the general public and it will mean that, when we release the lockdown and return children to school, we can do it with the confidence that we will not have to go back again.

We are concerned about the lag in take up, particularly in black African communities. There are clearly, among the really good stories of take up, one or two areas where we are concerned. The work of the communications team on anti-vaxxers’ stories and the support we have got from social media firms has been really good across the board, but this is one area where we are enormously focused. The data is not always crystal clear, and we have not published it all yet, but this is one area where the noble Baroness is entirely right and we are very concerned.

The noble Baroness asked for reassurance on the second dose: will everyone get a second dose, and are there enough supplies in the warehouses for everyone? I reassure her and all noble Lords who may be concerned on that point that we are absolutely committed to the second dose. Everyone will get it, and they will get it on time. The supplies are in place.

The noble Baroness, Lady Brinton, asked about whether it was our policy to give a difference second dose to the first. I will be crystal clear: this is not our policy. If you are given a dose of “A” then your first dose will be “A” and your second dose will be “A” as well, and not “B.” We are looking into clinical trials that seek to understand whether an “AB” combination might be safe and may even be better. There are examples in other spheres where mixing two different vaccines can have a benign effect on the body and can stimulate a greater antibody response. We are looking at this very carefully. The COM COV clinical trial has been given £7 million to look into this. It is a long-term clinical trial and we are not expecting a readout any time soon but, if there are benefits, we will chase those down.

I completely agree with the noble Baronesses, Lady Thornton and Lady Brinton, on variants of concern. We have all been alerted to the grave danger that a mutation might have enhanced transmissibility, increased severity and escapology. Should such a variant emerge that could somehow jeopardise the Ming vase of our massive vaccination success story, we would be extremely concerned to address it. We are shortly having a debate on borders, and I shall save my comments for that debate, but I completely endorse the concerns of both noble Baronesses.

The noble Baroness, Lady Brinton, mentioned Professor Chris Whitty. To all those who missed it, I mention the presentation he gave yesterday on the investment in therapeutic drugs and antivirals, which was unbelievably impressive. We are enormously lucky to have someone like Chris as our Chief Medical Officer. Indeed, the Deputy Chief Medical Officers, Jonathan Van-Tam and the others, have all served us extremely well. I also praise others who have stepped up to public life in our time of need, including Kate Bingham and the noble Baroness, Lady Harding. They have both done an enormous public service and deserve enormous praise.

The noble Baroness, Lady Brinton, asked about disabled people. She is entirely right: there are those who are disabled or who have learning difficulties, and we are concerned about the impact of Covid on them. Many who are clinically extremely vulnerable are already in the priority level 4 and will already be in the prioritisation list. Others will be in prioritisation level 6. We are looking at whether we should change the prioritisation system in any way, and the JCVI keeps a running watch on this. I reassure the noble Baroness that all those in a high-risk group will be prioritised in a reasonable fashion. We will be reaching prioritisation level 6 very soon indeed.

The noble Baroness, Lady Brinton, talked about the importance of sharing vaccine with other countries. Tedros is absolutely right: we are not safe until everyone is safe. Britain has taken leadership role in CEPI, Gavi and ACT; we continue to support the global distribution of vaccines through our contribution of IP, our massive financial contribution and our diplomatic leadership. We remain committed to that, and we will continue to use our chairmanship of the G7 to influence other nations to step up to their responsibilities.

[The Deputy Speaker (Lord Bates) (Con)]

My Lords, we now come to the 20 minutes allocated for Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of speakers.

[Lord Hamilton of Epsom (Con)]

My Lords, I congratulate the Government on the vaccine programme. After a pretty disastrous war against Covid, it looks as though the Government may be winning the last battle, which is the one that counts. What happens to people who have received the jab and are registered under the test and trace system? Will they be forced to isolate, despite inoculation making it very unlikely that they will catch the disease or transmit it to others?

[Lord Bethell (Con)]

My Lords, I am afraid that is not the view of the scientists at the moment. I am extremely glad about all those who have had their first jab, but the very strong recommendation is that everyone has to abide by the lockdown rules at the moment. The transmissibility is still there: a person who has had the jab can still, and often may well, be infected by the disease, carry it and communicate it to someone who has not had the jab. They remain a danger to the community and, until a very large number of the population have had the jabs, those protocols will remain in place.

[Baroness Hayman (CB) [V]]

My Lords, I will first follow up on an earlier question. I am not sure that the Minister managed to reply on the issue of when and if we are expecting evidence on the interval levels between doses on the Pfizer, rather than the AstraZeneca, vaccine?

My main question is about how, given the impressive and successful vaccine programme, we have to recognise that it has mobilised enormous effort and resources. There is growing evidence that Covid will be with us long-term, so it is not a one-off exercise. Can the Minister share government thinking on the sustainability of the programme—for example, the potential for future programmes to be combined with the annual flu vaccination drive or for a single bivalent vaccine against both diseases?

[Lord Bethell (Con)]

My Lords, I reassure the noble Baroness that the interval protocols for the Pfizer vaccine have been completely endorsed by the JCVI, the CMO and the MHRA. They are extremely clearly endorsed by the British authorities, and she should feel enormous confidence in our approach to that.

However, the noble Baroness is right: I do not know, and cannot say for certain, what the long-term prognosis is. We do not know what the transmissibility of the disease will be with the current vaccine. We are working on new versions of it that should address the South African variant, but we do not know for sure whether that will prove dominant in the UK. It is the view of the CMO, Jon Van-Tam, that it will not beat either Covid classic or Covid Kent—but it is not certain whether that is the case right now.

We do not know whether there will be a rolling programme of mutations that roll on to the shore and require us to update the vaccine regularly—or whether we will have to hold our borders as they are now until we have the kind of vaccine development programme that can turn around refreshed vaccines within, say, 100 days. Those are all possibilities; we are putting in place the necessary plans in case that should be required, but it is my confident hope that the current vaccine will have a massive impact on Covid and that we can return to something that approaches normal in the very near future.

[The Lord Bishop of St Albans]

I too add my congratulations to Her Majesty’s Government on an extraordinarily rollout of the vaccines. I pay tribute to all those involved, not least one group not often mentioned —the practice managers, who often work through the night. Can the Minister comment on the community champions scheme? Faith leaders across Hertfordshire and Bedfordshire, where I live, have been waiting to use our huge, extensive network of people on the ground to communicate with hard-to-reach groups, such as ethnic minorities and so on. Only now are we being brought into that opportunity. Will the Government commit to working with us, since we are keen to use all our resources to help get those messages out to those hard-to-reach groups?

[Lord Bethell (Con)]

I am enormously grateful to the right reverend Prelate for mentioning practice managers. Managers in the NHS are sometimes given a bit of a hard time and are too often overlooked. But, my goodness, if the vaccine deployment has been a success and been run smoothly—and if the constant reports I get of two-minute turnarounds, accurate invitations and appointments made briskly and accurately are correct—it is because of those managers. The NHS practice managers are running a tight ship and delivering huge value for the NHS. They are too often overlooked but, boy oh boy, have they delivered on this occasion.

The right reverend Prelate is entirely right to raise the issue of not only community champions but volunteering overall. It has been one of the toughest aspects of our response to Covid to make use of the hundreds of thousands of people who have stepped forward in various schemes to help with it. There are returning practitioners from healthcare; there are community champions, which he rightly described, along with the faith groups; there is also St John Ambulance and the vaccinating volunteers. Quite often, hygiene protocols and the necessity to put in place measures to avoid transmission of the disease have meant that it has been difficult to mobilise the army of volunteers. One thing that we should look back at, when we do our post-mortem, is how we as a country can deploy civic society more effectively.

Regarding the faith groups the right reverend Prelate specifically mentioned, I pay tribute to their role in the vaccine deployment. The sight of vaccines being given out in synagogues, mosques, gurdwaras and temples up and down the country surely has a huge part to play in their successful deployment among many difficult-to-reach groups.

[Baroness Massey of Darwen (Lab) [V]]

My Lords, may I press the Minister once more on care homes, as mentioned by the noble Baronesses, Lady Brinton and Lady Thornton? The progress on vaccinating residents is indeed impressive. Are there now plans to also vaccinate as a priority, with encouragement if necessary, the staff who work in care homes and to offer the vaccine to relatives who wish to visit, so that family life of some sort can be re-established?

[Lord Bethell (Con)]

My Lords, we have done an enormous amount to prioritise care home staff, for the entirely pragmatic reason that it would make no sense at all for vulnerable care home residents to be infected by the staff who come and serve them. It is not always possible to put care home staff in exactly the same queue as those residents, sometimes because they are the ones delivering the vaccines. There is in fact a hugely sophisticated NHS route for care home staff to get their vaccine. However, I hear loud and clearly the concerns of noble Lords on this area. Let me please look at it more closely and I will correspond with the noble Baroness, Lady Massey, if I can provide her with any more details that would be helpful.

[Lord Scriven (LD) [V]]

My Lords, some GPs in Sheffield have told me today that their hubs have a zero supply of vaccine and have been closed for over a week. However, they have not yet vaccinated all of their high priority patients. Those patients are now being directed to travel by bus up to 10 miles to the mass vaccination centre, but the most nervous and vulnerable say that they will not go there. What can the Minister say to GPs who are waiting and able to vaccinate patients but have no vaccine because it has all gone to the distant mass vaccination centre?

[Lord Bethell (Con)]

My Lords, I have heard the noble Lord’s concerns about this matter when he has brought them up previously, but I simply do not recognise the story he is telling. I would remind him that 95.6% of those aged 75 to 79 have had the vaccine. This is not the story of people who are concerned about going to mass vaccination centres. There are GP centres up and down the country that are closed because they do not have supplies, and it is supply that is undoubtedly the rate-limiting factor. That is because, as he knows, the supply comes in large boxes. If GPs do not have enough people to use up a large box, we have to prioritise those who have longer lists.

[Lord Lansley (Con) [V]]

My Lords, I want to ask my noble friend about the Moderna vaccine. I understand that we have 17 million doses on order, the first batches of which are likely to arrive in the spring—let us say, in May. Where will the vaccine be used? It seems that with a trial taking place in America of its use among 12 to 17 year-olds, there is an argument for it to be reserved for use in vulnerable younger people or, indeed, given its relative significant effectiveness, to be reserved for use later in the year as a booster vaccine for the most vulnerable groups. Can he tell us the Government’s thinking about the use of this vaccine?

[Lord Bethell (Con)]

As ever, my noble friend is extremely perceptive in his insight. The Moderna vaccine is indeed an interesting one that may well prove to be a useful complement to the Pfizer and AstraZeneca vaccines, which are the bulwarks of our vaccination deployment at the moment. As he probably knows, the MHRA has already sanctioned the use of existing vaccines in some children where there may be a strong clinical need, and under the advice of their clinicians. However, it is our aspiration to spread the vaccines as widely as possible. Unfortunately, children are a vector of infection and it may be that there are strong arguments for vaccinating not just vulnerable children, but perhaps a large number of children. We will look at various different vaccines for that, and Moderna may possibly be a candidate for the kind of A-B double-dose vaccine that I alluded to earlier.

[Baroness Scott of Needham Market (LD) [V]]

My Lords, as we move towards group six, we are getting into a rather complex situation where vaccination is not determined only by age but by health conditions and their severity. Can the Minister say something about how we will communicate to the public the kind of conditions and the level at which they have them that will lead them to be vaccinated so that people have a clear understanding and GP practices are not inundated by the task of having to give that information out?

[Lord Bethell (Con)]

The noble Baroness is entirely right. We are entering a different phase of the rollout where definitions are not based so clearly on age and where more choices have to be made. Noble Lords have raised special groups and interests for which they have made a good case for them to be prioritised. We are reaching the moment when that communication will be made more clearly. I cannot say for certain what it will be because I do not yet have the information in my gift. However, I reassure the noble Baroness that, when that moment comes, the communication will be done very clearly and all the arguments that have been made in this Chamber will be listened to.

[Lord Singh of Wimbledon (CB) [V]]

My Lords, I have two concerns about a generally impressive vaccine rollout. The first is the advice not to book a summer holiday. Even if it is cancelled later, planning for a break can have an important therapeutic effect on people at a very difficult time. The second is the policy of not allowing visits to relatives in care homes until all staff and residents have been vaccinated. However, I am reliably told that the vaccination take-up among staff in some homes is as low as 20%. Does the Minister agree that a policy which bars vaccinated relatives while giving unvaccinated staff unrestricted access needs to be revisited urgently?

[Lord Bethell (Con)]

My Lords, the noble Lord touches on one very positive subject: summer holidays. I entirely agree with him on the therapeutic effect of planning one’s holiday. I spend far too much time looking at Scottish cottages and the North Coast 500 to inspire me about the months ahead.

The noble Lord touches on the very difficult subject of care homes. I do not avoid the fact that this is one of the most awkward and regretful circumstances of the moment we are in. The bottom line is that care homes have many residents of different ages. A care home epidemic is unbelievably difficult to control and leads to mortality and sickness. I do not recognise the 20% figure that he articulated, but he is right that in many homes it is not the case that 100% of residents have been vaccinated. It is certainly not the case that everybody who would wish to visit one has been vaccinated. We are in a strange lacuna where visits are not possible—at least not indoor visits, only outdoor ones. I hope that we can end this awkward and difficult moment with the swift and emphatic deployment of the vaccine.

[Lord Wigley (PC) [V]]

My Lords, will the Minister join me in welcoming the fact that Wales had become the first of the UK nations to have vaccinated more than 20% of its population? Will he confirm that the availability of vaccine supplies for all four homes nations has been co-ordinated by the NHS centrally? That being so, can he reassure me that adequate supplies will consistently be made available to the NHS in Wales to keep up this rate of vaccination, and to enable it to give to all those who have had their first jab their second follow-up jab within 12 weeks?

[Lord Bethell (Con)]

My Lords, I pay tribute to the Welsh for hitting that remarkable number. I thank the noble Lord very much indeed for bringing it to the House’s attention. I absolutely assure him that distribution of the vaccines is done in very close concert between the four nations. These numbers are assessed and gone through in great detail on a weekly call on Thursday evenings between the Secretary of the State and his opposite numbers. The JCVI and Emily Lawson, who is running the vaccination programme, are in close contact with their DA counterparts. The figures I have seen suggest that the supply to the nations is more than the target numbers that we had originally planned.

[Lord Haselhurst (Con) [V]]

My Lords, is it not the case that, however brilliantly successful the vaccine rollout has so far been, we still know too little about transmissibility for it to be wise to switch at a stroke from lockdown to the previous normality? While this uncertainty persists, will the Government put caution before risk in their approach to the lifting of restrictions?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, my noble friend is entirely right that there are many mysteries of immunity that we do not fully understand. While we have some strong evidence on the transmissibility of the disease after vaccination, it is not crystal clear. The evidence we have is that it reduces infection by two-thirds, but that still means that a third of people who have the vaccine might get the disease and be able to pass it on. That is an extremely serious risk when the vast majority of the population have not been vaccinated at all. We do not want a situation where a small minority of the population might be spared sickness and death, but a very large amount of the population become infected with a disease that might hospitalise them or lead to other infections. That is why we are cautious. We are also conscious of variants of concern, which remain a potent threat as long as the vaccine has not been rolled out.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, I will press the Minister a little further on the low take-up of the vaccine by some care home staff, which has already been raised by other noble Lords. Recent research from the National Care Forum has shown that some of the significant factors accounting for this low take-up include vaccinators coming to homes with enough vaccines only for residents, and staff being expected to travel to vaccination centres if they are not vaccinated in the home, but not being given time off. Those not on shift when vaccinators come, such as night shift staff, are missed, and some fear having to take unpaid time off if they develop a reaction to the vaccine. Could the Minister say what steps the Government are considering taking to tackle these very specific barriers?

[Lord Bethell (Con)]

My Lords, I do hear the noble Baroness and I would be happy to look into this matter further. However, my understanding is that the vaccination rates among care home staff are much higher than she describes. It is not unusual for care home staff to have their health provided for by the local NHS, and for them to be required to travel to receive that support. That is quite normal for anyone getting a vaccine, even if they work in social care. It is entirely in our interests to make sure that social care staff are vaccinated, so there is no way that there is any kind of policy or deliberate effort to avoid vaccinating care home staff. However, I will be glad to look into this further and, if I may, I will copy the noble Baroness into the correspondence that will clearly result from this debate.

[Lord Farmer (Con) [V]]

My Lords, having vaccinated the vulnerable tiers, at what level do we revert to normal, bearing in mind, first, that the remaining population is highly unlikely to require hospitalisation or to die from Covid; and, secondly, the mental health stresses which are starting to unravel our social fabric? On that note, do any members of SAGE have recognised expertise in mental health, so that their advice is weighted to this consideration as well as to others?

[Lord Bethell (Con)]

My Lords, the honest truth is that I cannot lay out a timetable for my noble friend. That will happen in the week of 22 February and the Prime Minister has made that clear. He is entirely right that the vaccine dramatically reduces hospitalisation and death. Target groups 1 to 4 account for nearly 90% of the deaths, so this is a dramatically improved situation. However, it does not remove the threat of Covid altogether. At the moment we have an infection rate of around 2% in the country. Were we to open up tomorrow, that infection rate might lead to a much higher rate: 10% or 20%. If we ran at a rate of 20% we would have a very large number of young people who would end up in hospital one way or the other, and who might experience long-standing damage from the Covid disease. We would also increase the rate of mutations in our own country and we would have a great displacement of that effect on the rest of the NHS system.

So this is not a binary game in which we have suddenly hit the moment where we can lift everything. We have to tread cautiously on that. However, I agree with my noble friend that the mental health impact of the lockdown is intense. I reassure him that two members of the SAGE subgroup SPI-B are members of the British Psychological Society. SPI-B presents the independent expert behavioural science to advise the top SAGE—the Scientific Advisory Group for Emergencies—and it brings to the debate a very clear insight on mental health and brings to our awareness the impact of lockdown, which, as my noble friend quite rightly points out, is immense.

[The Deputy Speaker (Lord Bates) (Con)]

My Lords, the time allowed for Back-Bench questions on this Statement has now elapsed. I apologise to those whom I was unable to call. There will now be a short pause to allow for some changes before taking the second Statement.